01 May 2007
Louis Wustemann

"We have picked most of the low-hanging fruit. If we are to reach the top of the tree we will have to put in more effort."

The CBI's head of health and safety Janet Asherson summed up one of the  themes of IOSH 07, the Institution of Occupational Safety and Health's annual gathering, held in Telford on 27 and 28 March.

As accident rates have fallen, then plateaued, arguably the biggest challenges remaining for health and safety professionals involve less concrete hazards that lead to stress or musculoskeletal conditions.

The message is not a new one but it was louder and more insistent at this year's IOSH conference than previous years, with plenty of sessions on stress management and employee rehabilitation after illness or injury. IOSH used the conference to launch the first part of its free online toolkit (see www.ohtoolkit.co.uk), the baby of ex-president Neil Budworth, which is designed to help health and safety managers tackle occupational health issues such as musculoskeletal problems and skin disorders. 

Man at the top

Plenty of core safety topics were aired at the conference as well. In his keynote speech on the second day, HSE chief executive Geoffrey Podger tried to dispel any idea that budget cuts were forcing the HSE to rein back on its enforcement activity. "Like other public sector bodies we are having to tighten our belts," he admitted, but he assured delegates the executive is "alive, well and, dare I say, kicking, and that's how we intend to remain."

He said there had been a downturn in prosecutions in past years but, referring to a recent increase (see HSE's new hard line pushes prosecutions up 20%), added, "I am pleased to see the trend has been reversed."

Podger touched on the cooperation between the HSE and local authorities as health and safety enforcers and said attempts at joined-up working were showing healthy results. But later he described a question from the floor on whether it was time for the HSE to absorb local authorities' policing role and create a unified inspectorate - a suggestion which drew applause from the delegates - as "an invitation to start World War Three".

He commended IOSH's efforts in parallel with the HSE to emphasise to the public that the health and safety profession was focused on sensible risk management rather than being overly restrictive. But he sounded a note of caution about the zeal of some consultants. He said consultancy was "unbelievably important and valuable" but added, "We still find people who are trying to over-complicate everything and that turns people off the things that really need to be done in health and safety." He also warned of the dangers of concentrating on paperwork rather than practical measures to reduce risk.

He recalled visiting a light engineering firm after an accident, where the risk assessments for the work were buried in a manager's office "and had they been seen by the members of the workforce involved in the accident, would have been completely unintelligible to them."

The moral, he said, was that risk assessments should cover real risks, specify sensible control measures and be presented in a meaningful way to those facing the risk.

The profession's ongoing image problems in the national press cropped up again in several sessions. Vera Shilling, health and safety officer at the National Trust, noted that though "barely a day goes by without a negative story in the press," it isn't always reports of safety practitioners banning activities for spurious reasons.

Shilling recalled a news story she was involved in about asbestos in farm tracks in Cambridgeshire - a common occurrence throughout the county, as hardcore containing asbestos cemented sheets was often used for tracks. The National Trust tested the tracks and found no airborne fibres. At a meeting with local residents, Shilling explained that there was no risk to local people. Asked if she would allow her children to play in the area, she said she would, as there was no risk to health.

The headline in the newspaper coverage that followed was a quote from a resident that read: "She was happy for our children to play in asbestos."

Misrepresentation of safety decisions in the press - deliberate or otherwise - means health and safety practitioners have to be more aware of how they write risk assessments and communicate their results, warned Shilling.

Error message

Even in companies with the best safety procedures and highly trained employees, accidents can happen because people make mistakes. So what can be done to minimise errors?

"The key message is that you try to change situations. You will not change people, whatever you do," argued Shailesh Purohit, safety, health and environment manager at Jotun Paints, who has a special interest in human error.

Purohit gave the example of an incident where an experienced operator "forgot" to shut a critical valve as he went on a break. The result: a hazardous spillage of xylene. Purohit suggested the instinctive reaction might be to discipline and/or retrain the individual. But that wouldn't prevent a similar mistake being made by an operator again.

The answer, he argued, is to improve the mechanics of the task and provide visual reminders of correct procedures to help minimise the chance of recurrence. But he warned against introducing time-consuming, non-instinctive procedures; "if you ask someone to do something that is really awkward, they won't do it," he cautioned.

The reasons for mistakes are varied, according to Purohit: the person might not know what to do; they might have poor motivation and not want to do something; they might not be able to do it; or their attention might lapse. There are various options for employers: make the task easier; provide training; teach flexibility and problem-solving skills; avoid contradictory instructions; explain the need for any action; or redesign the work.

"It's not helpful to say 'accidents happen because of human error'," Purohit argued. "What are you going to do about it?"

Ministerial address

Secretary of state for work and pensions John Hutton explained in his keynote address how the government expects to contribute to reducing the annual total of 20 million working days lost to workplace ill health and injury.

The current welfare reform plans would "eradicate the entrenched concept of incapacity from our benefit system," replacing it with a new focus on capability. "The new personal capability assessment will examine not only what an individual can't do but also what they can do," he said.

The new system will bring higher benefits for those whose conditions mean they genuinely cannot work and lower payments plus a tailored package of support for those who would benefit from rehabilitation. Organisations should mirror the changes by trying to keep employees at work, he argued, citing an employer whose rehabilitation programme had cut average sickness absence after injury from 26 days to only four, claiming a twelve-fold return on the initial scheme investment.

Hutton stressed the role of GPs in intervening early to help employees return to work and said his department had piloted implanting employment advisers in doctors' surgeries to support GPs with advice on patients' fitness to stay in, or return to, work.

"Many health conditions initially reported, such as back and neck pain, depression, heart and circulatory problems, shouldn't make long-term inactivity inevitable," he said. "In fact we know that work can be good for people, both in staying healthy and as a critical part of rehabilitation."

"Health and safety practitioners clearly have a crucial role to play in mentoring and supporting those rejoining or joining the workforce," he concluded.

Bank on it

The theme of minimising long-term sickness absence continued in a session led by Rebecca Gallagher, rehabilitation adviser at QBE European Operations.

Gallagher outlined various factors that maximise the chance of a successful return-to-work process: early access to physical treatment, appropriate psychological and social support, effective communication between all the parties and alterations in the workplace to accommodate the  worker.

The critical stage where the process often breaks down, she said, is when the medical professional assesses the injured worker's fitness to return. More often than not, the medical professional will know little about the job nor the alterations that could be made, so the worker is deemed unfit to return. This leads to further physical deterioration, and in some case anxiety and depression, and the chances of a successful return in the future are reduced further. "The employer loses any benefit of the early intervention they've invested in," she explained.

Gallagher described a system of task analysis and "job banks", increasingly used in the US and Canada to overcome communication difficulties between the employer/worker and the medical professional. The system involves independent analysis of job roles by a health professional.

In the event of an employee being injured, the employer sends the task analysis to the medical professional assessing the worker so they can make informed decisions about the possibility of return and appropriate workplace adjustments - increasing the chance of a successful return and "preventing spiralling anxiety" for the worker.

Dame Carol Black, the government's national director for health and work, made a similar point in a later keynote presentation when she said that UK GPs consulted about their role in rehabilitation had come up with the idea of "reverse" sick notes from employers to doctors, explaining what work an injured or sick employee could be offered.

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Olympian task

Lawrence Waterman, chair of consultancy Sypol and, more recently, head of health and safety at the Olympic Delivery Authority (ODA), told delegates about the challenges of managing a project - creating a home for the 2012 games in east London - that involves the largest planning application ever in the UK, the biggest urban park created in 150 years and a demolition programme that will remove two structures a day at its height.

Waterman has set a tough target of no more than one reportable accident per million working hours. Safety starts at board level, with workshops for directors, and goes down to a requirement that any contractor allocates five days' safety training a year for all site workers.

Though the ODA will "disappear in a puff of smoke" when the Olympics are finished, it is keen to make sure that the areas it touches benefit from its existence. This stretches beyond ensuring all the permanent buildings it constructs have a life after the games, to its health and safety codes. The authority has produced an 80-page design and construction health and safety standard, available free to anyone (www.london2012.com/en/ourvision/ODA/Healthandsafety.htm), designed to promote best practice in construction procurement. "Most of our material is paid for by you," said Waterman. "So it is being made available for you to make use of."

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