Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 180 - 199)

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 question.

  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 of us.

  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, no.

  Q184  Mr Gibb: So how do you manage them then?

  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 called?

  Sir Nigel Crisp: The appointments panel.

  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 Executive prescribe.

  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 priorities—so our priorities are cancer and coronary heart disease and not renal surgery, for example—to 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 that approval?

  Sir Nigel Crisp: Yes, I can.

  Q197  Mr Gibb: So you can manage these people?

  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 chief executive.

  Q198  Mr Gibb: When did you last do that?

  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 Steinberg?

  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.

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