Select Committee on Public Accounts Second Report


HEALTH AND SAFETY IN NHS ACUTE HOSPITAL TRUSTS IN ENGLAND (continued)

TRUSTS' COMPLIANCE WITH LEGISLATION AND GUIDANCE
C&AG's Report, para 21
para 1.14
  20.  A few of the trusts visited by the National Audit Office and District Audit had taken significant steps to comply with legislation in the six key areas examined. Most trusts, however, had a considerable amount of work still to do to ensure that they complied with statutory requirements. In addition, the Health and Safety Executive had estimated that the health sector report on average only 37 per cent of the accidents they are legally required to report.
Q 1   21.  The NHS Executive told our predecessors that since Crown Immunity was lifted in the late 1980s, the Health Service had had to live by the law. That change alone had made people much more aware of the importance of tackling this issue. The NHS Executive had taken the approach of backing up the legislation with guidance about good practice.
Qs 22, 73
Q 1
  22.  Our predecessors asked whether the NHS had fallen behind the general pace in the country on health and safety because Crown Immunity had been in force until the late 1980s. The NHS Executive told us that Crown Immunity had created a lack of discipline in some places. In other places, people had always taken the issue seriously. In the period before Crown Immunity was removed, there had been some very good practice in the NHS, but there was no doubt that there had also been some sloppy practice. The NHS Executive put on record, however, that the Health and Safety Executive believed the health service had consistently improved its performance since the lifting of Crown Immunity. The NHS Executive considered this encouraging but recognised that, as set out in the Comptroller and Auditor General's report, they still had a long way to go to achieve the sort of compliance with legislation and good practice that they would like.
Qs 22, 125   23.  The NHS Executive admitted that they had been surprised about the level of non-compliance. The NHS was striving to live within the legislation but it was clear that in some cases they were failing.
Qs 6, 27, 30-33   24.  Our predecessors asked why the NHS Executive's guidance had apparently been ignored, and whether issuing guidance without checks on compliance was the most effective approach. The Executive replied that it was not true to claim there had been universal non- compliance-there had been higher compliance on some aspects such as hazardous substances, but poorer compliance in other areas such as manual handling. They added that the enforcement authority in this area was the Health and Safety Executive, not the NHS Executive. They accepted, though, that they had a responsibility to follow their guidance through. They did this by encouraging a process of self-assessment, review, confidential reporting and follow-up action which they felt was very successful.
Qs 30, 37, 58   25.  The NHS Executive added that, in visits to hospitals, the Health and Safety Executive offered advice and expected their advice to be taken and problems rectified within a certain timescale. They could also issue enforcement notices and prohibition notices and if action was no taken they could proceed to prosecution. Since the lifting of Crown Immunity the number of prosecutions had been, on average, four a year.
Qs 131-132   26.  Our predecessors asked the NHS Executive whether they were satisfied that trusts were making the best use of the self-audit package developed by the University of Strathclyde with funding from the NHS Executive. The Executive accepted that it was clear that not all of the trusts were making best use of it. Over the last couple of years they had received 1,200 requests for copies of the package, so it was in use in a lot of places. The University of Strathclyde were about to produce a better version within the next few months and there was reasonable interest from the NHS in this latest software.
Conclusions
  27.  We are disturbed by the low and variable levels of trusts' compliance with health and safety legislation and that the NHS Executive were unaware of this state of affairs. We consider it highly unsatisfactory that the health sector reports to the Health and Safety Executive only 37 per cent of the accidents which it is legally required to report.
  28.  We note the NHS Executive's view that the position has improved since the removal of Crown immunity, but we consider that there is still a long way to go before the NHS can demonstrate an acceptable level of performance in this area.
  29.  We are concerned that there has been only limited action on the part of trusts in response to the considerable volume of guidance issued in recent years by the NHS Executive. We are also surprised that there has been little effective check on whether trusts are implementing such guidance. We do not regard it as acceptable for the NHS Executive to rely on the Health and Safety Executive on this issue.
  30.  We expect trusts to draw up detailed action plans for achieving full compliance with legislation and that trust boards should regularly review progress against such plans. We also recommend that the NHS Executive should review the progress made by trusts in implementing these arrangements.




 
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Prepared 13 December 1997