… to discover that many firms are turning a blind eye to the serious long-term health risks that their workers are being exposed to. We diagnose the problems.
Compared with site deaths and disabling injuries, the occupational health problems of construction workers sound piffling. Cut fingers and sore backs just don't grab the headlines in the same way as severed limbs or falls from dodgy scaffolding.

"Everyone quite rightly gets concerned about the accident figures. But the reality is accidents are easy to identify, whereas health-related matters are like slow-burning accidents, the results of longer-term exposure," explains Kevin Myers, the Health and Safety Executive's chief inspector of construction. "It's much more difficult to get your head round, so it is difficult to get the same level of attention."

But it is about time the industry did start paying attention. Occupational health issues are costing contractors a fortune and exacerbating the skills crisis. John Hanley, director for health, safety and environment at construction manager Mace, puts forward the financial case. "It costs us £120 for a small injury, by the time it is looked at and the accident report made," he says. "If there are 10 small injuries a month on a site, you are talking about £1200; over a year that adds up to nearly £15,000. If you are working on a margin of 5%, that represents £300,000 worth of work."

Laurence Waterman, who heads Sypol – a health and safety consultancy that advises big clients and the HSE – outlines the skills implications. "We know we lose bricklayers every year from dermatitis," he says. "Because of the fragmented nature of the industry, their disappearance is not noticed in the same way as in, say, it is in the pharmaceutical industry." (See "The top five", page 45.) Furthermore, workers who are made ill by their job take time off sick. This impacts on build programmes and ultimately affects the bottom line.

Waterman has another stark warning for the industry – litigation. "The UK is second only to the US in the compensation culture, which is also why insurance is going up. Claims for people who are damaged long term tend to be higher than for a fatality."

The figures for occupational health problems are staggering. According to the HSE, 79 people in construction died between 2001 and 2002, and there were 3959 serious accidents over the same period. Compare that with the HSE's estimate for occupational health problems in the same period: 137,000 people in the construction industry suffered from an illness they believed was caused, or made worse by their job.

The term "occupational health" covers a multitude of problems. It includes minor injuries, such as a cut finger, and long-term health problems, such as bad backs caused by lifting heavy objects. Indeed, musculoskeletal disorders are higher in construction than in any other industry. These types of problem have an escalating effect – in the short term, the worker takes time off, but then leaves the industry altogether.

Occupational health includes the wider issues of diet and other general health problems that may affect a worker's ability to do their job. This includes stress, whether caused by the job or non-work factors.

Some good news is that the bigger contractors are waking up to the problem. "If you went back 10 years, you wouldn't hear health mentioned at all," says Waterman. "People who have been plugging away for a number of years on this topic feel it's coming to fruition now."

In fact, the Major Contractors Group has signed up to a set of targets including reducing reportable injuries 10% a year, and the incidence of ill health 10% a year from 2003.

Since factors affecting occupational health are so wide-ranging, a variety of initiatives are being adopted. Skanska's approach is typical of larger firms. It employs an occupational health nurse who looks after the whole company, and agency nurses are permanently stationed on large sites, with smaller sites visited occasionally. The nurses look at the risk assessment to identify occupational health risks and ways to reduce them. They also carry out screening, offer dietary advice and deal with minor injuries.

It’s very hard to make a big issue out of someone who has hit their finger with a hammer. The only way is to add up all the figures and commercialise it – then you get the attention of senior management

But it is not just up to the contractor to tackle the risks. Sypol's Waterman says it is vital to eliminate at design stage anything likely to cause occupational health problems. He is currently advising Bovis Lend Lease, the planning supervisor at BAA's Terminal 5 at Heathrow. At T5, the occupational health programme was aligned with the environmental one – so, for example, materials likely to cause dermatitis would be identified in the same way as materials from non-sustainable sources. A "red list" was produced and anything on it had to be fully justified before being used.

Mace's Hanley believes there is a tendency for the industry to react to headline problems that in reality don't affect most trades on site. "You can find you are spending a lot of money on things that are not a problem," he says. Mace records all its minor injuries and identifies the sector where they occur, whether it is piling or drylining – each trade has its own occupational health problem. This allows the firm to identify and respond to trends – for example, manufacturers could round off sharp edges on ducts so workers do not cut themselves when handling them.

The figures can also be used to persuade management to invest in occupational health measures. Hanley says: "It's very hard to make someone who has hit their finger with a hammer a big issue when senior management has to make major decisions on site. The only way is to add up all the figures and commercialise it – then you get the attention of senior management."

Sharon Copland Jones, personnel director at Shepherd Construction, thinks a sound occupational health policy is vital to attracting and retaining staff. Like Hanley, she believes collecting hard data is key to an effective occupational health policy and has been monitoring problems for a year. As more statistics are needed before targeted action can be taken, she says, other approaches have been implemented in the meantime. "Before, if someone went off sick, we weren't very proactive in getting them back – we wanted them to come back with all guns blazing," says Copland Jones. "Now we refer them to an occupational health specialist and phase them back in progressively."

Shepherd's approach has paid off. Copland Jones says sickness rates at the firm have gone down 15% and staff turnover has dropped from 25% a year to 12%. She also looks at other industries to learn lessons, including the rail sector and petrochemicals, particularly oil rigs. She says: "We can learn more from other industries that are light years ahead rather than the industry that has the problem."

Copland Jones focuses on sectors with a similar, largely male, culture to construction because part of the problem, she says, is that people perceive illness as a sign of weakness. This makes identifying and tackling the problems much more difficult.

But it is clear that one or two forward-thinking contractors will not change the entire construction industry, however well researched their approaches.

The HSE realises this, and has employed the services of Sypol's Waterman to help formulate and test an occupational health pilot scheme for the sector. If it is successful, the scheme will be rolled out nationally.

Waterman says the initiative will offer information and advice. He explains that there are only a handful of trained occupational health professionals available, so the scheme is intended to use them most efficiently. So, rather than have the professionals visit sites in person, the idea is to train site managers to detect a possible health problems and refer workers. The site managers would play a similar role to GPs in the health system.

The HSE’s top five occupational health priorities

  • Musculoskeletal disorders top the list of construction’s occupational health problems. They range from bad backs to sprains to repetitive strain injury. According to the HSE, 26% of all reportable incidents in the industry are musculoskeletal in nature. Of those incidents, 34% are injuries lasting longer than three days – in fact, the HSE says workers take an average of 11 days off a year. If temporary injuries are not properly treated and the worker carries on doing the same tasks, the problem can become chronic and disabling.

  • The big killer is asbestos, with 3000 fatalities a year. The HSE estimates a quarter of these deaths are due to exposure to asbestos during building work. The HSE reckons this figure will rise to 10,000 deaths a year by 2010. What’s more, the HSE says, there are thousands of tonnes of the stuff still in buildings, with over half a million non-domestic buildings affected.

  • Noise-induced hearing loss is irreversible and seriously affects people’s quality of life. It is caused by one-off exposure to a loud noise or, more commonly, long-term exposure to the high levels of noise typical on construction sites. Sufferers first notice they find it hard to hear what people are saying at parties or in noisy pubs. This is followed by tinnitus – a ringing in the ears – and more serious loss of hearing if exposure to high levels of noise continues.

  • More than 3000 new cases of hand–arm vibration syndrome are reported each year. This describes a group of conditions caused by exposure of the hands to vibration, the most common being “vibration white finger”. It is usually caused by using power tools such as breakers and hammer drills, whose mechanism of vibration damages blood circulation. When cold or wet, the fingertips turn white and numb. When the circulation returns they become red and painful. If steps are not taken to prevent exposure to vibration, the whole finger can become affected.

  • Cement dermatitis is a skin complaint caused by exposure to wet concrete or mortar, with plasterers, bricklayers and concrete layers at particular risk. Affected skin feels itchy and sore, and becomes red and cracked. There are two variants – irritant dermatitis, caused by the fine particles in the cement irritating the skin, and allergic dermatitis, caused by sensitisation of the skin to chromates contained in cement, causing an allergic reaction. The HSE says between 5% and 10% of construction workers may be sensitised to cement, and of the bricklayers who develop allergic dermatitis, 10% leave the industry. One recent move is a European Union directive limiting the amount of free chromates in cement.

Doing the maths: How healthcare saves money

Logistics specialist Wilson James says it has figures proving that looking after your workforce saves money. The company provided a first-aid and occupational health scheme at Paternoster Square for contractor Bovis Lend Lease, which was working for developer Stanhope. Wilson James’ figures show that the scheme saved £145,000 between April 2002 and January 2003.

The savings are made by dealing with minor injuries on the spot instead of forcing workers to leave site to be treated. Senior site nurse Janine Berns explains: “I get a lot of small injuries – dust in the eye, a graze, a cut … These are things that they would normally have to go to A&E for.” Her most dramatic incident was when a crane operator’s back went into spasm. Berns had to be lifted up to the crane’s cab in a man rider (a box attached to the hook of a second crane) to massage the crane driver’s back and get him down to the ground.

Often workers may have other health problems unrelated to work that need to be looked at. Having the nurse available means a quick diagnosis is possible without the person having to take time off to see the doctor. Savings are also made because help is so immediate – often the worker might not otherwise have bothered to seek help.

Berns also provides a screening service for problems such as cholesterol and diabetes, and she has picked up on several life-threatening diseases – including cancer. She also finds that just having someone impartial to talk to is important. “Someone comes in with a cut finger and then it all comes out – perhaps a relative has died,” she says. Earning and maintaining the trust of the workers is key to the success of the initiative. When Wilson James first started offering the service back in 1998, many workers were suspicious of the screening services, thinking urine samples would be tested for alcohol or drugs. Berns had to reassure them this was not the case. “After I did the induction, I was inundated,” she explains. But she still has to be proactive, and spends time in the canteen with workers to gain their trust.

Gary Sullivan, director of Wilson James, believes this type of service will become more common in the future because workers might sue employers for injuries. It is also part of improving site conditions in general. “We are trying to create sites that are more like a warehouse environment with a reception and people who can look after health issues,” he explains. “If you look at the figures, it is compelling,” says Sullivan. “There is no doubt it has a massive input on the bottom line – and as a human being, it is hard not to do it.”