Developing a new framework for managing absence Dr Richard Preece, - - PowerPoint PPT Presentation

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.”

Boorman re-analysed existing data to demonstrate important links between staff health and outcomes

NHS Staff Health Review

Boorman highlighted the size of the opportunity

NHS Staff Health Review

Current Reality Across the NHS, reducing overall absence by 33% would result in An average sized Trust, moving from lower quartile to upper quartile, would gain8: Trust Type Rate of absence6 Range across Trusts Additional FTEs per year Annual savings Additional FTEs per year Annual savings Overall1 4.48% 1.75% - 7.42% 14,900 £560 million 48 £1.8 million Ambulance2 5.76% 4.17% - 7.42% 600 £21 million 37 £1.3 million Mental Health3 5.24% 1.95% - 6.91% 2,400 £83 million 39 £1.4 million PCT4 4.43% 1.91% - 6.17% 2,800 £98 million 14 £485,000 Acute5 4.17% 1.75% - 6.17% 8,800 £340 million 42 £1.6 million

… 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

• ccupational health services in

many places.” Steve Boorman (2009)

NHS Staff Health Review

The Improvement Framework

“The key consideration in deciding

• n the health and well-being

services that will be required is that this is not simply an issue linked to sickness absence or attendance.”

NHS Staff Health Review

1 2 3 4 5 6 1998 1999 2000 2001 2002 2003 2004 2005 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

5 10 15 20 25 Low (0-2) Moderate (3-4) High (5+)

Days

Burton W et al, JOEM 1999; 41:10, 863

Health risks impact on productivity

Health risks impact on productivity

5 10 15 20 25 30 0 Risks 1 Risk 2 Risks 3 Risks 4 Risks 5 Risks 6 Risks %

Mean productivity impairment in past seven days

2 hours 10 hours

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

• rganisation - wide plan or policy:

North West

(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?

0‐1 1‐2 2‐3 3‐4 4‐5 5‐6 6‐7 7‐8 8‐9 9‐10

Frequency of absences episodes by weeks of duration

How long does absence continue?

10% 20% 30% 40% 50% 60% 70% 80% 90% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Weeks of absence

not returned 4 weeks later

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

0‐1 1‐2 2‐3 3‐4 4‐5 5‐6 6‐7 7‐8 8‐9 9‐10

Frequency of absences episodes by weeks of duration Health improvement assessment OH referral Return2health referral

0‐1 1‐2 2‐3 3‐4 4‐5 5‐6 6‐7 7‐8 8‐9 9‐10

Frequency of absences episodes by weeks of duration

Health improvement assessment OH referral Return2health referral

A new process

Day 1: Contact as usual – we need to give guidance on manager’s follow up calls End of Week 2: Manager prompted to take actions a)If already back or definitely coming back within next week (and not referred for health improvement assessment in past two years 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 initiate a health improvement assessment. A simple face-to-face health check possibly supported by a health promotion tool:

• to identify modifiable health risk factors
• to discuss health needs
• to discuss lifestyle change
• and if necessary to refer for specific health

interventions including

– smoking cessation – multi-component weight management – EAP

0‐1 1‐2 2‐3 3‐4 4‐5 5‐6 6‐7 7‐8 8‐9 9‐10

Frequency of absences episodes by weeks of duration

Health improvement assessment OH referral Return2health referral

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