Gerry Steinberg MPIn the House...

Commons Gate

A Safer Place to Work: Improving the management of health and safety risks to staff in NHS trusts (HC 623)

Public Accounts Committee 12 May 2003

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Witnesses: SIR NIGEL CRISP, KCB, Permanent Secretary/NHS Chief Executive, and MR ANDREW FOSTER, Director of Human Resources, Department of Health, examined

Mr. Steinberg

Q36 Mr. Gerry Steinberg (City of Durham): On reading the report it seemed to me that, in fact, most NHS trusts had taken the topic quite seriously, not simply because of the figures that are given in the report. 94% of trusts have computerised systems and probably 4% of the trusts have data recording systems which will not be as good, but at least they do some things with that. So that is what 98% of the trusts who do something. However, the report did seem to indicate that the performance of the trusts did vary considerably in terms of the comprehensiveness of how they report accidents and consistency with how they did it. That has got to be worrying, has it not?

Sir Nigel Crisp: Yes.

Q37 Mr. Gerry Steinberg (City of Durham): How do you think you could bring in a standard level of performance that should be the backbone of the NHS?

Sir Nigel Crisp: Yes. Now, I absolutely agree with you. If you look at the results of this report compared with the one of six years ago, there have been enormous moves forward. What it has revealed is precisely the point you make, which is that there are people doing it well and there are too many laggards, so how do we deal with the laggards? The two policies, which are the universal policies, are the ones of the Improving Working Lives Standard which people are signed up to and then monitored on; that is the first base and that is the external monitoring. The second one is the whole Controls Assurance process which requires, for example, health and safety to be reported to the board on a regular basis and there is plenty of evidence that is now happening. Also, the other thing though that we have done and which we will continue to do, is to work with the Health and Safety Executive about targeting particular areas, or indeed particular trusts. The whole relationship with the Health and Safety Executive has moved on enormously, again, in the last six years, so that we can start to think about: "Well, how are we going to target the outliers effectively"?

Q38 Mr. Gerry Steinberg (City of Durham): Yes. Also, again, which is slightly worrying, is the fact that some groups do not or seem to refrain from reporting. David mentioned the doctors and that does not surprise me at all, I have got to say. If you remember we did a report recently on the side effects of some medicines, is that right? If I remember rightly doctors had to fill in a form if there was a side effect. Even though they had forms on the desk ---

Sir Nigel Crisp: This was around clinical negligence, was it not?

Mr Burr: The Medicines Control Agency.

Sir Nigel Crisp: Yes.

Q39 Mr. Gerry Steinberg (City of Durham): --- they failed to do that. Here, again, we see that they have failed to report accidents. It seems to me that the only time they ever fill a form in is if they are getting paid for it; they are quite keen to do it then. I have just paid £15 for getting a doctor to fill in two little boxes but never mind. It makes one a little bit cynical. It seems to me to be the same here. I have not declared any interests, I have got recovery from the legal profession. There was a stage when I was going to be a doctor, but I did not have patience. Why do we treat doctors with kid gloves? If they fail to report an accident and something comes of it, action should be taken against them should it not, really? Obviously, I do not want to pursue the point.

Sir Nigel Crisp: Yes. There are two or three things that are different. This report does not break down the difference between, if you like, the permanent staff of the hospital and doctors in training who will rotate through the hospital. One of the issues for us within hospitals, which we are getting better at, is making sure that the doctors who are there only for six months, or 12 months, or 18 months understand the policies of the hospital are part of the induction programme and understand how you do these things and so on. I think that is one point which distinguishes doctors in general from others, but your general wider point about employees of an organisation should behave equally as all other employees and, indeed, many do. Again, I think the other point that Mr Foster made was we need, of course, to make it easier for people to report.

Q40 Mr. Gerry Steinberg (City of Durham): Yes, that is important. Again, in the report - I think it has been mentioned previously - something like 60% of accidents that by law should be reported are not being reported, they are not being reported to the HSE. What do you intend to do about it because that seems to me to be a hell of a lot of accidents that have taken place that have not been reported? Is there anything you can do about that?

Sir Nigel Crisp: Again, it is the same issue that it really needs to be tackled locally against national standards. The point you opened with about how do we have a national standard, at least we now have a national standard and we have a methodology for imposing that national standard, and for making sure that the boards locally look back at their own record and that it is on their agenda to do so. It is putting a lot more responsibility on the local board, which is the way it should be, because we cannot manage that sort of detail from here, so we have put that mechanism in. I am sure part of the improvement we have seen over the last six years is simply that focus.

Q41 Mr. Gerry Steinberg (City of Durham): You can make statistics prove anything. The Chairman took us to Appendix 3, I would like to go back there again, it is on page 46, figure 1. On the figures it clearly shows that serious accidents are declining, from 1996-97 to 2001-02 it has gone from 7,500 down to 5,992; that looks good, excellent. Is it that good because if we are arguing and saying that 60% of accidents are not being reported anyway, are these not misleading figures?

Sir Nigel Crisp: I think there are two sorts. These are reportable accidents to the Health and Safety Executive under this particular set of regulations which, as I recall it, means that the people have been off sick for three days or more is the arrangement in which you have to report those. Those are much more likely to be reported it seems to me than the much more trivial accidents.

Q42 Mr. Gerry Steinberg (City of Durham): Are you saying that the 60% that are not reported are trivial? I am not trying to goad you or anything.

Sir Nigel Crisp: Okay. Let me take back the word "trivial", are less important than these ones, are less major incidents than these ones. We have seen a reduction in the major incidents, which is this type of accident, at the same time when we have seen an overall increase in reporting. Now, whether or not there are people who are not reporting, we have seen an increase in reporting but we have seen a reduction in the number of serious ones.

Q43 Mr. Gerry Steinberg (City of Durham): One would assume that if it was a serious accident then it would be reported?

Sir Nigel Crisp: Yes, I would have thought so.

Q44 Mr. Gerry Steinberg (City of Durham): If somebody breaks a leg they are hardly likely not to fill the form in?

Sir Nigel Crisp: Yes.

Q45 Mr. Gerry Steinberg (City of Durham): So from the ambulance agency the fact is 60% have not been reported. These are the figures that you have given them, are they?

Sir Nigel Crisp: They are the less serious, that is probably the right word, yes.

Q46 Mr. Gerry Steinberg (City of Durham): Okay. Bearing in mind the way things have moved in the NHS over the last few years and the huge number of agency staff working in our hospitals now - in my own hospital, admin, cleaning and catering, all these things are contracted out and no longer run by the NHS and are run by locums working in the place - I am not trying to criticise at all, but can it be part of the problem lies with them? They are the ones who are not reporting the accidents, or if they are not NHS staff they will see it is important that they do that or whatever or, in fact, they are not trained to do it?

Mr Foster: The whole issue is one of balancing various pressures and commitments. You started off by saying it was difficult to get doctors to fill in forms, yet I am sure we all agree we want to doctors to spend as much time as possible looking after patients. That is really why I gave the example in answer to Mr Rendel, that the trust had designed a very simple, computerised intranet form to fill in. It is really a matter of trying to find a balance, especially in the less serious incidents where, as you rightly say, the motivation to report is less great than where there is a serious accident involved. What we must do is through the top-down control assurance inspections and bottom-up staff interviews for Improving Working Life is keep exerting pressure on organisations to raise the level of reporting.

Q47 Mr. Gerry Steinberg (City of Durham): Turning back to doctors, again paragraph 3.22 on page 35, I was not going through the Report looking for criticisms of the medical profession but it did jump out, again it says that doctors were the least likely to participate in health and safety education. It might be slightly beneath them to do this, but it is important, I suspect, they should participate. Why do they not participate and why do you not persuade them to participate?

Sir Nigel Crisp: This particular example is specifically about induction training. I agree with you, all employees in the organisation should be treated in the same way as regard to health and safety issues and other general policies. I think documents like this draw out that point and, as I think the record over the last five years shows, we have actually attended as an NHS to the issues that were the issues of five years ago. We have done a lot of work on backs and on a whole series of issues that have brought about change. It is harder for doctors who are moving through hospitals, so perhaps over a six month period they are in another hospital.

Q48 Mr. Gerry Steinberg (City of Durham): I was very interested to read in paragraph 3.20 what has been done in Wales, where standardised health and safety training courses had been put on for members of staff and staff were given a training passport which was transferable between NHS organisations. This means they are trained at the same level of competence and avoids duplication by individual trusts. I thought that was an excellent idea. That seems sensible, you train somebody to a standard procedure, a national standard procedure, a nation curriculum and once they have taken that and done that curriculum they can move on through any part of the National Health Service, presenting their passport or a certificate to show that they have done that. Why do we not do that and copy the Welsh?

Sir Nigel Crisp: We again agree with that. The NHS University is designed to make sure that we get some of that standardisation on, for example, induction.

Mr Foster: This may well be a very good example but we can point to initiatives, for example the occupational health smart card for doctors in England, which is a project that is regarded as being extremely successful.

Q49 Mr. Gerry Steinberg (City of Durham): For?

Mr Foster: Occupational smart cards.

Q50 Mr. Gerry Steinberg (City of Durham): I was talking about the whole of the Health Service.

Mr Foster: I am saying we have tried things which have succeeded for the migrant populations and the people who only spend six months in one organisation and then move to another, that is a good example of something that we have been able to do to record their training. Indeed this is an enormous project we have, to introduce an electronic staff record for all staff which will be the biggest such record system in the entire world and will have the capacity that you describe, to record people's learning and training experience at all stages in their career. That system will be able to embrace that.


Q199 Mr. Gerry Steinberg (City of Durham): One quick question. The reason I did not ask it originally was because I thought other people would pick it up and they have not. It is these needlesticks. When I read the report it seemed incredible that so many people were injured through pure negligence. I would have thought that it was one of the most dangerous things in a hospital yet it says in the report that 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 previous 12 months. Then there is a compensation payment of £2,000 every time it is done. How did this £2,000 figure come about? Is the £2,000 paid out where it is obvious negligence? It seems to me that this should not happen. It is a nice little earner in some respects!

Sir Nigel Crisp: We got a lot of briefing on needlesticks, as you would expect. There were 23,000 last year out of a use of 250 million devices, so 250 billion times a needle was used, and 23,000 times somebody had a problem with that. How we handle this is something which is kept constantly under review, and the issue here is about getting improved training. We need to make sure there is training in use and particularly in disposal. That is the biggest issue.

Q200 Mr. Gerry Steinberg (City of Durham): What is being done to ensure that needles are not left lying around? That is presumably how it happens, they are just left lying around.

Sir Nigel Crisp: No, I do not think it is.

Q201 Mr. Gerry Steinberg (City of Durham): It is more sophisticated than that, is it?

Sir Nigel Crisp: They are not just left lying around.

Q202 Mr. Gerry Steinberg (City of Durham): Do the doctors say, "Hey, you, arrgh!"

Mr Foster: I do not think that is the most common cause of needlestick injury, where they are just left lying around. Clearly there is a whole process here from when you pick it up in the first place to when you use it, to when you put it down for other staff. I do not think they are just being left lying around.

Q203 Mr. Gerry Steinberg (City of Durham): How does the £2,000 per prick work out?

Mr Foster: I think that is a ----

Q204 Mr. Gerry Steinberg (City of Durham): Why was it not £1,500 or £2,500?

Mr Foster: This is not an official sum, this is a sort of going rate which has been emerging.

Q205 Mr. Gerry Steinberg (City of Durham): It says here, "UNISON have negotiated a deal with employers whereby claims against NHS trusts for certain needlestick injuries are immediately settled by the trust for £2,000." So somebody gets stuck and goes off to the chief executive and says, "I have been stuck by a needle", and then there is a cheque for £2,000 by the sound of things. It does not work like that?

Mr Foster: As I say, it is a figure which has emerged through a series of case studies, where there is a demonstrable case of mental stress which has resulted from the needlestick injury. It is not an automatic payment. Clearly the employer has got to balance a duty of care to an employee who has been afflicted in this way with the cost of being taken to an employment tribunal and all the legal costs, and I think this is a sort of rule of thumb figure which sorts that out.

Q206 Mr. Gerry Steinberg (City of Durham): If you can get £2,000 for being stuck by a needle, why are 23% not reported? The first thing I would do if I was stuck by a needle would be to report it and go and get my £2,000.

Sir Nigel Crisp: We do not have the details here but it does say very clearly that this is for certain needlestick injuries, and presumably it is ones where the employer is going to be found at fault, which would not be every case.

Q207 Mr. Gerry Steinberg (City of Durham): You do not mean the employer --- yes, sorry, you mean the person who has stuck themselves and missed.

Sir Nigel Crisp: There are 250 million a year so 23,000 is serious but not very big.

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