Examination of Witnesses (Questions 240-259)
5 MAY 2004
MS HOPE
DALEY, MS
JUNE CHANDLER,
MS SHEELAGH
BREWER AND
MS CYNTHIA
ATWELL
Q240 Rob Marris: Would that mean abolishing
the other bodies to which you refer or simply saying you do not
have that statutory responsibility; that lies with the HSE?
Ms Brewer: The other bodies clearly
are going to have a role in terms of some of the expertise that
they are able to bring. It is about making sure that there is
good partnership working, that those resources are brought together
and that there is much more collaborative working, to get the
best out of both bodies.
Q241 Rob Marris: Those other bodies would
have a research and advisory role, would they?
Ms Brewer: That is the sort of
thing they could do, to support the Health and Safety Executive's
policy and strategies.
Q242 Rob Marris: I wanted to ask UNISON
a similar question but about the social care sector. Is there
the same fragmentation there or is it more coherent? From what
you said earlier, I suspect I know the answer.
Ms Daley: It is the same fragmentation
that exists in the social care sector. I think there is a lack
of joined up working, so one group of people is happily going
off doing something whilst another is doing something else and
never the twain meet. It is very similar to the health service.
Q243 Rob Marris: Would your solution
be similar to that which the RCN have just suggested?
Ms Daley: Yes, it would. There
is also a role for advisory committees that the HSE sets up which
can look at all the areas in social care or health and produce
the type of guidance that everyone in those areas can follow.
Q244 Rob Marris: How would you counter
the criticism that might be made, were that to happen, that there
is simply more bureaucracy?
Ms Daley: I would argue that that
is not the case. Given the numbers of injuries that we have in
both sectors, some level of bureaucracy is needed and it should
be from an authoritative source. That is where I see something
like an HSE advisory committee doing that work which all the fragmented
areas could follow.
Q245 Rob Marris: Can I turn to agency
workers which also bedevil the social care sector? What needs
to be done to protect them? Is there adequate protection and,
if not, what needs to be done?
Ms Daley: It is difficult for
there to be adequate protection for agency workers because of
the way they are appointed. Very often, they come in very quickly
on an ad hoc basis covering sickness absences and staff shortages
at very short notice. Also, the people who are supplying them
are very confused about what their role is in health and safety.
They very often do not know anything about the risks that the
workers they are supplying are going to face. Very often, they
have never visited the places they have been supplying staff to
for many, many years. There are difficulties around how those
staff are given proper training, how their risk assessment and
the duties that they are supposed to carry out are tackled and
how they know about what local, good practice is. In some instances,
agency workers can be working alongside permanent staff and they
have been instructed, as agency workers, not to do particular
types of work such as, for example, administering medication;
whereas the permanent member of staff has to do that. There are
gaps in how those workers are protected for a number of reasons.
Q246 Rob Marris: How do you address those
gaps?
Ms Daley: I think clearer guidance
is needed to agency suppliers about what their role is.
Q247 Rob Marris: From whom? From the
HSE, the employer?
Ms Daley: From the HSE, I think.
Agencies need to be clearer about what their role is in terms
of health and safety and what advice, training and information
they need to give to staff before they are supplied and possibly
either put in dangerous positions or end up creating danger because
of their actions.
Q248 Rob Marris: A parallel question
with the NHS agency workers: adequate protection? If not, what
shall we do?
Ms Brewer: It is very similar.
There is confusion about who has the responsibility for the health
and safety of temporary workers. They do obviously put themselves
at risk in terms of nurses who are not appropriately qualified
for the area they find themselves working in. It is not only that
they are vulnerable in terms of their own professional role but
clearly in that situation patients are put at risk as well. NHS
Professionals, which is coming on stream, may go some way towards
having a dedicated body of temporary workers so that they can
improve the training that those nurses are exposed to.
Q249 Rob Marris: That would be like an
in-house bank, would it?
Ms Brewer: That is right. They
would employ nurses on a temporary basis and NHS trusts would
get those people from NHS Professionals.
Q250 Rob Marris: Do you see that as desirable?
Ms Brewer: In terms of having
a body of people who have skills and are more familiar with those
workplaces, yes, it should work well.
Q251 Mr Goodman: I am going to ask some
questions about stress and I would like to start with Sheelagh
because you mentioned stress during your exchange with the Chairman.
You are obviously concerned that issues like stress are not dealt
with quickly or effectively enough so perhaps you would like to
take the opportunity to explain to the Committee why you think
this is so.
Ms Brewer: There is now plenty
of evidence around that stress is a real problem in health care.
We have the NHS staff survey released this year. 39% of respondents
said they had experienced stress in the last 12 months. The National
Audit Office identified it as an increasing problem. Our own survey
that we did in 2002 showed that 11% of the respondents demonstrated
a level of psychological ill health that put them in the same
group as those people in the clinical group as well. Clearly it
is a problem. There has been a lot of research and the HSE have
done some very good research. There is a very good contract research
report which exists but the difficulty is, it is really not very
accessible to most employers unless they put in real effort to
dig it out and work their way through a lot of pages. What we
need is something that is much more accessible, that really instructs
employers and gives them much more information on what they can
do. Simply saying they need to do a risk assessment is not helpful.
It is quite difficult to do a systematic risk assessment in relation
to work related stress. There are complex issues. You have to
decide what is caused by work factors and you have to look at
it against a background of people's domestic circumstances as
well. What is needed is much clearer guidance from the Health
and Safety Executive and possibly other bodies in terms of what
needs to be done in order to reduce the causes of work related
stress and the sort of interventions that can be developed to
do that. They are not always resource intensive. Sometimes they
are very simple approaches. It is about reusing existing resources;
it is about management skills and time.
Q252 Mr Goodman: UNISON would echo and
agree with all that, I presume?
Ms Daley: Yes, we certainly would.
We believe that stress has been looked at as an area where one
solution has been looked for and where that is not found nothing
is done. More needs to be done in terms of accessible guidance
around how stress can be tackled and the factors that need to
be looked at in terms of carrying out risk assessment so that
these can be meaningful in reducing stress.
Q253 Mr Goodman: Could I ask about enforcement?
To date, the HSE has served just one improvement notice I think
on an NHS trust in relation to stress. Do you know what impact
this has had and do you think more enforcement notices would be
useful? Has the HSE the resources and focus to do this anyway?
Ms Brewer: In relation to the
particular example where the improvement notice was issued in
relation to the lack of a risk assessment, it has clearly made
a big difference to that trust. They now have done the risk assessment
and I understand that they are working on interventions to reduce
the sources of work related stress. In all the other examples
we have where either improvement notices or prosecutions have
taken place, they have resulted in quite significant improvements.
Swindon is another example where prosecution took place a few
years ago and that was not in relation to any specific incident.
That was a lack of systems, arrangements and policies which related
to the management of occupational health and safety in the workplace.
It is clear that when the Health and Safety Executive have taken
enforcement action there has been a very good response in terms
of improving the situation. From that point of view, although
it is not an ideal solution, more enforcement on occasions would
help improve the situation and would encourage people to devote
more resources to improving the workplace.
Q254 Mr Goodman: Do you think they are
concentrating enough on enforcement?
Ms Brewer: It is a problem of
the resources of the Health and Safety Executive themselves in
terms of the number of inspectors they have who are available
to inspect NHS premises. I think they do in the region of 40 audits
per year. In terms of the number of separate employers there are
within the trust, that is just a small proportion of the number
of trusts there are around.
Ms Daley: Whilst enforcement is
labour intensive and takes up quite a lot of the HSE's resources,
it does also mean that awareness is raised around the issue of
stress. For example, the improvement notice that you referred
to led to the Department of Health circulating information about
that and drawing attention to the systems that need to be in place.
I think that is a success in itself.
Q255 Mr Goodman: Are employers focused
enough on stress? Are they doing enough about it, in your view?
What are they not doing that they should be doing?
Ms Brewer: I do not think they
are taking it seriously in terms of the impact it has on people's
health. It is not only about reducing sickness absence caused
by stress but very often it is about people who turn up to work
on a day to day basis who are themselves suffering from stress
and the potential impact on the safety of patients in those circumstances.
I do not think employers are seriously addressing it and I think
they are uncertain also about what can be done about it; hence
the need for more guidance and more support in encouraging them
to look at the risks and hazards, and introduce some controls
for those hazards.
Ms Atwell: There was a survey
carried out with employers and employees asking about the issues
of stress in around 2000. They identified that employers wanted
information on how to manage stress because mental health problems
are not being dealt with in the same manner as maybe other health
problems are. There is still quite a stigma of fear attached to
mental health. There is a desperate need both in the private and
public sectors for a better understanding of what stress is, how
it can be managed and prevented in the workplace.
Ms Daley: I am going to agree
by saying that I think stress has been totally underestimated.
The effects of stress have been underestimated. On the one hand,
you can have quite a number of staff who are suffering from stress
and having to take sickness absence because of it and, on the
other hand, you will have within the same employer steps taken
to reduce sickness absence without any thought to the causes.
Basically, I believe that more can be done to reduce work related
stress but more information and help are needed for employers
to enable them to do something to tackle stress.
Q256 Miss Begg: Can I ask about back
pain? The National Audit Office found that 24% of NHS staff regularly
experience back pain and that was in 1996. The evidence since
then suggests it has become even worse. Is there more that the
HSE can do to ensure that the problem of back pain is tackled
effectively?
Ms Brewer: Clearly, back pain
and musculoskeletal disorders remain a real problem for nurses
and other health care workers. The prevalence statistics have
been very consistent over the last 10 or 15 years but it is also
an area in which the Health and Safety Executive have done a lot
of work. They have done research and produced guidance. I think
we need a deeper understanding of the complexity of back pain
and musculoskeletal disorders. It would appear that there is a
view now that some people have a predisposition to having a back
injury, regardless of the occupation they end up in. We have no
way of knowing which staff are going to develop back pain so what
we have to do is make sure that the working environment is as
safe as we can possibly make it. There have been one or two examples.
The Wigan and Leigh Trust, for example, did some very significant
work by systematically looking at the problem, by investing in
appropriate equipment, by investing in training, by making sure
that the supervision was there so that the staff followed the
good practice. They have demonstrated that they can reduce the
amount of sickness absence through back injuries and, more importantly
to the trust, probably reduce the cost of that as well, despite
the investment in new equipment. It is that sort of good practice
and that systematic approach that we need to make sure exists
in all trusts. The other issue about back pain is the guidance
that is available to GPs in terms of managing it. There is guidance
around for GPs which focuses more on getting people back to work,
rather than the previous advice of bed rest and staying off work.
More has to be done in making sure the messages get out about
what is the best way to deal with the problem. We know that if
people stay off work for four weeks that decreases their chances
of a successful return to work.
Q257 Miss Begg: If someone with back
pain, one of the most common treatments is physiotherapy because
that is helpful in rehabilitation. Is there any work being done
on having the rehabilitation before it happens for people who
work in the health service who might have potentially heavy jobs
so that they are encouraged to do physiotherapy to strengthen
their back in order that they are not putting themselves at risk
from back pain once they get into these situations?
Ms Brewer: I think there are some
programmes of work of that nature around. Equally, there are not
many trusts that will fast track staff so that when they present
with symptoms of back pain they can get speedy access to, first
of all, assessment and then treatment. That would help the situation
in terms of getting people back to work quicker. The key must
be about making sure that the workplace is as safe as possible
and eliminating all the hazards that are foreseeable in terms
of the things that make a contribution to nurses injuring their
backs.
Q258 Miss Begg: Is there anything UNISON
wants to add, because I think you say that the risk assessments
are not conducted properly with regard to back pain.
Ms Daley: In relation to social
care workers, back pain and injury is a particular problem, particularly
for people who work in residential care homes and as home carers.
The reason for this is around the inadequate risk assessments
that are carried out and the level of training that is given to
such staff. For many of these types of workers, they are often
left alone to do jobs that should be carried out by a couple of
people, lifting tasks that should be done by more than one person.
Indeed, sometimes their policy states this but because of staff
shortages this does not happen. Left alone in a situation where
you have a service user and they need to be lifted, often the
carer will do so without any thought at all to back injuries.
I think more needs to be done in terms of the type of guidance
that is issued, relating to risk assessment for back injuries.
Better training needs to be provided to staff as well.
Q259 Miss Begg: That leads on to questions
on manual handling because the UK Home Care Association argues
exactly the point you are making, that very often limited resources
mean that only one care worker is available when there should
be two. How do we remedy that, especially when very often the
person who is getting the care is the purchaser of that care and
they have limited resources as well? How do we make sure that
they are getting the service they need, which is lifting? We cannot
get away from it. They need to be toileted; they need to be dressed;
they need to be got up in the morning. Also, how do we make sure
that the care workers are doing it in a safe environment?
Ms Daley: Ultimately it goes back
to resourcing. It is about looking at the care plan and making
a decision about whether one or two people are needed for the
particular task that has to be carried out and looking at the
aids that can be used at the same time. There is no point in having
a care plan that recognises that someone is going to need to be
lifted in and out of positions at regular intervals, but yet you
only send along one person to do that job. It is around the question
of resource.
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