Health Surveillance for Respirable Crystalline Silica (RCS) Exposure

Clinical guidance from Dr Andy Sproston, Chief Medical Officer at Insight Workplace Health

Who requires silica health surveillance?

Health surveillance must be provided where workers are exposed to RCS dust and there is a reasonable likelihood that silicosis may develop.

High-risk occupations for workers developing silicosis include construction, foundry work, brick and tile work, ceramics, slate works, worktop manufacturing and installation (including engineered stone), quarrying and stone working.

What does silica health surveillance include?

Health surveillance includes periodic administration of a respiratory symptom questionnaire, lung function testing and chest X-rays.

What happens when an abnormal result is identified?

As advised by the HSE, any worker with abnormal lung function “should be assessed by an occupational health professional, with referral to an occupational lung disease specialist for further investigation as necessary.”

By entering into silica health surveillance undertaken by Insight Workplace Health, the employer explicitly accepts that compliance with HSE standards may necessitate an appointment being booked with an Occupational Physician (OHP), potential referral for chest X-rays, and GP or medical specialist consultations as detailed below.

Outcome A: Normal results

If the X-ray and clinical assessments are clear, no further immediate action is required.

Outcome B: Abnormal results

If any abnormal investigation results are identified, an urgent consultation will be scheduled with the OHP.

The OHP will conduct a clinical review and coordinate external referrals, potentially to the employee’s General Practitioner (GP) or the Royal Brompton Hospital’s ‘Lungs at Work’ service for definitive diagnosis and management if there is thought to be an occupational causation.

Whilst these are free services, the latter is likely to result in a requirement to attend hospital in London for review.

Benefits of silica health surveillance for employers

Regulatory compliance

Providing health surveillance fulfils legal obligations under COSHH and the Health and Safety at Work etc. Act 1974. It helps to prevent employee illness and ensures that the business is working safely in line with Health and Safety Executive (HSE) expectations.

Validation of engineering controls

Health surveillance acts as a check on workplace safety measures, such as Local Exhaust Ventilation (LEV), wet cutting or dust suppression.

If routine health checks show lung function deterioration across a team, it may indicate that dust controls or Respiratory Protective Equipment (RPE) could be failing and possible intervention required.

Long-term legal compliance

Silicosis and occupational lung diseases can take decades to develop. Employers are required to maintain health surveillance records for at least 40 years.

Having clear, historic health monitoring records is therefore crucial for both the employer and employee.

Lower absenteeism

Proactive monitoring reduces lost work time caused by respiratory illnesses.

Improved morale and staff retention

Demonstrating a clear duty of care reassures employees that their health is taken seriously, boosting workforce confidence and retention.

Benefits of silica health surveillance for employees

Early detection of lung disease

Silicosis is a progressive disease with early stages that are often asymptomatic.

Regular baseline and periodic health surveillance, via spirometry and respiratory questionnaires, with chest X-rays at appropriate times and intervals, detects early degradation in lung function long before symptoms become severe or irreversible.

Timely medical advice and adjustments

If health checks reveal early signs of lung damage, occupational health professionals can advise that employers review and consider appropriate control measures, or advise the employer to adjust the employee’s duties or role.

Reassurance and safe working guidance

Surveillance provides impartial medical feedback on personal lung health, helping to reassure employees regarding safe working practices.

Education and awareness

Health checks give workers direct access to occupational health technicians and clinicians who can offer guidance on correct RPE fitting, the dangers of smoking combined with silica inhalation, and safe work practices.

Confidentiality and job protection

Individual medical results remain confidential between the worker and the occupational health professional.

The employer receives only a functional report stating whether the worker is “fit”, “unfit” or “fit with restrictions” for silica exposure, helping protect employee privacy while ensuring workplace safety.

Arrange silica health surveillance

Does your workforce require health surveillance for exposure to respirable crystalline silica?

Insight Workplace Health can help your organisation establish an appropriate health surveillance programme and provide the necessary clinical assessment, testing and follow-up.

Call our team on 01792 321010 or contact Insight Workplace Health to discuss your requirements.