Internal Audit Report Managing Sickness Absence August 2011
Internal Audit Report Managing Sickness Absence August 2011 1 Executive Summary...1 2 Background...2 3 Scope...2 4 Summary of Findings...2 5 Management Action Plan...3
1 Executive Summary Conclusion In general, controls over sickness absence at are adequately designed; however, the controls are not being implemented consistently across the organisation. Although achieved a monthly sickness absence rate of less than 4% in May 2011 for the first time, the annual average remains above the 4% target. Main findings There is a clear commitment to improving the process for managing, monitoring and reporting sickness absence within and management are aware that there is currently some inconsistency in the application of the policy. Of particular note are North CHP where the annual absence average has reduced from 5.15 to 4.03% and Argyll and Bute CHP which has conducted a review of its application of the Promoting Attendance policy. Our testing indicates that key aspects of the Promoting Attendance policy, namely completing records of absence and holding return to work interviews are not being implemented consistently across the organisation. Because of this, the message from the board - that reducing sickness absence is a priority - is not being transmitted to staff. This also makes it harder for management to identify patterns of absence that may indicate an employee requires additional support. The findings of the Argyll and Bute CHP review, reported to the CHP Committee in June 2011, are consistent with the findings in this report. Based on our testing, it is likely that the key issues identified in the Argyll and Bute CHP report are relevant across. We therefore recommend that the report is shared and that the recommendations are implemented across the organisation in conjunction with the Management Action Plan in this report. In the Management Action Plan we have identified a number of areas which, if addressed, would strengthen the organisation s application of the Promoting Attendance policy: Ensuring that managers understand the relevance and importance of record of absence and return to work interviews will enable staff to receive the appropriate level of support from the organisation. Maintaining and communicating the Promoting Attendance policy will provide managers with a better understanding of their roles and responsibilities in relation to managing sickness absence and outline minimum standards. Formal introduction and refresher training on the policy will ensure that the process is applied consistently. Making relevant data available to line managers involved in managing attendance will enable them to make more informed decisions regarding the management of absence. Value for money By implementing the recommendations in this report and the Argyll and Bute CHP report, will be in a better position to improve sickness absence rates and associated efficiency savings. In particular, providing line managers with more detailed information about sickness absence and requiring all staff to follow the Promoting Attendance policy consistently across the organisation should help to drive improvements in sickness absence rates. Risk management This review focused on the controls in place to mitigate the following risks on the Corporate Risk Register (as at May 2011): OR02 Difficulty in providing care in remote and rural areas (risk rating: high) August 2011 1
OR26 - Impact of integration of Argyll & Bute CHP (risk rating: high) FR10 - Failure to deliver the Financial Strategy through failure to deliver agreed efficiency programme or through additional expenditure (risk rating: high) SR11 - Reducing staffing requirements which has a negative impact on quality and patient safety (risk rating: medium) While these risks will be mitigated by more controls than those relating to sickness absence, we consider that the risk rating is appropriate in respect of sickness absence. Acknowledgements We would like to thank all staff consulted during this review for their assistance and co-operation. 2 Background Health boards in Scotland reported 32.5 million of efficiency savings in 2008/09 through reducing levels of sickness absence. However, the majority of health boards continue to report sickness absence levels above the Scottish Government s target of 4% (2008/09 HEAT target). Further efficiency savings and improvements in the quality of services provided by health boards can, therefore, be achieved by reducing sickness absence levels further. is committed to managing sickness absence to a rate of 4% or below. To help achieve this target the Board has published a policy on Promoting Attendance. 3 Scope In accordance with the 2011/12 internal audit plan we performed a review of the arrangements in place for managing sickness absence within. We examined the Promoting Attendance policy and the application of this policy across, including the four CHPs and Raigmore. 4 Summary of Findings The table below summarises our assessment of the adequacy and effectiveness of the control procedures for each of the key control objectives, and the number of recommendations against each key control objective. Where the control objective was not deemed to be fully met we have reported the weaknesses identified in the Management Action Plan (section 5 of the report). No. 1. 2. 3. 4. Key Control Objective provides a fair, consistent and supportive approach to promoting attendance. Roles and responsibilities in relation to promoting attendance are defined, communicated and adhered to. Sickness absence levels are maintained within a range acceptable to (<4%). Effective mechanisms are in place for monitoring and reporting compliance with s Promoting Attendance policy. Adequacy / Effectiveness of No. of agreed actions control procedures 5 4 3 2 1 YELLOW 1 RED 1 1 YELLOW 1 YELLOW 1 August 2011 2
TOTAL NUMBER OF AGREED ACTIONS 0 1 4 0 0 Assessment BLACK RED YELLOW GREEN Definition Fundamental absence or failure of key control procedures - immediate action required. The control procedures in place are not effective - inadequate management of key risks. No major weaknesses in control but scope for improvement. Adequate and effective controls which are operating satisfactorily. 5 Management Action Plan Grading of recommendations Our grading structure helps management assess the significance of the issues raised and prioritise the action required to address them. The grading structure is as follows: Grade Definition 5 Very high risk exposure - Major concerns requiring immediate Board attention. 4 High risk exposure - Absence / failure of significant key controls. 3 Moderate risk exposure - Not all key control procedures are working effectively. 2 Limited risk exposure - Minor control procedures are not in place / not working effectively. 1 Efficiency / housekeeping point. August 2011 3
Management Action Plan 1 Key control objective: provides a fair, consistent and supportive approach to promoting attendance. Observation and Risk Recommendation Management Response 1.1 Out of date policy PIN (Partnership Information Network) Policy Promoting Attendance June 2008 is in place and available on the intranet for staff to view and use. However the policy was due for review in 2010 and this review has not taken place. Further, a line manager was found to be using a previous version of the policy. The process described in the obsolete version of the policy differs from current practice; for example, it does not contain the record of absence forms. An up to date policy that is communicated to staff will ensure staff are fully aware of their roles and responsibilities, and the control standards expected of them. should review the Promoting Attendance policy, updating it if required, and ensure that line managers and staff are aware of the current version and current practice. Agreed. The consistent application of the Promoting Attendance Policy is identified as a challenge across our diverse area. The PIN Policy is a National document which is applied within Highland. The HR Sub Group reviewed the FAQs on Promoting Attendance last year and ran Workshops for managers on the subject. It is agreed that further communication on the Policy is desirable to ensure full understanding and appropriate application. The suite of Managing Health at Work PIN policies, one of which is the Promoting Attendance policy, is due to be fully released by May 2012. The release date for the Promoting Attendance policy is not known so the target date has been set for May 2012. To be actioned by: HR Sub Group No later than: 31 May 2012 Grade 3 August 2011 4
Management Action Plan 2 Key control objective: Roles and responsibilities in relation to promoting attendance are defined, communicated and adhered to. Observation and Risk Recommendation Management Response 2.1 Line Managers may not have appropriate experience and training to manage absences. Line managers were invited to attend workshops when the policy was last revised in 2008 with the workshops taking place in 2009/10. No formal training or refresher training courses have been run since that time. New managers are referred to the policy and FAQ document and one to one advice is available from the personnel officers should it be requested. Without refresher training and specific training for new managers, there is an increased risk that managers will not apply the policy consistently. should require members of staff promoted to a line manager role, either on a temporary or permanent basis, to attend the training to help them understand and comply with the policy. HR should monitor completion of the course. Agreed. Training materials exist and were utilised in our workshops over the last 2 years. Case studies and materials also exist within our Personnel Skills Development Programme which is commended to new managers, supervisors and Team Leaders. To be actioned by: Head of Personnel No later than: 31 March 2012 Grade 3 August 2011 5
Management Action Plan Observation and Risk Recommendation Management Response 2.2 Records of absence forms and return to work interviews are not completed and retained for all staff. We tested a sample of personnel files from South- East (SE), North and Mid CHP to determine whether staff are adhering to the Policy. We found the following exceptions: The record of absence form was not completed for 3 of 11 SE CHP files; 11 of 11 MID CHP files; and 10 of 10 North CHP files. Furthermore, the form was not fully completed for an additional 4 of the 11 SE CHP forms. The return to work (RTW) paperwork was not completed for 3 of the 11 SE CHP files and 5 of the 11 MID CHP files. There were 4 instances where a sickness self certification form was not provided and 4 where a medical certificate was not provided. There was also 1 instance where a medical certificate did not cover first 24 days of absence. There is a risk that, without maintaining and monitoring records, employees may not receive required support or a referral to Occupational Health. In addition, failure to complete the record of absence forms and hold the RTW interviews does not demonstrate that managers are spending sufficient time on improving attendance. should determine the best method of ensuring that line managers have access to a full record of absence for their employees. This may be by enforcing the use of record of absence forms or consider the logistics of supplying alert and trigger absence reports to line managers. should enforce the use of documented return to work interviews when required by policy. Agreed. provides detailed absence information to localities (General Mangers and Personnel Managers) to allow appropriate action to be taken. We note the Audit findings that appropriate record keeping is not being consistently maintained. We propose referral to the HR Sub Group of the HPF to develop an action plan to raise awareness and ensure compliance with the policy. The HR Sub Group will monitor implementation of the action plan. To be actioned by: HR Sub group No later than: 31 December 2011 Grade 4 August 2011 6
Management Action Plan 3 Key control objective: Sickness absence levels are maintained within a range acceptable to (<4%). The monthly sickness absence rate has decreased significantly since January 2011, with the absence rate in May 2011 falling below the 4% target for the first time. However, the average annual rate for is consistently above 4%, with little reduction over the last 12 months, as shown in the graphs below (produced by the HR department and reported to CHP Committees). When the sickness absence rates for each CHP are examined, the majority exceed 4%. Argyll & Bute CHP had the highest sickness absence rate in May 2011, at 5.21%, while Corporate Services had the lowest rate, at 2.91%. 5.50 5.50 Staff Sickness Annual Average Trends 5.00 5.00 4.50 Percentages 4.00 4.50 3.50 Percentage of Available Hours 4.00 3.00 2.50 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 3.50 3.00 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 NHSH SWISS Monthly 4.63 4.57 4.67 4.70 4.80 4.55 4.66 4.96 5.32 4.51 4.57 4.07 3.94 NHSH SWISS Annual 4.86 4.87 4.85 4.86 4.88 4.86 4.81 4.82 4.85 4.85 4.80 4.76 4.70 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Argyll and Bute CHP 5.08 5.05 5.10 5.16 5.24 5.30 5.33 5.41 5.43 5.46 5.37 5.29 5.21 Corporate Services 3.23 3.20 3.16 3.06 2.92 2.85 2.80 2.87 2.92 2.90 2.91 2.89 2.91 Mid Highland CHP 4.62 4.63 4.56 4.57 4.60 4.68 4.68 4.66 4.71 4.72 4.68 4.54 4.46 North Highland CHP 5.17 5.15 5.06 4.93 4.86 4.69 4.49 4.36 4.28 4.20 4.14 4.03 4.05 Operational Support Services 3.19 3.20 3.27 3.33 3.39 3.46 3.46 3.55 3.56 3.72 3.85 3.87 4.02 Raigmore Hospital 4.05 4.08 4.11 4.16 4.19 4.18 4.12 4.12 4.11 4.08 4.07 4.03 4.00 South East Highland CHP 4.57 4.67 4.68 4.68 4.71 4.71 4.66 4.66 4.70 4.69 4.62 4.52 4.42 NHSH Local 4.40 4.42 4.42 4.44 4.46 4.46 4.42 4.43 4.44 4.43 4.40 4.33 4.29 NHSH SWISS 4.86 4.87 4.85 4.86 4.88 4.86 4.81 4.82 4.85 4.85 4.80 4.76 4.70 August 2011 7
Management Action Plan Observation and Risk Recommendation Management Response 3.1 Actions required to improve compliance with policy The high sickness absence rate within Argyll & Bute led to a review of compliance with the Promoting Attendance Policy across the CHP. The report was issued in June 2011, and identified the same issues around compliance with procedures and use of management information as we have reported at 2.2 and 4.1 in this report. The report contained a number of other recommendations for management within Argyll & Bute to action. However, there is currently no plan to implement these recommendations in other operational units within. We recommend that the findings of the Argyll & Bute CHP review of compliance with the Promoting Attendance policy are shared, and that the actions are implemented, across. The implementation of those actions should be monitored by each CHP Committee. Agreed. The actions and learning from the Argyll & Bute Review are disseminated across Highland through the HR Sub Group for local action and monitoring. The HR Sub Group will monitor the implementation of the actions. To be actioned by: HR Sub Group No later than: 31 March 2012 Grade 3 August 2011 8
Management Action Plan 4 Key control objective: Effective mechanisms are in place for monitoring and reporting compliance with s Promoting Attendance Policy. Observation and Risk Recommendation Management Response 4.1 Absence data reports are not available to line managers The HR department produces reports that contain data such as working days lost and the number of absences in a rolling year, which indicate where an employee has reached any trigger levels for absence management as described in the policy. However these reports are not filtered down to the line managers directly managing the employees. Disseminating relevant reports to the direct line managers may allow trends of absence to be acted upon that otherwise may be missed by line managers as records of absence forms are not always completed. should consider disseminating relevant absence reports to line managers. Conducting a survey of line managers or implementing a pilot may help in determining any potential benefits. Agreed. currently produces absence reports and alert reports which are cascaded to operational units. An exercise can be undertaken to ensure these reports are received by the appropriate persons for action. To be actioned by: HR Sub Group No later than: 31 March 2012 Grade 3 August 2011 9
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