Guidance for Construction Clients

Why clients should play a proactive role - Guidance for Clients

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Occupational health in the industry – an overview
There are over 250,000 companies employing in excess of 2.0 M people within the Construction Industry.  Half of those workers are employed by SME or micro companies including the self-employed.

There was a call to arms in the mid-nineties to make a step change improvement in serious injuries and deaths in the industry.  Although safety improved significantly, health issues did not get the same focus, mainly out of a lack of awareness.

The larger contractors have made significant improvements in managing occupational health during the past five years, but the fact still remains that 98% of work related deaths in 2009/10 were caused by ill health.

Only 46% of men are still able to do the job at the age of 60.  This, against a backdrop of an increasing retirement age; the industry emerging from a recession and the estimated cost of circa £100,000 to train a replacement worker with similar work experience.

The nature of the Construction Industry means it tends to have a transient workforce, with workers more likely to live and work in different parts of the country, with a consequential lack of access to GP services or other health providers. Being away from the influence of their families, they are less likely to seek medical attention timely when symptoms first present themselves.

The Legal Requirement:
The Health and Safety at Work   Act 1974 requires employers, the self-employed and those in control of work to ensure the health,  safety and welfare of  employees and others who may be affected by their work activities (such as others working on the site or members of the public). This means that the employer, or person in control of the work, needs to take action to ensure that risk is controlled.  This risk can include where the poor health of a worker could affect their ability to carry out any work related task, they have been given, safely.
Under The Management of Health and Safety at Work Regulations 1999 employers have a duty to carry out risk assessments to identify risk and the level  of risk associated with a particular work activity. Then follow up by applying the appropriate control measures needed to eliminate or control these identified risk(s). Employers also need to ensure, under Regulation 6 of the Act, that relevant health surveillance is provided, with the appropriate health surveillance relating to the risk(s) that has been identified through the risk assessment process.

Other, more specific regulations also outline legislative requirements for risk assessment and health surveillance, and therefore the prevention and control of occupational health issues:

• The Control of Asbestos at Work Regulations 2012
• The Control of Lead at Work Regulations 2002
• The Control of Substances Hazardous to Health Regulations 20024 (COSHH)
• The Control of Vibration at Work Regulations 2005
• The Control of Noise at Work Regulations 2005

There are also far reaching duties under the Construction Design and Management (CDM) Regulations 2007 placing greater emphasis on the prevention of exposure to uncontrolled risks and is the guiding Regulations on construction with clear duties for clients to ensure that all risks are considered and assessed.

History of Constructing Better Health (CBH)
In 2005 it was recognised that the Construction Industry’s approach to occupational health was fragmented, poorly informed and generally not working efficiently.  This gave birth to CBH an industry owned, not for profit organisation (currently in the process of becoming a Charitable Trust) which focussed on equipping the industry with the tools and knowledge to tackle the health challenges of the sector.  CBH with the input of industry created:

  • National Occupational Health Standards for the industry (the Industry Standards)
  • An accredited list of Occupational Health Service Providers (OHSP) who are able to advise contractors and undertake health checks required by law and for best practice
  • Guidance on  matters for all of those involved in Occupational Health  relating  to the Construction Industry
  • A national database and Construction Health Action Toolkit (CHAT), providing for the first time, one accessible location where all relevant information to monitor the health of workers is stored.  This legacy information significantly  reduces the cost of health checks as workers change employers, both in terms of OH input and lost productive time, providing a truly sustainable solution
  • Clear definitions of safety critical worker occupations
  • An easy to use template for assessing health risks to eliminate, reduce or manage the risk in hand, which can be cascaded down throughout the supply chain
  • Guidance notes and  advice on matters relating to occupational health provision
  • A CBH membership card that can link to other industry recognised cards e.g. CSCS, to enable employers to check an individual’s health status
  • National help line

The client’s role as an enabler
There is good evidence to show that by following industry best practice, better value can be derived by all involved in the construction process.  It must be remembered that the adoption of effective occupational health within the construction industry is still in its infancy; at the lower reaches of the supply chain there are further obstacles created by the transient nature and culture of the workforce. The larger employer organisations, although committed to placing the same importance to health as they do with safety with their own employees, they do  struggle to achieve these standards down through their supply chains.
It is recommended that clients should:

  • Sign up to CBH and incorporate in their procurement process a request that those tendering need to demonstrate that they manage occupational health to the CBH Industry  Standards, including the management of the supply chain.
  • Consider whether it is appropriate given the size, nature and location of the project to invest in a centralised site based occupational health facility. The provision of workplace access to OH is proven to reduce ill health downtime or time lost from attending clinics or hospital. It must however be remembered that this is not a sustainable solution for the majority of the supply chain in isolation. Clients are recommended to ensure that all suppliers should be asked to demonstrate that they have engaged an occupational health provider to service their company if they do not have in-house capability. Clients should also be aware of principal suppliers influencing the provision of on-site facilities at the client's expense when they already have costs allocated in the overheads they are charging. These conversations should commence with the principal contractor/s providing the facility at their cost and only embark on a client funded solution where there is a clear benefit.
  • Be proactive in reviewing the policy and strategy of the principal contractor in addressing occupational health issues.
  • Proactively engage in healthy living provision when establishing and maintaining site facilities and worker services. A fit and healthy workforce is likely to be more productive. Improving health has got to be a good objective! It is seen by the workforce as a positive benefit and will help reduce the turnover of site staff.

The benefits of proactive involvement with CBH
Although it is clearly the responsibility of the client’s principal contractor to manage and co-ordinate health and safety on the site, this is greatly enhanced by the support of the client.  It has been shown that being clear on what is required and proactive involvement gives added value to the client’s undertaking as:

  • The workforce are more productive  as they react well to a client who is intent on sending them home at night in as good or better condition than they arrived that morning.
  • Turnover of workers improve, leading to better productivity and savings in induction and site specific training, particularly if a client has restricted access problems.
  • Your Principal Contractor and supply chain partners who are signed up to CBH will be following robust guidance, reducing wasted time and resource in carrying out health checks that are now based on a competent risk assessment.
  • You will be adding to the wealth of knowledge being collected within CBH national database, which can be used to research health issues in the future and help create a sustainable workforce for the future.

Your contractor will be able to recruit workers who can be medically assessed before starting work and continue to be monitored via construction industry specific occupational health service providers; further health status will be able to be checked through checking a card and to see if any further health checks are required or have lapsed

Selection of an appropriate approach
Clients within the construction industry vary in size and complexity; some are repeat clients with large programmes of work, while others could have a simple one off project to complete to satisfy their business needs.  It is therefore important to look at industry best practices and learn from others when you have a project or programme of works of an extraordinary nature.

Occupational Health programmes may be delivered in different ways.

  • Clients managing large portfolios of work in a limited geographical area may take the view that a shared occupational health facility will be provided (at their cost) for the whole construction workforce irrespective of the contracting employers working at any given time. This provides the advantage of the Client being able to choose the OH provider e.g. BAA at Heathrow, and the Olympic Delivery Authority
  • Clients of larger projects may determine that they expect the Principal Contractors to operate occupational health (OH) schemes covering their direct employees and the employees of their supply chain. (Crossrail operates an excellent example of this approach) This needs to be supported through the provision of good quality OH facilities within site welfare accommodation. In order to be proactive - clients should monitor standards of OH delivery. 
  • One off clients with smaller projects or geographically diverse projects may tend to use contractor led programmes. However this scenario can sometimes have a tendency to focus on health and safety (H&S) compliance rather than a proactive service as described above with little attention given to the ‘health’ side of the equation


Further advice and support:

CBH Client Charter Agreement

Useful Links Contractors Occupational Health Service Providers Employees Clients Affiliates