Health Surveillance in the Construction Industry- what are the issues?

1. Health Surveillance in the Construction Industry- what are the issues? Dr Marianne Dyer

3. Health Risks In Construction • Physical • Noise • Dust • Asbestos • Vibration • Solar radiation • Radiation • Temperature • Chemical • Cement • Isocyanates • Lead • Solvents • Mineral Oils • Diesel Exhaust Emissions • Psychosocial • Work Related Stress • Shift-work • Fatigue • Common Mental Health problems • Lifestyle • Biological • Weil’s Disease • Lyme Disease • Water supplies • Sewage • Needles • Infectious illness • Manual Handling • Back injury • Work Related Upper Limb Disorder • Carpal tunnel • Muscular sprains / strains

4. Occupational Illness in Construction • 2012/13 39 construction deaths from accidents • 100x as many deaths from occupational illness • 56% of occupational cancers are in construction • Large burden of morbidity • Poor recording and reporting

5. Prescribed Diseases

6. Health Surveillance The Challenges: • Knowledge • Work and workforce dynamics • Appropriate OH provision and support • Recording and reporting • Enforcement & consequences

7. Knowledge • Injury / Accident vs occupational illness • “Slow accident” • Legislative requirement • Benefits to company and individual workers • Health surveillance vs Fitness for work • Health like safety approach

8. Work • Phases of construction: • Enablement • Ground phase • Build phase • Fit out phase • Handover phase

10. Workforce Variation

11. Workforce Work Organisation Principle Contractor Sub-contractors Sub-sub-contractors Sub-sub-sub-contractors White van man Worker • Male • Itinerant • Unusual to have sick pay • Personal health awareness and contact with services • Potentially limited skills and inability to undertake other employment

12. Appropriate OH Provision • Guidance • CONIAC • Constructing Better Health • DoH Responsibility Deal • Professional Body advice e.g. IOSH, FOM, CCG • Intelligent customer • Intelligent provider

14. Delivery of Health Surveillance • OH Resources • Facilities • Equipment • Trained Staff • Appointed Doctors • Responsible Person Training • Skin monitors • HAVs monitors • OH records • Consent and DPA • Connectivity

15. Recording and Reporting • Who to? • What to be reported? • What will they do with a positive result? • RIDDORs • HSE inspections • The individual and follow up

16. Enforcement and Consequences • HSE Plan of work 2014/15 • Targeting occupational health risks • Raising knowledge • Companies • Becoming more aware of their responsibilities • HSE enforcement • Business case • The Worker • Benefits of health surveillance to them • Understanding how to protect their health • Fitness to work

17. Conclusion • There are many health risks within construction which can be managed by the normal risk assessment and control mechanisms • Knowledge and understanding of health surveillance is increasing within the construction industry – companies and workforce. • The organisation of work and the workforce are a challenge to how the programmes are operated • Good, open, ongoing planning and collaboration between the company and the OH provider is required

19. Fitness For Work in Construction

20. Workforce • Around 2 million workers in construction in the UK • Diverse range of trades and job requirements • Fitness requirements depend upon: • Type of work undertaken • Safety Critical • Non-safety Critical • Statutory requirements • Company Medical Requirements • Location • Risk based

21. Standards • Statutory • No specific legislation for Construction but there remains the “Duty of Care” to ensure workers are fit to undertake their work • Personal Trackside Safety PTS • London Underground • UK Oil and Gas • CAA • HGV / Forklift Truck • Lead / Radiation • Best Practice • Construction Better Heath • OH Provider Companies • Plant Safety Group/ FOM / • DVLA

23. Fitness Assessment • Agreed Fitness Standards for the Project • Undertaken prior to starting work on the Project • All workers, regardless of employer • Existing evidence of fitness • PTS certificate • CBH • Approved other form of Fitness certificate • Fitness assessment • By OH staff • Screening questionnaire • Safety / Non-safety critical workers

24. HSE Definition Some jobs industry involve activities that can place workers at risk, unless the person has full, unimpaired control of their physical and mental capabilities. These jobs are called ‘safety critical' and the people who do them are ‘safety-critical workers'. Safety Critical Workers

25. Safety Critical Work An activity containing a safety-critical element; and An incapacitated worker might expose themselves or others to a significant risk of harm. Location and rescue Safety Critical Workers

26. HSE Guidance “Before someone starts safety-critical work, it is good practice for the employer to agree what health checks and/or medical examination are required, and record the agreement. It is important to be clear which aspects of fitness are relevant to the safety-critical work, and to specify the required level.“ Medical Requirements

28. Heavy Plant Tower Cranes Tunnelers Electricians Demolition Electricity and utilities Safety Critical Workers in Construction

29. In particular, focus on health conditions that may involve: • Sudden loss of consciousness (e.g. epilepsy, some heart conditions, diabetes (particularly insulin-dependent diabetes)); • Impaired awareness or concentration; • Sudden incapacity; • Impaired balance or coordination; • Restricted mobility; and • Impaired vision or hearing. Medical Considerations

31. Safety Critical Medical Outcomes

32. Hypertension Altered glucose metabolism Eyesight Medical Problems Identified

33. Final Outcome of Fitness to Work

34. Large incidence of undiagnosed conditions which can affect their ability to work safely. Most cases these are easily treated or managed. Change in perception of safety critical medicals from negative to positive – about enabling people to work rather than stopping them. Key Points

35. Proportionate to the Job Level of Acceptable Risk Discrimination: Direct / Indirect/ Assumption Based on Evidence Case by case assessment New starters vs continued fitness to work Statutory Requirements Standards and the Equality Act

36. Very common within UK construction Pre-placement, Random, For-cause Imperative to have a clear and consistent policy PTS requirement Drug and Alcohol Testing

37. Risk Assessment

38. Location

39. Other Considerations • Unfit for Work • Interval of Assessments • Recording of medical information • Consent and DPA • OH record maintainance and security • CBH database • Personal record • Maintaining and improving individual health and fitness

40. Conclusion • More acceptance of fitness to work assessments within construction • No specific statutory standards however there is the “duty of Care” • Good guidance and best practice standards available • There may be some statutory requirements • Workers are employed by their own companies, not the Project.