Examination of Witnesses (Questions 140
MONDAY 12 MAY 2003
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
Q141 Mr Davidson: Can I ask the C&AG,
is there any evidence that employing more staff has a beneficial
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.
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
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
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
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
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
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
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
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
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