Improving occupational health risk management in SMEs: the role of major projects - Research report
2019-03-27T12:01:05Z (GMT) by
Project background Although the management of occupational safety and health (OSH) in construction has been problematic historically, there have been improvements in recent years. Health, however, is typically more difficult to manage than safety, and is often the poor relation, despite the evidence that the human costs of work-related ill-health far exceed those of accidents in construction. Improving practices in small and medium enterprises (SMEs) can be particularly difficult but there is evidence that, for safety at least, good practices ‘trickle’ from major projects and companies to smaller organisations and to those who work in them. This research assessed the impact that large projects can have specifically on the way SMEs manage occupational health (OH) risks: it used in-depth interviews with workers, managers and OSH professionals. The research was conducted on the Defence and National Rehabilitation Centre (DNRC), a major construction project which sought to drive good practice in its supply chain. By focussing in detail on eleven of these ‘mid-level’ companies – which sit between the well-resourced main contractors and very small, typically family-run, micro-organisations – it was possible to explore the specific barriers to good practice becoming embedded and consider the interventions necessary to overcome these. Key findings Many of those working on the project considered that the general arrangements for health risk management were similar to the way they usually worked, and particularly were in line with the way that they would work on other high-profile projects. This reduced the likelihood of those companies learning new practices specifically from this project. Nevertheless, there were some cases where subcontractors had purchased new equipment or adopted new habits to meet the requirements in relation to the management of dust or manual handling. This had given them an insight into the usefulness and benefits of such tools or measures and increased their commitment to use them elsewhere. The main area where interviewees reported requirements on this project to be substantially different to their usual practices was for health assessments. This was an area where the client/main contractor had set out to achieve high standards, by bringing an OH provider onto site and requiring that all contractors arranged health checks for their workers. It was also an area where many of the subcontractors were currently falling below recognised good practice. Some companies which had not done health assessments previously said they would now continue with them; and those who were already doing them to a limited degree had used the project to drive the process forward internally. Some had also learnt about risk assessing and supporting individuals with health conditions, largely as a result of discussions with the occupational health adviser (OHA) on site. Many operational workers interviewed were well informed about risk; they were also highly motivated to take care of their health. There was substantial evidence of ‘trickle-down’, that these workers learnt from large projects such as this and carried this knowledge with them. Those in more senior or professional roles also learnt and transferred good practice between jobs. The subcontractors which adopted good practices most willingly were those which were already working hard to improve their OSH. This typically reflected a growing recognition of their responsibility and duty of care towards their workforce and also an organisational desire to do more work on prestigious projects (which were likely to pay the subcontractors enough to be able to work to these higher standards). One of the biggest barriers to good practice in relation to occupational health risks was a lack of knowledge – individuals at all levels made decisions based on an incorrect understanding of either the risks involved or the legal requirements. For example, the legal requirements relating to health surveillance were widely misunderstood; also, many workers believed masks to be the best solution to dust exposure but underestimated the importance of being clean shaven. Many interviewees commented that their main exposure to health hazards, particularly noise and dust, arose from the activities of others. Typically, they relied on PPE to protect them in these situations. A third barrier to good practice was the relatively high proportion of subcontract, self-employed or agency workers. This reflects common working practice in the industry, and the high turnover of workers on site was reported to influence training, safety culture and the costs and provision of health assessments. However, there were examples of contractors working hard to overcome this, by using the same subcontractors or self-employed workers regularly, or actively increasing the number of workers employed directly. Cost was also identified as a potential barrier to good practice: not necessarily for those working on this project, but, in their opinion, for others on less prestigious projects and those running smaller businesses. Conclusions and Recommendations This research has confirmed the impact that major projects can have on driving good practice along the supply chain and that this applies to health as much as it does to safety. It is therefore important that the clients on such projects: • Set and enforce consistently high standards, to expose the supply chain and its workforce to good practices and encourage them to rise to these expectations • Set expectations for the provision of health assessments, so that companies are motivated and supported to put mechanisms in place • Make such expectations very clear at the tender stage to ensure that work is priced and planned appropriately • Employ suitable occupational health specialists such as OH advisers and occupational hygienists to raise standards and support and educate managers and OSH practitioners • Actively develop knowledge in the supply chain by sharing the expertise of in-house specialists • Manage the interactions between contractors to minimise worker exposures from trades other than their own Additionally, industry wide commitment is required relating to: • Consistency within the industry, and ensuring that prequalification and accreditation schemes set high standards for health alongside those for safety • Training for managers, supervisors and OSH professionals to ensure they are as knowledgeable about health as they are about safety • Improved materials for workforce training so that they fully understand the impact of work related ill-health and know how to avoid it • Increased education regarding OH/medical obligations so that senior managers and others in small companies understand what sensitive data they should and should not collect • Processes for managing OH data at an industry level to ensure that records can follow a worker from one project or employer to another, and that all are working to the same minimum standard; such a process could then operate alongside the current requirement for each worker to have a CSCS card. • Increasing the availability of specialist resource such as OH advisers, OH physicians and occupational hygienists, as there is a shortage of all disciplines across the UK Ongoing efforts will be required to achieve widespread change. Clients on major projects need to focus on setting high standards and clear expectations; and ongoing engagement from major contractors and from bodies such as the Health in Construction Leadership Group, Build UK, and Working Well Together are important to propagate good practice through the supply chain. At the same time, wider industry interventions and continued technological advancements will be needed to enable and build on this; alongside legal intervention where necessary to support the minimum acceptable standard.