Health surveillance and occupational health

Employers have a legal duty to implement a health surveillance programme if their employees are exposed to certain health risks. The programme should ensure that procedures are in place to detect early signs of work-related ill health, with the results swiftly acted upon.

For certain health risks, there is a statutory duty on employers to provide occupational health surveillance, although this can be fulfilled by appointing a competent person (such as an occupational healthcare provider).

Health surveillance is required in any workplace where each of the following are met:

• the work is known to harm health in some way
• there are valid ways of detecting the disease or condition
• there is a reasonable likelihood that damage to health may occur under the particular conditions at work
• the surveillance is likely to benefit the employee
• the technique of investigation is of low risk to the employee

Proactive health surveillance (with health records kept) is appropriate for occupations where contact is likely with known or suspected BBV-infected patients or with BBV-contaminated materials. Healthcare organisations will have policies to manage and follow-up recognised incidents of sharps injuries during surgical and needle-related procedures.

It is also a statutory requirement to keep health records in relation to work involving risk of exposure to BBV under COSHH regulation 11(3).

Keeping health records

Health records are not medically confidential documents. They provide feedback to management on the results of health surveillance, both for the purpose of safely deploying each employee and allowing collective analysis of the overall effectiveness of immunisation for staff at risk. Health records also allow for outcome analysis of ill health from BBV exposure to be done at a later stage (should this prove necessary), as required under regulation 5 of the MHSWR.

Health records – those showing the outcome of occupational health surveillance – should be held by and available to managers responsible for deploying staff. The only exception is when an employer can demonstrate that reasonable access to these records is available to such managers whenever the relevant staff are working (eg through health records retained by an occupational health department).

There are additional provisions for health records relating to work with biological agents, such as a historical record of work with - or exposure to - blood-borne viruses. This is particularly relevant for:

• infectious agents that have the potential to cause persistent or latent infections, or which may have serious long-term consequences (ie Hazard Group 3 biological agents)
• BBVs with potential for causing sub-clinical, chronic infections (regarded as Category 1 Carcinogens), such as hepatitis B and hepatitis C (see: Employer guidance for monitoring occupational exposure to BBV for further information).