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
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
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
All their staff are provided with
access to a competent confidential Occupational Health and Safety
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 NHSacute
trusts, primary care and mental healththe 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;
Cancer Services Collaborative;
Coronary Heart Disease Collaborative;
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?
ROLES AND RESPONSIBILITIES
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
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.
HEALTH AND SAFETY RECORD
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
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