Developing a new framework for managing absence Dr Richard Preece, Consultant in occupational medicine Melissa Holley, Head of Human Resources Management Mid Cheshire Hospitals NHS FT A celebration of those ‘light bulb moments’ that are transforming patient experience and care across the North West
Overview • The staff health opportunity • Evidence-based workplace health • Learning from others • Re-analysing the data • The new model • Next steps
Who we are • Mid Cheshire Hospitals NHS Foundation Trust (Crewe) • East Cheshire NHS Trust (Macclesfield) • Cheshire Occupational Health Service • SEQOHS accredited
NHS Staff Health (Boorman) Review “At its simplest, staff health and well- being is vital to enabling the NHS to deliver high standards of quality and good patient outcomes. “Organisations that work with their staff to provide healthy and safe work combined with a caring environment perform better, and, …deliver reliably.”
NHS Staff Health Review Boorman re-analysed existing data to demonstrate important links between staff health and outcomes
NHS Staff Health Review An average sized Trust, moving from Across the NHS, reducing overall Current Reality lower quartile to upper quartile, would absence by 33% would result in gain 8 : Rate of Range across Additional FTEs Additional FTEs Trust Type Annual savings Annual savings absence 6 Trusts per year per year Overall 1 4.48% 1.75% - 7.42% 14,900 £560 million 48 £1.8 million Ambulance 2 5.76% 4.17% - 7.42% 600 £21 million 37 £1.3 million Mental Health 3 5.24% 1.95% - 6.91% 2,400 £83 million 39 £1.4 million PCT 4 4.43% 1.91% - 6.17% 2,800 £98 million 14 £485,000 Acute 5 4.17% 1.75% - 6.17% 8,800 £340 million 42 £1.6 million Boorman highlighted the size of the opportunity
NHS Staff Health Review … but only 38% of respondents agreed OH was proactive NHS Staff Health & Wellbeing Review 2009
NHS Staff Health Review “Shifting the focus of staff health … will require a remodelling of occupational health services in many places.” Steve Boorman (2009)
The Improvement Framework “The key consideration in deciding on the health and well-being services that will be required is that this is not simply an issue linked to sickness absence or attendance.”
2005 2004 2003 NHS Staff Health Review 2002 2001 2000 1999 1998 6 5 4 3 2 1 0 Absence rate (%)
Sickness absence rate • 1998 = 4.6% (North West) – Set target to reduce by 30% by 2003 • 2008 (Boorman) = 4.48% (England) – Set target to reduce by 1/3 by 2014 • 2012 = 4.8% (North West) …and we are all doing much, much more
BBC 29 March 2009
Health risks impact on productivity 25 20 15 Days 10 5 0 Low (0-2) Moderate (3-4) High (5+) Burton W et al, JOEM 1999; 41:10, 863
Health risks impact on productivity Mean productivity impairment in past seven days 30 10 hours 25 20 % 15 10 2 hours 5 0 0 Risks 1 Risk 2 Risks 3 Risks 4 Risks 5 Risks 6 Risks Pronk et al, JOEM 2004 46:1,19
Modifying health effects productivity
Lessons from the national audit More likely to implement actions if: •Health and wellbeing is regular leadership team agenda item •Staff involved in planning and designing approaches •Done the needs assessments
Staff health improvement Does the trust have an North West organisation - wide plan or policy: (47 Trusts participated) To reduce obesity 19% To increase physically activity 30% To encourage smoking cessation 78% To promote mental wellbeing 51% Implementing NICE public health guidance for the workplace: a national organisational audit (2011)
Absence referral pathway • Routine monitoring of length of time from: • start of absence to referral 25% • receipt of referral to OH appointment 65% • appointment to issuing report 52% • Only 19% monitor all stages of the OH pathway Implementing NICE public health guidance for the workplace: a national organisational audit (2011)
Drawing on wide experience • 4 regional QIPP events • Several RCP HWDU events • Drawing on leading practice examples incl: – Southampton return2health – Worcester – Plymouth – Derbyshire – York – etc • Implementing NICE guidance
Drawing on wide experience: messages • Target support at those with most health need • Focus on improved health and capability • Promote positive health beliefs • Provide health support intervention services • Intervene early • Actively manage cases of absence • Communicate the key supportive messages
How long are staff absent due to illness? Frequency of absences episodes by weeks of duration 0 ‐ 1 1 ‐ 2 2 ‐ 3 3 ‐ 4 4 ‐ 5 5 ‐ 6 6 ‐ 7 7 ‐ 8 8 ‐ 9 9 ‐ 10
How long does absence continue? 90% 80% 70% 60% 50% 40% 30% not returned 4 weeks later 20% 10% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Weeks of absence
Who returns to work? Lessons • Most absences are short. They put pressure on teams, are disruptive, and costly. – We need an effective means support staff in staying at work. • The longer staff are absent the more likely they will be absent for a long time risking loss of pay and loss of employment. – We need to intervene earlier and actively manage absentees. • If we are to change the attendance culture we must fully commit to a new approach.
New attendance management model Frequency of absences episodes by weeks of duration Health improvement assessment Return2health referral OH referral 0 ‐ 1 1 ‐ 2 2 ‐ 3 3 ‐ 4 4 ‐ 5 5 ‐ 6 6 ‐ 7 7 ‐ 8 8 ‐ 9 9 ‐ 10
A new process Day 1: Contact as usual – we need to give Frequency of absences episodes by weeks of duration guidance on manager’s follow up calls Health improvement assessment Return2health referral End of Week 2: Manager prompted to take actions OH referral a)If already back or definitely coming back within next week (and not referred for health improvement assessment in past two years 0 ‐ 1 1 ‐ 2 2 ‐ 3 3 ‐ 4 4 ‐ 5 5 ‐ 6 6 ‐ 7 7 ‐ 8 8 ‐ 9 9 ‐ 10 automatic referral (from RTW interview) b)If not definitely coming back within next week automatic referral to return2health support
Health improvement assessment If first absence in a rolling two years period Frequency of absences episodes by weeks of duration initiate a health improvement assessment. Health improvement assessment Return2health referral A simple face-to-face health check possibly supported by a health promotion tool: OH referral •to identify modifiable health risk factors •to discuss health needs 0 ‐ 1 1 ‐ 2 2 ‐ 3 3 ‐ 4 4 ‐ 5 5 ‐ 6 6 ‐ 7 7 ‐ 8 8 ‐ 9 9 ‐ 10 •to discuss lifestyle change •and if necessary to refer for specific health interventions including – smoking cessation – multi-component weight management – EAP
Active case management **NICE recommends active case management
Critical Success Factors • Staff side support • Amended attendance policy • Ownership and investment by Divisions • Real time absence data • Automated intervention prompts • Investment in new support systems • Focal point in Human Resources
Cost benefit – an illustration • Resources = £100K • Agency cover for sickness = £1m • If reduce agency (sickness) spend by 10% = breakeven… • … and, many other benefits are accrued
Thank you • Melissa Holley melissa.holley@mcht.nhs.uk • Richard Preece richardpreece@nhs.net
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