Trust Board 23rd April 2013 Public section paper

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1 Trust Board 23rd April 2013 Public section paper Report of Jackie Green Director of Human Resources Presented by Karl Milner Director of External Affairs & Communications Paper prepared by Christopher Carvey Deputy Director of HR Subject/Title Management of Sickness Absence Background papers Purpose of Paper IQPR To provide Board members with a highlevel overview of sickness absence. Action/Decision required The Board is asked to note the report. Link to: NHS strategies and policy Link to: Trust s Strategic Direction Corporate objectives Becoming a Foundation Trust Hospital of choice for patients and staff Achieving excellent clinical outcomes Resource impact Consideration of legal issues Acronyms and abbreviations As detailed in Paper. N/A N/A 1

2 THE LEEDS TEACHING HOSPITALS NHS TRUST BOARD MEETING - 23rd April Introduction Management of Sickness Absence Public Section Paper As recommended in the 2009 Boorman review in relation to the health and wellbeing of NHS staff, the Trust has set its sickness target to meet the recommendation of reducing sickness absence rates by one third. The current target is to reduce 12 month rolling sickness absence rates to 3.0% by March Currently performance against this target is RAG rated as red and it is a key priority for 2013/14 to improve performance in order to return to the planned trajectory. This report details the managerial interventions taken to date and the planned interventions to the current year. High levels of sickness absence in the Trust adversely affects the quality of patient care, as staff are not available to provide care. Between January 2012 and December 2012 the Trust lost the equivalent of 571 full time equivalent staff 1 due to sickness absence. Sickness absence costs the Trust approximately 40 million per year 2. High levels of sickness absence also adversely impact on the health and wellbeing of the staff who remain in the workplace as high levels of absence increases workload and work pressure for the employees at work. 2. Current Position The chart below shows that as at March 2013 the rolling 12 month sickness absence rate was 4.44% compared to a target of 3.94% target. 1 Based on 225 working days per year 2 Based on the cost of the days absence. 2

3 The graph below shows in month sickness absence rates since 2009/10. Sickness absence was on a decreasing trend until February 2012, but has been increasing from that time. However, the sickness absence rate in March 2013 was slightly lower than March 2012, however, it is clearly too early to say if this will be a continuing trend. Sickness Absence by Staff group Additional Clinical Services is the staff group reporting the highest sickness rate of 7.56%. This staff group includes individuals such as Clinical Support Workers. The next highest rates are among Estates and Ancillary staff and Administrative and Clerical staff, at 6.02% and 4.5% respectively. Medical and Dental staff have the lowest reported sickness absence figures, however, this is likely to be at least partly down to incomplete reporting and recording. 3

4 Reason for Absence Musculo-Skeletal is the single largest self reported reason for sickness absence at 25.3% of total sickness absence. Stress, anxiety and depression is the second largest reported reason at 19.6%. % of Sickness Days Lost by Reason April 12 - March % Musculo-skeletal 13.2% 8.5% 25.3% Stress, Anxiety, Depression Unknown/ unspecified 14.7% 16.8% 19.6% All other reasons Influenza, Colds, Respiratory, ENT Diarrhoea/Vomiting & Gastro- Intestinal Headaches Long term Absence The graph below shows the proportion of sickness absence which is long term (i.e. four weeks or over) and it can be seen that long term sickness absence accounts for the majority of sickness and the proportion is increasing. External Comparison The graph over shows external comparisons and it can clearly be seen that the pattern of sickness absence across the entire NHS follows a very similar pattern. The increase in sickness absence rates experienced in this Trust are mirrored in all other parts of the NHS. 4

5 The Trust s sickness absence rate is above the average rate for the NHS in England, below the average rate for Yorkshire and Humber. However, the most important comparison is with similar organisations and the sickness absence rate in this Trust is consistently above the average rate for acute teaching hospitals. 3. Changes to National Terms and Conditions New national terms and conditions came in to effect for Occupational Sick Pay from 1st April Previously staff employed on Agenda for Change terms and conditions who were absent due to sickness would continue to receive the pay enhancements (for example night duty supplement or bank holiday rate) they would have received had they been in work. Now Occupational Sick Pay will be normally be the same as basic pay. These changes to terms and conditions will inevitably reduce the cost of sickness absence and it is envisaged that they will also contribute to reduced absence. However, employees on the lowest pay points of Agenda for Change are excluded from these changes and traditionally, as a group, these employees have the highest sickness absence levels. 4. Management Actions Management of sickness absence remains a top managerial priority, however, it is clear that interventions taken to date have not made the step change required. The Director of HR chaired a half day summit with key stakeholders in January to agree high impact interventions in respect of attendance management. This was followed up with a further summit in April which reviewed health and well-being interventions. A range of managerial interventions are in operation for 2013/14: 5

6 4.1 Active Management of Sickness Absence The management of individual employees and departments who have high sickness absence remains a top managerial priority and it is a key priority of the HR Department work with managers to ensure all cases are being proactively managed. There are, approximately 4000 employees who are in the formal Attendance Management process at any time and as part of the response to the wider Trust management realignment, the advisory HR service has taken the opportunity to realign priorities and create a dedicated team which will focus on the Trustwide reduction of sickness absence as its key priority. This team will be managed by the Senior HR Manager who oversaw the reduction of sickness absence with Estates and Facilities. This is a model which has proven to be effective in other Trusts. The Trust s Attendance Management Policy has been recently reviewed and is in accordance with best practice, however, there remains a challenge to ensure that both employees and line managers fully comply with the Policy. This new dedicated team Attendance Management Team will have a key role in ensuring this is the case. This will be achieved through both skills development for managers and also by active performance management process. 4.2 Occupational Health Services The management of the Occupational Health Service has now transferred to the Director of HR and a review of the Department s activities is underway to ensure activities which assist in the key priority of reducing sickness absence are prioritised. Given the high and increasing proportion of long term sickness absence it is essential that Occupational Health, HR and line managers work together in an integrated way in order to facilitate employees returning to work at the appropriate time or where this is not possible, the prompt resolution of the case. The creation of the dedicated Attendance Management Team in HR will allow for easier and more consistent liaison between these three parties. 4.3 FirstCare FirstCare is a system which has been introduced to improve the reporting and recording of sickness absence. The system also removes a significant amount of administration from line managers and provides them with timely and useful attendance data in order to allow them to manage employee s attendance in a timely and consistent way. The system also provides a mechanism for employee s to speak to a trained health professional at the time they report their sickness absence in order that they can receive appropriate health advice and to allow for an upfront discussion about potential return to work dates. This system has been implemented in a range 6

7 of private and public sector organisations, including a number of NHS Trusts, leading to significant reductions in sickness absence. Since its introduction for Nursing Staff in the Medicine Division in December 2012, FirstCare has now been rolled out across all inpatient ward areas and across theatres. Firstcare has also been introduced for all staff in the following two services: Cardio-Respiratory Urgent Care At this stage of the roll out we are now in the position where we are in receipt of reliable data from all the areas which have gone live and from April 2013 we will be in a position to undertake detailed monthly comparisons for each area with the corresponding period in the previous year. This will allow us to assess the on-going benefits of this new system and this work will be reported on a regular basis to the Workforce Committee. Research evidence shows that timely and effective return to work interviews are the single most effective intervention to reduce sickness absence. A part of the functionality of the FirstCare system is to electronically capture this information and track the timeliness of return to work interviews. This information was not previously easily available and the introduction of the FirstCare system has immediately highlighted that return to work interviews are not happening in a timely way. The Trust has set a target that return to work interviews should be undertaken as soon as is practicable, ideally on the day of return and where this is not possible within 7 calendar days of the date of return. Information from the FirstCare system has revealed that this target is not being met. For example, in the first month of implementation only 48% of return to work interviews for staff on the system within the Medicine Division received a return to work interview in the specified time. This has risen to 55% in March This clearly shows that a key priority area for improvement is in relation to timely and effective return to work interviews by managers. This will be a key performance indicator against which line managers will be assessed in 2013/14. The dedicated Attendance Management team will work with line managers to ensure appropriate mechanisms are put in place in areas currently out of scope for FirstCare to ensure timely and effective return to work interviews also occur in these areas. 4.4 E-rostering The Erostering system, especially when it is used in conjunction with the FirstCare system dramatically improves the quality, timeliness and accessibility of data in relation to sickness absence and timeliness of data in terms of sickness absence. Throughout the course of the next 12 months this information will be used to more easily identify patterns of sickness absence (for example in relation to sickness on bank holidays or sickness following or preceding a scheduled day off) to ensure that any such patterns are identified and appropriately managed. 7

8 4.5 Staff Engagement An employee s motivation to attend work is an extremely important factor in determining their level of sickness absence. At its last meeting the Board received and supported a proposition in relation to achieving excellent staff engagement at LTHT. This will now be taken forward by the Workforce Committee in terms of a detailed work programme and costing s with on-going assurance against delivery of the programme. This work will have a particular impact on the number of employees who are reporting sickness absence by reason of stress, anxiety and depression, which as stated earlier is the second highest reported cause of sickness. 4.6 Health and Wellbeing The Trust undertakes a wide range of activities designed to improve health and wellbeing. These include: The provision of gyms and a physical activity team A variety of health promotion activity Counselling services Fast track physiotherapy Following the health and wellbeing summit it was agreed that the good work which is currently being undertaken is not fully communicated to employees in a consistent and effective way, with many employees being unaware of the range of options available to them. Furthermore, it was agreed that the work currently being undertaken requires additional alignment to Trust priorities, such as reducing sickness absence. In Quarter /14, there will be a review of both the managerial and governance arrangements for health and wellbeing activities and priorities will be realigned with each work stream having clear output targets against which they will be monitored. 5. Conclusion Reducing sickness absence by a third is a challenging target for the Trust and the wider NHS, however, current levels of sickness absence within the Trust are not acceptable, particularly when we compare ourselves to similar organisations. A range of new initiatives are being implemented or are planned for 2013/14 which are designed to reduce sickness absence and ensure practice within the Trust is consistent with recognised best practice. The Workforce Committee will continue to receive reporting in relation to sickness absence performance and interventions. 8

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