I write in response to your request for information in relation to staff sickness absence in NHS Lothian.

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1 Lothian NHS Board = Waverley Gate 2-4 Waterloo Place Edinburgh EH1 3EG = Telephone: Date: 24/03/2015 Our Ref: 5080 Enquiries to : Bryony Pillath Extension: Direct Line: bryony.pillath@nhslothian.scot.nhs.uk Dear FREEDOM OF INFORMATION STAFF SICKNESS ABSENCE I write in response to your request for information in relation to staff sickness absence in NHS Lothian. I have been provided with information to answer your request by Ms Ruth Kelly, Associate Director of Human Resources, NHS Lothian. Questions: 1. Do you have a Sickness Absence Policy? 2. Could you please supply a copy of your policy? Answer: NHS Lothian s sickness absence policy, the Promoting Attendance Policy and Procedure, is enclosed with this response. Question: 3. What are your levels of sickness absence for the past 3 years? Answer: Sickness absence levels for all NHS Lothian staff are detailed in the table below: NHS Lothian sickness absence levels for all staff Year Absence rate % % %

2 5080 Staff Sickness Absence March 2015 Question: 4. Does your policy deal with stress and mental health issues? Answer: The Promoting Attendance Policy does not specifically deal with stress and mental health issues, but these are covered in a separate Dealing Positively with Stress Policy at Work, which I have enclosed. Questions: 5. Do you hold separate statistics on stress and mental health issues? 6. Can you please advise what those levels are for the past 3 years? Answer: NHS Lothian holds some statistics on stress and mental health issues. This information is collected using national codes and categories for recording absence, which includes a category combining anxiety, depression and psychiatric illness. We do not collect data which would determine what proportion of the absences recorded under this category relate to stress and mental health issues only. The percentage of hours lost through sickness which are in the category of anxiety, depression and psychiatric illness is detailed in the table below. Hours lost through absence due to anxiety, depression and psychiatric illness as a percentage of total hours lost through staff sickness, NHS Lothian Year Percentage hours lost % % % Questions: 7. Does your policy deal with Work/Life Balance issues? 8. How is this done? Answer: NHS Lothian has a separate suite of policies dealing with work life balance, including policies on flexible working arrangements, carers leave, special leave, maternity leave, paternity leave and parental leave. Page 2 of 4

3 5080 Staff Sickness Absence March 2015 Questions: 9. Do you have occupational health provision for your employees? 10. Please say how this is carried out. Answer: All NHS Lothian employees have access to Occupational Health Services either through a management referral or through self referral. The service includes a staff counselling service and a staff physiotherapy service. Questions: 11. Does your policy have triggers to instigate intervention in the sickness absence levels of your employees? 12. Do these triggers apply equally to disabled and non-disabled people? 13. Do you adjust the triggers to meet reasonable adjustments for disabled people? 14. What adjustments do you offer to meet the needs of disabled people? Answer: Yes, the Promoting Attendance Policy uses triggers for absence levels. Review is required if a member of staff has been off for four or more spells or a single absence of ten days or more in a twelve month period. These triggers apply equally to disabled and non-disabled staff, but individual circumstances will be taken into account when deciding on appropriate action to be taken and any reasonable adjustments are made at this stage on a case by case basis. Please see Appendix D of the Promoting Attendance Policy. Advice is also available to staff from the Occupational Health Service. I hope the information provided helps with your request. If you are unhappy with our response to your request, you do have the right to request us to review it. Your request should be made within 40 working days of receipt of this letter, and we will reply within 20 working days of receipt. If our decision is unchanged following a review and you remain dissatisfied with this, you then have the right to make a formal complaint to the Scottish Information Commissioner. Page 3 of 4

4 5080 Staff Sickness Absence March 2015 If you require a review of our decision to be carried out, please write to the FOI Reviewer at the address at the head of this letter. The review will be undertaken by a Reviewer who was not involved in the original decision-making process. FOI responses (subject to redaction of personal information) may appear on NHS Lothian s Freedom of Information website at: Yours sincerely ALAN BOYTER Director of Human Resources and Organisational Development Cc: Chief Executive Enc. Page 4 of 4

5 EMPLOYMENT POLICIES AND PROCEDURES DEALING POSITIVELY WITH STRESS AT WORK SEPTEMBER 2007

6 1. INTRODUCTION Definition Commitment 2 2. SCOPE 2 3. POLICY AIMS 3 4. RESPONSIBILITIES Senior Managers Line Managers All Staff Human Resources Trade Unions/Professional Organisations Occupational Health Service Staff Support and Counselling Service 6 5. RISK ASSESSMENT IN THE WORKPLACE NHS Lothian Process Control Measures Risk Assessment Review Risk Assessment Process 8 6. STRESS AUDIT 8 7. DIAGNOSIS OF WORK RELATED MENTAL ILL HEALTH 8 8. ANNUAL STAFF SUPPORT AND COUNSELLING SERVICE REPORT 9 9. CRITICAL INCIDENTS EDUCATION & TRAINING OTHER RELEVANT POLICIES MONITORING & REVIEW 10 APPENDIX A: APPENDIX B: APPENDIX C: APPENDIX D: APPENDIX E: APPENDIX F: TEAM RISK ASSESSMENT (TEMPLATE AND EXAMPLE) INDIVIDUAL RISK ASSESSMENT (TEMPLATE AND EXAMPLE) RISK ASSESSMENT FLOW CHART RECORDING OF OCCUPATIONAL MENTAL ILL HEALTH ADDITIONAL INFORMATION AND GUIDANCE PSYCHOLOGICAL FIRST AID: INFORMATION SHEET 1

7 1 Introduction NHS Lothian is committed to promoting a healthy workforce by placing value on both physical and mental health. It is acknowledged that stress problems have many causes, including the workplace and the outside world. NHS Lothian recognises that excessive and sustained pressures at work can have negative effects on staff, and will encourage and actively promote a supportive environment and working culture for all employees to help reduce, control and manage stress at work. It is also recognised that domestic factors (for example housing, family problems and bereavement) may add to levels of stress experienced by staff. 1.1 Definition The term stress is often misused and misunderstood, and is a complex subject. For the purposes of this policy, NHS Lothian follows the Health and Safety Executive s definition and regards stress as an adverse reaction that people have to excessive pressures or demands placed upon them, and arises when individuals believe they are unable to cope. Stress therefore is not an illness or a type of ill health; it is a cause of illness or ill health. 1.2 Commitment NHS Lothian is committed to taking steps, as far as is reasonably practicable, to ensure that an employee s health is not placed at risk through excessive and sustained levels of pressure arising from the way work is organised, the way people deal with each other or the day-to-day demands placed on the workforce. All staff have a responsibility to contribute to this positive way of working. NHS Lothian is committed to a proactive plan of action that includes:- Being proactive in the prevention of stress by carrying out workplace risk assessment and putting in place controls and corrective measures as required. Taking positive action to tackle stress and help all staff to manage and identify causes and effects of stress by developing appropriate awareness training and stress management tools. Ensuring that appropriate measures are taken to manage the return to work of those who have suffered mental or physical health problems associated with stress, to make sure their skills are not lost. This will include managing health problems associated with stress by recognising stress early, managing stress appropriately, providing access to counselling and providing advice and sources of help. Monitoring and reviewing employees perception of stress through stress audit across the organisation. 2 Scope This policy applies to all staff employed by NHS Lothian. 3 Policy Aims This policy aims to maintain and encourage staff well being within NHS Lothian. Positive action will be taken to discourage the stigma attached to stress and raise 2

8 awareness of ill health associated with stress, its causes and associated factors: This involves changing aspects of the workplace/job which have been identified (through risk assessment) as increasing the stress risk, and enhancing the factors that reduce the risk of stress. The proactive identification of the causes of work related stress through the risk assessment process (see guidance below) must be continuous. It is a legal requirement to undertake such an assessment under the Management of Health and Safety at Work Regulations, regulation 3. It is NHS Lothian s intention to educate staff in techniques for coping with pressure and stress, and through information and education encourage everyone to recognise problems. Appropriate measures will be put in place to prevent stress arising in the workplace. NHS Lothian will also provide staff with help if they have mental or physical health problems associated with stress, including well-publicised systems of support. The organisation will encourage staff to get help at an early stage, and offer easy access to counselling and other professional help and, as far as is reasonably practicable, assure job security, sick leave and the retention of status and generally make sure there is no blame attached to those using the support mechanisms. As part of dealing with stress positively NHS Lothian has procedures for return to, and rehabilitation in, work and will make sure that these procedures are flexible enough to meet varying needs. Note: NHS Lothian has other policies which may be relevant in particular circumstances, including Promoting Attendance at Work, Managing Employee Capability and Dignity at Work; these should be consulted where appropriate in conjunction with this policy. Appendix E attached to this policy gives additional information to assist in dealing positively with stress at work. 4 Responsibilities 4.1 Senior Managers It is the responsibility of senior managers to implement processes to proactively measure and control potential hazards in the workplace associated with stress, and to make sure that an organisational culture is developed where stress is not seen as a sign of weakness or incompetence and where seeking help in managing negative stress is seen as a sign of strength and good practice. It will be policy to ensure: advice and information is provided for managers on their duty of care to staff, suitable training and guidance is provided to equip them to undertake the necessary risk assessments in relation to stress in the workplace, and effective control measures are implemented where appropriate; stress, which is likely to lead to ill health, is eliminated from the work environment as far as is reasonably practicable; information is provided for staff on the effects of stress at work and how to 3

9 recognise the symptoms of negative stress in themselves and others; positive coping mechanisms and general health improving activities are promoted within the workplace; a working environment is promoted where employees who feel they are at risk of suffering from the negative effects of stress can raise the issue in confidence, and necessary support mechanisms are put in place; good practice guidelines based on current evidence and knowledge are produced and reviewed regularly; risk assessments are acted on and resources are made available to address the issues highlighted. 4.2 Line Managers Line managers also are responsible for assessing proactively and managing potential hazards in the workplace associated with stress, to make sure that an organisational culture is developed where stress is not seen as a sign of weakness or incompetence and where seeking help in managing negative stress is seen as a sign of strength and good practice. As part of their responsibility they must also ensure, as far as is reasonably practicable: that the work environments for staff are safe and do not expose them to risks that may give rise to stress at work, by carrying out risk assessments in accordance with this policy; a robust recruitment, selection and employment process is in place which includes the provision of clear and concise job information, job descriptions (outlining lines of responsibility, accountability and reporting), individual supervision, ongoing appraisal and development with clear objectives that are regularly reviewed and monitored; that all new staff receive appropriate induction to and training for their job, including reference to support services, for example, OHS, HR and the Staff Counselling Service; they consider the implications and impact for staff of any changes to working practices, ways of working, work location, new policies or procedures and the need for appropriate support and training. This will also include regularly reviewing excess hours worked by staff, time back, absence monitoring and staff turnover, and carrying out exit interviews; they encourage the involvement of individual staff and staff teams in seeking solutions, as part of the risk assessment process; promote openness and discussion and involve others outside the team as necessary; also make sure that staff teams take time out to review and celebrate positive achievements and likewise less positive outcomes so that a sense of balance can be achieved; practical management of absence in accordance with the policy on Promoting Attendance at Work, and linking to other policies as necessary such as Dignity at Work, Managing Employee Capability etc. 4.3 All Staff All staff have a duty to take care of themselves and others who may be affected by their acts or omissions at work, including those issues associated with stress. Where control measures have been provided to reduce work related stress employees have a duty to use them, and must report any incidents associated with 4

10 stress. They also have a responsibility for treating colleagues in an appropriate and respectful manner and to co-operate with their employer in ensuring Dignity at Work. Staff can resolve issues by talking to their manager if there is a problem, or accessing areas of support i.e. OHS, HR or their trade union/professional organisation; also by: being actively involved in the risk assessment process, discussing with their manager how it may be possible to resolve the issues identified, including altering the job if necessary to make it less stressful, while recognising all team members needs. supporting their colleagues if they are experiencing work related stress and encouraging them to talk to their manager, OHS, HR or trade union/professional organisation. 4.4 Human Resources The role of HR is in making sure that organisational policies and codes of working are compliant with changes in the law and promoting adherence by all staff. They will also become involved in: facilitating discussions within areas of conflict; liaising with management to carry out risk assessments, including reviewing absence figures and linking these with other policies that may be relevant; advocating clarity of roles and responsibilities, advising on job descriptions and organisational structure; monitoring trends in conduct (disciplinary and grievance issues), attendance, turnover etc; promoting positive cultural change within the workforce. 4.5 Trade Unions/Professional Organisations Trade unions/professional organisations are responsible for encouraging members to speak up as soon as they feel they that their working environment is beginning to affect their health, and to seek information and advice on coping with work pressures. This could involve them investigating potential hazards and complaints from their members, and receiving information they need from the employer to protect members health and safety. This could also involve encouraging members to keep a written record of any problems and to put things in writing to management, so that there is evidence of any problems and that management is aware of them. 4.6 Occupational Health Services Occupational Health Services play an active part in the prevention, investigation and diagnosis of work related illness, including that resulting from work related stress. They have experience and knowledge in the field, providing advice and services to both management and staff. Key roles include: provision of advice on occupational stresses, the risk assessment process, and mechanisms of control; at the request of management, investigation and evaluation of particular groups of staff where occupational stresses may be an issue, including use of interviews, focus groups and small stress audits; management referral, providing advice on the formal diagnosis of illnesses 5

11 related to work related stress, management of affected staff, further control measures in the workplace and requirements for a return to work; health input into the education and training programme; monitoring work related illness in terms of sickness absence and self/management referral numbers; by management or self-referral providing support for staff experiencing the negative effects of stress The Staff Support & Counselling Service The Staff Support and Counselling Service is an independent part of the Occupational Health Service. Experienced counsellors provide counselling to staff who self refer with a wide range of problems, including stress, in a safe confidential environment. Counsellors have a responsibility to support and assist employees in managing their experiences of stress and to work with individuals towards implementing effective strategies to maintain emotional/mental health by: offering an opportunity to talk in confidence about any problem, whether work related or not; offering support to help people gain insight into their difficulties and enabling them to be more effective in dealing with their situation; helping individuals to identify, think through and resolve current difficulties; assisting individuals to develop strategies that will help them to deal with future difficulties. The service is for all NHS Lothian staff who wish to self refer. Management referral is not an option, but managers may feel it is appropriate to inform/remind staff that the service is available. If staff do self refer, no information will be sent to line management. 5.0 Risk Assessment In the Workplace Stress is recognised as a significant workplace hazard, resulting in mental and physical ill health. As such there is a statutory requirement to undertake workplace risk assessment, and where appropriate instigate effective control measures. Managers and staff must comply with the risk assessment processes documented in this section. In common with a number of workplace hazards such as noise or ionising radiations, there is significant variation in an individual s ability to cope with work pressure and hence their susceptibility to work related stresses. In addition, an individual s susceptibility may vary with time, particularly in relation to the amount of non-work related pressures they are encountering. This situation determines that risk assessment for work related stress and mental ill health should have components which are both individual and continuous. In addition, staff operate within teams, with common goals and common pressures. Risk assessment therefore requires consideration of the team as a whole as well as the effect on the individual. Risk assessment for work related stress must therefore form an important part of a manager s regular discussion with the team as well as an integral part of regular performance review of individual team members. 5.1 The NHS Lothian Process The Health and Safety Executive (HSE) commissioned research which identifies 6 major areas in the workplace associated with pressure and stress. These are 6

12 Demands, Control, Support, Relationships, Role and Change. The risk assessment process used in NHS Lothian is based on this data, and divides workplace pressures and stresses into three general categories: stressful exposures (such as noise, violence and aggression, fear of violence and aggression, poor lighting etc); capability constraints (i.e. time, staffing, qualifications, work pattern); relationships at work (individuals, groups, management, patients, customers). In addition, it is recognised that other aspects not fundamentally related to the work itself can place pressures on staff i.e. changes, perceived job insecurity, disciplinary considerations etc. Within the context of normal team management, and team meetings, a team summary of the important stresses must be documented at least annually. The format for this documentation, including a worked example, is at Appendix A. Based on this team consideration, the need for team based control measures must be identified, documented and implemented. Additionally, personal development planning for the individual staff member must include a review of this team based work related hazard identification. At this review, the need for individual based control measures should be considered and documented. The format for this documentation, including an example, is at Appendix B. When deemed appropriate by the team or requested by the individual, a review of the current risk assessment must take place. 5.2 Control Measures Control measures can be considered in relation to the grouping of stresses identified earlier: Stress from exposure Risk assessment and control of the exposure itself Individual training on the nature of the hazard and control of the causes of the stressful exposure Provision of appropriate personal protective equipment Balance of capability and expectation Individual training to enhance capability Measures to enhance team capability Adequate staffing Effective performance review and personal development review Relationships at work Effective communications Teamwork and team solutions Open systems and airing problems Others Communication regarding changes Implementation and monitoring of appropriate policies and procedures Regular contact between manager and staff, at both individual and team 7

13 level, is in itself an effective control measure for work related stress. The risk assessment process will in some cases identify the need for control measures with financial implications in terms of training, staffing, protection etc. In addition to the control measures aimed at eliminating the hazard or reducing risk, measures can be introduced to reduce the effect. These include stress awareness training, stress management and time management training, and individual services such as counselling and Occupational Health involvement. Details of these are recorded in the other sections of this policy. Where risk assessment indicates the potential for significant team based problems the manager may seek assistance from Human Resources and Occupational Health; specific stress audit and stress support may be indicated. 5.3 Risk Assessment Review The team-based documentation (Appendix A) should be reviewed at least annually. The individual assessment (Appendix B) should be reviewed: at each performance review/appraisal; at the request of the individual (management style and systems should encourage the airing of problems); when management consider it necessary, for example change of work or responsibility, considerations of performance. In considering situations of uncertainty, change, discipline and grievance issues, the management responsibility is not to ensure that these situations do not occur, but that the systems in place function well enough to ensure that the processes themselves do not add to the pressures felt by those involved; additionally, that the system provides the individuals with the information they need. 5.4 Risk Assessment Process A flowchart summarising the risk assessment process can be found in Appendix C. 6 Stress Audit Stress audit provides a valuable tool to identify staff perceptions of organisational structure, culture and work pressures. As such it is separate from the risk assessment process outlined above. There are a number of tools available for this purpose, including one issued by the HSE. NHS Lothian obtains stress audit data on the organisation as a whole from the regular NHS Scotland Staff Survey. Audit of small groups and teams may be instigated following discussions in partnership, including the OHS, where specific issues have been suggested or in relation to the introduction of new processes. 7 Diagnosis of Work Related Mental Ill Health Where staff members attend Occupational Health by either management or self referral with a perceived stress condition, a key function of the assessment is the identification of whether the staff member suffers from an illness which is related to their work. This situation applies in relation to stress through considering work related mental ill health. For information, the principles of the system operated by NHS Lothian in this regard are at Appendix D, which outlines the prognosis and 8

14 recording of occupational mental ill health. 8 Annual Staff Support and Counselling Service Report In addition to risk assessment, audit and numbers of cases of occupational ill health, the annual Staff Support and Counselling Service Report provides data on the perceptions of clients on the relevance of both home and work-related pressures in relation to their problems. 9 Critical Incidents Some events in the workplace have the potential to raise psychological issues for staff. Some of these may trigger contact with the Staff Support and Counselling Service. In order to be of maximum help to their staff, managers should make use of the guidance in Appendix F. 10 Education and Training To deal positively with stress in the workplace, NHS Lothian recognises the importance of: the link between home and the workplace; identifying particularly vulnerable groups, and; the effects of prescribed medication on work performance. These key points will be highlighted in general health education and induction programmes. It is also important that specific management training (i.e. stress recognition and risk assessment), and awareness training for employees are developed in line with this policy. Currently available to all NHS Lothian employees is a two-day Stress Resolution Programme, which is run on a regular basis: The programme will help identify what contributes to people s stress on an organisational and personal level. It will explore the sources of stress and an individual's emotional and physical responses to stressors. The programme will be delivered in small groups, providing a safe and confidential space with time to explore the issues of stress and how this impacts on daily life. The programme aims to help individuals identify ways and strategies to manage stress. For further information, contact the Workforce and Organisational Development Department. 11 Other Relevant Policies NHS Lothian has in place a number of other policies which complement and support this policy, including the various Work-Life Balance Policies. Also of particular relevance is the Policy on Managing Employee Capability, which should be read in conjunction with this policy wherever there are issues in relation to individual performance. 9

15 12 Monitoring and Review Risk assessments should be reviewed in light of any changes to work activities. Regular evaluation of staff turnover, sickness absence and stress related incidents identified from the application of other NHS Lothian policies and accidents will contribute to the monitoring and reviewing of the policy. The effectiveness of the overall policy will be reviewed after a period of two years by the Lothian Partnership Forum. 10

16 APPENDIX A TEAM RISK ASSESSMENT Sources of Stress at Work Work related stress hazard identification form (Used as part of ongoing team meetings and discussions to identify/recognise areas of potential stress in the workplace.) LOCATION DEPT MANAGER TEAM ROLE/OPERATION/ACTIVITY EXPOSURES (Workplace exposures recognised as a potential stressor) Controls required CAPABILITY CONSTRAINTS (List constraints of time, staffing, qualification, work pattern) 11

17 2 (continued) KEY RELATIONSHIPS (List/identify key groups within or outwith the team which team members must relate to at work) Example: Controls required 1 HR Team (Team to identify issues or stressors they think may be present in relation to contacts they 2 General Managers have outwith their own teams. 3 Groups of Staff/Employees 4 Staff Representatives Individuals issues and control mechanisms will be discussed on a one to one basis using Appendix B.) 5 External Contacts 1 Others Assessment based on team input Signed.. (Manager) Designation.. Date.. N.B Team risk assessment when used as part of ongoing regular team discussions may produce general team concerns. Individual concerns identified as part of this process will be detailed and progressed using Appendix B. 12

18 APPENDIX A EXAMPLE TEAM RISK ASSESSMENT Sources of Stress at Work Work related stress hazard identification form (Used as part of ongoing team meetings and discussions to identify/recognise areas of potential stress in the workplace.) LOCATION NHS Lothian DEPT MANAGER Jane Smith TEAM ROLE/OPERATION/ACTIVITY Lift from role of department in job description. EXPOSURES (Workplace exposures recognised as a potential stressor) 1. Lack of admin support due to staff vacancies / sickness Controls required Review admin tasks and prioritise essential tasks. Utilise Promoting Attendance policy. 2. Managing difficult people /aggression 4. Policies / decisions outwith our control e.g deadlines on Agenda for Change/ uncertainty re pay / review process Complete Violence and Aggression risk assessment / provide relevant training to staff Provide as much information as possible to staff e.g Agenda for Change updates, Lothian Report. Discuss concerns with staff. 7. Inter-agency working Need to review models of good practice. Continue to develop relationships with Edinburgh Council. CAPABILITY CONSTRAINTS (List constraints of time, staffing, qualification, work pattern) Lack of clarity over postgraduate qualifications required for the posts. Action: Complete KSF post outlines Staff doing A & C tasks due to staffing constraints. Action: Repeat unique review 13

19 2 (continued) KEY RELATIONSHIPS (List/identify key groups within or outwith the team which team members must relate to at work) Controls required 1. Staff within the immediate department Communicate with mutual respect and understanding. Possibly develop a team contract. 2. Staff within the extended department Foster relationships. Develop lines of communication / procedures for referral. 3. Managers Use the phone rather than on individual issues. 4. All staff Utilise influencing and coaching skills. Provide training in this if required. Others Assessment based on team input The team managed to identify stressors and potential controls well through discussion and negotiation. Signed.. (Manager) Designation.. Date.. N.B Team risk assessment when used as part of ongoing regular team discussions may produce general team concerns. Individual concerns identified as part of this process will be detailed and progressed using Appendix B. 14

20 APPENDIX B INDIVIDUAL RISK ASSESSMENT Sources of Stress at Work Work related stress hazard identification form (Used as part of employee s ongoing KSF/Performance Review based on Team Risk Assessment dated:...) LOCATION DEPT MANAGER NAME ROLE/OPERATION/ACTIVITY EXPOSURES (Workplace exposures recognised as a potential stressor) Individual control measures CAPABILITY CONSTRAINTS (List constraints of time, staffing, qualification, work pattern) Individual control measures 15

21 2 (continued) KEY RELATIONSHIPS (List key groups within or outwith the team which team members must relate to at work; starting point is team risk assessment see Appendix A.) Individual stressor control measures 1 Others Signed: Team Member Date:.. 16

22 APPENDIX B EXAMPLE INDIVIDUAL RISK ASSESSMENT Sources of Stress at Work Work related stress hazard identification form (Used as part of employee s ongoing KSF/Performance Review based on Team Risk Assessment dated:...) LOCATION NHS Lothian DEPT MANAGER NAME ROLE/OPERATION/ACTIVITY EXPOSURES (Workplace exposures recognised as a potential stressor) Individual control measures 1. Lack of admin support due to staff vacancies. 2. Managing difficult people/aggression Review admin tasks and prioritise and undertake essential tasks only until situation resolved. Attend Violence and Aggression training. Regularly discuss how to manage difficult people with line manager. CAPABILITY CONSTRAINTS (List constraints of time, staffing, qualification, work pattern) Individual control measures Required to undertake A & C tasks therefore less time to do professional tasks Prioritise admin tasks and professional tasks. Discuss this prioritisation with line manager regularly. 17

23 2 (continued) KEY RELATIONSHIPS (List key groups within or outwith the team which team members must relate to at work; starting point is team risk assessment see Appendix A.) Individual stressor control measures Managers If there is lack of clarity or concern in relation to tone of an , phone the staff member concerned 1 Others Signed: Team Member Date:.. 18

24 APPENDIX C RISK ASSESSMENT PROCESS Annual Team Risk Assessment Annual Individual Risk Assessment/PDP Stress Hazards Identified Control Measures Identified seek advice as necessary Reduce the Effect Training and/or Counselling Implement Control Measures. Monitor and Review No Stress No Stress Identified Identified Stress Identified No Action Further Support and Guidance This process should be repeated as appropriate, for example on specific request or when there is organisational change. 19

25 APPENDIX D Recording of Occupational Mental Ill Health NHS Lothian requires to gather Health and Safety data on the number of staff suffering work related mental ill health and the resultant sickness absence. This requirement defines the need for a standard recording and diagnostic system. Diagnostic system The diagnostic system used for all occupational ill health recording in NHS Lothian is as follows: 1 The responsibility for diagnosis rests with the Occupational Health professional to whom the individual has been referred. The process may involve seeking reports, clinical examination and investigations. When a decision is reached as to whether the condition is considered related to work or not, in all cases the individual is informed of this conclusion. 2 It is not considered possible to diagnose occupational illness in a clinic without consideration of the workplace itself. Diagnosis therefore requires direct contact with line management, seeking of reports, and where appropriate investigation. Contact with management involving direct considerations of a clinical case may only proceed where the staff member s consent has been obtained. In circumstances where the diagnosis of occupational causation cannot be confirmed without managerial contact and the patient withholds consent, the case is categorised as not confirmed. Basic principles for occupational mental ill health reporting 1 Only cases where in the view of the Occupational Health professional work or workplace considerations are the predominant factor in inducing mental ill health will be recorded. A crucial test will be whether it is considered that in the absence of the occupational incident or exposure there would have been a significant difference in the individual s underlying mental health. 2 Occupational stress is regarded as a physiological process or response, rather than a diagnosis of ill health itself. Individuals will only be recorded on the system where occupational factors have resulted in significant ill health recognised by national or international systems of disease classification. 3 It is important to include some estimate of the causative factors of work responsible for the mental ill health. Without such data appropriate corrective action and learning from experience cannot occur. 4 There are work related factors such as job uncertainty, termination of employment and the operation of disciplinary procedures which, even when handled appropriately by management, may nevertheless result in stress and in turn mental ill health. It is not considered that these events are preventable under the legal obligation placed on management by the Heath and Safety at Work Act and as such they will not be recognised within this system as occupational mental ill health. The system will however record incidences of this type separately under a category of non-occupational workplace mental ill health. 20

26 Categories of occupational mental ill health reporting Category M1 Significant occupational mental ill health related to specific workplace exposures ie toxic chemical, risk of violence and aggression, noise etc. Category M2 Significant occupational mental ill health related to the imbalance of capability and work load/work contact ie work overload, work underload etc. Category M3 Significant occupational mental ill health related to interpersonal or interorganisational relationships at work ie bullying, managerial style, workforce attitude, lack of autonomy, relations with colleagues. In addition to the three categories of occupational mental ill health data will also be recorded on the incidence of the following category: Category M0 Significant mental ill health related to workplace factors, but not in relation to the duties of the employer under the Health and Safety at Work Act, ie job uncertainty, termination of employment, operation of disciplinary procedures. (Note the existence of disciplinary case or job uncertainty etc does not in itself determine the categorisation of any mental ill health as M0. Against a backdrop of M0 issues, significant mental ill health can occur related to M1, M2 or M3 and would be categorised accordingly.) 21

27 ADDITIONAL INFORMATION AND GUIDANCE APPENDIX E 1 STRESS RECOGNITION Managers and supervisors will be trained to understand the causes of stress and to recognise the signs and symptoms of stress in the people working for them. Managers should, more importantly, be aware of stress within themselves and the impact this can have on others. Individuals will also be trained to recognise the signs of stress within themselves. Daily contact with employees by managers and supervisors will enable recognition of stress-related symptoms. As part of part NHS Lothian's Policy on Promoting Attendance at Work, where it is suspected that stress may be the cause, it should be fully investigated and the causes, where reasonably practicable should be eliminated. Managers should also plan an individual s return to work after a stress-related illness to ensure ongoing support is provided. 2 WORK RELATED STRESS FACTORS There are many factors in the workplace that can cause an increase in pressure, which can result in stress and mental ill health. It is convenient to divide these into three groups. (i) Stressful exposures There are a number of workplace hazards, for which you will already have risk assessments, which can result in pressure and stress on staff. These include: i) threat of violence and/or aggression ii) noise iii) fear of chemical exposure iv) lack of work space (ii) Imbalance between capability and expectation Imbalance between an individual s capability and workload is a common cause of pressure and stress in a number of situations: i) work overload ii) work underload iii) work beyond an individual s knowledge or skills iv) work much below an individual s knowledge or skills (iii)relationships at work Interpersonal relationships in the workplace can also result in pressure and stress on individual or groups of staff, for example: i) tension and conflict between colleagues ii) poor relationships with clients/patients iii) management style iv) bullying and harassment 22

28 The important elements of the team member s activity should be documented using the work related stress hazard identification form. The form should be completed based on discussions of the team and the individual s role and work. 3 SIGNS & CAUSES OF STRESS (i) Signs that may indicate a stress problem may include: Work Performance: a reduction in output or quality; increased wastage or mistakes; accidents; poor decision making. Employee Attitude and Behaviour: loss of motivation; working longer hours for diminishing return; not taking annual holidays; reluctance to let go; erratic timekeeping. Sickness Absence: increase in overall absence; frequent short absences. Relationships at Work: tension and conflict between colleagues; poor relationship with customers and/or clients; increased disciplinary problems; lack of communication; mood swings. (ii) Stress can be due to one or more of the following causes: Work Environment: excessive heat; noise; humidity; vibration; hazardous substances; overcrowding; unsuitable work equipment or furniture; inadequate welfare facilities (toilets, rest areas, etc); new technology. The Job: excessive or insufficient workload; unrealistic deadlines and targets; lack of direction, goals or objectives; inadequate or too much supervision; job isolation; pace and flow of work; boring or repetitive work; excessive or lack of skills and/or aptitude; and under-utilisation of skills. Contractual Problems: unsociable hours, shift work; insecurity (reorganisation, redundancy, temporary contracts); and low pay. Relationships: lack of communication; lack of leadership; lack of support; exclusion; bullying; sexual and racial harassment. The above causes of stress are only examples and the list is not exhaustive. It should also be noted that each case should be considered individually, as what would cause one person stress may be acceptable to another. 4 PHYSICAL SYMPTOMS Personal signs and symptoms: If excessive pressure has led or is leading to stress and this becomes prolonged, it is likely that there could be an increase in the following: back pain, increase in alcohol intake, increased smoking, drug taking, irritability, lack of concentration, stammering, headaches, visual problems, muscular pains, tiredness, disturbed sleep patterns, insomnia, shortened temper, change in appetite or loss of self esteem. 23

29 5 LIFESTYLE Some of the following lifestyle factors may indicate that there is a potential problem: eating on the run and constantly rushing, hurrying. being available to everyone, doing several jobs at once taking work home with you having no time for exercise or relaxation. 6 STEPS TO REDUCE STRESS Steps that management can take may include: Reduce/Increase Workload: a temporary reallocation of work or consideration of work methods to enhance productivity may make a workload more manageable or reasonable. Alternative Work: where the nature of the work is the source of stress, the employee or the manager may consider voluntary transfer to another job or section. Reduced Hours: fewer or changed hours may reduce the pressure at home or at work. If hours worked are excessive, or breaks or holidays are regularly not taken, this must be tackled by reviewing the workload. Job Redesign: if the balance of tasks within a job is problematic, consider changing it through planning, rotation, automation or different work distribution within a section. Increased Supervision: if particular aspects of the work are the source of the problem, increased involvement and support from the supervisor may alleviate some of the concerns. Management Style: if the style or mode of supervision is the source of pressure then consider changing or adopting a different management or supervisory style, where appropriate. Management should ensure that work aims, objectives, targets and priorities are known and clearly understood by all employees when implementing any of the above measures. 7 AREAS OF SUPPORT AVAILABLE The following support should be considered: Management Support: a supportive environment in which employees can approach their line manager should be provided. The acceptance and recognition of stress as a genuine problem that requires management support and action is encouraged. Managers should tackle signs of stress both proactively and reactively. Managers should however be aware of their own limitations in counselling staff with problems. Employee Approach: employees are encouraged to be open and speak to their manager if they are experiencing problems or are aware of a situation that may lead 24

30 to a stress problem, on either an individual or a group basis. Employees may also approach their trade union representative or seek confidential support from the Staff Support & Counselling Service. Employees who feel the problem is not being adequately addressed by their manager, or who feel that they are unable to discuss the situation openly with their manager, may contact any other of the sources of support mentioned for advice. The Staff Support & Counselling Service: access to a qualified counsellor at no charge, with time off work with pay, if necessary, is currently available. Development & Training: ensure the identification and meeting of training needs, particularly where an employee moves to a new or changed role. Training to enable managers and individuals to recognise and manage stress will be available through management development programmes. Confidential Contacts: Under NHS Lothian s Policies on Dignity at Work, Equal Opportunities and Race Equality, the organisation has identified and trained a number of individuals who can be contacted by employees who feel they may have been subject to bullying, harassment or discrimination in order to discuss their situation and to seek support in making a decision about how they wish the matter to be dealt with. The Confidential Contact has no formal role within the Dealing Positively with Stress at Work procedures and is not expected or trained to fulfil a professional counselling role. It is important to understand that the Confidential Contact is only there to support the individual in making the decision about the way forward not to make the decision for them. Occupational Health: advice is available from the Occupational Health Service for staff with health problems that either affect their work or are affected by their work. In the event that an employee is absent with work-related stress, then they should be referred to the Occupational Health Service, following a meeting with management, at the earliest opportunity. Any such referral should clearly be seen as supportive. Further discussions should occur on receipt of the Occupational Health Service's report and any recommendations/actions discussed openly between management and the individual. 25

31 APPENDIX F Psychological First Aid Information for Managers Introduction Working in the NHS can involve staff facing a range of challenges and unpredictable situations. Such events can be difficult for the individuals directly involved, their colleagues and managers. This information sheet aims to give guidance for the support and management of the staff affected. Definition of a Critical Incident Formal Definition: Person exposed to event in which:- - they experienced, witnessed or were confronted with an event, or events, that involved actual or threatened death, or serious injury, or a threat to the physical integrity of self or others, AND - the person s response involved intense fear, helplessness or horror. In more general terms a critical incident within our work context could involve a serious assault, suicide, life threatening accident, perceived threat or other traumatic event. Management Response It is important that all staff who have had ANY involvement in, or exposure to, a traumatic event have the opportunity to be supported. Individual reactions to such event can vary enormously, as will individual support networks and attitudes towards asking for help. Therefore, it is a manager s responsibility to check with all concerned as to how they are coping. Research informs us that the acknowledgement of a traumatic event by managers and early informal support has a major impact on long term recovery. It is also important that staff are aware of the range of normal responses to an abnormal event. See the separate information leaflet, Critical Incident Protocol: Information for Staff, available from the OHS and HR Departments. Suggested below is a process for supporting staff in the immediate aftermath of a critical incident * Incident * 1. Identify who is on shift make a list of all personnel, any of whom may be affected by the incident. 2. Prioritise from the list key individuals involved in the situation; this should include immediate witnesses to the event, but may include others e.g. telephonist. 3. Make time to check with individuals to find out how they are feeling. This 26

32 needs to happen as soon as possible after the event in order to reassure staff with regards to their safety and any practical help that can be offered. In some situations this may involve staff going home or some time out. Being offered the support is often more helpful than anything else. 4. Listen to staff concerns and allow them to express their feelings. 5. Ensure that all staff are aware of typical reactions to trauma so that feelings are normalised and people reassured; offer the information leaflet to take home and share with others in a support network. 6. Arrange to check in with staff 2-3 weeks after the event to give recognition to what has happened and facilitate the moving on. 7. Encourage informal support within the group affected, even where there may be confidentiality boundaries. It is very important for staff to know they can, and may need, to talk about their feelings. 8. Ask Occupational Health for advice or support at any stage in the process if required, and ensure information on the Counselling and Support Service is available to all. 9. When giving information about Occupational Health and the Counselling Service please ensure the incident is reported to these services in order that appropriate response and support can be offered. 10. Continue to provide any appropriate information regarding the event so that staff have answers to likely concerns regarding the outcome or consequences of the event. 11. If formal proceedings or investigations are implemented, managers should keep relevant staff informed as much as possible particularly if staff are suspended or under investigation. Occupational Health Enquiries: (4)9364 Staff Counselling Service: (4)