Clinical (1) Laboratory (2) Non-clinical (3) DPT and MMR BCG not routinely recommended + + For polio, only boost those handling fecal specimens; diphtheria special arrangements to boost those handling organisms History of routine childhood immunization: diphtheria, polio, tetanus (DPT); mumps, measles , rubella (MMR); tuberculosis (BCG) or positive measles, rubella antibodies, and Mantoux te st if no satisfactory history of immunity and immunization of non-immune History of infection with varicella (chicken pox) or positive varicella antibodies if histo ry unsatisfactory and immunization of non-immune + + + History of immunization against hepatitis B and immunization, followed by check of serology in non-immune + + + If exposed to blood or body \202 uids History of immunization against hepatitis A and typhoid and immunization of non-immune Only if handling speci \201 c organisms Only if exposed to sewage, e.g. drainage engineers In \202 uenza: offer of annual immunization + Only if handling organisms Cholera, meningococcus ACW 135Y, smallpox, tick-borne encephalitis, yellow fever, rabies, J apanese encephalitis, anthrax Only if handling speci \201 c organisms Detailed guidance: Department of health. Chapter 12. In: Immunization against infectious di sease . Available at: M http://www.dh.gov.uk/health/category/publications/reports-publicati ons/ Special \201 tness requirements \200 Fitness for exposure prone procedures (see b p. 49 4, Fitness for exposure prone procedures 1; b p. 496, Fitness for exposure prone procedures 2) \200 Fitness to work with children and vulnerable patients (see b p. 498, Fitness to work with children). 24_Smedley_Chap24.indd 491 1/2/2013 12:38:07 PM CHAPTER 24 Fitness for speci \201 c work 492 Transfer of information about \201 tness for work Transfer of OH records or conclusions a bout \201 tness for work (including immunization status) should only be done with the emp loyee \200\231s consent. Smart cards (transferable electronic record) are increasingly used for some staff groups, e.g. junior doctors and medical students. Specialist skills for professionals who care for HCWs It is recognized that OH and other he alth professionals who provide care and support to healthcare practitioners need particular skills, including the management of alcohol and substance abuse. The Faculty of Occupation al Medicine and Royal College of Psychiatrists have published guidance on competencies for OH Physicians and psychiatrists, respectively. 24_Smedley_Chap24.indd 492 1/2/2013 12:38:08 PM This page intentionally left blank CHAPTER 24 Fitness for speci \201 c work 494 Fitness for exposure prone procedures 1 De \201 nition of EPPs EPPs are health care proced ures where there is a risk that injury to the HCW may result in the exposure of the patient \200\231s open tissues to the blood of the worker (bleed-back). Procedures include those w here the worker \200\231s gloved hands may be in contact with sharp instruments, needle tip s and sharp tissues (spicules of bone or teeth) inside a patient \200\231s open body cavity , wound, or con \201 ned anatomical space where the hands or \201 ngertips may not be co mpletely visible at all times. Categorization of EPPs EPPs are classi \201 ed according to the likelihood that infection would be transmitted from an infected HCW to the patient. Category 1 Procedures where the hands and \201 ngertips of the worker are usually vis- ib le and outside of the body most of the time and the possibility of injury to the worker \200\231s gloved hands from sharp instruments and/or tissues is slight. This means that the risk of the HCW bleeding into the patient \200\231s open tissues should be remote. Category 2 Procedures where the \201 ngertips may not be visible at all times but injury to the worker \200\231s gloved hands from sharp instruments and/or tissues is unlikely. If injury occurs it is likely to be noticed and acted upon quickly to avoid the HCW \200\231s blood contaminating the patient \200\231s open tissues. Category 3 Procedures where the \201 ngertips are out of sight for a signi \201 cant par t of the procedure, or during certain stages, and in which there is a distinct risk of inju ry to the worker \200\231s gloved hands from sharp instruments and/or tissues. In such circ umstances it is possible that exposure of the patient \200\231s open tissues to the HCW \200\231s blood may go unnoticed or would not be noticed immediately. Transmission from infected HCW to patients following EPPs \200 HBV transmission from HbeA g positive HCW is well documented. Several transmissions from HbeAg negative HCW prompted the use of HBV viral load testing in determining \201 tness for EPPs HCV \200\2245 reported incidents of transmission to 15 patients in the UK, and at least 4 other incidents worldwide HIV \200\2243 reported incidents with 8 possible transmissions worldwide. None in the UK de spite 28 noti \201 cation exercises in 7,000 patients up to the year 2003.The risk of tran smission to patients is very low. Duties of health care workers HCWs who carry out EPPs and believe they have been exposed to BBV have a duty to seek professional advice on whether they should be tested. HCWs who kno w they are infected must seek and follow con \201 dential occupational health and expert m edical advice. 24_Smedley_Chap24.indd 494 1/2/2013 12:38:08 PM FITNESS FOR EXPOSURE-PRONE PROCEDURES 1 495 Duties of employers Employers in the health care sector must \200 Ensure that staff are a ware of the guidance on BBV and EPPs \200 Make every effort to arrange occupational adjus tments, re-training, or (as a last resort) ill health retirement for infected employees \200 Promote a climate wh ich encourages con \201 dential disclosure \200 Arrange for HCW to have access to a Cons ultant Occupational Physician. Table 24.2 Summary of testing protocol to assess \201 tness for EPPs Initial screening (minimum documentation of \201 tness for EPPs) Periodic annual screening All HCW undertaking EPPs HBsAg \200\223ve or HBsAg +ve, but HBeAg \200\223ve and HBV DNA< 10 3 copies /mL Annual HBsAg if non-responder to vaccine (persistent anti-HBs <10 IU/L) and not naturally i mmune (anti-HBc \200\223ve) Annual HBV DNA (must remain below 10 3 geq/mL) New HCW Anti-HCV \200\223ve or Anti-HCV +ve AND HCV RNA \200\223ve and Anti-HIV \200\223 ve Routine assessment of \201 tness for EPPs Laboratory tests (summary in Table 24.2) \200 In new HCW: 1 HBsAg (and, if negative, HBeAg with viral load testing (HBV DNA) in those who are HBeAg +ve) and HCV antibody (and, if +ve, HCV RNA) \200 and HIV antibody. Must be carried out on an identi \201 ed validated sample (IVS), i.e.: \200 blood sample taken in an occupational health department \200 photographic proof of identity provided \200 sample not delivered to laboratory by HCW Must be carried out in an accredited laboratory. Only two speci \201 c laboratories are de signated by DH for HBV DNA testing (see HSC 2000/020 under Further reading and guidance ( b p. 496, Exposure prone procedures 2). 1 New HCW are de \201 ned as those who are new to the NHS, those who are starting a post o r training involving EPPs for the \201 rst time, and those who are returning to the NHS a nd many have been exposed to BBV while they were away. All locum and agency recruited HCW p erforming EPPs should be treated as new HCW. 24_Smedley_Chap24.indd 495 1/2/2013 12:38:08 PM CHAPTER 24 Fitness for speci \201 c work 496 Fitness for exposure prone procedures 2 Restrictions from work involving EPPs Box 24.1 summ arizes the current UK guidance on initial restriction of the practice of HCWs who are infec ted with blood-borne viruses, and the speci \201 c circumstances under which HCWs can be a llowed to return to EPPs following appropriate treatment. Box 24.1 UK guidance on initial restriction of the practice of HCWs who are infected with b lood-borne viruses Restrict from work involving EPPs HCW with the following serological markers of infection: \200 Hepatitis B e antigen (HBeAg) +ve \200 Hepatitis B surface antigen (HBsAg) +ve, bu t HBeAg \200\223ve unless viral load (HBV DNA) <10 3 geq/mL Hepatitis C antibody (anti-HCV) +ve AND HCV RNA +ve \200 HIV antibody +ve ( (cid:2) this guidance is subject to current public consultation \200\224see following bullet points). Fitness for EPPs following treatment for BBV infection HBV and HCV infected HCW can recomme nce EPPs under speci \201 ed circumstances following successful antiviral treatment. \200 If HBV DNA levels are <10 3 copies/mL during continuous antiviral treatment or 12mths after treatment ceases \200 during treatment, monitoring HBV DNA at 3 -monthly intervals by a designated hepatologist is mandatory and they must cease EPPs immediately if treatment stops \200 sharps injuries to an infect ed HCW during EPP must be reported, and the patient offered counseling and post-exposure tr eatment with HB immune globulin, according to a risk assessment an infected HCW must cease EPPs if HBV DNA rises >10 3 geq/mL either during or after treatment If HCV RNA is negative 6mths after cessation of therapy. A further check on HCV RNA should be carried out 6mths later. HCV infected HCW may not carry out EPPs during treatment Currently HIV infected HCW who are on antiviral treatment cannot resume EPPs. (cid:2) However, a public consultation is in progress regarding a change in policy to allow EPPs if viral load remains consistently <200 copies/ mL on combination antiretroviral trea tment subject to explicitly de \201 ned 3-monthly monitoring and follow-up by a consultant occupational physician and HIV specialist. Patient noti \201 cation exercises \200 Noti \201 cation of patients who are known to h ave been exposed to a risk of infection from an infected HCW is necessary: \200 to inform the patient about the nature and magnitude of risk \200 to enable treatment and prevention of onward transmiss ion; and 24_Smedley_Chap24.indd 496 1/2/2013 12:38:08 PM FITNESS FOR EXPOSURE PRONE PROCEDURES 2 497 to inform existing estimates of the risks of nosocomial transmission Newly identi \201 ed cases of infected HCW who have carried out EPPs should be discussed w ith the local Director of Public Health (DPH), who will decide on the need to notify patien ts In the presence of an index case of transmission from the HCW to a patient, a patient noti \201 cation exercises will be required in the case of: \200 HBV \200 HCV \200 HIV In the absence of proven transmission: HBV or HCV \200\224there is no automatic requirement for a patient noti \201 cation exercise, but anonymized case-speci \201 c advice must be sought from UK AP (see b p. 497, Speci \201 c advisory bodies) \200 HIV \200\224in the absence of known transmission, noti \201 cation will be con \201 ned to patients who have undergone Category 3 EPPs by the infected HCW. 1 Speci \201 c advisory bodies Advice about restrictions to work and the need for noti \201 cation exercises for new cases of BBV-infected HCW is available from the UK Advisory Panel for health care workers infected with blood-borne viruses (UKAP). Further legislation and guidance Department of Health (2007). Health clearance for tubercul osis, hepatitis B, hepatitis C and HIV: new healthcare workers. Available at: M http://www. dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyandGuidance/DH_07313 2 Department of Health (2005). HIV infected health care workers: guidance on management and p atient noti \201 cation . Available at: M http://www.dh.gov.uk/assetRoot/04/11/64/16/04116416.pdf Department of Health (1993). Protecting health care workers and patients from hepatitis B , HSG(93)40. Available at: M http://www.dh.gov.uk/assetRoot/04/07/93/06/04079306.pdf Department of Health (1996). Protecting health care workers and patients from hepatitis B , Addendum to HSG(93)40. Available at: M http://www.dh.gov.uk/assetRoot/04/08/06/26/04080626 .pdf Department of Health (2000). Hepatitis B infected health care workers , guidance on im ple- mentation of Health Service Circular 2000/020. Available at: M http://www.dh.gov.uk/ a ssetRoot/04/05/75/38/04057538.pdf Department of Health (2007). Hepatitis B infected healthcare workers and antiviral therapy. Available at: M http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publication sPolicyAndGuidance/ DH_073164 Department of Health (2002). Hepatitis C infected health care workers. Available at: M http :// www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4010554 UK Advisory Panel for health care workers infected with blood-borne viruses. Available at: M http:// www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/BloodborneVirusesAndOccupat ional Exposure/UKAP/ 1 Department of health (2005). HIV infected health care workers , guidance on management an d patient noti \201 cation. DH, London. 24_Smedley_Chap24.indd 497 1/2/2013 12:38:08 PM CHAPTER 24 Fitness for speci \201 c work 498 Fitness to work with children General considerations Considerable psychological and emotion al demands are placed on peo- ple who work with children. Some jobs involve the worker acti ng in loco parentis , or supervision of potentially hazardous sports, such as swimming. Wor kers need to be able to relate to children and be able to maintain control without loss of temper or physical violence. Hazards associated with working with children \200 Voice trauma \200 Communicable disea ses \200 Ergonomic (bending, manual handling, sitting on small chairs) \200 Physical or verbal assault from children or parents. Criminal record Individuals whose work will involve contact with children should have their records checked by the Criminal Records Bureau. This will under- take a level of disclosur e appropriate to the post applied for M http:// www.homeof \201 ce.gov.uk/agencies-public- bodies/crb/ Statutory requirements The Education (Health Standards) (England) Regulations 2003 state th at employers and training providers must ensure that a person has the health and physical \201 tness to teach. If it appears to an employer that a teacher may no longer have the he alth or physical capacity to carry out a rel- evant activity, the employer must follow the procedures under the 2003 regulations. Occupational health assessment The decision on \201 tness should be made following an ind ividual risk assess- ment based on \200 The nature of the work \200 The age group of th e children \200 The health status of the worker. General factors \200 Ability to undert ake the duties of the post (adjusted if necessary), without constituting a health or safety risk to the children \200 Ability to communicate effectively with children, parents and colleagues Ability to deal with an emergency situation and administration of \201 rst aid Any adverse effect the job may have on the individual \200\231s health \200 Individuals w hose responsibility includes driving children should meet the DVLA driving standards A history of pedophilia or voyeurism (e.g. child pornography websites) precludes working with children. (cid:2) Any decision to \201 nd an individual un \201 t should be made only if the indiv idual has been fully investigated by their GP or specialist and has been 24_Smedley_Chap24.indd 498 1/2/2013 12:38:08 PM FITNESS TO WORK WITH CHILDREN 499 given appropriate treatment. Such decisions are often dif \201 cult and may be contentious ; therefore discussion with a more experienced colleague may be helpful. The following speci \201 c conditions would need careful consideration in consultation wit h a specialist: \200 Speci \201 c psychiatric conditions: \200 Schizophrenia poorly controlled bipolar affective disorder \200 persistent or recurrent severe depressi on resistant to treatment \200 anxiety disorder with uncontrolled panic attacks \200 ea ting disorders associated with self-injury \200 Fabricated or Induced Illness (FII) (prev iously known as Munchausen \200\231s syndrome and Munchausen \200\231s syndrome by proxy) profound personality disorder \200 drug or alcohol dependency Individuals with epilepsy (see b p. 464, Epilepsy), or impairment of vision or hearing must have a full risk assessment Individuals with active tuberculosis should not work with children until they are non-infectious. Protection of employees \200 Consider testing female staff of childbearing age for rubell a antibodies and offer immunization well in advance of pregnancy if non-immune \200 Consi der Hepatitis B vaccine if working with children with learning dif \201 culties or behavio ral problems, due to the risk of biting or scratching. Legislation and guidance \200 The Equality Act 2010 \200 The Education (Health Standard s) (England) Regulations 2003 \200 Fitness to Teach. Occupational health guidelines for t he training and employment of teachers. Department of Education and Employment. 24_Smedley_Chap24.indd 499 1/2/2013 12:38:08 PM CHAPTER 24 Fitness for speci \201 c work 500 Fitness for work in con \201 ned spaces (or with respirators) Task demands Con \201 ned s paces can be found in many workplaces. Hazards in con \201 ned spaces include: \200 Dif \201 cult access/egress \200 A non-respirable atmosphere \200 Low oxygen levels \200 Toxic gas \200 An explosive atmosphere. One means of controlling some of these risks is a full-face respirator or, in some circumstances, an escape set. General principles \200 The worker should not be suffering from a medical condition that would be aggravated by wearing a respirator Any illness should not pose an unacceptable risk to the health or safety of the individual or other workers. Examples of conditions which may cause problems include: \200 cardiac d isease \200 chronic obstructive pulmonary disease (COPD) \200 musculoskeletal problems A doctor should carry out a pre-placement medical assessment focusing on \201 tness to use a respirator Test lung function using spirometry to identify individuals with impaired lung function as this might compromise their ability to tolerate a respirator or to escape in an emergency Getting the prospective worker to use the relevant respirator is a useful exercise to see if he/she has any dif \201 culties. Assessment frequency \200 Every 2yrs for workers over age 18 \200 Following illness or injury if it is believed the operator may be un \201 t. Speci \201 c issues \200 Vision should be adequate: 6/6 corrected vision in the better e ye without visual \201 eld de \201 cit Asthma: some asthmatics cannot tolerate a respirator \200 Claustrophobia: is a contraindi cation to work in con \201 ned spaces. \200 Respirator \201 t: should be tested 1 idea lly by a Fit2Fit accredited \201 t tester. Factors that in \202 uence respirator \201 t: \200 facial deformity, e.g. retrognathia \200 beard \200 other PPE. 1 HSE Fit testing of respiratory protective equipment face pieces , HSE operational circula r OC282/28. Available at: M http://www.hse.gov.uk/foi/internalops/fod/oc/200 \200\223299/28 2_28.pdf 24_Smedley_Chap24.indd 500 1/2/2013 12:38:08 PM FITNESS FOR WORK IN CONFINED SPACES (OR WITH RESPIRATORS) 501 Legislation and guidance \200 Con \201 ned Spaces Regulations 1997. Approved Code of Pra ctice, Regulations and Guidance . L101, HSE Books, Norwich, 1997. ISBN 071761405. Cox R, Edwards F, Palmer K (eds) (2007). Fitness for Work: The Medical Aspects (4th edn). Oxford University Press, Oxford. British Safety Industry Federation Fit2Fit RPE \201 t testers accreditation scheme M http://www. \201 t2 \201 t.org/ 24_Smedley_Chap24.indd 501 1/2/2013 12:38:08 PM CHAPTER 24 Fitness for speci \201 c work 502 Fitness for seafaring Task demands \200 Seafaring is a diverse occupation that encompasse s those operating in near-coastal waters and those sailing in distant waters. The latter gr oup may be at sea for many weeks in remote locations far from medical assistance Broadly speaking, there are three categories of crew: deck crew (cargo handling, watch keeping) \200 engineers and radio operators \200 suppo rt staff (caterers, stewards, etc.) Fitness standards and task demands vary by occupation, but in any event crew must be \201 t to undertake emergency response procedures (e.g. abandon ship, \201 re \201 ghting) MSN1765 (M) provides guidance on task demands and the rationale for \201 tness standards for speci \201 c conditions. General principles \200 The seafarer should not be suffering from a medical condition tha t would be aggravated by being at sea Any illness should not pose an unacceptable risk to the health or safety of the individual, other crew, or the vessel A doctor approved by the Maritime and Coastguard Agency (MCA) carries out seafarer medical assessments The doctor assesses the individual \200\231s \201 tness against occupational demands and the medical and eyesight standards Following assessment the doctor issues a medical \201 tness certi \201 cate (form ENG1) for category 1 or 2. An ENG3 form Notice of Failure/ Restriction is issued for categories 3 or 4 If the ENG3 form runs for longer than 3/12 the seafarer may appeal against the examining doctor \200\231s decision. Assessment frequency \200 Every 2yr for seafarers over age 18 \200 Annually for seafare rs aged less than 18yrs old \200 Where, as a result of illness or injury, it is believed that the seafarer may no longer be \201 t. Fitness categories \200 Category 1: Fit for sea service, with no restrictions \200 Cate gory 2: Fit for sea service but with restrictions (e.g. near-coastal waters only) Category 3: Temporarily un \201 t for sea service \200 Category 4: Permanently un \201 t for sea service Speci \201 c issues \200 Vision: deck crew should have 6/6 corrected vision in the bette r eye and 6/12 vision in the other eye without visual \201 eld de \201 cits 24_Smedley_Chap24.indd 502 1/2/2013 12:38:08 PM FITNESS FOR SEAFARING 503 Color vision: deck crew must have normal color vision assessed using Ishihara test plates t o undertake watch keeping. Where an individual fails this test, he/she may be tested using the Holmes Wright B Lantern at an MCA of \201 ce. Legislation and guidance Merchant Shipping (Medical Examination) Regulations 2002: Seafarer Medical Examination System and Medical and Eyesight Standards. Maritime and Coastguard Age ncy, Merchant Shipping Notice MSN 1765 (M). 24_Smedley_Chap24.indd 503 1/2/2013 12:38:08 PM CHAPTER 24 Fitness for speci \201 c work 504 Fitness for safety critical work De \201 nition Safety critical work is any task that (in the event of failure) may lead to an accident, or otherwise compromise the safety of: \200 People (employees, clients or service users, the public) \200 Plant or premises \200 The environment. Safety critical work \200 Regular vehicle driving, particularly passenger vehicles, e.g. train drivers, pilots \200 Work at heights \200 Work in con \201 ned spaces \200 Work with , or near, electrical or mechanical equipment, including those in customer \200\231s houses Managing safety critical control systems, e.g. plant control rooms, air traf \201 c controllers, nuclear industry Working on railroad premises or infrastructure; this includes drivers, guards, and signalmen Work on construction sites, e.g. banks men, tower crane operators. Task demands and \201 tness standards Safety critical jobs depend on the employee being c ompetent to under- take the required task, and being \201 t to do so. \200 Fitness stan dards for safety critical work vary by industry. Some are statutory and others advisory (se e b p. 474, Fitness to drive 2; b p. 476, Fitness for professional diving; b p. 484, Fitnes s for work in professional pilots) Doctors who advise about \201 tness for safety critical work must have special knowledge of both task demands and statutory or industry \201 tness standards. General principles \200 A useful rule of thumb is \200\230Would this person be able to d rive an LGV/ PCV under DVLA rules? \200\231 A disease or disability may affect \201 tness for safety critical posts where the conditi on is a \201 xed disability (e.g. loss of a limb) or a progressive condition that may com promise \201 tness in the future, such as multiple sclerosis Pharmacological treatment of a condition may compromise \201 tness for safety critical posts, e.g. by leading to increased drowsiness (these effects may be te mporary) Broadly speaking, conditions that may compromise \201 tness for safety critical posts are those that: \200 lead to sudden incapacity/altered consciousness (e.g. epilepsy, diabetes) affect mobility (e.g. rheumatoid arthritis) \200 affect balance (e.g. M ni re \200 \231s disease) \200 affect cognition (e.g. dementia, brain damage) 24_Smedley_Chap24.indd 504 1/2/2013 12:38:08 PM FITNESS FOR SAFETY CRITICAL WORK 505 affect risk perception (e.g. mental handicap) \200 affect behavior (e.g. psychosis, perso nality disorder, substance misuse) affect communication (e.g. deafness, visual impairment, speech problems, abnormal color vision) Review of the job description, task analysis, a workplace visit, and discussion with experienced supervisors will assist in determining the demands of a safety critical post When assessing an individual \200\231s \201 tness for a safety critical post it may be di f \201 cult to obtain suf \201 cient information to make an informed decision based solel y on a health questionnaire. In such cases a consultation for a detailed medical history an d examination will be necessary Useful additional information regarding the medical condition may be obtained from the indi vidual \200\231s GP or specialist, especially when dealing with an employee suffering from a rare condition In cases of doubt, discussion with a senior OH physician may be helpful In some cases a supervised workplace assessment may be necessary to establish an individual \200\231s \201 tness for the task. Speci \201 c issues Health and safety reasons may genuinely preclude an individual with a dis- ability from undertaking a safety critical task. However, before concluding an employe e is un \201 t, an employer should consider whether any reasona- ble workplace adjustments would allow the employee to undertake safety critical work. The employer should carefully document their reasoning in case it is subsequently challenged at an employment tribunal un der the Equality Act 2010. Assessment frequency This will vary by industry sector. Generally, annual review is the min imum assessment interval, but longer intervals may be stipulated where dealing with young \201 t workers without pre-existing disease. Where an employee suffers from a progressive medical condition, more frequent review of \201 t- ness by the physician may be indicated . Legislation and guidance Guidance on Alcohol and Drug Misuse in the Workplace . Faculty of Occupational Medicine, London, 2006. ISBN 1860162819. 24_Smedley_Chap24.indd 505 1/2/2013 12:38:08 PM This page intentionally left blank Section 5 Occupational health law 25 UK health and safety legislation 26 Employment law 27 Legislation related to OH records 28 Environmental legislation 509 557 577 585 25_Smedley_Chap25.indd 507 1/2/2013 12:40:03 PM This page intentionally left blank 509 Chapter 25 UK health and safety legislation Health and safety regulation in the UK 510 Health and safety inspectors 512 Regulations, ap proved codes of practice, and guidance 514 Safety committees and safety representatives 516 Health and Safety at Work etc. Act 1974 518 Management of Health and Safety at Work Regulations 1999 520 Young people at work 522 New and expectant mothers 524 Workplace (Heal th, Safety and Welfare) Regulations 1992 526 Health and Safety (Display Screen Equipment) R egulations 1992 528 Provision and Use of Work Equipment Regulations 1998 530 Control of Substances Hazardous to Health Regulations 2002 532 Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 534 First Aid at Work Regulations 1981 536 Control of Lead at Work Regulations 2002 538 Control of Asbestos Regulations 2012 540 Ionizing Radiation Regulations 1999 542 Diving at Work Re gulations 1997 544 Work in Compressed Air Regulations 1996 546 Control of Noise at Work Reg ulations 2005 548 Control of Vibration at Work Regulations 2005 550 Food Hygiene Regulation s 2006 552 Registration, Evaluation, Authorization and Restriction of Chemicals 554 25_Smedley_Chap25.indd 509 1/2/2013 12:40:03 PM CHAPTER 25 UK health and safety legislation 510 Health and safety regulation in the UK Background Health and safety legislation in the UK d eveloped in a piecemeal fashion from the early nineteenth century onwards. This had the unf ortunate con- sequence of some sectors being heavily regulated by many separate pieces of l egislation, while others were effectively unregulated. In 1970, the Robens Commission was set up to review the UK \200\231s work- place health and safety laws. Their report led to: \200 The Health and Safety at Work, et c., Act of 1974 (HSW) \200 The establishment of the Health and Safety Executive (HSE). Health and Safety Executive \200 Exists to protect the health and safety of workers (incl uding the self-employed) and the public from hazards arising from work Governing board of up 12 persons, appointed by the Secretary of State for Work and Pensions in consultation with key stakeholders: \200 employers \200\231 orga nizations \200 employee organizations \200\223 trade unions \200 local authorities Proposes health and safety legislation and associated guidance to government ministers Responsible for enforcement of health and safety legislation in conjunction with local authorities Undertakes reactive and planned inspection of workplaces \200 Funds research into health and safety issues in support of regulation. HSE strategy 2011 Good for Everyone. The next steps in the Government \200\231s plans for r eform of the health and safety system in Britain. 2011. See M http://www.dwp.gov.uk/docs/go od-health-and-safety.pdf This document sets out a new plan for health and safety regulation in the UK, with a deregu latory agenda that aims to reduce the burden of bureaucracy for businesses. The key feature s are: \200 Reducing the number of HSE inspections, but \200 focusing inspections on hi gh risk industries \200 shifting away from scrutiny of low risk organizations \200 Taki ng strong action against employers who breach seriously health and safety law, and making them responsible for the costs of inspections and recti \201 cation of the breach Developing a register of competent Health and Safety Consultants, and clamping down on a pe rceived plethora of health and safety advisers who are not competent Simplifying health and safety legislation and providing simple summary advice to low risk businesses A review of health and safety regulation. 25_Smedley_Chap25.indd 510 1/2/2013 12:40:03 PM HEALTH AND SAFETY REGULATION IN THE UK 511 Local authorities \200 Statutory responsibility for health and safety inspection and enforcement in: \200 shops \200 of \201 ces \200 leisure \200 residential homes \200 hotels and restaurants \200 distribution (wholesale and retail) including gasoline stations \200 Links with HSE through the Health and Safety Executive/Local Authorities En forcement Liaison Committee (HELA) to ensure conformity of approach by Local Authorities ac ross the UK (see b p. 512, Health and safety inspectors). Relevant legislation \200 Legislation.gov.uk (2003). Health and Safety at Work etc. Act 1 974 , Chapter 37. TSO, Norwich. Available at: M http://www.legislation.gov. uk/ukpga/1974/37 The Legislative Reform (Health and Safety Executive) Order 2008. Available at: M http://www.legislation.gov.uk/uksi/2008/960/contents/ made Further information The health and safety system in Great Britain M http://www.hse.gov.uk/ pubns/ohsingb.pdf 25_Smedley_Chap25.indd 511 1/2/2013 12:40:03 PM CHAPTER 25 UK health and safety legislation 512 Health and safety inspectors Enforcement of workplace health and safety law in the UK is th e respon- sibility of HSE inspectors and their equivalents in local authority environ- ment al health departments. HSE inspectors HSE inspectors are normally graduates, from a range of industry back- ground s. On appointment, they receive extensive additional training in health and safety and the relevant law. Currently, inspectors are organized into several directorates. \200 Field O perations Directorate (FOD) is the largest grouping of inspectors, and covers a number of sectors excluding railways (the rail industry is the res ponsibility of the Of \201 ce of the Rail Regulator): the regional of \201 ces also house the occupational physicians and nurses who work with FOD Of \201 ce for Nuclear Regulation: an agency of the HSE: regulates the nuclear industry Hazardous Installations Directorate covers health and safety in the following sectors: \200 petrochemical industry \200 explosives industry \200 mines \200 diving \200 sites where genetically modi \201 ed organisms or biological agents ar e handled transportation of hazardous agents. Role of HSE inspectors The role of HSE inspectors includes: \200 Inspection of workplaces : this may lead to: advice to the employer \200 improvement notice \200 prohibition notice \200 prosecuti on Accident investigation \200 Liaison with local authorities \200 Advice to the public \200 Information gathering. Local authority inspectors Local authority inspectors are generally environmental health of \201 cers (EHOs). Some inspectors, in larger authorities, specialize in a speci \201 c a rea such as health and safety. In contrast, EHOs in smaller authorities may also be respons ible for dealing with food hygiene, noise pollution, and other statutory duties placed on l ocal authorities. Powers of inspectors \200 Statutory right of entry to work places (without notice) \200 Right to interview staff and supervisors 25_Smedley_Chap25.indd 512 1/2/2013 12:40:03 PM HEALTH AND SAFETY INSPECTORS 513 Right to take samples and photographs \200 Right to seize dangerous equipment \200 Enfo rcement: inspectors can take enforcement action against employers, the self-employed, or employees where the prevailing standards of health and saf ety management are unacceptable. They can issue either an improvement notice or a prohibiti on notice. In serious cases they may also pursue a prosecution through the criminal courts. Improvement notice This notice requires an organization to address a named health and safet y breach within a speci \201 ed period. An employer may appeal to an employ- ment tribunal against an improvement notice. In this case, the notice is suspended pending the decision of the tribunal. Prohibition notice Issued by an inspector where there is thought to be a risk of illness or injury. Work must stop until the breach is addressed. Generally, a prohibi- tion notice ta kes immediate effect unless stopping a process immediately will be dangerous. In that situa tion a prohibition notice will be delayed until the process is complete. No suspension occu rs if an appeal against a prohibition notice is made to an employment tribunal. Relevant legislation HM Govt. (2003). Health and Safety at Work, etc., Act 1974 , Chapter 3 7. TSO, Norwich. Available at: M http://www.legislation.gov.uk/ ukpga/1974/37 25_Smedley_Chap25.indd 513 1/2/2013 12:40:03 PM CHAPTER 25 UK health and safety legislation 514 Regulations, approved codes of practice, and guidance The Health and Safety at Work etc. Ac t 1974 laid down the framework for subsequent health and safety legislation in the UK. The Act has been supplemented by various regulations that relate to particular topics (e.g. man ual handling at work). Regulations set out general principles, and are supported by more de tailed codes of practice. Regulations The Secretary of State, on the recommendation of the Health and Safety Executiv e, makes new regulations under the umbrella of the Health and Safety at Work etc. Act 1974. Increasingly, new regulations are brought forward in response to EC directives. Any propos ed new regulation under the Health and Safety at Work etc. Act 1974 must be laid before par lia- ment for a period of 21 days. Thereafter, it becomes law, provided that no objections are raised during this period. Approved codes of practice Approved Codes of Practice (ACOPs) have a special status within the UK regulatory framework. The Health and Safety Executive approve ACOPs after agreement by the relevant Secretary of State. Failure to comply with an ACOP can be held to be eviden ce of a breach of the Health and Safety at Work etc. Act 1974, or a breach of the speci \201 c regulations to which the ACOP relates. In principle, an employer can choose not to follow an ACOP. However, in the event of challe nge by an inspector, defendants must demonstrate that they have complied with regulations i n an equivalent manner to that recommended by the ACOP. \200 In practice, it is easier fo r employers to comply with an ACOP than to justify their own approach As an ACOP can be readily updated, this allows health and safety standards to be kept up to date. Guidance The Health and Safety Executive regularly issue guidance on health and safety matt ers, and on the implementation of health and safety regulations. Unlike ACOPs, employers ar e not compelled to follow guidance notes. However, compliance with regulations must still b e achieved. Relevant legislation HM Govt. (2003). Health and Safety at Work, etc., Act 1974 , Chapter 3 7. TSO, Norwich. Available at: M http://www.legislation.gov.uk/ ukpga/1974/37 25_Smedley_Chap25.indd 514 1/2/2013 12:40:03 PM This page intentionally left blank CHAPTER 25 UK health and safety legislation 516 Safety committees and safety representatives The Safety Representatives and Safety Committe es Regulations 1977 cover the prescribed functions of union-appointed safety representative s. Representatives of employee safety are the equivalent of union-ap- pointed \200\230safe ty reps \200\231 in non-unionized workplaces. Their more limited role is de \201 ned in th e Health and Safety (Consultation with Employees) Regulations 1996. Separate regulations, the Offshore Installations (Safety Representatives and Safety Committ ees) Regulations 1989, apply to workers on offshore installations, Safety representatives \200 Represent employees \200\231 interests on matters of workplac e health and safety Are immune from prosecution for their actions as safety reps \200 Must be given paid time off work to act as safety reps, and to attend training relevant to their role and responsi bilities. If an employer fails to give paid time off, the safety rep. can complain to an in dustrial tribunal. Representatives of employee safety Although the role of representatives of employee safety is more limited than that of safety reps, it is open to the employer to give them a wider r emit. Their role, as de \201 ned in legislation, is: \200 To represent workers \200\231 interests to the employer \200 To approach the employer about workplace hazards/dangerous occurrences To approach the employer about issues affecting the workers they