04 March 2006
Sara Bean

Safety management has been highly effective in reducing workplace accidents and injuries in the UK. There was a marked downward trend in accident measures over the quarter century after the introduction of the Health and Safety at Work Act 1974, which has only levelled out in the past few years.

But the official figures reveal that it is in the area of health, rather than safety, that the greatest challenge now lies. Of the 35 million working days lost due to work-related injury or ill health in 2004-2005, seven million were due to workplace injury, while 28 million were due to work-related ill health.

More than half of all cases of work-related illness were musculoskeletal disorders (MSDs) or stress. Other types of ill health, including lung diseases such as asthma and pneumoconiosis; dermatitis and other skin diseases; infections and disorders related to vibration or noise, accounted for the rest. 

Unhealthy priorities

This isn't a new trend. Over the last few years, reams of statistics, published by the government, unions and employers' groups such as the CBI, have underlined the fact that stress and MSDs are the leading causes of workplace absence.

Tackling the main causes of absence should be a major priority for any business, so the Institution of Occupational Safety and Health (IOSH) was understandably disappointed to find that among many of its members, health issues aren't given enough attention.

Around 50% of the respondents to IOSH's Value of Health and Safety survey last year said occupational health management does not figure as highly in their working day as it should. More than half (52%) said health issues occupied less than a quarter of their time at work.

It's a worrying finding and begs the question: why are so many of those working at the front line of health and safety so reticent in tackling an area of such key importance?

Back to work

"The first thing to remember is that safety is quite a tangible thing," says IOSH president Neil Budworth. "Its output is immediate and the solutions are usually pretty definable, but with health it's not so clear, there is often a mix of social issues involved to account for work-related ill health."

Elizabeth Gyngell, head of the Health and Safety Executive's (HSE) Better Working Division, agrees that many advisers are simply more comfortable dealing with safety issues than health issues but she also cites the effect of a changing workplace, one that has shifted from manual labour and heavy industry to sedentary office work.

"We mustn't assume that dealing with health issues is new," she says. "For example, you don't hear much about lead poisoning any more, but that isn't because that risk has disappeared, there are just much better ways of controlling it now. But those are of course the traditional types of health problems; you see a hazard and you cage it.

"The problem is that, today, the two greatest causes of ill health absence are stress-related illness and MSDs. These are what keep people off work. Yet these common health problems don't all have causation from work, you've got to take into account external factors, so the 'caging' approach can't work."

It is also difficult, she says, to determine what measures are most effective in tackling these "newer" work-related health problems. Getting people back to work is the first priority, she explains, which is why the government's welfare reform green paper, published for consultation at the end of January, aims to get the estimated one million incapacity benefit claimants back to work within a year (see news story on page 4).

"You can't wholly prevent some kinds of stress and musculoskeletal problems," she explains. "Especially as it's not always down to the work environment alone, and this can be anathema to health and safety people. But if you can't entirely prevent ill health caused by work you can help people learn to live with their problems, and getting people back to work is often part of the cure."

The bottom line

Encouragingly, the 2005 IOSH survey also revealed that health and safety professionals are aware of the prevalence of occupational illness, and showed health and safety managers were keen for more investment by their employers in helping them tackle the problem. Nearly 65% said more should be invested in addressing work-related stress and 59% wanted more resources put  into preventing MSDs.

Employers need to support health and safety managers with procedures to help tackle work-related ill health, says Budworth. Severn Trent Water, where he is health and safety manager, now has a policy to refer staff for treatment as early as possible. The policy, which is driven by the health and safety department, ensures that anyone who presents with a back or shoulder injury is referred to a physiotherapist within a week.

"Health and safety should aim for procedures and policies that managers can follow, so that referral comes as early as possible," says Budworth. "For instance, stress-related conditions are less definable, and sometimes a line manager may pick up that an employee is suffering from stress before they've taken any sick leave."

The early referral policy helped push sickness absence rates at Severn Trent  down from 4.3% in 1999-2000 to 3.3% in 2003-2004 - saving the company about £1.4 million a year in sick pay. Added to this is a productivity increase equivalent to 28 750 working days, worth an extra £4.3 million.

Statistics like this are hard proof of the impact good health management can have on an organisation's bottom line.

The public sector may not have to worry about profitability, but with constant drives for efficiency savings, sickness absence cuts can be a painless way of reducing costs.

At HM Prison Belmarsh, the sickness absence rate was as high as 25 days per member of staff in July 2002 but, after a radical overhaul of the absence management procedures, by July 2004 the rate was down by almost half to 12.8 per staff member.

At Grimsby Institute of Further and Higher Education sickness absence among the 1250-strong workforce has been cut from an average of 6.5 working days per employee in 2002 to 4.5 days in 2005. This is the result of a new combined initiative by health and safety and HR staff, which includes more on-site health surveillance, stress management training for line managers and a more rapid response to sickness absence.

Getting closer

John Walker, managing director of Business Health Advisors, an occupational health and safety consultancy, has qualifications in both occupational health and health and safety, and firmly believes in the power of multidisciplinary team working to tackle both safety and health issues. In a presentation to IOSH members last year he argued that occupational health practitioners and health and safety managers need to forge closer links to effectively manage health hazards at work effectively.

"For many people in health and safety there is sometimes a nervousness that they may be overstepping the mark," he explains. "But the same concern exists from the health side. Yes, you do need to be qualified to do certain jobs, but you can also look things up, or if you're not sure about something just ask. If you suspect something is a health hazard, look it up, document it and, if appropriate, pass it on to an expert."

IOSH is also taking action to address the current lack of focus on health issues. Budworth says the institute is arranging a meeting with health professionals, employers' organisations and trade unions to work on formulating some practical tools to help address health problems caused by work. "The challenge for H&S is to try and find simple tools that can be used by non-medical practitioners," he explains, "that are not intended to take over the role of health practitioners but to support them and help them work together as a big team."

He also thinks that more should be done to demystify occupational health: "It's a question of resources. Let's face it, there aren't enough occupational health nurses and doctors in the country to monitor health at work. But you don't have to be a doctor to know to refer a worker who presents with red inflamed skin."

There also needs to be a culture change amongst health and safety practitioners, argues Gyngell, from focusing on paper, processes and enforcement, to using their expertise to help line managers reduce the causes of ill health at work - especially stress-related conditions.

Well connected

The HSE has recently set up Workplace Health Connect (www.hse.gov.uk/workplacehealth), a confidential service dispensing free advice on workplace health, safety and return-to-work issues. It is aimed at small and medium-sized businesses in England and Wales with five to 250 workers and aims to pass on knowledge and skills to managers and workers, so that in the future they can identify and manage workplace health issues themselves.

"This can be a model for health and safety managers," says Gyngell. "They should enable line managers to manage well, by raising the importance of maintaining the health of those at work. We have to shift the thinking from being experts who tell people what they must do, to being advisors helping line managers manage better."

Workplace Health Connect is just part of a wider strategy to address ill health caused by work. Last October the government launched the strategy Health, Work and Wellbeing - Caring for our Future, which combines the forces of the Department for Work and Pensions, the Department of Health and the HSE. It follows the 2004 white paper, Choosing Health, which flagged up the importance of work to both mental and physical health.

This latest initiative involves the creation of a new health "tsar", the national director of occupational health, who will lead the strategy. The new director will be appointed in the next few months and a charter is promised for sometime in the spring.

"Health and safety advisors need to be au fait with the current thinking," concludes Gyngell. "The government has published Health, Wealth and Wellbeing to set the agenda for the way forward. This will mean a change in culture, ensuring that when you are at work, health issues are at the forefront."

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