Chain Awareness on the Shop Floor

• Conclusions
• Recommendations
• Response of the ministers

Some of the problems we face in society have so many facets that a multi-disciplinary approach has to be taken to them. However, since the range of expertise needed often cannot be found in a single organisation it is better to have specialised organisations tackle the separate parts of a problem. Together, these organisations form the links in a chain. The Court of Audit has investigated the performance of such chains in the public domain. We have audited the factors that determine whether a chain performs well or not. We looked at three chains:

(1) the chain to supervise the removal of asbestos from buildings due for demolition,

(2) the chain in place to respond to child abuse, and

(3) the chain to provide emergency care (ambulance care and first aid).

Conclusions

Cooperation is the least developed in the chain to supervise the removal of asbestos from buildings due for demolition. There is no systematic coordination, exchange of information or concerted action among the organisations concerned (municipalities, provinces, police forces, Labour Inspectorate, VROM Inspectorate and V&W Inspectorate). There are widespread indications that buildings are being demolished illegally without the municipalities, police or inspectorates being aware. Calculating companies don't follow the rules very strictly and the chance of being caught is low because the links in the chain have only limited supervisory capacity.

Cooperation between the organisations involved in the response to child abuse is better. The roles within the chain are reasonably well defined: the municipalities have primary responsibility for prevention and initial assistance; the provincial Youth Care Agencies have primary responsibility for more serious assistance; the Child Care and Protection Board and the administrative courts decide what measures should be taken. Nonetheless, serious problems sometimes occur in the coordination of the parties involved. Improvements could be made, for example, in detecting and reporting child abuse and the waiting and lead times for parents and children are very long. The chain lacks the clear management it deserves. The exchange of information between and within the organisations is badly organised.

Cooperation is best in the emergency care chain. Although there is no explicit management function, in most cases the individual 'links' (the emergency service centres, ambulance services, hospital accident and emergency departments, GP centres, etc.) know what they have to do and what demands will be made by the following link in the chain. Areas for improvement in the chain are ambulance response times and the reliability and expertise of some accident and emergency departments and GP centres.

There are several reasons for the differences between the three chains. Firstly, it takes time before organisations work well together. The enforcement organisations in the asbestos supervision chain did not start cooperating with each other until 2005, while the emergency care chain has been working together for decades. Secondly, the more urgent the problem, the closer the cooperation; this is a particularly strong factor in the emergency care chain. Finally, cooperation is more difficult if the organisations concerned must also carry out many other tasks outside the chain, as is the case at many inspectorates and municipal agencies.

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Recommendations

The Ministers of Housing, Spatial Planning and the Environment (VROM) and of Social Affairs and Employment (SZW) should organise a roundtable conference for all the links in the asbestos removal chain. The central issue should be how to improve the quality of supervision so that risks can be reduced during demolition work, during the transportation of asbestos and at waste disposal sites. Periodic measurements should also be taken of breaches of asbestos regulations. At the same time, a study should be carried out of the VROM Inspectorate's effectiveness. The Minister for Youth and Families should ensure that measures taken to shorten the time needed to provide care to victims of child abuse cover the entire process from notification to actual assistance and do not stop when a court takes a decision. A wider study should also be made of the effectiveness of prevention and treatment methods. Furthermore, the minister should ensure that improvements are made in the case management system in place for children receiving assistance. The Minister of Health, Welfare and Sport (VWS) should promote an open debate of the advantages and disadvantages of integrated emergency care centres (accommodating both GP centres and accident and emergency departments). The minister should also facilitate the Health Care Inspectorate so that it can carry out a study in the near future of the quality of emergency care.

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Response of the ministers

In the field of asbestos supervision, the ministers concerned (VROM, SZW, Justice and V&W) adopted our recommendations in a joint response. The Minister of VWS also agreed with our recommendations. The Minister for Youth and Families did not respond to our recommendation to consider actual care provision in the measures taken to shorten lead times.

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