Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)

MONDAY 12 MAY 2003


  Q20  Mr Rendel: What I am asking is are all PCTs providing some money to provide that service, or using some of that money to provide that service?

  Sir Nigel Crisp: I am afraid I do not know that answer and it was not covered specifically in that way within this Report.

  Q21  Mr Rendel: No, it was not.

  Mr Foster: The standard that I was talking about, the Improving Working Lives Standard, which did require NHS trusts to have occupational health service available by 31 March of this year, the same target is set for PCTs by 31 March next year.

  Q22  Mr Rendel: Anyway, you have not yet said that they have not used any of that money for providing a service, only by the beginning of next year?

  Mr Foster: They have to demonstrate that they have reached that target by the end of this financial year, yes.

  Q23  Mr Rendel: Do you know how many there are?

  Mr Foster: I cannot answer that at the moment, no, I am sorry.

  Q24  Mr Rendel: Is it possible to provide a note about it? Have you had that information?

  Mr Foster: I am not sure whether we have had the information, but if we have, sure we can let you have that.

  Sir Nigel Crisp: We can provide you with a note telling you where we are and when we will have that information.[1]

  Q25  Mr Rendel: Okay. Thank you. Doctors, we are told, are the worst of all of the staff at reporting accidents. That seems to me to be quite a fundamental point, in that one would expect them to be, if anything, setting an example with other staff. What are you doing in particular to try to persuade the doctors in the NHS staff to announce when they have had an accident which is reportable?

  Mr Foster: This is very much a matter for local management and national guidance. There are some particularly good examples. I mention the Hammersmith Trust which has got an Intranet, which makes it remarkably easy to record a clinical incident by simply drawing up a form on the Intranet system and that is done to make it far easier to report these incidents. I think one would expect as part of the Improving Working Lives Strategy that one asks all types of staff what their experiences are of meeting the various criteria including improving health and safety at work and that would include meeting groups of doctors. They are intended to be embraced in the same way.

  Q26  Mr Rendel: Do you have any sort of sanction if you find out after the event that somebody has not reported what is obviously a reportable accident under health and safety legislation?

  Mr Foster: Under health and safety legislation I cannot imagine that it is a criminal offence. I would imagine that what most trusts do is have internal reporting procedures which will lay down the clear responsibility on all members of staff to report incidents.

  Q27  Mr Rendel: What happens if they do not? As I understand it the NAO found that something like 60% of those accidents attributable are not being reported. That is a hell of a whack. There must be at least some occasions on which that has later come to light and an accident, as it happens, has not been properly reported, although I am wondering what then happens to the member of staff there?

  Mr Foster: I think it would be using a hammer excessively to invoke the disciplinary procedures unless there is some really gross negligence involved, but this is very much something that we would leave to local organisations to use their common sense.

  Q28  Mr Rendel: What action is taken? I am not necessarily saying they have to be stopped from being a doctor or stopped from being a nurse or whatever. If we just leave it that reportable accidents are not recorded and nothing ever happens, then it seems to me that there is every incentive not to report accidents, not least because it might be damaging to the person's career if they have an accident which it might be felt they caused to themselves?

  Sir Nigel Crisp: Okay. As I understand it there is no legal sanction that is taken, but what can be taken is anything to do with the trust disciplinary procedure, which can range from counselling to whoever is in charge of the department pointing out to people what they should be doing.

  Q29  Mr Rendel: Does that happen? Are these procedures being put in place?

  Sir Nigel Crisp: I have to say, I do not know anecdotally of specific instances of that, but that is the sanction that would be used. It is just the normal employment process within the trust.

  Q30  Mr Rendel: Although some 60% of accidents are not being reported, you do not know what action is being taken?

  Sir Nigel Crisp: I have to say the professional bodies as well are also encouraging reporting, so the BMA and others also are encouraging reporting, so there is a lot of pressure.

  Q31  Mr Rendel: It seems surprising that if as many as 60% are not being reported, one needs to decide more about it, not least because, as I say, if the main source of non-reporting is coming right from the top, then you are hardly going to get more junior members of staff reporting it. Nothing is being done and the senior members of staff are found not to report.

  Mr Foster: Yes, but typically this is what a Controls Assurance audit would attempt to pick up. It would scrutinise a department, find out what the level of non-reporting is, try and identify where the non-reporting is not taking place and then add to the local policies, whether it should be a counter-checking procedure. It is very much a local issue as to how you implement your own policies.

  Q32  Mr Rendel: Have you set targets for how many such accidents should be reported in future so that you can notice whether they have increased from the 40% or gone down?

  Sir Nigel Crisp: Only in as much as we have a policy that they should be reported. We have not set particular targets as milestones towards 100% reporting, no.

  Q33  Mr Rendel: Would that not be a good idea? It seems to me that the level is really part of the argument. I cannot help feeling that if only 40% are being recorded, that is not a very good figure.

  Sir Nigel Crisp: Yes. The way we are trying to approach it, as Mr Foster has said, is making sure that we have got the mechanisms in place. The two review mechanisms we use are the one around Improving Working Lives and the Controls Assurance mechanisms, which do review what is happening in the trust and report to the trust board for the trust board to take action.

  Q34  Mr Rendel: Can I ask what work you are doing to get better estimates of the costs to the NHS of the accidents and ill health that are happening operationally at present?

  Sir Nigel Crisp: Yes. Again, in a sense, as I replied to the Chairman earlier, there has been relatively little work at this stage in looking at that. We have asked trusts to do it. As you know from the previous report, some trusts have done work on costing the impact of lapses in health and safety. We will now be re-invigorating that in association with the Health and Safety Executive and others and, as I say, better able to do it because we will have a decent staff record which we can work with.

  Q35  Mr Rendel: Presumably you will not really have a handle on what you ought to be doing or how much work you ought to be doing to try to prevent accidents involved in operational terms until you know just what it costs. There must be some sort of a payoff here, is there not?

  Sir Nigel Crisp: This is precisely the point about why we need to get a better handle on costs. As you will have seen within this Report we have set certain priorities, which are the obvious ones around backpain and so on, in order to make sure we tackle them and we have seen reductions in those. We do now need to move on, and I particularly accept the point, to getting as good a handle on costs as we can. It is difficult, it is not an easy issue and quite a lot of the studies on costs have been really quite difficult in terms of all of the different aspects of coming to it.

  Q36  Mr Steinberg: On reading the Report it seemed to me that, in fact, most NHS trusts had taken the topic quite seriously, not simply because of the figures that are given in the Report. 94% of trusts have computerised systems and probably 4% of the trusts have data recording systems which will not be as good, but at least they do some things with that. So that is what, 98% of the trusts who do something? However, the Report did seem to indicate that the performance of the trusts did vary considerably in terms of the comprehensiveness of how they report accidents and consistency with how they did it. That has got to be worrying, has it not?

  Sir Nigel Crisp: Yes.

  Q37  Mr Steinberg: How do you think you could bring in a standard level of performance that should be the backbone of the NHS?

  Sir Nigel Crisp: Yes. Now, I absolutely agree with you. If you look at the results of this Report compared with the one of six years ago, there have been enormous moves forward. What it has revealed is precisely the point you make, which is that there are people doing it well and there are too many laggards, so how do we deal with the laggards? The two policies, which are the universal policies, are the ones of the Improving Working Lives Standard which people are signed up to and then monitored on; that is the first base and that is the external monitoring. The second one is the whole Controls Assurance process which requires, for example, health and safety to be reported to the board on a regular basis and there is plenty of evidence that is now happening. Also, the other thing though that we have done and which we will continue to do, is to work with the Health and Safety Executive about targeting particular areas, or indeed particular trusts. The whole relationship with the Health and Safety Executive has moved on enormously, again, in the last six years, so that we can start to think about: "Well, how are we going to target the outliers effectively"?

  Q38  Mr Steinberg: Yes. Also, again, which is slightly worrying, is the fact that some groups do not or seem to refrain from reporting. David mentioned the doctors and that does not surprise me at all, I have got to say. If you remember we did a report recently on the side effects of some medicines, is that right? If I remember rightly doctors had to fill in a form if there was a side effect. Even though they had forms on the desk—

  Sir Nigel Crisp: This was around clinical negligence, was it not?

  Mr Burr: The Medicines Control Agency.

  Sir Nigel Crisp: Yes.

  Q39  Mr Steinberg:—they failed to do that. Here, again, we see that they have failed to report accidents. It seems to me that the only time they ever fill a form in is if they are getting paid for it; they are quite keen to do it then. I have just paid £15 for getting a doctor to fill in two little boxes but never mind. It makes one a little bit cynical. It seems to me to be the same here. I have not declared any interests. However, there was a stage when I was going to be a doctor, but I did not have patience. Why do we treat doctors with kid gloves? If they fail to report an accident and something comes of it, action should be taken against them should it not, really? Obviously, I do not want to pursue the point.

  Sir Nigel Crisp: Yes. There are two or three things that are different. This Report does not break down the difference between, if you like, the permanent staff of the hospital and doctors in training who will rotate through the hospital. One of the issues for us within hospitals, which we are getting better at, is making sure that the doctors who are there only for six months, or 12 months, or 18 months understand the policies of the hospital are part of the induction programme and understand how you do these things and so on. I think that is one point which distinguishes doctors in general from others, but your general wider point about employees of an organisation should behave equally as all other employees and, indeed, many do. Again, I think the other point that Mr Foster made was we need, of course, to make it easier for people to report.

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