SHORT REPORT |
Delivery of health surveillance for hand–arm vibration in the West Midlands
Church Road, 1 Park House, Snitterfield, Nr Stratford Upon Avon CV37 0LE, UK
Correspondence to: Mary Kinoulty, Church Road, 1 Park House, Snitterfield, Nr Stratford Upon Avon CV37 0LE, UK. Tel: +44 17 8973 0365; e-mail: mary.kinoulty{at}hse.gsi.gov.uk
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Abstract |
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Background Concerns about provider competence and quality of hand–arm vibrations (HAVs) health surveillance programmes were identified by Health & Safety Executive (HSE) inspectors.
Aims To evaluate health surveillance programmes and compare them with published HSE guidance. To identify deficiencies and areas for improvement in the health surveillance programmes.
Methods A proforma was developed for the study and used on a sample of 10 local occupational health providers.
Results All 10 organizations were aware of current HSE guidance for health surveillance for HAVs but only a minority (30%) were following it. Occupational health provider training, written procedures and health surveillance delivery were all identified as areas requiring improvement.
Conclusions The majority of organizations were not following HSE guidance. Occupational health providers undertaking health surveillance for HAV require specific training.
Keywords Competence; hand–arm vibration; health surveillance
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Introduction |
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The UK Health & Safety Executive (HSE) has included hand–arm vibration (HAV) as one of the priority topics in their ‘Revitalising Health and Safety’ campaign. Feedback from inspectors has suggested that providers lack competence and understanding of the requirements for health surveillance.
Health surveillance for HAV is a statutory requirement under the Management of Health and Safety at Work Regulations 1999 [1] which also requires employers to appoint competent persons to provide health and safety assistance.
The current HSE guidance on provision of health surveillance for HAV is laid out in the publication HS(G)88 Hand–Arm Vibration [2] first published in 1994.
The Faculty of Occupational Medicine has also published guidance [3] in 1993 and more recently, in 2004, an evidence review of clinical testing and management [4].
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Method |
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Between September 2003 and March 2004, 12 local occupational health providers were identified, approached by telephone or e-mail and asked if they carried out health surveillance for HAV. Positive responders were asked to participate in a review of their systems and procedures.
A proforma was developed, based on the document HSG65 Successful Health and Safety Management [5] and HS(G)88, and used as the basis of the interview with the responsible physicians, nurses and technicians.
Copies of policies and procedures were reviewed and outstanding issues of clarification were dealt with in writing.
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Results |
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TopAbstractIntroductionMethodResultsDiscussionConflicts of interestReferences |
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Of the 12 organizations approached, 11 carried out health surveillance and 10 agreed to participate. These comprised two NHS-based services, two in-house services and six external providers.
All organizations involved both occupational health nurses and physicians in the health surveillance process, 10% also used a technician to administer questionnaires. Ninety per cent of organizations had at least one accredited specialist (Membership of the Faculty of Occupational Medicine), and 10% [1] had a physician with the Diploma in Occupational Medicine. Nursing qualifications ranged from no occupational health qualifications to a Degree in Occupational Health, with all organizations having at least one occupational health trained nurse.
All organizations were aware of the HSE document HS(G)88. Thirty per cent of organizations were following the health surveillance guidance in this document, and 70% provided less frequent and/or less detailed surveillance.
Forty per cent of the organizations had policies and procedures in place which clearly identified individual responsibilities and indicated points of onward referral. A further 40% of organizations had limited policies or procedures.
Fifty per cent of organizations carried out only part of the health surveillance process, e.g. questionnaire and general practitioner (GP) referral.
With regard to the organization of the health surveillance, 40% had clear allocation of tasks within the occupational health team.
Referrals were often made on the basis of individual judgement and showed inconsistency within the team.
Communication of results varied with half providing written and half providing verbal feedback to the employee.
Ninety per cent provided written advice on fitness for work to the employer, but only 50% included advice on exposure reduction or job modification. Both in-house services provided written feedback on fitness for work and job modification.
Only 30% of organizations carried out site visits routinely. Clear advice on reporting cases of HAVs under the Reporting of Diseases and Dangerous Occurrences Regulations 1995 [6] was given by 60% of the organizations.
Twenty per cent required all staff to have specific training, and an additional 50% provided in-house or external training for occupational health nurses but not for physicians. Twenty per cent provided in-house training for the physicians.
All organizations stated that they followed their written documentation. This was not evaluated.
Only 30% of the organizations had a system in place to measure performance, undertake audit or review performance.
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Discussion |
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Box 1 highlights the key deficiencies identified by this review. Lack of training on the topic of HAV, for both occupational health nurses and physicians, was clearly identified. Many organizations assumed that physicians were competent to carry out assessments without specific training, or considered sitting in with an experienced colleague for one or two sessions to be sufficient. Training of occupational health nurses was more common, but often not required prior to delivering health surveillance for HAV.
Box 1. Areas where deficiencies were identified
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Only a minority (40%) have clear policies and procedures in place, leaving 60% with the potential for inappropriate management or onward referral.
Fifty per cent of the organizations were providing incomplete health surveillance often with referral of identified problems to a GP and no systems in place to review the response or lack thereof, leading to inadequate feedback to the employer.
Feedback to employers on fitness was generally well done, often using standardized letters, but the implications on work restrictions for exposure reduction and review of processes or control measures were tackled less well, if at all.
For the majority, site visits were not routine as clients would not pay for this service. In these situations, knowledge of the tasks and tools used was limited.
In conclusion, this local review has highlighted that all participating organizations were aware of current HSE guidance on health surveillance for HAV but most were providing a more limited service. The lack of training particularly for occupational physicians and also occupational health nurses on this topic is noteworthy, despite the majority of those involved having an occupational health qualification. Information from this review was fed into the Faculty of Occupational Medicine Working Group on Hand Transmitted Vibration which has recommended the development of competency-based training to be run as a certificated course.
The reviewed health surveillance provision was often incomplete and therefore did not fully protect employees. Feedback to the employer on the adequacy of control measures and necessary work restrictions was frequently omitted.
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Conflicts of interest |
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TopAbstractIntroductionMethodResultsDiscussionConflicts of interestReferences |
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None declared.
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References |
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- HSE. Management of Health and Safety at Work Regulations 1999: Approved Code of Practice L21. London: HSE, 1999.
- HSE. Hand–Arm Vibration. HS(G)88. London: HSE, 1994.
- Faculty of Occupational Medicine of the RCP. Hand-Transmitted Vibration: Clinical Effects and Pathophysiology. London: RCP, 1993.
- Faculty of Occupational Medicine. Clinical Testing and Management of Individuals Exposed to Hand Transmitted Vibration. An Evidence Review, 2004 London: Faculty of Occupational Medicine.
- HSE. Successful Health and Safety Management. HSG65. London: HSE, 2000.
- HSE. A Guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations L73. London: HSE, 1999.
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