This case study, written by Matt Wilson, explores the response to a workplace accident in the construction sector, including the steps taken to support the employee and actions to improve safety procedures.
Although the UK’s construction industry is considered one of the safest in the world, injuries and workplace accidents are not uncommon due to how the work environment changes as projects progress, which can create hazards (Sherratt & Dainty, 2017).
‘Bob’ (not his real name), a plasterer employed by a subcontractor, suffered a severely sprained ankle after tripping over a concrete block that was used to raise pallets of plasterboard to allow forklift trucks to move them. The concrete block had remained in place after the load was moved and Bob tripped, injuring his left ankle.
The principal contractor has legal duties under health and safety legislation including the Construction Design Management (CDM) Regulations 2015, which states that “the principal contractor must plan, manage and monitor the construction phase and coordinate matters relating to health and safety during the construction phase to ensure that, so far as is reasonably practicable, construction work is carried out without risks to health or safety”.
Bob’s employer also has a non-delegable duty of care under Section 2 of the Health and Safety at Work Act 1974 and must also undertake general risk assessments under Regulation 3 of the Management of Health and Safety at Work Regulations 1999.
Investigating a workplace accident
Workplace accident response
All workplace accidents should be investigated in order to prevent recurrences. The follow-up team in this case included the health and safety officers for both the employer and principal contractor, subcontractor employees, and management representatives, including the site manager.
The team had to take matters beyond the physiological injury into account to facilitate a successful return to work for Bob. These included psychological and sociological perspectives.
As well as having financial consequences, significant time off work can affect Bob’s recovery. Work is good for health and it is in the worker’s best interest to return as soon as possible (Waddell and Burton, 2004). The longer they are absent, the greater the perceived negative effects to their self-esteem, mental health and general health resulting from inactivity (Kosny et al, 2019). In many cases, work can be considered a form of vocational rehabilitation (HSE, 2020; TUC, 2019).
The team considered what could be done to ensure Bob’s acute injury would not lead to long-term absence. Musculoskeletal injuries along with poor mental health are the greatest contributors to long-term absence (HSE, 2020).
Return-to-work planning
Bob’s injury was treated onsite by the first aid team. He followed this up with a visit to his GP and physiotherapy, which focused on mobilisation and stabilisation exercises and incrementally increasing his activity level (Donovan & Hertel, 2015). His rehabilitation aimed to match function to the level at which Bob can meet job demands (Lin et al, 2010).
A phased return to work was planned, and Bob’s employer was told that the plan might have required modification as the physical demands of the job might aggravate his injury. This type of injury is likely to result in pain and instability for anything up to a year, with decreased strength and range of motion likely (Donovan & Hertel, 2015).
The longer they are absent, the greater the perceived negative effects to their self-esteem, mental health and general health resulting from inactivity.”
Bob’s personal motivation and participation in the absence management process was vital for it to be successful (Waddell and Burton, 2004).
A vocational rehabilitation approach was taken, following the recommendations stated on the fit note completed by Bob’s GP. This was discussed with him at a return-to-work interview, where a phased return with reduced hours and amended duties was agreed, along with time to facilitate ongoing physiotherapy. Such interviews are effective in dealing with short-term absence post injury (TUC 2009, HSE 2010).
The interview considered not just physiological barriers but those that could have arisen because of the absence itself, and the social and psychological effects of the injury, such as stress or anxiety (Waddell & Burton, 2004). Construction employees often under-report work-related ill health and absence (Stocks et al, 2010) and may be reluctant to follow process as a result of being considered weak or lazy. They may under-report pain in order to get back to work and are often reluctant to seek medical help (Kotera et al, 2019), and worry that will be unable to carry out their role to their previous standard. Employees need to know they have the support of their employer while they are recovering.
A note on fit notes
It is important to remember that the GP preparing a fit note may have little understanding of employee’s occupation and the conditions of their work (Kosny et al, 2019; TUC, 2009). They may also have little occupational health training. Additionally, while the majority of studies imply that a return to work is important for the wellbeing of the employee, not all workplaces will be safe to return to while an employee is injured, due to their inherent risk (Grzywacz & Dooley, 2003).
Fit note recommendations should be viewed cautiously, as any excessive duties or mismanagement of the injury may lead to further accidents and a longer period of absence. However, following their recommendations will in most cases lead to a shorter period off work (Dorrington et al, 2018).
Absence management best practice
Employers have no legal obligation to manage sickness absences nor assist employees in returning to work following a workplace accident(TUC, 2019). However, there is a strong business case that this is in their best interests, as sickness costs can be among the highest business overheads (Waddell & Burton, 2004).
Employers should make contact with the employee as soon as possible and maintain consistent contact during their absence, giving them input in decisions concerning their return (Lewis & Thornbury, 2010).
Using the HSE’s guide to managing sickness absence (HSE, 2010) the employer should:
- Record sickness absences
- Maintain contact with the employee
- Use professional advice/treatment to plan a return to work, incorporating reasonable adjustments when necessary
- Agree a return to work plan with a periodic review
- Coordinate the return process
This process can be problematic for SMEs that do not have a dedicated HR or OH team in place. However small companies may consider the closer personal relationships they have with their employees advantageous.
Employers should make allowances for days off due to acute flare-ups of the injury and time off during working hours for rehabilitation (Donovan & Hertel, 2015). Ideally, there should be no reduction in pay as it will only hasten a return to full-time work, which could exacerbate the injury and lead to further absences.
Preventing reoccurrence
More CPD for occupational health
CPD: Ergonomics in relation to health and safety
CPD: How occupational therapy can strengthen occupational health
To prevent workplace accidents like this happening again, the employer in Bob’s case contacted the manufacturer of the product supplied on pallets to highlight the difficulties associated with the pallet height. As a result, the manufacturer reviewed their pallet supply chain and it was agreed that only pallets of a certain size would be used in future.
The employer became more stringent about load lifting methods. Toolbox talks were delivered to raise awareness among subcontractors, who were also made clear that any deviation from the agreed method would result in significant penalties; this is especially prudent as the accident occurred while the employee was not actually performing a construction task, but simply moving around.
The suitability of the footwear worn on site was also reviewed, as Bob’s boots allowed significant ankle rolling. Boots meeting the minimum ISO 20345:2011 and safety class S3 standards are recommended, and such footwear should be high shafted and/or have built in ankle protection for any trade undertaking manual handling to mitigate slip and trip risks (Dobson et al, 2019).
A review of the manual handling training and risk assessments was carried out, including considering the accumulative effect of fatigue on performance and safety during physically-demanding tasks. Carelessness, fatigue from long working hours, and pressures of the contract encouraged speed, which in this case led to risk-taking behaviours taking priority over safety (Sherratt and Dainty, 2017). With plasterboards weighing approximately 12kg, lifting and manoeuvring them over the course of the day could have resulted in prolonged strain on the muscles of the lower limbs, increasing the risk of sprains or strains (Dobson et al, 2015).
Bob made a successful return to work. However, had he been unable to return to his original job, alternative solutions may have needed to be considered by the organisation (HSE, 2010).
Following Bob’s return, regular reviews of his working arrangements have been made, taking into consideration his rehabilitation progress.
References
Dobson J A., Riddiford-Harland D L, Steele J R (2015)
“Effects of wearing gumboots and leather lace-up boots on lower limb muscle activity when walking on simulated underground coal mine surfaces” Appl. Ergon., Vol.49 (2015), pp. 34-40
Donovan, L and Hertel, J (2015). “A New Paradigm for Rehabilitation of Patients with Chronic Ankle Instability.” The Physician and Sports Medicine Vol.40(4): 41-51.
Dorrington S E, Roberts A, Mykletun S, Hatch I, Madan and M Hotopf (2018). “Systematic review of fit note use for workers in the UK.” Occupational and Environmental Medicine Vol.75(7): 530-539.
Grzywacz J G & Dooley D (2003) “Good jobs” to “bad jobs”: replicated evidence of an employment continuum from two large surveys, Social Science & Medicine, Vol.56, Issue 8, Pp 1749-1760,
HSE (2005). Occupational health and safety support systems for small and medium sized enterprises – A literature review Research report 410.
HSE (2010) Managing Sick Leave and Return to Work. Available at: https://www.hse.gov.uk/sicknessabsence/
HSE (2020) Health and safety at work Summary statistics for Great Britain 2020
Kotera, Y, Green, P, and Sheffield, D (2019) ‘Mental health shame of UK construction workers: “Relationship with masculinity, work motivation, and self-compassion” Journal of Work and Organizational Psychology, Vol.35(2), pp. 1-9.
Lewis, J and Thornbory, G (2010). Employment Law and Occupational Health: A Practical Handbook. Hoboken, Hoboken: John Wiley & Sons
Lin, C, Hiller, C E, & de Bie, R A, (2010) “Evidence-based treatment for ankle injuries: a clinical perspective” Journal of Manual & Manipulative Therapy, Vol.18:1, 22-28
Sherratt, F and Dainty (2017). “UK construction safety: a zero paradox?” Policy and practice in health and safety Vol.15(2): Pp 108-116.
Stocks S J, McNamee R, Carder M, (2010) “The incidence of medically reported work-related ill health in the UK construction industry” Occupational and Environmental Medicine Vol.67:574-576.
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TUC (2009) Rehabilitation – A short guide to the evidence.
Available at: https://www.tuc.org.uk/research-analysis/reports/rehabilitation-short-guide-evidence
Waddell, G and Burton, A. K (2004) Concepts of rehabilitation for the management of common health problems. TSO, London.
