Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 80 - 99)

MONDAY 12 MAY 2003

DEPARTMENT OF HEALTH

  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 standards.

  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 and training.

  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.[2]

  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 there.

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 zero tolerance.

  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 Chief Executive?

  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 hospitals?

  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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