A feature of British legislation on employee representation in health and safety is its restriction to recognized trade unions. This has made British provisions unique within the European Union. New legislative provisions are under consultation and are likely to widen the existing Safety Representatives and Safety Committees Regulations. The approach of the proposed regulations raises a number of questions about the determinants of effectiveness of worker representation in health and safety that are discussed in this article. The significance of trade union support for representation in health and safety is shown to play an important role in determining the effectiveness of health and safety representatives, both through the role of trade unions within the workplace and through their ability to provide support for representation through training and information. Trends in national economies and employment patterns in Europe mean that trade unions' influence is diminishing, but their supportive role in health and safety representation has not been replaced by any alternative form of employee organization. The proposed new British Regulations are discussed in the light of these observations.