EHJ July 2005, pages 26-27

Last month EHJ revealed that local authorities were failing to address the risk from skin cancer. This month we talk to Nigel Coates who last year spent six months inspecting Bradford's sunbeds, a project that earned his authority a Hela award

Like everywhere else in the UK, consultant dermatologists in Bradford have been seeing an alarming increase in patients needing treatment for skin cancer. Rising rates of the potentially fatal disease prompted heath officials to set up a skin cancer prevention group, with environmental health representation. While some education work had been done with tanning salons back in the 1990s, local EHPs realised that much more needed to be done to stem the unsafe use of sunbeds in their borough. It fell to local EHO Nigel Coates to implement an inspection programme. First, he needed to find out where all Bradford's sunbeds were located and then he had to assess the current level of knowledge among staff and premises owners in order to bring everyone in the industry up to speed on sunbed safety.

RESEARCH

The first stage was to bring himself up-to-speed on issues surrounding sunbeds. The Health and Safety Executive has issued guidance and he turned to local resources like his local consultant dermatologist, his health authority's chief radiation physicist and the council's own recreation officer in charge of sunbeds in council-run premises. Then there were outside groups like the Sunbed Association, the British Medical Association, the CIEH, and, of course, colleagues around the country.

LOCATING SUNBEDS

This is not as easy as it may first appear. For Mr Coates the starting point was Thomson's local and the Yellow pages. The office clerk phoned each nail salon, gymnasium hair salon and solarium in the Bradford area to see whether they had a sunbed. Sometimes you need to be imaginative over names, "the most unusual one we came across was "Tans in 'ere"â says Mr Coates. Often sunbeds were found in the most unexpected places. Vertical tanning machines can take up little space and so can be put in any business. Mr Coates discovered four machines tucked away in a cheque exchange. "In this business there is a lot of profit sharing going on," explains Mr Coates. "A supplier will approach a small business like a hairdresser or nail studio and put one in a back room. It costs the proprietor nothing, they just give the machine owner a percentage of takings that go through the machine."

One way to get around this problem is to approach the suppliers. In Bradford's case it soon became apparent that many of the machines were of the same make and coming from the same source. "It soon became clear that 14 salons were owned by one person and that he had the agency for selling these machines and for providing a profit share scheme," says Mr Coates. "Early on I met the big players and informed them of my intentions. I formed informal partnerships to the point where one of them appointed a member of staff as their health and safety officer." Another trick of the trade is for machine owners to use profit sharing as a way of testing the market. "If you are a good business man you will go to a rural village and put two or three machines in on profit share, and if they are a success you then open a tanning salon," says Mr Coates. He also discovered the location of machines by word of mouth, with businesses revealing where competitor machines were located. By the end of the process Bradford had updated its list of premises containing machines from 20 to 130.

TYPES OF PREMISES

These would range from the top quality gymnasium down to the smallest business with a vertical machine in the corner. There were some practices that were of particular concern. Mr Coates discovered three machines that were coin operated. The potential health risk was enormous with no controls on usage. These have been converted into token operated machines. Some high quality gymnasiums also offer an "in-house" credit card facility where usage of facilities is paid for at the end of the month. In some instances tanning machines were included, allowing unlimited usage. Salons were also found to be offering unlimited usage deals. For £12 a client could use the machine as often as they wanted in a week. This practice has also now been stopped.

INITIAL MEETING

Mr Coates believes that the success of the Bradford project was down to the time spent during the initial meeting. Often up to an hour would be spent with the manager or owner of premises discussing their health and safety responsibilities. "I also made proprietors aware of common law, and that if they allowed someone to burn, they could face action from a personal claim." Each of the 130 premises were visited with a prior appointment being made. "Prior appointments are important because people are self employed," explains Mr Coates. "You can't inspect while someone is doing something, you need quality time. I also made an appointment to make sure the right people were there and to ensure I got the full attention of staff." It was also important during this initial meeting to assess the current knowledge of staff. This required taking the time to discuss procedures with staff members.

THE INSPECTION

Mr Coates checked for a general health and safety policy, a written health and safety policy and made sure a poster was clearly displayed. He also checked for first aid and Riddor procedures and that risk assessments had been done for both staff and clients. According to Mr Coates, particular things to look out for include whether panic buttons can be reached when clients are in the tanning position and whether staff can enter a cubicle in an emergency. Timers also need to be checked to see if they can be altered by the client. Records are key, including service maintenance, client records and medical questionnaires. What sort of eye protection is being used? Are they using goggles and are they being sanitised after each session?

"Often goggles were just hung up around the door when they went into a place. Often proprietors never thought of sanitising them so they became a possible way of transmitting conjunctivitis," says Mr Coates. "Talking to proprietors it is apparent that people are vain and will take goggles off. Proprietors can tell whether someone has used eye protection and in my opinion proprietors have a duty to make sure goggles are used."

Another area that should be checked is the frequency with which machines are retuned. "When a bed is retuned it becomes much more powerful. So check for warning signs to tell clients that a machine has been retuned or for session times being reduced to compensate," says Mr Coates. "Also, when there are two sunbeds, do not retune them at the same time so there is always a low power bed there." Policies on cosmetics should also be checked. "Some deodorants can cause additional sensitivity in a client," says Mr Coates. Checks were also made on the sort of advice given to clients on usage over a year, although Mr Coates admits this can be difficult. "Specifying exact numbers is difficult because it depends on skin type, the power of the machine and the length of the session. I advised the HSE recommend a maximum of 20 minutes." Information given to staff also needs to be checked to avoid unnecessary exposure to UV radiation and to ensure they understand the health risks and what advice to give clients. They also need to know what to do in an emergency and who should not use the equipment.

FOLLOW UP

A closing meeting was held following each inspection where actions taken were explained and a hand written inspection was left for the owner. Each premises was left with a certificate saying they had been inspected. Follow up visits were then arranged to check that changes had been implemented. "No improvement notices were served which I put down to the quality of time spent in the initial meeting. Owners showed no hostility and there was obstruction. They all showed a very positive attitude to compliance," says Mr Coates.