Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 1 - 19)

MONDAY 12 MAY 2003

DEPARTMENT OF HEALTH

  Q1  Chairman: Good afternoon, welcome to the Committee of Public Accounts. This afternoon we are looking at the Comptroller & Auditor General's Report on A Safer Place to Work: Improving the management of health and safety risks to staff in NHS trusts. I would like, once again, to welcome Sir Nigel Crisp back. Would you like to introduce your colleague?

  Sir Nigel Crisp: Mr Andrew Foster, who is Director of Human Resources for the NHS.

  Q2  Chairman: Thank you very much for coming this afternoon. Perhaps I could begin the questioning by asking you to look at page 16, please, Sir Nigel, and could you look at figure 4. My question is this: You have reported to the Committee of Public Accounts in 1996 since then your Department has adopted a target to reduce accidents by 20% by the end of 2001. If we look at figure 4 we will see that the number of reported accidents is now starting to increase again. What is going on and why have reported accidents increased?

  Sir Nigel Crisp: Right. We think that the main cause here—though it is difficult to be precise and, indeed, this document does go into a number of reasons for why figures may have gone up—is mostly about actual reporting. I think the good news within this picture is that since then the number of major accidents, the ones that they have to report to the Health and Safety Executive, has gone down. So we have seen the more serious ones coming down, even though we have seen the overall level of reporting going up.

  Q3  Chairman: Let us look at the serious accidents. Would you like to look now at Appendix 3 and turn, please, to page 46. You will see there that there were about 6,000 of these accidents which were serious enough—it is a large number—to be reported to the Health and Safety Executive. What are you doing to reduce this very large number of serious accidents?

  Sir Nigel Crisp: This is where an enormous amount of effort has gone in because, as you say, on that table it has gone down since the last report from 7,500 to 6,000, which is the right direction. One of the biggest issues in that is the serious manual handling issues, serious manual injuries, which we get an awful lot of in the NHS obviously in terms of the amount of lifting that is done. There has been an awful lot of work done on that by the Department, but not just by the Department, by the Royal College of Nursing, by the National Back Exchange, by a whole lot of groups who make sure that we handle that set of issues much better. Also, I think there is a role that the Health and Safety Executive itself has played, for example, in issues around glutaraldehyde and so on where they have drawn our attention to it and they have taken a much more targeted approach. We have been working closely with the Health and Safety Executive about targeting the bigger problems, so there is progress there; a long way to go, however.

  Q4  Chairman: Okay. If you could turn to page 3, please, and look at paragraph 14. Could you explain to us, please, the reason for the increase in the number of prosecutions of NHS trusts by the Health and Safety Executive over the last few years?

  Sir Nigel Crisp: First of all, I do not think this gives a figure, but my understanding is that the figure is that in recent years there has been about four or five cases a year, it went up to nine and now it has come back down to seven, so any increases are fairly marginal in those terms. Also, that has been at a time when the Health and Safety Executive has taken health as one of its priority areas. It is not surprising we have seen something of an increase—it is disappointing to see that—but I think that is the broad reason, so I think that it is a case by case really.

  Q5  Chairman: Could you look further down that page, please, look at paragraph 17, and explain to the Committee why, according to this paragraph, little progress in evaluating and understanding the costs and impact of accidents has been made?

  Sir Nigel Crisp: Yes. I think this is fair comment. Also, I think that the main reason for this is it is very difficult. What we have committed ourselves to do, as part of the recommendations from this Report six years on from the previous one, is to revisit a whole set of issues around cost with people from the Health and Safety Executive with others, so that we can try and get a much tighter grip on it. One of the things that will enable us to do this is that we will fairly shortly have Electronic Staff Record, which will give us much better information about staff and will allow us to get the information and get the detail much more appropriately.

  Q6  Chairman: Can you now, please, turn to page 28—which I find quite an interesting page—figure 10, and you will see there various examples of compensation. You will see, for instance, that an occupational therapy assistant won £600,000 from the taxpayer in compensation after she slipped on a wet vinyl floor and fractured her right ankle. That seems a lot of money for somebody—I am personally familiar with this particular injury—to receive. What are you doing to manage the costs of these very large awards? For instance, I see that a doctor has received £465,000 who developed a psychiatric illness following a sharps injury, even though the incident did not lead to any physical infection. The taxpayer will think that these are very large sums of money.

  Sir Nigel Crisp: It partly relates to your last point. It is very important that we do identify the real costs because they will help be a driver for improvement. In terms of how we are helping people to manage these, we have now brought these incidents into the remit of the NHS Litigation Authority which allows pooling arrangements which are similar to the way in which we handle clinical negligence. So we have now got professional support from the Litigation Authority and, if you like, the mutual insurance arrangements that also provides. That is the support that we are providing to trusts as well as the more general policies for seeking to improve health and safety, such as the Improving Working Lives Initiative and so on.

  Q7  Chairman: We might not see a repetition, for instance, in the third bullet point there of a former intensive care nurse accepting £800,000 compensation in an out of court settlement after injuring his back at work? We might not see that as an example?

  Sir Nigel Crisp: I would very much hope that we would see less, but with a lot of staff in the organisation clearly we will continue to see incidents like this, but we have got to make them an absolute minimum. That is, as I say, what all the improvement policies are about.

  Q8  Chairman: Okay. You are relying increasingly on agency staff. Are you going to ensure that they get the appropriate health and safety training that other staff may already get?

  Sir Nigel Crisp: The point about agency staff is that for the employer it is the same responsibility on the site whoever the staff are employed by. I am disappointed to see from this Report that the NAO has found some employers not to be treating agency staff in the same way as this. We are going to be producing some new guidance about this in the   autumn and reminding people of their responsibilities with regard to agency staff.

  Q9  Chairman: Okay. Lastly, can I ask you about the NHS trusts employing contractors and you can find this reference in paragraphs 3.45 and 3.51 at pages 40 and 41. You are employing this wide range of contractors, but you remain responsible for their health and safety, that is correct, is it? What is your assessment of the risk to the NHS?

  Sir Nigel Crisp: The individual employer remains responsible, the trust in question remains responsible for that. I think we are looking at this in a lot of different ways because, as you say, there is an increasing reliance on contractual staff in a number of areas. My colleague, Mr Foster, would be better able to describe a bit more detail of what we are doing around this, in terms of particularly when we are TUPE-ing staff across from the NHS into contractual organisations and making sure that we embody the appropriate responsibilities.

  Q10  Chairman: Do you want to say something about this?

  Mr Foster: Yes. We have taken a series of initiatives to strengthen the parallel treatment of contractor staff and the way that NHS staff are treated. For example, now when PFI projects are let the employing body has to be vetted by the trade unions across a range of issues before they can be approved for use. I should have mentioned the retention of employment model was another phase of effectively seconding management staff to the NHS to look after NHS staff, so that maintained them within the same family. The next phase of this, which Sir Nigel referred to, is examining the context of local government, the two-tier workforce approach, and whether that can be applied to the NHS. So that effectively we are doing what we call a TUPE-plus of staff, a TUPE of staff across to the private sector but with a higher level of protection across a range of issues including health and safety.

  Chairman: All right. Thank you very much.

  Q11  Mr Rendel: First of all, may I declare I have an interest in the subject, namely, a wife who is a GP and, partly because of that, I would like to start off with some questions about PCTs and National Health Service trusts, which are not mentioned very much in this Report. I wonder if, Sir Nigel, you could tell us what PCTs are expected to provide by way of occupational health management and support for their staff?

  Sir Nigel Crisp: Right. The same issue as last time around, violence, where we are conscious that the occupational health arrangements within the older NHS organisations are more advanced. Effectively it is the same policies that we would be expecting to be put in place for Primary Care Trust staff, so we would be expecting, as in this Report, that the occupational health arrangements, and counselling arrangements and so on are available to PCT staff as well.

  Q12  Mr Rendel: Are PCTs given explicit funds for that purpose?

  Sir Nigel Crisp: I do not know if Mr Foster wants to come in on that? We are increasingly not giving specific allocations to anyone for anything. We are trying to give the money to the PCTs so that they make the decisions within the framework of national policies. At the moment I am not aware that we are targeting money on that.

  Mr Foster: Can I just add one thing to what you have said there. Yes, PCTs, as statutory employers, are liable in exactly the same way as NHS trusts are as employers. In terms of one of our own major measures of increasing compliance with high employment standards, the Improving Working Lives Standard, we have recognised that PCTs are less well advanced organisations and their targets lag about one year behind NHS trusts. So we are still expecting to achieve the same standards, we are just giving them a little bit more time. There has indeed been, as I have just been reminded, a small amount of pump priming money to help move this forward in occupational health services for GPs in the current financial year that has just started.

  Q13  Mr Rendel: Could you explain that a bit more?

  Mr Foster: We have targeted a small amount of money, £8 million I understand, on occupational health services for GPs in the current financial year.

  Q14  Mr Rendel: GPs themselves are also self-employed, but they are being given—

  Mr Foster:—access to it.

  Q15  Mr Rendel:—access to confidential help and advice within the PCTs?

  Mr Foster: Yes. The occupational health service would be obtained from wherever they are available. They are not very likely to be within the PCTs, more likely under a service level agreement from a neighbouring trust.

  Q16  Mr Rendel: This is available to any GP you are saying, is that right?

  Mr Foster: That is the purpose of the money.

  Q17  Mr Rendel: To various trusts and so on?

  Mr Foster: Yes.

  Sir Nigel Crisp: Yes, but let me stress, we are starting from a low base so this is an improvement.

  Q18  Mr Rendel: Are all PCTs using some of their money to provide occupational health advice?

  Sir Nigel Crisp: I do not think I know that answer because this particular money only became available as of 1 April.

  Q19  Mr Rendel: I did not just mean the £8 million for the GP. You are saying that PCTs are expected in general to provide out of their general funds occupational health advice for all their staff?

  Sir Nigel Crisp: Yes, in the same way as NHS trusts.


 
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