Select Committee on Public Accounts Minutes of Evidence

Supplementary memorandum submitted by the Department of Health

Question 24: What are the occupational health service arrangements for General Practitioners and their staff?


  The NHS Plan, published by the Secretary of State for Health in July 2000, announced that Occupational Health Services, already a requirement in hospitals and community Trusts, would be extended to general practitioners and their staff from 1 April 2001. Funding of £21 million was provided for this over the three years 2001-04.


  There was historically no national occupational health and safety service (OHSS) available for GPs or their employees, although such a service was available to those who worked in, and for, NHS Trusts and Health Authorities. Some NHS Trusts and Health Authorities already made their OHSS available to Primary Care staff through locally financed initiatives but these services were, at best, patchy.

  An NHS Executive Working Group was set up in 1998 to look at what services should be provided for GPs and their staff and how these might best be delivered. The Group, which included representatives from the medical and occupational health representative bodies, including the GPC, looked at a wide range of issues. These included the very different conditions in rural and urban practices, the impact of current changes in the primary care sector, and what the likely financial implications were of providing the service. As a result of the Working Group's deliberations a working paper was finally agreed which set out the range of services to be provided together with suggestions for delivery of the service. This working paper informed the basis of a proposal for funding as part of the Central Spending Review 2000.

  The NHS Executive proposal which was put to Ministers set out the case for a comprehensive, confidential occupational health services to general practitioners and their staff. It pointed out that the initiative supported Government objectives on improving staff health and welfare, Our Healthier Nation targets on healthy workplaces, "Supporting Doctors, Protecting Patients", and would extend to GP's and their staff a provision that already existed for all other staff working in the NHS. In addition the provision of occupational health services to all NHS staff is a target set in "Working Together" the NHS Human Resources Framework and is required under the Health and Safety at Work Act 1974.

  The objectives of the service are:

    —  to provide all GP's and their staff with access to quality occupational health services;

    —  to improve the quality of healthcare provision for staff working in the primary care sector;

    —  to improve the availability of services to address the needs of doctors with health problems in the NHS workforce; and

    —  to assist GP's by the provision of advice and guidance on risk assessment and risk management (through the occupational health service);

  The benefits to GPs and their staff are:

    —  improvements in levels of risk assessment and reduction together with hazard identification;

    —  reductions in the levels of stress and psychological distress suffered by GP's and their staff;

    —  a general improvement in the health of GP's and their staff;

    —  a reduction in work related ill health and accidents and consequent improvement in staff morale;

    —  making GP's and their staff feel an integral part of the NHS by providing access to the range of occupational health services already provided to other NHS staff.


  The following are considered to be the minimum essential requirements for the provision of occupational health and safety services to staff working in both the primary and secondary care sectors.

    —  All their staff are provided with access to a competent confidential Occupational Health and Safety Service's (OHSS);

    —  The OHSS is geared appropriately to the needs of the organisation and the health and safety risks identified, and is staffed by competent and appropriately trained medical, nursing and other staff;

    —  Staff representatives are consulted over setting up and reviewing the running of the OHSS. Arrangements should also be made for continuing discussions, eg a user's committee.


  Occupational health and safety services for general practitioners and their staff were commissioned by health authorities from 1 April 2001. The funding in 2003-04 has been made available directly to PCTs for them to ensure the services are provided. Some PCTs have their own small occupational health unit or a shared one with neighbouring PCTs. Others buy services from established local NHS providers. In the rare cases where a local NHS organisation cannot provide the service it is purchased from a private service provider.

  Guidance on the arrangements for commissioning services was issued to health authorities early in 2001.

  The Department does not currently have data on the number of PCTs providing direct occupational health services and those purchasing them from other NHS or private providers.

Question 85: Shouldn't you manage properly by nurturing and training?


  The NHS Modernisation Agency works in close partnership with Strategic Health Authorities to align its work to local priorities and commits funding, resources and expertise to SHAs' modernisation objectives. The Agency operates across the whole performance spectrum, working with three star organisations to support leading edge innovation, (for example through the Pursuing Perfection programme,) with zero star trusts to provide intensive support, and with one and two star organisations to ensure the rapid spread of best practice. At any one time there are thousands of Agency projects in place across England and the learning from individual programmes is spread and sustained so that healthcare improvement moves from the minority to the mainstream in the NHS.

  The redesign of systems, one of the central tenets of modernisation, is required so that investment is matched by improvement, resulting in services centred on patients' wants and needs. The Agency combines quality improvement methods with changes in working practices and the benefits to be secured from new clinical and information technologies. Most importantly, PCT and trust boards, working together with their frontline staff, must have full ownership of the modernisation effort. The NHS Modernisation Agency Associate scheme invites frontline staff to become local ambassadors in healthcare improvement. Agency Associates advocate best practice and deliver, encourage and facilitate local improvement activity and share their knowledge with the Agency and SHA.

  Operating across all sectors of the NHS—acute trusts, primary care and mental health—the system redesign work of the Agency is underpinned by the major principles of quality of patient safety, leadership and workforce development.


  The Agency's Service Improvement Team manages six core programmes in the secondary healthcare sector:

    —  National Booking Programme;

    —  Access Booking and Choice;

    —  Critical Care;

    —  Cancer Services Collaborative;

    —  Coronary Heart Disease Collaborative;

    —  Emergency Services.


  The NHS Modernisation Agency's National Primary and Care Trust Development Programme (NatPaCT) is working with Chief Executives, Chairs, Professional Executive Committee Chairs, Directors, clinicians, Non-Executive Directors, managers and other staff in all PCTs, and through and with colleagues in SHAs, to enable all PCTs to get fit for purpose and play their decisive role in modernisation.

  An affiliate of the Agency that has also been working in this sector is the National Primary Care Development Team (NPDT). This was set up in February 2000 to manage the National Primary Care Collaborative, although it now runs a number of improvement programmes involving multi-agency working.


  Effective leadership is a key ingredient in modernising today's health service and ensures better patient care and improved working practices for NHS staff. The NHS Leadership Centre is part of the Modernisation Agency, and provides an integrated approach to the challenges of modernisation through courses covering areas including Chief Executive leadership, management training scheme, national nursing leadership programmes, Allied Health Professionals and Human Resources development.


  The Agency's Changing Workforce Programme is helping the NHS and other health and social care organisations to test, implement and spread new ways of working through role redesign. This process improves patient services through staff development; expanding the capacity of the healthcare team to shorten waiting times and improve the patient experience. In addition, it is working at both local and national level to remove "blocks" to change such as regulation or disjointed initiatives.

Question 116: What is your responsibility and general record for health and safety in the Department of Health?



  As head of the Department, the Chief Executive has overall responsibility for maintaining a healthy and safe working environment and for promoting safe working practices for all employees and others who are involved in or affected by the Department's activities. This includes ensuring that sufficient resources are provided to achieve the objectives of this policy.


  The Board Directors are accountable to the Chief Executive for maintaining a healthy and safe environment and for promoting safe working practices for staff and others in all business areas. The individual Directors have identical responsibilities within their own business areas and are responsible for the management of risk.


  The Director of Corporate Affairs has been appointed by the Chief Executive as the Board Member with the lead responsibility for health and safety in the Department and is accountable to the Chief Executive for the provision of health and safety policy and guidance to staff and line managers.


  Regular consultation occurs with the Departmental Trade Union Side through the formal Health and Safety Committees. These consultations cover the interests of all staff.


  Overall the Department's record on Health and Safety has been satisfactory, the last major incident occurring in 1999 with the discovery of Amosite asbestos in Eileen House.

  Between 1 April 2002 and 31 March 2003 the Department has recorded a total of 101 accidents, 23 of which have resulted in staff absence.

Question 117: What will be the relationship between health and safety and Foundation Trusts?

  NHS Foundation Trusts (NHSFTs) are a new type of NHS organisation to be set up under the recently introduced Health and Social Care (Community Health and Standards) Bill. NHSFTs are part of the NHS but with greater independence from Whitehall control and offering greater freedoms for the organisations. NHSFTs will operate within a framework designed to safeguard patient care across the NHS without compromising the NHSFTs' independence. Essentially they will be regulated but not managed.

  As part of this new "lighter touch" framework NHSFTs will be freed from Secretary of State and Department of Health powers of direction. NHS Foundation Trusts will have to deliver on the national targets and standards just like the rest of the NHS. However, NHSFTs will be free to decide how they achieve this. They will not be subject to performance management by Strategic Health Authorities and the Department of Health.

  Freedom from Department of Health and Secretary of State directions does not however affect the obligation to meet statutory requirements, eg employment law, the Working Time Directive, and Health and Safety legislation.

  The Bill sets out in clause 7(6) that an NHS Foundation Trust will not enjoy any status, immunity or privilege of the Crown. The property of the NHSFT will not be regarded as the property of, or property held on behalf of, the Crown.

  This means that NHSFTs, like NHS Trusts, will be subject to overarching Health & Safety legislation. NHSFTs will need to implement the requirements of such legislation.

  We have said that Department of Health guidance will be available to NHSFTs to refer to as good practice where they consider it helpful but DH would not be able to require compliance. The Independent Regulator for NHS Foundation Trusts would, however, be able to take action if a significant or persistent breach of health and safety legislation meant that an NHSFT was no longer complying with its terms of authorisation.

Questions 137-138: What sort of ill health retirement do you have in the NHS?

  The Treasury Review of Ill Health Retirements in the Public Sector was published in July 2000 and the Secretary of State for Health signalled his broad acceptance of the findings.

  As a result of the Review the Treasury set a target for the reduction in numbers of ill health retirements in the public sector, which NHS employers are expected to work towards achieving. This target was:

    —  "For all employers to aim to achieve rates of ill health retirement which are comparable or better than the current best quartile of employers (3.96 per thousand employees) by 2005."

  Guidance, "Managing Ill Health Retirement in the NHS: A guide for human resource and occupational health services" was published to the service in November 2001 which set out the actions to be taken by NHS employers to ensure they met the target. It also included details of the actions to be taken by the NHS Pensions Agency to assist them and monitor progress.

  The number of ill health retirements in the NHS in 2001-02 was 4,507 with 321 NHS employers reporting ill health retirements already below 3.96 per thousand and 156 employers still above target.

  The guidance published in November 2001 took the opportunity to ensure that a number of actions had to have taken place before a recommendation was made to NHS Pensions Agency for the granting of ill health retirement. These include a tighter definition of trigger points for review of sickness absence/long term absence and the requirement to prove that rehabilitation has been considered together with the options for redeployment within the organisation. Employers are required to show that all actions that could be taken to provide the member of staff with suitable employment, taking into account their illness or incapacity, have been taken prior to recommending ill health retirement. We believe that this new policy has removed any possible "incentive" to retire early on ill health grounds.

12 June 2003

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Prepared 15 October 2003