Examination of Witnesses (Questions 100
MONDAY 12 MAY 2003
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
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
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.
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 announcedno doubt
you will have helped in framing the Bill and can envisage what
could happencan 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
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
Sir Nigel Crisp: The Department
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
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
Sir Nigel Crisp: I am happy to
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.
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
Ev 22 Back
Ev 23 Back