Corporate report

Tailored Review of the Industrial Injuries Advisory Council

Published 6 February 2020

Foreword

The Industrial Injuries Advisory Council (IIAC) is a unique blend of highly distinguished experts across a wide field of relevant academia, occupational disease science, clinical medicine and industry health and safety. It has been a tremendously valuable learning experience to discover more about how the council serves DWP and our citizens. The members give their time generously to the work of the council and its Research Working Group (RWG). They have the best of public intentions and they enrich their contribution by generously using their academic research knowledge and global contact networks of expertise. Through this review, I have seen evidence of how the council are the light for many external stakeholders who depend on it for knowledge of the Industrial Injuries Disability Benefit (IIDB) scheme.

I am left in no doubt that the IIDB scheme works significantly better because of the work of the council. The way the council and the RWG confidently engage with DWP officials and the ministerial team by providing impartial and objective advice should be celebrated. The council are proudly independent of DWP and that feature is a huge benefit to the citizen as evidenced by the high academic quality and time that goes into the products provided by the council. Faced with multiple demands for their time, to explain the science behind the workings of the prescribed diseases under the scheme, the council is under excellent leadership. They are a good role model for how an Advisory Non Departmental Public Body (ANDPB) can work well in a modern government setting. The recommendations which follow are well within the grasp of the council and DWP to take on board as an even better opportunity for future success. I would like to thank everyone who gave their time to the interviews and discussions. Most notably I would like to express my gratitude to the DWP officials closest to the review. This review and the resulting report would not have been achievable without the dedication and support of my review team to which I offer my greatest appreciation.

Vijay Sharma
Lead Reviewer

1. Introduction

Aims of the tailored review

Tailored reviews are periodic reviews that provide assurance and challenge about the continuing need, efficiency and good governance of public bodies. All tailored reviews are carried out in line with the Cabinet Office ‘Tailored Reviews: Guidance on Reviews of Public Bodies’.

As a non-departmental public body (NDPB), the Industrial Injuries Advisory Council (IIAC) is subject to a tailored review at least once in the lifetime of a parliament. IIAC was subject to a previous triennial review in 2015. This review will consider the implementation of recommendations made in the previous one.

Overview of IIAC

The Industrial Injuries Advisory Council (IIAC) is an advisory non-departmental public body (NDPB) which provides expert scientific advice to the Secretary of State for Work and Pensions (DWP) in Great Britain and the Department for Communities (DfC) in Northern Ireland about the Industrial Injuries Scheme. IIAC was established under the National Insurance (Industrial Injuries) Act 1946, which came into effect on 5 July 1948.

The Industrial Injuries scheme provides no-fault benefits to employed earners who become sick or injured as a result of their job. The principle benefit of the scheme is Industrial Injuries Disablement Benefit (IIDB), which can be claimed by those whose employment caused one of the diseases which the scheme covers.

IIAC’s functions are set out in sections 171 to 173 of the Social Security Administration Act 1992 and corresponding Northern Ireland legislation. These are:

1. To consider and advise on matters relating to Industrial Injuries Disablement Benefit or its administration referred to it by the Secretary of State for Work and Pensions in Great Britain or the DfC in Northern Ireland.

2. To advise on any other matter relating to the Industrial Injuries Disablement Benefit or its administration.

3. To consider and provide advice on any draft regulations the Secretary of State proposes to make on Industrial Injuries Disablement Benefit or its administration.

The council’s role is purely advisory, it has no power or authority to become involved in individual cases or in the decision-making process and has no executive or administrative functions.

In practice, most of IIAC’s resource is dedicated to investigating the evidence for occupational diseases. IIAC considers whether a disease meets the conditions set out in legislation for it to be included in the list of prescribed diseases for which people can claim IIDB^{[footnote 1]}. IIAC then advises the Secretary of State for Work and Pensions of its findings through published reports.

There are 4 full meetings of the council each year. In between these, the Research Working Group subcommittee of the council meets in order to discuss the technical and scientific detail of investigations.

IIAC currently consists of 14 members, including the Chair. Members include independent experts from the field of occupational medicine, representatives of employers and representatives of employees. IIAC is supported by a secretariat of 2 full time employees (FTE), provided by DWP, who also provide the departmental partnership function for IIAC. DWP also provides a small administration budget which is managed by the secretariat. IIAC’s annual expenditure allocation for 2018 to 2019 was £55,000.

IIAC is also a Scientific Advisory Committee and is due for review as required by the Government Office for Science. These reviews are being combined in the interest of proportionality and value for money. This review therefore considers IIAC’s compliance with the Code of Practice for Scientific Advisory Committees and the Principles of Scientific Advice to Government.

At present, IIAC faces the challenge of investigating diseases of the modern workplace, which are often complex and linked to many different causes. This makes such diseases challenging to prescribe for under the conditions of the IIDB scheme, though this is a constraint outside of IIAC’s control.

In the wider context, IIDB is planned to be devolved to Scotland in 2020 and IIAC may have a role to play in advising the department on any changes to the administration of the UK IIDB scheme which may result.

Process

The review was led by Vijay Sharma, supported by a small dedicated review team. The review was conducted between May and July 2019. Evidence was collected from written materials supplied by IIAC and the DWP’s ALB Partnership team, as well as one to one interviews conducted with IIAC members, key stakeholders and civil servants from the DWP’s Private Pensions and ALB Partnership division. The review team have consulted with IIAC throughout the review process.

2. Recommendations

The review makes the following recommendations:

Form and function

1. IIAC should retain its classification as an Advisory Non-Departmental Public Body.

2. IIAC should continue to actively maintain their existing connections with other organisations that deal with occupational health, such as the Health and Safety Executive, to encourage knowledge sharing and collaboration on cross-cutting topics.

Partnership

3. DWP Medical Policy and Industrial Injuries Benefit Policy officials should attend all meetings of the full council, in order to support IIAC to provide high quality advice to the department. Medical Policy officials would also be able to aid the council by attending Research Working Group meetings.

4. IIAC should ensure all members have a clear understanding of the roles and objectives of DWP Policy officials before officials join and take part in meetings.

Governance

5. IIAC should publish statistics related to the sources and outcomes of investigations to improve transparency.

6. IIAC should introduce open meetings, to provide transparency in years in which a public meeting is not held.

7. The department should review and benchmark the day rate paid to IIAC Members.

Effectiveness and efficiency

8. IIAC should produce and publish a 12 month forward look, regularly updated by the council, to increase transparency to stakeholders and to ensure work is more effectively prioritised.

3. Form and function

Are the functions of IIAC still needed?

This review concluded that the functions of IIAC are still needed. As long as the Industrial Injuries scheme exists, there is a need for expert independent scientific advice to fairly determine what diseases should be prescribed under the scheme.

The Secretary of State for Work and Pensions is required to decide what the scheme covers, including:

• which diseases and relevant occupations should qualify for payment
• whether the individual’s disease or accident was caused by their occupation
• the extent of the disablement caused by the disease or accident

To support the Secretary of State to make these decisions, there is a need for expert advice from those with knowledge of occupational diseases and the current research in this field. IIAC provides this support and stakeholders unanimously agreed that their functions continue to be needed.

The evidence base for occupational diseases is constantly growing and changing, as is the number and nature of occupations UK workers do. Scientific expertise is needed to understand and assess the evidence base, so that the Industrial Injuries scheme can continue to aid those with an occupational disease.

IIAC’s main function is to advise on matters relating to Industrial Injuries Disablement Benefit (IIDB) or its administration, particularly by advising what occupational diseases should be covered by the Industrial Injuries scheme. IIAC’s other functions support this main function by providing scientific advice around how the scheme covers those diseases.

IIAC advises the department on the drafting of regulations on IIDB. Regulations on IIDB are largely additions or amendments to the list of prescribed diseases that IIAC has recommended and so IIAC’s advice ensures that the prescription is medically and scientifically accurate.

IIAC also assists the department on work related to IIDB when asked. This can take many forms, but extends the ability of the department to utilise the scientific expertise within IIAC. An example of this function has been IIAC’s work to revise and update some of the guidance used by DWP medical assessors in assessing claimants for IIDB.

Does each function of IIAC contribute to the core business of the organisation, to DWP and to the government as a whole?

By supporting the effective design of the Industrial Injuries scheme, IIAC contributes to DWP’s objective to “improve outcomes and ensure financial security for disabled people and people with health conditions, so they view the benefits system and the department as an ally.”^{[footnote 2]}

Is IIAC’s current form the most appropriate for its functions?

There are 3 ‘tests’ which must be considered when establishing an Arm’s Length Body and IIAC passes all 3:

Is this a technical function (which needs external expertise to deliver)?

Yes. The provision of advice about occupational diseases in the context of the Industrial Injuries Scheme requires scientific and medical expertise.

Is this a function which needs to be, and be seen to be, delivered with absolute political impartiality (such as certain regulatory or funding functions)?

Yes. Political impartiality is required to assure the public that advice concerning what diseases are prescribed under the Scheme is based on scientific evidence.

Is this a function which needs to be delivered independently of ministers to establish facts and/or figures with integrity?

Yes. IIAC is a well-respected scientific body, whose status relies on the confidence of the academic community and other stakeholders in the scientific impartiality of their work.

Public body classification

IIAC is currently classified under Cabinet Office guidance as an advisory NDPB. As IIAC meets the 3 ‘tests’, we have concluded that IIAC should continue to be delivered at arm’s length from government.

We have considered alternative delivery models for IIAC, focussing on the possibilities for merging IIAC with another body or reclassifying it as an Expert Committee. IIAC’s small size and lack of executive functions make it unsuitable for consideration as an Executive Agency or non ministerial department.

IIAC does not significantly overlap in functions with any other public body. IIAC requires a large number of members to cover the wide field of occupational health as well as knowledge about workplaces and employees. This prevents it being usefully combined with any other scientific committees across government, as any merger would reduce the range of expertise available to carry out IIAC’s functions and negatively impact on the quality of advice it provides.

The review team also explored whether there was any overlap between IIAC and DWP’s other advisory NDPB, the Social Security Advisory Committee (SSAC). The situation of both bodies in DWP would have made a merger more feasible. However, they differ in their main function: IIAC largely provides advice to contribute to the formation of policy, while SSAC’s main role of scrutinising social security legislation occurs after policy is made.

SSAC also requires a different set of expertise from IIAC, with a focus on knowledge of the social security system and technical understanding of legislation, rather than scientific expertise.

The Cabinet Office classification system for public bodies includes guidance on distinguishing between Advisory NDPBs and Expert Committees. The 2 classifications are very similar and each can be applied to committees of external specialists such as IIAC.

IIAC straddles the dividing line between the 2 classifications. A full description of how it fits into each category can be found in Annex A. Though IIAC meets some of the criteria for an Expert Committee, the review team consider that a change in classification would bring few benefits. The only clear benefit of changing to an Expert Committee would be less administrative oversight of IIAC by the department. However, we concluded that there would be minimal savings for the department from any change, as the department’s partnership function is already combined with IIAC’s secretariat function, and so the resource required to support the council would remain roughly the same. The administrative costs of a change could also outweigh any potential savings.

Stakeholders also expressed concern that a change in classification would damage IIAC’s reputation.

Stakeholders at present understand that IIAC’s position as an advisory NDPB means that it is clearly independent from government, but a change of classification to an Expert Committee could damage this perception of independence.

IIAC’s current classification allows it to perform its functions and there is not an appropriate alternative delivery model. We have therefore concluded that IIAC should retain its current classification as an advisory NDPB.

1. IIAC should retain its classification as an Advisory Non-Departmental Public Body

How does IIAC work with other government departments and ALBs?

Ministry of Defence (MoD)

A medical adviser from MoD attends IIAC meetings as an observer in order to provide wider knowledge of the armed forces and field of occupational epidemiology.

Other organisations

IIAC reaches out to other organisations when seeking evidence to inform their investigations, such as Public Health England and the Health and Safety Executive (HSE), a HSE official attends all IIAC meetings. IIAC is effective at identifying and accessing expertise in other organisations and when necessary invites representatives of organisations to attend Council meetings to share their knowledge.

This review recognised the importance of these relationships, and encourages IIAC to actively maintain them. The organisations in this field at times research similar topics so clear links present the opportunity for IIAC to take a joined up approach with other organisations to researching emerging topics, promoting efficiency. Links with other organisations can be especially useful as IIAC consider their forward work programme and look to proactively predict likely future challenges.

2. IIAC should continue to actively maintain their existing connections with other organisations that deal with occupational health, such as the Health and Safety Executive, to encourage knowledge sharing and collaboration on cross-cutting topics.

Devolution

Department for Communities Northern Ireland

IIAC provides advice to DfC regarding the Industrial Injuries scheme in the same way it advises the Secretary of State for Work and Pensions. IIAC have a good relationship with DfC, engaging with them when required. Northern Ireland takes a position of maintaining parity with the UK’s legislation for IIDB. This means that Northern Ireland’s legislation regarding IIDB largely mirrors UK legislation. Northern Ireland therefore also draws on IIAC’s advice when putting through their own regulations.

Scotland

As part of the continuing devolution of benefits to Scotland, IIDB is scheduled to be devolved to Scotland in 2020.

Under section 33 of the Scotland Act 2016, IIAC cannot give advice to Scottish Ministers on benefits for which the Scottish Parliament have legislative competence. Scottish Ministers will also not be able to refer draft regulations to IIAC for consideration or refer questions relating to relevant social security enactments or industrial injuries benefits. However, Scotland will be able to make use of IIAC’s published reports if it so chooses. Scotland’s government will be implementing their own alternative scheme and whilst not duplicating with IIAC, will determine their own approach in due course.

The department keeps IIAC informed of decisions around the devolution of IIDB. In 2017, an IIAC member linked into the Scottish Government gave consideration of the topic^{[footnote 3]}.

The review team are confident that IIAC is attentive to any developments in the timeline for devolution of IIDB and are prepared to work with the department to ensure their procedures reflect the government’s decisions on who they can advise.

However, IIAC should make clear in its annual reports how it is affected by devolution (if at all). Both the UK and Scottish Governments have previously released statements concerning IIAC’s role when IIDB is devolved, IIAC should ensure that this information is clear to the public.

The UK’s Exit from the European Union

The UK’s Exit from the European Union will have minimal impact on IIAC as the provision of IIDB is not affected by EU regulations.

4. Arrangements between IIAC and the department

Roles and responsibilities

The relationship between IIAC and the department, including roles and responsibilities, is set out in IIAC’s published Terms of Reference. The department’s Permanent Secretary is the Principal Accounting Officer for IIAC, and is accountable for IIAC’s expenditure, performance and risk management. The DWP ALB Partnership Division is responsible for oversight on behalf of ministers and the Permanent Secretary, with dedicated partners overseeing IIAC.

DWP provides budgetary resources for the council. DWP also provides a secretariat for the council, consisting of a secretary, an administrative secretary and a scientific adviser. This team also function as the department’s dedicated partners.

Engagement between IIAC and the department

IIAC and the department have a close and supportive relationship. Ministerial engagement takes place as needed.

The department utilises the guidelines set out in the Cabinet Office’s Partnerships with arm’s length bodies: code of good practice when reviewing the partnership arrangements between the 2 organisations. The Secretary of State, supported by the DWP’s Public Appointments team, is responsible for the appointment of the Chair and Members of the Council.

The department conducts an Annual Assurance Assessment for each of its Arm’s Length Bodies. In 2018 it concluded that IIAC is successful in its core functions and is overall a ‘low’ risk to the department. Aggregate ALB risks are also reported into the Departmental Audit and Risk Committee on a periodic basis.

Engagement with DWP Policy teams

IIAC also engages with DWP Policy and Legal teams, as the policy teams handle the advice IIAC gives the department and the legal team draft the IIDB legislation that IIAC scrutinises.

IIDB policy officials attend IIAC meetings. They contribute to meetings in order to advise the council on what the policy and operations implications of the council’s decisions may be. The council has a strong collaborative relationship with the IIDB Policy team and regularly interacts between meetings.

Medical Policy officials also engage with IIAC, though to a lesser degree. The review team found that Medical Policy has been disengaged from the council for at least the last year and have not been attending meetings.

They have interacted with the council to ask it for advice; at Medical Policy’s request, IIAC spent significant amounts of time in the last year reviewing the guidance for medical assessors of IIDB claims.

We are concerned that this is not sufficient engagement with IIAC. IIAC needs timely support from Medical Policy to ensure that their advice is feasible and can be translated into medical guidance for assessors. This support can take the same form as that from IIDB Policy officials, with regular attendance at meetings.

IIAC make decisions on what advice to issue by consensus in meetings. The discussion that takes place in both the Research Working Group and full council meetings allows members to come to a decision on investigations, this is where policy officials can most helpfully add their insight into the operational implications of what IIAC discusses.

Meeting attendance would ensure that officials are aware of IIAC investigations and advice before it is published, allowing them to make preparations to improve the speed at which advice is put into practice if accepted. Several stakeholders highlighted the department’s speed of accepting and implementing IIAC’s advice as an issue.

Many referred to IIAC’s advice on Dupuytren’s Contracture as an example of a lack of pace: IIAC published its original command paper on Dupuytren’s in 2014, though the department did not officially respond to the advice until 2016, when it rejected IIAC’s recommendation to add Dupuytren’s to the list of diseases covered by IIDB. After further consultation with IIAC, the department reversed its decision in 2018. The Chancellor then announced in Autumn 2018 that the department would be adding Dupuytren’s Contracture to the list of prescribed diseases for IIDB in autumn 2019. Closer engagement by policy officials with IIAC could help prevent such delay occurring in future.

3. DWP Medical Policy and Industrial Injuries Benefit Policy officials should attend all meetings of the full council, in order to support IIAC to provide high quality advice to the department. Medical Policy officials would also be able to aid the council by attending Research Working Group meetings.

The review also found that IIAC members were unclear on the roles of the DWP policy officials. There was confusion about what the policy officials were supposed to contribute in meetings and an inconsistent estimation of the value they add to discussion. Concerns were also raised about whether policy officials raise queries at the appropriate points in investigations. For instance, queries raised at the Research Working Group, where an investigation is not yet being decided on, were found to be more helpful than those raised at full council meetings when most of the work on an investigation had already been completed.

We are convinced of the value that policy officials bring to IIAC meetings, as explained above. This value could be increased if members and policy officials have a clear understanding of each other’s roles and objectives before officials join and take part in meetings.

4. IIAC should ensure all members have a clear understanding of the roles and objectives of DWP policy officials before officials join and take part in meetings.

5. Governance

The composition, structure, and functions of IIAC are set out in the Social Security Act 1992. As an advisory NDPB, IIAC follows the principles of the ‘Government Code of Good Practice on Corporate Governance’ and those set out in ‘Managing Public Money’.

Membership

The Secretary of State determines the number of members of the Council. However, legislation states IIAC must have an equal number of representatives of employees and employers. These members act as a conduit between the technical research and the experience of those involved in the occupations being discussed. At present, IIAC has 3 representatives each of employees and employers. There are currently 14 members, including the Chair.

IIAC usually consists of around 17 members. The Secretary of State is responsible for the appointment of the Chair and all members of the council, as well as determining their terms and conditions.

The council consists of independent members, who have relevant specialist skills, representatives of employees and representatives of employers.

Independent members bring specialist expertise to the council. Current members include specialists in respiratory conditions, psychiatry, muscular skeletal problems, statistics, epidemiology, and law. Those with medical and scientific expertise contribute to IIAC investigations and help draft reports.

This review considered whether the number of members on the council is correct, as it is larger than similar organisations. We have concluded that the council is able to function effectively with its current membership. Any risk of delayed decision making due to a large number of people involved is mitigated by the use of the Research Working Group to have initial technical and scientific discussions about investigations.

Additionally, we are assured that the number of members is needed in order to provide the breadth of expertise IIAC requires. Members told the review team that fewer independent members could damage IIAC’s effectiveness, as the range of skills is required, given the number of concurrent investigations it undertakes.

Skills

The skills range of council members is considered in depth for recruitment exercises. IIAC uses a skills matrix to identify the council’s areas of expertise and any skill gaps. The Chair, Secretariat and department work closely to identify what is needed when recruiting.

When an investigation requires a particular specialism that the council lacks, experts are brought in to aid the investigation, allowing IIAC to ensure its work is of high quality. We are assured that the current skills range of the council is appropriate.

Role of the Chair

The Chair of IIAC has responsibility for ensuring that IIAC carries out its statutory roles to a high standard. They facilitate open discussion in meetings and ensure work is effectively prioritised. Their role includes meeting annually with the Minister for Disabled People and leading Public Meetings. The Chair is also responsible for participating in recruitment and ensuring members are inducted appropriately and annually assessed.

Secretariat

IIAC is supported by a secretariat consisting of a Secretary, Administrative Secretary, and Scientific Advisor. This Secretariat is supplied by DWP and also act as DWP’s Partners for IIAC. The Scientific Advisor provides specialist support to IIAC, supporting their research and horizon scanning through reviews of scientific literature. The Secretariat also maintains communication between IIAC and teams within the department.

The review explored whether the current structure of the Partnership function is effective at providing oversight of IIAC. While the combination of the Partnership and Secretariat functions is anomalous when compared to other DWP organisations, we have concluded that there is no evidence that it is ineffective. The combination of roles raised concern that conflict of interests would prevent the Partnership function from being able to adequately challenge IIAC. However, this conflict is more illusory than real.

The review team explored other alternatives for the placement of the IIAC Secretariat, as the separation of the Partnership and Secretariat functions would prevent this appearance of conflict. For example, we considered whether the IIAC Secretariat could be combined with the Secretariat function of SSAC. However, as with the question of merging IIAC and SSAC, we found that the different functions of the bodies meant that the skills required of their secretariats could not be entirely reconciled. IIAC requires specialised scientific support, while SSAC requires detailed knowledge of social security legislation. A combination of the secretariats could also introduce a risk of IIAC’s work being subsumed by the high workload of SSAC, which meets much more frequently than IIAC.

We also considered whether the IIAC Secretariat could be placed elsewhere within DWP. However, we identified no sensible alternative. If IIAC’s Secretariat were placed in a policy area related to its work, their independence might also be threatened. The review team concluded that the combination of the Partnership and Secretariat functions remains effective. Interviews suggested that sufficient challenge occurs between the department and IIAC. Also, that the department remains assured that they have sufficient oversight of IIAC.

Research Working Group

The council has a sub-group, the Research Working Group (RWG). The Chair determines who will act as RWG Chair and in consultation with the RWG Chair determines what members attend RWG meetings. The RWG meets 4 times per year, in between the dates of full council meetings.

The RWG undertakes the detailed scientific investigations which inform IIAC’s advice. At present the membership of the RWG is flexible, with membership changing to reflect the needs of the current investigations.

Diversity

The council currently comprises of 10 males and 4 females. All members are recruited by the department’s Public Appointments process, which includes monitoring and consideration of all protected characteristics.

Is IIAC effectively governed?

The review team interviewed IIAC members and others who have attended IIAC meetings and attended an RWG meeting. We have concluded that IIAC is well run and that the Chair ensures that IIAC carries out its statutory functions. IIAC complies with the Principles of Good Corporate Governance. Though the full council only meets 4 times a year, it uses its time well and is effective at decision making. Discussion in meetings is open and all decisions are reached by consensus. Any divergence in opinion is recorded in the minutes of meetings.

Conflicts of interest

Members understand their responsibility to declare any conflicts of interest and these expectations are clearly stated in member guidance. IIAC keeps a public register of all conflicts which is updated annually. Every meeting begins with the opportunity for members to declare any conflicts.

Induction

There is a thorough induction in place for new council members. Members are given thorough induction material and are supported by the Secretariat. Members also are offered the opportunity to visit DWP sites to learn the process for handling IIDB claims in depth.

How transparent is IIAC?

All IIAC investigations result in reports published on their GOV.UK webpages. All minutes of meetings are also published. Any member of the public can contact IIAC with a query about an occupational disease.

The review found that IIAC is a transparent organisation, though did identify opportunities for further improvement. IIAC publishes an Annual Report and has published additional information about how they conduct investigations.

The review team found that IIAC could be visibly clearer in showing how they take on new work and the results of investigations. In 2016 to 2017, IIAC included charts showing this information in their Annual Report, but this exemplary concept has not been included before or since.

The review team found the inclusion of clear statistics demonstrating, for example, the percentage of investigations that come from MP queries, extremely helpful in gaining an understanding of where IIAC’s work comes from. This information also provides assurance to the public of IIAC’s ability to respond to queries. The data about what the outcomes of investigation are was also a useful proof of IIAC’s impartiality, as it was clear that investigations did not all result in the same answers.

The inclusion of this information in future Annual Reports would be useful to other stakeholders seeking to understand IIAC’s role better.

5. IIAC should publish statistics related to the sources and outcomes of investigations to improve transparency.

Open meetings

IIAC holds public meetings every 2 years, attended by stakeholders. Meetings are held around the country to allow stakeholders to better access them. These meetings allow IIAC to inform attendees about their work and approach to decision making. They also include opportunities for attendees to ask questions and raise issues for IIAC to consider. Topics raised by stakeholders in public meetings are followed up in IIAC’s meetings.

The public meetings were held annually until 2017, but moved to a frequency of every 2 years due to low attendance making the meetings poor value for money. The review found that stakeholders were disappointed by this move and felt uninformed of IIAC’s work in the intervening time between meetings. Though IIAC publishes its minutes and reports, it can be difficult for stakeholders to follow what work is occurring in between meetings. Investigations can take many months to complete and so it can be unclear to stakeholders when a particular enquiry will be pursued.

We therefore recommend that IIAC invite stakeholders to a scheduled meeting in the years in which a public meeting is not held. This would take the form of a regularly scheduled full council meeting which is opened up to observation by stakeholders. The cost of this can be kept to a minimum by holding the meeting in DWP buildings and inviting stakeholders to travel to observe the meeting if they wish. This will give stakeholders clearer sight of the work IIAC is doing.

6. IIAC should introduce an open meeting, to provide transparency in years in which a public meeting is not held.

Is IIAC effective in recruiting and retaining its members?

Recruitment

The Secretary of State is responsible for the appointment of all IIAC members and for determining their terms and conditions. All recruitment takes place by open competition and in line with OCPA (Office of the Commissioner for Public Appointments) guidance. The current schedule of appointments is well staggered, allowing for knowledge and experience to be retained when members’ terms end.

In 2018 to 2019, a new Chair and 6 new members were appointed. A 7th new member was appointed from May 2019. Despite concerns that such a large recruitment exercise would be difficult within a small pool of talent, the appointed members were of a high calibre.

The review team found that the transition to the new Chair has occurred smoothly and that the council has adjusted well to new ways of working.

Remuneration

The position of IIAC as a public body means that many of its members are motivated by public duty rather than remuneration. The high reputation of IIAC within its field is also seen as a benefit to its members.

In 2018 to 2019, remuneration of £15,000 per annum was introduced for the IIAC Chair. This was in order to better reflect the amount of work required of the Chair outside of meetings.

IIAC members receive a fee for attending meetings. Some Committee members expressed discontent with the meeting fee to the review team, saying that it is not sufficient remuneration for the many hours of work put in to prepare for meetings and conduct investigations.

Figure 1: IIAC meeting fees

Meeting type	Member type	Fee
Full council meetings	IIAC member	£142
Sub-committee meetings	RWG Chair	£182
	RWG member	£142

The level of member fees for attending meetings was last reviewed in 2007. The review team found that there is not a consistent approach to remuneration for advisory committees across government. Many committees only receive expenses, though they are often supported by larger specialised secretariats; IIAC is fairly unique in that members, not the IIAC secretariat, are responsible for the drafting of reports. As a comparison, it is unclear how much of their own time members of other committees are expected to contribute to equivalent work.

DWP’s only other advisory committee, SSAC, has a different system of remunerating members. Members are paid a day rate per day worked, rather than only for attending meetings. In the interests of proportionality, the review team’s work in this area has been surface level, with the understanding that the department will ultimately decide funding matters. We therefore recommend that the department review and benchmark the day rate paid to IIAC members, to ensure it more closely reflects current prices and provides sufficient incentive for IIAC members to complete work efficiently.  

7. The department should review and benchmark the day rate paid to IIAC Members.

6. Scientific Advisory Committee

As a Scientific Advisory Committee, IIAC must adhere to the Code of Practice for Scientific Advisory Committees and the Principles of Scientific Advice to government. This chapter assesses how IIAC adheres to these guidelines and concludes that IIAC should retain its status as a Scientific Advisory Committee. Many of the elements of IIAC’s workings which are required by the Code are explained elsewhere in this report and are therefore summarised here.

Purpose

In line with the principle of clear roles and responsibilities, the roles and responsibilities of IIAC are clearly defined in legislation and in the council’s Terms of Reference, which are updated every 3 years. IIAC reports to the Secretary of State for Work and Pensions. On a day-to-day basis the Chair reports into DWP’s Arm’s Length Bodies Partnership Division through the Secretariat.

Membership

Recruitment and responsibilities of IIAC members is discussed in chapter 4. Members are recruited according to what skills the council requires, so that a balance of expertise is maintained.

Members are leaders in their field where they maintain their professional development and links with the broader academic community. The Secretariat offers further learning opportunities where appropriate, such as in the induction programme for new members.

Independence and objectivity

IIAC has clear independence from the department. It sets its own agendas and ensures its advice is well evidenced. IIAC members were confident of their separation from the department and ability to give advice that was not influenced by DWP pressure. The recommendation for the department to add Dupuytren’s Contracture to the list of prescribed diseases is an example of IIAC acting independently of departmental pressure.

Working practice

The principles set out that Scientific Advisory Committees operate from a position of openness. IIAC does this through publication of its minutes and reports. All investigations result in a publication, regardless of whether they have resulted in direct advice to ministers. IIAC clarifies its working practices wherever possible, such as its publication of the guidelines used by members when evaluating evidence for investigations. IIAC aims to make its papers accessible, with lay summaries and glossaries added to reports.

IIAC follows the Code in its working practices. The review saw examples of IIAC assessing the reliability of evidence being used, reviewing previous advice in the light of new evidence and proactively identifying emerging issues.

Communication and transparency

IIAC is a highly transparent organisation, though recommendations to further improve are included elsewhere in this report. IIAC reports are clearly referenced to allow identification of sources for information used. All reports are published on IIAC’s GOV.UK website.

7. Effectiveness and efficiency

Does IIAC carry out its functions effectively?

IIAC is effective at carrying out its functions of advising the Secretary of State on matters relating to IIDB or its administration. Its reports are well respected by the scientific community and stakeholders alike. It is a testament to the high quality of IIAC’s advice that its reports are cited in tribunals and recognised by international organisations. The review team saw evidence of IIAC’s commitment to accuracy and detail in all of their outputs.

IIAC responds to every query they receive in a timely fashion. Meeting minutes demonstrate that queries are followed up and investigated further when necessary.

IIAC effectiveness can be most clearly seen by the quantity of their outputs. All investigations IIAC undertakes result in a published report. Command Papers contain evidence and recommendations which require a change in legislation, such as a new disease to be added to the list of prescribed diseases. Position Papers detail the council’s review of a topic that did not result in recommendations for legislative changes. Information notes summarise IIAC investigations which do not result in recommendations and where there is a changing or incomplete evidence base.

Figure 2: Published reports

Type of report	2018 to 2019	2017 to 2018	2016 to 2017
Command Paper	1	3	4
Position Paper	2	6	4
Information Note	3	6	7

Papers are sometimes published in the year after an investigation has taken place, but the number of published reports per year indicate the average number of investigations IIAC is undertaking.

In 2018 to 2019, IIAC went through significant change as a new Chair came into post and several members completed their terms on the council. In addition to the published papers listed above, IIAC published guidance on how they evaluate evidence. IIAC also communicated how they considered a set of draft regulations and conducted 5 in depth investigations which will be concluded in 2019 to 2020^{[footnote 4]}.

We note that this is a steady output of high quality products, particularly as the council meets in full only 4 times per year and papers are written by members in their own time.

Conducting investigations into whether diseases should be added to the list of prescribed diseases takes up the majority of IIAC’s time. The amount of resource spent on their other advisory functions varies. For instance, the resource spent advising on draft regulations is dependent on the number of regulations being laid in any given year. In 2017 to 2018, IIAC considered no draft regulations and in 2018 to 2019 IIAC advised on one set of draft regulations.

IIAC assists the department when asked, though must balance this with their investigations. IIAC’s extra assistance to the department has recently taken the form of advising on and updating the clinical handbooks used by medical assessors. The review found that this kind of activity is regarded as extremely useful by the department, but does take disproportionate amounts of member time which could be used conducting investigations on diseases. We conclude that IIAC’s own investigations, which only they have the expertise to conduct, should take precedent over other assistance for the department which could be conducted by the department itself.

Business planning

Reactive work

Most of IIAC’s investigations are driven by the queries they receive. These come from members of the public, MPs and stakeholder groups. The reactive nature of IIAC’s work can make it difficult for the council to forecast demand or plan their investigations and means that pieces of work must be frequently re-prioritised according to what new issues are raised.

Proactive work

IIAC’s work is also proactive, to ensure that the list of prescribed diseases is up to date. Members instigate investigations based on their own knowledge of emerging issues in fields of interest. IIAC is forward looking, conducting regular horizon-scanning through an annual review of recent research. For example, an interest in whether an occupational disease may arise from use of nanotubes in industry was raised in interview with several members. IIAC also occasionally commissions reviews of particular topics to ensure the evidence base for an issue has been fully explored.

IIAC periodically reviews existing prescribed diseases to ensure that prescriptions reflect current research. It also reviews statistics for IIDB claims in order to note any anomalies which may reflect misunderstanding of the current prescription. This type of activity ensures that the prescriptions for diseases remain accurate over time.

The review noted that IIAC is not perceived as focussed on the occupational diseases of the modern workplace, but that this is not due to a lack of effort on IIAC’s part. The Industrial Injuries scheme itself does not accommodate the prescription of emerging diseases from the modern workplace, as it requires that there is evidence of a clear doubling of risk from a specific occupation. Evidence of occupational diseases can take decades to be clear enough for IIAC to recommend a new prescription, because of the length of time it can take for diseases to appear and then to be adequately researched.

It was also noted that diseases that are not yet prescribed for are often complex, with multiple causes that make it difficult to show a clear causal link between an occupation and a disease. Therefore, limitations exist over the steps IIAC could take to investigate or recommend prescription of emerging diseases.

Work plans

It appears that work plans are not published, despite a recommendation to do so in the previous Triennial Review. We recognise that IIAC has a constantly evolving work plan, as their work is demand led, though this is not a barrier to the production of a dynamic, frequently updated work plan.

The review found that stakeholders were unclear what investigations IIAC is undertaking at any given time, making it difficult to know whether their queries are being followed up until a report is published. The process of an investigation can take many months to complete. Therefore, clarity of IIAC’s work in the intervening time between a query and a published report would be welcomed by stakeholders.

The publication of a forward look would make it clearer to stakeholders what investigations IIAC is conducting or is planning to take on. This would combat the perception found by the review team that IIAC does not operate at pace. This forward look could also be helpful to the department from an assurance perspective, through the inclusion and tracking of milestones.

The review also found that IIAC is under pressure with their current levels of resourcing. Council members devote significant amounts of their own time to IIAC work. A forward look which was adjusted to reflect the latest demands on the council would allow IIAC members to plan for when they would be expected to commit more of their own time to the council’s work. A dynamic forward look would ensure that member time is used most effectively.

A forward look would facilitate dynamic planning and prioritisation, allowing IIAC to ensure investigations are prioritised appropriately. This would contribute to IIAC working effectively and efficiently.

8. IIAC should produce and publish a 12 month forward look, regularly updated by the council, to increase transparency to stakeholders and to ensure work is more effectively prioritised.

Measuring and improving performance

The reactive nature of IIAC’s work makes it difficult for there to be any measures of performance. IIAC’s investigations also vary in the amount of resource required to complete them, due to the varying evidence bases and complexity of topics they consider. This results in it being difficult to identify any targets for timescales or outputs to measure IIAC’s performance.

We are assured that IIAC does continue to perform well. Papers continue to be generated at a steady pace with DWP and wider stakeholders content that the quality of IIAC’s work is high.

Stakeholder opinion/public standing

IIAC has a good reputation in the field of occupational medicine and this reputation has the effect of helping to attract talent to join the council. The specialist nature of IIAC’s work means there is little public knowledge of it and a limited number of interested stakeholders.

IIAC does have strong relationships with stakeholders who do have an interest in its work. The biannual public meetings help maintain those relationships and give IIAC the opportunity to collect feedback from its stakeholders.

IIAC also uses the public meetings to tell stakeholders about its current work and provide information on how it conducts investigations.

Does IIAC carry out its functions efficiently?

Funding and financial planning

IIAC does not have its own budget, but receives its funding from DWP, which provides a small administration budget managed by the Secretariat. Its annual expenditure allocation for 2018 to 2019 was £40,000 plus £15,000 for the Chair’s salary. The review team saw no other system of funding IIAC that would not impact upon its ability to provide independent and impartial advice.

Figure 3: Net expenditure

2016 to 2017	2017 to 2018	2018 to 2019
£22,394	£26,959	£32,094

IIAC members receive a fee for attending meetings. Travel expenses are also payable in accordance with DWP rates and conditions.

IIAC occasionally bids for DWP funding to commission a review in an area where there is a large body of evidence that would require too much of IIAC’s limited time. This last occurred in 2014 to 2015, when IIAC commissioned a review on ‘Assessing disablement under the Industrial Injuries Disablement Benefit Scheme’. IIAC is considering pursuing funding within 2019 to 2020 for research into bystander exposure to asbestos^{[footnote 5]}.

If recommendation 7 results in a change in the meeting fee for members, this could increase IIAC’s future funding requirements. The review team found no other issues in the pipeline that would impact on IIAC’s funding.

Efficiency

IIAC produces a large amount of advice for the department each year. The nature of IIAC’s work means that the time taken on an investigation can vary greatly depending on the complexity of the topic and quality of evidence available.

The review did not see evidence of any complaints over the length of time investigations take, though the publication of a forward look (recommendation 8) will make IIAC’s workload more transparent to their stakeholders.

We have concluded that this variance in investigation times is not an issue. Thorough research requires time and IIAC continues to produce high quality reports. IIAC’s published advice is referred to in tribunals and sometimes translated into legislation, so members are acutely aware that their reports must be accurate. IIAC’s continued reputation for accuracy and high quality scientific advice demonstrates the benefits of devoting extra time to investigations that require it.

Value for money

The review team found no more cost effective method of providing scientific advice on occupational health. The alternative to a standing committee which receives fees for meetings would be the department commissioning experts to investigate individual diseases. This alternative would undoubtedly cost more, as funding would need to reflect the full amount of time required to complete such work.

There is a clear case that IIAC is good value for money. Members are only paid fees for attending meetings, though the work to prepare for meetings and the writing of reports all takes place in members’ own time.

Expenditure

IIAC’s expenditure fluctuates according to the number of members on the council and the occurrence of public meetings.

Figure 4: IIAC expenditure*

Type of expenditure	2016 to 2017	2017 to 2018	2018 to 2019
Professional fees	£11,006	£12,546	£24,544
Expenses	£6,007	£6,036	£4,730
Printing	£3,090	£2,565	£1,700
Meetings	£1,152	£4,665	-
Research material	£391	£233	£210
Catering	£748	£914	£910
Total	£22,394	£26,959	£32,094

*Source: Numbers taken from Annual Reports. All numbers rounded to the nearest pound.

The budget allocated to IIAC for 2019 to 2020 is £55,000. The increase takes account of the extra costs for the 2019 public meeting and an almost full membership following the recruitment of several members in 2018 to 2019.

Professional fees cover the payments to members for attending meetings (discussed above). The increase between 2017 to 2018 and 2018 to 2019 is due to the introduction of an annual remuneration for the Chair. From April 2018, the IIAC Chair receives £15,000 per annum.

As IIAC does not have its own budget and its Secretariat is provided by DWP, there are no further opportunities for efficiency through use of shared services. IIAC does not rent any accommodation, except for space when required for public meetings.

8. Next steps

The Tailored Review team has worked closely with IIAC, the Department for Work and Pensions and the Cabinet Office. All of the recommendations of this review have been accepted by IIAC, the department and Cabinet Office and approved by the Minister for Disabled People. Progress against the recommendations of the review will be monitored by the department’s ALB Partnership Team.

The next Tailored Review of IIAC should take place in around 5 years’ time and should consider the progress made against the recommendations of this review.

Annex A

Analysis of IIAC against Cabinet Office guidance ‘Annex C: Expert Committees and NDPBs with Advisory Functions.

Feature	Indicative of ANDPB	Indicative of Expert Committee	Position of IIAC
Frequency and volume (of advice provided)	Typically, high frequency and volume of advice. Constant requests and responses.	Typically, lower frequency and volume of advice. Possibly periods of committee inactivity.	IIAC has 4 full meetings per year, and the RWG meets an additional 4 times. Although there isn’t a high volume of advice compared to some other bodies, there are no periods of committee inactivity. IIAC receives frequent queries from MPs, trade unions, and members of the public.
Risk Mitigation	Where there is a significant reputational or operational risk to the process of commissioning, developing or using the advice, due to the perception of an increased likelihood of interference from home departments.	Where there is a reduced/negligible reputational or operational risk to the advice associated with its commissioning, development or use. (This does not cover or negate the risk of not appointing independent experts)	IIAC’s advice must be impartial. However, IIAC advises on IIDB, one of DWP’s smaller and less high profile benefits. There is a medium reputational risk to the advice if IIAC were to be changed into an Expert Committee. The expert membership of the Committee would however provide assurance and reduce reputational risk.
Size of committee	Where there could be more than 5 committee members standing at any given time. Where more than one committee member is needed to cover the same issue under scrutiny. Where individual members cannot cover multiple issues (due to specialist skills required for each issue).	Where fewer than 10 committee members could be required to be standing at any given time. Where only a single committee member is required to cover each issue under scrutiny. Where multiple discrete issues can be resolved by a single committee member.	The Secretary of State for Work and Pensions sets the number of council members. The council usually operates with 17 members.
Size of the secretariat	Where the secretariat could be greater than 2 FTEs. Where the ANDPB’s staff/secretariat do more than administration – i.e. are involved in research, analysis or policy development.	Where the secretariat is usually fewer than 5 FTEs. Where the Expert Committee does not require additional staff to conduct research, analysis or policy development (such activities can be carried out by the home department).	IIAC Secretariat is 2 FTEs. The Secretariat do not conduct investigations or write reports, though a Scientific Officer assists the council’s research.
Statutory framework	There can be underlying legislation. This will be especially evident if the legislation requires advice that could only be provided by a body with the characteristics of an ANDPB. No separate legal personality.	Typically, (though not always) there is no underlying legislation. Alternatively, where there is legislation, it will not require advice that could only be provided by a body with the characteristics of an ANDPB. No separate legal personality.	The legislation governing IIAC is set out in sections 171 to 173 of the Social Security Administration Act 1992.
Funding	No criteria	No criteria	-
Duration	Body must be active for at least 3 years	No time limit, although usually permanent	Active in excess of 3 years

1. These conditions are set out section 108(2) of the Contributions and Benefits Act 1992. IIAC’s 2018 to 2019 Annual Report summarises these conditions: “In other words, a disease can only be prescribed if the risk to workers in a certain occupation is substantially greater than the risk to the general population and the link between the disease and the occupation can be established in each individual case or presumed with reasonable certainty.” Department for Work and Pensions, (2019), Annual Report 2018 to 2019 ↩

2. Department for Work and Pensions, (June 2019), Department for Work and Pensions single departmental plan ↩

3. Industrial Injuries Advisory Council, (2018), IIAC Minutes October 2017 ↩

4. As summarised in the 2018 to 2019 Annual Report, pp. 9-13 ↩

5. As summarised in the 2018 to 2019 Annual Report ↩