Sara Dalmasso is General Manager and Vice President at Omnicell International. Here she reflects how automating the medication management process can support hospitals during the COVID-19 second wave.
The public perception of the construction industry – tough men, stripped to the waist in all weathers with jeans slung, perhaps, a little too low – has for years belied an ugly truth that lay at the heart of UK’s largest employer: those rough, tough men were sick.
Often exposed to life-threatening hazards on a daily basis, on-site injuries were seen as a rite of passage; men (and women) were exposed to a variety of unseen hazards ranging from asbestos to a variety of other potentially harmful chemicals; the nomadic nature of the business meant that very few workers had ready access to the services of a general practitioner; excessive drinking and smoking were considered an integral part of the after work bonding ritual; and the majority of construction canteens specialised in a single, unifying ingredient – cholesterol.
But times are changing. A series of ongoing government and industry initiatives has helped to improve the traditionally poor health of its workforce whilst, at the same time, addressing more modern issues such as drink and drugs misuse. And while some of these initiatives would have been greeted with the derision of the industry’s forebears who eschewed hard hats for flat caps, there is no question that they’re proving effective, simultaneously increasing worker health and industry productivity.
LEADING FROM THE FRONT
In a sector that is built upon multiple layers of contractors, sub-contractors and specialist contractors, the construction industry has understandably adopted a top-down approach to improving the health of its workforce. For more than a decade, the upper echelons of the industry have been blazing the trail for improved worker welfare with an increasingly rigid regime of compulsory health and welfare checks for its own workers.
Having got its own house in order, these large national and multi-national concerns are now using their power and influence to insist that the sub and specialist contractors working on their sites follow their health and welfare lead. Indeed worker health checks and, increasingly, drink and drug checks have become a common requirement in the industry’s pre-tender qualification process. In short, if you don’t look after your workers, you’re not working for the UK’s largest and most influential main contractors.
And the industry is not stopping there. An increasing number are throwing their weight behind Constructing Better Health (CBH), a not-for-profit scheme set up by the construction industry to improve the health of its workforce.
“During an initial pilot scheme, it was found that approximately one-third of workers had health issues that could affect their work,” says CBH chief executive Michelle Aldous. “In an industry that lost over 1.8 million days between 2008 and 2009 as a result of work related illness, effective management of occupational health is crucial.”
Through membership of CBH, members can access the Construction Health Action Toolkit (CHAT) that allows them to upload personnel information for all their direct employees. This software then compares the employee’s job title with a health assessment matrix to determine an action plan for subsequent health checks. Employees are issued with a CBH card and unique registration number, which employers may then use to access the individual’s fitness-for-task outcome.
The database and card access scheme is designed to ensure the effective management of any work related health issues in line with any recommendations to protect the health of a worker. In addition, it allows workers to move from different sites without the added costs to the employer of repeating occupational health checks. Using the CBH card, an employer can check that an employee is fit-for-task, but is not permitted access to their medical records. As part of the scheme, CBH also provides a list of accredited occupational health providers who can be contacted with the confidence that they have met the standards defined by CBH.
However, while the sector is making huge strides in addressing underlying health issues among its workforce, it is increasingly being required to focus its attention on issues of a more self-inflicted nature. Six years ago, Screen Safe UK, an accredited drugs testing agency, was called in to test at random the employees at an international construction company. The results were alarming: 100 per cent of workers failed the test. “Even we were surprised,” recalls Matthew Taylor, Screen Safe’s managing director. “But within six months, through promoting awareness of random testing and proper education, the figure was down to between five and ten per cent.”
Those initial results appeared to confirm what many in the industry had feared, historically at least: that misuse of drink and drugs was endemic and posed a serious challenge to responsible employers. All kinds of people are involved in drug misuse; they do not conform to any stereotype, making detection difficult. It is why random testing has become, for some companies at least, firmly embodied in their occupational health culture, providing a decisive deterrent to many habitual offenders. But not all.
Industry-wide, says Taylor, there remains a stubborn 20 per cent failure rate, and the pattern of drugs misuse is changing constantly: “People will always find new drugs; if one drug is banned, they will find other substances, such as ‘legal highs’ like mephedrone.” Mephedrone was only recently given a category B classification under the Misuse of Drugs Act 1971.
It is widely acknowledged that employees whose performance is impaired while under the influence of alcohol or controlled substances are a potential danger to themselves and to others. Yet in addition to the obvious health and safety issues, ignorance of, or a passive approach to substance misuse can have devastating commercial implications for employers. Companies that fail to have in place a robust policy to detect and eradicate substance misuse or rely on an informal ‘understanding’ will miss out where blue chip clients, increasingly, demand a zero tolerance approach.
Zero tolerance of drink and drugs misuse is fast becoming the norm in the UK construction and allied industries. In the rail industry, the zero tolerance rule is underscored in Personal Track Safety (PTS) training, and random testing for alcohol and controlled drugs is commonplace. More and more names are following their lead and widening the net to include trade contractors in the big crackdown on drugs. For alcohol, the pass limit is much lower than, say, that stipulated in existing drink-drive legislation. For driving the limit is 80 mg alcohol per 100 ml of blood. The limit for rail industry workers is 29 mg.
Building Health’s managing director is Nichola Elvy who, as an occupational health nurse, formed the company in 2004. She says controlled drugs are more of a problem than alcohol in terms of the scale of misuse. “We know from our regular screening of employees that some drink a lot more than they should, sometimes 80 units a week [contemporary wisdom advises a maximum for males of 21 units, and 14 for women] but because of the already strict drink-drive laws, and because most people have to drive to work, we find mostly that employees arrive sober. Other substances, particularly drugs such as cannabis and cocaine, are much more of a problem.”
Drug screening or testing is, of course, a sensitive issue because of the many employment implications involved. Securing the agreement of the workforce to the principle of screening is essential, partly because of the practical and legal issues involved. More often than not, organisations in safety-sensitive industries are using random but continuous screening and testing as a way of controlling drug problems. Testing can be by taking samples of breath, urine, hair or saliva, the last three of these for analysis at an approved United Kingdom Accreditation Service (UKAS) laboratory.
Employers’ legal position on drugs is outlined in a variety of Acts of Parliament. They have a general duty under the Health and Safety at Work etc Act 1974 (HSW Act) to ensure, as far as is reasonably practicable, the health, safety and welfare at work of their employees. They also have a duty under the Management of Health and Safety at Work Regulations 1992, to assess the risks to the health and safety of their employees. Firms that knowingly allow an employee under the influence of drug misuse to continue working and his or her behaviour places the employee or others at risk, could face prosecution.
The principal legislation in the UK for controlling the misuse of drugs is the Misuse of Drugs Act 1971. Nearly all drugs with misuse and/or dependence liability are covered by it. There is further guidance from The Chartered Institute of Personnel Development, which has published ‘A practical guide to the key issues in managing employees who misuse drugs and alcohol’. It includes: developing a policy, recruitment – including health screening, providing support and taking disciplinary action, supporting the substance misuser, testing for drug and alcohol misuse at work, and the legal implications. There are appendices with sample policy statements, specific sources of help and advice, model drug and alcohol workplace policies, and risk assessments when employing ex-substance users.
Testing can be a thorny issue with the unions, however. Barckley Sumner, a spokesman for UCATT, says the union accepts companies feel the need to introduce drink and drug testing: “However, we believe that all new workers needed to be informed of the procedures before they start work. All existing workers need to be properly informed of the new procedures, they also have to be given the opportunity to pass the new tests. For instance cannabis can remain in the body for three months, so a significant lead in time is required. Drink and drug testing should not be used as a form of intimidation, where certain people are repeatedly targeted, for example trade union activists.”
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