Health and Safety at Work

My Lords, it need not be a counsellor, it can be anybody. In truth, the matter is incredibly difficult since, in our own homes, we change light bulbs on our own. Yet people who are employed by public authorities must be protected from injury. There are all kinds of further risks; we have got ourselves into a mess in this area. For instance, while working on a book partly concerned with the subject, I interviewed a great many nurses anonymously, for they did not want to be reported on it. They said that they were increasingly nervous about touching patients—holding a hand, or rubbing a back—because of the consequences of it going wrong and them being accused of assault. Similarly, there are cases of teachers worried about putting sun lotion on small children because of our incredible obsession with paedophilia. Some of that is well placed and some of it plainly not. So, they are nervous of someone accusing them of doing the wrong thing. I do not know whether your Lordships have ever seen two five-year olds trying to put sun lotion on each other, but I would rather take that risk. I raise these examples to make a few substantive points. Some regulations are enormously sensible; for example, those on backs are hugely important. We have seen too many terrible injuries to feel anything else, as the noble Lord, Lord Harrison, made clear. My own NHS experience makes that abundantly clear. None of us should quarrel with them, but we should quarrel with how they are interpreted. What is wrong—as the risk doctors who have written eloquently about this, David Hillson and Ruth Murray-Webster, argued strongly yesterday when briefing me for today—is the fear of the consequences of taking a risk: not the back injury, which might be a genuine risk, but the managers who are furious because the rules have not been followed. So the regulations become stronger to stop people breaking the rules than either the Health Service Executive or NHS management originally intended. People become increasingly scared of going against procedures. Nurses become increasingly frightened of touching patients, so they put their natural desire to give comfort into cold storage. For the best of reasons, they are more likely to put in a central line than to hold a hand or rub a back, but they are hiding behind the regulations. Members of staff become increasingly scared of taking a chance. They either give up entirely or they become too process-driven, blaming the Health Service Executive incorrectly for what they are not doing, incidentally making the system increasingly unkind. Noble Lords will talk about other areas today, but my concern lies with this increasingly process-driven way of approaching health and social care. The can-do attitude that lies within superb health and social care workers is being suffocated by the perceived weight of the regulations. Managers get impatient and staff take fewer risks. On looking at the data, for example, compulsory admissions under mental health legislation have increased 6 per cent over nine years, but there is no increase in the homicide or suicide rates of that group. So what should we do? It is not about the Health Service Executive changing its values or saying that accidents at work do not matter. They plainly do. It is about three discrete things. The first, an important point, is that the Health Service Executive needs to be clear about why a particular regulation—for example, on backs—is there and the risks involved. It needs to be ready to back off if necessary. Secondly, to achieve that and to be taken seriously, we need much greater education of young people about these issues—perhaps what one could broadly call citizenship education. We need to get children and young people to understand that life is full of risks—we cannot remove them all—but that they have to take a proper view of what is likely or reasonable, and what is a risk to them or others. We have to make choices and we have conflicting objectives. We need to obey the procedures and to get the job done. Finally, there is the much more difficult area of risk to personal standing, esteem and career—we have seen a fair bit of that in politics in the past few weeks. Teachers are increasingly terrified of touching pupils because of our watchfulness. One teacher who I know very well was watching football practice when a child got badly hurt. He was 11 or 12 years old and was crying for his mother. After consideration for quite a few minutes, the male teacher eventually decided to put an arm around the child to comfort him. The risk of being judged a paedophile was not great. But should he have been accused, he, his family and school would have been treated mercilessly. So, too, are those thought to assault patients or who are afraid that they might be thought to do so. The risks may be small, but the consequences are huge. Last year, the Prime Minister, in a superb speech to the Institute for Public Policy Research and the Association of British Insurers, pointed out that no public servant ever gets brownie points for not regulating or not taking action. He was absolutely right. Officials and government have to be seen to do something. But sometimes that something might be to say that life is not risk-free; that we have to protect ourselves and the vulnerable; but that sometimes we have to say that things have to go on as they are and we have to take risks ourselves. I hope that the Health and Safety Executive and the Minister will lead a public debate on these issues, for we surely need one.