the most out of occupational health services
A decent occupational health service (OHS) should is a real asset. It
can troubleshoot health problems and it can help rehabilitate the sick
or injured and accommodate those with disabilities. But OHS are rare and
good ones rarer still. Simon Pickvance and Rory O’Neill
spell out how to get the service you deserve.
Louise Brooks developed arthritis as a result of physically demanding,
repetitive work in a shipyard. The 31-year-old was sacked by A&P Falmouth
four years after being diagnosed.
The ship repair company was criticised by a 2007 employment tribunal
for adopting an “out of sight, out of mind” approach to her
plight, and ruled its behaviour amounted to disability discrimination
and unfair dismissal. She had been diagnosed with an arthritic type disability
and signed off sick in 2002; subsequent medical reports related the condition
to her job. After spending the greater part of four years unpaid she was
fired in June 2006. The tribunal heard there were at least 15 other suitable
jobs Louise could have been offered, but wasn’t. Louise had been
referred to the workplace occupational health service, which did nothing
to help her and, self-evidently, nothing to help her keep her job.
There’s a big job for OHS to do. The government says there are
175 million working days lost to sickness absence each year, costing businesses
and the economy around £13 billion. Each week, one million people
take sick leave every week; 3,000 of these will not return within six
months. But not all workers have access to OHS – in 2006, the Department
of Work and Pensions reported only 15 per cent of firms provided even
basic occupational health support, with only 3 per cent providing comprehensive
And where firms do act, they frequently get it wrong (Hazards
93). A June 2007 Investors in People (IIP) survey found that 17 per cent
of employers believed it would be too expensive for them to improve their
workers' well-being. Another 24 per cent of bosses said they did not know
what action they should take. From the workforce side, almost a third
(30 per cent) of employees said that their employers think healthy working
is either a wasted investment, a waste of time, nothing to do with them
or that it doesn’t mean anything.
What can go wrong?
Common OHS defects
1. Wrong health checks
2. Ineffective workplace monitoring
3. Health checks/questionnaires not analysed
4. Recommendations not acted on
5. Ineffective remedies
6. Competent staff not appointed
7. Staff appointed found not to be competent
8. Advice of competent staff not taken
9. No follow-up measurements
10. Lack of overall control of OHS system
A properly functioning occupational health service is not
a souped up first aid service, to patch up the wounded and get them back
on the job. Increasingly – particularly since the creation of Workplace
Health Connect and the recent expansion of the NHS Plus – the NHS
offshoot providing occupational health services to firms – OHS are
Working well, an occupational health service, whether in-house or contracted
in, can improve the quality of work, help assess, reduce and remove risks
and ensure suitable jobs and adaptations for ill or injured workers, or
workers with disabilities. Key roles include:
• identifying what can cause or contribute to ill health in the
workplace, including assessing potential problems from new processes
or substances, or changes to existing jobs;
• determining the action required to prevent people being made
ill by work, based on a well informed assessment of the risks;
• introducing suitable control measures to prevent ill health,
such as back pain arising from working conditions and practices;
• Ensuring people with health conditions, or who have a disability
or impairment, are not unreasonably prevented from taking up job opportunities;
• Ensuring people at work are fit to perform their required tasks,
for example, by adapting work practices for people with conditions such
as epilepsy or asthma, or making sure that people working in compressed
air are fit to do so;
• Providing or arranging provision of necessary health surveillance;
• Review of occupational accident, ill-health and sickness records
to determine root cause of problems;
• Assessing fitness for work and suitability of available or alternative
• Providing first aid;
• Providing health education and counselling.
• Supporting sick or injured workers.
Theoretically, all workers in the European Union are supposed to have
access to occupational health provision. The UK version of the Euro-law
doesn’t put explicit duties on firms to provide occupational health
services. Instead, the assumption is that the NHS, supplemented by piecemeal
initiatives like NHS Plus and Workplace Health Connect, fill the gaps.
An employment tribunal in October 2006, however, ruled in favour of HSE
and said Dundee Council was in breach of the Management of Health and
Safety at Work Regulations 1999 because it had neither in-house occupational
health specialists nor a contract with an external occupational health
provider (see Not
good, Hazards 98 ).
Under regulation 5 of the management regulations,
employers should make arrangements to manage effectively health and safety.
It was this regulation that was cited by HSE when it issued the improvement
notice that led to the Dundee tribunal ruling, even though the regulation
makes no specific reference to occupational health.
Regulation 6 says based on the findings
of risk assessments - required by regulation 3
- the employer should provide employees “such health surveillance
as is appropriate”. Employers most also appoint the “competent
persons” necessary to allow compliance with legal safety duties
The safety rep role
Unions have to make sure occupational health services work in the interest
of the workforce, and are not the sick leave police. They should be consulted
on the design and operation of OHS, and in the selection of competent
persons, consultants and advisers.
Union safety reps can also demand information from the OHS to help with
their own assessments of possible problems. For example, the Information
Commissioner’s Office code on workers’ health information
acknowledges safety reps’ rights to information and says: “Safety
representatives should be provided with anonymised information unless
any workers concerned have consented to the provision of information in
an identifiable form.” This could include accident reports, findings
of health surveillance or surveys or any other health and safety related
information “they need to fulfil their functions”, says guidance
on the code (Hazards 87).
But union reps should not just be passive recipients of OHS information.
They should use safety committees and consultative processes to require
OHS to investigate, with union participation, areas of concern –
for example, concerns that a particular job, substance, process or work
method could be causing certain injuries or health effects. Findings of
the union’s own research, for example bodymapping exercises or surveys,
can also be fed back the other way. However, in all cases there need to
be explicit ground rules on how information is used – the occupational
health service, and management, should only act in consultation with the
Safety rep checklist
Give your workplace occupational health cover a health check.
- Who is in charge of occupational health and safety?
- Has a full occupational health and safety audit been carried out?
- What risk assessments have been carried out?
- Have issues raised by safety reps or at safety committee meetings
been investigated thoroughly?
- Have workers been consulted about each risk assessment?
- As a result of the risk assessment, was action recommended and
taken, for example:
• Health surveillance?
• A health questionnaire?
• Process changes?
• Engineering controls?
• Personal protective equipment?
• Modifications for people with disabilities?
- Has a competent person been appointed to carry out health surveillance?
- Did health surveillance cover all those at risk?
- Were the results analysed for patterns?
- Were anonymised results released to safety representatives?
- Did the competent person make recommendations?
- Were these recommendations acted on?
- Did the competent person refer employees to another specialist?
- Was the referral made?
- Was the specialist’s advice taken?
- Was the questionnaire suitable?
- Were results analysed properly?
- Was anonymity of individual workers protected? (Hazards
workers’ health information factsheet).
- On the basis of the questionnaire was health surveillance required
for any member of staff?
- Was a referral made?
- Was a competent person appointed to carry out monitoring?
- Was monitoring carried out for all those at risk?
- Were employees consulted to ensure that appropriate monitoring
- Were the results analysed to look for patterns?
- Did the competent person make recommendations?
- Were these recommendations carried out?
- Did the competent person recommend use of another specialist?
- Was the specialist appointed?
- Was the specialist’s advice taken?
- Did the inspector speak to union reps?
- Were the inspector’s recommendations on health surveillance,
monitoring, engineering controls, and disability adjustments been
Planning control measures
- Have the results of monitoring, health questionnaires and health
surveillance been analysed?
- Was a competent person asked to carry out the analysis?
- Were recommendations made on control of risks, for example:
• Stress Action Plan
• Process Change
• Engineering controls/equipment changes
• Personal protection
• Change in working arrangements (hours, job description,
- Were the recommendations carried out?
- Were checks made to find out if the recommendations were effective?
These checks could be:
• Further health surveillance
• Environmental monitoring
• Contact with affected employees
- Has the occupational health and safety management system been
reviewed each year?
- Have workers been consulted about the results of this review?
- If defects in the system have been identified, have they been
- Have repeat tests (health surveillance, health questionnaire,
environmental monitoring) been carried out at the frequency recommended
by a competent person?
A real life case history
What if you work for a company with a safety officer, access to
a doctor, consultants, occupational hygienists, regular visits from
HSE inspectors, doctors, nurses and technical specialists? You think
you’ll not end up sick? A real workplace case history at a
UK engineering firm shows if they don’t work together and
they fail to take the necessary action, you are far from safe in
Year 1 Workers raise concerns about
oil mist. The issue is raised at safety committee meetings. Air
levels measured. Conclusion: “No risk to health.” Occupational
hygiene consultant recommends improvements to local exhaust ventilation
Year 2 HSE is informed during a
routine visit about breathing problems and calls for improvements
in health and safety management.
Year 4 Oil mists found to be above
exposure limits. Company concludes that no medical surveillance
is required. Ongoing health concerns lead to a local GP being asked
to see selected employees. The GP fails to diagnose occupational
Year 5 Safety reps ask to be involved
when the next survey of oil mist levels is carried out. Complaints
were made to visiting HSE inspectors.
Years 5-8 Safety committee minutes
continue to register concern about oil mist.
Year 8 Industrial hygiene survey
concludes ‘no special risk’ from metalworking fluids,
Concludes LEV not needed.
Year 9 Further complaints at safety
committee meeting. Questionnaire planned and “if required”
a programme of screening relevant employees would be set up. One
worker advised by NHS doctor he had occupational asthma. Union compensation
Year 10 HSE reports poor management
leads to high risk of inhalation exposure. Says health surveillance
Year 11 A local occupational health
service carries out limited health surveillance. A third provider
called in to carry out more breathing tests. Not all workers investigated.
Occupational asthma identified. No changes were made to extraction
equipment. HSE puts improvement notices on the plant. Nothing is
done. HSE medical team investigate.
Year 12 HSE plans to prosecute the
company. The company plans to employ extraction specialists. As
many as 15 current employees have occupational asthma; other affected
workers have already left the firm.
Hazards website Work
and health • Sickness
• Tools •
advice for union branches on workplace health services
Work and Health Information
Facility of Occupational Medicine
Work and Well-being strategy