Construction industry occupational health special report: Game plan

We will probably never know how many workers have been injured or killed building the infrastructure for next year’s Olympic Games in Beijing, given the secretive nature of that country’s regime. But the signs are not good.

In April alone, six men died after a tunnel connecting the Olympic Village to the city collapsed. And the city’s huge facelift ahead of the Games next August has been double quick – often a sign of corners being cut.

It’s not the first time an Olympic deadline has led to health and safety taking a back seat. The Athens Olympics in 2004 were roundly criticised after at least 13 workers were killed and many more injured in the rush to complete projects on schedule. Compare that with the Sydney Olympics four years before, when just a single employee was killed during the construction of its venues.

The big question for occupational health (OH) and health and safety professionals is how will London in 2012 turn out to be? Will it, like Sydney, become an example of best practice? Or will it end up being tarred with the same brush as Athens and Beijing?

Despite a mass of high-profile campaigns, initiatives and inspection ‘blitzes’ by the Health and Safety Executive (HSE), the construction industry’s track record remains stubbornly poor. And the latest accident and injury figures for the industry do not make happy reading.

The figures for 2006-07 show a 25% year-on-year increase in fatal accidents, reversing the declining trend seen over the past two years. The sector had the highest total of fatal injuries and accounted for 31% of all fatal injuries to workers in the UK. The vast majority of these accidents, some 70%, were in the new-build commercial, housing, and repair and maintenance sectors.

The figures have been described by Stephen Williams, HSE chief inspector of construction, as “frankly, completely unacceptable” and “very, very disappointing”.

Nevertheless, while the death toll remains too high, he insists that safety is improving. “There has been steady progress, but more work can be done and more work should be done. More than one person a week is still being killed on UK construction sites,” he says.

Some high-profile projects, such as Heathrow Airport’s Terminal 5, have provided good examples of how OH and construction can work together, he points out. But there is still a lot to do, and OH and health and safety need to become part of the thinking early on in the process, at the planning and tendering stage, rather than something that is only picked up on after an incident, he suggests.

“Speak to the bosses in the industry, and they will tell you that good production, control, environmental awareness, health and safety and OH all go hand in hand. We have got to get to the stage on a construction site where anybody feels confident about being able to challenge unsafe actions, from the most junior member of staff to the directors themselves,” says Williams.

“The top companies and senior management have put a lot of effort into raising awareness. What we have to do is to drive that message down to the smaller and medium-sized businesses (SMEs). Fatal injuries predominantly now occur in small companies and on small sites – including small sites run by larger companies.

“One of the priorities for the HSE looking ahead is these SMEs and smaller sites. We want to build on our existing work and work with larger companies. We want to work with them to bring smaller companies to events and get across the health and safety message,” he adds.

However you spin it, whatever individual success stories you point to, you cannot get around the rising number of deaths, stresses Barckley Sumner, spokesman for construction union Ucatt. He says that, generally speaking, the safety track record is much better where sites have safety reps.

“In the self-employed market, it is much more fragmented. Every time you subcontract things or use an agency, the safety message is weakened,” he says.

Sumner believes the transient, often migrant, workforce attracted to the industry does not help the situation. “There is a lot of anecdotal evidence that suggests migrant workers in particular are very vulnerable on site,” he explains.

And while some health and safety messages may be getting through, taking things a step further and offering staff access to OH services is proving an even tougher battle.

“It is still something relatively new to the industry,” says Sumner. “It is about actually persuading them to pay for it. It is hard enough getting them to look at health and safety then to get them to take a longer term view and look at health – that is a big leap.”

Early retirement levels in the industry are notoriously high but, again, the transient, casual nature of the workforce means that many staff who become unable to work through injury or ill health simply don’t turn up on site again, or move elsewhere.

The structure of the industry, with its multitude of small, even micro, operators, makes it an extremely hard OH and health and safety nut to crack, agrees Claire Tyres, principal research fellow at the Institute of Employment Studies (IES).

Tyres was behind a study released in June 2007, which summarised the findings of the Constructing Better Health (CBH) pilot OH scheme. The scheme, which worked with more than 360 employers from October 2004 to June 2006, was designed to test the extent to which occupational support for the construction industry could offer demonstrable benefits.

CBH is now a long-term industry-led scheme which is setting standards for OH and safety.

During the pilot, more than 1,700 workers attended voluntary health checks, and 2,600 went along to ‘toolbox talks’ providing training on OH issues.

A third were found to have OH issues as a consequence of noise and vibration, while a third were also found to have general health problems – most commonly related to high blood pressure or respiratory issues. Overall, around 600 people needed to be referred to a GP.

Intriguingly, the IES study found that it was middle managers, not workers, who needed the most encouragement to get involved.

“The training that Constructing Better Health offered, which was aimed at managers, was rarely taken up. These same managers, however, were often very supportive and proactive in putting forward their workers for training,” Tyres points out.

Even though Constructing Better Health was a free service and was located on construction sites, it was still largely unable to penetrate the huge pool of small, independent contractors.

“You simply cannot go into Mrs Jones’s living room or wherever and have people doing training on-site,” Tyres explains. “Something like Constructing Better Health can work well on the bigger commercial sites, but for smaller, domestic building projects it is much more difficult.”

This means that, in effect, in OH and health and safety terms there is a two-tier industry, with the big companies able (and by and large more than willing) to invest in access to OH, but many smaller contractors either unwilling or unable (or both) to follow their lead.

“They have very low margins and pressures from clients, so it is much harder for them to engage with this agenda,” Tyres points out. “What’s more, their chance of being inspected is very low, so the carrot doesn’t work, and the stick doesn’t work either.”

Nevertheless, the government is taking action, not least with its passing of the long-awaited Corporate Manslaughter and Corporate Homicide Bill, which makes companies responsible for deaths of employees at work where there has been company negligence, rather than individuals.

In September, the new work and pensions secretary, Peter Hain, also called for employers, trade unions and business groups to join a forum, to focus on ways to improve health and safety in the housebuilding and refurbishment sectors.

So, where does this leave the Olympics? All at least are agreed that the run-up to 2012 is going to be a vitally important time for the industry and its public image.

And at this early stage the Olympic Development Authority is certainly making very positive noises. One significant move was the announcement in March that it would run a tendering process for an OH service for the construction workers on the Olympic Park site in East London.

The successful bidder will be required to support the ODA in ensuring health and safety is built into the construction and design of the site, carry out health questionnaire assessment of all new workers, offer various other health assessments and practical health checks, and provide on-site emergency first aid and paramedic service from a dedicated health centre.

“We are going to be setting up an OH service that helps to plug the gaps between what is already being run by individual contractors,” points out Lawrence Waterman, ODA head of health and safety.

In fact, even the appointment of Waterman, a former president of the Institute of Occupational Safety and Health, sends a very clear message about the seriousness with which the issue is taken by the ODA.

Once the right OH contractor has been identified and appointed, a priority will be to get arrangements and a presence established on site, he says.

“London 2012 is seen by many as an opportunity to step things up a gear. It is a shop window for the UK construction industry and a shop window for occupational health. The ODA has a much more holistic approach to OH than has perhaps been seen in construction before,” Waterman adds.

Issues on the radar include things such as dermatitis as well much as the perhaps more conventional trips, slips, falls and musculoskeletal issues. And there will be links with the Men’s Health Forum, local NHS providers, smoking cessation services, diet experts and so on.

“Construction workers are often mobile, peripatetic workers and they do not have much contact with their GPs. So it is about helping them to become more aware of their own bodies and managing their health,” says Waterman. “The key is to make sure the construction process does not expose people to health risks, but around the fringes we are going to be doing a lot of work on enhancing health and wellbeing issues. It is not just about avoiding harm but weaving OH and health and safety into every operating process,” he adds.

“There are going to be all sorts of legacies that we are working hard to build out of 2012. Some of it is physical and environmental, but it is also about management style and the perception of the construction industry.”

For others, including Ucatt, the jury is still out.

Sumner says: “It all depends on what employment model they adopt. If they go for the self-employment, fragmented employment model then it is going to be very difficult to have a safe Olympics. In Sydney it was all employed labour. In Athens, it was not. The ODA needs to take lessons from that.”

In light of the latest figures, Ucatt is now pushing for a repeat of the 2002 construction health and safety summit, after which the numbers of deaths in the industry, at least until last year, steadily declined.

“Now there has been a big expansion in the industry it has become more fragmented. So it is something the government really needs to be taking more seriously,” Sumner adds.

So far, as IES points out, the signs for the Olympics are relatively good. The schedule appears to be on track (with the International Olympic Committee expressing itself pleased at the progress being made), and the fact OH has even been mentioned at this early stage is promising. And Tyres believes a successful Olympics, at least from the workplace health and health and safety perspective, could act as a catalyst for raising awareness of the issues elsewhere within the industry.

“The problem will arise if things start to become rushed,” warns Tyres. “Then, do we come up with more money to keep things safe, or do we just try to meet the deadline? Are we prepared to pay the price for a safe Olympics?”

Case study: Bupa

There is a growing recognition of (and willingness to pay for) occupational health (OH) services within the industry, says Amanda Brown, an OH manager at healthcare provider Bupa, which specialises in providing services to the construction industry.

“They appreciate that healthy, satisfied staff increase productivity by reducing illness, injury and sickness absence,” says Brown.

The services Bupa now commonly provides include pre-employment health screening for all potential employees, risk assessment-based health surveillance and sickness absence monitoring and rehabilitation programmes.

One of the difficulties, though, is that OH’s benefits may not show up immediately on the balance sheet, so part of the job is persuading companies to persevere. It is still sometimes the case, too, that OH provision is perceived as being too expensive for the smaller construction companies. Another hurdle is that those outside the profession may not always understand exactly what OH can or is supposed to do.

“From analysing the trends over the past three years, at the [construction] company I predominantly work for there has been a marginal reduction in accidents and sickness absence, the causes for which fall in line with national trends. However, the true benefit is hard to quantify as reporting sickness absence has also changed to capture more employees who previously fell through the net,” says Brown.

“As with the introduction of any initiative, effective communication and buy-in at a senior director level is the key. This has certainly been the case with our success, along with a proactive, supportive safety team that has helped to ensure compliance with the initiatives at site level,” she adds.

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