GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST

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1 GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST Title Reasons for Staff Sickness Report date July 2014 Indicative discussion time required 10 minutes Please classify the paper as: To note To endorse To approve Executive Summary Please describe as appropriate the link to: The Trust Strategic Objectives The Trust In-Year Objectives The Trust Mission The Trust Values Please describe how this affects patients/staff/carers etc. Please describe what stakeholders think about this. To note the broader approach which incorporates sickness management and health promotion An outline of current performance on sickness management including reasons for sickness and a description of the portfolio approach to health promotion within the sustainability agenda Effective sickness management is fundamental to financial performance and our aspirations to be an employer of choice. There is a clear link between healthy staff and improved patient outcomes This agenda involves significant partnership working internally and externally. Please describe how this affects our: performance quality and safety cost activity Is what is described in the paper affordable? Please explain when you will be able to report progress about this issue. Please identify the risks associated with this issue and describe how they will be dealt with. Please set out in the report in risk register format the risks associated with the issue. Please describe the aspects of this paper that might require wider stakeholder engagement or public consultation, and early engagement with Governors. Please identify any other significant impact or outcomes (where applicable) in relation to Financial issues, Equality and Diversity, the NHS Constitution, Legal issues or Sustainable Development. Recommendation Author/Presenting Director Sickness absence costs the trust c. 10m annually. Reducing this by 0.5% will also impact on continuity of care for patients Improved health and wellbeing will save the trust money Absence rates are reported monthly through the PMF Focusing purely on sickness could lead to presenteeism and a further increase in stress related conditions. The approaches described are intended to mitigate these risks. Engagement is already taking place with staff on this subject and Governors have been updated on progress Assisting staff in maintaining their health and wellbeing is an organizational pledge contained within the NHS Constitution. The Board notes the broad approach to managing sickness and improving health Dave Smith Reasons for Staff Sickness Page 1 of 1 Main Board July 2014

2 GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST MAIN BOARD JULY 2014 REASONS FOR STAFF SICKNESS 1. Aim To update the Board on reasons for staff sickness and to describe not only the trust approach to managing this, but also the link with health promotion and maintenance and the developing trust strategy in this regard. 2. Background The link between a healthy workforce and good organisational outcomes is a well- travelled path. A number of significant public figures have produced the evidence base which exhorts organisations to go beyond a core health and safety perspective to positive health promotion. In the field of healthcare, the most notable contributors have included Dame Carol Black, Working for a Healthier Tomorrow (2008), Lord Darzi, High Quality Care for All (2009) and Dr Steve Boorman, NHS Health and Wellbeing (2009). All make very clear the link between improved staff health and wellbeing and improved patient care. This was further enshrined within the NHS Constitution (2009) with the pledge to staff that organisations would provide support and opportunities for staff to maintain their health, wellbeing and safety. Both the problem and the prize were clearly articulated. It was assessed that poor staff health and wellbeing was costing the NHS 1.7bn in direct salary costs. A reduction of one third would mean; 3.4 million available working days per year Equivalent to an extra 14,900 fte Estimated annual direct cost saving of 555m. As a consequence, the Department of Health set all NHS organisations the goal of bringing their sickness absence levels down to less than 3% and we have incorporated this into our trust Performance Management Framework for the last 2 years. Our current performance in terms of an annualised sickness rate sits at 3.79%* and this paper deals with our approach to improve the health of our staff to the degree that means that we are able to improve (and maintain) our performance to the desired levels. 3. Current performance The last 3 years has seen an increasing focus on sickness management however only a 0.5% reduction in sickness levels. Notwithstanding this, our current annualised percentage of 3.79% stands favourable comparison with the local healthcare community as well as regionally and nationally. The national problem and prize articulated above can also be translated locally; 91,800 fte working days are lost annually Equivalent to 383 fte Indirect costs of 6.5m with estimated backfill costs of 3.5m *The annualised rate at the end of 2013/14 stood at 3.85% and has reduced further over the first two months of 2014/15 At a time when the NHS nationally and trusts locally are beleaguered by the twin problems of financial challenges and workforce supply, it is very important to understand those strategies that would assist with those challenges. It is estimated internally that a further Reasons for Staff Sickness Page 1 of 8

3 0.5% reduction in sickness would deliver in the region of 1m in savings, but would also impact patient care, particularly in terms of continuity of care. Table 1 (below) shows the sickness absence rate by staff group and Table 2 shows the sickness absence rate by division. Both tables show marginal movements (primarily) with the most significant changes being upward movements in Unscheduled Care and Estates and Ancillary. Table 1 Sickness Absence by Staff Group Apr 12 to Mar 13 Apr 13 to Mar Estates & Ancillary Additional Clinical Services Nursing & Midwifery Admin & Clerical Additional Prof Scientific & Technical Healthcare Scientists Allied Health Professionals % sickness absence Medical & Dental Trustwide Table 2 Sickness Absence by Division Apr 12 to Mar 13 Apr 13 to Mar 14 % sickness absence Surgery Unschedule d Care Medicine Womens & Children Diagnostics & Specialty Corporate Trustwide As part of the development of a new sickness policy within the trust, we agreed with Staff Side colleagues that we should commence collecting reasons for sickness. We are now 6 months into this process which is enabling us to determine if there are any particular trends. Appendix 1 identifies sickness absence by reason, appendix 2 breaks this down by division and appendix 3 highlights this by staff group (focusing on the top 3 reasons for absence). Trustwide, the three most common reasons stated for sickness are; 1. Anxiety/stress/depression/other psychiatric illness 13.59% 2. Cold, cough, flu 9.26% 3. Gastrointestinal problems 7.49% It should be noted that in about 30% of cases currently, the reasons are either not specified, or they do not appear on the current list of options. It should also be noted that combining back problems with other musculoskeletal problems would create a category which would Reasons for Staff Sickness Page 2 of 8

4 be the second biggest cause of sickness absence at 12.04%. Whilst anxiety/stress/depression consistently features as the highest reason for sickness, there are still marked disparities between divisions and staff groups. This does however begin to provide us with a rich source of data to help improve our performance locally and trustwide. 4. Local approach- Promoting Health and Wellbeing In his 2009 work NHS Health and Wellbeing, Dr Steven Boorman outlined 5 key strategies for improving the health and wellbeing of staff and we have used this to underpin our own approach; Ensure senior level ownership of health and wellbeing Investigate to understand and target local needs and underlying influences Map all health and wellbeing initiatives and services Involve staff in identifying and designing appropriate interventions Learn from good practices within the trust and NHS Dr Boorman had recognised that this is about much more than managing absence. Indeed the phenomenon of presenteeism (attending work when not fit to do so) is likely to cost the NHS an equal or greater amount of money in the long term, than absenteeism. It is also clear that you cannot simply policy your way to improved outcomes and this involves a portfolio approach. The influences on staff health and wellbeing are many however fundamental to improving these is the recognition of shared responsibility. For our trust, in addition to our obligations under the NHS Constitution, is our aspiration to be an employer of choice with a genuine regard for the welfare of staff. There is an equal obligation on staff however to maintain their health and avail themselves of opportunities to do. There are precise parallels with our patients and prevention is both preferable and cost effective to cure. It is also important to recognise the part played by mental health and wellbeing and giving it equal status with physical health, particularly as the symptoms may be more difficult to spot and there remains a degree of stigma surrounding this subject. With reference to our own delivery of the approach described by Dr Boorman, there is senior ownership of this subject through the trust Health and Wellbeing Group, chaired by Dr Sally Pearson, the trust Stress and Wellbeing Group chaired by Dave Smith and the trust Sustainability Group (into whom these groups report) chaired by non-executive director Maria Bond. We are using our newly gathered data to design interventions with an example being the current piloting of resilience workshops through our Staff Support team, following the confirmation in our sickness data of anxiety, stress and depression as a significant contributor to sickness levels. In terms of mapping all health and wellbeing initiatives and services, it is true to say that our trust has long had a proactive stance to these issues. Significant work has taken place over the years in a number of areas, including smoking cessation, weight management, and sun awareness to name but a few. Our current approach is to map all of those initiatives and to develop a series of new ones, linking them to our trust values and to promote them more heavily to staff our agreed strapline ( Go on, it s Better For You ) maintains consistency with other corporate messages built around Better For You. Much of this work is going to be carried out with the involvement of staff and a new Staff Health and Wellbeing Committee has been formed and this will report into the broader Health and Wellbeing Committee. A copy of the terms of reference for this group are contained in Appendix 4. This group is chaired by one of the joint Staff Side Chairs and there is significant representation from staff. A staff health and wellbeing strategy will be co-authored, all of the enablers and blocks to progressing with this work stream will be identified, some key metrics for measuring progress will be set and there will be a strong focus on partnership working, both internally and externally. Within the portfolio approach to be overseen by this group, consideration will be given to a number of issues; Reasons for Staff Sickness Page 3 of 8

5 Food/diet, smoking cessation, alcohol Exercise/sport/facilities Benefits survey Work-life balance Emotional Wellbeing Community activities, choir, baking, non-sporting clubs Internal service provision, staff support/occupational health Developing partnerships Flexible working, holiday clubs Retirement planning, health and wellbeing across the ages The final recommendation from Dr Boorman related to learning from good practices within the NHS and this has been picked up more broadly within the NHS by the publication in April 2014 of the NHS Employers report, Reducing Sickness Absence in the NHS Using Evidence- Based Strategies. This was initially developed through a Department of Health commissioned project to work with NHS trusts to implement evidence-based strategies in order to reduce sickness absence levels and improve staff health and wellbeing. 102 trusts participated in the project, including our trust and the culmination of this work in October 2013 has led to the 2014 report referred to above with its 5 high impact recommended interventions; Developing local evidence-based improvement plans Strong, visible leadership Improved management capacity Access to local, high quality, accredited occupational health services Encouragement and enablement of staff to take personal responsibility. These build very clearly on the work of Dr Boorman and are embodied in our own approach. The NHS Employers report provides specific examples of best practice in all areas and the Staff Health and Wellbeing Group is currently considering the report and how the recommendations contained in it can be included in the programme of this work for the coming year. 5. Conclusion and Recommendations Significant work has been done over time to manage sickness levels and to promote health and wellbeing, almost as distinct items. Both have been well managed, however a shift in approach is required in order that we progress to the next level. Demonstrating to staff that we can balance both important messages can only really be done in partnership with them and the importance of our staff side colleagues in promoting these messages cannot be underestimated. The Trust Board is asked to 1. Note the broadening approach to managing sickness within a positive framework of promoting health and wellbeing. 2. Agree to receive the co-authored Staff Health and Wellbeing strategy at a future Board meeting. Author and Presenting Director: Dave Smith, Director of HR and OD, July 2014 Reasons for Staff Sickness Page 4 of 8

6 GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST Trust Summary Appendix 1 GHNHSFT Sickness Absence by Reason 01 November 2013 to 30 April 2014 Abs (FTE) Avail (FTE) November 13 to April 14 % Abs Salary Based Cost % 45, ,172, % 3,271, ,825 S10 Anxiety/stress/depression/other psychiatric illnesses 6, % 452, % S11 Back Problems 2, % 153, % S12 Other musculoskeletal problems 3, % 204, % S13 Cold, Cough, Flu - Influenza 4, % 293, , % S14 Asthma % 8, % S15 Chest & respiratory problems 1, % 105, % S16 Headache / migraine % 43, % S17 Benign and malignant tumours, cancers 1, % 77, % S18 Blood disorders % 42, % S19 Heart, cardiac & circulatory problems % 45, % S20 Burns, poisoning, frostbite, hypothermia % % S21 Ear, nose, throat (ENT) 1, % 85, % S22 Dental and oral problems % 11, % S23 Eye problems % 26, % S24 Endocrine / glandular problems % 7, % S25 Gastrointestinal problems 3, % 216, , % S26 Genitourinary & gynaecological disorders 1, % 120, % S27 Infectious diseases % 12, % S28 Injury, fracture 2, % 180, % S29 Nervous system disorders % 16, % S30 Pregnancy related disorders 1, % 82, % S31 Skin disorders % 9, % S32 Substance abuse % % S98 Other known causes - not elsewhere classified 3, % 231, % S99 Unknown causes / Not specified 10, % 844, , % Reasons for Staff Sickness Page 5 of 8

7 By Division Appendix 2 Abs (FTE) Avail (FTE) November 13 to April 14 % Abs Rate (FTE) Salary Based Cost Trust 45, ,172, % 3,271, ,825 Corporate Division 3, , % 239, Diagnostics & Specialty Division % S10 Anxiety/stress/depression/other psychiatric illnesses % 34, % S13 Cold, Cough, Flu - Influenza % 28, % S25 Gastrointestinal problems % 17, % 9, , % 667, ,079 S10 Anxiety/stress/depression/other psychiatric illnesses 1, % 90, % S13 Cold, Cough, Flu - Influenza 1, % 71, % S98 Other known causes - not elsewhere classified % 61, % Estates & Facilities Division 4, , % 214, S12 Other musculoskeletal problems % 37, % S10 Anxiety/stress/depression/other psychiatric illnesses % 20, % S28 Injury, fracture % 18, % Medicine Division 7, , % 498, ,450 S10 Anxiety/stress/depression/other psychiatric illnesses 1, % 83, % S25 Gastrointestinal problems % 42, % S12 Other musculoskeletal problems % 39, % Surgery Division 13, , % 978, ,289 S10 Anxiety/stress/depression/other psychiatric illnesses 1, % 95, % S13 Cold, Cough, Flu - Influenza 1, % 93, % S98 Other known causes - not elsewhere classified 1, % 72, % Unscheduled Care Division 2, , % 223, S10 Anxiety/stress/depression/other psychiatric illnesses % 48, % S13 Cold, Cough, Flu - Influenza % 21, % S11 Back Problems % 15, % Womens & Children Division 4, , % 394, S10 Anxiety/stress/depression/other psychiatric illnesses % 71, % S13 Cold, Cough, Flu - Influenza % 30, % S98 Other known causes - not elsewhere classified % 25, % Reasons for Staff Sickness Page 6 of 8

8 By Staff Group Appendix 3 Add Prof Scientific and Technic Abs (FTE) Avail (FTE) % Abs Rate (FTE) Salary Based Cost 2, , % 167, % S17 Benign and malignant tumours, cancers % 26, % S13 Cold, Cough, Flu - Influenza % 16, % S98 Other known causes - not elsewhere classified % 11, % Additional Clinical Services 10, , % 485, ,171 S10 Anxiety/stress/depression/other psychiatric illnesses 1, % 64, % S25 Gastrointestinal problems 1, % 44, % S12 Other musculoskeletal problems % 45, % Administrative and Clerical 8, , % 483, ,709 S10 Anxiety/stress/depression/other psychiatric illnesses 1, % 76, % S13 Cold, Cough, Flu - Influenza % 47, % S98 Other known causes - not elsewhere classified % 35, % Allied Health Professionals 1, , % 120, S98 Other known causes - not elsewhere classified % 21, % S13 Cold, Cough, Flu - Influenza % 17, % S10 Anxiety/stress/depression/other psychiatric illnesses % 12, % Estates and Ancillary 3, , % 169, S12 Other musculoskeletal problems % 24, % S10 Anxiety/stress/depression/other psychiatric illnesses % 20, % S28 Injury, fracture % 19, % Healthcare Scientists 1, , % 97, S10 Anxiety/stress/depression/other psychiatric illnesses % 21, % S11 Back Problems % 15, % S13 Cold, Cough, Flu - Influenza % 14, % Medical and Dental 2, , % 396, Nursing and Midwifery Registered S10 Anxiety/stress/depression/other psychiatric illnesses % 54, % S18 Blood disorders % 35, % S98 Other known causes - not elsewhere classified % 22, % 16, , % 1,350, ,911 S10 Anxiety/stress/depression/other psychiatric illnesses 2, % 189, % S13 Cold, Cough, Flu - Influenza 1, % 139, % S25 Gastrointestinal problems 1, % 95, % Reasons for Staff Sickness Page 7 of 8

9 Staff Health & Wellbeing Terms of Reference Frequency: Monthly for 1 st 3 months Timing : then bi - monthly Chair: Iestyn Rees Appendix 4 Membership: Iestyn Rees, Dawn Cooper, Dave Smith, Mark McBride, Jane Hadlington, Leslie Morrison, Cathy Perkins, LNC + Jnr Doctor, nomination from Estates, rep from Divisional Engagement Group and Jane Evans PURPOSE: To improve and maintain the Health and Wellbeing of all our staff. OBJECTIVES: 1. Write and oversee a Health & Wellbeing Strategy for Staff 2. Define all of the enablers current and desired to improve health & wellbeing 3. Identifying blocks and barriers to improving staff health & wellbeing 4. Promoting a sense of mutual responsibility to improve and maintain health & wellbeing 5. Defining measurable outcomes for staff health & wellbeing 6. To develop internal and external partnerships which assist with health & wellbeing promotion 7. To develop communications which ensure staff are aware of all opportunities to improve health. Reports to: Trust Health & Wellbeing Committee Links to: JSCC, SWBG, Culture Group, Staff Benefits Committee Administration: HR Admin Team Reasons for Staff Sickness Page 8 of 8 Main Boar - July 2014