Overview of H&S Management in a Diverse organisation Graham Cowan CMIOSH, FIIRSM,RSP, AIEMA, ACIEH, EurOHSM, MIOD Group Health, Safety & Environmental Director
Our Vision Nuffield Health look to provide a fully integrated Health and Wellbeing service - Provision of lifestyle advice and services to promote wellbeing and healthy lifestyle - Provision of health screening and monitoring services - Provision of Physiotherapy through our Fusion network ( Largest provider of Physiotherapy outside of the NHS) - Provision of Primary Care GP services through our wellbeing centres and stand alone clinics - Provision of surgical procedures through our hospital network - Provision of rehabilitation services through our Recovery Plus offering undertaken through our Wellbeing centres and Physio network. - Our Aim is to provide a truly integrated joined up health & wellbeing service p 2
Nuffield Health Who we are and what we do 31 Independent private hospitals 6 Healthcare sterile service units (HSSU) 6 Stand alone Clinics Corporate health and fitness provision for over 200 corporate clients 77 Fitness & Wellbeing Centres Head office at Epsom p 3
Challenges of H&S Management Hospitals Wellbeing - 31 hospitals all managed as individual business units responsible for their own growth, development and budgets. - Modern facilities often put into an ageing estate - Ever increasing surgical capability and case mix - Closer working with NHS therefore requirement to report in accordance with their criteria - 77 commercial fitness & wellbeing facilities. 24 with CQC registered services - Modern facilities often put into an ageing estate - High churn of staff - Facilities run within and on behalf of corporate clients - Inexperienced managers in comparison to Hospital Division p 4
GROUP HEALTH, SAFETY & ENVIRONMENT TEAM GENERAL COUNSEL & COMPANY SECRETARY LUKE TALBUTT GROUP HEALTH, SAFETY & ENVIRONMENTAL DIRECTOR Group Health, Safety & Environmental Manager Hospitals Group Health Safety & Environmental Manager- Wellbeing Group Health, Safety & Environmental Manager, Wellbeing- Corporate
Our Approach Change of style from central fed, and monitored system to more reliance on local management. - Develop a system of risk control documents suitable to cover group activities- these included strategic level policies with local divisional SOP as required, Standard approach and methodology to risk assessment. Standard approach to risk reporting even though risk categories may change from division to division. - Group level system that can be adapted locally depending upon facility and service provision. ( Nuffield Health 10 Folder system) - Development of Nuffield Health H&S management system training course- delivered to all managers with H&S responsibility. - Identification and training of local managers/coordinators to manage the system at operational level. - Monitoring of risks through dashboard reporting system monthly against identified key risk areas. p 6
Our Approach Dashboard Monitoring Site Audit Annual Compliance Monthly Deliverables H&S Coord 2013 2014 2015 Qual Water HS03 L8 HS08 HS29 HS02 Plant Room Quality Bournemouth 93.9% TBC TBC NEBOSH TBC TBC Brentwood 91.8% 96.0% TBC NEBOSH N/A N/A Brighton 89.4% 95.9% TBC IOSH N/A N/A Bristol 90.0% 90.9% TBC NEBOSH N/A N/A Cambridge 92.5% TBC TBC NEBOSH N/A N/A Cheltenham 90.2% TBC TBC NVQ5 N/A N/A Chester 93.8% 93.8% TBC IOSH N/A N/A Chichester 83.5% 90.2% TBC IOSH N/A N/A Derby 98.4% TBC TBC NEBOSH N/A N/A Exeter 95.4% 90.1% TBC NVQ4 N/A N/A Glasgow 94.3% 94.7% TBC NEBOSH N/A N/A Guildford 88.4% TBC TBC NEBOSH N/A N/A Haywards Heath 92.3% TBC TBC NEBOSH N/A N/A Hereford 90.0% 93.7% TBC IOSH N/A N/A Ipswich 95.3% TBC TBC NEBOSH N/A N/A Leeds 89.6% 90.5% TBC NEBOSH N/A N/A Leicester 93.1% TBC TBC NEBOSH N/A N/A Newcastle ut 95.3% TBC TBC IOSH N/A N/A North Staffs 90.3% TBC TBC IOSH N/A N/A Oxford Manor 95.4% TBC TBC NEBOSH N/A N/A Plymouth 95.0% 93.2% TBC NEBOSH N/A N/A Shrewsbury 97.0% TBC TBC IOSH N/A N/A Taunton 90.2% 91.7% TBC NEBOSH N/A N/A Tees 96.0% 97.0% TBC IOSH N/A N/A Tunbridge Wells 93.3% TBC TBC IOSH N/A N/A Vale 94.0% 96.8% TBC IOSH N/A N/A Warwickshire 95.5% TBC TBC NEBOSH N/A N/A Wessex 89.1% BSI TBC IOSH TBC TBC Woking 93.8% TBC TBC IOSH N/A N/A Wolverhampton 90.0% 92.5% TBC NEBOSH N/A N/A York 98.1% 98.3% TBC NEBOSH N/A N/A Never Event 15 RAG p 7
Integration of H&S into Group Governance Due to the diverse nature of our business we have rebadged Governance into Quality and Safety - The term Governance was associated within the business as clinical and it was difficult to get adequate engagement within the Wellbeing Division - Originally H&S was part of the Group Clinical Directorate - Quality & Safety has helped to integrate reporting and monitoring throughout the business - The CQC reporting format is now used as our Group Quality report: - Safe, Effective, Caring Responsive, and Well Led - The previous central Governance committees have been re named - Hospitals Quality & Safety Committee - Wellbeing Quality & Safety Committee - Group Quality & Safety Committee - Board Quality & Safety Committee - Expert Advisory Groups are used to support reporting and monitoring EAG HSE, Infection Prevention, Safeguarding p 8
Cascading the messages Use of internal seminars and Workshops to facilitate change - It is important that when facilitating change and a new approach, that the business is taken along on the journey as opposed to the outcome being delivered to the business. - Good explanation and rationale is required in order to engage with all levels of the business. - The business needs to share your enthusiasm and drive in order to facilitate the new approach. - It is equally important to highlight previous shortfalls and the benefits of the newer approach, as rationale for change - Support in the change management is important, and this may be extensive in some areas but quite light touch in others. Remember- just because you have told people does not mean they are briefed and on-board You may well have to reinforce the message again and again. p 9
External Monitoring Due to the diversity and nature Nuffield are regulated through several agencies. - CQC- Principal Regulator- Hospitals and Wellbeing. - HSE- Hospitals- We have a principal inspector relationship with the HSE - EHO ( Local Authority) Food in Hospitals but predominantly Wellbeing activity- we have a primary authority arrangement in place with Bristol City Council ( Moving to Warwickshire in 2015) - Fire Authority Group- we have a primary authority arrangement in place with Hampshire Fire & Rescue - We also hold external accreditations: - OHSAS 18001- BSI - ISO 27001- BSI - ISO 9001 & ISO 14001 are both in progress p 10
Some challenges on our Journey Criminal Prosecution Fitness & Wellbeing Division Cannock The circumstances leading to this prosecution are that on Saturday 7 th March 2009, A Honeywell engineer was undertaking some maintenance work in the pool plant room at Cannock. During the activity the engineer noticed that the chemical tanks located within the pool plant room were running low, and he decided to fill them. This is a task that is regularly and contractually undertaken by Honeywell engineers as part of the contract with Nuffield Health. The Engineer inadvertently poured the wrong chemical into the tank and due to the chemical reaction Chlorine gas was produced and released. The swimming pool and fitness centre were evacuated and 10 people including some children were taken to hospital with respiratory distress. Nobody however was detained in hospital overnight. Nuffield Health appearedatstaffordmagistratescourt withthe co- accused Honeywell services. Both companies were fined 15k plus costs The investigation and management of the prosecution gave me the platform to effect change within the Wellbeing division and move from a central fed H&S management system to a more inclusive local accountability for H&S management. I also initiated a full upgrade of Nuffield pool plant rooms to reduce the likelihood of re occurrence. A programme to upgrade the chemical dosing systems across the estate costing over 3million was implemented and took 3 years to complete. p 11
Cannock Bunding of Chemical Container p 12
Cannock Improvements New Dosing system p 13
Some challenges on our Journey Criminal Prosecution Nuffield Ipswich Hospital - The HSE is prosecuting Nuffield Health for one offence alleging a breach of Section 2(1) of the Health and Safety at Work etc. Act 1974. (HSWA). Section 2(1) of HSWA requires employing organisations to conduct their undertakings in such a way as to ensure, so far as is reasonably practicable, that persons in their employment are not exposed to risks to their safety. - A staff member slipped on a wet floor and sustained a fractured patella ( RIDDOR) - The Case Summary sets out the key facts and matters the HSE intend to prove. The main allegations made against Nuffield Health can be summarised as follows: - Nuffield Health failed to carry out a suitable and sufficient risk assessment for the wet-mopping of floors at the hospital. - The Case Summary refers to two Nuffield Health risk assessments: (1) Ward Department Gen Risk Assessment;; and (2) Housekeeping Department Gen Risk Assessment. These are criticised for failing to consider all the risks resulting from wet-mopping, safest cleaning times i.e. quieter periods, suitable cleaning methods such as floor drying and use of antislip footwear. - p 16
Some challenges on our Journey Criminal Prosecution Nuffield Ipswich Hospital - Nuffield Health failed to implement systems of work for the wet-mopping of floors at the hospital, that were safe and without risk to health. - The Case Summary criticises the system of work including that the Clinic room floor had been wet-mopped daily at between 8:30am - 08:45am this being the room s busiest time, floors were left to air-dry after wet- mopping, no floor drying operation was undertaken and employees were not provided with anti-slip footwear. - Nuffield Health failed to provide adequate instruction and training for employees regarding the control of risk resulting from wet-mopping of floors within the hospital. - The Case Summary provides that employees were not provided with copies of slips and trips risk assessments, they did not receive any instruction or training on the sequence of mopping rooms and it is alleged that generally housekeepers were not suitably trained or supervised in accordance with all the slips, trips and falls requirements of the Housekeeping Risk Assessment. p 17
Some challenges on our Journey Criminal Prosecution Nuffield Ipswich Hospital - Nuffield Health Appeared at Ipswich Magistrates court and were fined 5K plus costs - Corrective actions implemented: - All Hospital H&S coordinators trained to NEBOSH General Certificate level - Hospital floors surface roughness tested annually - HSE surface roughness test risk assessment toolkit used - Risk assessments implemented and monitored - Policy on Slips Trips and falls updated and monitored as Key Risk area - Floors are cleaned using wet/dry scrubbers to minimise the wet floor situation. p 20
Some challenges on our Journey Summary of Lessons Learnt Facing a prosecution or enforcement action is not easy or pleasant for the organisation or individuals concerned, however it is important to utilise the additional leverage and focus it presents to implement robust measuresand controlsinorder to re establishthesafeculture. Look for engineering, process and people issues to address the likelihood ofre occurrence Solutions have to be well thought out and researched and mindful of cost and other logistical issues, but generally the executive will value input, robust business case submission and longer term benefits. Don t always look to compare us with the industry standard look to develop and implement the best measuresin line with your strategicgoals and objectives. Be sure of your ground and present the case takinginto consideration all of the above. p 21
The Future Nuffield are always looking to be forward thinking - Current and future developments: - Increased marketing TV Advert - Electronic reporting system allowing the central resource to review data from operational sites - ISO 14001 Accreditation - Completion of our first truly integrated facility at Manchester University - Further wellbeing acquisitions to increase footprint - Development of Nuffield Health staff through our Learning Academy- Professional and leadership training - Continued development of internal H&S team ( CPD, involvement with external bodies, PWTAG, British Safety Council, IOSH) - Upgrading of our current estate- (Cambridge Hospital) p 22
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