Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 100 - 119)

MONDAY 12 MAY 2003

DEPARTMENT OF HEALTH

  Q100  Jon Trickett: In health and safety terms it has not made any difference, any of the constitutional, legal or institutional changes that we have made in the last however many years, has it?

  Sir Nigel Crisp: I think that is probably right.

  Q101  Jon Trickett: Can I go on to paragraph 3.50, which is dealing with 28,000 people who work for you who are not employed by the NHS, many of them obviously by contract, and some of them presumably as sole traders: "The Health and Safety Executive recommends that at all stages of the engagement process", ie of sub-contractors, "close attention should be paid to the health and safety performance of contractors" Only 5% of trusts are doing such a thing at pre-contract stage, therefore 95% of the NHS are ignoring the Health and Safety Executive recommendations in this matter. What is your legal responsibility in relation to the knowledge which you now have that this overwhelming failure is taking place?

  Sir Nigel Crisp: I am not sure I can couch it in terms of my legal responsibility but I clearly have a responsibility in my job to pick up where there are failures like that and to act on it.

  Q102  Jon Trickett: What are you doing then?

  Sir Nigel Crisp: A number of things that we said earlier. On that specific one we are making clear what people need to do about it. We have got the two major policies that I talked about, the Improving Working Lives Policy is specifically about a whole series of related measures about how we employ people within organisations. All of the stuff we have done on control assurance is about improving the way in which local boards work, our responsibility is to help them to do their job as effectively as possible and to support the trusts.

  Q103  Jon Trickett: You have no line management function yourself in relation to any of these trusts, PCTs or any of these other fancy institutions we created which try to devolve decision-making down? You have no line management responsibility?

  Sir Nigel Crisp: I have a series of responsibilities, it depends on whether you call them line management or not, I have responsibilities associated with appointment, with holding people to account, making sure the chief executives of these trusts are accountable officers and therefore able to discharge their responsibility and can be called in front of this Committee, and a responsibility to intervene when there is a major problem that is happening.

  Q104  Jon Trickett: The fact is that we can bring you in front of this Committee but you could safely say to us it is not my managerial responsibility the fact that 95% of the trusts are not doing what the Health and Safety Executive require them to do.

  Sir Nigel Crisp: You will note I am not saying that. The management task is really a very complicated one. Sometimes in front of this Committee we are accused of getting involved in micro-management and trying to show local people how to do things and sometimes we are accused of being far too distant round the issue of guidance. The reality is that out there we have something of the order of 600 organisations who we need to make sure are as competent as we can get them to be to spend on average, each of them, something like £90 million. Those are big, substantial organisations. Our responsibility is to make sure the system works, that is the most sensible way to look at it. That means when a bit of it falls over to make sure there is some way of intervening when there is a major problem. What it is not to do is to get involved in every individual incident within the NHS. When there is a significant issue that is brought up, as your predecessor did six years ago, round health and safety, it is to make sure progress is made on it. It is about managing the system, not managing every individual detail of it.

  Q105  Jon Trickett: 3.51 says: "37% of health and safety leads stated that their own NHS trust's system for the control of contractors has inadequacies in some or all respects". How many of that 37% had inadequacies in all respects?

  Sir Nigel Crisp: I do not know that information, I do not believe we have been given that information.

  Ms Taylor: I will have to let you have a note on that.[3]

  Q106  Jon Trickett: Sir Nigel, do you not think it would be fair to say that you have been somewhat remiss, to say the least. There are some failing totally in exercising their duties and whatever your responsibility that is a gross failure, is it not?

  Sir Nigel Crisp: If you look at the Report as a whole and you look at where we were six years ago you will see there have been enormous changes and enormous improvements. The issue has moved on, the issue is how do we deal with the people who are not performing. I agree with that, there is a lot of work to be done, I do not say that is being grossly remiss, I am saying we have a lot more to do, but we have come a long way.

  Q107  Jon Trickett: Under foundation hospitals, which I accept are not yet announced—no doubt you will have helped in framing the Bill and can envisage what could happen—can you tell me, what is your role in health and safety matters in relation to foundation hospitals, which we have been told are setting the trusts more or less free, the sort of philosophical and institutional arrangements that have been used to advocate this structure? What would your role be in relation to health and safety in relation to foundation hospitals?

  Sir Nigel Crisp: The health and safety law will apply as now and they as individual employers will be responsible for securing health and safety.

  Q108  Jon Trickett: At the moment you have an over-arching responsibility for the trusts.

  Sir Nigel Crisp: The levers that I will have in future will be about the management of that system and they will be about making sure that when NHS money is being spent through the NHS trusts, the Primary Care Trusts that they do so against national standards, which may well be about making sure they are safe services as well.

  Q109  Jon Trickett: Are you saying that your role will not change in any way at all in relation to health and safety when the foundation trusts proceed as envisaged?

  Sir Nigel Crisp: The foundation trusts will be accountable to their local community through the arrangements that are in the Act and not accountable directly to me in the way that they are now.

  Q110  Jon Trickett: There will be a severing of the connection between you and exercising your duty in relation to the health and safety as exercised now?

  Sir Nigel Crisp: In relation to individual institutions but not to the whole system because we still hold responsibility for how the money comes into the system, how it is spent and against what standards. That is why I keep stressing the importance of the role of Primary Care Trusts in decision-making.

  Q111  Jon Trickett: Those people who are employed directly by the NHS rather than through the trust, the PCTs or any other devolved body, the Civil Service, and other people.

  Sir Nigel Crisp: The Department of Health.

  Q112  Jon Trickett: Probably others as well, what is your role in relation to them?

  Sir Nigel Crisp: I am the employer. Specifically for the people who are Department of Health employees then I am in the position which chief executives are to their trusts and I do have a responsibility for them.

  Q113  Jon Trickett: Directly in health and safety matters.

  Sir Nigel Crisp: Yes.

  Q114  Jon Trickett: I do not think the Report spends a lot of time on that, how many staff does that involve?

  Sir Nigel Crisp: About 5,000 in total, including agencies.

  Q115  Jon Trickett: Are you able to point to anywhere in here where the issues of health and safety are addressed for those people?

  Sir Nigel Crisp: They are not addressed in this Report, looking at this Report I asked the question you have just asked as to where we stand in relation to the standards here. I have a board level director, we have processes in place.

  Q116  Jon Trickett: For the sake of completeness it might be useful to receive a short note to explain what happens and your general record in terms of accidents, and so on.

  Sir Nigel Crisp: I am happy to provide that.[4]

  Q117  Chairman: I am still unclear about this question both Mr Trickett and Mr Gibb asked about the line of authority through you and to Parliament. I am particularly interested in Mr Trickett's question about foundation hospitals. You gave an explanation about how the line of responsibility takes place in relation to particular incidents in hospitals under the present arrangements, how will this be different under foundation hospitals? Presumably, as you said, they are responsible to the local community, not to you, and therefore not to Parliament, if there was a particular case, an accident which revealed some problem in that hospital or the board I take it that would be a matter for the local community?

  Sir Nigel Crisp: That is how it is now. When you drew attention earlier to those individual cases those were individual trusts that paid compensation. If you would like a note on the relationship between foundation trusts and health and safety we will provide that.[5]

  Q118  Mr Osborne: Can I begin by picking up on something Mr Steinberg was asking Mr Foster about, this is what they have done in Wales, the idea of a national training standard, a training passport. In response to my colleague you said things like, they may well be a good idea, I am not saying it is not a good example. That is not very specific. It is a good example, are you going to do it?

  Mr Foster: It is a good example and we will certainly look at it but given we have another major initiative which will embrace a broader approach to record training and learning for all staff it is unlikely we will do this in parallel.

  Q119  Mr Osborne: You will look at it but you will not do it in parallel.

  Mr Foster: We are introducing this electronic staff record which covers all the staff in the NHS, it will record their learning and training histories, it will record a much broader set of information than the Welsh example. It seems to me to be unlikely that we will install a system at the same time that records all learning and a system separately that records a particular type of learning.


3   Note by the NAO: 14 Trusts stated that they had no systems in place for controlling the health and safety risks to contractors on their premises. Back

4   Ev 22 Back

5   Ev 23 Back


 
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