Sensible heath surveillance

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  • Delighted to give this short presentation.Three brief points about myself:Not an OH specialist, but all qualified OSH advisors know OH basics.Principles of effective health management are identical to those for effective safety management. You do need some health-related competences but, using published guidance and knowledge of effective safety management, a qualified H&S advisor can do quite a lot.I have colleagues at Hawkes Associates with that more detailed OH knowledge and experience, who have peer reviewed this presentation, and they do the same for my professional advice.So I’m a practical example of someone with general Occupational Health & Safety skills who knows when to call on those with more specialist Occ Health competences when needed.Of course health surveillance does cost money. A sensible approach will ensure that money is spent wisely (sorry the illustration I found shows $ rather than £). It’s also all about balance – I could have shown the traditional scales, but decided a bike is better – you need to have balance in order to progress! Those with very keen eyes will realise this bike has no pedals – it’s actually called a balance bicycle.
  • Definition is taken from HSE guidance.Have deliberately used a slightly scary illustration, as that’s the way many people initially react – both employers and employees. But actually lots of it is common sense – though everyone needs some basic training for that common sense to work properly.Some ‘early signs’ are quite easy to see once you know what to look for – for example dermatitis on a worker’s hands, others can be identified by asking the right questions.Other early signs may need specific tests or sampling – for example to detect hearing loss, or to measure absorbed lead in a blood sample.Some may require more detailed examination by Occupational Health Physician.The Sensible health surveillance I’m going to describe may use none or all of these ‘watching out’ processes!
  • Sensible Health Surveillance is risk-based. If the risk is very low, there will be no surveillance. As the risk increases, the need for surveillance will tend to rise.A risk-based system follows the well-known Plan-Do-Check-Act continual improvement cycle. Risk-based surveillance is one is part of the ‘Check’ element within the overall cycle.Let’s go back to the beginning of the cycle: First you have to identify what health hazards are present in your workplace. How does this hazard affect the body – many health hazards have to be breathed in, so they start in the lungs; or they may be ingested into the stomach; or they may be absorbed by the skin. (Some exceptions, for example noise affects ears, vibration typically affects hands, ionising radiation can affect the whole body externally).Once you have identified the range of hazards that are present, and their consequences for individual health; you also need to know whether there is a defined Workplace Exposure Limit (WEL – for chemicals) or other Action Limit for each hazard.Next you need to put workplace-specific controls in place; firstly to prevent any exposure, if that’s feasible; secondly to ensure residual exposures are as low as reasonably practicable. Obviously any defined exposure limits are important benchmarks to help define how far you go with these controls.So that’s the Plan and Do elements, but you also need to be systematic about checking whether the controls you have devised actually work. Do people really use them and, if so, do they prevent or limit exposures to the levels you predicted in your risk assessment?It’s in this checking stage that work-related ill health becomes rather trickier than work-related safety. If you get your safety controls wrong, the resulting injuries are usually easily observed, so you get feedback without needing a complicated system. But ill health effects often happen much slower, and early symptoms may be hard to detect, or to differentiate from effects that are NOT work-related. So you need to put more effort into taking workplace measurements and samples, to check what the worker exposures actually are, and you need to decide whether it’s also reasonably practicable to look for early signs that their health is being affected.
  • I’ve just summarised how health hazards SHOULD be managed, what do we actually find in practice (this is Hawkes Associates experience, but HSE have reported similar findings).Firstly, there are often no systematic risk assessments for health hazards.There may well be some health-related procedures in place, but if you ask “Where is the risk assessment that shows why this procedure is needed” you just get a blank look!Sometimes there may be some health surveillance going on. But usually the individual data isn’t grouped or analysed statistically. When we ask employers what feedback they get from their OH service provider they say ‘nothing’ and when we ask the OH service provider why they don’t give such feedback they say they’ve never been asked for it! So no one is actually managing the whole surveillance system. Once an initial decision is made to do some health surveillance, the employer just continues to pay for it – whether or not it might show that exposure levels are actually very low and/or that the other controls are all working effectively.Overall, such systems are rather like separate bits of information stuffed into a filing box – rather than all being part of a properly designed and well-used operations manual.
  • There are 4 main categories of work-related health hazard, plus Psycho-social – which is all about how work is organised and its impacts on the mind of the worker. That seems pretty broad, and it is – basically all these categories can affect the health of people at work.No time to go into detail – a reminder that effective management of work-related health hazards requires more than just compliance with the COSHH regulations.
  • We’ve used successfully with a range of clients – typically they are in the position identified earlier, they are doing some good things to manage health exposures, but their procedures and those of their OH service contractor are NOT based on a fully systematic approach.Who might be exposed – identify groups with similar exposures – I’ll give some examples on the next slide.Are exposures significant?If so, can specific symptoms be detected?Outlined like this, it may seem quite simple, but you do need access to a range of competent advice:To a H&S advisor or an Occupational Hygienist for the Hazard Identification and the controls review.To a hygienist or other competent person to qualitatively assess potential exposures and, where they may be significant, to quantify them using suitable sampling methods.To an OH physician or experienced OH Nurse for defining and planning suitable health surveillance.Hopefully you are aware of the new searchable HSE Register for competent H&S Consultants, OSHCR. There’s also a professional accreditation standard for Occ Health service providers, I’ll give details at the end.
  • This summarises a typical offshore production installation – the hazards may be different in your organisation, but the process can be the same.These are the typical SEGs – I’m sure you will have some of these, such as office workers, DSE users, cleaners, maintenance – even if you don’t produce a product or work round the clock.
  • This is our general approach – where there is specific legislation covering a hazard it may need to be slightly adapted.Where all your exposures are low, then time and effort spent on medical surveillance is unlikely to be justified.If you have exposures approaching the WEL/AP, the first priority is to carry out workplace monitoring to identify which tasks lead to the most significant exposures. You should also consider simple surveillance for the most exposed SEGs – for example by adding some targeted questions to what would otherwise be ‘routine health checks’. If you don’t do such routine medicals, then some basic health surveillance for the most exposed groups would be appropriate.If some potential exposures are, or could be, above the WEL/AP, then some of your controls will involve wearing suitable PPE to reduce personal exposures. All such persons should be under surveillance, as this will show whether the PPE is an effective control.As surveillance results accumulate, if no early symptoms are found, then you can consider reducing the surveillance effort – for example by checking only a proportion of the most exposed group. All such changes need to be in consultation with the appropriate competent advisors, and of course with the workers themselves.
  • In 15 minutes it’s not possible to cover all the details, even in summary.This list is a reminder that managing anything requires consultation, defined responsibilities, data, etc.
  • Here are some key references. From HSE, can all be downloaded from their website.If you have a contracted Occupational Health provider, best practice is to ensure their internal processes are audited and accredited to a suitable, and the Faculty of Occupational Medicine published a standard in 2010 and accreditation has just begun. The OSHCR register, initially operated by HSE, began at the end of January.Hawkes Associates, if you would like some more detail – we provide services directly, and also in association with an OH provider in Aberdeen.Thanks for your attention.
  • Sensible heath surveillance

    1. 1. A SENSIBLE APPROACH TO HEALTH SURVEILLANCE<br />Ian Waldram & Darrin Hawkes <br />PHASS Meeting<br />
    2. 2. HEALTH SURVEILLANCE<br />DEFINITION:<br />“SYSTEMATICALLY WATCHING OUT FOR EARLY SIGNS OF WORK-RELATED ILL HEALTH IN EMPLOYEES EXPOSED TO CERTAIN HEALTH RISKS.”<br />MAY INCLUDE:<br /><ul><li>Looking for/asking about signs
    3. 3. Measurements
    4. 4. Medical examinations</li></ul>PHASS Meeting<br />
    5. 5. SENSIBLE HEALTH SURVEILLANCE<br />RISK-BASED:<br />IDENTIFY HEALTH HAZARDS (PLAN)<br /><ul><li>How does the hazard affect the body?
    6. 6. Workplace Exposure Limits [WELs] or other Action Points?</li></ul>IMPLEMENT CONTROLS (DO)<br /><ul><li>Prevent exposure(s); control exposure(s)</li></ul>ARE THESE EFFECTIVE? (CHECK)<br /><ul><li>Measure residual exposure(s)
    7. 7. Look for ill health evidence/indicators</li></ul>PHASS Meeting<br />
    8. 8. TYPICAL DEFICIENCIES<br />NO SYSTEMATIC HEALTH RISK ASSESSMENTS (HRA)<br />‘RANDOM’ HEALTH-RELATED PROCEDURES<br />REPEATED SURVEYS AND ASSESSMENTS,NO IMPROVEMENT ACTIONS<br />INDIVIDUAL HEALTH SURVEILLANCE DATA ONLY<br /><ul><li>No analysis of data, no link to controls
    9. 9. No systematic feedback to employer
    10. 10. No formal review, to optimise surveillance</li></ul>PHASS Meeting<br />
    11. 11. THE RANGE OF HEALTH HAZARDS<br />PHYSICAL<br /><ul><li>Noise
    12. 12. Hand-arm vibration
    13. 13. Ionising radiation, diving</li></ul>CHEMICAL<br /><ul><li>Liquid, vapour/fume, gas</li></ul>DUST<br /><ul><li>Asbestos</li></ul>BIOLOGICAL<br />PSYCHO-SOCIAL<br />PHASS Meeting<br />
    14. 14. A SENSIBLE APPROACH<br />1. WHO MIGHT BE EXPOSED?<br /><ul><li>Identify Similar Exposure Groups (SEGs)
    15. 15. Review current controls: improvements needed?</li></ul>2. FOR EACH SEG, ARE LIKELY EXPOSURES SIGNIFICANT?<br /><ul><li>Assess/measure ‘reasonable worst case’ exposures
    16. 16. Consider Health Surveillance unless << WEL</li></ul>3. CAN SPECIFIC ILL HEALTH SYMPTOMS BE DETECTED?<br />NEED COMPETENT ADVICE FOR:<br /><ul><li>Controls review
    17. 17. Exposure measurements
    18. 18. Health Surveillance plan</li></ul>PHASS Meeting<br />
    19. 19. OFFSHORE OPERATIONS EXAMPLE<br />HRA FOR EACH FACILITY (OFFSHORE, ONSHORE)<br /><ul><li>Occ. Hygienist for higher hazards
    20. 20. H&S Advisor for lower hazards</li></ul>SEGS IDENTIFIED<br /><ul><li>Office/generic
    21. 21. DSE users
    22. 22. Catering
    23. 23. Operations
    24. 24. Drilling
    25. 25. Maintenance
    26. 26. Painters
    27. 27. Cleaners
    28. 28. Shifts
    29. 29. NDT
    30. 30. Medic/First Aiders
    31. 31. New/expectant mothers</li></ul>PHASS Meeting<br />
    32. 32. OPTIMISED SURVEILLANCE<br />NO EXPOSURES NEAR WEL/ACTION POINT<br /><ul><li>Reactive only</li></ul>APPROACHING WEL/AP<br /><ul><li>Workplace monitoring
    33. 33. Include job-related checks in ‘routine medicals’</li></ul>AT/ABOVE WEL/AP<br /><ul><li>Specific monitoring + 100% health surveillance
    34. 34. Review results, reduce intensity if no evidence of control failures</li></ul>PHASS Meeting<br />
    35. 35. OTHER ESSENTIALS(NOT COVERED BY THIS PRESENTATION)<br />WORKER INVOLVEMENT, INCLUDING<br /><ul><li>Suitable information, instruction, training
    36. 36. Contractors</li></ul>‘PERSON ACCOUNTABLE’ FOR THE OVERALL SYSTEM<br />INTEGRATED HEALTH AND SAFETY<br />RECORDS<br />CONTINUAL IMPROVEMENT PROCESS<br /><ul><li>Regular reinforcement</li></ul>PHASS Meeting<br />
    37. 37. FURTHER INFORMATION<br />UNDERSTANDING HEALTH SURVEILLANCE AT WORK, INDG304<br />HEALTH SURVEILLANCE AT WORK, HSG61(3rd edition due April 2011)<br />Workplace Exposure Limits, EH40<br />OCC HEALTH SERVICE STANDARDS FOR ACCREDITATION<br />OCC SAFETY& HEALTH CONSULTANTS REGISTER<br />HAWKES ASSOCIATES<br />www.facoccmed.ac.uk/pubspol/pubs.jsp<br />www.oshcr.org<br />www.hawkesassociates.co.uk<br />PHASS Meeting<br />

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