CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Agenda Item 9.1 Report of: Executive Director of Human & Corporate Resources Margot Johnson Paper prepared by: Head of Operational HR - Gill Porter Date of paper: 19 th December 2014 Subject: Workforce Performance Indicate which by Information to note Purpose of Report: Support Resolution Approval Consideration of Risk against Key Priorities: (Impact of report on key priorities and risks to give assurance to the Board that its decisions are effectively delivering the Trust s strategy in a risk aware manner) Reducing sickness absence is essential to maintaining safe staffing and reducing the associated cost of staff absence which will help the Trust achieve financial stability. Recommendations: To note the actions already taken and planned to reduce sickness absence Contact: Name: Gill Porter, Head of Operational HR Tel: 0161 901 7135 P a g e 1

1. Introduction 1.1 This paper provides an update on a number of workforce indicators, with a primary focus on Trust sickness absence levels, including underlying causes and the actions planned to secure improvement during Q4. 1.2 The management of sickness absence should be part of an all-round healthy working relationship between managers and employees. If employee sickness is supported and managed appropriately sickness absence should be minimised, agency spend reduced and retention and general performance of the department improved. 1.3 The information contained in this paper compares the sickness absence rates of the Trust against national and regional comparators; it also identifies the actions in place to achieve reduced sickness absence, including plans to improve performance in other workforce indicators most likely to impact adversely on staff attendance. 1.4 In addition to the recovery plans for the Trust the revised sickness absence trajectories by Division are detailed to provide an update on the ongoing work to reduce sickness absence Trust-wide. 2. Performance and Underlying Causes 2.1 Sickness Absence 2.1.1 The Trust s current level of sickness absence is 5.6% (November 2014) which is an increase of 0.92% on the August figure of 4.68% reported at the September Board and 0.4% higher than in November 2013. The Trust has seen sickness absence continuing to increase to a current level of 5.6% which is equal to the Trusts highest reported figure in January 2014. Sickness Absence Rates December 2013 November 2014 2013 % 2014 % 2014 % December 5.3 April 4.8 August 4.68 January 5.6 May 4.7 September 5.0 February 5.1 June 5.0 October 5.4 March 4.9 July 5.2 November 5.6 * The sickness absence percentage rate is calculated by dividing the FTE (Full Time Equivalent) Days lost by the FTE Days available. P a g e 2

2.2 Benchmarking 2.2.1 National The Trust has reviewed national performance including a publication from NHS Employers which shows sickness absence rates by Health Education England (HEE) region for January to March 2014. The North West HEE region had the highest aggregated sickness absence rate (4.87%) followed by North East HEE region (4.77%) and Yorkshire and the Humber HEE region (4.60%). North Central and East London HEE region had the lowest rate (3.43%) followed by North West London (3.55%), although Special Health Authorities and other Statutory bodies would have had the second lowest rate (3.49%) if classed as an area. When considering the data contained in this report the North West HEE region is the only HEE region that has seen a rise in their sickness absence rate based on the same period in 2013. 2.2.2 North - South Divide In a recent publication from the Health and Social Care Information Centre (HSCIC) i there is further evidence of a North - South divide when comparing sickness absence rates. Research ii suggests that this is due to systematic regional variations in employee s characteristics, the strongest influence being the difference in pay. 2.2.3 Regional A review of North West sickness absence data has been taken from the E-Win Portal and used to benchmark Trust sickness rates across the North West Region during the January 2012 September 2014 period (Table 1 below). Table 1 - North West Sickness Absence Comparison Data 2012-2014 North West Group Comparisons Q1-2012 Q2-2012 Q3-2012 Q4-2012 Q1-2013 Q2-2013 Q3-2013 Q4-2013 Q1-2014 Q2-2014 Q3-2014 Q4-2014 North West Region - Acute Average 4.1% 4.3% 4.6% 4.7% 4.0% 4.1% 4.4% 4.4% 4.2% 4.4% No Data Available Highest Sickness Absence Rate 4.9% 4.9% 5.9% 7.1% 4.9% 5.0% 5.2% 5.9% 5.40% 5.40% No Data Available Lowest Sickness Absence Rate 3.1% 3.3% 3.6% 3.5% 2.7% 2.6% 3.3% 3.2% 3.1% 3.4% No Data Available CMFT - Sickness Absence Rate 4.7% 4.3% 4.9% 4.6% 4.2% 4.5% 5.2% 5.2% 4.8% 5.0% No Data Available P a g e 3

2.2.4 Specialist Hospitals In comparison to other Specialist Hospitals within the Northwest (see Table 2), the Trust has neither the highest nor lowest sickness absence rates. It is also clear that the majority of the Trusts are seeing an increase in their sickness absence rates in comparison to 2013. Table 2 also highlights a general increase in sickness absence across most of the Trusts from Q1 to Q4 each year. Table 2 - Specialist Hospital Sickness Absence Comparison Average Sickness Absence Data taken from the E-win Portal Highest Rate Lowest Rate Specialist Hospitals Sickness Absence Q1-2012 Q2-2012 Q3-2012 Q4-2012 Q1-2013 Q2-2013 Q3-2013 Q4-2013 Q1-2014 Q2-2014 Q3-2014 Q4-2014 Hospital A 4.6% 4.5% 5.9% 6.6% 4.7% 5.0% 5.0% 5.9% 5.4% 5.4% TBC TBC Hospital B 4.3% 4.0% 4.1% 4.2% 3.6% 3.8% 4.3% 4.4% 4.1% 4.3% TBC TBC Hospital C 4.0% 3.7% 4.1% 4.1% 3.6% 3.2% 3.7% 3.7% 3.2% 3.4% TBC TBC Hospital D 4.7% 4.8% 5.1% 5.0% 4.5% 4.7% 4.8% 4.8% 4.4% 4.6% TBC TBC Hospital E 3.7% 3.9% 4.2% 4.1% 3.7% 3.7% 4.2% 4.3% 4.1% 4.1% TBC TBC Hospital F 4.8% 4.6% 4.7% 4.8% 4.5% 4.9% 5.2% 5.5% 4.9% 4.7% TBC TBC Hospital G 4.6% 4.4% 4.5% 4.4% 4.2% 4.1% 4.3% 4.6% 4.5% 4.7% TBC TBC Hospital H 4.2% 4.3% 4.9% 4.7% 4.2% 4.1% 4.5% 4.4% 4.0% 4.4% TBC TBC Hospital I 3.4% 3.7% 4.1% 4.2% 3.7% 3.6% 4.0% 4.2% 4.0% 4.2% TBC TBC Hospital J 4.1% 4.0% 4.4% 4.2% 3.7% 3.9% 4.2% 4.3% 4.0% 4.6% TBC TBC CMFT 4.7% 4.3% 4.9% 4.6% 4.2% 4.5% 5.2% 5.2% 4.8% 5.0% 2.2.5 Trusts with Community Services The HSCIC iii publication and a report produced by NHS Employers Reducing Sickness Absence in the NHS using Evidence-based strategies April 2014 also suggests that Trusts who have recently acquired Community Services may have higher sickness absence rates. However, on analysing the figures for CMFT it is evident that removing Community Services from the CMFT figures for comparison purposes has a minor impact on the overall sickness absence figure, resulting in on average a 0.1% reduction overall. 2.2.6 The Shelford Group The next table (Table 3) provides an outline of sickness absence rates across the Shelford Group for the period May to October 2014. The Shelford Trusts absence rates indicate that the Trust has a high absence rate compared to the other members. It is acknowledged that they are a diverse group of Trusts which differ in size, location and speciality and therefore are difficult to compare, however, table 3 indicates that the majority of the Trusts are seeing an increase in sickness absence rates during Q1/2. The figures in table 3 support the research outlined in section 2.2. as those Shelford Trusts in the north of England (highlighted in yellow) do have higher rates of sickness than their southern counterparts and are collectively seeing an increase in their sickness rates. P a g e 4

Table 3 - Shelford Group Sickness Absence Rate - Reporting Period May - Oct 2014 Trust Sickness Absence Rate (data taken from HSCIC for those Trust awaiting a response) Staff Numbers Community Included Y/N May June July August Sept Oct University Hospital Birmingham 3.3% 3.4% 3.7% 8,500 Cambridge University Hospital 2.7% 2.9% 3.0% TBC 8,000 Sheffield Teaching Hospital 3.8% 3.9% 4.1% 13,500 Yes Guys & St Thomas' 3.3% 3.2% 3.2% 3.0% 3.3% 3.4% 13,000 Yes University College London Hospitals 3.0% 3.0% 3.2% TBC 8,000 Oxford University Hospitals 3.2% 3.8% 3.7% 3.5% 3.8% 3.9% 7,000 No Kings College 2.9% 3.0% 3.2% 2.9% 3.4% 3.7% 6,100 No Newcastle-upon-Tyne 3.9% 3.9% 3.9% 3.8% 3.8% 3.8% 13,500 Yes Imperial College London 3.3% 3.5% 3.2% 3.2% 3.4% 3.7% 10,000 Yes CMFT 4.7% 5.0% 5.2% 4.9% 5.0% 5.4% 12,400 Yes (October 2014 figures have been requested from the Trusts and information received so far suggest a rise in sickness absence e.g. Kings College 3.7%, Imperial College 3.7% and Oxford University 3.9%) Trend 2.3 Underlying Cause for Deterioration in Performance 2.3.1 The sickness absence per Division for November is detailed in table 4. The Divisions with a high sickness absence on a consistent basis are those which experience the greatest impact of urgent care pressures. The figures for November show that 4 of the 5 Divisions with absence rates of 6% or above have high turnover and all 5 have at least one active change management process. Table 54 - Excludes Doctors Doctors in Training Training Sickness / Turnover / Managing Change / Time to Fill (November 2014) Division Sickness Turnover Managing Change Process - current (in progress) Time to Fill (Days) Trafford 6.1% 17.3% Currently 8 major changes (+3 or 4 anticipated) 84.4 Medicine & Community 6.1% 15.2% 2 major changes (+2 major changes anticipated) 77.5 Specialist Medicine 6.2% 15.0% 2 (+/3 anticipated) 77.3 Surgery 6.0% 12.5% 1 (+1 anticipated) 67.3 St Mary's 5.9% 12.6% 0 80.5 Corporate Services 5.4% 12.9% 1 68.1 Children's 5.5% 13.6% (+1 anticipated) 78.4 CSS 4.3% 15.4% 1 69.8 Royal Eye Hospital 6.1% 14.9% 1 73.6 Dental 4.1% 11.7% 0 70.8 R & I 4.8% 18.5% (+1 anticipated) 70.5 2.4 Emerging Themes The HR teams have undertaken an analysis of reasons for staff taking time off sick in order to identify where to focus their interventions. A number of common themes have emerged highlighting the reasons for absence: a. Stress related illnesses stress audits are undertaken with outcomes and actions monitored by the Strategic Health & Safety Committee. b. Pregnancy related illness to be expected in a predominantly female workforce c. Staff are reporting a degree of change fatigue and uncertainty regarding future employment. Current research indicates that such issues can cause staff to take more time off work. d. Capacity/capability of managers to appropriately manage sickness including the completion of return to work discussions. P a g e 5

3. Progress on Actions There has been an increased focus on the management of sickness absence across five key high impact changes: High impact change 1 Development of local evidence based improvement plans Divisions with support from their HR Business Partner have developed detailed sickness absence action plans with assigned responsibilities. HR balanced scorecards are produced monthly for the hotspot areas to enable a quick high level review of performance across a range of HR indicators including sickness absence. The dashboard monitors the impact of the interventions and their overall performance which includes a triangulation of time to fill and turnover data. (An example is attached). Improvements to exit questionnaires to identify intelligence and common themes for individuals leaving the Trust. This has resulted in an increased take up from 7% to 24% with data now being analysed and fed into action plans. Managers in each department/ward area identify who is off sick and agree an action plan for each individual to ensure they are being appropriately managed in line with the relevant procedure. High impact change 2 Strong, visible leadership The four Divisions, with the most significant financial and performance challenges: Medicine and Community; Surgery; Children s Hospital and Trafford Hospital are working with their Executive Director lead on their absence action plans Regular meetings take place with senior nursing leads to review areas of high turnover and identify reasons for leaving. High impact change 3 Improved management capacity The 20 worst performing areas have been identified and the managers from these areas met with the Director of Nursing (Adults) and representatives of the HR team to identify ways of improving the management of sickness absence. This group continues to meet regularly to provide the managers with the support they need. This forum allows for sharing learning where/when improvements have been made. Development and communication of the HR micro site which is populated with policies, template letters, guidance notes and tools to support managers dealing with sickness management. A new dedicated sickness absence telephone line has been introduced and is operated by a member of the HR team 9-5pm Monday to Friday to provide immediate advice to managers. Additional sickness absence training has been arranged to provide at least two sessions per month between September 2014 and June 2015. In addition, the HR teams have been undertaking more localised focussed sickness training to concentrate on key elements such as Return to Work meetings. P a g e 6

High impact change 4 Access to local, high quality accredited occupational health services The Trust s Health and Well-being Strategy provides a framework for integrating health and well-being activities across the Trust bringing existing staff well-being issues to the forefront whilst seeking to create an organisation culture where negative well-being issues are identified, minimised and managed The Staff Support service has seen a reduction in waiting times due to waiting list management and skill mix adjustment within the team. Creation of a nurse led triage model to reduce waiting times, manage the appointments and speed up the occupational health review process. High impact change 5 Encouragement and enablement of staff to take personal responsibility Specific analysis of each individual member of staff taking time off sick; working with ward/directorate managers to agree arrangements for managing that individual. One Division is highlighting on their ward boards the planned staffing, the number of shifts lost to sickness absence; residual staffing levels in order to demonstrate to staff the impact of their sickness on other staff and patients. A focus on return to work meetings with members of staff. Work often means more than just a salary for many employees in the NHS. Return to work meetings identify employees whose return may be delayed or prevented unless the manager intervenes; It helps employees whose frequent absences may disguise other problems, e.g. domestic issues, work-related causes, or the onset of disability. 4. Recruitment and Retention Recruitment activity can affect sickness absence where a lengthy vacancy period impacts negatively on staff working alongside a vacant post. The average time to fill across the Trust currently stands at 75.04 days. Within this overall figure there are variable rates across the Divisions from 67 days through to 84 days. Time to fill reporting can be detailed by identified phases of recruitment and a deep dive analysis is being undertaken to identify where further improvements can be made. The recruitment team continue to work with Divisions to create shared ownership of the recruitment process and to ensure recruitment staff fully understand divisional priorities so that they can work with candidates to progress and update them on the actions needed to commence work in the quickest time possible. HR Business Partners are facilitating the development of this relationship building to support the recruitment team in becoming proactive. 5. Recovery Trajectory and Plan 5.1 Improvement Trajectories Divisional trajectories were developed following an examination of seasonal variations and final targets adjusted to reflect the fluctuations. The Trust established a target of 3.6% for Divisions to work towards by 31 March 2015. This was shared with Divisional P a g e 7

Directors at review meetings during August/September 2014 and whilst some agreed that the target was achievable, some Divisions indicated the need for additional support. In these areas, HR Business Partners undertook a more detailed review of individual sickness information. 5.2 Revised Trajectories It has, however, been recognised that, in the current environment, delivering the projected 3.6% target by March 2015 across the Trust is not consistently achievable. The HR Business Partners have therefore worked with their Divisional Director and management teams to review what will be achievable by 31 st March 2015. The revised trajectories have been based on a critical assessment of current sickness caseload, planned actions for resolution, local plans in operation to tackle sickness hotspots and in particular reduce short term sickness, and, an analysis of trends and averages over previous years. The finance planning bridges for 2014/15 into 2015/16 were also factored in where appropriate. The following trajectories have been agreed with Divisional Directors as a target for 31 st March 2015: Division Nov 2014 Sickness absence % Sickness absence % Target Children s 5.5 3.6 Surgery 6.0 4.7 Specialist Medicine 6.2 5.2 St Marys 5.9 4.8 Medicine & Community 6.1 4.3 Trafford 6.1 5.1 Royal Eyes Hospital 6.1 4.0 Dental 4.1 3.6 R&I 4.8 3.6 CSS 4.3 4.1 Further trajectories for March 2016 are currently being developed. 5.2.1 A revised ceiling of 65 days for the time to fill a vacant post has been introduced from November 2014. A programme of continuous review has been put in place to identify improvements and efficiencies within the recruitment timeline 5.2.2 The intelligence drawn from the exit questionnaires is being used to develop a retention plan for each division s hot spots and to share good practice amongst the wider organisation. Over 40% of those who completed the questionnaire left for the following reasons; training/career development (19.6%), relocation (12.3%) and parking/travel (8.2%). Building on this feedback from staff, a more robust preceptorship programme has been introduced to support newly qualified band 5 nurses with their training and career development; there is a strong focus on engaging with those staff who intend to leave to identify possible opportunities to retain them through personal development, review of working patterns or a transfer into another department. P a g e 8

The retention plans are based on a triangulation of retention data, other workforce performance indicators and external factors to ensure plans are based on the best evidence available. 5.2.3 The operational Director of HR will work with Divisional Directors to put in place local governance arrangements that will support personal accountability and ownership by managers for reducing sickness absence. A more disciplined regime through line management will provide an improved level of focus and scrutiny. 5.3. Performance Reports With effect from 5 st January 2015 each ward/department will be asked to complete a weekly Situation Report (SITREP) outlining progress towards achieving their revised trajectory. SITREPS will be aggregated by Directorate and Division to be returned to the Executive Director of Human Resources for review and to inform revisions to Divisional improvement plans. 5.4 Executive Sign Off The Divisional Directors, HR Business Partners and Divisional Heads of Nursing will meet with the Executive Director of HR & Corporate Services to formally sign off their revised sickness absence plans and improvement trajectories to enable scrutiny of Divisional and HR performance. 6. A New Sickness Policy A new sickness policy has been drafted and is currently in consultation with staff side with a proposed implementation date of February 2015. This timescale takes into account that it is subject to agreement of the policy at TJNCC (23 rd January 2015) and HR Committee (17 th February 2015). The new policy will provide managers with the structure, guidance and support to manage sickness consistently and in a timely manner. The new policy will be applied to all Trust staff. Currently there are a number of policies in use for the various groups of staff transferred into the Trust under TUPE Regulations. 7. Key Performance Indicators The success of the management of sickness absence interventions will be measured by: A reduction in the Divisional sickness absence rates as detailed A reduction in the temporary workforce spend to 4.0% of the total bay bill. A proportionate reduction in the number of long-term sick staff to support the overall agreed reduced absence target Documented return to work interviews in 90% of all cases A new sickness absence policy for the Trust by end of January 2015 (implementation date February 2015) 8. Governance Arrangements On-going and tight management coupled with Executive Director review will feature as well as reporting on a regular basis to the Trust Management Board, Operational Managers Group, through the Intelligent Board, HR Committee and TJNCC. P a g e 9

9. Conclusions This report demonstrates the continuing challenge in terms of managing sickness absence levels within the Trust and highlights the significant interventions already taken to address levels. Reducing sickness absence levels by March 2015 is challenging for the Trust however current levels of sickness absence are not acceptable, particularly when we compare ourselves against other similar organisations. Our vision is to lead by example. The options detailed are designed to provide a deeper level of scrutiny to reduce sickness levels and ensure that managers actions within the Trust are consistent with recognised best practice. i Health & Social Care Information Centre, Publication date: 22 July 2014. ii Understanding the North-South divide in UK employee s sickness absence: a Blinder-Oaxaca decomposition: T. Barmby (University of Aberdeen) and M.G. Ercolani (University Birmingham) iii Health & Social Care Information Centre, Publication date: 22 July 2014. P a g e 10