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Hazards magazine, issue 99
July- September2007

- What can go wrong?
OHS functions
The law
The safety rep role
Safety rep checklist
A real life case history

Related Hazards websites
Work and health
Testing Times


Getting 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 support.

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

OHS functions

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 provided externally.

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 jobs;

• Providing first aid;

• Providing health education and counselling.

• Supporting sick or injured workers.

The law

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 (regulation 7).

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 union.


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?
• Measurements/assessments?
• Process changes?
• Engineering controls?
• Personal protective equipment?
• Modifications for people with disabilities?

Health surveillance

- 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?

Health questionnaire

- 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?

Workplace monitoring

- 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 methods?

- 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?

Official inspections

- Did the inspector speak to union reps?

- Were the inspector’s recommendations on health surveillance, monitoring, engineering controls, and disability adjustments been acted on?

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, training)

- 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 put right?

- 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 their hands.

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 (LEV).

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 disease.

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 claim started.

Year 10 HSE reports poor management leads to high risk of inhalation exposure. Says health surveillance should “continue”.

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 healthSicknessTools Rehabilitation

UNISON advice for union branches on workplace health services

TUC rehabilitation webpages

Work and Health Information Gateway (WHIG)

IOSH occupational health toolkit

NHS Plus

Facility of Occupational Medicine

Health Work and Well-being strategy