Health surveillance is defined by the Health and Safety Executive (HSE) as ‘putting in place systematic, regular and appropriate procedures to detect early signs of work-related ill health among employees exposed to certain health risks; and acting on the results’ (HSE 1999a p. 5). Health surveillance is a statutory requirement under several regulations, in- cluding but not limited to:
r The Management of Health and Safety at Work (Amendment) Reg- ulations 2006, Regulation 6 (HSE 2006a).
r The Control of Substances Hazardous to Health (Amendment) Reg- ulations 2004, Regulation 11 (HSE 2004).
r The Control of Lead at Work Regulations 2002, Regulation 10 (HSE 2002).
Health surveillance is often confused with general health screening.
It is important that the OH nurse understands the difference and can identify the need for health surveillance through the risk assessment process. Health surveillance is a legal requirement under certain cir- cumstances. Health screening is ‘good practice’ as a means of promot- ing a healthy lifestyle and identifying early signs of non-occupational disease.
In February 2004 the Health and Safety Commission (HSC) launched a strategy for workplace health and safety (HSC 2004). In this, the HSC presents a vision for the future of health and safety and for the first time health at work has been recognised as a major factor in the health of the nation. This document highlights the need to work in partnership with others and states that one of the aims is ‘to contribute to the nation’s health and well-being, and [deal] with health inequalities’.
In order to know if and what type of health surveillance is necessary to comply with legal requirements, a full assessment of risks to health must be carried out. Once the risks have been identified, a decision must be made on the type of surveillance that is appropriate.
It may well be the occupational health nurse, either alone or with a health and safety manager, who carries out the assessment of health risks as part of the overall risk assessment process. This requires a methodical approach, examining exactly what is being handled in the work process. Figure 9.1 is a suggested checklist for assessing risks to health.
If the occupational health nurse is to be responsible for health surveil- lance activities within the organisation then it is vital to have a writ- ten procedure that documents how this will be carried out and when
What work is being carried out?
Examine all the jobs and functions workers are carrying out, e.g. office, sales production, maintenance, stores, loading, delivery, cleaning, packing, driving.
What are they doing? What are the hazards to health?
r Physical, e.g. noise, excesses of heat/cold, vibrating tools, sources of radiation.
r Chemical, e.g. dust, fumes, gases, liquids.
r Biological, e.g. infections from human or animal sources such as blood, infestation.
r Psychosocial, e.g. piecework, shifts, night work, dealing with public, risk of violence, repetitive work, high/low responsibility.
r Ergonomic, e.g. manual handling, computer work (DSEs), machine displays, rapid/repetitive handwork, using hand tools, standing/sitting.
How will the hazard affect the worker?
r Can it be inhaled? e.g. dust from production process, packaging, cleaning; fumes from welding, soldering, solvent tanks/cleaners; any other source of dust, gases, fumes, vapours that could be inhaled.
r Can it be ingested? e.g. potential hand-to-mouth contamination.
r Can it be absorbed through the skin or eyes? e.g. chemical absorption through broken or unbroken skin; splashes to the eyes or on to skin.
r Can it cause deafness? e.g. noise from machinery, other sources – is it continuous or intermittent and for how long are people exposed?
r Who is exposed to the hazard? Male/female; young/old; pregnant or nursing moth- ers. How many people are exposed and for how long; is it continuous or intermittent?
r What are the likely health effects? Short and/or long-term on e.g. lungs, skin, other systems; also consider effects on mental health.
How well is the hazard controlled (hierarchy of measures)?
r Eliminate, substitute or change, i.e. don’t do it, use something less harmful or change the process.
r Enclose and isolate, e.g. handle in enclosed unit.
r Segregate to reduce numbers of people exposed to the hazard.
r Reduce by improving ventilation, e.g. local extraction ventilation; general ventilation (open windows).
r Control by implementing a safe system of work, e.g. can the work be done in a different way that makes it safer?
r Suppress (noise/dust), e.g. damp dusting; use of acoustic material on noisy machinery/tools.
r Control by improved housekeeping and/or disposal of waste, e.g. keeping work areas tidy, with no clutter; putting items away and storing them properly; getting rid of waste materials regularly.
r Use of personal protective equipment (PPE) or clothing, e.g. gloves, aprons, respira- tory protection, eye protection. Is it adequate; does it provide sufficient protection in the circumstances in which it is being used?
Figure 9.1 Assessing Risks to Health
employees will be referred to an occupational physician. An example of a health surveillance procedure is shown in Figure 9.2.
Health surveillance aims to detect early signs of work-related ill health so that appropriate actions such as referral to medical special- ists can be taken.
r A definition of what is meant by health surveillance, such as: ‘Health surveillance is a statutory requirement specified in the health and safety regulations for workers potentially exposed to hazards to health that have been identified through the risk assessment process. This surveillance may include clinical tests such as lung function testing and audiometry, as well as other examinations such as skin examination.’
r Health surveillance will be carried out as agreed with the employer, identified through the risk assessment process.
r Testing procedures such as lung function testing, audiometry and vision screening will be undertaken in accordance with the procedures set out in the occupational health instruction manual and/or the equipment manufacturer’s instructions.
r Any employee who has an abnormal test result and/or for whom the OH nurse identifies a potential or actual health effect will be referred for a further assessment, preferably to an occupational physician, for advice and/or examination.
r Details of the health surveillance findings, including test results, will be recorded in the employee’s health records, appropriately signed and dated. These records will be maintained and kept in accordance with the requirements of health and safety regulations, the Data Protection Act 1998, the Nursing and Midwifery Council (NMC) and the General Medical Council (GMC).
r The employee will be informed of the outcome of the health surveillance and appro- priate occupational health advice and information will be given.
r Management will be informed of the overall results of the health surveillance of groups of employees, ensuring confidentiality is maintained.
r The OH nurse will advise the company on the implementation of a recall system to comply with health and safety regulations and/or the needs of the employee.
Figure 9.2 Example of a Health Surveillance Procedure
National Surveillance Schemes
At a national level, statistics on occupational disease are produced from a variety of sources, including physician-reporting and self-reporting schemes. There is no one UK centre responsible for national surveil- lance of all occupational disease but composite figures are produced by the HSE in their occupational health statistics bulletin (HSE 2006b).
Examples of information included in this bulletin are: data on self- reported ill health from the Labour Force Survey, data from specialist doctors in THOR (The Health and Occupation Reporting Network) and data on fatal occupational diseases.
Manchester University runs the UK voluntary occupational health surveillance scheme, THOR (www.medicine.manchester.ac.uk/coeh/
thor/). THOR incorporates SWORD (Surveillance of Work-related and Occupational Respiratory Disease) and several other surveillance schemes.
The Reporting of Injuries, Diseases and Dangerous Occurrences Reg- ulations (HSE 1995a) require employers, the self-employed and those in control of premises to report workplace incidents to the Health and Safety Executive (or local authority where appropriate) within specified times. There are more deaths from workplace-related diseases than from