CBH health card: Will firms adopt system?

Having created construction-specific industry standards and a portal of information, Constructing Better Health now wants to see every worker carrying a card containing their personal occupational health data. It will be an uphill struggle. Kristina Smith  reports.

Information on workers' health will be uploaded on to the CBH database, but this will only be accessible by CBH-approved occupational health firms

Can you imagine a construction industry so professional that each worker carries a smart card containing information about their competencies, last health check and any health issues which might impact on their performance?

It's difficult. But by next year, there should be a few such workers out there. Because in March this year Constructing Better Health (CBH), whose goal is to roll out occupational health surveillance across the industry, joined forces with CSCS.

The idea is that the roving construction worker arrives with a CSCS/CBH card complete with occupational health check history so that a new employer can see they are fit to work - as well as competent.

The card would also provide a record to show that contractors have been looking after their employees' health should problems surface years into the future and the worker is looking to take legal action.

"We understand that a lot of larger contractors do undertake health surveillance of their direct workforce but it's when they are managing large projects that they need to have a way to ensure their supply chain has occupational risk management programmes in place," says CBH's chief executive Michelle Aldous. "These cards will mean that they can check workers are fit to undertake the job."

It's a good idea. But the huge hurdle it faces - as the CSCS card did and still does - is the diverse and fragmented nature of the industry. Add the current economic situation into the mix, with clients looking for the keenest price, and it seems unlikely that principle contractors will choose to burden their supply chain with an additional cost of around £100 per worker.

Hand-arm vibration

The card will hold information about what and when the last health check was, for example surveillance for hand-arm vibration (HAV), and what the outcome was. The outcome could be that there are restrictions in place, which with HAVS could mean certain tools are out of bounds.

Health information will also be uploaded on to the database, but this will only be accessible by CBH-approved occupational health firms.

It's hard to imagine anyone signing up to a scheme which says to an employer "this bloke's got a dodgy back, so you can't really expect him to do anything" or any company wanting someone whose back could go at any minute to be working on site.

But Aldous explains that any restrictions imposed by a person's health are couched positively. "It took an awfully long time to get that agreed," she says. "The last thing we want to do is to say an individual cannot work and that is not how the card should be read.

"We want to keep the individual in the industry for as long as possible and we are giving the information and guidance to enable us to prevent any further damage to the individual and to protect their long-term working capability."

CBH has issued 1,000 cards to date

To date, CBH has issued 1,000 cards, thanks to retailer Sainsbury's which has provided funding to implement the card throughout its supply chain because it fits well with the company ethos.

"At Sainsbury's the health and safety of our colleagues is of paramount importance," says Richard Rust, Sainsbury's head of delivery and construction. "In the construction industry there has been a real focus over recent years in improving site safety. Health issues are not always so visible but can have the same devastating impact." The scheme is voluntary - workers can refuse to be screened or refuse to have their data uploaded - but so far 98% have agreed.

It seems unlikely that the big players will follow Sainsbury's lead. Many of them already have occupational health screening programmes in place which they had started to develop before the CBH pilot. The Major Contractors Group - which has now expanded its membership and become UK Contractors Group (UKCG) - published an occupational health strategy in 2000.

"Quite a lot of our members are using their standards and some of their material," says UKCG director Stephen Ratcliffe. "But they probably had their own arrangements in place pre-CBH. Some of the CBH product is geared towards companies that are not so far advanced."

Ratcliffe says that UKCG supports the idea of smart cards, pointing out that many contractors employ similar cards on a project-by-project basis. "The idea of a universal card is hugely appealing, providing the costs are no more than the investments they are making on individual projects," he adds.

Firms such as Balfour Beatty and Bovis Lend Lease are taking a different approach to looking after the health of their supply chain's workers. They employ an on-site nurse who deals with all health issues from treating injuries and changing dressings to lifestyle-related health problems and work-related ones.

Productivity increase

Caroline Mcleod, managing director of ConstructionCare, says main contractors find that absenteeism is down, productivity is up, and the risk of accidents due to ill health or dependency problems are down.

She considered joining CBH as an occupational health service provider, but although she applauds their aims, does not think they are achievable.

"I work with a couple of small contractors in London and most of their guys don't even have CSCS," she says. "Small firms are being asked to pay £100 for a screening, and then there's the maintenance and follow-up situation. It's complex and costly."

Aldous argues that it doesn't have to be so costly. A screening for a safety critical worker such as a plant operator where everything is checked would come in at between £80 and £120 per person, she says. But screening for one problem - such as hearing impairment - would cost less.

"Rather than a blanket approach where contractors consider that every worker could have been exposed to everything, firms should work out what the risks are for each individual and screen them accordingly," she says.

And, Aldous adds, health screening isn't a 'nice-to-have'. Employers are required by law to carry out health surveillance if the job they are doing could be causing them harm (see panel below).

But Aldous and her team are under no illusions about the immense task before them and have set themselves a modest target of 5,000 cards in the first year.

"I think that this is going to be a bit like the CSCS," says Ratcliffe.

"It's going to take a number of years before it becomes a core part of the industry."

The difficulty could be that if more parts of the industry can't get behind Constructing Better Health with more than just words, it won't survive to help deliver that professional industry we imagined.

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Health surveillance: legal obligations

Section 2 of the Health and Safety at Work Act 1974 (HSAWA) states that employers have a general duty of care to ensure (so far as is reasonably practicable) the health, safety and welfare of all their employees.

Employers have a legal duty to reduce (so far as reasonably practicable), the risks to the health and safety of employees and others who may be affected by work activity.

The starting point is to assess the risks. If the risk assessment shows there is significant residual risk to employees, even after reasonably practicable control measures have been applied, health surveillance should be considered.

Employees need to understand their role and responsibilities within a health surveillance program so it is best practice to include employee representatives in developing them.

An employee's attendance for health surveillance is mandatory where a risk assessment has established that a genuine need for health surveillance exists.

An employee does not, however, have to undertake any tests or answer medical questions. If this case arises, the occupational health provider would inform the employer of this fact and that they would not be able to make a fitness-for-work statement.

It then becomes a management decision under the relevant employment legislation.