The secret epidemic

The secret epidemic

“You’re lucky you’re not going home in a wooden box tonight, boys,” the police officer told two construction workers after he saw the wreckage of the car that a drunk driver had driven into the hole they had been working in (pages 38-39). More than 70 people a year in construction aren’t that lucky, and 137,000 other workers suffer health problems caused by their jobs.

On 22 October, the Health and Safety Executive launched its latest project to turn around these statistics. Constructing Better Health aims to tackle everything from high blood pressure to falls from height. Its remit is intimidatingly broad, but that reflects the sheer number of ways that people in the industry can come to harm – everything from infected scratches to chronic musculoskeletal disorders, from hand-arm vibration syndrome to cement dermatitis and post-traumatic stress disorder. And these problems aren’t isolated – 3000 new cases of hand-arm vibration syndrome and 30,000 new musculoskeletal disorders are reported each year, and 10% of construction workers develop cement dermatitis at some point in their career. To begin, the pilot is targeting smaller firms, but if it is successful it could be scaled up to cover all construction businesses.

The HSE pilot project in Leicester is run by Sypol, a health and safety consultant. Lawrence Waterman, who runs the consultancy, points out that although the accident figures grab the headlines, longer-term health issue can be more devastating. “Peoples can understand the relationship between collapsed scaffolding and someone getting injured,” Waterman says. “What they don’t notice is the number of building workers that have had to give up work because they are suffering from work-related health problems.”

As well as destroying livelihoods, these health problems cost the industry a fortune in lost work days. In this special Building guide, we look at ways to keep your workforce – and your bottom line – healthy, including:

• The disturbing evidence BAA’s on-site occupational health centre at Heathrow Terminal 5 has unearthed about power tools (page 41)
• The psychological hazards on site (pages 39-40)
• Plus we go on site at the HSE’s new testing laboratory (pages 44-46).

Caring for survivors

After every accident, psychological shockwaves hit witnesses and colleagues as well as victims. But untreated mental trauma can lock individuals into a personal hell, and the industry into a cycle of inefficiency and further accidents

The statistics tell their own shocking story. The construction industry accounts for 17% of all major workplace accidents, and 31% of all work-related fatal accidents. At least one construction worker is killed each week. Last year, 70 construction workers died. And current statistics show that a construction worker commits suicide every two days.

After each incident, the victim will be treated for their physical injuries. On the site itself, accident forms and reports will be completed, site inspections made, safety training assessed and risk assessments made to gauge the likelihood a similar incident recurring. But none of these processes will take into account the psychological injury suffered by both the victim of the accident and those who witnessed it. But according to Keith Guy, an occupational health specialist at consultant the Red Poppy Company, psychological injury can be more devastating than physical injury.

Incidents of workplace accidents, fatalities, sudden death or suicide can give rise to psychological trauma injury, or post-traumatic stress disorder as it’s also know. This is most often associated with soldiers who have seen combat, and the high suicide rates that result. “More veterans have committed suicide since the Falklands war than died during the conflict,” says Guy. But construction accidents can produce wounds as horrific as those on the battlefield. As a result, Guy believes, the victims, witnesses or even those colleagues who go to the victim’s aid “are as likely to develop post-traumatic stress disorder as the military”.

But despite the high incidence of physically and emotionally traumatic accidents, there is no support for the victims. “Not once have I spoken to anybody in construction who has said they have received counselling after an accident,” says Guy. “There is no support; workers are just expected to get on with the job.” Statistically speaking, this means that every two days, construction workers somewhere in the UK will have to cope with a colleague’s suicide; every week, employees will have to deal with the accidental death of a mate.

“Construction industry employers are failing their employees in their psychological duty of care,” Guy adds, pointing out that other sectors such as the police, the fire service, the oil and gas industries and mining are able to provide instant responses to accidents. “Even the financial service industries such as banks and building societies, where robbery is a possibility, routinely provide critical incident response,” says Guy.

“It is an oversight,” agrees Brian Rye, regional secretary of construction union UCATT, who is assisting the Red Poppy Company by providing case studies of construction accidents.

Some employers create a culture that stresses 'getting back on the horse'

The absence of any psychological support mechanism is all the more remarkable when the possible effects on a victim are considered. According to Guy, as many as half of all victims will suffer a prolonged reaction to the incident, and may need professional help. Victims will re-experience the event through flashbacks and nightmares, and will ruminate about what happened or what they might have done differently. “They will have no control over these intrusive images, thoughts and memories,” explains Guy.

One symptom of psychological distress is avoidance. “Workers will not wish to talk about the accident and will often avoid the place, or any similar place, where it happened,” Guy says. So for example, if the incident occurred while an operative was working from a scaffold tower, they may well be fearful of returning to a similar workplace. According to Guy this is a “normal” and predictable reaction. However, the only option open to a construction operative experiencing this problem is to manage their symptoms by signing off sick.

Studies have shown that affected workers will often suffer emotional difficulties including anxiety, aggression and mood swings. Frequently, individuals will turn to alcohol or drugs to cope, which in turn increases the risk of further accidents at work. “Half of the victims of post-traumatic stress disorder will go on to suffer from anxiety or depression or they may even turn to substance abuse,” Guy confirms.

If victims of the disorder are ignored, the consequences can even be fatal. “Sadly, there is a link between suffering from post-traumatic stress disorder, self-harm and suicide,” Guy says. With one construction worker committing suicide every two days, this can create a domino effect adding further trauma to the family friends and work colleagues left behind.

The failure of the industry to address the psychological welfare of its workers can be put down to a variety of factors, starting with a straightforward lack of awareness that the problem exists. On the other hand, some employers may choose to ignore the reactions of their workers, and create an unspoken culture that stresses “getting back on the horse”. Managers may focus their resources on the physical aspects of health and safety – which have the benefit of being more easily quantifiable – to the detriment of the psychological aspects.

The Health and Safety Executive currently does not compile statistics that would show what proportion of sickness in the construction industry is due to psychological ill health. However, construction union UCATT suggests that the cost of occupational ill health to the construction industry is £736m a year.

Construction’s neglect of its psychological duty of care to its workers is all the more alarming in the context of both Health and Safety at Work legislation and European Union regulations, which spell out that employers have a responsibility to protect the psychological as well as the physical wellbeing of their employees. As with physical hazards, employers are required to assess the psychological risks their employees face. “Failure to put the proper infrastructure in place for psychological care can leave an employer open to compensation claims for work-related injury,” Guy says.

Construction is a dangerous occupation. If the suicide rate and other psychological difficulties are ever to be reduced, then construction employees have the right to the same level of psychological care workers in other dangerous occupations. This is not a choice between physical and psychological health – they are equally important. “Death, whether by suicide or a fall, has the same consequence,” Guy concludes.

Keith Guy’s tips for dealing with post-accident trauma

• Every organisation should prepare a clear set of policies and procedures to safeguard the physical and psychological wellbeing of the workforce.
• All organisations need to prepare a plan so that they can respond positively to an accident.
• Managers need to be trained in how to respond to workplace accidents.
• After an accident, swift and thorough crisis support is required. Prompt action saves money by promoting recovery and effectiveness.
• Managers need to understand that workplace accidents will affect even those not directly involved, and that workers will not be able to “carry on regardless”.
• Remember that accidents impact on the workforce as a whole and not just on individuals.
• Managers need to recognise that if a worker remains at work it does not necessarily mean that they are alright.
• A plan to promote the workforce’s psychological wellbeing should be added to an organisation’s health and safety training programme.

Occupational health

More than 60,000 people will work on Heathrow Terminal 5 by the time it is finished. So how can the UK’s only occupational health centre help them to leave the job with their well-being intact?

BAA’s Terminal 5 mega-site is one of the only projects in the UK to have a dedicated occupational health facility. The unit contains a small waiting room, two treatment rooms and a drug and alcohol screening room.

For BAA, the decision to invest in an occupational health facility was purely commercial. “We estimated that at its peak the workforce would top 6000,” says Mike Evans, T5’s health and safety manager. However, once workforce churn is taken into account, with different trades coming and going as the project progresses, the actual number of people who have worked on the terminal will be near 60,000 by the time it is completed.

The safe exposure time was 30 minutes. The makers said it was 7.5 hours

The occupational health unit came into being as part of a package of facilities provided by BAA to tempt workers to this site. It was clear from the outset that not everyone would want to drive around the M25 to get here; that some people would be unhappy about having to park their car away from the site and that the site’s isolated location would prevent workers nipping to the shops at lunchtime. “We thought ‘labour is tight in the South-east, so how do we attract that number of people to work on this site?’,” says Evans. The occupational health unit was one part of a package of incentives introduced by BAA; other facilities included a high standard of catering and an on-site training centre.

Having tempted workers to the site, Evans says the occupational health unit has two main purposes, one commercial and the other philanthropic: “The unit is there firstly to make sure people are fit to do the work they are employed to do and secondly to make sure that this work does not damage their health.”

One of the key tasks of the occupational health centre is to screen workers in safety-critical roles for their pre-employment medicals. A safety-critical job could be a crane operator or a plant operator: someone whose actions could jeopardise the safety of others.

The results of the screening emphasis the need for more occupational health monitoring in construction – particularly given the number of itinerant workers in the industry. According to Evans, roughly one-third of all workers fall into the safety-critical category; and a third of these have been found to have medical problems that could pose a danger to others. “The screening highlighted three common health problems: poor vision had the highest number of failures, next was high blood pressure, with E E undiagnosed diabetes the common reason for failure,” says Evans.

He is keen to emphasise that the screening process is not about excluding workers from the project. “Once we find a problem, it is about treating it and helping these people to get them fixed,” he says. “Often we’ll bring in a local GP for a second opinion.”

The occupational healthcare unit also tries to help people change their lifestyle. It has introduced an hour-long lifestyle medical that includes cholesterol monitoring, blood pressure and dietary advice. Evans points out that staff at the unit also promote health education among workers: “They’ll go into the canteen at lunchtime and offer health advice on testicular cancer or how to give up smoking.”

One of the big successes at T5 has been in the prevention of cement dermatitis, which is caused by an allergic reaction from one of the material’s components. “It’s a nasty illness if you get it and it’s with you for life,” says Evans. To help prevent the ailment, the occupational health unit has trained the concrete gangs’ supervisors on how to look for symptoms of the disease on the hands of operatives.

Evans says that the occupational health unit has made a big effort to find out more about the work-related illness, such as hand-arm vibration syndrome, also known as vibration white finger. “A lot of industries have used occupational health defensively, usually to investigate why someone has not been in work; I had a belief that industry should do more for its workers because there are some hugely debilitating diseases, such as vibration white finger, in construction.”

Hand-arm vibration syndrome is an occupational health risk for workers who regularly operate high vibration tools such as drills, breakers and grinders. It most commonly manifests itself as vibration white finger, which can result in pain in the hands and wrists and damage to muscles, bones and joints. According to the HSE, the number of people with vibration white finger in construction is six times higher than in the rest of the population.

Research into hand-arm vibration syndrome by BAA’s occupational health unit at the T5 site has found that manufacturers’ guidance for the safe use of power tools may be misleading – tool vibration levels that are measured on site are significantly higher than those measured in laboratory conditions. “The field measurements can be magnitudes higher than the manufacturers’ data,” says Chris Pugh of Duradiamond Healthcare, the operator of the occupational health unit.

Worryingly in one instance Pugh’s study revealed the manufacturers’ data for safe usage time was out by a factor of 15. “The value of doing this study was highlighted when a measurement revealed a daily safe exposure time of 30 minutes against the manufacturer’s data that stated a safe daily exposure time of 7.5 hours,” says Pugh (see “What Hilti has done”, below).

Pugh has been in talks with designers about the occupational health risks of power tools. “You have to appeal to their specialist knowledge; it would be ludicrous to suggest that I can tell a designer how to alter their design to lessen its impact on a worker’s occupational health, but I can inform them of the health risks of a particular material or design to raise their awareness of an issue,” says Pugh. He says that his talks with the designers have enabled them to make huge steps forward in designs to avoid “strapping operatives” to power tools. One such example has been to change the design of the pile caps to eliminate the need to use hand tools to break out the tops of the concrete piles.

T5’s safety manager Evans picks up the design theme: “We have a formal process, via the CDM supervisor, that ensures we design in safety including feedback from the site to designers,” he says.