Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 140 - 159)

MONDAY 12 MAY 2003

DEPARTMENT OF HEALTH

  Q140  Mr Davidson: I am not comparing the ambulance trusts with the NHS. With the ambulance trusts we have some at one and some at six, is there any evidence that having six times as many staff dealing with health and safety actually produces commensurate results?

  Sir Nigel Crisp: Not that we are aware of. We do not know which trusts these are on this scale yet.

  Q141  Mr Davidson: Can I ask the C&AG, is there any evidence that employing more staff has a beneficial result?

  Ms Taylor: We did do an analysis and there was no statistical correlation between the number of staff and the reduction in sickness absence or in incidents. Given that the data itself is very broad brush and there is lots of under reporting there is scope there to do more, we have shared all our data with the Department of Health.[7]

  Q142  Mr Davidson: We see in the ambulance service they are employing six times as many as another area.

  Mr Foster: I suspect a significant feature here is that some organisations will have staff whose entire job is to be health and safety and other organisations will have staff where part of their job is to be responsible for health and safety, that is some of the variations being picked up here.

  Q143  Mr Davidson: Turning to the next page, Chart 14, about induction courses, again is there any correlation between having induction courses and success, however measured?

  Mr Foster: I am not aware of a specific NHS programme, there is certainly a wide range of broader academic studies on the importance of induction surveys and the results are across a wide range of indicators. We could have a trawl through the academic evidence if you like.

  Q144  Mr Davidson: I have just been involved in the Scottish elections, I will put that down as a "don't know".

  Mr Foster: It is a yes, but not NHS specific as far as I am aware.

  Q145  Mr Davidson: You have no evidence as to what sort of induction processes work any better than others?

  Mr Foster: We have left induction courses to individual organisations to carry out. We are aware of a broad variation in practice, as indeed in many of the areas covered by this Report. This is one of the clearest areas by which the next time your Committee looks at this subject we will have made a great advance on. The NHS University, which is to be established from November of this year, has taken as one of the first major initiatives that it is going to do the provision of a common core induction programme for all NHS staff, which will be expected to include health and safety modules.

  Q146  Mr Davidson: A common provision which includes core elements will not necessarily be as efficient as it might be unless there is some evidence of what works and what does not. I have had various statements given to me by people in the NHS about this, saying they have done various courses, much of which are about management covering their own back saying, "We cannot be blamed if anything untoward happens". That is why I wonder if there is in assessment of what works and what does not?

  Mr Foster: As far as I know not an NHS specific one. There has been plenty of work into what works and what does not, and I am sure the NHS University will be using the broader information.

  Q147  Mr Davidson: It is not unreasonable for doctors who have a greater degree of control over their own time to body-swerve some of these things if they are pointless or a waste of time, is that not reasonable?

  Sir Nigel Crisp: You make two very good points which are in this, they do need to be evaluated and we do need to make sure that the standard of the training is sufficiently high. I do think the NHS will help us with that, not least because the valuation will be built into it.

  Q148  Mr Davidson: Why has this not been done already?

  Mr Foster: Certainly high quality induction does happen in many organisations, the question, as in so many of these issues, is why are some organisations doing this extremely well and others giving it considerably less attention?

  Q149  Mr Davidson: How do you know who is doing it extremely well if you have no assessment?

  Mr Foster: One of the assessments we do have is the Improving Working Lives inspection which takes place on an annual basis, where staff are asked about induction where they are newly appointed the staff.

  Q150  Mr Davidson: That would tell you whether or not they are happier or attention is paid to their needs, it does not necessarily corelate with effectiveness, does it?

  Mr Foster: I think that it would be a pretty good measure for trusts' employment policies where the staff themselves felt they were being implemented well. In addition to there are other ways of evaluating the effects of programmes through the statistics like the ones reported here.

  Q151  Mr Davidson: Can I ask about contractors, cleaning, catering, security, largely contracts set on price, people trying to cut corners and all of the rest of it, can I ask what assessments have been made comparing the grades working in these jobs in the Health Service with the same grades doing other things in the Health Service to see whether the practice of contractors has led to more accidents and also comparing them with similar posts in different functions elsewhere in the economy, or whether or not catering in education has a higher accident rate than catering in the health service. Have you done any of these cost comparisons?

  Mr Foster: I am not aware of any specific comparisons. In terms of evolving policy towards introducing higher standards of employment amongst contractors we would be aware of reported incidents where standards have been lower with contracted staff than with NHS staff. That is why in the first instance we would have increasing requirements through the contracting process. Secondly, we introduce the retention of employment model of contracting out staff. Thirdly, we would be looking in the future at a TUPE Plus arrangement that would give staff better than the minimum statutory requirement.

  Q152  Mr Davidson: Have you taken action against any contractors who are thought to be inadequate in their coverage of health and safety?

  Mr Foster: When you say "you", this would be down to individual trusts.

  Q153  Mr Davidson: You collectively.

  Mr Foster: These contracts come up for review once every three or five years. I know plenty of cases where contracts have not been renewed across a multiplicity of factors.

  Q154  Mr Davidson: We are discussing health and safety, people can lose contracts for a wide variety of reasons, price probably being the most important. Is there any action that you are aware of taken against contractors on the basis they were inadequate in health and safety?

  Mr Foster: I cannot give you an anecdotal example. We can try and respond to you later if you wish.

  Q155  Mr Davidson: If there is no evidence or no knowledge of this at the centre you can appreciate my concern that this is not given the coverage that it ought to be. I was going to go on and ask whether there was any particular firm that were employed to work in the National Health Service that had a poor record in terms of health and safety, be it catering, security or any other of the contracted-out functions? You would not be able to tell me that either!

  Mr Foster: I cannot give you that information off the top of my head. What I can tell you is that the opposite happened, there are organisations which have a good record of health and safety which are approved not by us but by the trade unions who now have a saying, "in letting of these contracts".

  Q156  Mr Williams: Sir Nigel, you both referred to the electronic passport, the electronic staff record, is this going to be based on IT, with a computer at the centre of it, is it going to be one of those?

  Mr Foster: It is.

  Q157  Mr Williams: We have had a few of those!

  Mr Foster: It is an IT system. Any employing organisation at the moment would have a payroll system which is probably computerised, some would have records of staff learning and education which would be computerised. All NHS organisations have these type of records but there are about 38 different ones at present. The idea is to have a single, national scheme which therefore enables us to track staff as they move from one NHS employer to another and have a record of their entire career in the NHS.

  Q158  Mr Williams: And you are confident it will work?

  Mr Foster: It is a huge project.

  Q159  Mr Williams: They always are.

  Mr Foster: They always are in the NHS because it is such a big employer. We are introducing it first of all as a pilot and then a series of waves of implementation to make sure it happens gradually and successfully.


7   Note by the NAO: As a result of some further analysis, the NAO can demonstrate that as the number of health and safety staff per thousand employees increases the number of reported accidents falls. The correlation is significant at the 0.01 level (2-tailed). Back


 
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