Examination of Witnesses (Questions 1
MONDAY 12 MAY 2003
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 herethough it is difficult to be precise
and, indeed, this document does go into a number of reasons for
why figures may have gone upis 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 enoughit is a large
numberto be reported to the Health and Safety Executive.
What are you doing to reduce this very large number of serious
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
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 increaseit is disappointing
to see thatbut 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 28which I find quite an interesting pagefigure
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 somebodyI am personally familiar
with this particular injuryto 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
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
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.