Examination of Witnesses (Questions 80
MONDAY 12 MAY 2003
Q80 Mr Gibb: They could have personal
objectives, they do not get targets set?
Sir Nigel Crisp: Very clearly
over the last two years we have pointed out that we are moving
towards a decentralised system, whereby we set the national framework
and we hold people to account for a limited number of issues.
The responsibility needs to be firmly located locally, not just
locally at chief executive level but locally within the organisation.
Q81 Mr Gibb: Then you have less managing?
Sir Nigel Crisp: We are moving
to a much more decentralised system and approach that is probably
in common with a number of other large organisations.
Q82 Mr Gibb: Large organisations
give local managers a lot of discretion but they are very centrally
managed, they have a proper pyramid of structure.
Sir Nigel Crisp: What I think
you will see they do is they have a relatively small number, smaller
than us, in terms of key targets against which they manage very
tightly and they give local managers very considerable discretion.
That is exactly the sort of model that we are moving towards.
We happen to have more targets than most other organisations but
that is the sort of model that we are moving towards.
Q83 Mr Gibb: How many inspectorates
are there that wander round hospitals?
Sir Nigel Crisp: If you include
all of the public sector bodies, like health and safety, there
are a lot. In terms of inspectorates related to health care there
are two, assuming that does not include yourselves.
Q84 Mr Gibb: "While there are
acknowledged benefits in having risk management frameworks just
under half of all NHS trusts identified constraint tasks".
Does this indicate to you that there is some kind of confusion
about the way the structure is managed?
Sir Nigel Crisp: That is referring
to structures actually within trusts, is it not, within the local
management discretion. The wider point you make is precisely why
we, and I am obviously happy to talk about it at some other point,
are going through a significant set of changes in how we manage
the NHS, and moving away from a top-down guidance, orientated
organisation to a managed organisation with locally decentralised
responsibility and accountability but within a framework of national
Q85 Mr Gibb: Is that not worse? My
perception is that because you have no proper management powers
as the Chief Executive of the NHS you manage therefore by a whole
range of guidance and targets and inspectorates, which is not
how proper managers manage, you should manage properly by nurturing
Sir Nigel Crisp: I am very happy
to provide you with a proper understanding of what we do, including
the fact we have, as you probably know, developed something called
the Modernisation Agency, which is precisely modelled on some
of the things that have happened elsewhere in industry, which
is about development, training and spreading good practice, recognising
that the way you get to conformity is about showing people and
helping people and supporting people to do that. I will happily
send you a note about that. That is something on which this Committee
has received information on many occasions.
Q86 Mr Field: Sir Nigel, can I ask
you two points, the first follows on from Mr Steinberg's question
about the 60% reporting rate, obviously you could judge that the
more serious the more likely that people would report an accident,
have you carried out any surveys recently that suggest that it
is the less important ones which are not reported?
Sir Nigel Crisp: I do not know
the answer to that question.
Mr Foster: I know that it is the
less important ones that are not reported. I am not sure whether
that is the result of a formal surveyor or collective wisdom,
but I am sure it is the case.
Q87 Mr Field: Collective wisdom!
My second point relates to the answer you gave, the fall in the
number of serious accidents from 7,000 to 5,900, and although
it does not relate to this point we are discussing, the physical
well-being of staff, I wonder whether you have the figures of
the number of acts of violence by patients and their families
on staff for us to compare with the number of other acts of dis-wellbeing,
if that is the proper word, through incidents?
Mr Foster: You, the NAO, published
a parallel report about a month ago which in many ways showed
very similar issues, it showed a reduction in the number of serious
violent incidents but a growth in the number of incidents recorded,
this is because less serious incidents like verbal aggression
were included in the figures. There is a lot of information available.
Q88 Mr Field: The total figure?
Mr Foster: I cannot remember that
off the top of my head.
Sir Nigel Crisp: We can obviously
tally it up, I think it is in the "other", but it is
not in the top five.
Chairman: We will take a little break
The Committee suspended from 5.30 pm to
5.38 pm for a division in the House.
Q89 Mr Field: Is there an answer
to that question?
Sir Nigel Crisp: 64 from your
last month's report. There were a lot of more incidents, but 64
were required to be reported in this way.
Q90 Mr Field: On this area the Government
has a very clear policy, the Secretary of State says that it is
Sir Nigel Crisp: Zero tolerance.
Q91 Mr Field: It has not quite come
over the same about your Department's feel for accidents. That
last remark is much more a point to leave with you rather than
a question. If one was trying to improve matters before you come
back next time for this issue in what way could one have as equally
a dramatic an affect on the way trusts view this issue and therefore
push the numbers down more significantly than they are?
Sir Nigel Crisp: We will think
about that. The slight problem is there are so many different
causes. Somebody thumping a nurse is visually easier to tackle
in that way. I do take your point.
Q92 Jon Trickett: I want to come
back, if I may, to the question of corporate governance, which
was raised by Mr Gibb. I notice in 3.47 that we are dealing with
some contractors who were being exposed to risk for which the
NHS was prosecuted. It was the trusts that were prosecuted rather
than yourself as the Chief Executive. Can you explain to me why
responsibility lies with the trusts rather than with you as the
Sir Nigel Crisp: Because they
are the employer. That is the simple answer.
Q93 Jon Trickett: Of the contractor.
Sir Nigel Crisp: They are the
employer on site and they are responsible for the site. That is
why they have the responsibility in law. Mr Gibb makes a very
good point, as Chief Executive it is a different sort of chief
executive than some other organisations would have.
Q94 Jon Trickett: What legal responsibility
do you think you have in relation to health and safety?
Sir Nigel Crisp: Let me make the
point, the Health and Safety Act is framed in the way that it
is the employer on site who is responsible for that operation.
Our responsibility is to make sure that we are doing everything
that we can to make sure that there is a proper health and safety
environment and a quality environment within the NHS with the
tools that are at our disposal. I do not think that I am particularly
named or my role is named in the health and safety legislation.
Q95 Jon Trickett: When you were talking
about the changes to the way in which responsibility is devolved
or centralised I assume you are referring to the Bill which is
in front of us at the moment, the establishment of foundations
Sir Nigel Crisp: Partly, but also
Primary Care Trusts, which were introduced a year ago.
Q96 Jon Trickett: The fact is it
will not make any difference whatsoever since you just said it
is the site management who are responsible in terms of health
and safety, it will not make the slightest bit of difference.
Sir Nigel Crisp: The decentralisation
was also referring to Primary Care Trusts.
Q97 Jon Trickett: You are not their
site manager either, are you?
Sir Nigel Crisp: No. You were
talking about foundations trusts and I was talking about the Primary
Care Trusts. The point is that we have been decentralising in
a lot of different ways within the NHS foundation trusts.
Q98 Jon Trickett: Before the PCTs
were established did you have direct responsibility for health
and safety for those staff?
Sir Nigel Crisp: No.
Q99 Jon Trickett: No. What difference
has it made then?
Sir Nigel Crisp: I think I was
talking in a wider context than health and safety about who makes
what decision and at what level in the organisation. The health
and safety law is quite explicit.
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