Reasons for Staff Sickness Page 1 of 1 Main Board –July 2014
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
To note the broader approach which
incorporates sickness management and
health promotion
Executive Summary
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
Please describe as appropriate the link to:
•
The Trust Strategic Objectives
•
The Trust In-Year Objectives
•
The Trust Mission
•
The Trust Values
Effective sickness management is
fundamental to financial performance and
our aspirations to be an ‘employer of choice’.
Please
describe
how
this
affects
patients/staff/carers etc.
There is a clear link between healthy staff
and improved patient outcomes
Please describe what stakeholders think
about this.
This agenda involves significant partnership
working internally and externally.
Please describe how this affects our:
•
performance
•
quality and safety
•
cost
•
activity
Sickness absence costs the trust c.£10m
annually. Reducing this by 0.5% will also
impact on continuity of care for patients
Is what is described in the paper
affordable?
Improved health and wellbeing will save the
trust money
Please explain when you will be able to
report progress about this issue.
Absence rates are reported monthly through
the PMF
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.
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.
Please describe the aspects of this paper
that might require wider stakeholder
engagement or public consultation, and
early engagement with Governors.
Engagement is already taking place with
staff on this subject and Governors have
been updated on progress
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.
Assisting staff in maintaining their health and
wellbeing is an organizational ‘pledge’
contained within the NHS Constitution.
Recommendation
The Board notes the broad approach to
managing sickness and improving health
Author/Presenting Director
Dave Smith
GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
Reasons for Staff Sickness Page 1 of 8
Main Board – July 2014
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 2 of 8 Main Board – July 2014
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
Table 2
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
5 .1 9 5 .2 8 4 .6 6 3 .5 4 3 .4 7 2 .5 2 2 .4 4 1 .0 3 3 .8 7 5 .5 1 5 .1 9 4 .7 7 3 .4 6 3 .4 5 2 .1 1 2 .0 8 1 .5 0 3 .8 4 0 1 2 3 4 5 6 E s ta te s & A n c ill a ry A d d it io n a l C lin ic a l S e rv ic e s N u rs in g & M id w if e ry A d m in & C le ri c a l A d d it io n a l P ro f S c ie n ti fi c & T e c h n ic a l H e a lt h c a re S c ie n ti s ts A lli e d H e a lt h P ro fe s s io n a ls M e d ic a l & D e n ta l T ru s tw id e % s ic k n e s s a b s e n c e
Sickness Absence by Staff Group
Apr 12 to Mar 13 Apr 13 to Mar 14
4 .1 8 3 .5 5 4 .1 5 4 .1 3 3 .3 4 3 .1 6 3 .8 7 4 .3 8 4 .3 6 4 .3 0 4 .0 5 3 .1 3 2 .9 8 3 .8 4 0 1 2 3 4 5 6 S u rg e ry U n s c h e d u le d C a re M e d ic in e W o m e n s & C h ild re n D ia g n o s ti c s & S p e c ia lt y C o rp o ra te T ru s tw id e % s ic k n e s s a b s e n c e
Sickness Absence by Division
Reasons for Staff Sickness Page 3 of 8 Main Board – July 2014
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 4 of 8 Main Board – July 2014
•
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:
GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
Reasons for Staff Sickness Page 5 of 8
Main Board – July 2014
Appendix 1
Trust Summary
November 13 to April 14 GHNHSFT Sickness Absence by Reason 01 November 2013 to 30 April 2014 Cumulative
Abs (FTE) Cumulative Avail (FTE) Cumulative % Abs Cumulative Salary Based Cost Cumulative Episodes % Episodes 45,961.54 1,172,430.38 3.92% 3,271,664.48 8,825
S10 Anxiety/stress/depression/other psychiatric illnesses 6,248.31 13.59% 452,069.22 577 6.54%
S11 Back Problems 2,356.82 5.13% 153,074.09 328 3.72%
S12 Other musculoskeletal problems 3,176.29 6.91% 204,165.56 349 3.95%
S13 Cold, Cough, Flu - Influenza 4,254.90 9.26% 293,253.89 1,558 17.65%
S14 Asthma 123.19 0.27% 8,329.61 23 0.26%
S15 Chest & respiratory problems 1,627.73 3.54% 105,433.36 284 3.22% S16 Headache / migraine 640.35 1.39% 43,298.47 362 4.10% S17 Benign and malignant tumours, cancers 1,131.25 2.46% 77,859.65 72 0.82%
S18 Blood disorders 272.85 0.59% 42,901.98 23 0.26%
S19 Heart, cardiac & circulatory problems 451.56 0.98% 45,241.28 59 0.67% S20 Burns, poisoning, frostbite, hypothermia 9.00 0.02% 648.36 3 0.03% S21 Ear, nose, throat (ENT) 1,333.86 2.90% 85,979.64 271 3.07% S22 Dental and oral problems 181.44 0.39% 11,310.05 79 0.90%
S23 Eye problems 399.15 0.87% 26,151.56 82 0.93%
S24 Endocrine / glandular problems 118.13 0.26% 7,258.54 24 0.27%
S25 Gastrointestinal problems 3,444.49 7.49% 216,189.23 1,304 14.78%
S26 Genitourinary & gynaecological disorders 1,655.44 3.60% 120,161.42 276 3.13%
S27 Infectious diseases 162.20 0.35% 12,583.22 26 0.29%
S28 Injury, fracture 2,660.97 5.79% 180,449.92 239 2.71% S29 Nervous system disorders 272.10 0.59% 16,840.84 29 0.33% S30 Pregnancy related disorders 1,145.72 2.49% 82,749.87 195 2.21%
S31 Skin disorders 148.43 0.32% 9,487.34 36 0.41%
S32 Substance abuse 0.80 0.00% 32.27 1 0.01%
S98 Other known causes - not elsewhere classified 3,383.39 7.36% 231,939.87 626 7.09% S99 Unknown causes / Not specified 10,763.17 23.42% 844,255.25 1,998 22.64%
Reasons for Staff Sickness Page 6 of 8 Main Board – July 2014
Appendix 2
By Division
November 13 to April 14 Cumulative Abs (FTE) Cumulative Avail (FTE) Cumulative % Abs Rate (FTE)
Cumulative Salary Based Cost Cumulative Episodes % Episodes Trust 45,956.83 1,172,432.78 3.92% 3,271,439.46 8,825 Corporate Division 3,161.56 101,616.92 3.11% 239,430.49 716
S10 Anxiety/stress/depression/other psychiatric illnesses 420.14 13.29% 34,561.23 42 5.87% S13 Cold, Cough, Flu - Influenza 395.38 12.51% 28,828.98 154 21.51%
S25 Gastrointestinal problems 259.05 8.19% 17,748.58 134 18.72%
Diagnostics & Specialty Division
9,535.50 274,507.39 3.47% 667,744.74 2,079
S10 Anxiety/stress/depression/other psychiatric illnesses 1,393.85 14.62% 90,787.41 136 6.54% S13 Cold, Cough, Flu - Influenza 1,062.17 11.14% 71,800.25 435 20.92% S98 Other known causes - not elsewhere classified 842.76 8.84% 61,897.82 177 8.51%
Estates & Facilities Division 4,152.80 88,724.95 4.68% 214,764.21 664
S12 Other musculoskeletal problems 694.23 16.72% 37,604.61 56 8.43% S10 Anxiety/stress/depression/other psychiatric illnesses 444.33 10.70% 20,128.63 38 5.72%
S28 Injury, fracture 374.73 9.02% 18,873.41 29 4.37%
Medicine Division 7,576.01 157,623.50 4.81% 498,598.42 1,450
S10 Anxiety/stress/depression/other psychiatric illnesses 1,037.96 13.70% 83,240.08 91 6.28% S25 Gastrointestinal problems 793.01 10.47% 42,680.36 247 17.03% S12 Other musculoskeletal problems 632.89 8.35% 39,536.33 54 3.72%
Surgery Division 13,410.90 299,834.80 4.47% 978,093.90 2,289
S10 Anxiety/stress/depression/other psychiatric illnesses 1,452.77 10.83% 95,430.15 132 5.77% S13 Cold, Cough, Flu - Influenza 1,308.92 9.76% 93,115.36 417 18.22% S98 Other known causes - not elsewhere classified 1,099.83 8.20% 72,376.37 132 5.77%
Unscheduled Care Division 2,770.95 64,595.08 4.29% 223,763.46 583
S10 Anxiety/stress/depression/other psychiatric illnesses 734.26 26.50% 48,143.80 54 9.26% S13 Cold, Cough, Flu - Influenza 286.12 10.33% 21,226.95 121 20.75%
S11 Back Problems 219.40 7.92% 15,695.35 29 4.97%
Womens & Children Division 4,773.13 116,906.74 4.08% 394,951.34 930
S10 Anxiety/stress/depression/other psychiatric illnesses 681.98 14.29% 71,216.97 71 7.63% S13 Cold, Cough, Flu - Influenza 430.86 9.03% 30,557.29 151 16.24% S98 Other known causes - not elsewhere classified 339.27 7.11% 25,991.93 51 5.48%
Reasons for Staff Sickness Page 7 of 8 Main Board – July 2014
By Staff Group
Appendix 3
Cumulative
Abs (FTE)
Cumulative Avail (FTE)
Cumulative % Abs Rate (FTE)
Cumulative Salary Based Cost Cumulative Episodes % Episodes
Add Prof Scientific and Technic
2,001.51 52,701.18 3.80% 167,937.62 356
S17 Benign and malignant tumours, cancers 271.40 13.56% 26,883.89 19 5.34% S13 Cold, Cough, Flu - Influenza 217.06 10.84% 16,943.17 73 20.51% S98 Other known causes - not elsewhere classified 143.33 7.16% 11,631.82 23 6.46%
Additional Clinical Services 10,532.52 190,819.61 5.52% 485,239.21 2,171
S10 Anxiety/stress/depression/other psychiatric illnesses 1,369.93 13.01% 64,984.89 134 6.17% S25 Gastrointestinal problems 1,025.91 9.74% 44,976.67 363 16.72% S12 Other musculoskeletal problems 952.04 9.04% 45,582.92 103 4.74%
Administrative and Clerical 8,134.34 230,756.54 3.53% 483,444.55 1,709
S10 Anxiety/stress/depression/other psychiatric illnesses 1,303.47 16.02% 76,524.51 137 8.02% S13 Cold, Cough, Flu - Influenza 793.33 9.75% 47,810.47 331 19.37% S98 Other known causes - not elsewhere classified 655.14 8.05% 35,832.69 135 7.90%
Allied Health Professionals 1,366.19 56,880.54 2.40% 120,965.96 389
S98 Other known causes - not elsewhere classified 247.39 18.11% 21,677.80 37 9.51% S13 Cold, Cough, Flu - Influenza 207.03 15.15% 17,139.72 100 25.71% S10 Anxiety/stress/depression/other psychiatric illnesses 141.49 10.36% 12,668.67 29 7.46%
Estates and Ancillary 3,618.64 74,695.83 4.84% 169,192.35 584
S12 Other musculoskeletal problems 541.23 14.96% 24,288.16 50 8.56% S10 Anxiety/stress/depression/other psychiatric illnesses 443.68 12.26% 20,101.69 38 6.51%
S28 Injury, fracture 380.33 10.51% 19,092.71 31 5.31%
Healthcare Scientists 1,049.92 33,162.56 3.17% 97,769.63 204
S10 Anxiety/stress/depression/other psychiatric illnesses 242.09 23.06% 21,703.18 13 6.37%
S11 Back Problems 167.36 15.94% 15,460.92 12 5.88%
S13 Cold, Cough, Flu - Influenza 149.77 14.27% 14,713.30 59 28.92%
Medical and Dental 2,756.07 199,148.30 1.38% 396,683.94 517
S10 Anxiety/stress/depression/other psychiatric illnesses 356.38 12.93% 54,735.26 26 5.03%
S18 Blood disorders 163.80 5.94% 35,860.46 7 1.35%
S98 Other known causes - not elsewhere classified 115.63 4.20% 22,599.62 19 3.68% Nursing and Midwifery
Registered
16,502.37 334,265.82 4.94% 1,350,431.22 2,911
S10 Anxiety/stress/depression/other psychiatric illnesses 2,261.86 13.71% 189,977.72 183 6.29% S13 Cold, Cough, Flu - Influenza 1,781.51 10.80% 139,136.57 554 19.03% S25 Gastrointestinal problems 1,257.30 7.62% 95,964.32 372 12.78%
Reasons for Staff Sickness Page 8 of 8 Main Boar - July 2014
