Examination of Witnesses (Questions 40
- 59)
MONDAY 12 MAY 2003
DEPARTMENT OF
HEALTH
Q40 Mr Steinberg: Yes, that is important.
Again, in the Report—I think it has been mentioned previously—something
like 60% of accidents that by law should be reported are not being
reported, they are not being reported to the HSE. What do you
intend to do about it because that seems to me to be a hell of
a lot of accidents that have taken place that have not been reported?
Is there anything you can do about that?
Sir Nigel Crisp: Again, it is
the same issue that it really needs to be tackled locally against
national standards. The point you opened with about how do we
have a national standard, at least we now have a national standard
and we have a methodology for imposing that national standard,
and for making sure that the boards locally look back at their
own record and that it is on their agenda to do so. It is putting
a lot more responsibility on the local board, which is the way
it should be, because we cannot manage that sort of detail from
here, so we have put that mechanism in. I am sure part of the
improvement we have seen over the last six years is simply that
focus.
Q41 Mr Steinberg: You can make statistics
prove anything. The Chairman took us to Appendix 3, I would like
to go back there again, it is on page 46, Figure 1. On the figures
it clearly shows that serious accidents are declining, from 1996-97
to 2001-02 it has gone from 7,500 down to 5,992; that looks good,
excellent. Is it that good because if we are arguing and saying
that 60% of accidents are not being reported anyway, are these
not misleading figures?
Sir Nigel Crisp: I think there
are two sorts. These are reportable accidents to the Health and
Safety Executive under this particular set of regulations which,
as I recall it, means that the people have been off sick for three
days or more is the arrangement in which you have to report those.
Those are much more likely to be reported it seems to me than
the much more trivial accidents.
Q42 Mr Steinberg: Are you saying
that the 60% that are not reported are trivial? I am not trying
to goad you or anything.
Sir Nigel Crisp: Okay. Let me
take back the word "trivial", are less important than
these ones, are less major incidents than these ones. We have
seen a reduction in the major incidents, which is this type of
accident, at the same time when we have seen an overall increase
in reporting. Now, whether or not there are people who are not
reporting, we have seen an increase in reporting but we have seen
a reduction in the number of serious ones.
Q43 Mr Steinberg: One would assume
that if it was a serious accident then it would be reported?
Sir Nigel Crisp: Yes, I would
have thought so.
Q44 Mr Steinberg: If somebody breaks
a leg they are hardly likely not to fill the form in?
Sir Nigel Crisp: Yes.
Q45 Mr Steinberg: So from the ambulance
agency the fact is 60% have not been reported. These are the figures
that you have given them, are they?
Sir Nigel Crisp: They are the
less serious, that is probably the right word, yes.
Q46 Mr Steinberg: Okay. Bearing in
mind the way things have moved in the NHS over the last few years
and the huge number of agency staff working in our hospitals now—in
my own hospital, admin, cleaning and catering, all these things
are contracted out and no longer run by the NHS. There are also
locums working in the place—I am not trying to criticise
at all, but can it be part of the problem lies with them? They
are the ones who are not reporting the accidents, or if they are
not NHS staff will they see it is important that they do that?
Or, in fact, are they not trained to do it?
Mr Foster: The whole issue is
one of balancing various pressures and commitments. You started
off by saying it was difficult to get doctors to fill in forms,
yet I am sure we all agree we want to doctors to spend as much
time as possible looking after patients. That is really why I
gave the example in answer to Mr Rendel, that the trust had designed
a very simple, computerised intranet form to fill in. It is really
a matter of trying to find a balance, especially in the less serious
incidents where, as you rightly say, the motivation to report
is less great than where there is a serious accident involved.
What we must do is through the top-down control assurance inspections
and bottom-up staff interviews for Improving Working Life is keep
exerting pressure on organisations to raise the level of reporting.
Q47 Mr Steinberg: Turning back to
doctors, again paragraph 3.22 on page 35, I was not going through
the Report looking for criticisms of the medical profession but
it did jump out, again it says that doctors were the least likely
to participate in health and safety education. It might be slightly
beneath them to do this, but it is important, I suspect, they
should participate. Why do they not participate and why do you
not persuade them to participate?
Sir Nigel Crisp: This particular
example is specifically about induction training. I agree with
you, all employees in the organisation should be treated in the
same way as regard to health and safety issues and other general
policies. I think documents like this draw out that point and,
as I think the record over the last five years shows, we have
actually attended as an NHS to the issues that were the issues
of five years ago. We have done a lot of work on backs and on
a whole series of issues that have brought about change. It is
harder for doctors who are moving through hospitals, so perhaps
over a six month period they are in another hospital.
Q48 Mr Steinberg: I was very interested
to read in paragraph 3.20 what has been done in Wales, where standardised
health and safety training courses had been put on for members
of staff and staff were given a training passport which was transferable
between NHS organisations. This means they are trained at the
same level of competence and avoids duplication by individual
trusts. I thought that was an excellent idea. That seems sensible,
you train somebody to a standard procedure, a national standard
procedure, a national curriculum and once they have taken that
and done that curriculum they can move on through any part of
the National Health Service, presenting their passport or a certificate
to show that they have done that. Why do we not do that and copy
the Welsh?
Sir Nigel Crisp: We again agree
with that. The NHS University is designed to make sure that we
get some of that standardisation on, for example, induction.
Mr Foster: This may well be a
very good example but we can point to initiatives, for example
the occupational health smart card for doctors in England, which
is a project that is regarded as being extremely successful.
Q49 Mr Steinberg: For?
Mr Foster: Occupational smart
cards.
Q50 Mr Steinberg: I was talking about
the whole of the Health Service.
Mr Foster: I am saying we have
tried things which have succeeded for the junior doctor migrant
populations—the people who only spend six months in one
organisation and then move to another—that is a good example
of something that we have been able to do to record their training.
Indeed this is an enormous project we have, to introduce an electronic
staff record for all staff which will be the biggest such record
system in the entire world and will have the capacity that you
describe, to record people's learning and training experience
at all stages in their career. That system will be able to embrace
that.
Q51 Mr Gibb: Sir Nigel, can you turn
to page 9 and look at the sickness absent rate table, again which
shows increases in the sickness absence rate. Can you tell me
what the best practice sickness absence rate is in the public
sector?
Sir Nigel Crisp: You are looking
at the table and the reference above it to the relationship with
other public sectors.
Q52 Mr Gibb: Yes.
Sir Nigel Crisp: The first point
is that I do not think there is a precise figure but we did set
a target, which is the best we can do, as to where we think we
want to be, which are the figures in here of 4.6 and 4.3, and
you can see from this target that the figures that we have move
towards it. If you look at paragraph 1.2 above it shows the average
in the NHS of 4.9% compared with the average 3.7 from the other
public sector bodies. There is a slight anomaly in this which
is that the 4.9% is the actual lost time over the year 2001-02.
There are different ways of measuring sickness absence. I understand
the 3.7% figure is actually a one week snapshot in October, where
one is actual lost time and one is a one week snapshot. I have
seen other ways of calculating this which shows that the NHS is
very much in the middle, if not slightly better, than some other
parts of the public sector.
Q53 Mr Gibb: The 3.7 is an average,
even 3.7 is a long way above the best if that is the average?
Sir Nigel Crisp: The difficulty
is that we have tried to compare ourselves with ourselves to see
improvement happening within our own organisation. One of the
issues the NHS shares with other parts of the public sector is
heavy lifting.
Q54 Mr Gibb: That is accidents. I
am talking about sickness now.
Sir Nigel Crisp: It relates to
sickness.
Q55 Mr Gibb: How do you compare with
private sector haulage companies?
Sir Nigel Crisp: If you look at
the different figures produced for the private sector some of
them are snapshots, some of them are round 3.5% and some are round
5%. I have spent a bit of time in the last two weeks trying to
get a fix on this question, effectively I have come to the view
it is better if we compare ourselves with our past performance
rather than some magic figure.
Q56 Mr Gibb: You are not seeing improvements.
In 2000 it was 4%, it is now it 4.5%, in all the trusts it is
going up.
Sir Nigel Crisp: The outturn in
2000 on all trusts was 5.1 and in 2001 it was 4.9.
Q57 Mr Gibb: It is all going up from
the year 2000, is it not?
Sir Nigel Crisp: It is coming
down, but it is getting further from target, that is what that
graph shows us.
Q58 Mr Gibb: Do you accept there
is generally a 20% productivity gap in the NHS—
Sir Nigel Crisp: No.
Q59 Mr Gibb:—which is what
some health policy experts are saying? You do not think there
is. Do you think you are at premium capacity?
Sir Nigel Crisp: What do you mean
by productivity gap?
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