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Scottish Needs Assessment Programme

Workplace Accidents in Scotland

SCOTTISH FORUM FOR PUBLIC HEALTH MEDICINE

69 Oakfleld AvenueGlasgowG12 8QQ

Tel - 041-330-5607Tel/Fax - 04 1-307-8036

Scottish Needs Assessment Programme

Health Promotion Review: Accident Prevention

Workplace Accidents in Scotland

Dr Cameron Stark Department of Public Health MedicineArgyll and Clyde Health Board

January 1995

Scottish Forum for Public Health Medicine69 Oakfield AvenueGlasgow GI2 8QQ

Tel - 041 330 5607Fax - 041 307 8036

ACCIDENTS IN SCOTLAND- GENERAL

STATEMENT OF THE PROBLEM

Mortality

Deaths resulting from accidents account for a substantial proportion of all deathsand are the fourth largest single cause of death in Scotland. In the 1980s deathsfrom accidents showed a downward trend but this has now levelled off.

Although death rates due to accidents increase with age, much of the impact onyears of life lost is due to deaths among children and young adults, especiallyyoung men. Accidents are the third largest single cause of years of life lost,calculated as years of life lost before the age of 75 years.

Morbidity

Figures on the morbidity caused by accidents is limited. Information on communitymorbidity is not collected nationally. There may be information collected byindividual practices or health visitors but this is not yet in a systematised form.Accident and emergency department information is limited by the proportion ofattendances not coded completely. Information collected in the hospital serviceconcentrates on the injury rather than on the place of injury or how it was causedand is, therefore, not complete.

Need for a common data set

Information on the number of accidents and types of accidents are collected bymany agencies but as yet there is no common data set of information agreed by thevarious agencies and limited use can, therefore, be made of these data.

RISK FACTORS

The risk factors and their amenability to intervention depends very much on thesetting in which the potential accident takes place. However, it is widely recognisednow that in order to reduce injury and death from accidents it is necessary toreduce the number of accidents as well as to reduce the adverse effects of theaccident.

EFFECTIVENESS AND COST-EFFECTIVENESS OF INTERVENTION

There is limited published information about the effectiveness and cost-effectiveness of interventions to both reduce the number of accidents and also toreduce the adverse effects of an accident. Much more research is required in thisarea. However, in sununmT, the value of health education initiatives alone isquestionable. When coupled with structural or environmental changes, there canbe an improvement in the outcome.

COSTS TO THE NHS OF ACCIDENTS

The cost of accidents is very difficult to estimate and therefore these estimates, inmost cases, have been limited to the costs of the Health Service. These are meant toindicate the likely scale of the problem in Scotland.

School accidentsWorkplace(NHS as a workplace}Road accidentsLeisure and wateraccidentsHome accidents

Hospital costsMedical care costs

{Total costs}Total costs

Hospital costs

Hospital costs

£1 million per year£5-22 million per year(£85 million per year}£608 million per year

£15-27 million per year

£8-13 million per year

OVERALL RECOMMENDATIONS

At national level

Information systems between the various organisations should agree on aminimum data set of information to allow for better analyses of the statistics toinform an action plan

• A joint strategy for accident prevention by setting should be drawn up inconjunction with all agencies involved.

At local level

* Purchasers should encourage Healthy Alliances to examine accidents locallyand produce an action plan.

Purchasers should require improved completeness and accuracy of statistics.

A pilot scheme to evaluate the costs and effectiveness of community healthservice staff and domiciliary social work staff (such as home helps} undertakinga safety audit with advice within the homes of young people and the elderlyshould be undertaken.

Various initiatives to reduce injuries from road accidents should be promotedincluding encouragement of the use of public transport, separation ofpedestrians and cyclists from traffic, automatic speed cameras, especially indangerous areas, the use of cycle helmets, infant car seats and rear seat belts,advanced driver training, especially by employers for their staff who drive, andsensible alcohol consumption

• The NHS should implement the SCOTMEG recommendations and monitor thesethrough the contracting mechanism.

• Health Promotion initiatives with employers should include accident prevention.

• Schools should be encouraged to review regularly their information on accidentsto identify risks and design an action plan incorporating the Findings.

• All leisure and sports centres and clubs should collect and analyse data onaccidents to identify risks and design an action plan to reduce these risks.

WORKPLACE ACCIDENTS - EXECUTIVE SUMMARY

The type of accident and measures taken to prevent them depend largely on theworkplace activity and size of employment unit. The majority of employees inScotland are employed in the service sector. Workplaces employing less than 25people account for 8896 of all workplaces.

Legislation provides a framework for the health and safety of employees in mostworkplaces. Employers are responsible for preventing workplace accidents, withseveral bodies enforcing this requirement or contributing to its implementation.These include the Health and Safety Executive and Commission, EnvironmentalHealth Officers, and company Occupational Health Services.

Despite the large number of bodies collecting Information on workplaceaccidents, there are no routine sources which provide mortality, morbidity orcost data on workplace accidents in Scotland. The Scottish Office, however,estimate that accidents at work in Scotland cost £1-1.5 billion per year. Thecost of accidents occurring in the NHS in Scotland is estimated at around £85million per year.

Costs of accident prevention strategies can be offset by reductions in the cost ofaccidents up to a certain point, beyond which the costs of further preventionactivities outweigh the benefits. Few companies, however, have reached thiscut-off point.

To some extent, accident prevention and health promotion go hand in hand,although not all workplaces welcome health promotion activities. Among thosewho do, reduced accident, injury and absence rates have been reported, alongwith decreased labour turnover and increasing profits.

"Off-the-job" accidents are also important; some companies invest largeamounts of capital on programmes designed to reduce these accidents.Workplace health action must come from the needs of individual workplaces aswell as an overall health promotion strategy, so that companies focus onpromoting health and safety within their own particular establishment.

In order to encourage good health and safety practice within the NHS, actiontaken by purchasers can include a contractual requirement for workplacehealth promotion activities within provider units, and the setting of targets foraccident reduction in Units where health and safety give cause for concern.

Suggested recommendations for provider units include: the provision of aminimum data set on workplace accidents, analysis of which could be fed backthroughout the unit; appropriate training in health and safety for seniormanagement; and setting and monitoring targets for accident reduction. Toprevent accidents, providers should focus action on those accidents whichoccur most frequently and/or at the greatest cost.

Involvement of various health service bodies with health promotion activities inthe private sector is also recommended, particularly where businessesencounter difficulty in delivering their own occupational health service.

Finally, there is a need for accident prevention and health promotion activitiesto be evaluated in order to determine those which are most effective, thusenabling recommendations to be made for specific interventions.

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RECOMMENDATIONS

These recommendations review possible actions for the health service as anemployer, as a participant in healthy alliances, as a provider of services tocommercial organisations and as one of the major collators of information onaccidents. Many of the possible accident prevention activities are not within thedirect control of the NHS, thus emphasising the importance of healthy alliances.

1.1 Health Service Accidents

The NHS as an Employer

NHS Trusts and Directly Managed Units are major employers, and purchasers willhave a continuing interest in ensuring that appropriate standards of health andsafety are in place in the provider units with which they enter into contracts. Giventhe opportunities for health promotion, purchasers may want to includerequirements for workplace health promotion activities in overall servicespecifications.

SCOTMEG Recommendations

The SCOTMEG recommendations on accidents in the NHS are shown below. Theycover three areas, accident reporting, management of health and safety, andaccident prevention. They are broadly in sympathy with the HSE work reviewedabove.

1.1.1 Accident Reporting

Providers: All units and trusts should collect the information identified bySCOTMEG as a minimum data set. This information should be fed back to allmanagers and supervisors, and quarterly and annual reports should be produced.Units should use the reporting form designed by SCOTMEG, and should keep costinformation on accidents.

Purchasers: Should display an interest in accident rates, and should have accessto providers' annual Health and Safety Reports. Accident rates should also becentrally compiled in order to compare rates between hospitals.

1.1.2 Management of Health and Safety

Providers: Units and Trusts should demonstrate that health and safetymanagement is included on their senior management agenda. Senior staff shouldfocus on policy, monitoring, assessing performance and achieving a cultural changeto move from accident reporting to accident prevention and safety management.

Senior management must have appropriate training in health and safety, andshould ensure that their staff are also appropriately trained. Units and Trustsshould ensure that, wherever possible, there is one single point of health and safetyadvice. The Management Executive (ME) guidelines on components of acomprehensive occupational health service for the NHS are appended (see Appendix(2}. Purchasers may wish to use them as a model.

Trusts and Units should set and monitor targets for accident reduction, both forspecific accidents such as needlestick injuries or back injuries, and also forabsence because of accidents.

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Purchasers: Should set targets to improve performance if accident rates or otheraspects of health and safety performance give concern.

1.1.3 Accident Prevention

Providers: SCOTMEG recommended three specific actions by Units and Trusts tobe taken immediately.

• They should focus action on those accidents which are most frequent, or causethe greatest financial or organisational costs.

• They should investigate the incidence of back injuries and sharps injuries, andset targets for their reduction.

• They should review their practices to ensure that they are doing all that isreasonable to protect staff from person to person assault.

1.2 Wider Issues for Purchasers

1.2.1 Health Promotion

Given the mounting evidence on the benefits of holistic approaches to healthpromotion in the workplace, purchasers should encourage provider units to includeaccident prevention within their overall health promotion activities. This is inkeeping with the Health at Work in the NHS initiative (HEA 1992). A Faculty ofPublic Health Medicine Working Group on Health Promotion in the Workplace willbe issuing guidelines later in the year. The group, which included representativesfrom Occupational Health, are also likely to emphasise the importance of a widerview of health promotion in the workplace.

1.2.2 Feedback within Provider Units

Where purchasers ask for the establishment of improved monitoring systems, theyshould also require evidence that the information collected is being disseminatedwithin the provider unit.

1.3 Additional Costs

Provider Units and Trusts may feel that health and safety practices cannot beimproved without extra funds. This is not supported by the HSE, nor by initiativesin industry where the cost savings associated with accident prevention have beenrecognised. There may be extra costs in the early stages of establishing an effectivemonitoring system, but once in place accident prevention activities should be seif-funding.

1.4 Monitoring

1.4.1 Data Quality

The NHS is best placed to drive forward improvements in data quality on accidentspresenting to health care services. There is considerable scope for epidemiologicalresearch but quality of routine data is likely to be of even greater importance.Providers can act to include appropriate data quality standards in all contracts withacute units in order to provide epidemiological information for needs assessmentand targeting of health promotion and accident prevention activity.

1.4.2 Accident and Emergency Information Systems

Good morbidity information will also be of value to businesses in planning andevaluating accident prevention activities. Where accident and emergencyinformation systems have been introduced, purchasers should require informationon the proportion of attendances in which relevant information has been recorded.This may require extra administrative staff time but should offer benefits topurchasers in their needs assessment responsibilities. If accident and emergencyinformation systems have not been established, purchasers should await guidancefrom Information Services Division (ISD) and the ME on the results of currentinformation systems trials.

1.4.3 SMRI System

The difficulties in identifying occupational accidents in the SMR1 system are ofconcern. ISD should review this to see whether this can be overcome withoutexcessive cost. Purchasers should not rely on SMR1 information for review ofoccupational accidents.

1.5 Extension of NHS Activities into Workplaces

1.5.1 Private Sector Involvement

NHS Trusts, Directly Managed Units and Health Boards include individuals anddepartments with expertise in evaluating accident prevention needs, interpretinginformation and providing services to organisations. Section 1.1.3 abovedemonstrates the impossibility of all businesses delivering their own occupationalhealth services to employees. There are opportunities for NHS bodies to enter intocontracts with businesses to deliver health promotion services to theseorganisations.

Purchasers should seek evidence of extension of health promotion activities to theworkplace, and should encourage provider units to consider entering into contractswith employers to support accident prevention activities.

1.5.2 Targeting of Workplace Initiatives

Where purchasers contract directly for health promotion and accident preventionactivities in the workplace, they may consider it more cost-effective to direct activityat larger employers, as contact with a smaUer number of workplaces will allowcontact with a large proportion of the workforce. However, these are the businessesmost likely to have occupational health services. In addition, the disproportionaterisk of accidents to part-time workers does suggest that making contact with smallbusinesses may offer benefits. Purchasers should consider funding innovativeschemes to assist small businesses without occupational health services.

1.5.3 Further Research

There is a need for well-designed intervention studies to evaluate the effectivenessof accident prevention and health promotion activities in the workplace. Previouswork suggests that appropriate expertise lies within the health care sector and canusefully supplement business research skills of employing organisations. Healthcare and health promotion workers must agree joint projects with businesses, useevaluation methods which will be satisfactory to all, and have the potential todemonstrate generalisable results. Many businesses have demonstrated an interestin health promotion, and this interest can be harnessed to produce transferableresults.

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