Improving Health and Wellbeing Striving for Excellence

WORKFORCE & OD COMMITTEE 09 DECEMBER 2014 AGENDA ITEM 2.1 NEW APPROACH TO ATTENDANCE MANAGEMENT Report of Director of Workforce and Organisational Development Paper prepared by Purpose of Paper Assistant Director of Workforce and Organisational Development - Operations To inform the Workforce and OD Committee of the teaching Health Board s new approach to attendance management Action/Decision required To receive the report and note the new approach to attendance management Link to Doing Well, Doing Better: Standards for Health Services in Wales : Link to Health Board s Corporate Plan This paper supports Standards 3. Health Promotion, Protection and Improvement 22. Managing Risk and Health and Safety Improving Health and Wellbeing Striving for Excellence Acronyms and abbreviations W&OD Workforce and Organisational Development ESR Electronic Staff Record BI Business Intelligence SIG Special Interest Group SSS Supervisor Self Service SEQOHS Safe Effective Quality Occupational Health Service DNA Did Not Attend Page 1 of 15

A NEW APPROACH TO ATTENDANCE MANAGEMENT Introduction Powys thb previously approved a paper outlining a new strategic approach to sickness absence management based on the 5 high impact changes identified by the Department of Health as follows: 1. Develop local evidence based improvement plans 2..with strong visible leadership 3. supported by improved management capability 4..with access to better, local high quality accredited occupational health services 5...where all staff are encouraged and enabled to take more personal responsibility This paper then builds on the strategic approach agreed previously and seeks support for a revised operational approach, led by W&OD but operationalised by all managers across the thb. This will ensure that sickness absence management based on best practice is in place, and that attendance is managed and evaluated locally, as well as corporately. This new visionary approach brings up to date workforce information to managers finger tips giving them ready access to a wealth of information about their staff presented in several user friendly formats. The change in approach will be signified by rebranding sickness absence management to attendance management and W&OD will focus on supporting compliance against the policy and training and support to managers to deliver against it through better controls, improvement actions and management development interventions. Background Traditionally Powys thb mangers have been provided with information about their staff via the Workforce Information team who provide monthly reports on sickness absence to the locality W&OD teams. Typically this information is provided a month in arrears. The locality W&OD teams then manipulate the data to provide managers with the relevant information for their individual teams this can be a 7/14 days following receipt of the information, meaning that the information received by managers is 6-8 weeks out of date. Recent Developments Page 2 of 15

Developments in ESR (Electronic Staff Record) have made a different approach to attendance management possible, and, with its high roll out of ESR Supervisor Self Service Powys in uniquely poised in Wales to implement a modernised self service approach to attendance management, where managers are confident to act on attendance management issues identifiable from easily accessible, user friendly, relevant and meaningful data. In March 2013 ESR was enhanced to include a Business Intelligence Reporting solution. This solution, known as ESR Business Intelligence (ESR BI) enhances the current range of standard reporting and includes additional ad-hoc reporting capability with significant functionality in the area of presentation of reports and dashboards. ESR BI is accessible to all managers and as Powys thb has made ESR available to all managers, managers can now benefit further from up to the minute additional reporting functionality now available to them. As decisions and supportive action can then be implemented quickly, based on up to the minute information, a new culture of attendance management will emerge. Benefits: 1. Local managerial ownership of data not reliant upon the provision of information by Workforce Information team 2. Ability to identify trends at an earlier stage 3. Ability to implement supportive measures at an earlier stage 4. Swifter response to attendance issues 5. Ability to identify and then support managers requiring additional levels of support Encouraging managers to access this information themselves will require additional training in the short term but once the training is delivered it will free up W&OD staff to provide value added support to managers including: The triangulation of sickness absence rates with variable pay, bank pay and vacancies Performance management of key indicators for each locality e.g. % return to work interviews complete, number of days taken to enter sickness data, consistency of sickness data entry, no of staff on long term sick who have not been referred to Occupational Health, identification of staff who have reached trigger points, but no management action has been recorded This transition for the W&OD team will firstly require the development and implementation of an agreed data standard for sickness absence entry. The All Wales WfIS team are likely to be able to support the work needed to ensure it is delivered speedily. Page 3 of 15

A high level tracking report has been produced for the Executive team and locality managers so sickness absence levels can be monitored on a monthly basis. Improvement Actions: Develop data standard for managers entry of sickness absence data in ESR, utilising all current fields to maximum potential Lobby All Wales HR & Recruitment ESR SIG (special interest group) to deliver improvements to the sickness absence data fields facilitating better quality information Explore the potential of ESR BI to bring workforce information direct to managers W&OD team to deliver Develop & deliver ESR BI training to managers & W&OD staff Develop suite of high level indicators to deliver values added information to localities High Impact Change N o 1 Develop Local Evidence Based Improvement Plans The accurate measuring & monitoring of absence is one of the main tools in an effective attendance management system. Across Powys the sickness absence rates achieved currently range from 0% (prompting concern that there is a lack of reporting/ staff are attending work when unfit to do so) to peaks of up to 20%. The target for Powys thb is 4.42 %. Currently this target is applied as a blanket approach, irrespective of the sickness absence rates demonstrated by individual teams. It is proposed that intelligent targets taking into account the age profile of the workforce, occupational factors, the current levels of long term sickness, and current levels of unmanaged sickness absence within the team are set in consultation with operational managers to ensure that realistic, achievable targets are introduced for each individual team. Ensure that line managers are following the absence management process effectively monitoring by business partners will identify areas where: Page 4 of 15

Indicator Features Action By whom No or little absence recorded no evidence of absence management process being followed Lack of queries on managing sickness absence management Prompt an audit of processes in that team to identify whether the reported absence levels are accurate. Lack of any sickness absence can be indicative of an unhealthy culture which may need further exploration Locality W&OD Team Locality W&OD team in conjunction with manager and staff side Absence rates consistent with or near target. Absence rates not prompting undue cause for concern Ongoing support & guidance and monitoring Locality W&OD Team Review of target for the area is it still appropriate? Locality W&OD team in conjunction with manager Identification of good practice to disseminate from other areas Locality W&OD team to share across locality and with wider W&OD team Absence rates significantly above target workforce data indicating cause for concern extra support offered to manger training for Locality W&OD Team Page 5 of 15

managers Briefings for staff Locality W&OD in partnership with team with staff side Monitoring of sickness absence cases on a case management basis Locality W&OD team with manager Improvement Actions: W&OD to monitor sickness absence rates for all teams across Powys & provide comparative data to allow the development of intelligent targets for attendance management activity High Impact Change N o 2.with Strong Visible Leadership The Director of Workforce & OD to lead a Sickness Absence Focus Group to support the local management of complex sickness absence cases using a case management basis. The group will comprise of locality W&OD teams who will have detailed knowledge of individual cases and be supported by occupational health and OD professionals to develop action plans to support each individual back into the workplace or, on occasion where this does not prove possible, to fully explore alternate course of action. The group will be responsible for performance management at senior level all complex sickness absence and long term sickness absence cases with the organisation Page 6 of 15

In addition to its case management function, the Sickness Absence Focus Group will provide a learning & development environment where wider sickness absence management issues can be discussed and developed. Attendance to form one of the locality performance indicators at the locality performance meetings. Improvement actions: Formation of a Powys thb Sickness Absence Focus Group with Executive level support, to meet on a monthly basis In recognition of its Tier 1 status, Attendance to be a standing item on performance management meetings. High Impact Change N o 3..supported by Improved Capability An absence trigger is a defined level of sickness absence which should prompt the process whereby the line manager looks into the level of sickness further in consultation with the employee. Consistently acting on triggers has been proven to reduce absence levels. The use of absence triggers should be an open and transparent process and promoted as part of an overall attendance management strategy. It is therefore imperative that absence triggers are clear and communicated to all staff and their representatives. Staff side representatives are supportive to the consistent application of the sickness absence policy and staff also need to have an awareness of the triggers for action identified in the sickness absence policy. Line managers have an essential role to play in the attendance management process from reporting absence initially, conducting supportive return to work interviews through to acting consistently when triggers are met. To support the managers to undertake these key roles, we need to ensure that they are equipped with the relevant skills. It is therefore proposed that a comprehensive attendance management training package is developed to provide maximum support to managers, staff and their representatives and to the W&OD team to improve the attendance rates within the organisation. Page 7 of 15

Training Outcome Status Managers Attendance Training Understanding & consistent application of the All Wales Sickness Absence Policy & Powys thb Sickness Absence Toolkit Mandatory Business Partners/HR Advisors/Occupational Health Staff, Workforce Information Team in conjunction with Staff side representatives Attendance Master Class Annual refresher/update sessions for managers who have previously attended the above Mandatory Business Partners/ Hr Advisors in conjunction with Staff side representatives ESR SSS Training (level 1) Confident use of the ESR SSS module more focus on absence calendar & correct entry of sickness data Mandatory all new mangers Workforce Trainers/HR Advisors ESR SSS Training - Attendance Masterclass (level 2) Proficient use of ESR tools to support attendance management: Absence Calendar, correct entry of sickness data, use of BI to Mandatory all managers on completion of level 1 above W&OD Team Page 8 of 15

generate staff sickness absence data & identify staff reaching trigger points for action Holding Difficult Conversations Increased confidence and willingness to prepare for & hold difficult conversations with staff, which will impact on many areas of staff management To be considered as part of the forthcoming Managers Competency Framework Business Partners/ W& OD Learning & Development Team Coaching Skills To support and encourage staff To be considered as part of the forthcoming Managers Competency Framework W& OD Learning & Development Team Staff Attendance Briefings Understanding of the All Wales Sickness Absence Policy. Can be delivered as part of existing team meetings, action learning sets, corporate induction etc Mangers/HR Advisors in conjunction with staff side representatives Staff Side Representatives Attendance in Co-production of the consistent application of the Page 9 of 15 Briefings and Q&A sessions specifically for Business Partners/HR Advisors/Deputy

Powys thb All Wales Sickness Absence Policy, Q&As, development of information for staff staff side representatives Director of W&OD W&OD Staff Use of BI to support attendance management Appreciation of how the ESR BI tool supports managers in attendance management. Use of ESR BI as a HR user to monitor the performance of managers in tbc W&OD Team Discoverer Report Tool Understanding & use of the Discoverer Reporting tool Masterclass sessions for key W&OD staff to pull information from ESR effectively tbc Where sickness absence rates are high it is acknowledged that managers may need additional support to help implement the sickness management policy effectively. The south locality have been able to demonstrate that a team with historically high sickness absence rates, when provided with high levels of support can demonstrate substantially improved rates of sickness absence (Appendix A). It is therefore proposed to roll out this model in each locality. Improvement Actions: Appropriate training developed for managers, staff, staff representatives and W&OD staff to support attendance management. Page 10 of 15

Each locality to identify a small number of teams likely to benefit from a high level of support from local W&OD teams. High levels of support then to be provided by locality W&OD teams to support managers to implement the sickness management policy effectively. As management capability grows the additional levels of support will then withdraw to normal levels High Impact Change N o 4 with access to better, local high quality accredited Occupational Health Services It is recognised that a quality driven occupational health services is a support to both managers and staff in the effective attendance management. No NHS Wales Occupational Health Teams have achieved accreditation to SEQOHS standards. Powys Occupational Health team are therefore working with other NHS Wales Occupational Health Teams, and supported by Welsh Government, towards achieving this accreditation. In additional to the quality of advice from Occupational Health services the timeliness of that advice is extremely important in effective attendance management. With the increased work that is ongoing at operational level it is recognised that referrals to the service may well increase which could result in capacity issues. Therefore any negative impact on waiting time for an occupational health consultation (currently 4/6 weeks) should be avoided. In order to achieve this, the following measures are proposed: A short concise guide is issued to mangers identifying appropriate times to refer staff to the occupational health service This advice will be reinforced at attendance management training sessions, with a member of the Occupational health Team supporting the delivery of the training wherever possible The occupational health team to review DNA rate and identify any appropriate measures that would reduce DNA rates. Consideration of an audit of referral to occupational health to identify an inappropriate referrals and feedback to managers accordingly. The pilot projects across NHS Wales linking the Occupational Health system Cohort with ESR should bring efficiency benefits. The benefits of linking work between the Occupational Health Team and the W&OD Business Partners operating at locality level is being seen. This approach will be Page 11 of 15

further developed to aid communication and also to help ensure that consultations with appropriate staff are expedited if necessary Key Actions: Continuation of the work towards SEQOHS accreditation A clear, concise guide to be issued to managers as a prompt to for the referral of staff to our Occupational health Services Occupational Health Team to review and improve DNA rates Consideration of how the Occupational Health Team can be supported to audit the appropriateness of the referrals received Further development of links between OH Team and W&OD Business Partners High Impact Change N o 5..where all staff are encouraged and enabled to take more personal responsibility At its meeting in February 2014, the Board approved a Health and Wellbeing Strategy for the organisation. The intention of the strategy is to embed employee health and wellbeing into the culture of the organisation. In order to achieve this, the teaching Health Board will need to effectively focus its limited resources on providing integrated prevention and promotion activity and initiatives. This activity will be based on and respond to actual staff needs and be able to demonstrate that it can improve the health and wellbeing of our workforce. As such prevention and promotion activities and initiatives will be appropriately targeted, to reduce the identified risk factors that contribute to ill health amongst our workforce; and to champion lifestyle improvements, which will enable our staff to benefit from improvements to their health and wellbeing. For a number of years the thb has provided its workforce with a range of activity and initiatives to support staff health and wellbeing. Much of this activity has been driven by the Corporate Health Standard, which forms the national mark of quality for health and wellbeing in the workplace. The thb achieved the Gold Award in 2011 and is committed to work towards achieving the Platinum Award. In the future the thb will develop robust integrated, proactive, promotion and prevention activity and initiatives, which are introduced on an equitable basis, based on a proper assessment of need, with reference to the potential benefits to the workforce as a whole. This work, should link across to the key goals as set out in the Page 12 of 15

thb s Integrated Medium Term Plan and the Workforce and OD Strategy, Working Differently, Working Together which outline the thb s commitment to focusing on the health and wellbeing of our workforce and staff engagement. These documents make it clear that the objective of having a clearer focus on employee health and wellbeing and staff engagement is integral to the achievement of its wider strategic goal of delivering truly integrated care centred on the needs of the individual. The implementation of the thb s Health and Wellbeing Strategy will require all proposed activity and initiatives to be properly developed, assessed and costed. All associated activity will have a clear aim of diminishing or preventing the causes of ill health within our workforce and assisting the thb to achieve its wider service development, workforce and finance objectives. In addition a non financial award scheme for attendance should be explored with trade unions. In a recent review it was found that over 30 such schemes operate successfully in the NHS. Improvement Actions: Support and proactively promote a positive health and wellbeing environment; by encouraging staff to make lifestyle improvements, which will enhance and improve their health and wellbeing by reducing their existing or potential health risk factors. Actively promote the principles and behaviours contributing to positive staff wellbeing. Develop and implementing an action plan, which has a proactive staff health and wellbeing approach, focused on innovation and prevention. Ensure that health and wellbeing activity and initiatives have connectivity between improving staff health and wellbeing and improving the thb s ability to provide safe and effective services to our patients. Conclusion Although the Health Board has had some success in the management of sickness absence, the current rolling year, as at September, is 5.03%, over 0.5% above the expected target of 4.42%. The improvement actions identified in this paper aim to refocus sickness absence to promote attendance management. The overall outcome being to support staff wellbeing, attendance at work and in doing so reduce sickness absence to at least the target of 4.42%. Recommendation Page 13 of 15

The Workforce and OD Committee is asked to RECEIVE and NOTE the update on the teaching Health Board s new approach to attendance management. Report prepared by: David Long Assistant Director of Workforce and Organisational Development Presented By: Julie Rowles Director of Workforce and Organisational Development Dena Jones WOD Business Partner Background Papers Financial Consequences Other Resource Implications Consultees As determined by the report As determined by the report Executive Directors Local Partnership Forum Page 14 of 15

Appendix 1 Appendix A Page 15 of 15