Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 40 - 59)

MONDAY 12 MAY 2003


  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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