HEALTH SURVEILLANCE IN THE CONSTRUCTION INDUSTRY- WHAT ARE THE ISSUES?Dr Marianne Dyer

Health Risks In Construction• Physical

• Noise• Dust• Asbestos• Vibration• Solar radiation• Radiation• Temperature

• Chemical• Cement• Isocyanates• Lead• Solvents• Mineral Oils• Diesel Exhaust Emissions

• 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

• Psychosocial– Work Related

Stress– Shift-work– Fatigue– Common Mental

Health problems– Lifestyle

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

Prescribed Diseases

Asthma (D7)

Dermatitis (D5)

Vibration white

finger (A11)

Carpal tunnel

syndrome (A12)

Osteo- arthritis of the knee

(A14)

(c) Other musculo- skeletal

disorders (A4-A8, A13)

Occupational deafness

(A10)Asbestosis

(D1)Mesothelioma

(D3)

Diffuse pleural

thickening (D9)

Agriculture, forestry and fishing A 0.7 0.0 1.3 1.3 0.0 4.2 0.3 1.0 4.6 0.7

Extractive and Utility Supply (a) B, D 0.2 0.2 12.2 3.8 0.0 0.6 1.9 15.0 38.5 10.3

Manufacturing C 2.2 0.9 4.2 3.2 0.0 1.0 2.9 11.8 28.1 6.3

Water Supply: Sewerage, Waste Management and Remediation Activities E 0.0 0.0 1.2 2.1 0.0 0.0 0.2 1.7 2.9 0.5

Construction F 0.6 0.8 8.9 5.8 0.0 0.6 1.8 27.9 54.2 13.9

Services G-S 0.1 0.1 0.3 0.3 0.0 0.3 0.1 0.6 2.5 0.3

Other Service Activity outside the HSWA T-U 0.0 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.6 0.0

All sectors 0.4 0.2 1.3 1.0 0.0 0.4 0.5 3.3 8.1 1.8

Prescribed diseases: Rates of new assessments per 100 000 employees in each industry by disease, 2-year average (2011 & 2012)

SIC 2007 section

Disorder and disease reference

Health SurveillanceThe Challenges:

• Knowledge

• Work and workforce dynamics

• Appropriate OH provision and support

• Recording and reporting

• Enforcement & consequences

Knowledge

FatalityIllness and

Disability

Signs or symptoms of ill health

HEALTH IMPACTS

• 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

Work • Phases of construction:

• Enablement

• Ground phase

• Build phase

• Fit out phase

• Handover phase

Workforce Variation

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

Appropriate OH Provision

• Guidance

• CONIAC

• Constructing Better Health

• DoH Responsibility Deal

• Professional Body advice e.g. IOSH, FOM, CCG

• Intelligent customer

• Intelligent provider

    

   

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

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

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

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

FITNESS FOR WORK IN CONSTRUCTION

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

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

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

Safety Critical Workers

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

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

Medical RequirementsHSE 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.“

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

Medical Considerations• 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.

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0

10000

20000

30000

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Pre-employment

Safety Critical Med-icals

No Medical ProblemMedical Problem Identified

No Medical ProblemAlready AwareNew Diagnosis

Safety Critical Medical Outcomes

Medical Problems Identified

• Hypertension• Altered glucose metabolism• Eyesight

Working

Permanently Restricted

No Medical Problem

Medical Condition

Temporary Restrictions

Final Outcome of Fitness to Work

Key Points• 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.

Standards and the Equality Act

• 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

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

Risk Assessment

Location

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

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.