Health Surveillance

Next meeting: 17th April 2008,
The Netherwood Hotel, 13.30 hrs (new time!) www.netherwood-hotel.co.uk
Topic: HSE update & AGM
Speaker: Clint Backhouse,
HSE, Carlisle

Health Surveillance – destroying myths
Joint meeting with
South Cumbria IOSH District
(40 members attended)

Speaker: Dr Dil Sen, Senior Medical Inspector, HSE Manchester

Martin Fishwick, Chairman, introduced Dr Dil Sen to talk about Health Surveillance & Destroying the Myths.

Dil explained that a number of past HSE campaigns had addressed a range of ill health problems such as:
- Good Health is Good Business
- FIT 3 – Fit for work, Fit for Life and Fit for Tomorrow
- Revitalising H & S, and
- Securing Health

Loss of work time due to ill health (24 million days per year) was four times greater than lost time from workplace accidents (6 million days per year). A self reported work related ill health survey quoted 2 million cases; the financial cost is more than 4% of the UK’s GDP, but only 3% of companies provide full OH support.

Key workplace health problems (and HSE initiatives) are:
- Muscular Skeletal Disorders (MSDs)
- Bad Backs, Chemicals
- Noise & Vibration and
- Stress

He commented that the UK had not signed the ILO Occupational Health Convention, covering workplace occupational health provision, including access to OH nurses and doctors.

Dil then quoted specific workplace health problems, backed up by graphic examples of harm caused by inappropriate workplace practices and cases he had dealt with, such as workplace lead poisoning, tar burns, dermatitis, asthma and cancers (including the annual death toll of about 2,000 from Mesothelioma).

The main causes of workplace ill health problems are:
- Carrying heavy loads in an inappropriate manner - Muscular Skeletal Disorders (MSDs)
- Poor posture - Muscular Skeletal Disorders (MSDs)
- Use of chemicals without adequate safeguards - dermatitis, asthma, cancers (eg florists, beauticians, hairdressers as well as chemical workers and nurses wearing latex gloves)
- Workplace noise (above workplace noise limits) - deafness, tinnitus
- Vibration – Vibration White Finger (VWF) and Whole Body Vibration (WBV)
- Use of workplace radiation sources and lasers without appropriate safeguards - cancers, skin and eye damage
- Poor Management Systems and re-organisation procedures – stress, and some of the above
- Construction, poor management systems, inadequate training - cement burns, falls from height etc…
- Shipyards - asbestos related cancers
- Rubber Workers – bladder and kidney cancer
- Inadequate systems for materials handling and packaging (including isocyanates and some foodstuffs such as flour – dermatitis and/or asthma

Dil then reminded us of the domestic risk posed by some workplace hazards, for example, wives acquiring Mesothelioma from washing their husbands' asbestos contaminated overalls.

Dil then turned to some of the myths about Health Surveillance:
- Health Surveillance is a legal requirement, but it does not necessarily have to be undertaken by a doctor or nurse.
- Small employers are not exempt from Health Surveillance responsibilities; the requirement may arise from task risk assessment or because of specific legislation such as the lead and asbestos regulations.
Health Surveillance need not be expensive, simple checks can be undertaken by suitably trained members of staff, for example, simple checks for early signs of dermatitis.
- Health Surveillance does not necessarily have to be undertaken by a doctor or nurse, unless there are medical queries, or evidence of potential health problems following health checks.
- Health Surveillance can be carried out by a trained responsible person, such as a first aider or supervisor, as long as there is a system for referring an employee to an occupational health nurse or doctor if appropriate.
- The apparent non-use of chemicals does not eliminate the need for Health Surveillance; many employees use common chemicals, some of which can have adverse health effects, for example, cleaners, hairdressers etc... A Risk Assessment may identify a need for regular Health Surveillance checks for specific groups of workers.
- Health Surveillance covers many things other than chemicals for hazard related health checks, which are recorded, and acted on if appropriate.
- Health Surveillance is legally required, for example, vibration, ionizing radiation etc....
Health Surveillance is not like an MOT - a one-off, unfocussed GP check is health or lifestyle screening; it is not Health Surveillance!

Health Surveillance is legally required under both the Management and the COSHH Regulations. It is to:
- Protect employees' health from risks at work.
- Check for any adverse health effects caused by an employee’s work.
- Check that employees can continue to work on specific tasks, or whether they should be moved temporarily or permanently to other tasks, or, in extreme cases, to identify that an employee needs to be medically retired.
- to evaluate workplace control measures.

The aim of Health Surveillance is for workers to be Happy, Healthy, and Here!

Health Surveillance is required if:
- There is an identified hazard that may pose a health risk.
- A reasonable likelihood (Risk) of potential adverse health effects to the employee because of the job that they do.
- There are valid techniques to detect adverse health effects.
- It will protect an employee’s health.

A number of UK Regulations identify a requirement for Health Surveillance. For example: Control of Hazards Hazardous to Health (COSHH; including a list specific chemicals where there is a statutory requirement for Health Surveillance), Asbestos, Lead, Ionising Radiations, Diving, Compressed Air etc...

Health Surveillance will usually include:
- Enquiries about potential symptoms that relate to a known potential workplace hazard.
- Workplace Inspections – to check that Systems of Work are robust and being followed.
- Clinical examination (by doctor or nurse), as required by some UK regulations.
- Biological monitoring of the workplace if appropriate.
- Regular checks for biological effects amongst workers eg early signs of dermatitis
- A regular review of records (health, Risk Assessment and Systems of Work), results and history - including evaluation of control measures, collecting data, and protecting health.

Health Surveillance is not in lieu of any other measures or training; it is part of the overall management. It may involve:
- Trained Responsible Persons (Supervisor, First Aider, or other trained staff member)
- Nurse or Doctor (preferably with Occupational Health or Occupational Medicine qualifications)
- Technicians to carry out specific tests eg audiometry, dust levels etc…
- Test results may need “expert” interpretation, but the basic need is to confirm that an employee is fit to undertake specific tasks and that control measures to protect employee’s health at work are functioning correctly.

The overall aim of any Occupational Health service is protection of health and wellbeing. The health professions are restricted by medical confidentiality, but non medical responsible persons do not have the same constraints, but must respect personal privacy. Medical confidentiality may prevent certain courses of action, for example, information provided may be specific but not related to a particular employee, or specific to an employee, but general, for example, fit or unfit to continue working on a specific task but with no information about the medical reasons unless the individual agrees to the release of information.

Occupational Health check list for employers and senior managers:
1. Is there a problem, or a need for Occupational Health input?
2. What do I need to do?
3. Who do I need to do it?
4. Take action.
5. Check if the new system is working.

Providers of Occupational Health help and information include:
- Industry contacts: “experts” in best industrial practice.
- Trade organisations eg Print Federation.
- HSE: has produced a leaflet entitled Understanding Health Surveillance at Work.
http://www.hse.gov.uk/pubns/indg304.pdf
- Employment Medical Advisory Service (EMAS) - HSE has produced a publication explaining the role of EMAS http://www.hse.gov.uk/pubns/hse5.pdf and has a list of appointed doctors throughout the UK, although they cannot recommend individual doctors.
- Business Links.
- British Occupational Health Society (BOHS).
- Institute of Occupational Safety and Health (IOSH).

Ethical aspects of Occupational Health
- Informed consent of the individual is needed to release medical information.
- Any medical tests undertaken must be appropriate (some may be mandatory, eg blood tests for lead workers).
- Confidentiality extends to the safe keeping and controlled access to medical records.
- For drug and alcohol screening, company’s need a policy statement that has been agreed with trade unions and that is introduced to employees with appropriate training and advice.
- Confidentiality includes the restrictions on medical staff, the rights of employee and employer, but allows exceptions (eg if drunk, mentally ill, or a danger to self or others).

Dil concluded by mentioning an HSE survey done some years ago, which showed that:
- Only one third of firms had identified potential workplace health hazards.
- Many employers were unsure what Health Surveillance was.
- Occupational H & S was addressed in only one third of risk situations.
- A connection between Risk Assessment and Health Surveillance was lacking.

Questions raised by members included:
- The disposal of records: give them to the employee when they leave.
- Desk-top PCs versus laptop computers: more difficult to keep confidential information secure on laptops; need for secure systems eg password protected.
- Occupational Health Technicians: the formation of a professional body is being discussed.
- Need for Occupational Health staff to be proactive in getting about the work environment, whilst working jointly with the local Safety Adviser.

Martin Fishwick, chairman, warmly thanked Dr Sen for his comprehensive presentation and reminded members that handouts were available on the front desk and that Dil would be available for individual questions during tea and coffee.

NB the names of those attending our meetings are included on minutes posted to members; if you need proof of attendance please contact John Westmoreland, Business Secretary (01524 822 072), who will be able to help you.