Occupational health – Lighting the way

What can be learnt from the award-winning occupational-health provision on the Olympic Park and Athletes’ Village construction projects, and replicated on the more typical site? Claire Tyers evaluates its potential legacy.

Health and safety practitioners have often been accused in the past of being simply “safety officers” – the suggestion being that, in general, they have paid inadequate attention to health issues.

There have been various initiatives over the years from the likes of IOSH, the HSE and government to redress the balance, but, arguably, one of the best demonstrations of the benefits of addressing health risks in the workplace can be seen in the London 2012 construction programme.

Economically, the UK construction industry is facing some very tough times. Although there has been some expansion in the sector,¹ stimulated by activity on major projects in London and the South East, concerns remain that the industry may suffer from a lack of large-scale new projects once current ones, such as the Olympic build, are completed.

The Olympic Park and Olympic Village are unique projects for a number of reasons. They represent significant government investment in a time of public-spending cuts, and, during their build, were the largest public works and housing projects being undertaken anywhere in Europe. Is it really relevant, therefore, to try to apply learning from these sites with regard to the excellence achieved in safety and occupational health elsewhere in the sector? The results of a three-year examination of the occupational-health facilities on the site,² and additional work to estimate the potential economic returns from this service,³ suggest that it is.

The ‘real world’

For many years now, there has been significant interest from government and industry in improving standards of OH management within the construction industry. This reaches as far back as 2000, when agreement on working towards set targets in this area was reached at a conference involving representatives of employers, clients and trade unions.⁴ However, the policy agenda has seen a significant refocus under the coalition Government, with safety risk-profiling for inspection purposes and a focus on reducing business burdens the new priorities.

There has also been a notable lack of response from the Government to the recent review of the sickness-absence regime by Dame Carol Black and David Frost.⁵ The clearly-stated view from Whitehall is that cutting red tape will improve economic competitiveness, and much less attention will be given to the significant costs of work-related ill-health and accidents to individuals, business and tax-payers. Hopefully, the current government push will lead to a legitimate focus on pragmatic and proportionate responses to health risks, rather than them being ignored.

Businesses, too, are having to make tough decisions, and seemingly ‘soft’ issues, such as health and well-being, are often the first investments to be cut. Not only do these require long-term commitment but managers often see health issues as complex and difficult to manage. The fit note, too, has, thus far, been rather a damp squib, with GPs being asked to advise employers on work adjustments and return-to-work plans without having had any specific occupational-health training.⁶

There is also recognition within the occupational-health profession that there needs to be a more proactive approach. Preventing ill health must become the norm rather than providing a service that reacts to sickness-absence statistics. In this environment, then, how and why should we expect businesses to prioritise good practice in occupational-health management?

Quite simply, data from the Olympic build demonstrates that good health can be good business and doesn’t require a totally new approach.

Occupational health – the management

The Park and Village Health service had three priorities:

• Ill-health prevention – limiting the impact of work on people’s health;
• Clinical health intervention – limiting the impact of a person’s health on their work; and
• Health promotion – the use of the workplace environment to promote healthy behaviours.

These were intrinsically linked in the way the service was designed and delivered. Health promotion was seen as a key tool in promoting health behaviours in the workplace, and in other areas. Joint campaigns, for example, on reducing exposures to dust and smoking cessation, linked together all three elements of the service. Work also focused on the main OH risks facing workers in construction (exposures to hazardous substances, noise, vibration and manual handling) alongside emerging, or topical issues (e.g. work in cold weather).

The service was staffed by a multidisciplinary team comprising OH professionals and occupational hygienists. The hygienists are skilled in the recognition of OH hazards, and evaluation and control of OH risks. They helped provide practical support for managers in preventing ill health and adopted a ‘health like safety’ approach. This capitalised on the existing skills of safety professionals and construction operations managers, extending approaches already used to manage safety issues to tackle health risks as well.

Contractors were encouraged to share information about upcoming work with the occupational hygienists, through a process of quarterly risk-profiling, followed by a discussion between both parties to develop simple risk-management solutions. Principal contractors and their sub-contractors were assisted in incorporating occupational-health management into their day-to-day activities, through health risk-assessment reviews and by producing action plans for contractors to implement.

The occupational-health programme was structured to a certain extent to provide data for analysis and evaluation, so that ‘action research’ could help shape the services provided as work progressed. This also encouraged health and safety practitioners to think about initiatives and interventions designed, in part, to enable them to evaluate their performance. Involvement with the occupational-hygiene team therefore helped contractors identify what was going well on their projects and what needed to be modified to improve the impact, effectiveness and efficiency of their health management procedures.

Occupational health – the results

The approach to preventing ill health on the Olympic site can be characterised by a number of elements presented below. Essentially, however, the main difference was the priority afforded occupational health, in tandem with managers and workers being supported in the practical management of health issues on site. Some of the main components of the approach that could be replicated on other projects follow:

• The construction client prioritised health alongside safety. Standards of health management were also assured, which established senior management buy-in from the start. For example, standing items on occupational health were included on all health and safety and leadership meetings;
• The occupational-hygiene team developed tools for managing OH issues, which built on those already being used for safety management. One example was a tool that encouraged managers and workers to observe ‘health impacts’ in a similar way to near misses (e.g. in the case of an operative using equipment with appropriate hearing and respiratory protection, but doing so in the immediate vicinity of other workers not using protection);
• Measures were introduced that allowed contractors to assess their occupational-health performance. Using an adapted behavioural-safety matrix, managers were encouraged to assess their own occupational-health performance, including how well they filtered information about health risks (and how to manage them) through to their supply chain. This encouraged contractors to actively seek performance improvements, particularly when they benchmarked their performance against that of others;
• Professional support was available as and when necessary to deal promptly with specific issues that emerged. The occupational hygienists were fully briefed on projects, through their involvement in health risk assessments and work planning. This meant that if problems did occur during work, they were well placed to quickly identify the cause and provide practical and appropriate solutions. Often, this reduced the costs of stoppage time significantly, plus the actual professional time required to deal with each incident was relatively small, as the occupational hygienists already understood the details of the project;
• Managers and workers were encouraged to understand and assess health risks in the same way as safety risks, and were supported in doing so. An occupational-health risk register and health risk-profiling process were developed to ensure that, on a task-by-task basis, all health risks were identified and suitable control regimes and monitoring programmes implemented. Daily activity briefings for workers also included consideration of health, as well as safety, risks;
• Health was integrated into all inductions, CDM design reviews, and supervisor training. Consequently, contractors and their supply chains were encouraged to think and act on health information in the same manner as safety from the moment they arrived on site;
• Technical information was translated into easy-to-implement control regimes. The occupational hygienists created simple maps of the relative risks involved in different tasks (e.g. noise and hazardous substances). Health risk-assessment outcomes were thereby created and communicated with the end user in mind.
  

Investing in occupational health – is it worth the effort?

The award-winning OH provision on the Olympic site can be seen as supporting a broader ethos of good health management, alongside a sustained prioritisation of health issues in tandem with safety.⁷ This was achieved by offering effective tools, professional specialist inputs when required, and an accessible approach to preventing work-related ill health. While this may be laudable, many managers may still ask: “what’s in it for me, or my company?”

In assessing whether the economic benefits obtained on the Olympic build could be replicated on smaller projects, it is important to note that the occupational-health provisions were available to all contractors and workers on the Park and Village free of charge, as the service was funded by the Olympic Delivery Authority.

The costs of funding the service were significant, but it was set up to serve the needs of an estimated peak workforce of 12,000, and a total workforce of around 45,000. Individual contractors on other projects would therefore need to think carefully about which elements of the service might be applicable to them. What is reasonable and practical for each project will be dictated by factors such as workforce size, work complexity, and the likely nature of health risks.

Having occupational hygienists working as part of the health and safety management team had a number of measurable benefits. The occupational hygienists were able to respond more quickly, with access to better information about the site, and provide a more appropriate response than if they had been brought in on an ad-hoc basis. An on-site team, whether a physical or virtual presence, can help reduce the likelihood of unforeseen risks emerging and provide cost-effective solutions when they do.

Current estimates of how much this has saved contractors are being prepared and will be published later this summer, but examples of how the occupational hygienists have helped reduce stoppage time include:

• having knowledge of likely contaminants on the site, allowing the team to quickly identify the likely source of irritating odours affecting operatives as unlikely to cause significant health effects. This allowed work to continue without significant stoppage time. As a result, the contractor was able to save an estimated £98,000, as works could continue without disruption;
• the ability to offer immediate access to tailored asbestos awareness training allowed the hygiene team to save one contractor an estimated £656,000, as its workforce was able to return to work quickly following site closure, once asbestos-containing materials had been identified; and
• following the identification of potential methacrylate exposure, the on-site occupational-hygiene team was able to save a contractor an estimated £20,000 through speedy identification of the problem, and the introduction of a simple, but effective, control regime.

Offering the support of hygienists doesn’t have to be an expensive proposition. An equivalent workforce of 9500 operated on the site for three years at a cost of around £37 per worker, per year. If the provision of this service results in reduced absence rates and/or reduced stoppage time, then it takes very little for this investment to cover itself, and indeed pay back a significant amount to employers, individuals and society.

Conclusion

While the occupational-health provision on the Olympic Park and Athletes’ Village represented a significant investment, the cost per head of workforce was relatively low. Emerging evidence suggests that this investment really did pay dividends.

Moreover, the main elements of the approach are entirely scalable, but require demonstrable senior management commitment and clear messages about the priority given to health issues. This should be combined with an approach to health risk assessment and management, which mirrors activities already underway with regard to safety. Having the support of occupational hygienists, at least initially, can also be a worthwhile investment, even for more modest projects. 

References
1    http://www.guardian.co.uk/business/2012/may/02/uk-construction-maintain-recovery-markit-cips
 2    Tyers, C and Hicks, B (2012): Occupational-health provision on the Olympic Park and Athletes’ Village: Final report, Research Report 921, HSE
 3    Tyers, C, Speckesser, S, Hicks, B, Baxter, K, Gilbert, M and Ball, E (2012): Occupational Hygiene on the Olympic Park and Olympic Village: Can preventative workplace health management be cost-effective? IES Research Report
4    In 2000, at the Tackling Health Risks in Construction Conference, employers, clients and trade unions agreed to work together to pilot a comprehensive occupational-health support scheme. The HSC’s Construction Industry Advisory Committee (CONIAC) set up a company (Constructing Better Health) on a not-for-profit basis to manage this pilot
5    Black, C and Frost, D (2011): Health at work – an independent review of sickness absence, DWP
6    https://www.shponline.co.uk/news-content/full/employers-sceptical-about-fit-note-impact
7    The Olympic Delivery Authority – Park Health won the ‘Best Achievement in Health Care and Emergency Services’ at the 2011 SHP IOSH Awards – see https://www.shponline.co.uk/winners-2011

Claire Tyers is principal associate fellow at the Institute for Employment Studies, and director of Research Partners.

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