Few trusts have a robust understanding
of the impact of staff accidents
12. Following our predecessor Committee's Report
in 1997, the Department issued guidance to trusts asking them
to evaluate and improve their understanding of the costs and impacts
of accidents. Few trusts have made any progress in quantifying
the human and financial costs. Only 24 trusts (9%) had attempted
to estimate their costs and of these only 17 provided any cost
information. In the absence of robust data the NAO estimated that
the annual direct cost of health and safety accidents in 2001-02
was at least £173 million.[14]
The new Electronic Staff Record, which the Department expects
to have in place very shortly, would give more information about
staff and provide trusts with more effective access to the details
of staff absence and related information.[15]
13. The only published Departmental cost estimate
on staff sickness absence is the cost of injuries through manual
handling which accounts for 40% of NHS sickness absence costs
or in the region of £400 million a year. One in four nurses
has taken some time off work with a back injury sustained at work
and for some it has meant the end of their careers. Manual handling
issues is one of the biggest, most serious issues for NHS staff
because of the amount of lifting that is done. The availability
of cost information on back pain is one reason why the Department
have been able to give it priority, tackle it and as a result
see a reduction.[16]
14. Needlestick injury is one area where attempts
have been made to quantify the cost-benefits of interventions
to reduce accidents through the introduction of safer needles.
Such injuries occur mostly to nurses, doctors and ancillary staff.
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 last 12 months. The Department explained
that staff needed to receive improved training, particularly in
disposal. A reduction in needlestick injuries also depends on
proper surveillance and reporting procedures; a range of preventative
measures and safer working practices; and the adoption of safer
needles in higher risk areas. We asked the Department for reassurance
that this was being dealt with properly.[17]
15. The Department told us that there were 23,000
needlestick injuries reported in 2001-02 compared with 250 million
such devices used. The General Accounting Office has produced
an evaluation of needlestick injuries which suggested that as
many as 25% of accidents reported in the United States of America
were potentially preventable because needle use was unnecessary.
Therefore this type of accident might also be reduced by confining
the use of needles to procedures where there is no alternative.[18]
16. Further evidence, submitted by the Safer Needles
Network, also drew attention to the risk of healthcare workers
becoming infected following a needlestick injury. Health Protection
Agency data shows that in the UK there have been five healthcare
workers who acquired HIV occupationally, four of whom are now
deceased, and a further 12 healthcare workers who have probably
acquired HIV occupationally. The Department said that they were
unaware of any cases where HIV had been transmitted through needlestick
injuries in this country and that the five cases we raised with
them had occurred overseas. The Department has subsequently accepted
that these cases happened in UK hospitals.[19]
17. In relation to the costs of needlesticks injuries
to the NHS, we noted that UNISON had negotiated a deal with employers
whereby claims against NHS trusts for certain needlestick injuries
are immediately settled by the trust £2,000. The Department
explained that the amount of the compensation had emerged through
a series of case studies where there had been a demonstrable case
of mental stress. It was not an automatic payment, and employers
needed to balance the cost of settling with that of being taken
to an employment tribunal and the attendant legal costs.[20]
Compensation and ill health retirement
18. Accidents can result in compensation costs arising
from litigation, as evidenced by the examples given in the National
Audit Office's Report (reproduced below as Figure 2). In
order to help people to manage these costs, they had brought staff
accidents into the remit of the NHS Litigation Authority and their
risk pooling arrangements, which resemble those through which
clinical negligence is handled.[21]Figure
2: Compensation payments awarded by the courts to employees injured
in the course of their duties
- In 1998, a health authority paid an out of court settlement of £465,000 to a junior doctor who developed a psychiatric illness following a sharps injury, even thought the incident did not lead to any physical infection.
|
- In 2000, an occupational therapy assistant won £600,000 in compensation for injuries sustained at work. In March 1990 she slipped on a wet vinyl floor fracturing her right ankle. She continued to suffer considerable pain and disability in the knee and ankle, requiring numerous operations, and her employment was terminated on ill health grounds in 1992. In May 1997, she had to have her right leg amputated below the knee.
|
- In February 2000, a former intensive care nurse accepted £800,000 compensation in an out of court settlement after injuring his back at work. The incident happened in 1992, when the nurse lifted a patient with just one other colleague, although the NHS Trust policy recommended that staff should use a hoist or a minimum of four members of staff should lift a patient. The award was made on two counts: the lack of a mechanical hoist and that the hospital was deemed to have given inadequate lifting training.
|
- In June 2001, a former staff nurse was awarded £347,000 for a back injury caused by repetitive strain while working in a hospital which allegedly lacked suitable equipment to help move patients. She had suffered back pain from 1994 and was retired from Queen's Medical Centre, Nottingham, in 1996.
|
- In October 2001, a nurse who had a mental breakdown because of stress and overwork, in the aftermath of a traumatic pregnancy, won £140,000 compensation. The NHS Trust was ruled to have grossly dishonoured the arrangement that had been made to protect her health and welfare upon her return to work and the trust should have foreseen the substantial risk that she would suffer psychiatric injury. Excessive hours, lack of administrative assistance and covering for absent or sick colleagues were contributory. She has retired on the grounds of ill health.
|
- In 2002, a healthcare worker received an award of £58,000 for a needlestick injury received in 1997. While assisting a consultant anaesthetist a Senior Operating Departmental Assistant was injured when a tray of needles flipped over. One stuck in his arm, and in attempting to shake it off it penetrated his toe, through his shoe. The needle was contaminated and the assistant suffered severe shock and trauma.
|
- In October 2002, the High Court awarded £420,000 compensation for a nurse who was forced to retire in 1998 after moving patients without adequate arrangements. Patients of up to 12 stone in weight had to be manually lifted because the mechanical hoist was shared with another ward and staffing levels were poor. Newham Healthcare NHS Trust also faces legal expenses of £400,000.
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Source: National Audit Office Report[22]
19. However, the Department did not think that there
was significant abuse of ill health retirement on the grounds
of a work-related accident as they had a very sophisticated system
of checking and a great deal of occupational health expertise
available to them. In addition, the NHS Pensions Agency had conducted
a review two to three years ago which resulted in revised guidance
for trusts on the handling of cases of this nature. The number
of ill health retirements in 2001-02 was 4,507 which is already
below the Treasury's target of 3.96 per 1,000 employees by 2005.
The Department consider that their guidance "Managing
ill health retirement in the NHS: guide for human resource and
occupational health service", which was published in
November 2001, has tackled any possible incentive to retire early
on ill health grounds.[23]
2 2nd Report from the Committee of Public
Accounts, Health and Safety in NHS Acute Hospital Trusts in
England (HC 350, Session 1997-98) Back
3
C&AG's Report, A Safer Place to Work: Improving the management
of health and safety risks to staff in NHS Trusts (HC 623, Session
2002-03) para 1.10 Back
4
ibid, paras 1.11-1.12 and Appendix 2 Back
5
Q1; 39th Report from the Committee of Public Accounts,
A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff
from Violence and Aggression (HC 527, Session 2002-03) Back
6
C&AG's Report, para 2.8 Back
7
ibid, Figure 4 and Appendix 3, Table 1 Back
8
C&AG's Report, paras 11, 2.9-2.14 and Figures 5a-5c and Figure
6 Back
9
Qq 2-3, 41, 165 Back
10
C&AG's Report, pp 18-25, Appendix 3 para 6 and Table 1; Qq
2-3, 35, 47 Back
11
C&AG's Report, para 2.8; Qq 126-133 Back
12
C&AG's Report, paras 2.2-2.7, Appendix 3; Qq 36-37,41-45,
86 Back
13
Qq 25-33, 37-40, 46 Back
14
C&AG's Report, paras 2.22-2.26 and Figure 11; Qq 166-168,
209 Back
15
Qq 5, 34-35, 166-167 Back
16
C&AG's Report, para 2.24; Appendix 3 (para 6); Qq 3, 35, 47 Back
17
C&AG's Report, pp 20-21, para 2.28 and case example 6; Q 199;
Ev 25-26 Back
18
Qq 199, 207 Back
19
Q 208; Ev 23-25 Back
20
C&AG's Report p20; Qq 199-206 Back
21
C&AG's Report, para 2.23 and Figure 10; Qq 6, 7, 75 Back
22
C&AG's Report, Figures 7, 10 Back
23
Qq 136-138; Ev 23 (ref to Qq 137-138) Back