Health Surveillance for work-related risks from Health & Safety Reivew Conference 2006

1. Health Surveillance,
Screening,
Monitoring
Dr Peter Noone,
Consultant Occupational Physician,
Health service Executive, Dublin-North East Area.

2. Health Surveillance Definition
“the continuing scrutiny of all aspects of
occurrence and spread of a disease that
are pertinent to it’s effective control”
Last

3. Categorization of health surveillance procedures
Occupationally related Non-occupationally related
Risk-based Primary prevention Category 1
Biological monitoring,
fitness for work
Category 4
Lifestyle health
risk assessments
Secondary prevention Category 2
Biological effect monitoring,
routine surveillance for
adverse effects due to
occupational risk
Category 5
Surveillance for early
detection and intervention,
health screening
Unfocused Tertiary prevention Category 3
Surveillance for occupational
disease to minimize effects
Category 6
Surveillance for disease to
minimize effects
(J.G. Bell*, C. Bishop+, M. Gann*, M.J. Gilbert*, W. Howe, “A systematic approach to health surveillance in the workplace,
Occup. Med Vol 45, No 6, pp 305-310,1995)

4. Holistic Approach to Managing an Individual at Work
From Heron and Teasdale.

5. Drug testing

6. Drug testing at work
• What role, if any, does drug and alcohol
testing have in the workplace?
• In what circumstances, if any should an
employer discipline or dismiss staff for using
drugs or alcohol?
• Does the business have a legitimate interest
in what their staff do in their own time?
Ref Independent Inquiry into Drug Testing at Work. Joseph Rowntree Foundation
2005.

8. Drug testing at work 2.
• Employees engaged in illegal activities in the workplace;
• intoxicated in work hours;
• drug or alcohol use is having demonstrable impact on
employee performance beyond acceptable levels;
• the nature of the work is such that the reasonable employer
is expected to take all reasonable steps to minimise risk of
accident (e.g transport sector).
• The nature of the work is such that the public is entitled to
expect higher standard of behaviour from employees and/or
there is a risk of corruption (e.g police or prison officers).
• Is need for continued research, monitoring and analysis of
the impact and development of drug testing at work.
Ref Independent Inquiry into Drug Testing at Work. Joseph Rowntree Foundation
2005.

9. Arguments against drug testing
• Violation of the sanctity of the human body,
• It is rarely justified- proportionality,
• Discloses private and irrelevant information,
• Serious risk of mistake.

10. The Issues before screening
• Profitability,
• Employee Rights- data protection, HRA,
• “Colleague rights”,
• Third party rights,
• Criminal liability for D&A probs in workplace,
• Insurance implications.

11. Legal Obligations & Liabilities
• The common law duty to provide a safe
working environment,
• The Health & safety at work Act 2005,
• Misuse of Drugs Act 1977/1984,
• Negligence/vicarious liability,
• Insurance policies,
• Corporate manslaughter,
• Part 4, DPC ACOP on employee health
information, UK IC.

12. Social/political dimension
• Primacy of public safety,
• Maximise employment opportunities,
• Case by case assessment,
• Equity in decision making,
• Appeal arrangements,
• Tension between the aims, interests and
rights of employees, employers , regulators.

13. The Economic Imperative
• Do you need/want a policy?
• What specific business need are you
addressing?
• Gain the commitment of your organisation.

14. Data Protection Act
• Use of personal data in employee relations,
• Tests voluntary unless ‘safety critical’
justification,
• Tests of highest technical standards, rigorous
quality control,
• Tests to be undertaken by a medical practitioner
competent in field of drug testing.
• Different ethical perspectives of the therapeutic
officer, the MRO, the sample collector.

15. D&A Policy v HRA
• Article 8(1)- Right to private and family life,
home and correspondence,
• Art. 8(2)- the derogation from Art. 8(1),
“no interference by a public authority with this right except
as is in accordance with the law and is necessary in the
interests of national security, public safety or the
economic well-being of the country, for the prevention of
disorder and crime, for the protection of health and
morals or the protection of the rights and freedoms of
others” (Article 8(2)

16. Is your policy exempt from the right to
privacy?
• In accordance with the law,
• Necessary in a democratic society,
• For one of the reasons stated in Article
8(2)HRA,
• Proportionate to risks,
• Economic well-being, health and morals or
prevention of crime.

17. Proportionality
• Who will the policy apply to?
• When are you going to screen?
• How are you going to deal with employees
who violate the policy?
– Conduct v health issues,
– Therapeutic/rehabilitative aspects,
• On duty- v- off duty issues.

18. Testing
• Pre-employment,
• For cause,
• Routine – regular sample or everyone,
• Unannounced (random)

19. Implementation
• New employees- contractual clause,
• Existing employees- variation in contract,
– Need legal advice,
– Consultation,
– Force agreement,
– Legal defense to challenge of new terms.

20. Policy Areas
• Purpose,
• Scope,
• Principles,
• Testing,
• Responsibilities,
• Training,
• Legal requirements,
• Procedural guidelines.

21. Residual Issues
• Consent,
• Necessary?
• Confidentiality of sensitive health
information,
• Limited to sensitive or particular high risk
employees,
• Communicate and justify reasons for
consequence to employees.

22. Part 3, section 22-23, Safety Health &
Welfare Act 2005.
• “health surveillance” means the periodic
review, for the purpose of protecting
health and preventing occupationally
related disease, or the health of
employees, so that any adverse variations
in their health conditions are identified as
early as possible.

23. Purpose of assessments
• To assess fitness for a particular job,
• To assess fitness for entry to a pension fund,
• To assess ability and disability and the need
for adaptations and modifications,
• To assess if fit to continue working at all,
• To provide a baseline,
• For statutory regulations,
• For health screening,
• to assess susceptibility.

24. Considerations of risk assessment
• Exact nature of job,
• Working environment,
• Specific hazards,
• Health problems -susceptibility/vulnerability,
• Health - direct threat to self, colleagues,
patients,
• Specific physical, psychological requirements,
• Statutory or other regulatory requirements

25. Hand Arm Vibration Syndrome

26. When are Medicals carried out?
• Preparation for employment- trainees,
• Pre-employment,
• Pre-placement health assessment,
• In employment,
• At the end of working life.

27. Principles of Good Practice 2.
• PPM is only undertaken on receipt of a
conditional job offer, not as a means of
sifting those to be interviewed,
• The request should be accompanied by an
accurate job description,
• The assessment should focus on ability
and may include guidance on workplace
modification and adaptation.

28. Principles of Good Practice 3.
• Questionnaires sent out to collate health
information should be returned to
OHP/OHNA,
• rejection on grounds of health needs to be
undertaken with great care- on basis of
discussion with the worker and
explanation of (ideally) evidence based
decisions.

29. Statutory Medicals 1.
• Health Surveillance under chemical or
biological agents regulations, audiometry,
HAVS,
• Driving LGV/PSV,
• Appointed doctors- lead, ionising
radiation, seafarers.

30. Statutory Medicals 2.
• Competent OH professional,
• Follow agreed health standards,
• Worker understands the purpose, content
of the examination and how the report will
be used and gives free and valid consent,
• Group results given to employer,
• Reporting under H.S.A. scheme.

31. Health Surveillance
Appropriate where;
• the exposure of employee to a substance or hazard
to health is such that identifiable disease or adverse
health effect may be related to exposure,
• there is reasonable likelihood the disease or effect
may occur under particular circumstances of work
and
• there are valid techniques for detecting indications
of the disease or the effect.

32. Objectives of Health Surveillance
• Protection of health of individual by early
detection of adverse changes attributable to
the hazardous substance,
• to assist in evaluation of exposure-control
measures,
• Collection, maintenance and use of data for
detection and evaluation of hazards to
health,

33. Health Surveillance
• Results should lead to some action of benefit to
health of workers!
• The options, criteria for action and possible
outcomes should be established in advance and
agreed with stakeholders,
• Also method of recording, analysis and
interpretation of results of health surveillance.

34. Health Screening
• Routine periodic medical examinations- Non-
statutory untargeted health screening.
• Disease screening- targeted non-statutory health
screening such as examinations for breast and
cervical cancer. Risk-based, secondary prevention
of non-occupational related disease.
• Lifestyle health risk assessment - fall into the non-
occupational risk-based primary prevention
category.