What is health surveillance - The quick answer
‘Health surveillance’ is a way of protecting an employee from work related ill health by monitoring the effects of work on their health and ensuring ill health does not affect their work.
It's usually needed when an employee is exposed to possible hazards that could affect their health. e.g. noise, dust, chemicals, vibration. The assessments are repeated at regular intervals.
The results are compared over time allowing an overview of the workers’ health and early identification of any abnormalities.
Legislation sets out some known workplace health hazards and the law requires an employer to operate an appropriate health surveillance programme. At other times it is recommended best practice.
Health surveillance helps you ensure your health & safety control measures are effective in mitigating risk to worker’s health.
What is health surveillance - The longer answer
Health surveillance is a programme of workplace medicals carried out routinely to check the health of your employees over several years.
The medicals are usually specific to the hazards they are exposed to at work. For example, someone working in a noisy environment is likely to have a regular hearing test, or someone carrying out a process that generates a lot of dust is likely to need a routine lung function assessment.
The results are recorded and compared with previous results to make sure there has been no decline in health status that could be linked to their work.
A baseline assessment is often carried out before the employee starts work or becomes exposed to the hazard. This means that future results can be compared to their 'baseline health status' to look for any decline.
The advantages of this are three-fold:
Companies can ensure their health and safety practices are effective and not injuring their employees
Employee health trends can be monitored across an area, department, or job role allowing early identification of any issues that do arise so they can be rectified quickly
Having a baseline assessment to compare future results against can protect companies against future claims of work-related ill health
What happens during a health surveillance medical assessment?
What happens during a health surveillance medical assessment depends on the risks the employee is exposed to. Usually, it will contain any or all of the following:
General health questionnaire
A health questionnaire specific to the risks e.g. HAVS (hand-arm vibration syndrome) for workers exposed to vibration
Blood pressure check
Hearing test (audiometry)
Lung function test (respiratory test / spirometry)
Skin check
Musculoskeletal assessment (range of movement)
Vision test
Urinalysis
Blood test (if exposed to certain substances)
Mental health check in
Some basic health surveillance can be done by your own employees such as supervisors who have been trained to spot, for example, skin problems. In some circumstances, questionnaire screening by an occupational health practitioner is appropriate, and in other cases, a face to face medical assessment or a combination of these methods is necessary to meet the health surveillance requirements of your business.
It all depends on the level of risk identified in your health and safety risk assessments.
Do you need health surveillance in your workplace?
Health surveillance does what it says on the tin - it means looking at the health of an employee over a period of time, but in the context of their work.
In certain environments, health surveillance is a statutory requirement and the HSE will expect it to be carried out routinely. In other circumstances, it is advisable under your duty of care even if it is not required by law.
Whether or not you need a health surveillance programme depends on the nature of your business and the risk to employees. It is part of the health and safety process and is usually necessary when employees are exposed to risks which are not able to be removed completely and could affect their health.
These risks can include:
Noise
Dust
Fumes
Vibration
Biological agents
Solvents
Compressed air
Ionising radiation
Asbestos
Lead
Other substances hazardous to health
Manual handling
Climate
An example might be very loud processes where employees need to be present. The Control of Noise at Work Regulations 2005 require that any workers who are regularly exposed to noise exceeding the thresholds laid down, have health surveillance hearing checks. You will likely already have measures in place to lessen the risk such as providing hearing protection, rotating tasks to minimise time spent in noisy environments etc, but health surveillance acts as an extra check to make sure the solutions in place are effective.
When health surveillance isn't required by law, it is wise to look at industry best practice to ensure you are meeting the expectations of your peers, clients, employees, and suppliers.
Common industries likely to require health surveillance include manufacturing, construction, laboratories, agriculture, engineering, cleaning, waste management, stone working, carpentry. This list is not exhaustive and some businesses in the industries on this list may have processes in place that remove the risk and so do not require health surveillance.
It's important to have a thorough risk assessment carried out by a health and safety professional to identify individual risks. It is not always necessary to carry out the same health surveillance on every employee, as the risks will often be different in different parts of your workplace and for people in different roles. The risks a carpenter is exposed to would likely be very different to those a cleaner is exposed to.
How to decide what type of health surveillance programme you need
You might consider having an occupational health needs audit if you're not sure what type of health surveillance would be appropriate. These are offered by most occupational health providers and involve an experienced OH practitioner coming into your workplace to view the processes and risk assessments, and understand the level of risk involved to employees. They will then provide a report outlining their findings and recommendations for a suitable health surveillance programme.
A reputable provider will offer this as a stand-alone service and will not expect to be automatically given the health surveillance work. This gives you the confidence that the requirements have not been overstated to generate more work for the OH provider, and allows you to get quotes from other providers if you wish to.
The business case for health surveillance
Where health surveillance is required by law, the business case for health surveillance is clear - to avoid litigation, fines, harming your employees, and getting a poor reputation.
Such health surveillance is defined under the:
Control of Substances Hazardous to Health Regulations 2002 (COSHH)
Control of Noise at Work Regulations 2005
Control of Asbestos Regulations 2012
Control of Vibration at Work Regulations 2005
Manual Handling Operations Regulations 1992
Control of Lead at Work Regulations 2002
Ionising Radiations Regulations 2017
When health surveillance isn't required by law, it is wise to look at industry best practice to ensure you are meeting the expectations of your peers, clients, employees, and suppliers.
Many firms will opt to conduct additional health surveillance where there is a potential risk to employee health. Doing so provides peace of mind that health and safety measures to control employee's exposure to health risks are effective, or highlight problems early should they arise.
Early detection of health deterioration (for example hearing loss or reduced lung function) has huge benefits for an organisation:
With guidance from occupational health, measures can be taken to reverse any damage to health, or prevent significant further deterioration. This protects the employee and minimises the risk to the business of future HSE action or litigation by the injured party.
Health and safety teams can review safety management systems in areas where the employee has been exposed to ensure they are working as expected. Improvements and alternative process can be implemented where necessary to prevent more widespread health deterioration and protect other employees.
Should industrial injury claims be received, having a robust health surveillance programme provides evidence of an employee's health status throughout their time at an organisation. Combined with a baseline health assessment at commencement, this can prove invaluable in providing an accurate account of whether the employee's health was any worse at the time of the claim or their leaving the company than when they started. (Some age-related deterioration is expected but occupational health can provide advice about what is considered normal versus what is likely to be work-related.)
As well as the benefits of early detection, the presence of a health surveillance programme - especially one in which employees have the opportunity to speak to a health professional - can actually improve employee health.
From our own experience at All Health Matters, occupational health appointments are often the only opportunity many employees get to talk about their health. GP avoidance is particularly prevalent among men, with many "waiting out" problems until they become unbearable. Women in the workplace can also find it difficult to find the time to fit in a GP visit. Although occupational health cannot substitute for a GP, an OH practitioner can signpost employees to sources of support for medical issues raised that may or may not be work related. This encourages employees to seek appropriate support earlier than they might otherwise have done, with the confidence that they're not 'making a fuss'.
To use a real life example - one of the All Health Matters team picked up an anomaly in a routine urinalysis test and advised the employee to visit his GP, giving him a note to take with him describing the issue. The employee went to their GP and was diagnosed with cancer that was able to be treated quickly and effectively because it had been picked up so early.
From a human perspective, this was an excellent outcome for the employee and his employer was grateful that we had helped him identify the problem early. From a business perspective too, the amount of time off required to recover from cancer treatment when diagnosed early is often far less than if it is diagnosed later on and is harder to treat.
During health surveillance appointments employees are often encouraged to quit smoking, to lose weight, to drink less alcohol, and generally adopt healthier lifestyles to improve their results.
It's no secret that a healthier workforce is more effective than an unhealthy one, so the value of improving employee health often mitigates the cost of occupational health. To discuss your health surveillance needs with a member of the All Health Matters team, contact us now. Get Free Health Promotion Resources: Be the first to receive employee health and wellbeing content by signing up to our Health Chatter emails.