Select Committee on Work and Pensions Written Evidence

Memorandum submitted by the Royal College of Nursing


    —    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 infections.

    —    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 Select Committee.


  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 working environment.

  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.


  4.1  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 better health.

  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 agencies.

  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.


  7.1  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 needs.


  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

January 2008

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