Last December, the European Agency for Safety and Health at Work's (OSHA's) Risk Observatory published the best guesses of its panel of 60 health and safety experts in Europe and the US on the emerging risks to EU workers' health and safety.

Topping their predictions of what would keep health and safety managers busy in years to come were a lack of physical activity by desk-bound employees, thermal discomfort and "multi-factoral risks" where workers face a number of interacting risks.

The prime example the report (available at http://osha.eu.int/publications/reports/6805478) gives of workplaces likely to harbour these multi-factoral risks is call centres. It cites lack of job control and high time pressure, poor workstation design, background noise and inadequate headsets as factors that can interact to reinforce negative health effects (see box 1 below).

If call-handling staff are particularly vulnerable to these combined risks, then the issue is one that needs taking seriously, simply because call (or "contact") centres now account for so many UK jobs. Whatever the publicity given to some of the big banks and insurers shifting call handling work "offshore" to the sub-continent and the growth of online services, call centre employment in the UK is still rising and set to rise further in the short term at least.

Growth forecast

In 2004, business forecasters Datamonitor estimated there were 5,980 contact centres and 435,000 agent positions. They predicted that by 2008 there would be 7,320 centres and 500,000 agent positions. But the Department of Trade and Industry's figures suggest that the number of agent positions had already passed the half million mark as Datamonitor's figures were published.

Ever since the advent of the telephone, businesses have employed people whose jobs included making and receiving calls to sell products or answer queries, but taking on staff to handle these tasks exclusively and grouping them together in "centres", from the vast sheds with hundreds of workstations in the finance sector to the handful of employees in the corner of a local authority housing department, is a phenomenon that took hold only in the 1990s. The relative newness of the contact centre agent role means we are still learning about the health and safety issues it throws up for employers. Two that have emerged recently are both delivered via call handlers' ears.

Stressing a point

The pressures on customer-facing staff are well documented (see HSW December 2005, page 19) and call handlers face some of the same hazards as employees who deal with customers face-to-face. The HSE's definition of work-related violence includes verbal abuse and threats as well as physical assault and the former are a day-to-day reality for staff manning sales and customer care lines.

Persistent verbal abuse can lead to anxiety, stress and absence from work; the HSE estimates that 13 million days are lost to stress-related absence each year - a problem it is trying to help employers tackle by promoting its stress management standards (www.hse.gov.uk/stress/standards/index.htm). Stress from customer abuse can be compounded in call centres by ambitious call targets or key performance indicators (KPIs), a lack of task rotation, too few breaks and too little job flexibility. Stress also increases handlers' risk of developing voice disorders, and too few opportunities for making drinks due to heavy workloads can exacerbate the problem.

Agents at Lloyds TSB's UK centres are trained in coping with abusive customers at induction. "The advice is try not to panic or lose your temper, don't take the comments personally and talk to a colleague or your supervisor after the call if this will help," explains Ann Morrison, health risk manager at the bank. Company policy is that call handlers may terminate a call if the customer's behaviour does not improve after a warning, says Morrison. All such calls must be logged with a supervisor and there is the opportunity afterwards to listen to the recording of the abusive call with a more experienced colleague to help the call handler identify alternative ways of dealing with similar events in the future.

Morrison says the bank's advice to staff is based on the revised Local Authority Circular LAC94/1, drawn up by the HSE and Local Authorities Liaison Committee (HELA) (available at www.hse.gov.uk/lau/lacs/94-1.htm). The circular includes a series of checklists for local authority inspectors to use when assessing whether any call centre is a healthy and safe place to work.

"We've also got a healthcare helpline, open to all our staff, which offers confidential counselling and emotional support if anyone is particularly affected by an abusive phone call or other problem," says Morrison.

Dave Joyce, national health, safety and environment officer at the the Communication Workers' Union (CWU), which represents call centre staff, says the problem of verbal abuse is getting worse. "People who work in call centres are sometimes encouraged to try to appease people on the other end of the phone no matter how abusive they get," Joyce says. He says all employers should follow Lloyds TSB's example in using the HELA guidance as a starting point: "We would like all centres to match the standards that are set out in 94/1; not just the basic compliance but also the suggested best practice for the working environment, DSE [display screen equipment], stress."

Acoustic incidents

In October 2005, the CWU voiced concern about the safety of call centre workers in Aberdeen after staff complained of bursts of noise in their headsets. Over two days, according to the union, 45 out of 160 workers at the BT call centre suffered acoustic shock incidents, where sudden, piercing noises came through operators' headphones. BT carried out a full investigation, acknowledging that from time to time they received reports of "unexpected and sometimes unexplained sounds". A BT spokeperson said that in the "vast majority of cases" any side-effects were minor and temporary.

Recent research from Australia and Denmark suggests the BT workers are far from alone. The Acoustic Safety Programme (ASP) and the National Physical Laboratory (NPL) define an acoustic incident as "a sudden, unexpected noise event which is perceived as loud, transmitted through a telephone or headset"; and acoustic shock as "an adverse response to an acoustic incident resulting in alteration of auditory function" (see www.acousticshock.org).

The new ASP/NPL definitions, which are supported by the CWU and the Department of Trade and Industry, emphasise that "acoustic shock is not noise-induced hearing loss and occurs at sound pressure levels well below those which present a risk of immediate hearing damage". Call centre workers using headphones are thought to be vulnerable because of electrical interference and "sonic spikes", in addition to the more general risks from abusive callers, whistles and so on.

The symptoms associated with acoustic shock vary, but according to reports can include pain around the ear, hearing loss, tinnitus (ringing in the ears), sleep loss, noise sensitivity, lethargy, depression and headaches. These symptoms may be long-term or permanent.

While the HSE is keeping an open mind about the causes of these reported symptoms and has taken a cautious line on the new research (see box 2), the CWU claims acoustic shock is a "devastating 21st century industrial injury".

"It's a major issue for us," confirms Joyce. "It ruins call centre workers' lives and it's costing the industry millions of pounds." According to Joyce, the CWU and the PCS central government workers' union have already handled more than 700 cases, securing more than £2 million in out-of-court settlements, with awards ranging from several hundred pounds to more than £100 000. Joyce believes the industry is being too cautious about the problem: "A lot of people are in denial that it actually exists. But the call centre industry is one of the biggest industries in the UK today, and workers are at risk of injury every moment they're handling calls. We're campaigning hard for better recognition of the problem."

Holistic approach

The Customer Contact Association - which has more than 800 corporate members, representing 3,500 senior practitioners - stresses that while there have been reports of incidents and symptoms that have been described collectively as acoustic shock, not enough is known yet about the problem. "As there have been no proven cases as yet among people who work in call centres, our advice is to make sure you are compliant with the Noise at Work Directive," says a spokesperson for the association.

Tony Jones, marketing manager for contact centres at headset manufacturer Plantronics - the company that supplied the headset equipment through which Neil Armstrong broadcast from the moon in 1969 - explains that there are two distinct areas of noise that managers in contact centres and general offices need to consider.

"The first is sudden, loud noises that get referred to variously as acoustic shock, acoustic startle and acoustic incidents - there isn't really an agreed definition in this area," says Jones. Most telephone systems will limit sound above 118dB but, he points out, 118dB is still "incredibly loud" and this limit "offers fairly basic protection". It is known that noise above 118dB can cause hearing damage but there is increasing concern in call centres about incidents below this level, such as at the BT call centre. "Noises below that level can cause a lot of discomfort - it's not a nice thing to experience - but fortunately it doesn't happen too often. These things are still the exception."

The second area is the agent's average total exposure to noise over an entire working day, which must be managed according to the requirements of the new Noise at Work Regulations (see HSW March 2006, page 11). Jones warns that buyers should be wary of claims that products are "compliant" with the regulations: "Although we offer products that can help reduce exposure, you really can't say that any product is 'compliant' because the legislation is about someone's total exposure." Exposure could include noise from co-workers, air-conditioning or even nearby building works.

"What is really important is that contact centres look at this holistically, and that they look at not just one measure but a range of different measures," urges Jones. "They could consider sound baffling, the materials within the contact centre, agent placing, products that control the sound level via the headset; it really is important to look at the total environment."

Box 1: Multi-factoral risks in call centres

• Prolonged sitting
• Background noise
• Inadequate headsets
• Poor ergonomics
• Low job control
• High time pressure
• High mental and emotional demands
• Musculoskeletal disorders
• Varicose veins
• Nose and throat diseases
• Voice disorders
• Fatigue
• Stress
• Burn-out

Source: OSHA

Box 2: Acoustic shock: the HSE view

The HSE is considering new data on acoustic shock and will consult experts in the UK and other countries to form an opinion on the emerging evidence. It may issue guidance if it gets substantive evidence.

The executive says it cannot comment on the efficacy of "acoustic shock protection" devices designed to protect call centre workers. Its current advice to call centres is that they should implement a traceable reporting system for headset users who may have been exposed to acoustic shock incidents. The reports should include the following:

• date and time of the incident
• details of the source of the exposure
• description of the noise
• duration of the exposure
• details of the headset and telephone equipment used
• whether the incident was electronically recorded (a copy should be kept for future reference)
• symptoms experienced by the operator directly related to the acoustic shock incident.

The HSE says call centre agents should be trained to recognise such incidents and how to report them, and reminds employers of their duty to report certain types of work-related injuries under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).

It recommends call centre employers keep up to date with developments in this field through their professional associations and other representative bodies, as well as through their enforcing authority (usually the local authority) via the HSE website.