to their particular circumstances and the hazards in their workplace. Adequate facilities and equipment for rendering assistance to workers in the workplace in a case of accident or illness and for summoning an ambulance in an emergency must be provided. They must ensure that, if first aiders are appointed, they are provided with suitable training and have an appropriate first aid qualification which is regularly renewed. Where qualified doctors, nurses or paramedics are employed they can act as first aiders without additional training. In a low risk environment it may be sufficient to provide a first aid box and an appointed person (not necessarily a trained first aider) to take charge in an emergency. The number of employees on the site is a relevant consideration. Employers are not obliged by the First Aid Regulations to make provision for members of the public, although the practice of organisations like schools and places of entertainment in making first aid provision for non‐employees is strongly recommended by the HSE. The employer owes duties under the Health and Safety at Work Act 1974 both to his employees and also to people not employed by him. Employers must inform employees of the arrangements that have been made for first aid in the workplace. First aid does not include giving tablets or medicines to treat illness, except aspirin to someone with a suspected heart attack.
In recent years there has been a move towards putting pressure on employers to provide mental health first aid, though this is as yet not covered by the regulations. Mental health first aider training has become popular and has been supported by several large employers. At time of writing there was little evidence of its effectiveness, other than to help to reduce the stigma of mental illness. Detailed research is needed. This training should be distinguished from the training of managers in sensitivity to workers with stress and mental health problems, and how best to assist them.
As regards legal liability, first aiders owe a duty of care and a duty of confidence to those whom they assist. There is no responsibility in law as a Good Samaritan to go to the help of a stranger, although if assistance is given, reasonable care must be taken. However, first aiders appointed by the employer are not Good Samaritans. They hold themselves out as providing a service for which they are paid and therefore have a duty to assist if called upon; the standard of care expected is that of a reasonably competent trained first aider, not a doctor or nurse. The Compensation Act 2006 provides that when a court is considering a claim for negligence or breach of statutory duty it may consider whether the taking of reasonable steps to meet a standard of care might prevent a desirable activity from being undertaken (Chapter 6). The Social Action, Responsibility and Heroism Act 2015 provides that courts should take into account whether the person being sued acted for the benefit of society or its members in a predominantly responsible way or heroically in an emergency to assist another. No case has so far been recorded of a first aider being held legally liable, but it is advisable that they be covered by the employer’s liability and public liability insurance.
It will be noted that there is no obligation in these regulations to have a qualified doctor, nurse or paramedic on the premises or available. However, when workers are employed in especially hazardous processes, like working with asbestos, lead or ionising radiations, or with hazardous substances, vibrating tools or in a noisy environment, statutory regulations may require regular health surveillance, which will demand the occasional presence of qualified health professionals at least to supervise regular examinations (Chapter 4).
1.3 Who pays?
In some industrial countries, the provision of an occupational health service is regarded as an important part of the Welfare State. In Italy, for example, the prevention of accidents and ill health at work is one of the functions of the local health authorities. Though the NHS has in the past been seen primarily as a treatment service, preventive medicine has gained in importance, especially as soaring costs have placed intolerable strains on the Exchequer. The policy documents and strategies already discussed in this chapter demonstrate the new commitment to disease prevention and health promotion.
Facilities for the treatment of non‐emergency conditions at the workplace can with justification be charged to the employer. He may be willing to pay a dentist, nurse, physiotherapist or counsellor to treat his workers at the factory, especially when there is a long waiting list for NHS treatment. But what of the preventive aspect of occupational medicine? The state provides the Employment Medical Advisory Service, but the numbers of personnel are too small to be able to do more than lead and advise. Where statutory regulations oblige the employer to monitor the health of their workers, they are compelled by law to pay the fees of an Appointed Doctor. The small employer will find it difficult to do much more than this, but there is evidence that employees in such enterprises are at greater risk than those in larger organisations. If the provision of an OH service for every employee is to be a practical possibility, either it must be taken over by the NHS or more cost‐effective methods must be found.
The Gregson Committee was not enthusiastic about an NHS takeover, principally because it found that the health service did not yet succeed in caring adequately for its own personnel, let alone anyone else’s. Since the publication of the first edition of this book, NHS Trusts have improved their occupational health services, but a report of the National Audit Office in 2003 and the Boorman Review of 2009 described the provision of OH within the NHS as ‘patchy’. NHS Plus was a network of occupational health services based in NHS hospitals. The network provided an OH service to NHS staff, and also sold its services to the private sector. It also provided a popular helpline that was transferred to the Fit for Work service. NHS Plus was abolished and replaced by the NHS Health at Work Network. There are over 90 providers around the country offering a wide range of services to outside organisations. This is not part of free statutory NHS provision. The equivalent organisation in Scotland was Safe and Healthy Working (SAHW), now Healthy Working Lives, but its remit is wider than NHS Plus, since it gives all kinds of health and safety advice via NHS occupational health and safety services. It is also free and offers free workplace visits by a generalist health and safety practitioner.
The inevitable answer to the expansion of occupational health service provision is to persuade the employer to pay for it or impose a legal duty. Both France and the Netherlands, for example, impose a legal duty on employers to appoint occupational physicians who are closely involved in monitoring fitness for work and the management of sickness absence. Employers need to be persuaded of the cost effectiveness of OH services.
The HSE published two books in 1993 and 1997, under the title The costs of accidents at work, designed to show that ‘there is no contradiction between health and safety and profitability’. The Health and Safety Executive’s statistics demonstrate the costs to Britain of accidents and ill health at work. In 2018 there were 1.4 million cases of work‐related ill‐health involving an annual cost of new cases of £9.7 billion, excluding long latency diseases like cancer. There were 144 cases of fatal injury and 0.6 million non‐fatal injuries to workers, an annual cost of workplace injury of £5.2 billion. There were 30.7 million working days lost. Total costs fell by approximately 17 per cent between 2004/05 and 2009/10, driven by a reduction in the number of workplace injuries, probably due to the decline of heavy industry, but since then have remain broadly level.
Employers need to be shown how their business could benefit financially if they provide health and safety and occupational health services in the workplace. In 1989 the HSE listed the benefits of providing an occupational health service.
The benefits of providing an occupational health service
compliance with legal responsibilities;
reduced labour turnover and increased efficiency;
less sickness absence and fewer compensation claims through detection of health hazards and adoption of preventive measures;
less waste of employees’ work time through provision of on‐site first aid and treatment facilities;
improved general health through introduction of health promotion and education programmes;
a