Examination of Witnesses (Questions 160
MONDAY 12 MAY 2003
Q160 Mr Williams: So it will not
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 whileand 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
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 stickscarrots 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
Mr Foster: The answer is, we do
not take a prescriptive approach to the content of training.
Q169 Mr Williams: You certainly do
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
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
Sir Nigel Crisp:agreeing
the expenditure of the money which is, I think, what you are interested
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
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?