Take your partners

of SMEs in one of the poorest boroughs in Britain are the target for a campaign
promoting health and safety at work.  By
Marie Carroll

government-funded project in Sandwell, West Midlands, is pushing occupational
health to the forefront of innovative practice, at the same time placing the
discipline firmly on the public health agenda.

Workwell project was spawned following Sandwell’s designation by the Government
as one of the 11 first wave Health Action Zones, in April 1998.

Action Zones (HAZs) were established in response to the Government’s White
Paper Saving Lives: Our Healthier Nation1 which set out a plan improving health
and tackling inequalities through a partnership between individuals,
communities and Government.

focus on  issues that contribute to
ill-health, such as poor housing, as well as improving primary care and
developing integrated healthcare services2. They are areas identified as being
deprived, where there are significant inequalities in health.


is a borough of six towns, set in the heart of the West Midlands, which with
the three other boroughs of Walsall, Wolverhampton and Dudley form the Black

has a population of 290,000 and as the seventh most deprived borough in England
and Wales is an area of profound social and economic disadvantage. Sandwell has
a 26 per cent higher death rate than the national average and 15.1 per cent of
the population have a long-term limiting illness. One-third of all households
have a gross income of less than £5,500 a year, with 95.1 per cent of Sandwell
residents having no qualifications beyond school3. Many of these disadvantages
stem from Sandwell’s poor physical environment, the legacy of its heavily industrialised
manufacturing past and post-war mass public housing4.

the Workwell project is an occupational health project primarily for those in
small- and medium-sized enterprises (SMEs) – organisations employing less than
250 employees and with an annual turnover of less than £27m, or a balance sheet
of no more than £19m.

funding provides occupational health and safety services for GPs and dentists,
and a bid to the Department of Health’s Back in Work programme also secured
funding that allowed the Workwell project to examine the way back pain is

addition, the Workwell project will take into account initiatives announced in
any forthcoming government strategies, such as Revitalising Health and Safety5
and the Health and Safety Executive’s 10-year occupational health strategy6.
The project may also be regarded as part of the health secretary’s vision for
modernising the NHS occupational health services. His vision of a fast,
convenient, preventative and curative service (NHS Plus)7 could be realised by
the project.

Workwell project launched its long-term strategy on 11 May in West Bromwich in
the heart of Sandwell. In forming the strategy, the occupational health and
safety needs in Sandwell had to be established. Available sources of data such
as self-reported ill-health statistics8, reportable injuries9, occupational
physicians reporting activity10, local health care data11 and National Health
Service Direct data12 were collated to this end. A business survey of 300 firms
was also undertaken to explore occupational health and safety needs.

pilot project was also conducted, involving eight companies. The findings gave
an in-depth analysis of the occupational health and safety needs of a sample of
workplaces typically found in Sandwell. A similar pilot study was conducted
with five general practices.

illustrated in the table, manufacturing and retail/wholesale form the bulk of
business activity. Some 99 per cent of these are SMEs, with most employing less
than 25 people. There are 900 organisations, with a workforce of 50,000, many
of which are volunteers, involved in the voluntary and community sector within

SMEs are unresponsive to the concept of managing health and safety16.
Therefore, a close working relationship was formed with the personal business
advisers at the local Business Link to ensure the project team could
successfully access this population.

an initial visit to the company, a workplace assessment was carried out on their
occupational health and safety and environmental provision. Any health
promotion activities in the workplace were also noted. The firms were then
issued with a prioritised action plan. All firms stated they would be making
positive changes as a result of the Workwell intervention. Findings from the
pilot also indicated the most effective means of gaining access to this


local level, analysis of the data suggests back pain is one of the most
frequently reported injuries caused at work in Sandwell. The evidence collected
in the pilot studies further supports this assumption, in that all of the firms
involved in the pilot identified back pain as an occupational concern.

occupational diseases, are harder to quantify in Sandwell, due to the lack of
reliable data.

Sandwell, five people died as a result of workplace accidents during 1997/98,
with a further 1,059 accidents resulting in the employees requiring more than
three days sick leave9. It is recognised that employees of smaller businesses
are twice as likely to be killed or suffer a serious injury at work compared to
those working in larger businesses17. It is also suggested this may be as a
result of the different working cultures in SMEs as well as the risk
attributable to the management of health and safety18.

on the existing evidence and work with the pilot companies, the long-term
strategy of the activities of Workwell project will be based around the
following four key target areas.

Promoting best practice through partnerships:
Workwell will form
partnerships with SMEs to promote managing good health in the workplace.

Modernising services:
Workwell will coordinate and where necessary provide
occupational health advice and services to local enterprises.

Use the workplace to promote health:
Workwell will use the workplace as a
platform to promote health and support the Government’s National Service
Framework. It will establish an initiative to support the Sandwell Mental
Health Strategy in 2001. Workwell will also support initiatives at reducing the
incidence of the key related problems outlined in the National Service

will also encourage healthy employer initiatives such as smoking cessation and
alcohol management schemes.

Target inequalities in vulnerable groups:
Workwell will develop initiatives
for those who do not traditionally have access to occupational health advice,
for example home workers and construction workers. The voluntary sector will
also be able to access these facilities.

Carroll is a Workwell OHN adviser at Sandwell NHS Trust


Department of Health (1999) Saving lives: Our Healthier Nation. White Paper, TSO

Our Healthier Nation: Health Action Zones (2000)

Sandwell Health Authority (1997) A new deal for health in Sandwell? Planning
for a Health Action Zone. The 9th annual report of the director of Public
Health. Department of Public Health, Sandwell Health Authority

Sandwell Training and Enterprise Council. (1999) Sandwell’s Position and
Prospects: An economic and labour market assessment 1999/2000

Health and Safety Commission/Department of the Environment, Transport and the
Regions (1999). Revitalising Health and Safety. Consultation document, London:
Stationery Office

Health and Safety Executive (1998) Developing an occupational health strategy
for Great Britain. Discussion document DDE8, HSE

Alan Milburn MP, Health Secretary (2000). A healthier economy: the contribution
of a modern NHS. LSE Health Annual Lecture

Health and Safety Executive (1998) Self reported work related illness in 1995.
HSE Books

Health and Safety Executive (1999) Safety and enforcement statistics briefing
1997/98 Midlands Region. HSE

University of Manchester (1999) Occupational physicians reporting activity,
West Midlands 1996-1999. Unpublished

Sandwell Healthcare NHS Trust (1997). Unpublished.

Sandwell Health Authority (2000) Annual report. Sandwell Health Authority

Business Link Sandwell. Unpublished

National Online Management Information Service (1997) Annual Workplace Survey.

Catalyst Commissioning Service Agency (1999). Mapping the Voluntary Sector
Economy in Sandwell – An analysis of the sector as an employer.  Unpublished

Marriott, R (1999). Safely Managed Enterprises. The Health and Safety
Practitioner October 1999. Hertfordshire: Miller Freeman Publications

Health and Safety Executive (1999). New research confirms that smaller
workplaces can carry bigger risks. Press release E016:99

Stevens, G (1999). Workplace injuries in small and large manufacturing
workplaces 94/95-95/96. Labour Market Trends January 1999 pp19-26

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