Management of Health and Safety

The National Audit Office (NAO) in their report on “Health and Safety in NHS Acute Hospital Trusts” found that standards of health and safety management were variable, with a number of Trusts failing to meet their statutory obligations. Reports from Health and Safety Executive (HSE) Principal Inspectors have confirmed this view. This guidance, suggesting good practice and identifying some specific hazards prevalent in the NHS, reflects in the main the conclusions of the NAO report. The issues addressed are not exhaustive and do not intend to be comprehensive guidance on health and safety.

The NAO concluded; “To succeed in attaining the high standards expected, hospital trusts should aim to develop a more proactive, rather than a reactive, approach. This involves developing hospital-wide strategies to minimise the level of accidents. These strategies need to be supported by effective reporting arrangements to assess trends, and informed by comparisons of best practice in health and safety management from both within and outside the NHS. To achieve good progress, action should be led from the top by trust boards and chief executives, so that the health and safety of patients, visitors and employees is routinely accorded a high priority within and across all trusts”. (Paragraph 24 Health and Safety in NHS Acute Hospital Trusts in England).

Health and Safety is managed most effectively by integrating health and safety management with mainstream business objectives. An essential component of general management is the management of risk. The integration of health and safety management into risk management and thus into general management, creates the foundation for achieving a high standard of health and safety performance. Failure to manage health and safety can result in heavy costs, whether in terms of staff absences, low staff morale, financial losses, higher insurance premiums, civil and criminal legal action resulting in fines and compensation payments, or damage to the public reputation of the employer.


NHS Employers should; ensure that they are aware of and comply with their statutory health and safety obligations. consider the Health and Safety checklist (see Annex C) provided for NHS Boards. take steps to implement the recommendations of the NAO (these are listed in EL(96)104) and give a high priority to following best practice in the management of health and safety. have in place policies and procedures to investigate, record, monitor, review and assess the causes and costs of accidents, sickness absences, ill health retirement and occupational ill health provide their employees with access to a confidential and effective occupational health service.

Remind staff that it is the duty of every employee while at work to take reasonable care for the health and safety of themselves and of other persons who may be affected by their acts or omissions at work. Consider the inclusion of information on health and safety performance in their published reports. be aware of the principles in EL(96)104 & EL(96)44 “Health and Safety Management in the NHS”, HSG (94)51 “Occupational Health Services for NHS Staff”, “Risk Management in the NHS” (NHS Executive 1993) and the Health Services Advisory Committee’s (HSAC) guidance “Management of Health and Safety in the Health Services” . Take account of these guidelines when negotiating contracts between purchasers and providers. A significant source of good practice in managing health and safety in the NHS is the Health Services Advisory Committee of the Health and Safety Commission (HSAC). This committee which includes nominees of the representative organisations of NHS boards and of employee organisations has published guidance both on the interpretation of legislation and on good practice in this field (See Annex D).

The number and nature of accidents to patients, visitors and NHS employees and the associated costs of these accidents to the NHS; and the action hospital managers had taken to address their legal obligations on health and safety.

From this study, the NAO concluded that Trusts could do more to reduce the level of accidents and to implement the requirements of legislation and good practice in health and safety management. In particular, failure to adequately investigate accidents meant that employers were unaware of the true costs of failing to follow best practice in health and safety/occupational health. The NAO was concerned that the aggregated costs of; sickness absences as a result of accidents, compensation payments, increasing insurance premiums and possible premature retirement of valued employees would be considerable. Health and Safety Performance in the Contracting Process.

Purchasers are responsible for ensuring the quality of services provided by their Trusts. The contracting process can be used by them and by the providers to show the importance they attach to quality and their commitment to following best practice. Health and Safety policy can be seen as an important element of the quality agenda and can be addressed directly in the contracting process. At the outset, the purchaser might ensure that a credible health and safety policy is in place. They might then ensure that the commitments in the policy are explicitly referred to in the contract. If the purchaser chooses this route, it will be important that the monitoring of the contract covers the effectiveness of the policy and the performance of the Trust against agreed criteria.

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