Memorandum submitted by the Royal College
The RCN supports the proposed
merger of the Health and Safety Commission and Executive but user
participation must continue and key stakeholder/representative
organisations outside the TUC, such as the RCN, should be able
to input into the new organisation.
The Health and Safety at Work
Act is still relevant but mechanisms to improve "self regulation"
in the changing world of work through local partnerships, such
as a roving safety representative system, should be implemented.
The Health and Safety Commission/Executive
should value the role of safety representatives and the supporting
legislation needs to be promoted amongst duty holders and other
agencies involved in the regulation and promotion of quality care
and patient safety.
The Safety Representatives and
Safety Committee Regulations 1977 need to be revisited and strengthened.
Free resources, such as seminars
and prescriptive guidance, should be made available to SMEs in
health and social care.
The Health and Safety Executive
need to be adequately resourced to deal with and enforce occupational
health issues including work related stress.
The Health and Safety Executive
need to be adequately resourced to deal with the potential impact
and results of increased actively around healthcare associated
The Health and Safety Commission/Executive
needs to work coherently and consistently with other agencies
involved in quality and safety in health and social care and avoid
any duplication of work. Duty holders need to be clear on roles
and responsibilities of agencies.
The Health and Safety Executive,
in particular EMAS, needs to be adequately resourced to implement
policy and practice and give advice on the health and safety implications
of an ageing workforce.
2.1 With a membership of over 390,000 registered
nurses, midwives, health visitors, nursing students, health care
assistants and nurse cadets, the Royal College of Nursing (RCN)
is the voice of nursing across the UK and the largest professional
union of nursing staff in the world. RCN members work in a variety
of hospital and community settings in the NHS and the independent
sector, including the workplace. The RCN promotes patient and
nursing interests on a wide range of issues by working closely
with the Government, the UK parliaments and other national and
European political institutions, trade unions, professional bodies
and voluntary organisations.
2.2 The RCN has just under 1,000 safety
representatives. RCN safety representatives are trained and supported
by the RCN and carry out a vital role in raising workplace health
and safety standards.
2.3 The RCN also represents a significant
number of occupational health nurses working in both the public
and private sector. The RCN has been actively involved in shaping
the work led by Dame Carole Black on Health, Work and Wellbeing.
2.4 The RCN welcomes the opportunity to
make a written submission to the inquiry of the Work and Pensions
3. THE HEALTH
3.1 The RCN strongly supports the work of
the Health and Safety Commission and Executive and acknowledges
its impact on the health and safety of employees by reducing the
injury and fatality rate within Britain. It needs to continue
to have a strong profile, adequate resources to achieve its aims
and a structure which maximises efficiency, provides appropriate
governance arrangements and allows independence from Government.
One of the strengths of the structure is the tripartite approach
which has helped ensure that decisions are relevant for the modern
3.2 The RCN supported the proposed merger
between the Health and Safety Commission (HSC) and Health and
Safety Executive (HSE); however, it is essential that the "user
participation" element and tripartism is retained. There
is currently good engagement between the TUC and the HSC but major
organisations such as the RCN must be able to provide input to
any merged body.
4. THE LEGISLATIVE
4.1 The underlying ethos of the Roben's
review and the subsequent Health and Safety at Work Act was one
of self regulation through workplace partnerships between trade
unions and employers. There are sectors where this works well,
and in the parts of the NHS where employers truly want to engage
with staff, health and safety committees and joint consultative
mechanisms can be effective. We have welcomed the recognition
by the HSE and HSC on the "trade union effect" but were
disappointed that the consultation exercise on worker involvement
in 2006 did not result in a revision and strengthening of the
safety representatives and safety committee regulations. Due to
pressure of work and difficulties in backfilling posts, our safety
representatives are finding it increasingly difficult to get time
off to take part in activities which have been shown to improve
health and safety standards.
4.2 Trade union safety representatives can
be a powerful and effective resource. At a time when the Department
of Health is striving for improvements in patient safety including
reducing healthcare associated infections, RCN safety representatives
should be seen as a valuable resource in acting as the conduit
between staff and management and communicating the concerns raised
by staff. The Healthcare Commission's own report published in
Summer 2007 stated that "Trusts were likely to have lower
rates of Clostridium difficile-associated disease if they had
designated members of staff, working in a number of clinical areas
to link management with staff at the frontline and ensure policies
are put into practice on the wards".
4.3 The HSC and HSE need to actively promote
the role of the safety representative including the legal duties
of employers under the safety representative and safety committee
regulations and the added value they bring to improving safety
culture in the health and social care sector. They also need to
promote the role of safety representatives with other regulators
and bodies involved in promoting quality of care and patient safety.
4.4 We would ask that the safety representatives
and safety regulations are enforced and strengthened and regarded
by the HSC and HSE and other regulators as a rudimentary legislation
which has a positive impact on safety culture.
4.5 Another concern is the plurality of
providers in health and social care, many of which will be small
and medium sized enterprises, who may not have established consultation
mechanisms and a partnership approach to work. It is questionable
whether self regulation will work in these organisations. Due
to healthcare reforms we are likely to see an increase in new
organisations such as charities, voluntary organisations and social
enterprises delivering health and social care. Like other small
and medium sized enterprises, some may struggle with the requirements
of health and safety legislation, including the need to access
competent advice, and risk assessment. We would like to see freely
available prescriptive, rather than goal setting, guidance available
to these organisations. The HSE's excellent guidance on health
and safety in care homes is an example of a publication which
should be made freely available. Following a recent hearing into
a death in a care home the HSE inspector stated that every care
home should have access to the aforementioned guidance but at
a recent regional seminar delivered by the RCN to managers in
the independent sector, less than 50% of attendees were aware
of the HSE guidance. We would also support the further development
of tools for small and medium enterprises along the lines of the
excellent COSHH Essentials work. Free seminars/road shows on relevant
health and safety topics are also valuable, though we note that
a planned HSE health care event on electric profiling beds is
only available for acute and community trusts and large independent
care providers. Trade bodies, professional bodies and trade unions
can play a role in promoting such guidance and events.
4.6 We would also suggest a change in the
regulations to allow RCN safety representatives to access and
inspect small and medium sized workplaces where we have members
working so that there is an element of self-regulation. A scheme
of roving safety representatives similar to that piloted and evaluated
by the HSE in the Agricultural sector in Britain is recommended.
4.7 Free advice and guidance and should
only be one aspect of HSE's work, once the free advice and support
is given this should be accompanied by inspection activity and
enforcement action on those who still fail to comply. We are still
seeing too much of the carrot and not enough of the stick. The
prospect of an inspection by the HSE still has the power to send
shockwaves through an organisation be it large or small. It is
worth noting that in the 2004 report from the Work and Pensions
Select Committee, evidence given by the NHS Employers organisation
recognised the impact and ripple effect that enforcement activity,
in this case an improvement notice for failing to address work
related stress, had on the NHS community.
4.8 In the NHS, there is a danger that patient
safety and the health, safety and wellbeing of staff will be dealt
with in isolation. A number of recent high profile investigations
into failures in the NHS have been linked to failures in overall
health and safety management systems. Furthermore, there is a
growing body of evidence to suggest that the health and wellbeing
of staff has a direct impact on patient outcomes. The HSE and
other agencies such as the National Patient Safety Agency and
those involved in the regulation and inspection of health and
social care must work coherently, send out consistent messages
and avoid duplication. For example, we have one system of incident
investigation advocated by the National Patient Safety Agency
and another generic across industry system developed by the HSE,
which has left NHS organisations confused as to which practice
they should be following.
5.1 It appears that the HSE are increasingly
being drawn into the management of healthcare associated infections,
following serious outbreaks related to health and safety management
failures. The resource implications of this are significant, especially
as the HSE's own research has shown that the public expect them
to be addressing this issue. The proposed infection control inspections
by the Healthcare Commission on every acute trust in England starting
in April 2008 may well have a knock on effect on HSE resources.
The HSE must be effectively resourced to deal with investigations
and the potential impact of these acute sector inspections. Resources
should not be diverted away from work to reduce work related ill
health in the sector which is a major cause of sickness absence.
5.2 The RCN was opposed to the termination
of the Health and Safety Commission's Health Service Advisory
Committee (HSAC). HSAC achieved a number of high quality HSC badged
guides and brought together members from the NHS and independent
sector and representatives from Wales and Scotland as well as
England. The focus was health care (be it in the NHS or independent
sector) and members had an opportunity to share best practice
across the sectors and countries.
5.3 Whilst there is strong tripartite activity
being carried out at governmental level in some parts of Britain,
we believe there is still a need for an overall HSC led group
for Britain. The Partnership in Occupational Health and Safety
in Healthcare, which replaced HSAC focuses on the NHS in England
and without a dedicated budget has produced few outcomes. In addition,
without Commission input it is questionable whether this group
has the same degree of influence as HSAC.
6.1 The Concordat between agencies involved
in the regulation of healthcare and healthcare workers, particularly
the sharing of intelligence between agencies and its use in targeting
is welcomed. We particularly welcome the activity scheduler which
brings a degree of transparency to the process and informs safety
representatives of pending inspections. The HSE are the experts
in regulating health and safety risks. It is essential that they
work closely with bodies such as the Healthcare commission (and
its successor) that take more of a holistic view and feed into
initiatives such as the annual health check and standards for
6.2 We have also welcomed the recent enforcement
activity by the HSE where trusts have failed to follow Secretary
of State for Health Directions on the prevention of violence and
aggression in the NHS in England. We welcome this proactive approach
and clear information/intelligence exchanges between healthcare
6.3 The division between the HSE and local
authority inspection roles has the potential to become cloudy
due to the changes in the providers and delivery of health and
social care. We are aware that there are `flexible' inspection
arrangements in place but are concerned as some local authorities
give relatively low priority to health and safety regulations
as opposed to food safety or environmental protection.
6.4 There is also a need for more innovative
penalties following serious breaches of health and safety legislation
in the NHS. Financial penalties on NHS organisations following
health and safety related prosecutions may indirectly impact on
patient care and arguably have a different impact in the public
sector than they do in the private sector. The impact of penalties,
and the potential to be penalised, needs to grab the attention
of senior management and board members so that health and safety
is given a high priority.
7. MIGRANT WORKERS
7.1 The RCN has carried out a number of
studies on the working conditions of internationally recruited
nurses. Our surveys show that these groups of migrant nurses are
working longer hours and under more pressure than their UK counterparts.
The HSE needs to ensure that employers implement systems to manage
work related stress, such as working time, bullying and harassment,
which are inclusive of migrant workers and address their particular
8.1 The role of the HSE requires examination
as to how it will fulfil its role in a "new order" of
workplace health provision. There are a number of health and safety
regulations in place to protect the health of the working age
population and good employers will fulfil their obligation to
protect their workers. However, there remain a number of employers
who fail to comply with these regulations.
8.2 The HSE and specifically the Employment
Medical Advisory Service (EMAS) play an important role in preventing
work related ill health and the RCN is concerned that there has
been a lack of investment in these resources which has resulted
in a lack of specialist advice and enforcement activities.
8.3 Arguably the biggest work related health
problem that employees and employers face is work related stress
and nurses working in the healthcare sector are no exception.
A 2006 RCN survey found that the psychological wellbeing of nurses
is lower than that of the general population. The same survey
found that six in 10 nurses who took sick leave in the last three
months said that their job was very stressful. By effectively
addressing work related stress and the stressors that are prevalent
in the healthcare sector, including physical and verbal abuse,
bullying and harassment and organisational change, and by being
a "good employer" the wellbeing of nurses as a distinct
group is likely to improve.
8.4 The RCN welcomes the work that the HSE
has carried out over the past four years on work related stress
including the development of the stress management standards and
online resources. We also welcome the HSE seminars to educate
and inform senior managers in the NHS of their duties to address
work related stress and the economic case to do so. However, we
believe more needs to be done to tackle employers who are currently
failing to implement systems to reduce work related stress.
8.5 It is essential that the effects of
an ageing workforce are addressed by the HSE without delay. The
HSE has undertaken some horizon scanning activity but it appears
slow in translating this into policy and practice. In health and
social care working environments which are physically and psychologically
demanding the effects of and on an ageing workforce could be significant.
In spite of a growing body of knowledge surrounding the health
of the older workers a large majority of occupational health nurses
feel ill prepared to deal with the issues that this group of workers
presents. This is an area where the HSE needs to be proactive
and a well resourced EMAS could lead and support this work.
8.6 The HSE should concentrate on the prevention
of work related ill health, where their expertise lies, rather
than the rehabilitation agenda. However, it is essential that
the HSE ensure that organisations and their employees have access
to competent occupational health advice in order to promote an
agenda of prevention and support the rehabilitation programme.
Royal College of Nursing