Pick 'n' mix: the HSC names its intervention ingredients
Howard Fidderman looks at the likely approach of the HSE and local authorities to influencing HSW Act duty-holders.
The HSC has embarked on an important consultation exercise that will help determine how the HSE and local authorities influence organisations and individuals that hold duties under health and safety law. The consultation document1 outlines 13 ways in which the enforcing authorities make "interventions" and recommends a favoured mix of eight. It seeks views in particular on:
whether its preferred mix is the best recipe;
whether the HSE should give recognition to good performance; and
how to make the most of the resources available to enforcing authorities and others.
The consultation follows the February publication of the HSC's strategy for 2010 and beyond, which aims to focus on the enforcing authorities' core business using "the right interventions" and "doing things differently" (see "All dressed up", but where will the HSC's strategy go?). The results of the consultation will also contribute to the strategy's commitment to changing the way that the HSE and local authorities (LAs) work (see Happy together now as the HSE and councils make up).
The evidence for the mix
The HSC's preferred mix reflects the findings of a major review of research into interventions that was commissioned by the HSE from Greenstreet Berman to help inform the HSC's strategy (see below )2. The report reviews research on the effectiveness of interventions - nationally and internationally - and the factors that mediate their success, and analyses their relevance to the UK. It found a general acceptance that "traditional methods of HSE intervention are effective in the context of the traditional industries and large organisations". Such methods include "educational" information and advice, enforcement, inspection and accident investigation. Furthermore, reviews of the impact of new legislation and guidance were positive (see, for example, the HSE's personal protective equipment review in UK laws on workplace and PPE are just fine, says HSE). In short, inspection improves duty-holders' knowledge and improves precautions, with most employers motivated to change policies to comply with the law.
Against this, the world of work is changing in ways that question the efficacy of traditional HSE interventions: employer involvement in worker rehabilitation is poor; the numbers of home-based and mobile workers are increasing; and there has been a shift from manufacturing to the service sector. Furthermore, Greenstreet Berman concluded that the "reliance on traditional 'contact-based' methods is particularly challenged" by the large number of small and medium-sized enterprises (SMEs). The HSE and LAs have 1,700 inspectors and other front line staff to cope with 3.5 million businesses in Great Britain, of which 90% employ fewer than 10 people. (At the same time, nearly half of the workforce is employed in large organisations.)
In this feature, we first examine the HSC's consultation and then look in detail at the evidence underlying its proposals. We will also refer to the HSE's September statement on the provision of advice and support, which is one of the eight favoured interventions (see Support statement ).
The HSC believes that most of the 13 interventions merit wider use than is currently the case. It endorses the Greenstreet Berman conclusion that "there is a range of new ways (such as working via intermediaries and insurance incentives) of accessing, contacting and influencing employers, including the hard-to-reach SME sector. Accepting that there is a need to effect greater influence on SMEs, these avenues offer opportunities for the HSC/E and LAs to amplify their effect . . . There is, at the same time, evidence to support the continuation of current advisory, enforcement and regulation-based activities in all sectors and sizes of organisations."
Of the new interventions, the HSC's consultative document notes that some, such as partnerships, are resource intensive; others, such as supply chain pressure, require little effort by the regulator; while others, such as education and awareness, can have a wide impact relative to the resources used. (The designation of education and awareness as a new-style intervention is odd, given that the HSE has been involved with both for decades.)
The HSC believes that the research makes it clear that "all the interventions can and do produce improvements in the workplace", but that they cannot be ranked because they are mutually supportive. Nevertheless, it favours a preferred mix based on (and in no particular order):
1. inspection and enforcement;
2. accident and ill-health investigation;
3. dealing with issues of concern raised and complaints.
4. motivating senior managers;
5. intermediaries;
6. sector and industry-wide initiatives;
7. working with those at risk; and
8. education and awareness.
The four interventions left out of the mix are partnership, design, supply chain and best practice. The HSC invites views on how it might reallocate resources to increase activities around the eight interventions (see box 1), while satisfying the recommendation of the recent parliamentary select committee report on the HSC/E that there should be no decrease in enforcement and inspection (see Education or enforcement: MPs examine developing strategy). The HSC also looks in detail at what it might do with the 13th intervention, that is recognition of good employer practice.
SMEs present a conundrum for the HSC: in general, they prefer direct workplace contact with specific advice and information. Some want this from regulators; others do not because they feel that it would lead to enforcement. But as the HSE cannot visit all workplaces, it needs an alternative way to influence SMEs based on inspection, education and awareness-raising combined with support from intermediaries. Among larger organisations, the approach is likely to use education, the need to protect reputation, incentives (for example, public recognition of good performance), supply chain and inspection.
Enforcement-based interventions
The HSC's 2010 strategy insists that inspection and enforcement will remain a vital intervention that will often be the means by which other strategies are realised. Both are highly effective in ensuring workplace compliance, with most employers supporting a system of routine, unannounced visits. For small businesses, inspectors are the most commonly used and preferred sources of information and advice on health and safety issues. Small firms prefer activity-specific advice and feel that direct contact via inspection is the best means of achieving this. But other forms of interventions, notes the HSC, could be put to greater use for larger organisations.
The HSC's strategy already commits the HSE and LAs to two further types of interventions in that they will continue to identify circumstances that require investigation and possible enforcement in response to incidents and reports of ill health, and where complaints are made or concern expressed. The HSC notes that although investigation of an incident does not necessarily address the overall health and safety of an organisation, it focuses the duty-holder's attention on the underlying causes of failure, and can make it more receptive to advice. Investigations also provide the regulator with information and help inform policy development. They are also important to the victims, their families and the public as a means of bringing negligent duty-holders to account. The investigation of complaints is particularly important with low-risk premises that are visited less often because complaints can help identify any difficulties between planned inspections.
The fourth intervention involves motivating senior managers in larger organisations to make a commitment towards achieving continuous improvement in health and safety performance as part of corporate governance, and to ensure that lessons learnt in one part of the organisation are applied elsewhere. The HSE believes that large firms are sensitive to their public image in respect of the perceived level of internal governance and social responsibility. Firms with "high street" names want to protect their public image or "brand" and avoid negative publicity. The intervention involves initiatives such as contacting the managers during inspection, the "name and shame" database of offenders and the HSC's challenge to the UK's largest 350 companies to report publicly on health and safety (see Courts still failing to sentence properly and HSB 322). The HSC also points to the Environment Agency's "fame and shame" approach to businesses.
Cooperative interventions
The HSC's strategy envisaged the HSE and LAs doing more work with, and through, individuals and organisations that can influence duty-holders. Such intermediaries include trade bodies, insurance companies, investors, training and enterprise organisations, professional bodies and even the government (where it provides money or training to duty-holders). The HSC notes that intermediaries are particularly effective where there is an established network of contacts. Although the ability and level of interest shown by intermediaries varies greatly, intermediaries have been effective where they share goals with the enforcing authorities. The HSC believes that work with intermediaries, when combined with advice, awareness-raising and education, can benefit all sizes of organisation, and particularly SMEs.
Sector and industry-wide interventions involve stimulating a whole sector or an industry to sign up to an initiative that addresses important risks and setting improvement targets. This allows an approach that is transparent and consistent, and deploys level playing field arguments and peer pressure.
The seventh intervention involves the HSE working with those at risk, notably safety representatives, trade unions and other organisations that represent people exposed to work-related risks. The HSC stresses that organisations with union representation have up to 50% lower injury rates than those without representation, but that six out of 10 workplaces have no form of worker consultation arrangements on health and safety. Overall, the HSC concludes that: "There appears to be scope for more effective interaction with trade unions and safety representatives, with a greater impact achieved by applying effort at national, branch and regional levels." The interventions in this category envisaged by the HSE include the "worker-safety adviser" initiative in which roving safety advisers assist small businesses (see Worker Safety Advisers are go). In a different vein, one LA approached employees directly and helped them train in qualifications certified by the Chartered Institute of Environmental Health.
The eighth intervention, education and awareness, involves seeking further ways of spreading messages and advice to target groups at the earliest stages. This has proved particularly effective where it involved an intermediary, in conjunction with the HSE, recommending health and safety practices and distributing them to its members. This could be particularly useful for influencing difficult-to-reach groups. Channels include small business groups and chambers of commerce, as well as educational institutions. The HSE points to successful initiatives in agriculture (where there was also a "carrot" of no inspection for those attending a seminar), food, construction and manufacturing. The HSE is certain that the role of the internet will grow. But mailshots look to be on the way out; they have proved the least effective means of increasing awareness and the HSC says that the only time that they should be used in isolation is where the audience is already receptive (for example, dentists).
Just days before the HSC published its consultation document, the HSE issued a statement on how it would provide information and support to duty-holders3. The statement expands on some of the issues raised by the consultation document, adding that the HSE:
does not intend to separate its enforcement and advice functions, although it is still looking at the issue;
is not prepared to put all of its publications on the internet free of charge (it makes too much money from them), but it will make more publications free;
will introduce targeted, sector-specific online "self-assessment" tools; and
will develop online communities and advice forums for groups such as safety professionals.
Out of the mix
The HSC's omission of four further interventions - partnership, the supply chain, design and supply, and best practice - is not a rejection of their importance, but a recognition that the HSE and LAs are either not the best placed to lead on these interventions or that they do not represent the best use of their limited resources.
Partnerships can involve duty-holders, trade unions, regulators, government departments, trade bodies, investors, insurers and educational or media organisations. They are resource-intensive and require a long-term commitment. Experience has been varied with some notable successes such as the Lead Authority Partnership Schemes, which have improved the consistency of LA enforcement of health and safety. Partnership works well in large organisations and where strong communication already exists, but the HSC believes that there is scope for extension to SMEs and also for employers to forge their own partnerships.
Supply-chain interventions involve encouraging those at the top of the chain to use their influence to raise standards further down the chain through, for example, safety specifications in the contract. Although the impact here can be significant and lasting, the intervention is under-utilised and is limited since SMEs rarely have the purchasing power to exert influence. The evidence from the Good Neighbour schemes - in which larger employers offer free advice to SMEs - is mixed, and the HSC believes that this may be a fruitful area for employers to explore. Attempts are also under way to establish the government as an exemplar.
Design and supply interventions involve working with those who can improve the design of processes or products. Such interventions can include equipment, planning applications for new developments, and duties on designers and architects in construction projects.
The HSC believes that using best-practice examples to show others the practicality and value of improvements is most effective: when linked to partnership; where good practice is shared among trade association members; or disseminated via local safety forums. Regulators can encourage the use of this approach but cannot insist upon it, meaning that it is an area that duty-holders should explore themselves.
Recognising good performance
Although the HSC does not include the 13th intervention - recognising good performance - in its preferred mix of eight, it does not rule it out either. Indeed, the consultation is perhaps at its most interesting and undecided on this intervention.
An important element of the HSC's strategy is that the HSE and LAs will not intervene proactively where proper management of risks can be assured, ie where the risks are of low significance, well understood and properly managed. Recognition of good performance might become more formal under these targeting arrangements. Some public sector organisations - particularly LAs and NHS Trusts - already have formal opportunities to achieve a recognised status. The HSE has been discussing similar approaches, including a system for formal "earned autonomy", with other regulators. The HSC hopes it will be able to identify measures that will satisfy all regulators that a particular organisation is performing well. Employers appear to favour such an approach; unions, however, question whether it will save resources and in any case believe that regulation, far from being a burden, contributes to a safety culture. The HSC says that the regulators - except those dealing with major hazard industries - support the idea, providing it improves health and safety standards and is cost-effective, non-bureaucratic and accessible to all employers.
Crucial to the success of this intervention is an assessment of the duty-holders. The HSC highlights four main options, any two or more of which might be used in combination:
self-assessment - an organisation declares to the regulator that it meets the required standard. Directors could also be individually and collectively accountable for the declaration and their organisation's performance. Employees and insurers could endorse the declaration;
employee assessment - worker representatives confirm they are satisfied with their organisation's arrangements for ensuring the workforce's health and safety;
third-party assessment - independent auditors assess an organisation against required standards; and
regulator assessment - the HSE and LAs' current rating systems are expanded. For example, assessment of large multi-site organisations could eschew routine site-visiting in favour of a central analysis of the company's performance using the company's own systems and data.
The HSC suggests criteria that could be used in the assessment (see box 2), stressing that the acceptability of such a scheme would depend on:
the withdrawal of inspection being subject to re-assessment after a specified period or serious incident;
the enforcing body being able to take action if the organisation suffers an incident that meets its investigation criteria (the action could range from demanding an employer/employee representative investigation report to an investigation; and
the employer should not have any immunity from prosecution.
If good performers enjoy public recognition, the HSC argues, this would concentrate more resources on poorer-performing employers, amounting to an extension of the current targeting practices.
The role of legislation
The remainder of this feature examines the evidential base that underpins the HSC's proposals for its interventions mix. The Greenstreet Berman report first looked at research into the impact of health and safety legislation. A study carried out by the Institute of Employment Studies in 2001 found a link between the introduction of new legislation and improvements in health and safety awareness, compliance and standards. The impact of the legislation varied according to employer size and industry sector and was reduced where there was a lack of awareness and understanding of specific legislation and of how to obtain information on complying. These findings are backed up by EU research. Other research shows that the employment of a health and safety professional is important for successfully interpreting and implementing legislation, and that larger organisations are therefore better placed than SMEs, which tend to lack in-house expertise. Organisations also cite legislation as the principal reason for implementing specific measures such as health surveillance.
Small firms are less responsive to legislation because of a lack of awareness and their tendency to operate in lower-risk sectors. Other influences include:
the perceived fairness of the legislation;
the cost-benefits ratio and affordability of compliance;
whether organisations believe they already comply with the spirit of the legislation;
whether the legislation requires unnecessary, inefficient or ineffective measures;
whether the legislation is "process-based" or specific (SMEs find the former, such as the Management of Health and Safety at Work Regulations 1999, harder to understand than the latter, such as the Health and Safety (Display Screen Equipment) Regulations 1992);
the perception of whether the risk is sufficiently significant to warrant compliance; and
the presence of guidance, support and recognised standards.
Enforcement
The Greenstreet Berman report found it difficult to analyse the impact of formal enforcement action because most studies conflated enforcement with inspection, which has an advisory element. But most research accepts that enforcement action needs to be targeted and used in conjunction with other regulatory activities, for example advice and education. There is agreement that:
enforcement activity is an important element in securing compliance in the organisation itself and as a deterrent to others;
a mix of punishment and persuasion is best; and
the prospect of enforcement motivates all types of firms.
Furthermore:
a significant US study found that an increase in enforcement activity was followed by a 1% reduction in injury rates in all plants in the study but individual plants that were inspected and penalised saw injury rates drop 22% over three years;
penalties have a deterrence effect that is more specific than general, with data suggesting reduced injury rates as a result of sanctions;
many studies found prosecution to be "a blunt instrument" for gaining improvements and bringing perpetrators to account;
the tendency of prosecutions to focus on events limits the effectiveness of messages about the process of health and safety management; and
there is some evidence that the minimum necessary enforcement action will facilitate a longer-term internalisation of a desire to comply.
But the Greenstreet Berman report notes that it is not certain why organisations fear enforcement and how action against one company deters others. There is insufficient research both into the impact of enforcement in the long term and whether that impact is the same in LA- as HSE-enforced sectors.
How enforcement works
There is general acceptance that the prospect of enforcement is an important reason for making health and safety improvements. The reasons include damage to reputation arising from poor health and safety. Interestingly, the report notes that the "probability or certainty of detection, and subsequent enforcement action, is important, and possibly more so than the magnitude of any fine". Conversely, the fear of enforcement deters those without prior contact with the HSE from seeking its advice.
The report refers to earlier comprehensive research that found two distinct, but integrated, approaches to regulation and enforcement: from self-regulation to the detail of how to inspect. Inspectors decide which "track" to go down by looking at the presence of effective safety management systems (SMSs) and the ability of the duty-holder to work with more objective-setting Regulations and inspections. In the US, for example, an inspector who finds evidence of a good SMS will limit the inspection to the top four sector hazards.
The same research also points out that there is not always a link between profit and good occupational health and safety management; even where there is, it is often not perceived. The concept of "bounded rationality" means employers are unable to behave totally rationally in economic terms because, for example, of information overload or shortfall. And the benefits of an economic case are often only long term.
There is also research to show that SMEs are most impressed by authority and that this could explain why inspection works. Conversely, inspection is ineffective for the very smallest firms and it would appear that inspection is most effective in organisations with between 100 and 500 employees.
There is also evidence that enforcement is needed precisely because of limitations with educational and persuasive strategies (see box 3). Some other studies point to a lack of, or inadequate, enforcement as reasons for legislative failures that lead to incidents. Thus, the Cullen inquiry into the Ladbroke Grove rail collision identified under-resourcing as one of the reasons for the low level of rail inspectorate activity.
Enforcement and management
The report finds little research into any links between inspection and enforcement and occupational health and safety management. One study finds that effective occupational health and safety management must develop from the needs of the organisation: regulation and enforcement should thus be used with care, ensuring that attention is directed towards the overall assessment and management of hazards rather than focusing overly on specific aspects. This is a particular problem among SMEs. These findings suggest that:
inspection activity needs to be responsive to the situation, in terms of the type of duty-holder and the state of its progress towards compliance and the type of people who need to be influenced;
inspection and enforcement of occupational health and safety management should take into account the need for duty-holders to understand the purpose of such systematic management; and
moving from an enforcement approach to a more cooperative approach can improve compliance in certain circumstances.
Prosecution
There is very little research into the effectiveness of prosecution, but what there is suggests mixed effects. Some research shows that prosecutions are cost-effective because they send out "shock waves". But there are some occasions where an advisory approach will achieve compliance more effectively than a punitive approach. A 1998 evaluation of the HSE's Killing Field II campaign noted that although farmers thought increased prosecutions would be a driver for improvement, they would also reduce trust in the HSE as a source of advice. Academic research suggests that prosecution is a blunt instrument for dealing with offenders, often not tackling the health and safety issues in the round, and not fully addressing either individual or corporate accountabilities.
There is some evidence that the fear of prosecution encourages compliance among organisations other than the perpetrator, although the mechanism is not clear. Risks to reputation appear to be more of an incentive to larger companies. There is increasing evidence from the US that certainty of punishment is usually more important than the size of the penalty. Other studies highlight the cumulative effect of hearing of numerous prosecutions. The "ripple" effect is mediated by other organisations' perception of their own compliance and the chances of being inspected. Other studies appear to contradict this, finding that there is a clear motivation on the "inspected", but little evidence of a wider effect. Others point to the frequency of visits being important.
A few years ago, the HSE introduced a policy of "naming and shaming" on a register all organisations and individuals convicted of health and safety offences. There are no reviews of the efficacy of this register, although there is some work on how a mechanism might work. These include the notion that the nature of the sanction is rarely limited to reputation, and often involves an "economic backlash", "increased surveillance" or "revised management". One emerging theory is that naming and shaming works best when there is a "re-integrative" opportunity for the perpetrator that allows it to view the naming in some way as positive.
Enforcement and the HSC's strategy
In terms of the HSC's strategy for 2010 and beyond, the report concludes that:
enforcement and legislation are effective in securing compliance. They encourage self-compliance and create a fear of adverse business impacts in all sectors and organisation sizes. This means that there may be value in new charging regimes, enforcement strategies and penalties that are used around the world, such as assessment charges, closure notices, court orders for changes in an organisation and court-ordered publicity;
enforcement and HSE and LA leadership is important in prompting major hazard firms to manage health and safety;
enforcement supported by advice and guidance, and new legislation, are as relevant to health hazards as they are to safety;
hazard-specific legislation can secure greater improvements in risk management than general legislation; and
advice and information are less effective in the absence of the possibility of enforcement.
Financial and business incentives
Although the HSC/E have pounded the business case for health and safety since the 1990s (see Employers face £7bn "accident bill"), the report notes that, until recently, research has found that financial incentives do not prompt organisations to act. The situation may, however, be changing. Recent research found that one in two employers had taken action relating to the cost and availability of Employers' Liability Compulsory Insurance (ELCI). But the impact varies; local management action may be deterred if the premium is part of a central overhead in a large organisation; some organisations - particularly those in the public sector - are not cost sensitive; and the incentive may be lost if there is too long a time lag between improvements and securing a discount.
The report notes that it is "very clear" that the cost of workers' compensation in the US, Canada and Australia has been the "main driver for the increased promotion and application of return-to-work and vocational rehabilitation in these countries". Generally, when the absolute cost of workers compensation or absence rose, employers and insurers took a greater interest in seeking cost-effective ways of reducing these costs. But if the absolute cost is perceived to be low, then cost reduction methods are of little interest, even if savings outweigh expenditure.
In contrast, the UK is at a relatively early stage in how it uses insurance premiums as an incentive for health and safety. Evidence from home and abroad indicates that premiums can provide a new "lever" to influence employers. In September, the government published proposals to charge employers the NHS costs of treating people made ill by their work - a development that will increase the cost of insurance (see NHS recovery will raise insurance costs and Health and safety: the state of play ). There may also be scope for changing civil court guidance to give greater weight to the offer and acceptance of rehabilitation or increasing awards for pain and suffering, and for the Department for Work and Pensions to provide more directive advice on the right to litigate. The report also calls for further discussion on possible regulation of rehabilitation.
Risk to reputation
A 1999 analysis of the HSC's "Good Health is Good Business" (GHGB) initiative found that reputation and pressure group drivers were not important; only 2% of companies made improvements because of image and reputation, and just 1% cited shareholder, bank and campaign group pressure.
Subsequent studies have found that firms are sensitive to their public image in terms of internal governance and social responsibility, and that they manage health and safety bearing in mind the perceived social and moral case. "High street" names are also driven by the need to maintain their image. Pressure-group activity is adding to the concern about brand and risk to reputation. These factors are leading to attempts to: promote health and safety as part of CSR; highlight damage to reputation caused by adverse health and safety publicity; and put pressure on contractors. Of particular note here is the Corporate Health and Safety Performance Index for use by investors and insurers (see CHaSPI: the Corporate Health and Safety Performance Index) and the name and shame database. Studies also show that risk to reputation increases proactive direction of health and safety at board level. These studies have also reported that HSC/E initiatives around these drivers have been successful, with improvements in reporting by large companies after the HSC's "top 350 challenge" and board-level involvement after the HSE published guidance on directors' responsibilities (see Directors to take safety on board).
The report notes that one drawback of using "reputation risk" as a lever is that organisations may focus on a limited number of health and safety risks that they believe would most damage their reputation, but that these risks may not be the most significant. An example would be a nuclear organisation focusing on radiological risks at the expense of conventional occupational health and safety risks. A further controversial contention is that occupational health and safety can only have a negative impact on corporate reputation because a good performance will go unnoticed.
Other business benefits
Greenstreet Berman found less evidence of a change in organisations' perceptions of the "productivity" case for health and safety, notably cost reduction, productivity and profitability. The report attributes this partly to: the fact that few organisations account for the costs of injury, ill health and related under-performance; the cost of poor health and safety may be low compared to other costs; a paucity of information; and a short-term view of returns. There is also significant variation according to organisation size and sector, with the "safety pays" argument more readily accepted among organisations that are either larger or in higher-risk sectors. Nevertheless, studies have shown that both the perceived affordability and proportionality of improvements is important; although organisations are less inclined to improve health and safety to accrue business benefits, their acceptance of improvements is influenced by the belief that the business benefits outweigh the costs.
Incentives and the HSC's strategy
In terms of the business case element of the HSC's strategy, the Greenstreet Berman report concludes that SMEs would see a correlation between investment in safety and business benefits as an incentive. There may also be a role for insurance companies in the setting of standards or provision of advice, but research here is not conclusive. Evidence from abroad indicates that once the cost of insurance reaches a certain level, it leads to health and safety improvements; the main incentive for countries introducing rehabilitation and return to work programmes has been the desire to contain the cost of insurance. As such, says the report, there is a strong case for exploring a similar role for premiums in the UK.
But the fact that some organisations are not motivated by financial factors necessitates the use of persuasion and regulation combined with financial factors. Greater use should be made of financial and reputational incentives for safety management and rehabilitation, and also of supply chain pressure; although clients who make health and safety a precondition for their suppliers can have a significant impact on the suppliers, too many clients do not do so (apart from heavily-regulated sectors such as chemicals).
Finally, the report stresses the important role of social and moral factors, which can justify legislation and increase society's expectations. But while it is clear that the HSE is an "actor in the creation of societal concern", the only other current creators appear to be trade unions, civil law suits and professional bodies.
Advisory and information activities
Evaluations show that the HSE's advisory work is effective in raising awareness, and that awareness is important in improving health and safety precautions. Coupled with the similar experiences of overseas authorities, there is a consensus that education and information:
raise awareness of hazards and risks;
ensure duty-holders understand the risk so that they will be willing to take action;
improve understanding of how to control risks; and
improve understanding of legal duties.
The effectiveness of education is dependent on workforce size, industry sector, existing standards, the motivation to comply, the level of in-house health and safety expertise, the organisation's perception of the level of risk, the educational medium and the support and advice from intermediaries such as trade unions and employers.
The HSE as a source of advice
There is evidence that duty-holders perceive and expect the HSE and LAs to be a source of authoritative advice and information. Many studies note that the need to keep up to date with regulatory requirements will lead organisations to approach the HSE for information. In addition, HSE Books, the HSE's website and HSE Infoline are used extensively.
Conversely, some employers do not believe the HSE to be a trusted source of advice - farmers, ethnic minority businesses and small firms, for example. (HSE and LA inspectors are, however, also the most common and preferred sources of information and advice on health and safety issues for most small ethnic minority businesses.) These groups fear their calls will not be treated confidentially or will result in an enforcement visit. Similar fears were revealed in a recent study of occupational health physicians (see Physicians in the workplace). The report notes that most of these fears have been expressed within small studies and that more positive findings are found among larger studies. It is possible that the fear of approaching the HSE for advice may be greater among "first timers" than those who have had previous contact with the HSE.
Education and external advice is particularly important for SMEs, which tend to lack in-house safety expertise and the resources for external consultancy. Most studies suggest that SMEs would welcome a higher level of "prescriptive" advice and an all-in-one document. The desire for specific advice contradicts the HSE's favoured risk assessment approach, which generally requires some health and safety competence. This means that HSE information needs to be pitched at a lower level; at the same time SMEs agree that publications should be concise, free, sector or hazard-specific, and updated on a sector or hazard-specific basis only.
Penetrating the market
The degree of penetration and response to HSE advice and information increases where:
the sector is "tight knit";
there is a strong professional or trade association;
sectors already display adequate standards (although they take less action because they are "good enough" already);
organisations perceive themselves as higher risk; and
firms are larger (due in part to the presence of in-house safety professionals and a clear organisational structure).
Sector-based findings are less clear. The retail sector appears to have a low level of awareness and response to advice and information, while public and higher-risk sectors (such as manufacturing and construction) tend to display increased levels.
Employers in the US, Canada, Australia and New Zealand have similar attitudes. In these countries, the provision of advice increased - often with financial rewards for complying with the advice - because of government and employer concern at the rising level of workers' compensation. Although research into these interventions is not conclusive, the report notes that "it does appear that the increased focus on prevention by state bodies along with the incentive of reduced costs was associated with safety improvements."
The medium
Box 4 summarises the efficacies of the different mediums that the HSE uses to influence duty-holders. Overall:
Inspections have a large impact in stimulating action in all businesses. But questions remain as to whether or not the action taken as a response to inspection is of sufficient quality, ie the businesses did not always understand why a measure was necessary. Inspection should incorporate education so that businesses understand the reasons why action should be taken rather than just being told it should.
The success of seminars varied between industry sectors and could, at best, be as successful as inspection. One difficulty is that while seminars are effective in influencing compliant organisations, reluctant compliers are the least likely to attend seminars.
Mailshots induced considerably less action in companies than inspections and seminars (although they worked well among farmers due to the close knit community and interaction between farmers). Mailshots are least effective in industries where standards are already high.
Clear and concise leaflets generally provide a valuable source of information for businesses, particularly with "hard-to-reach" sectors.
Evaluation of the HSE's GHGB campaign found that mixed media campaigns could significantly improve occupational health standards, but that future campaigns should target "unaware" organisations. The analysis showed that occupational health should be included in general education and training to improve employers' competence before they enter business. It also recommended that improvements be made to the presentation of the business case and that the fear of individual prosecution be raised by increasing the number of inspections and prosecutions. These findings are consistent with other research. Training from other sources helps too, including NEBOSH-linked and other courses from consultants, colleges and training boards.
Television adverts have more mixed results. Assessment of the Killing Field II campaign found a high level of spontaneous recall but an ambivalent attitude. The GHGB evaluation found low levels of recollection of TV adverts, but an impact among those they did reach.
Many of the studies reviewed in the report were undertaken before use of the internet became so prevalent: only about 15% of small companies do not now have access to the internet. A 2003 study found that 56% of companies surveyed (of all sizes) used the internet to access health and safety information, while higher percentages indicated a willingness to receive emailed information. Other studies have suggested improvements to the HSE's SME pages. The HSE's recent statement on how it will provide advice and information outlines an enhanced role for the internet.
Videos are powerful tools, but are more relevant to larger companies that have the resources to show them.
Intermediaries
The HSE can have more influence if it works with organisations that have direct contact with specific sectors. Working with such "intermediaries" can change employer attitudes, awareness and behaviours; sector-specific initiatives such as in the paper and board sector improved health and safety practice, injury rates, participation and understanding. The effectiveness of intermediaries varies considerably according to:
their level of interest and ability;
the sector, for example a tight-knit industry with one or two employer associations and trade unions that represent the majority of members;
whether organisations within a sector share similar operations and systems, and accept that they need to improve their record; and
the HSE's own arrangements and resources, in particular, a clearly defined role for workplace contact officers and effective systems in its front-line directorates for working with intermediaries.
Proven intermediaries
Successful intermediaries include trade associations, training and enterprise organisations, trade unions, worker safety advisers and professional bodies. Even here, however, there is vast under-realisation of the potential role they might play.
Trade associations have had some notable successes as intermediaries, for example the work of the Paper Federation (HSE makes paper progress). At best, they have good penetration among employers, ready-made networks and can facilitate a common set of standards, but they also suffer from variable levels of membership, activity and interest in health and safety.
Training and Enterprise Councils (TECs) enjoy a good reputation with SMEs, have high penetration and can be influential, but the level of interest in health and safety varies. The report believes that TECs "represent largely untapped potential to multiply HSE influence among small firms". For example, training programmes such as NVQs are not exploited as vehicles of health and safety messages.
Trade unions are motivated intermediaries and can supply trained safety representatives in a national network. But they represent only one in four workers (although the number they cover in practice is likely to be significantly higher) and success will depend on the relationship with the employer. The report notes that it is clear that employee involvement is beneficial and that new ways of facilitating involvement would particularly benefit the non-union sector, although enabling more workers to become safety representatives would also be beneficial.
Worker safety advisers are a potentially useful tool for reaching the UK's non-unionised workforce, but there has been only a single pilot, albeit a successful one (Worker Safety Advisers are go).
Professional bodies are limited to specific roles but bring a high standard of competence. The report notes that the research in this area is limited.
Manufacturers are useful intermediaries but their role will be limited to equipment and materials. There are some examples of the HSE working with manufacturers to produce safer workplace equipment, for example with manufacturer trade associations on the appropriate design of lifting and mobile equipment under the Provision and Use of Work Equipment Regulations.
Unproven intermediaries
There are many other potential intermediaries, some of which should be able to play an important role in amplifying the work of the enforcing authorities. In some instances, the research has been unable to find any more than the most limited interest in health and safety; in others, the research is too limited or scarce for conclusions to be drawn.
Insurers offer a high level of contact with all sectors and sizes but a small number of proactive health and safety initiatives. As with consultants, the cost can be prohibitive for SMEs, with the level of interest depending on the cost of insurance. Studies in the 1990s found that few employers regarded insurers as a significant influence on their behaviour and few insurers took an interest in the health and safety arrangements of firms, especially SMEs. The average cost of ELCI premiums did not justify company-specific assessments, except for larger and higher-risk firms. The recent crisis in ELCI has meant that insurers could now require employers to demonstrate a minimum standard of health and safety management, introduce risk-based premium rating and promote rehabilitation and return to work as a means of containing costs (see box 5). They might also offer such services to their clients.
The Good Neighbour Forum allows a high level of contact, but the advice might not always be accurate and there is little evidence as to resulting improvements in health and safety.
Ethnic minority business intermediaries have a potentially valuable role to play - particularly, says the report, in respect of "ethnic groups who tend to be more mistrustful of authority and experience most difficulty around compliance as a result of a lack of familiarity with the UK system and language barriers". Some HSE leaflets are now translated into minority languages that are common in the UK, but the report notes that multilingual helplines would also be helpful.
Furthermore:
the limited evidence available indicates that the DTI's Small Business Scheme plays a marginal health and safety role;
the sole evaluation of Safety Information Centres indicates that they can act as valuable intermediaries (see box 6);
the Business Link initiative is under-used, but offers only a limited opportunity to influence large numbers of small firms because health and safety is not a business start-up priority;
although consultants have a high level of contact with larger and riskier sectors, their high fees can be prohibitive among SMEs;
despite being the most common business association, chambers of commerce have variable levels of activity; and
although banks and accountants are often the only intermediary encountered by SMEs, they do not see health and safety as a priority.
Working with statutory bodies
The report notes that much of the HSE's work with other government departments is at an early stage, but that it has the potential to yield important interventions. Work with the police and the Crown Prosecution Service under the work-related deaths protocol has been followed by a significant increase in manslaughter prosecutions, but there remains scope to work with the Lord Chancellor's department on the approach of the courts to rehabilitation by employers and insurers, and with the police on work-related traffic accidents. Opportunities also lie with bodies such as the Food Standards Agency and Environment Agency.
Work with LAs needs to be developed, although the HSC is now some way down this path (see Happy together now as the HSE and councils make up). Studies show that where the HSE has supplied central support, implementation by LAs has been successful. There is also evidence that inconsistency in enforcement practices creates confusion and diminishes respect for the law and that nationally coordinated sector-based initiatives can be effective.
An increase in the level of competent occupational health advice and support requires the involvement of healthcare organisations such as NHS Plus and primary care organisations. NHS Plus has been developed as a way of encouraging NHS occupational health departments to sell services to the private and public sectors. The report states that it is difficult to comment on the efficacy of these schemes because they are at an early stage, but it notes that surveys show that employers would welcome such provision and that SMEs will always need inexpensive external OH help.
HSE must reach out
The report notes that the advisory, awareness-raising and educational work of the enforcing authorities is of great importance for all company sizes and sectors, but particularly SMEs. The high level of usage of HSE advice and information, the positive reviews of HSE/LA advisory work and the desire for authoritative advice shows the need to continue, or even expand, the HSE's advisory activities in all industry sectors and sizes of organisation. But while many organisations, including SMEs, do "go to" the HSE for advice, and are satisfied with the service, the HSE needs to "reach out" to the "significant proportion" of organisations that do not approach it for advice and are unaware of its promotional activity. The HSE could attempt to allay organisations' fears of the HSE through promotional activity or by creating a "virtually" separate advisory service. These organisations would also benefit from the use of intermediaries, although the resource implications of this are uncertain.
Small firms, concludes the report, prefer "specific" advice and information that they do not need to interpret in order to apply them to their activities. They also want the advice to identify the control measures that they need to take (without having to carry out a risk assessment). Direct contact in the workplace is preferred.
Overall, Greenstreet Berman concludes that its review of the research indicates that there is a range of new ways of accessing, contacting and influencing employers, including SMEs. These avenues afford the HSE opportunities to exert greater influence over SMEs. But the report stresses that the novel nature of some of these interventions means that further research (see box 7) and evaluation is needed before conclusions can be drawn about the benefits and best balance of these interventions.
Howard Fidderman is editor of HSB and a freelance journalist.
1 "Regulation and recognition: towards good performance in health and safety", HSE, Daniel House, Trinity Road, Bootle, Merseyside L20 3TW. Comments should reach Jim Holt by 24 December 2004 at the HSE (room 908). A response form can also be download at www.hse.gov.uk/consult/condocs/cdinterventions.htm and returned via email to regulation and recognition@hse.gsi.gov.uk.
2 Greenstreet Berman Ltd (2004) "Building an evidence base for the HSC strategy to 2010 and beyond: a literature review of interventions to improve health and safety compliance", RR196, HSE Books, £15 or can be downloaded free at www.hse.gov.uk/research/rrhtm/rr196.htm.
3 "HSE statement on providing accessible advice and support", www.hse.gov.uk/aboutus/plans/index.htm.
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We reproduce below the 11 issues that the HSC's consultation document particularly wants feedback on. 1. What are your views on the proposed preferred mix of interventions? 2. Assuming that there is no increase in resource available, what balance would you advocate among the interventions? What should we [the HSC] concentrate on, and which should we draw back from? 3. What are your views on the proposed interventions that employers could pursue of their own volition? What other interventions could employers pursue themselves? What (if anything) should we do to encourage this? 4. What are your views on the use of the design and supply intervention? 5. What are your views on the analysis contained in the intervention matrix [ie which interventions work for which groups]? 6. Have we overlooked any important intervention techniques? Please provide details of any other approaches we should consider. 7. What other criteria should inform the choice or mix of interventions used? 8. Do you have any other comments on the ideas and proposals explored in [the consultation] document? 9. Should existing targeting arrangements, whereby the HSE and LAs direct interventions towards poorer performing organisations be developed and made more transparent? 10. The corollary of this targeting is that better performing organisations already receive less attention. Should this process be formalised and good performance be publicly recognised by regulators? 11. Other regulators (eg the Environment Agency and Food Standards Agency) are also examining how better performance could be assessed and influence the intervention regime for an organisation. Where this implies a withdrawal of proactive intervention, it has been termed an "earned autonomy" scheme. Should the HSE/LAs approach to this be developed in conjunction with other regulators or a stand-alone system?" Source: HSC. |
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The HSC's consultative document lists criteria that might be used in an assessment of an organisation to determine whether it will be exempt from proactive intervention by a regulator: management of health and safety - this could be against published standards, although sophisticated standards would not be appropriate for smaller organisations;
commitment to being a "learning organisation" that investigates incidents and concerns, has an improvement action plan with targets and is open in reporting performance to stakeholders;
injury and ill-health incidence rates, although these are only meaningfully available for large organisations;
worker involvement in health and safety issues;
involvement of directors, for example a named main board director accountable for health and safety performance; and
systems for engaging with third parties whose health, safety or amenity might be affected by the organisation's operations. |
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The Greenstreet Berman report concludes that there is sufficient evidence to support the continuation of the established activities undertaken by the HSE and LAs, but less evidence, and therefore more research needed, to evaluate their new activities. Specific gaps include: the extent to which prosecutions deter organisations and individuals other than the perpetrator;
the deterrence effect of preventive enforcement (improvement notices etc);
the extent to which financial issues, reputation and the supply chain influence employers at different levels of the chain;
whether a risk to reputation has an impact in the public sector;
how to influence health and safety among homeworkers;
whether enforcement has the same impact in LA- and HSE-enforced sectors;
whether enforcement has a lasting impact on organisational behaviour;
the relative benefits of working with intermediaries;
how to increase the impact of prosecution and preventive enforcement activities;
the relative effects of different combinations of education, incentives and enforcement, "although it is clear that all three are mutually reinforcing rather than mutually exclusive";
whether organisations can regulate themselves without proactive support and the prospect of enforcement by the regulator (the report concludes that this is unclear even among the most aware of major hazard organisations); and
the role of employment law provisions, tax rules, regulation and subsidies in promoting rehabilitation. |
