Examination of Witnesses (Questions 180
MONDAY 12 MAY 2003
Q180 Chairman: To be fair here, we
are at a very early stage and we cannot hold them to account in
a public session. You are at a fairly early stage of discussion,
are you not?
Mr Burr: Yes. We are raising questions
now which are about the management relationship between the Department
and the trusts which is a much wider question than just the accountability
Jon Trickett: I know this meeting is
to do with health and safety but it might help to form our view
as a Committee in relation to the legislation which is in front
Chairman: You can certainly ask the question
but I do not think you should necessarily expect the C&AG
to give a full response.
Q181 Jon Trickett: I accept that.
Mr Burr: I think it is in a sense
second-order to the management relationship.
Q182 Mr Gibb: You can appoint, can
you, a chief executive to an NHS trust?
Sir Nigel Crisp: No. The actual
relationship is that I have somebody on the appointment panel
acting as my representative, but I am also the person who signs
them off as an accountable officer.
Q183 Mr Gibb: So you cannot sack
a chief executive of a trust?
Sir Nigel Crisp: Not directly,
Q184 Mr Gibb: So how do you manage
Sir Nigel Crisp: There are various
other people in the system; the people who are accountable to
me where clearly I am in that direct line management relationship.
This is a relationship whereby the organisation is accountable
and if the organisation is failing then we clearly would take
that up with the chair.
Q185 Mr Gibb: So can the regional
Sir Nigel Crisp: The appointment
of a chief executive to a trust, if you are interested in NHS
trusts specifically, is the responsibility of the chair.
Q186 Mr Gibb: Of that trust.
Sir Nigel Crisp: Of that trust.
But they have a process for it whereby I have somebody on the
panel and I actually sign off that person, if I am willing to,
as being capable of being an accountable officer for the trust.
Q187 Mr Gibb: What is this panel
Sir Nigel Crisp: The appointments
Q188 Mr Gibb: It is a national thing?
Sir Nigel Crisp: No, sorry. The
chair creates an appointments panel, a local appointments panel,
and I have a representative on that and I will also have to sign
off that person as being capable of being an accountable officer.
Q189 Mr Gibb: Mr Foster said in answer
to some questions that you do not have a prescriptive approach,
and you said your role is to encourage and that the law is the
law and it would be superfluous for you to do X, Y and Z. In what
sense are any of those statements managing this organisation?
Mr Foster: There were two points
I was making there. One was that we do not have any ability to
override health and safety legislation, and that is the proper
relationship between the law and a NHS employer in fulfilling
health and safety law. We do not have any greater power than that.
What I was saying in general about our approach is that we will
set policy for what it is to be a good employer in respect of
issues such as health and safety; we have an inspection regime
Q190 Mr Gibb: You do not prescribe
though, you just encourage?
Mr Foster: The Health & Safety
Q191 Mr Gibb: No, they set the law.
You have to obey the law, so somebody has to do something to obey
the law, like put a railing round a piece of machinery, but you
do not prescribe on that?
Mr Foster: We will give a great
deal of guidance on how people should fulfil their responsibilities
as being a good employer. Then we would inspect the degree to
which they are doing it.
Sir Nigel Crisp: Can I put it
slightly differently? Our role is to set the policy, to determine
the major investment and the prioritiesso our priorities
are cancer and coronary heart disease and not renal surgery, for
exampleto hold to account and also to build the capacity
and capability of the whole system. So we are responsible for
making sure we get enough nurses into the system, for making sure
that we have an IT system which works across the whole of the
NHS; those type of issues.
Q192 Mr Gibb: Are you not responsible
for making sure those nurses work properly and are well-managed
locally? Are you not responsible for making sure the doctors do
a full eight-hour day or twelve-hour or fifteen-hour day?
Sir Nigel Crisp: The specific
responsibility is on the employer
Q193 Mr Gibb: Which is who? The chief
executive? Whom you have no responsibility over?
Sir Nigel Crisp: Which is whoever
the employer is. You will be aware that we also have national
contracts for consultants, for example, so there are a whole series
of things we do within that, but the specifics of managing the
situation need to be done by the local managers.
Q194 Mr Gibb: Who is not accountable
directly to you because you cannot fire him?
Sir Nigel Crisp: I am not the
line manager of the individual, yes.
Q195 Mr Gibb: Or even indirectly
you are not? There is no direct or indirect connection between
the local trust, the chief executive and you via anybody else?
It is all appointed locally. You have one representative on the
appointments panel and that is it?
Sir Nigel Crisp: And the responsibility
for appointing them as accounting officer without which they cannot
be chief executive.
Q196 Mr Gibb: But you cannot remove
Sir Nigel Crisp: Yes, I can.
Q197 Mr Gibb: So you can manage these
Sir Nigel Crisp: And you can remove
that approval, which does not necessarily lose them their job,
but the trust then has to decide what it does. For example, in
instances where there is a prima facie case that something
has gone wrong locally, we can say, "We will remove the accountable
officer status" and therefore they cannot continue to be
Q198 Mr Gibb: When did you last do
Sir Nigel Crisp: There have been
occasions where I have said, "Look, unless you as an organisation
deal with this issue, I will consider doing that." That is
a strong sanction actually.
Chairman: Thank you very much. Mr Gerry
Q199 Mr Steinberg: One quick question.
The reason I did not ask it originally was because I thought other
people would pick it up and they have not. It is these needlesticks.
When I read the Report it seemed incredible that so many people
were injured through pure negligence. I would have thought that
it was one of the most dangerous things in a hospital yet it says
in the Report that over a third of nurses, and half of agency
nurses, have been stuck by a needle/sharp at some point in their
career, with 7% being stuck more than once in the previous 12
months. Then there is a compensation payment of £2,000 every
time it is done. How did this £2,000 figure come about? Is
the £2,000 paid out where it is obvious negligence? It seems
to me that this should not happen. It is a nice little earner
in some respects!
Sir Nigel Crisp: We got a lot
of briefing on needlesticks, as you would expect. There were 23,000
last year out of a use of 250 million devices, so 250 million
times a needle was used, and 23,000 times somebody had a problem
with that. How we handle this is something which is kept constantly
under review, and the issue here is about getting improved training.
We need to make sure there is training in use and particularly
in disposal. That is the biggest issue.