Health Surveillance

Introduction

Over the years health surveillance has developed and expanded. There are many definitions for the term health surveillance, but the idea behind health surveillance has always remained the same and concentrates on the well-being of the employee. As a subject, it concentrates specifically on how certain work practices and activities can adversely affect the health of any employee in the work place.

Health surveillance is implemented to protect the health of the individual employ

• It concentrates on work processes and analyses any possible issues that may occur when an employee completes this process.
• It looks at any adverse effects this process could have and tries to implement guidelines that would avoid any problems to the health of the employee.
• It is vital in some jobs especially when employees are working with certain machinery or working with chemicals and substances.

How is it done?

This depends on the type of health surveillance required when people are working with something that could harm their health. Various methods can be used:

• A 'responsible person', such as a manager, looking for a clear reaction e.g. checking for skin conditions
• A 'qualified person' asking
  employees about symptoms, or inspecting or examining individuals for ill-health e.g. OH Nurse doing lung function tests
• Medical surveillance by a doctor which can include clinical examination
• Biological and biological effect monitoring to measure effects of exposure e.g. blood tests
• Keeping individual health records for all types

Other elements include:

• Self-checks by employees to look for and report any signs of work-related ill health. BUT to comply with regulations these have to be part of a program in which health records are kept and where employees are:

1. Trained about signs of illness or disease, and how and when to look for them
2. Told how and when to report signs and to who – a responsible or qualified person
3. Also subject to periodic checks by a responsible or qualified person

• Baseline health assessment on commencing a new post or placement

Why carry out health surveillance?

To benefit workers by:

• Detecting harmful health effects at an early stage
• Check that control measures are working
• Provide data by health records to detect and evaluate health risks
• Provide an opportunity to train and instruct employees
• Give employees a chance to raise concerns about the effect of work on health

But carrying out the health surveillance is not enough – you must act on the results.

Line Management Responsibilities

Ensure that:

• Risk assessments for work activity involving hazards; include consideration of the need for health surveillance
• Where health surveillance of individual employees is deemed to be necessary, it takes place at the required frequency.
• The results of health surveillance are acted upon to meet statutory and management requirements
• The records of results of health surveillance are maintained to meet statutory requirements and are available to HSE Inspectors requesting them

Employee Responsibility

To co-operate fully with employers' health surveillance programmes made during working time.

If the employee does not co-operate then we cannot advise management that the employee is fit to continue in those duties.

Making sure that health surveillance works!

Be clear about the purpose, who is in charge of the program, who is accountable for it and that the results are acted upon.

Involve employees and their representatives, so that there are clear lines of communication.

Introduce the right programme.

Have clear roles and responsibilities, with competent people, and appropriate instructions and time scales.
Record and act on the results in an appropriate manner.
Certain groups may need special protection e.g. pregnant workers, young workers.
Monitor and evaluate the programme.
Health records
Health surveillance programs should include keeping a health record for each individual to provide:

A historical record of jobs involving exposure to workplace hazards

A historical record of the outcome
Information for HSE or local authority inspectors

Ensure that the health records are completed routinely and systematically, are paper based or held on computer and, as a minimum, contain:

• Surname
• Forename
• Sex
• Date of birth
• Permanent addres
• NI number
• Date started present job
• Historical record of jobs involving exposure to the hazard for which health surveillance required during this employment
• Conclusions, decisions, fitness for work (but not clinical information)
• Date carried out
• Name of person carrying out the health surveillance

These records are subject to The Access to Health Records Act 1990 and Data Protection Act 1998. Health records must be kept for as long as those employees are employed. Some specific regulations state that the records need to be kept for up to 50 years (e.g. Ionising Radiation). It is good practice to offer the employee a copy when they leave the company.

Facilities

Where health surveillance involves inspections, examinations, taking samples and making enquiries it is essential that suitable facilities be provided. Rooms must have privacy, be clean, warm and airy, and have washing, lighting and separate toilet facilities.
In certain circumstances, medical surveillance is specified, which states that the employee requires surveillance carried out by a registered medical practitioner, who is "appointed" by the Health & Safety Executive for this purpose.
Where these requirements exist, the employer must ensure that a doctor is appointed and that he has the required access to the site, both to carry out the surveillance, and be aware of the work practices.

RIDDOR Reporting

For most businesses a reportable accident, dangerous occurrence or case of disease is a comparatively rare event. However, employers, self-employed or persons in control of work premises should be aware that they still have duties under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR'95). Information from reported accidents etc. enables enforcing authorities to identify where and how risks arise and to investigate accidents as considered appropriate.