Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 120 - 139)

MONDAY 12 MAY 2003

DEPARTMENT OF HEALTH

  Q120  Mr Osborne: Do you envisage under your computerised system that somebody would not be trained for the same thing twice?

  Mr Foster: Part of the reason for having a record is to ensure that people are not missed out more than to avoid duplication, although it would have that effect too.

  Q121  Mr Osborne: Presumably there is a lot of duplication, as people move round they are required to go through fairly similar training schemes. I do not know if Sir Nigel has an idea of how much that costs?

  Sir Nigel Crisp: No, I do not. Mr Foster referred to the electronic staff record earlier which will increase the portability of such things, so we will know where people end up.

  Q122  Mr Osborne: In effect they will have an electronic passport?

  Sir Nigel Crisp: Yes, to address that important issue.

  Q123  Mr Osborne: What about the Welsh idea of a   national health and safety training course customised for particular members of staff across the whole country?

  Sir Nigel Crisp: We see the NHS University as being very much part of the reason for doing that, to make sure that we have those sort of issues brought into line. Induction, health and safety, a whole lot of issues which are done locally now could be more centrally organised nationally.

  Q124  Mr Osborne: You do not have an NHS-wide occupational strategy such as they have in Scotland?

  Sir Nigel Crisp: That was the point that is made early on about bringing all this together within one strategy, is that the point you are making? What we have done is we have done a lot of work in a lot of specific areas in response to the last report. We have very recently brought a group together to coordinate it all following discussions with the Health and Safety Executive, that has happened really very recently. The short answer is we will have but we do not have now.

  Q125  Mr Osborne: The point is there is a range of national initiatives and they are spread over the controls assurance unit, employment policy branch, NHS estates and one of the specific recommendations in this Report is that you consider developing a national health and safety strategy, can you pre-empt your formal response to this Report and say that you will be adopting it?

  Sir Nigel Crisp: We do accept that and we have set up a group to coordinate this matter.

  Q126  Mr Osborne: Am I right in saying you do not think you are going to hit your target of reducing the number of incidents by 30% this year?

  Sir Nigel Crisp: Yes.

  Q127  Mr Osborne: You are not going to hit it?

  Sir Nigel Crisp: Yes.

  Q128  Mr Osborne: Why in 1999 were you so confident about setting these targets, which almost immediately you failed to hit?

  Mr Foster: When this policy was being drawn up in 1999 there were two arguments at the time, one said that we do not have adequate reporting systems. If you set a target of this nature and require there to be greater reporting you are more likely to have an increase in numbers. The other argument said that is not sufficient justification for not requiring a reduction in the levels of sickness absence, that is why we decided we would set a stretching target for the NHS using reports, such as was mentioned earlier on, by comparison with other sectors, where clearly there is potential for a reduction in sickness absence and in incidents and assaults, all types of things. It was necessary to set a stretching target. I think we knew at the time we set it there would be methodological problems ahead.

  Q129  Mr Osborne: Did you tell us there would be problems?

  Mr Foster: It was certainly debated within the NHS.

  Q130  Mr Osborne: Once it was outside the NHS—

  Mr Foster: It was a consultation process of the paper at the time, the "Working Together" paper. It was put out to various external stakeholders, like trade unions and everyone recognised the tension. It was more important to stress the priority and get on and do something about it.

  Q131  Mr Osborne: Sir Nigel, you said earlier that the NHS is notorious for having a large number of targets, do you think you should set targets where you can measure if they are accurate, and so on, instead of plucking out targets?

  Sir Nigel Crisp: We do not just pluck targets out of the air. Starting this April what we have done is we set out the targets that we were going to monitor people on and measure them on, which amounted to 44, that is still quite a lot but it is not as many as we have had perhaps. This is part of the decentralisation, we have given 75% of the money to PCTs and associated with that 44 targets and 18 assumptions, a total of 62 matters associated with that money for the expenditure of something like £150 billion. It seems to me that as a Public Accounts Committee you would want to have some—

  Q132  Mr Osborne: I do not disagree with that, I just want to make sure they are decent targets. We found this rather topically when we spoke to the international development secretary a while ago, they set up a load of targets four or five years ago that turned out to pretty blunt and difficult to measure and then a couple of years later they sharpened them down into ones they were more likely to measure and meet, would it be fair to say that the NHS has gone through a similar process?

  Sir Nigel Crisp: Yes, that is why we developed those targets. I can give you a specific example, we set out a national policy on cancer four years ago with a lot of targets associated with it and before Christmas we set out a national policy on diabetes with only two.

  Q133  Mr Osborne: You are learning from your mistakes.

  Sir Nigel Crisp: Learning from our experience and also being clear we did not want to inundate people with targets, and recognising that you get things done in other ways, including the spread of good practice. Targets are important, but well set ones.

  Q134  Mr Osborne: What is the general trend? We have looked over the last few years, and we were comparing it with the last five or six years, and if we look over 20 or 30 years is this a growing problem for the NHS? Is it being reduced?

  Mr Foster: It would be very different according to the type of problem. Manual lifting and handling problems were very much more prevalent several years ago because of an absence of training and an absence of physical devices that assist people to move patients without physically lifting them up themselves. I think the improvement we see there is part of a long-term result of better training and devices. If you take the violence from patients I think there has been a trend in the opposite direction. In the past patients tended to be more deferential and to be unquestioning about policy.

  Q135  Mr Osborne: Do you think NHS staff are more aware of their rights, more likely to complain about things they would have kept quiet about 20 years ago?

  Mr Foster: We encourage them to do that. This is where these evolutionary policies about turning the NHS into a good employer and having a range of sophisticated, best employment packages comes in, part of that is encouraging staff to report problems and part of that is inspecting progress by asking staff themselves if they can see progress happening, not by asking chief executives. Improving Working Lives asks large numbers of staff about how the organisation is progressing against a series of important objectives.

  Q136  Mr Osborne: Can I finally ask you about something that is touched on in Appendix 12, that is ill health retirement—for people who deal with the police this is a major problem within the police service—what sort of scale of problem is it in the NHS?

  Mr Foster: It is a problem that is very closely related to the issues we are talking about here. I think the Pensions Agency had a review of this about two or three years ago which resulted in them sending out revised guidance to trusts on the early handling of cases of this nature. Like many other aspects it is something that we need to do more about.

  Q137  Mr Osborne: What sort of rate of ill health retirement do you have?

  Mr Foster: I know the highest level is from ambulance trusts. I cannot pluck figures out of the air.

  Q138  Mr Osborne: Can I see a general note on this.[6] Is there any incentive in the pension system, the pension arrangements of the NHS to take ill health retirement as there are in other public services like the police?

  Mr Foster: I really do not think that is the motivation behind people taking ill health retirement. We have a very sophisticated system of checking and a great deal of occupational health expertise available to us. That was really part of what the Pensions Review was a couple of years ago, to improve those practices.

  Q139  Mr Davidson: I wonder if I can start off by looking at page 34, Chart 13, there really is a wide variation there in the number of health and safety staff employed by trusts. Is there any evidence of a correlation between the number of staff that you have employed in health and safety and the number of accidents?

  Sir Nigel Crisp: This chart does show we have more staff employed in ambulance services, which is where we have the bigger problem, which is good to see, and where we have seen more of a reduction. What we do not have at the moment, although I am sure that the NAO will give it to us, is details of which trusts are where on this, we do not have that spread to do that analysis.


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