AGENDA ITEM No. 12 MEETING : TRUST BOARD
DATE : 28 APRIL 2010
REPORT OF : WORKFORCE & OD DIRECTORATE Contact : Jo Davies, Director of HR & Development Officer Tel: 01792 562940
Email: jo.davies@ambulance.wales.nhs.uk
SICKNESS ABSENCE REPORT
1 At its last meeting, the Trust Board requested a report on sickness absence be brought to the April meeting providing additional analysis particularly in relation to long/short term absence and highlighting the main issues surrounding sickness absence. Also an explanation as to why the rates of absence in the North Region are consistently lower than the other two regions.
2 The attached report (see Appendix 1) provides an analysis of the sickness absence across the Trust.
3 A new All Wales Sickness Absence Policy has been developed and is currently under implementation. The Trust’s action plan to address the levels of sickness absence has also been revised (see Appendix 2).
RECOMMENDED: That
(1) the long/short term data provided be considered;
(2) the hierarchical Electronic Staff Record (ESR) reasons for the differences between the regions be noted; and
(3) the implementation of the action plan to address the high levels of non attendance due to sickness continue to be supported.
APPENDIX 1 SICKNESS ABSENCE REPORT
1. INTRODUCTION
In attempting to understand the incidence of and reasons for non attendance at work, it is recognised that there are a number of issues/factors which impact on the levels of sickness absence.
These issues/factors can be categorised as follows:- Reasons for absence
Patterns of absence Working patterns
Management of Sickness Absence Staff Wellbeing
Occupational Health Provision
The interrelationships between these factors are complex however the following analysis provides the Board with some indication of the key issues facing the Trust in relation to the challenges of reducing the non attendance levels due to sickness absence.
2 CURRENT LEVELS OF SICKNESS ABSENCE IN THE TRUST
In line with the NHS Wales standard, the Trust’s reporting of sickness is based on hours lost divided by hours available. NHS Wales has set a requirement that all organisations need to reduce their sickness levels on the basis of a % of current levels; i.e. a year on year improvement rather than an absolute target.; the Trust target is 6.25%. ESR (Electronic Staff Record) is able to provide statistical information on the basis of hours lost divided by hours available. Therefore, the data below must be seen as the only true accurate sickness absence data in the Trust.
NB. It is important to note that the sector norm for Ambulance Trusts is for sickness levels to be around 6% which is higher than the general NHS in England and Wales.
2.1 Trust sickness absence for the period
The chart shows the Trust’s sickness absence rate for the period March 2009 to February 2010 compared to the period 12 months earlier.
The cumulative sickness absence rate for the period of March 2009 to February 2010 is 7.25% (as against 6.58% for the period March 2008 to February 2009). The current actual absence figure for the month of February 2010 is 6.81%. This compares against the February 2009 figure of 5.81%. The absence rate for the month is up by 1% and the cumulative rate is also up by 0.67%.
2.2 Trust wide Short term and Long Term Sickness by Staff Group
This table shows short term and long term sickness absence by staff group
Total Days Lost Short Term Days % Short Term Long Term Days % Long Term Amb. Officer 1579 396 25.08% 1183 74.92% Paramedic Practitioner 18 18 100.00% 0 0.00% Paramedic 24747 8044 32.50% 16703 67.50% Technician / HDS 13211 3871 29.30% 9340 70.70% Trainee Tech. 82 33 40.24% 49 59.76% Sen. Mgr 707 335 47.38% 372 52.62% Manager 439 180 41.00% 259 59.00% Admin & Clerical 4564 1704 37.34% 2860 62.66% Control 8399 3202 38.12% 5197 61.88% Fleet / Workshop 90 44 48.89% 46 51.11% PCS 14674 3453 23.53% 11221 76.47% HCS / NAT / Domestic 2916 448 15.36% 2468 84.64% Nurse Manager 55 55 100.00% 0 0.00% Qualified Nurse 3306 827 25.02% 2479 74.98% Dental 364 110 30.22% 254 69.78%
The split between long and short term sickness for the immediate 12 months (March 2009 –April 2010) is 70.4% long term: 29.6% short term which is consistent with the norm for the NHS and also consistent with the previous 12 months at 69.36% long term: 30.64% short term. In all staff groups bar
Paramedic Practitioner and Nurse Manager the long term absence is a greater percentage than short term absence.
Trust wide Short term absence in days by Staff Group Feb 2009 to Jan 2010
Regional Sickness absence
The following table shows short term and long term absence for the Operational Directorate by Region for the period February 2009 to January 2010.
Total Days Lost Short Term Days % Short Term Long Term Days % Long Term
Deputy CEO Division 450 293 65.11% 157 34.89% C&W Regional Director Division 23,659 6,699 28.31% 16,960 71.69% North Regional Director Division 14,822 4,028 27.18% 10,794 72.82%
SE Regional Director Division 27,922 8,963 32.10% 18,959 67.90%
Trust Totals 66,853 19,983 29.89% 46,870 70.11%
Table : Regional Split of Short term and Long Term Sickness absence
Note: The total days lost is not a true comparison as the proportionate headcount across the regions differs. However the split across all regions is approximately one third short term and two thirds long term absence.
2.3 Reasons for absence Trust wide: Short term and Long Term Absence by Absence Reason
One of the key issues for the Trust is the nature of the work undertaken by the vast majority of our staff and the challenges this provides in relation to safe manual handling practice, and protecting from and supporting our staff following incidence of violence and aggression. Linked to this, a further consideration in terms of the workforce profile, is that our staff turnover is low (currently 4.93%) and that many of our staff remain in the service and in similar roles for many years and up to retirement. These present us with particular challenges in addressing the reasons for sickness absence.
Current statistics for the period February 2009 to January 2010 identify that the main reason for sickness absence is Musculo-skeletal. It contributes nearly 30% towards the total absences during this period.
The table below shows a breakdown of long and short term sickness absence by reason given for the absence as at 10 March 2010.
Absence reason Total
Days Short Term Days % Short Term Long Term Days % Long Term Blood Disorder 1 1 100.00% - 0.00% Cancer 712 27 3.79% 685 96.21% Cardiac/Coronary 1,947 326 16.74% 1,621 83.26% Cold 7,515 5,245 73.29% 2,270 26.71% Dermatological 685 235 34.31% 450 65.69% Diarrhoea/Vomiting 1,709 1,492 87.30% 217 12.70%
Ears, Nose and Throat 1,077 548 50.88% 529 49.12%
Eyes 77 - 0.00% 77 100.00% Gastro-intestinal 995 928 93.27% 67 6.73% Genito-Urinary 271 152 56.09% 119 43.91% Gynaecological 839 250 29.80% 589 70.20% Headache/Migraine 624 400 64.10% 224 35.90% Musculo-skeletal Back 9,431 2,520 26.72% 6,911 73.28% Musculo-skeletal Neck 30 - 0.00% 30 100.00%
Musculo-skeletal Other Joint, Lower Limb 12,529 2,662 21.25% 9,867 78.75%
Neurological 88 21 23.86% 67 76.14% Not Known 9,705 2,606 26.85% 7,099 73.15% Other 6,432 1,499 23.31% 4,933 76.69% Pregnancy Related 211 142 67.30% 69 32.70% Respiratory 2,033 848 41.71% 1,185 58.29% Stress/Anxiety 10,712 1,698 15.85% 9,014 84.15% Surgery 7,276 1,064 14.62% 6,212 85.38% Null 252 56 22.22% 196 77.78% Trust Totals 75,151 22,720 30.23% 52,431 69.77%
In recognising the impact of musculo-skeletal injury incurred, an assessment was made of the mandatory training that staff had received. This has highlighted the need for refresher training as well as ensuring that all new starters to the Trust are provided with mandatory training.
The Trust has already recognised the need to ensure that all staff are released for manual handling training and refresher training. Given the incidence of
musculoskeletal injury, it is clear that operational line managers must ensure that priority is given to attendance at the training. Due to the nature of
musculoskeletal injury, associated absence is often long term.
The training department have developed a training plan which will ensure that all staff receive the appropriate training. This plan is being discussed with Regional Directors and will then form the basis of discussions with the resource
departments to ensure that all staff have the training release built into their rota over the next three years. The recently introduced Trust induction programme and handbook will ensure that all staff receive level one manual handling training. A key reason for non attendance at training is the ability to release operational staff. There is something of a vicious circle in this situation and the need to prioritise the release of staff for training to minimise the incidence of injury and absence is clearly vital if sickness absence is to be reduced. As staffing levels increase and overtime reduces this should have a positive impact on sickness levels.
This is also shown below within the supporting graph– detailing principal reasons first.
The other principal reasons include stress and anxiety and colds with the ‘not known and other’ also representing a significant percentage of absences. In terms of stress and anxiety, the reasons giving rise to such absences are varied and include patterns of work, domestic issues, relationships at work and issues related to the nature of the work, i.e. distressing events and or experiencing violence/aggression.
The Trust has insufficient data on the correlation between these issues and a key action is to undertake such analysis. This has been identified as part of the work programme for the newly re-established health and wellbeing
working group. Key elements of this work will be completed by the end of May.
2.4 Consideration of Regional Differences
The Trust Board noted at its February meeting that the North figures were lower than the other two regions and sought an explanation for the reasons for this apparent difference.
An adjustment has since been made on ESR to correct the allocation of staff groupings with the regions and as a result the recent figures for January 2010, within operational areas only, no longer identify a significant difference between the regions. Also, the correction of an error on the ESR system in respect of the FTE figure for around 30 individuals had a marked effect on absence figures.
January 2010 sickness absence rates for operational directorates Central & West North South East
8.77% 9.09% 9.06%
The following table shows the sickness absence of the Operations Directorate split by Regional Operations. Please note that the figures now reflect the new management structure.
The absence rate is calculated on absence hours divided by hours available. The Regional sickness figures above show Regional Directors Divisions - these no longer include staff within the Associate Director of Support Services; Fleet & Logistics, H&S and Estates. Historically, these were attached to the Regional Directors and therefore would increase the available hours and which could impact on the absence rate generally.
Specifically, the sickness absence rates for Central & West and North have increased for the period from March to December 2009 and March to October 2009 respectively due to the correction of some hierarchical areas within ESR.
2.5 Action Plan – Current Activity to Reduce Sickness Absence Rates A draft action plan was considered by the HR Committee in March and is presented at appendix 2 for information.
Management of Sickness Absence
The data above illustrates that there is a need for further action to access the underlying causes of sickness absence in the Trust. Historically the management of sickness absence in the Trust has been inconsistent and significant work has been undertaken over the past year to train front line managers to manage sickness absence. In addition, the quality and frequency of reports has been addressed with the monthly availability of very detailed information to support line managers in managing absence.
The new All Wales policy provides the opportunity for HR and staffside
representatives to reinforce the principles of good management of absence with front line managers and a programme of training and education has been
developed to implement the new arrangements from May.
One of the regional HR Managers is now the Trust lead to ensure that there will be a consistent approach.
However, further analysis of the underlying causes of the high levels of absence needs to be undertaken to enable targeted initiatives to be developed.
Working Patterns
The Health & Safety Executive recognises that long working hours have a detrimental effect on individuals’ health. The main working pattern that exists in the Trust is a twelve hour shift pattern.
In trying to identify any correlation between working patterns and absence levels work has begun on analysing available information. The analysis to date is at a basic level but early indications are that there appear to be correlations at a number of levels including absence levels increasing immediately following a rest day, holiday periods, major sporting events, periods where there are increases in overtime working.
Further work will be undertaken with the Operations Directorate in relation to shift patterns and over-runs, with the twelve hour shift having the potential to breach the Working Time Directive. Work has commenced to identify whether there are any links between shift patterns and sickness absence, particularly stress related sickness.
A review of the flexibility working arrangements will also be undertaken to support this work.
This will be undertaken and reported to the Modernising Ways of Working – Working Group. An update of progress will be reported in the next Workforce Information Report. Consideration will also be given to the work being
undertaken as part of the Efficiency Review.
In addition working with the Resource Departments, building upon the work recently finalised by the joint working group, the new operating procedure for resource departments will be fully implemented. This will alleviate confusion and concerns about a range of issues which have caused staff dissatisfaction relating to the booking of shifts, overtime, TOIL and annual leave. Additionally, ProMis can now be accessed by staff from home and the Interim Director of Operations has been discussing the pilot of self-rostering with staff-side colleagues.
Staff Wellbeing
It is vital that the Trust is proactive in establishing strategies that will support the wellbeing of staff. The work that is currently being undertaken by the Health and Wellbeing Group will ensure that this takes place. Linkages will be made with existing strategies e.g. childcare voucher scheme; cycle to work scheme; family friendly policies; flexible working patterns. Key components of the work
programme include:
Management of Work Related Stress – A joint sub group had been
established to develop a new policy from scratch, based on the discussions which had taken place during the WPPWG Workshop. Stress related ill health remains one of the four most significant reasons for sickness absence. When completed, the revised policy would also meet the requirements of the
Healthcare Standards.
This work will be supported by a review of the Colleague Support
arrangements which has already commenced as there is evidence that this scheme is patchy in its effectiveness, together with the introduction of a debriefing process for critical incidents. Links will also be made to work conducted under the Violence and Aggression Group.
Development of Consistent Occupational Health Provision – Senior HR colleagues have been working with Occupational Health leads at an all Wales level to secure a more sustainable service for the Trust. A draft tender
document which specifies the services required for all staff has been developed and is under consideration currently by the lead Medical and Nursing joint Chairs of the All Wales Occupational Health Forum.
Dr M Tidely, Occupational Health Consultant at ABMU LHB and Chair of the above forum has agreed to act for the Trust as lead advisor. Both Dr Tidley and Vanessa Williams, Occupational Health Manager for Hywel Dda LHB are currently working with the Trust to develop agreed health standards for all staff and volunteers.
This work is being undertaken within the context of a range of disparate agreements with different OH providers resulting in patchy provision.
