Health & Safety Focus: CBH Standards: Setting the standards for occupational health
Breaches of safety regulations hit the headlines when accidents occur, but many more days are lost to ill health of a type caused or exacerbated by a current or previous job in construction.
While most health and safety measures concentrate on safety, PPE and risk assessments, a new initiative from Constructing Better Health (CBH) focuses on on-going health surveillance, and how the health of the individual worker affects, and can be affected by, their work and private life.
The pilot scheme in Leicestershire evaluated the occupational health needs of 2,600 construction employees, and its mobile screening unit found that more than 30% were recommended further testing for previously undiagnosed high blood pressure, diabetes, HAVS and hearing loss conditions that could deteriorate without treatment.
One of the key issues determined by the pilot was a lack of standards against which companies could benchmark themselves to develop effective occupational health programmes.
Several organisations contributed to the development of the standard, including trade unions, occupational health service providers, and contractors, as one of the key objectives of CBH was to consider all suggestions and to look at whether they would work in the best interests of the whole of the construction industry.
Michelle Aldous, chief executive of CBH, says: "This is why a national occupational health scheme for construction is important, as it is able to take an objective rather than a subjective view."
The CBH's Draft Proposals for Occupational Health Standards for the UK Construction Industry aim to cover workers not only in the safety-critical and increased risk workers category, but across the board.
The sectors/trades were determined using the Standard Occupational Classification system used by the government, although the Health Assessment Matrix may be reviewed if any sector that does not 'fit' within the trades outlined is uncovered.
While the draft document defines the safety-critical worker as "where the incapacity of an individual or ability to carry out a task through ill-health poses a significant risk to the health and safety of others", the final document is expected to re-word the definition, and the category of increased-risk worker ("individuals undertaking tasks where they are exposed to risks which may be increased by a pre-existing medical condition") will be excluded.
Fitness for work
Aldous explains: "Companies/employers will register with CBH to gain access to 'fitness for work' information and to access downloads/information. Individual workers will also be able to access information through www.fitbuilder.com, which is purposely set up to provide relevant information regarding both work-related health topics and more general health topics through links to other relevant health organisations such as the Men's Health Forum."
She continues: "CBH is looking at ways in which individual workers could access their own fitness for work information, however, security may be an issue here and we do not want to promise something that is not feasible. Workers will also have access to a call centre where they can ask questions relating to health."
The categories include weight, blood pressure, cholesterol testing, BMI, and smoking. Given the head in the sand attitude that many adults have to their health, does CBH consider this may make some workers feel that their employers are being given permission to be involved in what the worker thinks is a private matter?
"The general/lifestyle health checks are purely a nice to have and are in no way intended to be mandatory," Aldous affirms, "employers may choose to offer these as a benefit to their workforce, however, they would be voluntary only. If an employee chooses not to undergo general health checks, then employers cannot force them."
The take-up, though, was pleasingly high. "Our experience gained through the CBH pilot indicated that if health checks were easy to access and free, workers were very enthusiastic to get involved in them. This, coupled with toolbox talks that focus on explaining health issues and their prevention in appropriate ways to the target audience, appeared to take away the fear factor of discussing their health."
Changing perceptions
Francesca Machen, director of Sarsen Health, was involved in the consultation process and is hugely supportive of the proposals. "If there is an industry standard it helps us to overcome the negative perceptions many have of occupational health, although, as it has no supporting legislation, it would be a shame to see it reduced to a 'tick box' exercise. No formalised process means that the employer does not have to act upon it.
"I think that the larger companies will have to write in contractual obligations to their subcontractors to help enforce this, but when people can see a cost benefit, such as reduced insurance premiums for compliance, they will embrace it."
Undertaking the measurement of workers' occupational health requires a team of appropriately qualified medical professionals. In determining the standards, the medical profession has been involved at all levels. "Initially, the legal requirements for health surveillance were determined by the occupational health team at the Health and Safety Laboratories. CBH has its own team of professionals, headed by Dr Geoff Davies," says Aldous.
Proposing minimum competency standards for occupational health professionals (OHP), CBH recommends that doctors be qualified to either a Diploma in Occupational Medicine (D. Occ. Med.), or Associateship, Membership, or Fellowship of the Faculty of Occupational Medicine (A/M/FFOM).
The Diploma is to be recognised as the minimum standard for the construction industry, while higher risk projects would be expected to have the health provision led by a consultant occupational health physician.
Nurses employed as the main OHP must be registered with the Nursing and Midwifery Council (NMC), and also hold an occupational health qualification at Certificate, Diploma or Degree level. Nurses without the additional qualification should work under the supervision of an appropriately qualified doctor or nurse. Supporting doctors and nurses, and working only under their direction, are occupational health technicians.
And dependent upon a company's main area of work, their OHP may require additional specialist proficiencies, such as experience with HAVS, noise-induced hearing loss and/or respiratory problems.
Revalidation for doctors is every five years, and three for nurses.
The construction industry's mobile workforce, and the fact that about half are employed by small companies of less than five workers, means that the implementation of new legislation could be difficult. Service delivery support mechanisms, which include CBH's website and a helpline resourced by qualified OHPs, should improve the accessibility.
Tough to implement
Sarsen Health's Carole Miller says: "Implementation is not going to be easy, encompassing as it does companies from five-star blue-chip organisations to one-man operations, which previously had very little service of this sort. It will have to be phased in by working to best practice standards - expecting immediate compliance with every one of the proposals would not be practical."
Annual health assessments for safety-critical/increased risk workers were suggested by one respondent to CBH's proposals, but this was considered too onerous on the construction industry, particularly the small to medium-size employers. Aldous says: "There are no valid reasons why health assessments should be undertaken more frequently than every three years. However, if larger employers wish to undertake more frequent health assessments, then there is nothing that stops them implementing this."
The CBH standards are intended as best practice guidelines only, not mandatory, but are intended to provide the industry with a set of baselines from which OH programmes can be developed and tailored to meet organisations' specific needs.
Embracing the standards is Concept Development Solutions in Birmingham, which took part in the pilot study, and which is encouraging its subcontractors to also meet their obligations.
Mike Webb says: "Following trials of CBH and subsequent consultation with our subcontractors, Concept Development Solutions has adopted the occupational health model and now provides free of charge annual health screening via our OH provider - taking place this September. The uptake from our contractors following the trials with CBH was extremely positive, hence the now repeated screening."
CBH, in raising awareness of occupational health issues, and setting national standards for the monitoring professionals, should bring about an equality of health monitoring for the construction worker regardless of the size of the company or the size of the workforce.