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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