Head of the National Audit Office Sir John Bourn reported to Parliament today that, while there have been real improvements in the management of health and safety risks to staff in NHS trusts, progress overall is patchy. The number of reported accidents is increasing, the gap between the best and worst performing trusts is widening and more NHS trusts need to learn from and implement good practice.
Moving and handling, needlestick injuries, slips, trips and falls and exposure to substances hazardous to health remain the main causes of accidents, but work related stress has emerged as a serious issue with over two-thirds of trusts reporting an increase in the last three years.
The NHS employs over one million people yet the biggest constraint is staff shortages. Maintaining the health and safety of existing staff is essential; it is a statutory requirement and research shows that reducing the health and safety risks to staff reduces sickness absence, improves staff retention and improves productivity.
The number of reported accidents in acute, mental health and ambulance NHS trusts has increased by 24 per cent between the 2000-01 baseline and the 2001-02 target date set under the Department of Health 1999 Working Together initiative – with around 135,172 accidents in 2001-02. As a result, the Department’s national improvement target of a 20 per cent reduction by 2001-02 has not been met with only just over a fifth of trusts meeting the 20 per cent reduction target.
Better awareness of the need for reporting and more robust incident recording systems have contributed to this increase. The statistics also mask a complex position where in some trusts the number of accidents has fallen through improved training and practices, while in others improved awareness and reporting have led to an increase in reported accidents. But over a fifth of trusts identified staff shortages and increased workloads as leading to poor compliance with good practice and as a result an increase in accidents. And in all trusts there remains a significant problem of under-reporting.
Despite Departmental initiatives to encourage trusts to introduce procedures for assessing the cost and impact of accidents, little progress has been made. The NAO’s analysis suggests that the direct costs are at least £173 million: based on a rough estimate making use of the very limited information available of work-related sickness absence, and estimates of permanent injury benefits, ill health retirements and payments out of court relating to staff accidents. However, the true cost is substantially more once staff replacement costs, treatment costs and court compensations awards are taken into account, not to mention the substantial human costs of low productivity, staff turnover and their impact on delivering the NHS Plan.
Since 1996, NHS trusts have made improvements in compliance with the statutory and operational responsibilities and in their overall approach to risk management and health and safety training. However, the types and quality of risk assessments vary and there is considerable scope for more trusts to learn from and implement good practice.
In particular, the NHS needs to do the following:
- develop a national health and safety strategy to co-ordinate existing and new initiatives, including responsibilities within the Department and the roles and responsibilities of NHS Estates, Strategic Health Authorities, Workforce Development Confederations and relevant Special Health Authorities;
- commission and disseminate evidence-based guidelines on health and safety interventions to help NHS trusts improve the management of risks and reduce the impact on stress, sickness absence and staff retention; and
- work with the NHS Litigation Authority and Health and Safety Executive to support the development of a robust costing methodology for assessing the financial impacts/outcomes of accidents. And at the same time the NHS needs to ensure that the new NHS Electronic Staff Records System is developed to capture information on reasons for work-related staff sickness absences and turnover. Full appreciation of the impacts and costs should help NHS trusts prioritise actions and develop sound business cases for investment in interventions.
In addition, NHS trusts should:
- adopt a strategic approach to induction and other training and development based on an annual training needs analysis for all clinical and support staff;
- review their strategies for providing occupational health services to ensure that they are proactive and cover key issues including counselling, managing work related stress, rehabilitation and other support to staff – any arrangements should reflect departmental guidance on good practice and the option for fast tracking should be fully explored and a clear, unambiguous strategy implemented; and
- ensure better compliance and a more consistent and robust approach to identifying, recording and reporting accidents with measures for tackling under-reporting, drawing on the experiences of those trusts that have introduced good practice reporting systems.