YORK HOSPITALS NHS FOUNDATION TRUST

RESOURCE MANAGEMENT COMMITTEE

MANAGING SICKNESS ABSENCE

1. Introduction

This paper presents an options appraisal designed to reduce sickness absence and its associated costs at York Hospitals NHS Foundation Trust.

2. Background

The Trust is performing on a level with the NHS average on sickness absence. The most recent data identifies a sickness figure of 4.8%. Sickness has fluctuated between 4% and 5% since 1999. Sickness is however 0.7% higher (or 17% in real terms) than it was in March 2003.

The graph below identifies the Trust’s sickness absence levels over the last few years in comparison with NHS national averages.

3. The National Picture

The Government launched its Health, Work and Well-being Strategy in 2006. The focus of this strategy is to reduce sickness absence, predominantly amongst the public sector employers.

Specifically, the national picture for the NHS is one of high levels and costs of absence in comparison with the public sector.

Some of the key national statistics tell us that:

  • After six weeks off, 1 in 5 staff never return to work. When applying this statistic to York, 25 of our staff who have been absent for three months or more will never return to work
  • The “average” NHS employee takes 1 working day in 22 off sick
  • Across the English NHS Trusts, employees take an average 12 days sick per year (compared to 6 for the private sector)
  • Ward staff on average take 16.8 days sick per annum (based on a survey of 135,000 ward staff from 6,000 wards), with the highest levels being in stroke units, rehabilitation wards and geriatrics
  • In 2005, the annual organisational cost of sickness absence in an average size Trust was £3,794,061 (NHS Partners – Sickness absence and staff turnover survey [August 2005])
  • In 2006, the CIPD estimated the average cost of sickness as £778 per employee, per year
  • Across the NHS, 9.4% of total nursing expenditure is on temporary staff (bank/agency). 25% of all temporary nurses are booked because of sickness absence
  • 40% of NHS sickness absence is due to musculo-skeletal problems arising from manual handling injuries
  • There is a clear correlation between higher spending on occupational health and lower levels of sickness absence (Health Care Commission)
  • Statistical links exist between: high use of temporary staffing and low patient satisfaction scores; high levels of sickness and worse MRSA infection rates; staff immunised against influenza have lower sickness absence rates (Anna Walker, CEO, Health Care Commission)

4. The Local Picture

In the 12 months to 30 November, York Trust lost 286,989 hours to sickness absence. This equates to 38,030 days (assuming an average 7.5 hour working day), or 7,606 weeks (assuming a 37.5 hour week), or 146 wte staff (based on a 52 week year).

The length of sickness absence episodes for York Trust are as follows:

Data from payroll based upon department’s monthly reported returns for the 12 months to 30 November 2006 indicate the reasons for absence as follows:

(Provide further breakdown for duration of absences, for example):

Reasons for absence greater than 12 months (7 staff)

Major Illness-2,123 hours (2 staff)

Back/Neck Problems-1,110 hours (1 person)

Heart Problems-888 hours (1 staff)

Stress/Anxiety/Depression -690 hours (3 staff)

Overall breakdown of all reasons for absence

Reason / Hours Lost / % of total sickness /
Estimated cost (£000)*
/
Estimated cost (mid-point band 5) [£000)^
(Example) Miscellaneous / 91,668 / 31.8 / 1,206.4 / 1,233.2
Other Sickness
Surgery
Stress/Anxiety/ Depression
Back/Neck Problems
Musculo-Skeletal Problems
Diarrhoea/Vomiting
Major Illness
Gynae Problems; Prostrate
Repetitive Strain Injury
Debility
Heart Problems
Asthma
Skin Allergy
Chronic Fatigue Syndrome

Total

  • “Miscellaneous” includes viral illnesses (e.g. cold, influenza); infections (ear, eye, mouth, throat, chest); toothache; migraine/headache; infectious diseases; food poisoning.
  • “Repetitive strain injury” includes tenosynovitis; carpal tunnel; work-related upper limb disorders.
  • “Major illness” includes cancer; thyroid problems; multiple sclerosis; epilepsy; etc.

* Estimated cost is based upon NHS Partners data for the cost of sickness absence in an average Trust in 2005

^ Calculations based upon mid-point Band 5 (£13.40 per hour) including on-costs

5. Sickness Absence Costs for York Hospitals NHS Trust

The above table identifies the financial cost of absence by reason. The Trust is currently running at 4.8% absence, with the Managing Sickness Absence Policy establishing an individual target of 3.9%. If through managing absence differently, a 0.9% reduction in overall absence can be achieved, this represents a potential recurrent annual cost saving of between £726.5k. and £736.4k. in financial terms alone (dependent upon the levels of sickness ‘backfill’ used by departments).

6. The way forward

6.1 Options

The consistent pattern of sickness absence across York Trust suggests that absence will continue to remain at c. 4.8%, unless a different approach is taken.

Option 1 - Concede that 4.8% is an average acceptable performance roughly in line with the NHS average and take no additional action.

Option 2 - Introduce rigorous monitoring, management and action planning of sickness, and identify it as a key indicator at performance management meetings and at Board level to ensure a real focus on driving down absence rates. In supporting this option, HR would nominate a lead to work in partnership with Occupational Health and to devise an action plan to work in proactively reducing sickness absence across the Trust. Key actions within the plan would include reviewing the present sickness absence policy, targeting areas within the Trust with high levels of absence, and identifying areas of training and coaching of individual line managers.

Option 3 - Ensure much earlier proactive intervention in the first week of sickness, combined with rigorous management identified in option 2, to ensure that any required support and treatment is offered straight away (note 37.5 wte are absent for between 1 and 3 months). This required earlier intervention or support may include for example immediate health assessment within occupational health. Dependent on the health issue, there is potentially onward referral to Physiotherapy (musculo-skeletal problems and back/neck problems account for 13.2% [£506.6k. p.a.] of our total sickness. Referral for physio treatment from week one of sickness would reduce this absence). Other support may include involvement of other specialists such as the Manual Handling Service for advice/support in ergonomic assessment, helping to reduce the incidence of musculo-skeletal/back and neck problems and repetitive strain injuries.

Early signposting of the counselling service, or referral through to the clinical psychology service in Occupational Health would facilitate a reduction in the cases of absence related to stress, anxiety or depression (£341.7k. p.a.).

6.2 Supporting evidence

Audit of long-term absent staff (6 months plus) at York Hospital shows that the average time elapsed between the first day of sickness and their referral to occupational health by their manager is 15 weeks (for those staff that were referred). 15 out of the total of 47 staff absent for over 6 months had never been referred to occupational health for advice or support.

6.3 Investment Required

Options 1 and 2 require no additional revenue investment.

If pursuing option 3, and wanting to make an impact with the first twelve months, additional recurrent investment would be required to deliver the immediate potential cost savings. Additional staff would be needed to focus solely on reducing absence. The key aims for new roles would be to act as a champion on sickness absence, identifying and targeting areas with high levels of sickness utilising the available data, to assist line managers in proactively managing sickness absence in line with Trust policy, and to provide the immediate fast-tracking response to make this option work.

7. Recommendation

The Managing Resources Programme Board are asked to decide which option to pursue.

May 2007

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