The Trust s sickness absence target has not been met in each of the last seven consecutive months.

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1 Report to: Board of Directors Date of Meeting: 25 January 2017 Report Title: Sickness Absence Exception Report Status: For information Discussion Assurance Approval Regulatory requirement Mark relevant box with X X X Prepared by: Michael Smith, Head of Employee Health and Well Being Executive Sponsor Nick Parker, Director of HR and Workforce (presenting): Appendices (list if Sickness Absence Exception Report; Appendices 1, 2 and 3 applicable): Purpose of the Report The Trust s sickness absence target has not been met in each of the last seven consecutive months. The attached report provides an assessment of the sickness absence position across the Trust and the actions being taken to reduce absence to target levels. Key points for discussion The report provides an assessment of the current sickness absence position in comparison with others, between staff groups, by absence reason; and costs. Key points of note are: Airedale NHS FT s sickness absence rate has been higher than target for the last 7 months The health sector has higher levels of sickness absence than other sectors and Yorkshire and Humberside region has higher levels of sickness absence than other regions ( except the North West and North East) Sickness absence levels at Airedale are in line with other local trusts, though two trusts have consistently lower levels in the comparison period Absence levels are higher amongst some staff groups, namely estates and ancillary; additional clinical services; and nursing and midwifery, though this can be expected given the nature of the work undertaken Monday is the most prevalent day of absence, followed by Tuesday The main causes of absence differ between short and long term absence, though mental health related absences remain an area of concern There is a need to strike the right balance between the active management of absence and steps to improve overall staff health and well being The Trust has a comprehensive range of support/interventions to deal with sickness absence and staff well- being, but is looking to further strengthen arrangements through a review of the sickness absence management approach, use of the Bradford Factor methodology and increasing HR capacity. Recommendation The Board is asked to receive and note the attached report and appendices.

2 Sickness Absence Exception Report Background This report has been produced to provide an assessment of the sickness absence position across the Trust given that the Trust s sickness absence target has not been met in each of the last six consecutive months. Action To receive and note. Airedale sickness absence rates Appendix 1 provides details of Airedale NHS FT s absence rates and comparison data. For Airedale, the monthly sickness absence has been in excess of 4% with the highest rate of 4.79% reported in October With the exception of December, the remaining months have been under 4.5%. (Table 1.1) The comparison of sickness absence by month since 2013 is detailed within Table 1.2. Comparisons with other sectors and regions Tables 1.3 and 1.4 provide details of sickness absence by sector and by health education region between January 2016 and August The health sector has higher average sickness levels than other parts of the public sector. The highest rates of sickness absence are reported in the North West, North East and Yorkshire and the Humber. In August 2016 Yorkshire and Humber Region reported an overall sickness absence rate of 4.37%. Through this period the patterns of sickness absence between regions were very similar and share the same peaks. (Table 1.5) Comparisons with other local Trusts Table 1.6 provides details of absence rates between June and August 2016 for some of our local Trusts. More recent data is not yet available. The data for this period suggests absence levels at Airedale are in line with those in other local Trusts, though higher than Leeds THT and Harrogate FT. The prevalence of sickness absence by staff group For the purposes of this report the staff groups have separated into 8 groups and the rate of sickness absence for each of these groups is presented by month in Appendix 2. During the 6 months of July to December 2016 Estates and Ancillary and Additional Clinical Services have featured in the top 3 for absence in each month. The Nursing and Midwifery staff group has featured in the top 3 for absence levels on four occasions with the sickness absence for this group peaking at 5.51% in August, reducing to 5.34% in October with a further reduction to 4.72% in December. The nature of work undertaken by staff in the nursing and midwifery and additional clinical services staff groups is operationally demanding and brings them into regular contact with people that are unwell, so it is not surprising to see higher than average levels of absence amongst these groups. To a lesser extent the same 1

3 can be said of some of the staff within the estates and ancillary group (porters, domestics etc.), though the grading of posts may also be a factor here. Health care scientists and Medical and Dental groups have consistently ranked in the lowest three for sickness absence with Allied Health Professionals reporting in the lowest three through five consecutive months including December The prevalence of sickness absence by day of the week Appendix 2 tables 2.4 and 2.5 show the day of the week on which sickness absence commenced by employee headcount. Monday followed by Tuesday is the day with the highest prevalence. The highest incidence of sickness absence commencing on a Monday was through October and November. It should be noted the graph shows that in August, Tuesday became the highest day for reporting an episode of sickness absence. This related to the Bank Holiday within this month. Sickness absence short term and long term The HR reporting system allows the absence reason to be categorised and ranked by the rate of incidence for short term absence of less than 4 weeks and long term absence for periods greater than 4 weeks. Short term absence The short term absence report for the six months including December 2016 suggests that injury/fracture; pregnancy related disorders; back problems; anxiety, stress depression; and musculoskeletal problems are the main reasons for absence in terms of days lost. However, when illnesses such as cold, flu, respiratory, ear, nose and throat are combined they too would feature in the main reasons Appendix 2, Table 2.6. Long term absence The long term absence report for the six months to December 2016 presents a different presentation of absence reason with; anxiety, stress depression, musculoskeletal problems, other known causes not classified elsewhere and back problems as the main reasons for absence in terms of days lost. Table 2.7. Through this six month period, long term absence accounted for 13,280 days lost to the Trust. Generating this report has identified that categories S98 Other known causes not elsewhere classified and S99 unknown causes / not specified are used too frequently and are not useful when prioritising or addressing absence reasons. Steps will be taken to reduce and remove the use of these codes. Combined sickness absence (short and long term) The combined sickness absence report for the same period moves the main reasons for absence into a different order and presents injury, fracture, pregnancy related 2

4 disorders and back problems as the top three reasons followed by anxiety/ stress / depression / other psychiatric illnesses, Table 2.8. Through this six month period a total of 19,184 days have been lost through sickness absence. Sickness absence by absence reason for all staff groups Tables 2.9, 2.10 provide details of the main reasons for absence in terms of days lost by staff groups. The top absence reasons differ by staff groups with Estates and Ancillary reporting musculoskeletal and back problems as their top reasons. Healthcare Scientists reported pregnancy related disorders. The Nursing and Midwifery groups together with Additional Clinical Services and Admin and Clerical Groups reported anxiety / stress / depression as the main reason. Within the Admin and Clerical Group, management and corporate services have historically low levels of absence which suggests absence levels are higher than the rates presented for some areas of admin and clerical. The movement by month in sickness absence rates is provided in table The cost of sickness absence The productivity cost of sickness absence for the Trust is significant and this is summarised in Appendix 3. The total cost of sickness absence through the 9 month period from 1 April 2016 is estimated to be 2,203,144 with the full year effect estimated to be in the region of 2,900,000. This does not include the costs of providing cover for nurses, doctors etc. Staff attending work when they are no well enough to do so In the health sector, perhaps more than any other, it is important that staff, particularly front line staff, do not attend work when they are not well enough to do so to protect themselves and patients. The annual staff survey provides some insight into the numbers of staff who feel that they have attended work when unwell Appendix 3, Table 3.2. It is therefore important to strike the right balance when managing attendance, between the management of absence and staff well- being. Conclusion and next steps The data suggests that the sickness absence trend is upward and that there is no longer a clear differential between absence levels in the winter months and summer months, though with some peak periods. Airedale NHS FT s sickness absence levels were in line with other local trusts during the summer, though were not as low as Harrogate and Leeds THT. It is not clear from this analysis whether this is as a result of local demographic and workforce matters or management actions or both. The staff groups with the highest level of sickness absence are estates and ancillary, additional clinical services and nursing and midwifery. This is unsurprising given the nature of their work. The main causes of absence are equally unsurprising, though the level of sickness absence relating to mental health is an area of concern. There 3

5 also appears to be an issue in relation to staff taking absence most frequently on a Monday. The cost of sickness absence is significant in terms of lost productivity, the direct costs of back fill and the human costs both in terms of the individual and the impact on colleagues. Employee health and wellbeing is a key priority for Airedale NHS FT and the NHS. In order to reduce sickness absence and improve employee health and well-being the Trust already has in place the following: Sickness absence policy and procedures to guide managers when dealing with employee health issues and absence Training for line managers as part of the Line Manager Essentials Programme and Skills for Great Line Management on health and well-being and attendance management HR Business Partner support to business groups and line managers Employee Health and Wellbeing Service to provide support to staff, including a fast track service for musculoskeletal and work related stress cases. A health and well- being programme focused around eat well, exercise well and think well with access to health checks, exercise classes, resilience training and advice for staff A dedicated occupational therapist within the Employee Health Team focused on supporting staff with mental health and musculoskeletal issues and return to work. A range of local, targeted interventions to support staff and reduce stress in the workplace. In addition and informed by this analysis, the sickness absence policy and procedure is currently being reviewed, in consultation with staff side/unions, to improve it in line with practice elsewhere and to introduce the use of the Bradford Factor methodology to deal with short term frequent absence. The capacity of the HR team can limit the Trust s ability to proactively manage sickness absence and develop the skills of line managers. A business case for a dedicated case manager is currently under consideration with the costs being covered by anticipated reductions in sickness levels. 4

6 Appendix 1 Sickness Absence Rates Table Airedale sickness absence rates Airedale NHS Foundation Trust: Reported Sickness Absence: % Abs Rate (FTE) Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec % 4.42% 4.32% 4.79% 4.46% 4.63% Table 1.2 Comparison of Airedale NHS FT sickness absence rates by month since % Comparison of sickness absence rates by month since % 4.00% 3.00% 2.00% 1.00% % Sickness absence rates by sector Table 1.3 From the most recent data from 2015 the absence by sector as a percentage of working time lost per annum was: Sector Sickness Absence per annum Private Sector services average 2.5% time lost Manufacturing and production 2.6% average time lost Public Sector average time lost 3.8% For public sector organisations, the average percentage of working time lost in 2015 was: 5

7 Table 1.4 Public Sector Organisations Sickness Absence per annum Central Government 2.6% Local Government 4% Public Education 3.6% Public Safety 3.5% Public Health 4.3% Table 1.5 Monthly Sickness Absence Rates by Health Education England Region England Yorkshire and the Humber North East North West January % 4.94% 5.11% 5.20% February % 4.82% 4.96% 5.00% March % 4.58% 4.67% 4.80% April % 4.33% 4.47% 4.61% May % 4.20% 4.41% 4.45% June % 4.35% 4.51% 4.55% July % 4.47% 4.54% 4.74% August % 4.37% 4.39% 4.60% 6

8 Table Sickness absence rates compared to local Trusts 7

9 Append 2 - The prevalence of sickness absence Table 2.1 Staff Group: Reported Sickness Absence: % Abs Rate (FTE) Staff Group Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Additional Clinical Services 6.31% 5.56% 5.04% 6.37% 6.31% 7.06% Estates and Ancillary 5.06% 5.32% 5.49% 6.63% 5.29% 6.33% Nursing and Midwifery Registered 4.17% 5.51% 4.86% 5.34% 4.55% 4.72% Administrative and Clerical 3.82% 4.41% 5.00% 4.62% 4.83% 4.46% Allied Health Professionals 3.70% 3.43% 2.93% 2.84% 2.90% 3.04% Add Prof Scientific and Technic 2.74% 3.53% 3.01% 4.29% 5.07% 4.52% Medical and Dental 2.18% 1.26% 1.18% 1.52% 1.31% 0.89% Healthcare Scientists 1.10% 1.47% 2.76% 2.25% 2.06% 1.82% Table 2.2- Staff groups with the highest rates of sickness absence 8

10 Table Staff groups with the lowest rates of sickness absence Table The prevalence of sickness absence by day of the week 9

11 Table The prevalence of sickness absence by day of the week (graph) 10

12 Table 2.6 Short term sickness absence by reason 11

13 Table 2.7 Long term sickness absence by reason 12

14 Table 2.8 Combined sickness absence (short and long term) 13

15 Table Sickness Absence by absence reason: July to December 2016 (All Staff Groups) (Ranked by Grand Total: Sum of FTE Days Lost) 14

16 Table 2.10 reported sickness % absence rate (FTE) July to December

17 Table Sickness Absence by absence reason: July to December 2016 (All Classifications) (Ranked by Sum of FTE Days Lost July 2016) 16

18 Appendix 3 Costs of sickness absence and Presenteeism Table The cost of sickness absence Month Cost April ,303 May ,383 June ,726 July ,035 August ,203 September ,012 October ,578 November ,406 December ,498 Table 3.2 Presenteeism Presenteeism can be defined as the act of staying at work longer than usual to show that you work hard and are important to your employer (Cambridge Dictionary). The latest data shows that our presenteeism has reduced from the 2014 survey results and has been lower than the average from other Acute Trusts except in relation to staff putting themselves under pressure to come into work despite feeling unwell which shows that 2015 results were a percentage higher than 2014 and the average for other Acute Trusts. 17