22. Cuts and patient/staff safety

Resolution submitted by the RCN UK Safety Representatives Committee

That RCN Congress calls on RCN Council to lobby to minimise the impact of cuts on patient and staff safety following the Lord Young Review on Health and Safety

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Progress reports

Submitted by: UK Safety Representatives Committee
Council lead and committee assigned: David Miller (until October 2011) and Lorrae Allford (from October 2011), Membership and Representation Committee
Committee decision: Existing work addresses this issue
Members involved: Members of the UK Safety Representatives Committee

Final summary update at May 2012

The work to follow up the Lord Young review is co-ordinated by the UK Safety Representatives’ Committee.

The RCN responded to the Government consultation on Lord Young’s proposed health and safety reforms including the review of Reporting Injuries, Diseases and Dangerous Occurrences (RIDDOR) regulations and the Health and Safety Executive’s proposals to charge for interventions. Evidence was also submitted to the Lofstedt review, an independent review of health and safety legislation. 

The RCN is working with the Department of Health (DH) and NHS Employers through the NHS Staff Council, Partnership for Occupational Safety and Health in Healthcare (POSHH) to promote the health and safety of staff and the impact on patient outcomes. The RCN is also represented on the Social Partnership Forum on the DH Overview and Scrutiny Group, looking at the implementation of the Boorman Review.

The health and safety impacts of organisational change were communicated to RCN activists in December 2011’s RCN Activate magazine and the RCN is leading further work on organisational change through the NHS Staff Council POSHH group.

The RCN’s UK Safety Representatives’ Committee supported the TUC Day of Action on health and safety on 28 April and, through their 2012/13 work plan, will continue to lobby on issues including safe staffing levels and work-related stress.

Update at November 2011

In May and July of 2011 the RCN responded to the Government Consultation on Lord Young’s proposed health and safety reforms.  This included the review of Reporting of injuries, diseases and dangerous occurrences (RIDDOR) regulations and drafting a response to the Lofstedt review: an independent review of health and safety legislation.

The Congress resolution was discussed at the Safety Representatives meeting on 13 October 2011, with the RCN UK Safety Representatives’ conference taking place the following day, on 14 October 2011.   At the conference delegates were given an opportunity to discuss health and safety issues impacting on members and what the RCN and the UK Safety Representatives’ Committee should be focussing on in 2012.  A key issue to come out of the discussion was the impact of poor staffing levels and skill mixes on the health, safety and welfare of members. 

Work is continuing with DH/NHS Employers (Partnership for Occupational Safety and Health in Healthcare - POSHH) to promote the health and safety of staff and the impact of staff health, safety and wellbeing on patient outcomes.  Kim Sunley, RCN Senior Employment Relations Adviser has been invited to represent the Social Partnership Forum at the DH Overview and Scrutiny Group looking at the implementation of the Boorman review.

The RCN has responded to a Health and Safety Executive consultation on proposals to charge for interventions and enforcement action by a Health and Safety Executive (HSE) inspector following a visit to premises.  The RCN supported the proposals for charging, but with the proviso that money raised as a result of an intervention by an inspector is put back into preventative and proactive work by the HSE and not into the Treasury.

An article on the health and safety impacts of organisational change was included in December’s RCN Activate magazine. The article covered the potential impact of cuts and details questions that safety representatives can raise locally to ensure that change is being risk assessed and union reps are being consulted on the impact to the health and safety of members.

The TUC is planning a day of action on cuts to health and safety in April 2012.  Views will be sought from the RCN’s UK Safety Representatives’ Committee on whether the RCN should support this event and associated regional and national activities. 

 

Debate report

Paul Hopson of the UK Safety Representatives Committee proposed this item outlining how physically and emotionally demanding the nursing profession is. He stressed how cuts in the health service were impacting upon nursing staff and that an overstretched and under pressure workforce can lead to the disintegration of quality patient care.

Paul referred to budget cuts in the Health and Safety Executive and that this was likely to result in hospital inspections being reduced if not abolished completely. Catriona Forsyth, also of the UK Safety Representatives Committee, said this could “lead to another Mid-Staffs” and warned that inspections would only be carried out after a public safety disaster and not used as a preventative measure.

The resolution attracted overwhelming support with speaker after speaker urging the hall to vote in favour of the motion. Student member Clare Pye said cuts were creating a vicious cycle of stress and further ill health. “Cuts to staffing levels are making more work for existing staff,” she said. “This in turn is putting them under strain and making them ill so sickness absence increases. Students are not being treated as supernumery and the effects of tired and pressured staff are having an impact on care.”

The resolution was passed with almost a unanimous vote in favour.

Result

The resolution was passed.
For:  99.55% (442)
Against: 0.45% (2)
Abstain: 4

With high levels of sickness absence and ill health retirements caused by preventable work related injuries and illness, health care organisations recognise they need to do more to protect the health, safety and wellbeing of staff. What’s more, patient safety continues to be a concern following a number of high profile incidents and inquiries into large-scale safety and quality failings and patient fatalities, both in the NHS and the independent sector.

The safety of health care staff and patients are intrinsically linked; in his 2009 report on the health and wellbeing of the NHS workforce, (Boorman, 2009) Dr Steve Boorman identified that organisations that place importance on the health, safety and wellbeing of their staff are better performing organisations in terms of patient outcomes - including infection and mortality rates. A positive safety culture – featuring a strong leadership and an open and fair culture – was identified as key to improving the safety of both staff and patients.

Following concerns about a perceived ‘compensation culture’ and a disproportionate response to risk, in 2010 Lord Young was commissioned to review health and safety regulation in all sectors of the UK. In his report, Common sense, common safety, (Lord Young of Graffham, 2010) Lord Young makes several recommendations including  replacing risk assessment in low hazard environments such as offices with checklists, a consolidation of all health and safety laws, the regulation of health and safety consultants, and changes to the reporting of work-related injuries which result in three or more days absence from work.

Lord Young’s recommendations have been welcomed by certain elements of the media which have been critical of what they view as petty health and safety rules and the so-called compensation culture.

As the independent watchdog for work-related health, safety and illness the Health and Safety Executive (HSE) plays an important role in protecting staff and patients and works closely with other regulators including the Care Quality Commission. While Lord Young was supportive of the HSE’s work, the 2010 Comprehensive Spending Review resulted in a 35% cut in the HSE’s budget, raising concerns about its capacity to offer advice, investigate incidents and undertake proactive inspections of health care premises and other workplaces.

In addition Lord Young and the Coalition Government are concerned about the impact and burden of European directives, and there are anxieties that as a result the UK will take minimal steps to transpose such directives into UK law. This has implications for current directives which impact on both staff and patient safety – including the new Sharps Directive and the review of the Working Time Directive.

References and further reading

Boorman S (2009) NHS health and wellbeing: final report November 2009, London: Department of Health Available at: http://www.nhshealthandwellbeing.org/FinalReport.html (Accessed 07/02/11) (Web)

Lord Young of Graffham (2010) Common sense, common safety: a report by Lord Young of Graffham to the Prime Minister following a Whitehall-wide review of the operation of health and safety laws and the growth of the compensation culture. London: HM Government Available at: http://www.number10.gov.uk/wp-content/uploads/402906_CommonSense_acc.pdf (Accessed 07/02/11) (Web)