Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 160 - 179)

MONDAY 12 MAY 2003

DEPARTMENT OF HEALTH

  Q160  Mr Williams: So it will not happen overnight?

  Mr Foster: It is not a "big bang" one, no.

  Q161  Mr Williams: We had the regional computer system based on Wessex and that cost about £30-odd million and never really worked, then we had HISP which cost about £103 million and did not really work. Where are we with this one now? Are we at the specification stage? Who is doing the specification, who is doing the designing of it?

  Mr Foster: At the moment it is being tested in a single trust, and then at the turn of the year it will go out to, I think it is, 28 pilots in two or three waves.

  Q162  Mr Williams: Have you chosen an outside supplier?

  Mr Foster: Yes.

  Q163  Mr Williams: Who is that?

  Mr Foster: There are actually three or four contractors working together but the main one is Oracle & McKesson.

  Mr Williams: I wish you the best of luck with it. I have to say that those who have been on the Committee for a little while—and the NAO went a bit white about the gills when we heard you preferred the electronic passport—

  Q164  Mr Steinberg: I bet it is a future report!

  Sir Nigel Crisp: May I make one point on that? The last IT programme you looked at was NHS Direct from the NHS, and you did, rarely, compliment us on the way that had been implemented. I remember that.

  Q165  Mr Williams: I do remember that. Seven years ago, when we issued our report, you then issued guidance based on the report. What is striking, looking at this Report and listening to comments today, despite the issue of the guidance not a lot has happened, has it? Seven years ago you issued the guidance as a response and now we are being told no one is taking any notice of it.

  Mr Foster: I must say that I would not draw that conclusion, either in general or even from this Report. The fact is, we can demonstrate a reduction in the instance of major health and safety problems, we can point to the issue being taken much more seriously in organisations with board level responsibility and staff allocated to deal with this, and we can point to a series of systems which are inspecting all NHS organisations with a variety of carrots and sticks—carrots obviously for the successful ones, and then incentives for those organisations who have not performed as well.

  Q166  Mr Williams: You can point at those and I can point to page 28. On page 28 in big print there is a heading above paragraph 2.24 which says, "In the absence of NHS data we estimate that the direct cost of health and safety accidents is at least £173 million." It goes on to say, "The only published Departmental cost estimate on staff sickness absence is the cost of manual handling accidents." In paragraph 2.22 it says, referring to the advice you gave on the basis of our hearing seven years ago, ". . . the Department has reiterated this requirement in successive guidance, in response to our . . .", that is NAO's, ". . . survey, only 24 NHS trusts (9%) had attempted to estimate their costs and   of these, only 17 (6%) provided any cost information." So for seven years you have done all right on guidance but where is the delivery?

  Mr Foster: You can point to areas of this document which we will no doubt take great advantage of in producing further, more refined guidance later on this year, and we will have another iteration—

  Q167  Mr Williams: Well, 9% in seven years is not a notable achievement, is it?

  Mr Foster: Coming back to the specific question you asked, the question is really how does one measure the cost consequence of health and safety problems. It is far from a straight forward question. If I was ill tomorrow, what would it cost the Department of Health? You could argue it would cost them nothing as I will probably catch up with the work at the weekend, or you could take a measure of what my salary was for one day tomorrow. Which is the accurate statement? This is a very complicated area to get into, measuring the true cost to an NHS organisation as opposed to measuring a proportion of its pay bill which relates to the people who happen to be sick.

  Q168  Mr Williams: Okay, the arithmetic may be difficult but if we look at page 34, for example, it says, again in bold print, just before paragraph 3.18, "NHS trusts' provision of health and safety training varies widely", and it goes on to make the point that Departmental and HSE guidance emphasises the importance of training. It also says that in response to our 1996 Report the Department said, "NHS employers must ensure . . .", not must attempt to provide, ". . . that all staff . . .", not some staff or 7% of staff, ". . . are given appropriate health and safety training on recruitment and when exposed to new or increased risks . . .". Where is it?

  Mr Foster: The answer is, we do not take a prescriptive approach to the content of training.

  Q169  Mr Williams: You certainly do not.

  Mr Foster: As indeed we do not take a prescriptive approach to many of the details, but we do set general objectives and then we do inspect to see that organisations are fulfilling those objectives. Our inspections will reveal deficits and this Report reveals deficits.

  Sir Nigel Crisp: I think there are a list of things we could produce, and indeed which are produced in the Report, which actually show there has been considerable change. Clearly the major incidents one is a significant reduction over five years where reporting has got better; the stuff on violence which we talked about last time is also an improvement; the fact we have got board members in every trust and health and safety is now on the board are very important points. There is a whole series of things which have happened but I absolutely accept that it was coming from a poor base and we have a lot more to do.

  Q170  Mr Williams: In paragraph 10 of Appendix 3 it says,". . . the increased number of cases affecting staff in the last two years indicates that some trusts continue to commit serious breaches of health and safety law." Again, seven years on. You said you have issued guidance and you referred also to your ability to issue directives, have you ever issued a directive?

  Mr Foster: On health and safety I am not sure if we have or not.

  Q171  Mr Williams: I would have thought you might have remembered today if you had.

  Mr Foster: Personally in the last two years, no.

  Q172  Mr Williams: Do you know whether the Department has?

  Mr Foster: That was the question I was trying to answer.

  Q173  Mr Williams: Does anyone behind you know? You have one or two of your colleagues there. Is there anyone brave enough to put their hand up to say they know of a directive or they heard of one or there is a legend in the Department?

  Mr Foster: I think the point is that health and safety law is law; law governs health and safety. It would be superfluous for us to issue anything else, it is not our role to do that. It is our role to encourage organisations to meet the law.

  Q174  Mr Williams: That seems to be what you have been singularly unsuccessful doing, does it not?

  Mr Foster: I think we can point to a great deal of progress but we would certainly acknowledge that there is much more to be done.

  Mr Williams: Roll on the pilot studies and roll on the new computer, and we look forward to seeing you again in a couple of years time.

  Chairman: Just a couple more quick questions, if you do not mind.

  Q175  Jon Trickett: I want to slightly stretch your patience if you do not mind, Chairman, just on the question of foundation trusts. You will lose the power to hire and presumably therefore fire chief executives of trusts, which you relied on partly in your response to the questions we were asking about management and corporate governance and so on. Will you still be the accounting officer for foundation trusts?

  Sir Nigel Crisp: If you think about the relationship as being perhaps a bit more like the relationship with local government, I would still no doubt be held to account by you for the expenditure of £54 billion a year. The route of that expenditure will be through primary care trusts which will still be very much part of the current accountability framework. The fact they are spending it with foundation trusts as opposed to traditional NHS trusts or local authorities, or whatever—

  Q176  Jon Trickett: So is the answer no, you will not be the accounting officer for the foundation trusts themselves?

  Sir Nigel Crisp: I will be accountable for the public expenditure—

  Q177  Jon Trickett: You will be agreeing national targets or a national framework or something which will be—

  Sir Nigel Crisp:—agreeing the expenditure of the money which is, I think, what you are interested in.

  Q178  Jon Trickett: I am interested in the accountability to Parliament which the Chairman raised on health and safety, which may or may not be a national guidance and probably will not be, I should imagine, because you will be talking about clinical governance largely. It did raise a wider question about the accountability of the trusts and you have described it as a kind of institutional circumlocution, in a sense, in that the PCTs will be accountable for their expenditure. I wonder whether the NAO has given any consideration to this. I know it is only a Bill at this stage and so it is being slightly speculative, Chairman, but there is a big issue for us, if we are going to have to go through a complicated process to get to the way in which the foundation hospitals and trusts are spending the money. Perhaps the C&AG might give us some thoughts on this.

  Mr Burr: Yes, we certainly have given some thought to it, and we are in discussions with the Department about it.

  Q179  Jon Trickett: What view have you come to now at this stage?

  Mr Burr: Certainly there would be advantage in access rights to the foundation trusts so we are in a position to talk to the Department about accountability.

  Jon Trickett: Is it your view he will be the accounting officer? We have seen many agencies floated off now and we cannot easily get into them directly. Is that what they are saying?


 
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