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The need to save money has driven the National Health Service (NHS) to realise that improving occupational health and safety has its benefits. This is reinforced externally by the public perception influenced by high profile reports, such as the Francis report.
The Health and Safety Executive (HSE) is also on the perimeter. For example, the HSE occupational health section has carried out visits to Trusts and has recently reviewed dermatitis at work, as well as stress. These planned visits often result in either improvement notices being issued or a prosecution. Then there are the HSE’s unscheduled visits, often as a result of a serious accident – and, a times, concluding with a Trust being prosecuted through the courts.
If you have the time to look at the HSE’s prosecution database, you will find an array or prosecutions including: Trusts fined for insecure windows, needle-stick injuries, manual handling, and control of substances hazardous to health. The list goes on.
With the move for patients to have access to NHS Choices to decide where and who they go and see, Trusts need to ensure they have a good reputation. Unsurprisingly, any improvement notice or prosecution can have an effect on image and finances.
Across England, Wales, Scotland and Northern Ireland there are different bodies that also have a say. In England, the Care Quality Commission (CQC) is the independent regulator of health and social care. This includes the care provided by the NHS, local authorities and voluntary organisations in registered settings.
The CQC focuses on outcomes for people who use services and assesses these results using information from many sources. Reports of incidents are included, as well as information from both people who use services and that which the CQC seeks directly. The CQC has a wide range of enforcement powers it can use if it finds care services are not meeting essential standards.
Scottish healthcare system
In Scotland the Healthcare Improvement Scotland (HIS) was formed on 1 April 2011. The Healthcare Environment Inspectorate (HEI), which was set up in April 2009, is now part of HIS. HIS’ focus is to reduce healthcare associated infection risk to hospital patients, to improve the care of elderly patients, and to regulate independent healthcare services through an inspection framework. HIS inspectors do this by carrying out announced and unannounced inspections in acute NHS hospitals in Scotland. This is done to check that the NHS Quality Improvement Scotland standards for older people in acute care and standards for prevention and control of healthcare associated infection are being met.
In April 2011 the Social Care and Social Work Improvement Scotland (SCSWIS) was created to scrutinise social care, social work and child protection services. In September 2011, its everyday name became the “Care Inspectorate” although the formal name (SCSWIS), as set out in legislation, was not changed. As with HIS, the role of the Care Inspectorate is to inspect, regulate and support improvement of services and provide public assurance on service quality.
In Wales, the Healthcare Inspectorate Wales’ (HIW) role is to review and inspect NHS and independent healthcare organisations. Services are reviewed against a range of published standards, policies, guidance and regulations. It also registers independent services and has powers to take enforcement action in these matters.
HIW is the Local Supervisory Authority (LSA) for the statutory supervision of midwives. It also has inspection and enforcement powers for the Ionising Radiation (Medical Exposure) Regulations, which stem from the Health and Safety at Work Act 1974.
In Northern Ireland the Health & Safety Controls Assurance is completed by Health & Social Care (HSC) bodies to self-assess compliance with relevant standards. This process is also internally and externally audited and verified to ensure that there is substantive compliance and evidence of continual improvement.
Compliance with health & safety
The main enforcing body, for monitoring compliance with health and safety legislation, is HSENI. (Health and Safety Executive Northern Ireland).
There is also the NHS Litigation Authority (NHSLA) which is a not-for-profit part of the NHS. It manages negligence and other claims against the NHS in England. The NHSLA’s aim is to: resolve disputes fairly, share learning about risks and standards in the NHS and improve safety for patients and staff.
The NHSLA has tried and succeeded, to some extent, to introduce standards targeted around safety at different levels. With each level achieved comes savings for the Trust. Level 1 is the base line standard (having the policies in place) with level 3 the highest level (demonstrating you are doing what you say you are doing). Dependant on the size of the Trust, there is the potential to make huge savings the higher the level you have.
Currently the NHSLA is reviewing its standards, which includes the Clinical Negligence Scheme for Trusts (CNST) (Maternity) standards. The view here is that the current system has not improved outcomes and there will be a transition away from discount for Levels 1 to 3. In the future the payment from establishments will be made up from an organisation’s claims history and experience, known claims and from its risk profile (type, level, number of people and activity undertaken). The price paid will reflect risk, so organisations which are seen as safe will be recognised and rewarded.
Views from staff
Staff satisfaction surveys are now another measure of how good or bad Trusts are doing, with questions like: what percentage of staff has received health and safety training? What percentage of staff has been involved in violent or aggressive incidents? All the statistics and results are freely available for the public to view.
The NHS is striving for continual improvement in health and safety. The drivers for this are great – as are the benefits. Yes, the amount of different bodies and the continual changing of standards do not help the process, but who said working in the NHS would be easy?
The IOSH Healthcare Group brings with it a wealth of resources and information and now, with LinkedIn as a method of contacting health and safety professionals from across the country, it can only get better.
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