Historically in the construction industry, health issues have taken a back seat to safety, but larger construction firms now realise that neither the industry itself, nor the UK economy as a whole, can neglect the health of workers in the sector in the future.
The industry faces a skills and staff shortage. Sector skills body CITB Construction Skills predicts that a further 87,000 workers will be required each year just to replace those leaving the industry through retirement and other reasons. One way to retain skilled workers is to improve the way construction employers manage occupational health risk, and better management and procedures will also help make construction a more attractive environment in which to recruit.
The Constructing Better Health (CBH) initiative is tackling the issue by providing standards and accreditation and by acting as a conduit between employers and providers of OH services. The challenge the industry faces is demonstrated by the Health and Safety Executive’s finding that 1.8 million working days were lost in construction in 2006-07 as a result of work-related illness, while a report by the Institute for Employment Studies found that one-third of construction workers have OH issues.
The estimated annual cost of work-related ill health to the industry is £760m, and this has an impact on the growth of industries – for instance, the building of hospitals and major projects.
However, unlike accidents, ill health is not immediate, and can take many years to manifest itself. The mobility and transience of the construction industry’s workforce, and the misconception that OH will cost huge amounts of money and lead to civil claims all mean health can be placed in the ‘too difficult’ box.
I joined CBH last October, when the initial phase of the national CBH project was already under way following a successful pilot in Leicestershire between 2004 and 2006.
During the CBH pilot, the OH aspect focused on three areas:
Safety critical work – ensuring that employees are medically and physically capable of safely carrying out their work
Voluntary health checks.
In total, 400 employers took part, 1,724 employees used the mobile screening unit facilities, and 700 OH visits were undertaken to sites. The largest issue was noise exposure, with 30% recording hearing loss, followed by vibration exposure, with 6% reporting damage.
The key findings of the CBH pilot were:
There were no industry minimum common standards for fitness to work
There is a general lack of awareness about how to manage workplace health and a lack of knowledge of where to go for advice.
If advice and guidance is provided simply and in a way which helps workers to identify practical ways to minimise health risks from the work, they will take notice.
If health checks are confidential and easy to access, workers will want to take advantage of them.
When information is communicated in a way that complements their reading matter of choice, workforce interest in health greatly increased.
General health and lifestyle plays an important part in the overall health and productivity of the workforce.
Without the intervention of exposures to health risks, unidentified health problems would have remained unmanaged.
In August 2007, CBH became an independent not-for-profit organisation, charged with acting as an effective conduit between those who work in construction and those providing OH services, whether they be large companies or individual OH advisers working independently.
Part of the service to the construction industry is to provide a list of registered OH providers who can be contacted with the confidence that they have met the standards defined by CBH. It is essential that we accredit people with the skills and resources to serve not only the largest construction contractors, but also the smaller companies and self-employed which actually make up four in five workers in the industry.
Another role is to raise awareness of OH in construction and the benefits improving its management can make to the productivity and lives of those who work in it. The message will be given in industry events, and through the publication of research and education materials and through training courses.
While there was confidence that larger contractors with the knowledge and funds to provide what was required would back CBH, many were surprised that there was a real desire from workers at the sharp end to discuss their health concerns and undergo health surveillance programmes.
Time after time during the pilot, despite being told by their managers that “the lads won’t talk to nurses”, when the mobile health screening unit visited sites, the appointment list was full, and workers wanted to talk about their health and how their work could be affecting them.
The pilot also showed that there is a need for standards against which programmes for improved management of OH in construction may be developed and measured. The published CBH standards will achieve this and will mean that construction is among the first industries to have taken an in-depth review of what is required.
A further fundamental strand of the CBH scheme is the establishment of a construction industry database of fitness for task and health surveillance information about workers. Clearly much of this will be confidential. Given the familiar problem of health surveillance for a workforce that is particularly mobile, the ability to access a national, centralised source of reliable data is evident. This will enable far more efficient monitoring of an individual’s health status allowing for previous results to be compared and any deviation from the norm identified leading to early diagnosis of the onset of work-related disease.
This wealth of data will also enable CBH to report on trends and statistics and to offer validated information for research purposes. Construction companies will be able to use the information to, for example, assist with resource planning and development of communications campaigns to raise awareness of occupational health issues.
The CBH has produced standards divided into two parts and now published on the CBH website (www.fitbuilder.com/download.html).
A strong message received for the OH industry during the consultation on these standards was a high level of agreement with the setting of competency standards, including the familiarity and understanding of specific hazards and risks associated with working on construction sites.
The published standards provide access to workable practices that take into account the nature of the industry, work that has the potential to cause a whole raft of OH issues and a transient workforce that is dominated by individuals who work in a variety of locations constantly moving from company to company.
The standards are intended to empower employers with the knowledge to meet legislative and non-legislative requirements, and to provide construction employers and OH professionals with a point of reference for fitness for work standards.
The standards define safety critical workers in the industry as “where the ill health of an individual may compromise their ability to undertake a task defined as safety critical, thereby posing a significant risk to the health and safety of others”. They also define the ‘Fitness For Task’ requirements.
The standards also outline the minimum (legal) requirements for health surveillance for construction industry employers with further guidance on best practice and also outline the health assessments and procedures used in health surveillance and monitoring the health and fitness of workers in relation to their respective roles within the construction industry.
However, the standards do not, as yet, address risk prevention and control measures at this point.
Also included are a matrix of job roles and associated hazards which identifies relevant health checks and whether they are mandatory or best practice, an ‘at a glance’ fitness for work guidance for specific medical conditions’ a key to fitness for work categories and their interpretation and a summary of frequency of health surveillance/fitness for work assessments
The purpose of part two is to set a benchmark for OH service providers working in the industry, and to provide guidance on clinical information. It outlines the clinical operational practices for deliverers of work-related health surveillance, fitness for task assessments for safety critical workers and general health assessments.
CBH is currently developing an industry database and working in partnership with the CSCS, the construction certification scheme established in 1995 to help the industry “get quality up, accidents down and cowboy builders out” to develop an industry smartcard, which is likely to be introduced this summer.
The existing card is increasingly being demanded as proof of competence by the larger contractors within the industry and the Major Contractors Group has a policy of a 100% carded workforce. The aim is that the smartcard will hold the individual’s fitness for task and health surveillance outcomes, which will also be available via the CBH website or by phoning the CBH contact centre.
This is will enable a site manager or employer instantaneous access to an individual’s fitness to undertake various tasks. Furthermore it will reduce the potential for an individual, particularly those engaged in safety critical tasks, to work on a site when they are unfit.
Clinical data will obviously remain confidential, but future OH providers can have access to it by requesting it from CBH. We know that when an individual moves from one employer to another, their OH records rarely follow them. Records are only forwarded on when an employer swaps OH providers, but previously it was not clear whether service providers had compared previous health assessment results. CBH-registered OH providers will be expected to make those comparisons.
CBH wants to work with OH practitioners, not make life difficult for them. The implementation of a national scheme including the setting of industry standards is a significant step forward in construction, one that so far has not been collectively addressed in any other industry. Construction has truly responded to the need to put the ‘health’ back in to ‘health and safety’.
Wendy Stimson is occupational health service manager, Constructing Better Health
This article is based on the 2008 Ruth Alston lecture, organised by the Association of Occupational Health Nurse Practitioners, which took place earlier this year
Health and Safety Executive (June 2007) Research Report RR565 Constructing Better Health – Final Evaluation Report Tyers C, Sinclair A, Rick J, with Lucy D, Cowling M, Gordon-Dseagu V
Health and Safety Executive 2007 An analysis of the prevalence and distribution of stress in the construction industry, Prepared by the Health and Safety Laboratory,
Johanna Beswick, Kirsten Rogers, Edward Corbett, Sarah Binch & Kay Jackson
Key health risks in construction
Construction workers are four times more likely to suffer from Vibration White Finger than workers in any other industry. Regular and frequent exposure to hand-arm vibration can lead to hand-arm vibration syndrome (HAVS) and carpal tunnel syndrome. The Control of Vibration at Work Regulations established the necessity for health surveillance, and the introduction of the lower exposure action value together with a reduction in the exposure limit value means that many more workers will require health surveillance.
Health surveillance is a requirement under The Control of Noise at Work Regulations (2005) for those workers regularly exposed to noise over the upper exposure action value of 85 dB(A). Health surveillance means regular hearing tests, maintaining suitable records, informing workers about the state of their hearing, and also the proper fitting, cleaning and maintenance of any hearing protection used.
Occupational skin disease
The Health and Safety Executive states that occupational skin disease may be defined as a disease in which workplace exposure to a physical, chemical, or biological agent or a mechanical force has been the cause of or played a major role in the development of the disease. Work-related dermatitis forms 80% of occupational skin diseases and is caused by the skin coming into contact with certain hazardous substances at work. Ten per cent of bricklayers leave the industry each year due to dermatitis caused by working with building materials.
Occupational respiratory diseases
These include a broad spectrum of conditions, of which perhaps the most well known is occupational asthma. Respiratory diseases among construction workers may also include pneumoconiosis arising from silica (silicosis) or asbestos exposure, as well as asthma and other allergic reactions and chronic obstructive pulmonary disease.
A significant number of construction workers could be exposed to silica dust on an occasional basis, and about 140,000 workers exposed on a more regular basis. In people who have had high exposures over just a few months or years, a rapidly progressive and often fatal condition known as acute silicosis can occur.
Chronic Obstructive Pulmonary Disease (COPD) is a common chronic progressive lung disease which, although mainly caused by smoking, may be caused by exposure to certain substances in the workplace. The main emphasis should therefore be on primary prevention, which is best achieved by smoking cessation, and the elimination or reduction of exposures to causative substances in the workplace. Where there is a strong evidence base for a link between specific exposures and COPD then health surveillance will be appropriate.
Asbestosis is a serious, long-term lung disease caused by inhaling asbestos dust over a prolonged period of time. More people die from asbestos related disease per year than are killed on the roads, with 20 tradesmen dying from every week.
Asbestosis is one of a number of conditions that can be caused by exposure to asbestos. Other related conditions include cancer, mesothelioma and benign pleural thickening. The Control of Asbestos Regulations 2006 require a statutory medical under Regulation 22. Employees exposed to asbestos above the action level must be placed under adequate medical surveillance by a relevant doctor in accordance with the regulations.
Construction has the highest rate of musculoskeletal disease caused or made worse by workers’ current or most recent job. The average construction worker lifts the equivalent of 355 black cabs each year. More construction workers suffer back pain than those from any other industry. There are no legal requirements for undertaking mandatory health surveillance. However, symptoms should be regularly monitored in order to detect symptoms early.
Compared to other industries, the construction industry is not a sector known to be at high risk of work-related stress. However, a recent study conducted by the Health and Safety Laboratory found that around 10% of their sample of construction industry workers found their job very or extremely stressful. In their sample, management grade employees, along with road maintenance staff, designers and administration staff report more stress than other job roles, primarily construction labourers/operatives.