IndustraCare's Workplace Considerations series shines a light on different aspects of day-to-day health and safety management, with tips and techniques for development.
What is health surveillance?
An ongoing system of checks, with the aim of looking after at-risk workforces as determined by a risk assessment. Health surveillance could well be a legal requirement for your business, especially if your staff come into contact with noise or vibration exposure, ionising radiation, solvents, fumes, dusts, biological agents or any other substance which may be hazardous to health. 
So why should we care? Well health surveillance:
- is a vital indicator in early stage ill health at work, the aim being to use these indicators to implement better controls
- enables the gathering of data to help further and future evaluation of risks
- incorporating workforce concerns into health and safety planning
- developing better training and education programs
An important distinction here, is that health surveillance is a legal requirement in itself and should not be confused with any of the following:
- the monitoring of health where the effects from work are suspected but not established in evidence
- the promotion of healthy living
- 'fitness to work examinations' for example fitness to drive or crane operation
At its most basic, health surveillance is used to establish where more needs to be done to control risks where early signs of work-related ill health are detected.
Does health surveillance apply to my workplace?
Your risk assessment should be used to identify any need for health surveillance and further steps to be taken may be necessary. But here are a few things your workforce may be facing which fall under health surveillance:
- noise/vibration
- Solvents, dusts, fumes or other hazardous substances which can be breathed in
- asbestos or lead
- ionising radiation
But we have measures in place, why would we need to make things more complicated? Unfortunately controls can't be relied upon 100% of the time despite checking and maintenance, things fail and people make mistakes. This makes health surveillance vital in ensuring that cases of work-related ill health are detected and addressed as soon as possible.
So, to sum up this section, if the following criteria are met you need to consider health surveillance:
- Disease/adverse health is detected with a link to exposure which has occurred at work
- It is likely that adverse health effects could occur in your workplace
- There are valid techniques for detecting early signs of adverse health effects without posing a risk to employees
So how about some examples of health surveillance?
At its most basic, health surveillance could be as simple as members of staff checking themselves or each other for signs of adverse health. Employees should be equipped to do this through correct and thorough training. Refresher training won't hurt either. Should employees start experiencing breathing difficulties following work with hazardous substances known to affect breathing, they should be trained in how to deal with this.
Another example of health surveillance includes having a responsible person trained in carrying out routine checks, including skin inspections looking out for rashes, blotches or blisters. This role could be fulfilled by a first aider, supervisor or employee representative.
In high risk workplaces, for example where ionising radiation may be involved, an occupational health nurse or doctor can be employed (either directly or through a separate company) who will be able to carry out a thorough and in-depth examination. This can be done periodically or as required. Following this, there are a number of situations which result in statutory medical surveillance.
But what are these? That's right, more bullet points:
- Particular types of work including asbestos
- Work with lead
- Work with substances subject to Schedule 6 of the Control of Substances Hazardous to Health Regulations 2002
- Work involving ionising radiation
- Work in compressed air
Statutory medical surveillance can include examination and tests by a qualified Doctor appointed by the Health and Safety Executive.
That's great and everything, but how I actually set up health surveillance?
First and foremost, it is recommended by the HSE that you avoid blanket coverage for all employees as it can provide misleading results and waste money.
Initially, you need to decide who will run the health surveillance within the organisation, be it yourself, an employee representative, first aider or an external company as examples. Following this, consultations with your workforce will need to take place, an open dialogue must be kept to allow your workers to voice concerns moving forward, as at the end of the day, you're aiming to keep your people and the people your business may impact, safe.
Alongside your appointed responsible person you may now need to appoint a competent medical professional, as we mentioned earlier this is especially important should your business include work which results in medical surveillance becoming a statutory requirement.
The design of your health surveillance program should take shape around the individual fit of your workplace. It's important that only the employees that actually need it be covered by health surveillance. I don't mean this to sound harsh or as if you should only cover the employees you can afford to cover, quite the opposite. It wouldn't make sense to have retail staff carrying out identical checks as manufacturing staff as the risks are different.
Having a uniform heath surveillance program for your whole workforce, regardless of their role within the business, could result in both an ineffective program for some employees and a waste of time for others. This makes a tailored program vital.
Finally, keep your health surveillance program under constant review. An effective program will create data to be evaluated. This evaluation will provide areas for improvement, be it more effective controls or cost optimisation.
How should I involve my workforce in a meaningful way?
We've all sat through those seemingly pointless and never ending meetings. At times I'm amazed some businesses are surprised that they're losing money through lost productivity, especially large and bureaucratic organisations. I raise this point because the aim here isn't to create more meetings which the workforce roll their eyes at, but to open a two way dialogue.
We go into detail on engaging the workforce in our series on Health and Safety Culture
The workforce are the heart of the organisation, and as health surveillance is primarily around to support them, it's vital that they're involved in the creation of the plan moving forward. It will only work with their support, and they're the ones that will be able to tell you whether or not something is practical or even working at all.
The bosses of companies will always have ideas that impact the workforce but said workforce must not fear speaking out when something isn't working otherwise it's not only a waste of time and money but the trust of staff.
Essentially, you need to:
- Consult with your workforce be it through union reps or directly.
- Listen to your workforce and implement their ideas where practical.
- Demonstrate your commitment to keeping staff safe by investing in the best measures.
It is a legal requirement to consult your employees on health and safety matters.
What does competence count for here?
Competent advisors and responsible persons - both a necessity here. Ideally when it comes to finding a competent advisor you will need someone who has experience in working with the risks and hazards your business will be exposed to within your industry. An advisor who has only ever worked in shipping and transport may not be suitable for a nuclear power plant.
Having competent advisors is vital to an effective health surveillance program being rolled out.
Responsible persons are those appointed from within your organisation who are there to help deliver a health surveillance program. The responsible person(s) will require training or coaching, potentially on an ongoing basis to help them get started within the role.
The training of a responsible person could be provided by a health professional, such as a medical surveillance doctor, a health and safety professional such as a consultant, or management from within the organisation that have the necessary experience. You will be the most equipped to decide the type of training required depending on the type and level of hazards.
It is recommended that you choose someone with high written and verbal communication and interpersonal skills. There should also be trust - between both management and the responsible person and the responsible person and the workforce.
Further reading:
Checklist when purchasing health surveillance provision
Speak soon!
Danny
