Invisible Risks: Occupational Health In Construction Under The HSE’s Spotlight

The regulatory focus of the Health and Safety Executive has shifted. Regulatory scrutiny of traditional safety risks is taking a back seat, with occupational health taking centre stage. For the construction sector, which continues to have one of the highest workplace fatality and injury rates in the UK, this shift in focus is stark.

In this blog, we look at what this realignment of the HSE’s priorities looks like in practice with regard to occupational disease and what it means for those operating in the construction sector.

A strategic shift towards occupational health

Safety risks in construction are well known. Work at height, the use of heavy plant and machinery and close proximity of workers to moving vehicles are just some of the factors that make construction one of the most hazardous sectors for workers.

The greatest risks facing construction workers, however, are not always the most visible. In the period 2022/2023 to 2024/2025, an estimated 79,000 construction workers were suffering from work-related ill health. According to the HSE, the industry carries the largest burden of occupational cancer of any industrial sector and experiences high levels of work-related ill health arising from exposure to hazardous substances and physically demanding work.

What are the risks?

Occupational cancer remains one of the most significant health risks in construction. According to the HSE, past exposures in the construction sector are estimated to cause more than 5,000 occupational cancer cases and approximately 3,700 deaths each year. Asbestos remains the largest contributor, accounting for approximately 70% of construction-related occupational cancers. Refurbishment, demolition and maintenance projects frequently involve exposure to asbestos-containing materials.

In addition, construction workers are frequently exposed to other hazardous substances such as respirable crystalline silica which has been shown to cause severe and accelerated silicosis. Common activities such as cutting, drilling and grinding can generate these hazardous dusts, with evidence that this disease is fast growing, particularly among younger workers in the construction sector.

Musculoskeletal disorders remain one of the most common causes of work-related ill health in construction, often arising from repetitive tasks, awkward postures and manual handling activities. The HSE identifies manual handling as one of the most commonly reported causes of injuries resulting in more than seven days away from work.

Finally, excessive noise can result in permanent hearing damage, while vibration from hand-held power tools can cause hand-arm vibration syndrome and other long-term health conditions.

What does the HSE’s shift in focus look like?

With occupational disease imposing a significant burden on workers, employers and the wider economy, the HSE is making occupational health a priority. In its 10-year strategy, “Protecting People and Places: HSE Strategy 2022-2032”, the HSE’s first strategic objective was to reduce work related ill health, with a specific focus on mental health and stress. As we approach the half-way point of that strategic period, the focus on occupational health is increasingly being reflected in statutory consultations, legislative reviews and inspection campaigns, as set out in the HSE’s Business Plan for 2026/2027.

Whilst awareness-raising campaigns such as "Dust Kills", "Asbestos: Your Duty" and, more recently, the campaign on the risks of working with engineered stone (see our blog here) have become commonplace in the last few years, the HSE are now going one step further with full scale legislative reviews with a view to reducing occupational ill-health. As an example, the HSE’s current review of the Control of Asbestos Regulations 2012 focuses on minimising exposure risks of those working with the hazardous material.

Perhaps the most stark example of the HSE’s shift in focus, however, is their consultation on proposed changes to the RIDDOR regime which we have blogged about here.

Whilst the current RIDDOR regime requires the reporting of 6 occupational diseases (such as Carpal Tunnel Syndrome, Hand Arm Vibration Syndrome and Occupational Asthma), the HSE are proposing to include an additional 13 reportable conditions. 9 of these are being re-introduced (having previously been reportable under RIDDOR but subsequently removed) due to their continued prevalence, with the other 4 being newly introduced. The 13 conditions include various lung conditions which have historically arisen from workplace exposure to hazardous substances, including asbestos and silica dust, and which are prevalent in the construction sector. The HSE are also proposing to include, for the first time, noise induced hearing loss in the list of reportable conditions – again, a key risk in construction.

As we await the HSE’s response to that consultation (which is expected later this year), the message is clear: going forward, the HSE want to know about instances of occupational ill-health so they can target their regulatory activities accordingly.

We are not only seeing change at policy level. Change is being seen on the ground too. Restructuring of the HSE’s staff base into an inspection team and an investigation team has allowed the HSE to enhance their targets for proactive inspections. In the period 2026 to 2027, the HSE have undertaken to carry out 14,000 proactive inspections of workplaces with a focus on occupational ill health. The construction sector will be no exception.

As such, organisations must be able to demonstrate that they have sufficiently robust systems in place for managing risks associated with occupational ill-health. If not, they risk costly and disruptive enforcement action and/or prosecution for a health and safety offence.

What does this mean for those operating in the construction sector?

The HSE’s focus is squarely on how employers identify, assess and manage long-term health risks. As such, those operating in the construction sector should ensure that occupational health risks receive the same level of attention as more immediate safety hazards.

Employers should take the opportunity to review existing arrangements and ensure that occupational health and robust health surveillance forms a central part of their wider health and safety management systems.