The occupational health role in tackling asbestos in schools

Statistics from the Health and Safety Executive highlighte that past exposure to asbestos killed 2,542 people in the UK in 2015, compared with 2,519 in 2014.

Asbestos in schools remains a live issue and occupational health practitioners have a role to play both in schools directly or in assessing employees with symptoms of exposure dating from their schooldays. Nic Paton reports.

“We had two or three cases where we had to close off the school and students had to go into the de-fumigation van, an emergency van, to make sure they were hosed down and cleaned, and it really was that serious… it was not a building that was fit to have children in it for several years really, prior to its closure and us moving to the new building.”

So said Phil Keay, former headteacher of Hetton School in Sunderland, explaining back in March 2017 how the school had in the past been forced on occasion to deal with serious cases of exposure to asbestos dust, in evidence to an inquiry by the Parliamentary Public Accounts Committee into capital spending in schools.

The scale of the problem

The National Union of Teachers estimates that as many as 86% of schools contain asbestos.

While there are no statistics to show how many adults have died because of childhood exposure to asbestos, the NUT has pointed to research by Professor Julian Peto, Cancer Research UK chair of epidemiology at the London School of Hygiene and Tropical Medicine and the Institute of Cancer Research, who has estimated that between 200 and 300 people die each year of mesothelioma because of exposure to asbestos when they were a pupil.

A Freedom of Information request by the union revealed that at least 319 teachers have died from mesothelioma since 1980, and 205 of these deaths have occurred since 2001. However, the real figure is likely to be much higher because occupation is not listed among deaths of those aged over 75.

In February, a report by the Department for Education’s (DfE) Education Funding Agency concluded that asbestos was of “significant cause for concern” in more than 100 schools, and 20% of schools were “not fully compliant” with asbestos procedures “in that they did not have fully documented plans, processes and procedures in place at the time of the data collection, or did not know if asbestos was present.”

However, in April, the influential Parliamentary Public Accounts Committee (PAC), in a report looking at capital funding in schools, also highlighted that the DfE still did “not know enough about the state of the school estate, meaning that it cannot make well-informed decisions about how best to use its limited resources”.

Although the DfE did carry out a survey of its built estate in 2014, this did not assess the safety or suitability of school buildings or the extent of asbestos, pointed out the PAC. Although more than 80% of schools that responded to a separate survey by DfE conceded they contained asbestos, the PAC highlighted that only a quarter of schools had responded to this survey, meaning DfE did not have a complete picture.

It recommended the DfE “should set out a plan by December 2017 for how it will fill gaps in its knowledge about the school estate in areas not covered by the property data survey. Specifically it needs to understand the prevalence, condition and management of asbestos, and know more about the general suitability and safety of school buildings.”

His comments, shocking as they were, highlight all too graphically the very real danger some schools – pupils and staff – can face from exposure to asbestos.

For many occupational health practitioners, patients presenting with exposure to asbestos are something of a rarity these days. Although latest statistics from the Health and Safety Executive (HSE) in July highlighted that past exposure to asbestos killed 2,542 people in the UK in 2015, compared with 2,519 in 2014. So the figures are still rising, if only slightly, while the expectation is these rates will start to tail off after this decade, as exposure has become less prevalent.

Asbestos has been banned from being used in any building constructed after 2000 and our knowledge of – and wariness about – the safe handling and removal of asbestos has improved immeasurably in recent decades.

But that’s not to say OH practitioners should assume it is “job done” when it comes to managing asbestos within the workplace, far from it. As Keay’s comments highlight, asbestos is still very much a “live” issue for many schools and, if anything, is one that school leaders are becoming increasingly concerned about.

Labour MP Rachel Reeves, chair of the Asbestos in Schools group and, since July, also chair of the influential House of Commons Business, Energy and Industrial Strategy Committee, has described asbestos in schools as “a ticking time bomb”. Ian Hartwright, senior policy adviser at the National Union of Head Teachers, has called tackling asbestos in schools “an urgent priority”.

The reason why so many school leaders are so worried is because so much of the school built estate dates from the 1950s to 1980s when asbestos was used as standard within the fabric of thousands of so-called “system-built” buildings, such as “CLASP” (Consortium of Local Authorities Special Programme) prefabricated school buildings.

Asbestos can therefore be found within everything from fireproofing through to floor coverings, ceiling tiles, wall panels and doorframes. In fact, some 86% of school buildings are estimated to contain asbestos is some shape or form.

While, as Hartwright explains, much of this asbestos is sealed away and therefore the risk of exposure should be minimal, the fact many CLASP buildings are past their sell-by date and crumbling, plus simply the effect of intense day-to-day wear and tear they experience, is a growing worry.

“In every school you’re going to get bags banging against walls, doors being opened, shut and slammed and so on,” says Hartwright. “Asbestos may be hidden in floors and walls or in ceiling cavities. But it can also be in railings, stairs, door and window frames.

“It also depends on, say, the quality of the ceiling, for instance if a ceiling tile were to be disturbed – or even if a teacher simply sticks some drawing pins in the wall for Christmas cards or decorations – will that release asbestos fibres?”

What, then, should schools be doing about this? And, furthermore, what role can occupational health practitioners play, either in terms of working with schools directly or in terms of when or if employees present with symptoms of asbestos exposure from when they were a pupil at school, maybe 20 or 30 years previously?

Local authority expertise

In terms of actions schools can take, one of the best practical courses of action is simply to engage with their local authority, advises Bob Watt, Nottinghamshire County Council property asbestos/condition specialist.

“We have around 250 schools in our region with buildings constructed before 2000, and provide each of them with an asbestos register via our web-based asset management system. We undertake annual visits to each school to review and update the register if anything has changed, and we take the opportunity to check that their Local Asbestos Management Plan (LAMP) is being implemented,” Watt says.

Schools should have an asbestos management plan in place that can be readily accessed and there should be well communicated protocols that staff and, just as importantly, contractors coming on to site to do repair or maintenance work, should be following. Given the lengthy time-lag between exposure and presenting with mesothelioma, it is also a good idea to have an exposure record system in place, Watt advises.

One complication is the fact many schools these days are becoming either standalone or multi-academy trusts (MATs), and therefore no longer under the aegis of local authority control. But, even in this scenario, the expertise that local authorities can bring to bear will often be valuable.

“We can provide an audit and point the school in the right direction. The responsible person has to make sure that it has the right policies and procedures in place to ensure the children, employees and contractors as all protected, regardless of whether it is an academy or county school,” emphasises Watt.

One potentially positive effect from the move towards self-controlled academies, especially large MATs, has meant more schools nowadays are prepared to use and access specialist OH provision, argues Allison Caine, director of OH provider OHBM.

“In my experience, in most schools asbestos has been well-contained. From an OH perspective, mesothelioma is still something you more commonly will see in miners, the steel industry, electrical tradespeople and so on, people who, for example, will have been crawling through roof spaces, that sort of thing. Generally, it is becoming increasingly rare to find people presenting with mesothelioma, although that is not to say you do not get cases.

What unions are calling for

The Joint Union Asbestos Committee (JUAC) is calling on the government to tackle asbestos in schools in six ways, by ensuring:

  • Data is collected centrally on the extent, type and condition of asbestos in schools, and this should become an integral part of the data collection of the condition of the nation’s schools.
  • A programme is developed for the phased removal of asbestos from all schools, with the priority being given to those schools where the asbestos is considered to be most dangerous or damaged.
  • Standards are set around asbestos training, and that this training should be mandatory and properly funded.
  • The Department for Education and Health and Safety Executive together review the “trigger” levels for asbestos fibres present in schools to reflect the particular vulnerability of children to asbestos exposure, and to develop air testing that can measure these levels.
  • That the government and schools work together to encourage a policy of openness so that parents, teachers and support staff can be annually updated on the presence of asbestos in their schools and the measures that are being taken to manage it.
  • That a proactive inspection regime be reinstated so as to determine the standards of asbestos management in schools as well as to ensure that poor practice is identified and staff and pupils protected.

“If someone does present, the best course of action is to bring in a specialist OH physician, someone who is on the HSE register as being able to perform asbestos medicals. As an OH practitioner, you’d refer the case immediately on to ensure an asbestos medical is carried out as early as possible,” she advises.

This, however, opens up a whole further area of debate: the ongoing shortage of occupational medicine physicians, something that has been highlighted by the All Party Parliamentary Group on Occupational Safety and Health, the Society and Faculty of Occupational Medicine and the General Medical Council, among others.

According to Dr Paul Nicholson, former president of the Society of Occupational Medicine and chair of the British Medical Association’s occupational medicine committee until his retirement last year, there are currently 196 appointed doctors on the HSE register who can perform asbestos medicals.

He also points to relatively recent changes, led by the European Union, to the law in this area.

“In 2011 the EU required the UK to make changes to medical examinations required under the Control of Asbestos Regulations. Previously, only workers of contractors holding a licence to carry out work involving the most hazardous types of asbestos were required to undergo statutory medical examinations,” Nicholson says.

“Under the system, HSE appointed specific named medical professionals to carry out approximately 5,000 such medicals each year. However, from April 2012, as a result of a European Commission legal opinion, medical examinations were also required for workers who carry out certain types of less hazardous asbestos work that do not require a licence, for example those carrying out any work which disturbs the fabric of buildings (plumbers, electricians, joiners, construction workers, and so on).

“HSE estimated an extra 600,000 workers may have been in scope for the newly required medicals. In order to manage the increased volume, and to improve access to medical examinations, more flexible arrangements were introduced in April 2012,” Nicholson adds.

One change being promoted by unions, notably the Joint Union Asbestos Committee (see panel), is for the Department for Education and Health and Safety Executive to review the “trigger” levels for asbestos fibres present in schools and to develop more effective air testing that can measure these levels.

This chimes with a campaign launched by risk management and occupational safety company Lucion Services designed to highlight the hazards of asbestos-containing materials in schools. Its Asbestos in Schools initiative has, among other recommendations, set out the case for air monitoring using high-powered Scanning Electron Microscopy, or SEM.

As the company’s chief technical officer Charles Pickles says: “Current government guidance is that you should manage asbestos and make sure it is safe but leave it in situ where possible. So, you have a situation where you have all these carcinogens in schools that have to be managed in situ.

“Yet head teachers, school leaders and governors recognise they have a duty of care under law to show that their schools are safe. The technology we are promoting enables head teachers and governors to do just that, to show that their schools are safe for normal occupation.

“We can take larger samples of air, and during normal working hours when children are being taught in classrooms, rather than in holidays or quieter periods. If schools can gauge more effectively what the risks are, by measuring the fibres in the air, then they can better target their resources upon those risks. So, we can in fact help to preserve budgets by allocating resources more effectively,” he adds.

Useful resources

There is a multitude of resources in this area that OH practitioners may find helpful.

The Government’s official guidance.

HSE tools and FAQs.

Guidance and advice through the Asbestos in Schools group,

A free e-learning tool developed by Modern Governor, the National Association of Head Teachers, the Joint Union Asbestos Committee and the Independent Asbestos Training Providers Association.

The All Party Parliamentary Group on Occupational Safety and Health report.

Albeit not solely about the schools, BOHS, the Chartered Society for Worker Health Protection, ran a series of roadshows during the autumn on asbestos best practice and awareness, and in October launched a new faculty for asbestos professionals, the Faculty of Asbestos Assessment and Management.

Finally, as part of its campaign, Lucion Services has published a “white paper”, Asbestos in Schools: The case for reassurance air monitoring with Scanning Electron Microscopy. It has also published a video to accompany its campaign, which can be viewed on the same website.

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