HEALTH SURVEILLANCE IN THE CONSTRUCTION INDUSTRY- WHAT ARE THE ISSUES? Dr Marianne Dyer

Health Risks In Construction Physical Noise Dust Asbestos Vibration Solar radiation Radiation Temperature Chemical Cement Isocyanates Lead Solvents Mineral Oils Diesel Exhaust Emissions Biological – Weil’s Disease – Lyme Disease – Water supplies – Sewage – Needles – Infectious illness Manual Handling – Back injury – Work Related Upper Limb Disorder – Carpal tunnel – Muscular sprains / strains Psychosocial – Work Related Stress – Shift-work – Fatigue – Common Mental Health problems – Lifestyle

Occupational Illness in Construction 2012/13 39 construction deaths from accidents 100x as many deaths from occupational illness 56% of occupational cancers are in construction Large burden of morbidity Poor recording and reporting

Prescribed Diseases

Health Surveillance The Challenges: Knowledge Work and workforce dynamics Appropriate OH provision and support Recording and reporting Enforcement & consequences

Knowledge Fatality Illness and Disability Signs or symptoms of ill health HEALTH IMPACTS Injury / Accident vs occupational illness “Slow accident” Legislative requirement Benefits to company and individual workers Health surveillance vs Fitness for work Health like safety approach

Work Phases of construction: Enablement Ground phase Build phase Fit out phase Handover phase

Workforce Variation

Workforce Work Organisation Principle Contractor Sub-contractors Sub-sub-contractors Sub-sub-sub-contractors White van man Worker Male Itinerant Unusual to have sick pay Personal health awareness and contact with services Potentially limited skills and inability to undertake other employment

Appropriate OH Provision Guidance CONIAC Constructing Better Health DoH Responsibility Deal Professional Body advice e.g. IOSH, FOM, CCG Intelligent customer Intelligent provider

Delivery of Health Surveillance OH Resources Facilities Equipment Trained Staff Appointed Doctors Responsible Person Training Skin monitors HAVs monitors OH records Consent and DPA Connectivity

Recording and Reporting Who to? What to be reported? What will they do with a positive result? RIDDORs HSE inspections The individual and follow up

Enforcement and Consequences HSE Plan of work 2014/15 Targeting occupational health risks Raising knowledge Companies Becoming more aware of their responsibilities HSE enforcement Business case The Worker Benefits of health surveillance to them Understanding how to protect their health Fitness to work

Conclusion There are many health risks within construction which can be managed by the normal risk assessment and control mechanisms Knowledge and understanding of health surveillance is increasing within the construction industry – companies and workforce. The organisation of work and the workforce are a challenge to how the programmes are operated Good, open, ongoing planning and collaboration between the company and the OH provider is required

FITNESS FOR WORK IN CONSTRUCTION

Workforce Around 2 million workers in construction in the UK Diverse range of trades and job requirements Fitness requirements depend upon: Type of work undertaken Safety Critical Non-safety Critical Statutory requirements Company Medical Requirements Location Risk based

Standards Statutory No specific legislation for Construction but there remains the “Duty of Care” to ensure workers are fit to undertake their work Personal Trackside Safety PTS London Underground UK Oil and Gas CAA HGV / Forklift Truck Lead / Radiation Best Practice Construction Better Heath OH Provider Companies Plant Safety Group / FOM / DVLA

Fitness Assessment Agreed Fitness Standards for the Project Undertaken prior to starting work on the Project All workers, regardless of employer Existing evidence of fitness PTS certificate CBH Approved other form of Fitness certificate Fitness assessment By OH staff Screening questionnaire Safety / Non-safety critical workers

Safety Critical Workers HSE Definition Some jobs industry involve activities that can place workers at risk, unless the person has full, unimpaired control of their physical and mental capabilities. These jobs are called ‘safety critical' and the people who do them are ‘safety-critical workers'.

Safety Critical Workers Safety Critical Work An activity containing a safety-critical element; and An incapacitated worker might expose themselves or others to a significant risk of harm. Location and rescue

Medical Requirements HSE Guidance “Before someone starts safety-critical work, it is good practice for the employer to agree what health checks and/or medical examination are required, and record the agreement. It is important to be clear which aspects of fitness are relevant to the safety-critical work, and to specify the required level.“

Safety Critical Workers in Construction Heavy Plant Tower Cranes Tunnelers Electricians Demolition Electricity and utilities

Medical Considerations In particular, focus on health conditions that may involve: Sudden loss of consciousness (e.g. epilepsy, some heart conditions, diabetes (particularly insulin-dependent diabetes)); Impaired awareness or concentration; Sudden incapacity; Impaired balance or coordination; Restricted mobility; and Impaired vision or hearing.

Safety Critical Medical Outcomes

Medical Problems Identified Hypertension Altered glucose metabolism Eyesight

Final Outcome of Fitness to Work

Key Points Large incidence of undiagnosed conditions which can affect their ability to work safely. Most cases these are easily treated or managed. Change in perception of safety critical medicals from negative to positive – about enabling people to work rather than stopping them.

Standards and the Equality Act Proportionate to the Job Level of Acceptable Risk Discrimination: Direct / Indirect/ Assumption Based on Evidence Case by case assessment New starters vs continued fitness to work Statutory Requirements

Drug and Alcohol Testing Very common within UK construction Pre-placement, Random, For-cause Imperative to have a clear and consistent policy PTS requirement

Risk Assessment

Location

Other Considerations Unfit for Work Interval of Assessments Recording of medical information Consent and DPA OH record maintainance and security CBH database Personal record Maintaining and improving individual health and fitness

Conclusion More acceptance of fitness to work assessments within construction No specific statutory standards however there is the “duty of Care” Good guidance and best practice standards available There may be some statutory requirements Workers are employed by their own companies, not the Project.