Review of the Management of Sickness Absence Conwy County Borough Council

Audit 2004/2005 Date: December 2005 Authors: Ros Adams and George Jones Ref: 1072A2005 Review of the Management of Sickness Absence Conwy County Borough Council

Contents Summary Report Introduction 3 Background 3 Main conclusions 4 The way forward 5 Next steps 5 Detailed Report Findings 6 Appendices Action Plan 14 Examples of potential good practice in the management of sickness absence 16 Status of this report This report has been prepared for the internal use of the named body. Our reports are prepared: In relation to audit, under the relevant enabling legislation and the responsibilities detailed in the Code of Audit and Inspection Practice, and in the context of the Statement of Responsibilities, issued by the Auditor General for Wales. In relation to inspection, following inspection work carried out under the Local Government Act 1999, as amended by the Public Audit (Wales) Act 2004, and in accordance with guidance issued by the National Assembly for Wales. Reports are prepared by the staff of the Wales Audit Office and appointed auditors, and addressed to members or officers including those designated as accounting or accountable officers. They are prepared for the sole use of the named body, and no responsibility is taken by the Wales Audit Office or appointed auditors to any director/member or officer in their individual capacity, or to any third party. Page 2 of 18

Summary Report Introduction 1 Sickness absence clearly carries a measurable cost and is also directly related to the continuity of service delivery. The Welsh Assembly Government (the Assembly) in its strategic consultation document, Making the Connections: delivering better services for Wales (October 2004) recognises the importance of tackling sickness absence across the public sector in Wales. It points out that the potential benefits for reducing sickness absence and workplace stress are substantial. 2 In 2003, the Council undertook a risk assessment as part of the Wales Programme for Improvement (WPI).This identified significant risks in Human Resources (HR) management within the Council including the management of sickness absence. 3 These risks were reviewed by the Wales Audit Office and a report produced in April 2005 which recommended a number of actions to improve HR management including sickness absence. 4 This report sets out the findings of our review of the current corporate arrangements for the management of sickness absence and includes an evaluation of: the level of effectiveness of these arrangements; how sickness absence arrangements are implemented across directorates; and how sickness management data is collected, utilised and reported. Background 5 As part of its strategic and corporate role, the HR service or the Corporate Personnel Service (CPS) is responsible for co-ordinating and driving forward improvements to the management of sickness absence. The CPS forms part of the Performance Directorate and includes 13 staff including the head of service. 6 The majority of CPS staff are responsible for providing personnel support directly to services through a nominated link officer system. The remaining staff within CPS are responsible for corporate training and development, equalities and workforce development. 7 Sickness absence work is also included within the job description of one member of staff within Education Personnel. The duties take up approximately 30% of the individual s time and is part of the Service Level Agreements (SLAs) with schools. Page 3 of 18

Summary Report Main conclusions 8 There is a sickness absence policy in place which is thorough and clear in its guidelines. It includes information on the responsibility and role of each partner and the necessary procedures for implementing the policy. It is anticipated that this policy will be reviewed by the end of this business plan year. Identifying a realistic date for this to take place would provide more corporate focus on this action which should also include reviewing the policy s effectiveness. 9 Formal training of managers on the policy by an external consultant is ongoing and valuable follow-up sessions by the CPS takes place when necessary. But not all the names of participants on the training course have been recorded corporately and therefore the scale of the training is unknown. As a result there are potentially some managers who have not been trained on the policy. 10 In order to inform employees of the content of the policy, communication methods such as induction and team briefs are used. But these could be more extensive to reach a wider range of employees and to improve the accessibility of information to all employees. 11 There are links between the policy and other policies such as redeployment and rehabilitation. Also supportive measures such as occupational health and a counselling service are used by operational managers and the CPS to support the return to work of employees. These, together with the relevant health policies, provide managers with the necessary tools to manage long-term sickness more effectively. But not all employees are aware of these measures and activities to improve health which can affect the participation levels in such programmes. 12 The policy is seen as a valuable tool by managers and is generally implemented. But the scope and thoroughness of the implementation is unknown although there is evidently a concentrated thoroughness on implementing the policy within the services which have high sickness absence rates. 13 However, it is also evident that there are areas within the policy s implementation which need to be tightened up such as ensuring that return to work interviews and referrals to occupational health are carried out. 14 A lot of work has been put into establishing a manual system to collate data sickness absence information from services and produce corporate reports. This system works well and the reports are used by the Corporate Management Team (CMT) and scrutiny to monitor absence rates within services. This is a significant step forward in the management of sickness absence. It will provide the required information to report on the Assembly Performance Indicator (PI) on the number of days lost to sickness absence. 15 Apart from the corporate reports, the level of reporting and monitoring within services varies. A lot of work has gone into establishing and using monitoring data by some teams. These teams are mainly those with high absence rates, but other teams are not as rigorous. This is an area which should be addressed together with identifying directorate, service and team targets in order to support the achievement of the corporate target. Page 4 of 18

Summary Report 16 The Council recognises that the scope and type of management information needs to be improved. It sees the implementation of the new HR, payroll IT system as the main action which will bring about change. This development has the potential to bring about a major improvement to the management of sickness absence as it will allow easier access to data for a wider range of staff. But as part of the project plan for the system a number of areas need to be considered to ensure its full potential is achieved. The way forward 17 In summary, the Council has focused on: establishing a corporate system to record and report sickness absence; training managers in implementing procedures; and extending supportive measures to facilitate employees return to work. 18 Although there are necessary improvements that need to be made to these aspects, they are actions, together with the introduction of the new HR, payroll IT system, which have the potential to bring about considerable improvements to the management of sickness absence. But thorough procedures which managers are aware of, supportive health facilities and regular accurate data will not bring about significant change on their own. The scale of improvement depends on how successful the Council is in tackling key issues which are more difficult and complex to address. These are: the extent to which all operational managers carry out their role in the management of sickness absence in line with the policy; a well balanced approach between providing the relevant support to employees when absent through ill health and close monitoring of sickness absence rates to reduce the overall cost of sickness absence; and regular monitoring of the use of the Trent system to ensure a standard approach across the Council. Next steps 19 For the Council to consider the findings which are detailed below and to complete the action plan within Appendix one. The plan should be returned to George Jones by 13 January 2005. 20 As part of the regulatory plan Wales Audit Office will follow up the actions highlighted within this report. Page 5 of 18

Detailed Report Section 1 Findings Policy and procedures 21 The Council has a policy document which was produced in 2002 by the CPS and approved by the CMT. It outlines the Council s approach to the management of sickness which can be summarised as: aiming to control absence by adopting a positive approach through monitoring and counselling of employees and ensuring that all employees are treated fairly and consistently. 22 Although this document is titled A Sickness Absence Policy it also includes the corporate procedures in order to implement the policy. These procedures include: managing long and short-term sickness; identifying responsibilities for employees, line managers and directors; phased re-introduction to work and redeployment; the support of the occupational health service and ill health retirements; and the appeals procedure. 23 The document, therefore, includes all the aspects we would expect to find in a combined policy and procedure document. It is very thorough in its provision of advice and support and clear in its procedures. In particular, it provides an effective tool in outlining the role of each partner involved in the process. 24 It is used for all employees except for school based staff for whom the school governing body set the local terms and conditions of employment. To support the governing bodies identify and implement these conditions, the Council is in the process of developing a schools sickness absence policy. It is anticipated that this will contain the principles within the corporate policy but also provide each school with the opportunity to amend the procedures to accommodate governing body responsibilities. 25 This can potentially become a long process, particularly with each school deciding on the content of their own procedure. However, this is not seen as a major concern as previously schools have agreed broadly with the contents of the corporate document. 26 Reviewing the policy is a key aspect that the Council needs to consider on a planned and regular basis. It is anticipated that the document will be amended by the end of this service plan year but there is no identified date for this to take place. It is planned that the review of the policy will be based on receiving informal feedback from users as well as formal feedback from consultation. As well as the content of the policy we would suggest a review of its effectiveness to ensure it meets the corporate needs of the Council. Page 6 of 18

Detailed Report Recommendation R1 Identify a date for the formal review of the sickness absence management policy and its effectiveness. Communication of the policy and procedures 27 Formal training on the policy has been delivered to approximately 174 managers through the use of an external training provider. This corporate session is repeated throughout the year and is clearly outlined in the corporate training plan which services can book through corporate training. 28 However, not all the names are recorded of those officers who have participated in both formal and informal training. That is, the Council does not know which managers have been trained and those who still need to be trained. This is an action that needs to be addressed promptly so that all managers implement the procedure according to corporate guidelines and to identify the services that would benefit from follow-up sessions. 29 As well as this generic programme, training can also include a more informal workshop session on potential implementation difficulties that some operational managers might encounter within their own service. This follow-up session is delivered by the CPS staff and feedback from managers on the usefulness of this training has been positive. 30 Support from the CPS ranges from policy clarification and training, advice on the type of data to be collected, close monitoring of service data and supporting managers in dealing with individual cases. Although the type of support varies, depending on the needs of teams and the amount of available CPS staffing resources, this support is one of the key factors in enabling the Council to implement the sickness absence procedures. 31 For all new employees, the induction programme is used to inform them of the sickness absence policy and their responsibility. Some services extend this information by providing a copy of the policy to each new starter to minimise any misinterpretation of the policy. However, this practice is not consistent across all teams. 32 For existing employees the policy is accessible from the CPS or from the intranet. For those employees who do not have access to the intranet, hard copies are usually kept within each department or team. But there is a question over how accessible these copies are to all employees in that team depending on where they are kept. 33 Equally important is the question over whether or not the most up-to-date version is stored and used in each team as we found that some of the services were not using the most up-to-date version. 34 These two aspects are ones that should be discussed between the teams and the CPS as part of the role of the linked personnel officer. Page 7 of 18

Detailed Report 35 In addition to the methods mentioned above for communicating the policy, team briefs are also utilised to discuss sickness absence and, in some services, sickness absence rates to highlight areas of concern. The latter is good practice and one that can be extended when the new HR, Payroll IT system is fully implemented. More information on the new HR, Payroll system is outlined in the section management information. 36 One area that could improve employees understanding of their role is to produce and disseminate an employees sickness absence information leaflet. This could contain information on: what to do when absent from work; the role of occupational health; the availability of counselling; the well-being activities which are discussed in more depth in the next section; and employee obligations under the Health and Safety at Work Act. 37 A further method of informing employees of sickness absence matters is the production of a quarterly personnel information leaflet. This could be utilised to disseminate information and request for feedback on a number of issues. In particular, it could be used to support CPS in its role within organisational development which is a relatively new focus for the service. This recommendation is an area that CPS is currently considering. Recommendations R2 Complete an audit of managers who have been trained on the use of the policy to identify: those managers who need to participate on the corporate course; and R3 R4 R5 the services which would benefit from follow up workshop session. Ensure all employees receive a copy of the policy during the induction programme. Produce an employees sickness absence leaflet and distribute to all employees. Produce quarterly personnel information leaflets to inform employees of sickness absence matters as well as other HR developments. Links with other policies and strategies 38 The Council recognises that a key element of effective sickness management is ensuring that there are mechanisms in place to support the return to work of employees. Supportive measures that have been introduced include: a phased entry to employment after ill health; a redeployment facility when appropriate vacancies are available; a contracted Occupational Health Service with the local NHS Trust; and the use of an independent counselling service. Page 8 of 18

Detailed Report 39 These supportive measures for employees are also backed up by relevant policies such as the special leave and stress policies. In particular, stress within the workforce has been a focus for a number of activities as part of the supportive measures. These activities include: A stress audit amongst employees.the results from this audit demonstrate that the Council meets or exceeds all but one of the HSE standards. The one standard that the Council is not meeting is in the area of work demands with 76% of staff reporting that they find the pressure of work demands unacceptable. These findings are extremely useful in identifying the background issues to stress related absence and should be utilised with individual services to reduce the risk of employees suffering from work related stress. The challenge to the Council is the extent to which they address such issues. Although the need to produce a stress action plan, following these findings, has been identified by the CPS within its strategic action plan, we would see this as a priority activity to build on the momentum of the audit which raised the profile of stress in the work place. Introduction of a stress risk panel comprising of representatives from the CPS, the specific service and trade unions. This is seen as a safety valve to ensure all supportive measures have been utilised to their full extent. It is a fairly new and innovative development and one which hasn t been fully tried and tested. Availability of corporate training for managers on recognising stress. 40 There is also a corporate health action plan which we consider to be an important document in demonstrating the Council s commitment to improving employees health. It contains: Implementation of the Wales manual handling passport scheme through the support of a back care specialist. A pilot Employee Well Programme costing 12,000.This is an individual, confidential health assessment through the completion of a questionnaire and includes suggested actions to improve an employee s health. Health promotion activities such as partnership working with the Smoking Cessation Service and men s health day. Reduced rates for employees at local gyms and health clubs. A flu vaccination programme for all employees. 41 One of the main overall objectives of this plan is the Council s aim to achieve the gold standard of the Assembly s corporate health award. The Council has already achieved the bronze standard and will be reassessed in November 2005. Therefore, this impetus to achieve the gold standard provides an additional purpose to ensure the actions are implemented effectively. 42 From some operational managers point of view the information from the occupational health and medical services that can be provided is vague and isn t specific enough to progress an individual s case. Similarly, there are concerns over the length of time it takes to get reports from medical practitioners. Page 9 of 18

Detailed Report 43 Given the nature of some of the direct services to be delivered such as the environmental and technical service it is understandable that managers want to receive medical decisions as soon as possible. But apart from the Council getting involved in paying for medical treatment for employees, which we would not propose given the potential cost, it is going to be difficult to reduce the amount of waiting time. 44 Although the Council has implemented the above measures to support the return to work of employees as soon as possible, there is an improvement action which needs to be considered revolving around communication. That is, how the Council informs all employees of these measures, particularly those not working in the main administrative centres. As a large organisation, this is always going to be a difficult task. But to ensure the Council is fair and equal in its treatment of all employees, new mechanisms such as the personnel leaflet suggested previously and existing mechanisms such as the use of notice boards and payslips should be used on a continual basis. Recommendations R6 Produce a corporate action plan following the results of the stress audit and utilise this plan with individual services on a continuous basis. R7 Use new and existing communication methods to inform employees of the supportive measures in place for their return to work. Implementation of the policy and procedures 45 As a result of the Council s focus on reducing sickness absence rates, managers are following through that corporate objective by generally implementing the policy, although the scale and rigour of implementation is not known. There is evidently a concentrated thoroughness on implementing the policy within the services which have high sickness absence rates. Such services have also clear recording and monitoring systems in place. These are discussed in more depth in the next section. 46 However, it is also evident that there are areas within the policy s implementation which need to be tightened up. The main ones include: More consistency in the content and frequency of letters to employees whilst absent through illness. Effective referral to occupational health as specified in the policy, usually after a four week period of illness. Some managers are delaying this referral to give more time to employees to return to work. Such delays are provided for within this policy if the reason for the absence is clearly established and a finite period is needed for recovery. However, in some cases it is not clear whether the delays are because of this or for some other reason. Standardisation in the contents and use of the corporate self certification form. Better use of the probationary period to address sickness absence concerns. Standardisation in the use of the corporate return to work forms. Page 10 of 18

Detailed Report 47 An organisation s approach to managing sickness absence is a balance between providing the relevant support to employees when absent through ill health and close monitoring of sickness absence rates to reduce the overall cost of sickness absence. Although all managers would agree with the need for this balance, there is a perception that some managers put a lot of emphasis on the reduction of costs to the detriment of the support to individual employees. 48 Two activities that have the potential to start to influence this balance are: the management development pilots which have already began, initially involving 28 managers; and progress towards the Council s aim of achieving corporate IIP accreditation planned for February 2008. 49 We accept that this is a perception and have no tangible evidence to demonstrate this viewpoint, but it should be borne in mind by senior managers and the CPS when addressing improvements to the management of sickness absence. Recommendation R8 Identify and address inconsistent practices across services including return to work and self certification forms and letters to employees. Page 11 of 18 Management information 50 An important part of the management of sickness absence is the collation and use of accurate and up-to-date sickness absence information. Reliable information needs to be produced quickly and regularly which allows managers to analyse the date to take appropriate action. 51 The review of HR management report of April 2005 highlighted that, at the time of the review the Council had no formal corporate mechanism for recording sickness absence. 52 The situation has now changed as a result of additional staffing resources and a clear focus on addressing this need. Corporate reports are now produced by the CPS who record data monthly and report on a quarterly basis. 53 At present these reports are produced from service baseline data through the completion of a monthly form to the CPS. This form is in addition to the monthly sickness return form to be completed for payroll purposes. But managers appreciate that it is the only effective way of collecting the data at present and therefore, despite some initial difficulties when this system was introduced, the system now works well. 54 These reports contain statistics on absence figures for all directorates and a percentage figure for long-term sickness. But we would also expect such reports to contain some corporate information on the causes of absences, particularly for discussion at CMT meetings. If this information was available, the Council would be in a better position to prioritise expenditure to address the specific causes. 55 At present the causes of sickness can be retrieved from the payroll system but this facility has not been used widely and generally managers were not aware of it. Though if this facility was utilised, there is also the question over the accuracy of the data. However, the Council is introducing a new HR, payroll IT based payroll and personnel system (Trent) which is intended to be fully operational from April 2006. It therefore makes sense to maintain the current arrangements until that time.

Detailed Report 56 Although corporate reporting is now in place, it is not standard practice for reporting to schools. Where school reports are compiled, they are usually as a result of a request from the head teacher. These reports contain the causes of absence but the vast majority of these causes show unknown. This is a result of schools not providing the most up-to-date information to personnel on the causes of absence. 57 This is an area that needs to improve within the development of the Trent system, particularly as the current payroll system and data will be used together with the new system during the piloting of the new arrangements. We would suggest that this is incorporated into the project plan for the new system with the data cleansing exercise. Since our work on site, we are informed that new procedures have now been agreed for collecting information from schools, which will come into effect in January 2006. 58 Outside of the corporate reports, the level of reporting and monitoring within services varies. A lot of work has gone into establishing and using monitoring data by some teams, in the main, the teams with high absence rates. In these teams, data is collated using monthly returns into management reports and used to implement actions within the team through analysing this data. 59 The content of these reports varies. But in addition to the main data, they can contain information on the types of illnesses and the age profile of employees. This is good practice but not standard, even across these proactive teams. It is however, one that should be taken into consideration when establishing a corporate approach to the production of team reports through the Trent system. 60 In all the services we spoke to, it was evident that where rigorous monitoring and reporting takes place, it is linked to the availability of specific administrative support within the team to carry out these tasks or dedicated CPS support. Without the introduction of the Trent system, the availability of staffing resources to carry out these tasks would be a serious consideration. However, within the Trent system, it is anticipated that sickness absence data for managers will be easily accessible and reports generated promptly. If this aim is fully achieved it minimises the need to consider a review of available resources. 61 Within some of these proactive services, managers send out letters to inform employees of sickness absence developments or related matters. These include: Informing employees who are approaching or reached various stages within the policy such as sickness absence triggers and cautions. Information sent by head of services to employees on a regular basis highlighting areas of concern. Letters from heads of service to individual employees congratulating them on their exemplary sickness absence record. This approach is also used corporately through Chief Executive s correspondence to services who are better performers in terms of sickness absence rates. 62 These measures are valuable ways of regularly communicating with employees to support individuals and to monitor absences. But these practices need to be standardised across the Council and the relevant letters available within the policy which will need to be amended as a result of the new HR, payroll IT system. 63 In terms of monitoring arrangements, corporate reports are taken to CMT and scrutiny committee meetings.there is evidence, such as the reply to scrutiny after querying a service s absence rate, of an active monitoring of these reports by both scrutiny and CMT. Page 12 of 18

Detailed Report 64 There is an annual corporate sickness absence target of 10.3 working days per Full-Time Equivalent (FTE) lost due to sickness. In 2004/2005, 11 working days per FTE was recorded. This was based on a figure for part of the year rather a full year. For 2005/2006,at the six monthly stage the figure is 9.6 days (all Wales average for 2004/2005 is 11.93 days). 65 Although this figure is encouraging, the Council needs to be confident that this is accurate. In April 2005 the categories of employees to be included within the National Assembly s performance indicator was changed to include temporary employees. The guidance issued by HR was subsequently amended to reflect this change with effect from April 2005. 66 However, at the time of the audit, the monthly absence form had not been updated to reflect the change. Also managers interviewed weren t fully aware of this change in definition. 67 Despite the corporate target, there are no absence rate targets, to be achieved on an annual basis, for each directorate, service or team. There has been some movement in this direction through the CPS asking Directors and Heads of Services if they intend setting targets. Identifying such targets can further emphasis each team s responsibility to decrease their own rate and support the achievement of the corporate target. Therefore, we would suggest that this initial action is further developed. Recommendations R9 Within the development of the new HR and payroll IT system, ensure the following areas are taken into consideration: R10 causes of sickness within departments and services; as part of the training programme for staff on the use of the system particular emphasis on schools to input the necessary information; existing practices within some services to agree and implement corporate arrangements for reporting and monitoring; standardise the use of letters to employees to inform them of sickness absence developments; and amend the sickness absence policy in light of the introduction of the new HR, payroll IT system. Disseminate up to date information to managers of which employees to include in the monthly form. R11 Introduce directorate, service or team targets through consultation with operational managers. Page 13 of 18

Appendices Appendix 1 Action Plan Page Recommendation Priority 1 = Low 2 = Med 3 = High 7 R1 Identify a date for the formal review of the sickness absence management policy and its effectiveness. 8 R2 Complete an audit of managers who have been trained on the use of the policy to identify: those managers who need to participate on the corporate course; and the services which would benefit from follow up workshop sessions. 8 R3 Ensure all employees receive a copy of the policy during the induction programme. 8 R4 Produce an employees sickness absence leaflet and distribute to all employees. 8 R5 Identify and address inconsistent practices across directorates including welfare visits, return to work interviews and letters to employees. 10 R6 Produce a corporate action plan following the results of the stress audit and utilise this plan with individual services on a continuous basis. 10 R7 Use new and existing communication methods to inform employees of the supportive measures in place for their return to work. Responsibility Agreed Comments Date Page 14 of 18

Appendices Page Recommendation Priority 1 = Low 2 = Med 3 = High 11 R8 Identify and address inconsistent practices across services including return to work and self certification forms and letters to employees. 13 R9 Within the development of the new HR, payroll IT system ensure the following areas are taken into consideration: causes of sickness within departments and services; as part of the training programme for staff on the use of the system particular emphasis on schools to input the necessary information; existing practices within some services to agree and implement corporate arrangements for reporting and monitoring; standardise the use of letters to employees to inform them of sickness absence developments; and amend the sickness absence policy in light of the introduction of the new HR, payroll IT system. 13 R10 Disseminate up to date information to managers of which employees to include in the monthly form. 13 R11 Introduce directorate, service or team targets through consultation with operational managers. Responsibility Agreed Comments Date Page 15 of 18

Appendices Appendix 2 Examples of potential good practice in the management of sickness absence Management information clear systems for the recording of sickness absence; systems to verify the accuracy of sickness recording; identification of underlying trends in sickness absence; corporate targets for the level of sickness absence, communicated to all staff; regular monitoring of sickness absence trends at the local and corporate levels; and benchmarking with other organisations. Management procedures clear documented policies and procedures that are regularly reviewed; appropriate training for all management grades; clear and regular explanation of policies and procedures to all staff, particularly new staff; policies for the rehabilitation or redeployment of sick staff back into the workplace; return to work interviews for all absence; trigger points for the review of frequent or long-term absence; frequent and regular contact with sick staff; and systems to ensure the consistent application of sickness absence procedures. Prevention of absence general health promotion campaigns; recruitment and screening procedures; family friendly initiatives and flexible working arrangements; improving the physical working environment; workplace health and safety risk assessments; protection from violence and aggression; physiotherapy services, counselling services or other staff clinics; encouraging staff to look after their health, for example by providing discounted gym/sports facilities; and manual handling training. Source: National Audit Office Wales literature review Page 16 of 18

Wales Audit Office 2-4 Park Grove Cardiff CF10 3PA Tel: 029 2026 0260 Fax: 029 2026 0026 Textphone: 029 2026 2646 E-mail: info@wao.gov.uk Website: www.wao.gov.uk