Julie North from Systems Concepts looks at the importance of health surveillance when there is risk of exposure to dangerous substances.

Health surveillance is a term used to describe arrangements put in place by an employer to detect signs of work-related ill health in employees. In this article we discuss:

  • why health surveillance is required

  • how to determine health surveillance requirements

  • health surveillance methods

  • why it is important to get employee buy-in.

Health surveillance arrangements can vary depending on the industry and hazards present in the workplace, but why do employers have to provide it?

What the law says

There are legislative requirements for employers to implement some form of health surveillance where there is a risk of exposure identified in the risk assessment. These include the following.

  • The Management of Health and Safety at Work Regulations 1999.

  • Control of Asbestos Regulations 2012 ― where employees are exposed to asbestos, they should be placed under medical surveillance, which is to be provided by a relevant doctor.

  • Control of Lead at Work Regulations 2002 ― health surveillance should be provided for employees who are, or are liable to be, exposed to lead.

  • Control of Substances Hazardous to Health Regulations 2002 ― employers need to provide appropriate health surveillance under a range of conditions.

  • Control of Noise at Work Regulations 2005 and Control of Vibration at Work Regulations 2005 ― employers must provide health surveillance where there is a risk to the health of employees due to noise or vibration exposure, or potential exposure.

In addition to employer responsibilities, employees also have a legal responsibility to co-operate with their employer to allow them to fulfil their legal duties.

Getting a baseline

Employers should ensure they ask employees to attend a health surveillance when they first join. This can provide employers with a baseline of the employee’s health status at the beginning of employment, which can differentiate between personal and work-related exposure (for example, using earphones to listen to music could have already damaged an employee’s hearing), and can identify high-risk individuals to whom employers owe a higher duty of care. These may be employees who are more susceptible to disease or developing conditions, such as smokers who are exposed to asbestos, those with pre-existing musculoskeletal conditions who may be more susceptible to Hand Arm Vibration Syndrome (HAVS), and employees with skin conditions that are required to use chemicals.

Other benefits of health surveillance can include:

  • allowing employers to implement further, more stringent controls, such as improving personal protective equipment (PPE)

  • reduced sickness absence

  • reduced costs associated with sickness absence, such as overtime for other employees, re-training and workplace rehabilitation

  • preventing loss of productivity

  • confirming employee compliance to workplace requirements, such as wearing PPE

  • a reduction in liability costs should an employee take action for work-related ill health.

Implementing health surveillance makes good financial sense when you consider the potential for fines and prosecution. The Health and Safety Executive (HSE) recently reported that a manufacturing company was fined £60,000 and ordered to pay more than £18,000 in costs. This was due to an employee being diagnosed with carpal tunnel syndrome as a result of exposure to vibration. The employer did not act on reports of ill health from the individual. The HSE inspector commented: “Proper health surveillance is vital to detect and respond to early signs of damage.”

A textile company was fined £20,000 and ordered to pay £10,000 in costs for exposing a worker to substances that left them with breathing difficulties. The HSE investigated and found that the company’s health surveillance programme had been stopped in 2004 following a business takeover. The HSE inspector commented: “They should also have provided proper information, instruction, training and health surveillance for their employees. In addition, the company's failure to provide health surveillance as regards exposure to high noise levels at work has meant that some employees, previously identified as vulnerable, may have suffered further deterioration in their hearing due to continued exposure.”

How to determine whether you need to implement a health surveillance programme

The HSE’s website provides a decision-making map to help employers decide. In summary, a risk assessment should determine the control measures required and whether they are adequate to control exposure. If they are not, the decision-making map provides information on the types of exposure and corresponding health surveillance required.

Methods of health surveillance employed will vary depending on the hazard and can include the following.

  • Biological monitoring. This involves measuring and analysing the levels of a hazardous agent present in the body via breath, blood or urine samples. This is usually undertaken hand in hand with existing control measures, such as breathing apparatus.

  • Biological effect monitoring. This kind of monitoring involves evaluating the early biological effects of hazardous agents on employees by measuring the biological responses to exposure.

  • Medical surveillance. This involves a clinical examination, such as lung function tests.

  • Inspections. These involve checking for visible effects on the body, such as skin checks for those working with skin-sensitising substances.

  • Reviewing of records before and after exposure to a hazardous agent can determine whether the risk assessment was suitable and whether further actions are required.

It is important to ensure that employers obtain assistance from an experienced occupational health professional when implementing a health surveillance programme. This not only ensures that the samples are taken and analysed correctly, but also gives confidence around the ethical and sensitive issues of taking samples, and individual rights concerning sensitive health data protection.

Getting buy-in

We have discussed why health surveillance is required, the benefits of health surveillance and how to determine when it is required, but how easy is it to implement when it relies on buy-in and participation from employees?

Thinking about the issues associated with health surveillance, such as taking personal samples and physically checking employees, it may not be surprising that an employee may be reluctant to take part. Employees may see it as imposing, an invasion of privacy (thinking that samples are taken to see what they get up to at the weekend) and feel that “Big Brother” is watching them.

So how can employers gain employee buy-in?

All employers should consult employees on their health and safety. This is a legal requirement according to the Safety Representatives and Safety Committees Regulations 1977 or Health and Safety (Consultation with Employees) Regulations 1996, depending on whether your workforce is unionised. There are also other benefits, for example an engaged and informed workforce is more likely to participate in health surveillance when it is aware of the risks, benefits, and when it feels valued by its employer.

Methods of employee engagement ― education and awareness

Raising awareness among employees can be simply implemented. One option is to provide a briefing or toolbox talk when an employee is recruited, followed by an annual refresher. This could be done at appraisal time, to reinforce the message. The content could include the following.

  • Hazards of their role, such as working with lead.

  • Potential health effects of the hazards, ranging from headaches all the way through to kidney damage.

  • The reasons that health surveillance is in place, for example, to ensure their health, to ensure control measures are effective and being followed, as well as any legal requirements.

  • How the programme will benefit them, for example, providing an opportunity for employees to report any cases of ill health and feedback on the employers’ controls measures.

  • The form the health surveillance will take, such as taking blood samples.

  • Who implements the health surveillance, such as a directly employed occupational health practitioner or contracted occupational health organisation.

  • Employees’ individual rights concerning sensitive health data management, such as the use of the results from the samples.

  • The types of feedback and actions employees will receive on the results, for example, no action needed, that a review of control measures is required, or suspension from work.

It is worth considering who the information is presented by. Employees may be more receptive when receiving this type of information from a medical professional than they are from someone without any medical training.

It is essential that employers provide reassurance to employees on how samples will be handled. Employers need to obtain informed consent and should be advised of the following.

  • Samples taken are only analysed for the substances identified as hazardous in the workplace.

  • All health-related information is treated as confidential.

  • Results can be given to them, along with an explanation of what the results mean.

In addition to raising awareness, employee buy-in and participation could be increased if employees had direct involvement in decision-making on health surveillance. This could include the following.

  • Implement self-checking techniques where possible. Employees will need training in spotting signs of ill health and reporting procedures.

  • See a competent responsible person appointed at the organisation, such as a trusted fellow employee, to undertake basic health surveillance and reporting.

  • Select preferred methods of health surveillance where more than one option is available.

  • Select an occupational health practitioner of choice, such as a male or female practitioner.

  • Decide (within reason and mutual agreement with the employer) dates and times of their appointments.

  • Ensure that appointments are made at suitable times, eg within working hours and not clashing with break times.

  • Decide the locations of where they have their appointments, where possible.

  • Take part in trials of new health surveillance methods that are being considered.

  • Provide feedback on current health surveillance programmes to allow for opportunities for improvement.

  • Have easy access to their health surveillance records when requested.

Health surveillance is crucial to safeguarding employee health and should be considered at the early stages of the risk assessment process, as some effects of exposure cannot be reversed. Health surveillance procedures do not have to be in-depth or highly technical, and are easy to implement when employees are engaged, which should be incorporated into existing consultation procedures.

Last reviewed 10 December 2013