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"Everyone quite rightly gets concerned about the accident figures. But the reality is accidents are easy to identify, whereas health-related matters are like slow-burning accidents, the results of longer-term exposure," explains Kevin Myers, the Health and Safety Executive's chief inspector of construction. "It's much more difficult to get your head round, so it is difficult to get the same level of attention."

But it is about time the industry did start paying attention. Occupational health issues are costing contractors a fortune and exacerbating the skills crisis. John Hanley, director for health, safety and environment at construction manager Mace, puts forward the financial case. "It costs us 拢120 for a small injury, by the time it is looked at and the accident report made," he says. "If there are 10 small injuries a month on a site, you are talking about 拢1200; over a year that adds up to nearly 拢15,000. If you are working on a margin of 5%, that represents 拢300,000 worth of work."

Laurence Waterman, who heads Sypol 鈥� a health and safety consultancy that advises big clients and the HSE 鈥� outlines the skills implications. "We know we lose bricklayers every year from dermatitis," he says. "Because of the fragmented nature of the industry, their disappearance is not noticed in the same way as in, say, it is in the pharmaceutical industry." (See "The top five", page 45.) Furthermore, workers who are made ill by their job take time off sick. This impacts on build programmes and ultimately affects the bottom line.

Waterman has another stark warning for the industry 鈥� litigation. "The UK is second only to the US in the compensation culture, which is also why insurance is going up. Claims for people who are damaged long term tend to be higher than for a fatality."

The figures for occupational health problems are staggering. According to the HSE, 79 people in construction died between 2001 and 2002, and there were 3959 serious accidents over the same period. Compare that with the HSE's estimate for occupational health problems in the same period: 137,000 people in the construction industry suffered from an illness they believed was caused, or made worse by their job.

The term "occupational health" covers a multitude of problems. It includes minor injuries, such as a cut finger, and long-term health problems, such as bad backs caused by lifting heavy objects. Indeed, musculoskeletal disorders are higher in construction than in any other industry. These types of problem have an escalating effect 鈥� in the short term, the worker takes time off, but then leaves the industry altogether.

Occupational health includes the wider issues of diet and other general health problems that may affect a worker's ability to do their job. This includes stress, whether caused by the job or non-work factors.

Some good news is that the bigger contractors are waking up to the problem. "If you went back 10 years, you wouldn't hear health mentioned at all," says Waterman. "People who have been plugging away for a number of years on this topic feel it's coming to fruition now."

In fact, the Major Contractors Group has signed up to a set of targets including reducing reportable injuries 10% a year, and the incidence of ill health 10% a year from 2003.

Since factors affecting occupational health are so wide-ranging, a variety of initiatives are being adopted. Skanska's approach is typical of larger firms. It employs an occupational health nurse who looks after the whole company, and agency nurses are permanently stationed on large sites, with smaller sites visited occasionally. The nurses look at the risk assessment to identify occupational health risks and ways to reduce them. They also carry out screening, offer dietary advice and deal with minor injuries.

It鈥檚 very hard to make a big issue out of someone who has hit their finger with a hammer. The only way is to add up all the figures and commercialise it 鈥� then you get the attention of senior management

But it is not just up to the contractor to tackle the risks. Sypol's Waterman says it is vital to eliminate at design stage anything likely to cause occupational health problems. He is currently advising Bovis Lend Lease, the planning supervisor at BAA's Terminal 5 at Heathrow. At T5, the occupational health programme was aligned with the environmental one 鈥� so, for example, materials likely to cause dermatitis would be identified in the same way as materials from non-sustainable sources. A "red list" was produced and anything on it had to be fully justified before being used.

Mace's Hanley believes there is a tendency for the industry to react to headline problems that in reality don't affect most trades on site. "You can find you are spending a lot of money on things that are not a problem," he says. Mace records all its minor injuries and identifies the sector where they occur, whether it is piling or drylining 鈥� each trade has its own occupational health problem. This allows the firm to identify and respond to trends 鈥� for example, manufacturers could round off sharp edges on ducts so workers do not cut themselves when handling them.

The figures can also be used to persuade management to invest in occupational health measures. Hanley says: "It's very hard to make someone who has hit their finger with a hammer a big issue when senior management has to make major decisions on site. The only way is to add up all the figures and commercialise it 鈥� then you get the attention of senior management."

Sharon Copland Jones, personnel director at Shepherd Construction, thinks a sound occupational health policy is vital to attracting and retaining staff. Like Hanley, she believes collecting hard data is key to an effective occupational health policy and has been monitoring problems for a year. As more statistics are needed before targeted action can be taken, she says, other approaches have been implemented in the meantime. "Before, if someone went off sick, we weren't very proactive in getting them back 鈥� we wanted them to come back with all guns blazing," says Copland Jones. "Now we refer them to an occupational health specialist and phase them back in progressively."

Shepherd's approach has paid off. Copland Jones says sickness rates at the firm have gone down 15% and staff turnover has dropped from 25% a year to 12%. She also looks at other industries to learn lessons, including the rail sector and petrochemicals, particularly oil rigs. She says: "We can learn more from other industries that are light years ahead rather than the industry that has the problem."

Copland Jones focuses on sectors with a similar, largely male, culture to construction because part of the problem, she says, is that people perceive illness as a sign of weakness. This makes identifying and tackling the problems much more difficult.

But it is clear that one or two forward-thinking contractors will not change the entire construction industry, however well researched their approaches.

The HSE realises this, and has employed the services of Sypol's Waterman to help formulate and test an occupational health pilot scheme for the sector. If it is successful, the scheme will be rolled out nationally.

Waterman says the initiative will offer information and advice. He explains that there are only a handful of trained occupational health professionals available, so the scheme is intended to use them most efficiently. So, rather than have the professionals visit sites in person, the idea is to train site managers to detect a possible health problems and refer workers. The site managers would play a similar role to GPs in the health system.