Implementation of statutory occupational respiratory health surveillance.

Health surveillance is required by UK regulations in certain circumstances, and is usually provided through an occupational health organization. Although there are studies assessing the provision of health surveillance across the country, there are no published studies addressing the practical application of legislation, guidelines and medical research to respiratory health surveillance programmes. An audit of a multidisciplinary health surveillance programme was carried out, using review of occupational health records, occupational hygiene reports and managers' risk assessments, to compare the implementation of health surveillance in different organizations and under different contractual relationships. Sixty-six per cent of National Health Service (NHS) and 56% of industrial workplaces were able to provide risk assessments but were unable to link these with appropriate health surveillance. Twenty-seven per cent of NHS employees potentially exposed to respiratory sensitizers had baseline surveillance, compared with 87% in industry. Fifty-five per cent of Medical Research Council questionnaires were inappropriately administered by the employee themselves, rather than an interviewer as recommended. Other follow-up questionnaires in use had not been formally validated. Non-regular lung function assessment using spirometry was the predominant tool used for follow-up surveillance. There was no overall strategic approach to respiratory health surveillance in the organization studied. Health surveillance programmes should focus on disease prevention without becoming a repetitious application of unvalidated tools. Clinical governance demands quality assurance standards that will effectively implement a coordinated approach to health surveillance.