"The tragedy is that silicosis is entirely preventable and yet it still affects hundreds of workers every year."

The All Party Parliamentary Group (APPG) for Respiratory Health has published an up-date of its 2020 report on silicosis. The report was originally called Silica – The Next Asbestos?, but the update is, less dramatically, entitled Improving Silicosis Outcomes in the UK.

The up-date follows the APPG's review of its original report last year, which was a result, it said, of new evidence from industry. Industry was also invited to comment for the review (read last year's call for comments here...).

The original APPG group report was 40 pages long. The revision has reduced that to 29 pages, which can be downloaded here or by clicking on the link at the bottom of this report.

As a result, the new report contains less about Australia's findings and actions on silicosis, many of which relate to concerns about engineered quartz. Some manufacturers of engineered quartz have reduced the level of crystalline silica in their products and wet cutting and dust extraction helps suppress dust, although it does not eliminate respirable crystalline silica altogether.

The report still says those working in worktop manufacturing are at particular risk, along with others in the stone industry (those working sandstone are highlighted), those involved in mining and quarrying, and those involved in construction and demolition.

The report also still references the Health & Safety Executive (HSE) estimation that 600,000 workers are exposed to silica in the UK each year and that silica is “the biggest risk to construction workers after asbestos”. It references the NHS as estimating there are 2,000-4,000 new cases of interstitial lung disease (ILD) diagnosed each year, of which a proportion will be due to silicosis.

ILD is a group of 100 or so chronic lung disorders that cause inflammation and scarring, making it hard to breath because the lungs struggle to get enough oxygen.

The report says the actual level of silicosis is difficult to pin down, not least because in 2013 the UK government removed silicosis from the list of notifiable diseases. As well as being almost impossible to track and assess the actual extent of the problem it is also harder to link exposure to RCS resulting in silicosis to any particular employer.

Jim Shannon MP, Chair of the APPG, says: "Silicosis is rarely the recorded reason for death but it causes significant co-morbidities – it increases the likelihood of developing other health issues such as tuberculosis, chest infections, heart failure, arthritis, kidney disease, chronic bronchitis, chronic obstructive pulmonary disease (COPD) and lung cancer."

The APPG recommends in its up-dated report that silicosis should once again be included as a notifiable disease in the Health Protection (Notification) Regulations 2010, making silicosis notifiable through Public Health England. However, it has removed a recommendation in its original report that it should also be notifiable through RIDDOR (Reporting of Injuries, Diseases & Dangerous Occurrences Regulations), which would require firms to report cases among employees and make claims for compensation easier. Lobbying by the insurance industry might have influenced the RIDDOR exclusion. 

The report includes a comment from Stone Federation Great Britain that it felt the COSHH regulations worked well. The report says: "The Federation reminded us that COSHH requires control to be in line with the principles of good practice and exposure needs to be controlled to a level that is proportionate to the health risks and 'in any case to below the WEL'."

WEL is the workplace exposure limit. In the UK it is 0.1mg/m3, which is higher than in many other comparable countries. In Australia, the USA, Finland, Ireland, Italy and Portugal it is half the UK level and in Canada it is half that again. In the Netherlands the WEL is 0.075mg/m3, although in Poland the limit is three times higher than in the UK. The APPG recommends that the HSE should assess and determine the data and technology needed to allow the UK to reduce its WEL to 0.05mg/m3.

Gordon Sommerville, a stonemason who has also spoken to Trolex, the makers of a real-time silica monitor, about the various lung diseases he suffers as a result of exposure to dust (read more from Gordon Sommerville here...), is mentioned in the report. It says Gordon, "a silicosis sufferer following a long career in a silica-based industry, in a very moving and personal submission, asked that the government acknowledges these other co-morbidities and that the Industrial Injuries Advisory Council (IIAC) include these diseases on their compensable occupational diseases list". In other words, any lung disease caused by dust in the workplace should result in the sufferer receiving compensation.

The Trolex Air XS monitor that specifically identifies levels of RCS in the air in real time gets a significant mention in the new report. It was launched last year and consequently was not mentioned at all in the 2020 report. During 2022 the Air XS collected five awards for its innovative use of laser to identify the distinctive signature of RCS and measure its concentration in the air in real time. The APPG recommends it be adopted by industry.  

All the recommendations from the APPG to Parliament are that:

Clinical

• silicosis is included as a notifiable disease in the Health Protection (Notification) Regulations 2010
• any notification of previous RCS exposure is accessible within secondary care, specifically on presentation at the lung health checks and the community diagnostic centres
• occupational health services are introduced into GP surgeries to allow for occupational histories to be taken where RCS work-related ill health is suspected
• patient records should record if a person has been subject to health surveillance due to exposure to silicosis, and occupational health providers undertaking surveillance should be required to notify the GP
• where health surveillance has been discontinued because of change of employment, a flag should be available for primary care staff at health check ups and appointments as a possible symptoms referral trigger for further investigation for silicosis

Regulatory

• the Department for Education considers the inclusion of silica related risk as a compulsory syllabus item for all building and construction modules in government funded apprenticeship schemes and further education courses
• the HSE undertakes an industry awareness campaign on the dangers of respirable crystalline silica in order to improve compliance with the existing Work Exposure Limits (WEL)
• the Health & Safety Executive (HSE) assesses and determines the data and technology needed to allow the UK to reduce the WEL for work with silica to 0.05mg/m3
• the HSE takes active steps to look into real time monitoring systems as a matter of some urgency, to determine and share the data sets that they deem to be necessary to take this forward and liaise with industry to speed the process and introduction of real time monitoring systems
• the HSE actively considers and consults with industry on the position of real time monitoring to complement the hierarchy of control.