What is Health Surveillance?
Health Surveillance is the regular and repeated monitoring of an employee’s health to identify ill-health caused by work. Health Surveillance is legally required when employees are still exposed to health risks after control measures have been put in place. Some of the hazards that could affect employee health include noise, dust, chemicals and vibration.
The results are compared to create an overview of an employee’s health and create the ability to spot any trends.
There are generally two types of health surveillance:
- Statutory medicals required by law for hazards such as asbestos, lead, ionising radiation and compressed air.
- Risk assessment driven medicals for hazards such as noise, dust, fumes, solvents, repetitive tasks, vibration and manual handling.
Is it a legal requirement for employees to attend?
Put simply, yes.
As stated by Section 7 of the Health and Safety at Work etc. Act 1974, it shall be the duty of every employee while at work –
(a)to take reasonable care for the health and safety of himself and of other persons who may be affected by his acts or omissions at work; and
(b)as regards any duty or requirement imposed on his employer or any other person by or under any of the relevant statutory provisions, to co-operate with him so far as is necessary to enable that duty or requirement to be performed or complied with.
If an employee refuses to attend a health surveillance medical driven by a risk assessment it shows a lack of commitment to take reasonable care of themselves.
Employers should be aware though, that while employees have a duty to cooperate, it is an employer’s duty to ensure their employees understand those duties.
Consulting with employees on health and safety related matters, ensuring they understand the reasons for undertaking Health Surveillance, and the implications of not attending, can help to reduce the likelihood of an employee not attending.
What if an employee refuses to attend?
Due to the wide range of jobs and therefore the risks that go with them, there is no one solution that can be applied to every single person refusing to attend a Health Surveillance Medical. But it may be worth asking yourself the following:
Why are they refusing? Is there a legitimate reason such as a medical condition preventing them undergoing health surveillance? If so, a management referral may help you discover a solution.
Is it the date and time that is an issue? Could they attend another time?
Does their work pose a risk to their health? If they’re included in your health surveillance programme you’ve probably already established that it does, but it may be worth double checking. If they’ve recently moved to a new role or new processes have been implemented which removed a risk, they may no longer need health surveillance.
How great is the risk to their health? How high is the likelihood of their health being adversely affected by their work? If a statutory health surveillance medical is required, then the answer is high, but if it’s precautionary health surveillance, the likelihood may be lower.
Would the employee’s potential ill health put others at risk? Would an employee with noise-induced hearing loss put those around them at risk? Do they need to be able to hear warning signals and shouts, or other noises? The same logic can be applied to other risks to help assess any potential impact.
What are the risks of not taking part? Ill-health of the individual is one risk, but what if their ill-health prevents them from either being alerted to potential danger, or being unable to alert others to one. This could result in a severe workplace injury or even death.
Can those risks be reduced? Is it possible to move the employee to another department or area where the risk is no longer present?
Have you done everything which is reasonably practicable to get them to attend? Do they understand the reasons for the Health Surveillance and that it benefits not only their employer, but them too? Do they understand the possible consequences of not attending?
Some possible actions you can take take for an employee that continues to refuse to attend:
Ask them to sign a disclaimer, confirming they understand the risks of not attending routine health surveillance, along with the legal and contractual implications.
This option should be used with caution and only as a temporary measure while you explore your next steps.
A disclaimer will not protect you from HSE action. You should advise the employee that in signing the disclaimer they will be moved away from that job role and re-deployed, or if no other suitable work is available, that they may be subject to suspension or potentially even dismissal.
Seek an opinion from Occupational Health to establish whether there is a medical reason as to why the employee cannot attend. This would be useful if the employee is citing health reasons for their refusal, but won’t be useful if their refusal is due to another reason.
If health is the reason then an occupational health report would enable you to more fully understand your options, such as any reasonable adjustments that could be made to make their attendance possible.
Discipline the employee in line with your company policy to help them understand the gravity of the situation and give them the opportunity to reconsider.
If possible, redeploy the employee to a new job role/department to remove them from the risk.
Suspend the employee in line with your company policy if there is no suitable opportunity for redeployment. If the risk is only present for a short while then they may be able to return once the risk is no longer there. If not, this will remove them from the risk whilst you plan the next step.
Dismiss the employee on the grounds of failure to cooperate with their employer to enable them to fulfil their statutory duty, or failure to take reasonable care of themselves. Before taking this step you may wish to seek legal advice.
It is advisable that you advice from an experienced health and safety or employment law specialist if you have any questions or if there is a chance the situation could result in a lawsuit.
How to encourage attendance of Health Surveillance Medicals
The most common situation where employees refuse to attend Health Surveillance medicals is when the company hasn’t had a health surveillance programme in place before.
When Health Surveillance is introduced for the first time, it can be met with suspicion. Some employees see it as an intrusion of their privacy or a way of finding a reason to get rid of them.
The best way to prevent this happening is to be as clear as possible with your reasons for implementing health surveillance, and the benefits it will bring to all employees.
You can do this through several different channels such as posters, videos, toolbox talks, or even asking your Occupational Health provider to come and do a presentation or Q&A.
The most powerful tool to encourage employees to attend health surveillance is educating them about it.