Absence Management [234kb] - Sunderland City Council

Report of the Policy & Co-ordination Review Committee
Absence Management

Report of the Policy & Co-ordination Review Committee
Absence Management
Contents:
Chapter
Page
1. Foreword from the Chairman of the Committee 3
2. Scope of Review 4
3. Summary of Recommendations 5
4. Reasons for Review 6
5. Process of Review
Establishing a Focus 8
Evidence Gathering:
Sizing the issue 8
Healthy Workforce 9
A new focus 9
Feedback and Reporting 11
6. Our Findings
Manager Ownership 12
Healthy Workforce 16
Policy 19
Process 20
7. Bibliography 22
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Report of the Policy & Co-ordination Review Committee
Absence Management
Membership Councillors: John Donnelly (Chairman)
Kath Rolph (Vice-Chairman)
Joan Carthy
David Forbes
Bob Heron
George Howe
Bob Kirby
Stuart Porthouse
James Walker
Dennis Whalen
Linda Williams
Peter Wood
Subject
A study into absence management at the Council
Date of Report June, 2006
Contact
Paul Staines
Review Co-ordinator
0191 553 1006
paul.staines@sunderland.gov.uk
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Report of the Policy & Co-ordination Review Committee
Absence Management
Foreword from the Chairman of the Committee
“As Chairman of the Policy & Co-ordination Review Committee, I have pleasure in commending this report to you.
I would like to thank anyone who has, in any way, been involved in its preparation.
Council services are delivered by staff. Employees are therefore our principal resource in delivering quality services
to residents.
As a Committee, we have looked at how staff attendance is managed - with a vision of providing the best support
available to employees.
We have also looked at whether improved attendance - through the right interventions - can help the authority
meet calls for ‘greater public sector efficiencies’ in Sir Peter Gershon’s report Releasing Resources for the Frontline:
Independent Review of Public Sector Efficiency.
I believe our review has ‘added value’ to work already undertaken and to ongoing debate.
The review is not about weaknesses, but engaging around good practice - both from within the Council and elsewhere.
Councillor John Donnelly
Chairman, Policy & Co-ordination Review Committee
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Report of the Policy & Co-ordination Review Committee
Absence Management
2. Scope of the Review
2.1 The key question for us was “what can be done to reduce the Council’s overall rate of sickness absence”. Our
review sought to capture:
Within the Council -
• What policies there were
• What information was collected - and how was it used
• What management there was of attendance - including developing a healthy workforce; and
• What views there were from staff and the Trade Unions
Outside the Council -
• Best practice:
• from similar authorities
• from experience elsewhere in the private and public sector
2.2 In gathering information, we envisaged our study might indicate:
• Underlying reasons for absence (if any)
• Barriers to reducing levels of absence
• Directorate activity to deliver policy
• Directorate activity in promoting and supporting healthy lifestyles
• Individual manager activity in maximising attendance at work
• The role staff had themselves
2.3 By ‘sickness absence’, we mean:
• Short-term illhealth (uncertified but sanctioned by the manager, self certified illhealth
or illness covered by a Doctor’s Note)
• Long-term illhealth
• Unauthorised absence or persistent lateness, for a medical health related reasons
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Report of the Policy & Co-ordination Review Committee
Absence Management
3. Summary of Recommendations
3.1 Recommendations following our review are:
R1: MANAGER OWNERSHIP: The Council should support managers to take more ownership of
absence in their teams
R2: HEALTHY WORKFORCE: The Council should seek to mainstream, across all Directorates, equal
access to work-based wellness initiatives
R3: POLICY: The Council should consider including in its formal policy a written statement about
the role of the Occupational Health Service and the role of the employee’s ‘friend’
R4: PROCESS: The Council should consider reviewing correspondence with employee’s Medical
Practitioners to establish if an alternative to absence is appropriate considering the nature of the
employee’s absence
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Report of the Policy & Co-ordination Review Committee
Absence Management
4. Reasons for Review
4.1 We chose to study this area for two reasons:
1. Performance & Productivity: Everyone, at all levels in the workforce, feels the impact of illhealth and sickness
absence. It can significantly affect how the Council performs and crucially the quality of service to clients
2. Healthy Workforce: The Council will always lose some days to absence, but what does it do to
promote good health?
In short, the issue was not stopping/restricting sickness absence, but how best the Council could support
and encourage attendance.
4.2 When looking at key national and local drivers we noted:
Healthy
Workforce
The National Picture
Absence as a
costed issue
Gershon Efficiencies
Review
Council Performance
Previous Committe
Monitoring
Improvement Elsewhere
• The National Picture: Workplace absence rose for the first time in five years (2004 Confederation of British Industry)
costing the UK economy £12.2 billion. The CBI survey (of over 500 organisations) showed an average of 6.8
working days lost per employee in 2004. The Labour Force Survey (collecting information in a reference week)
showed some 1.7 million working days lost (March-May 2004). 2.9% of employees (3.1 in the public sector, 2.8
elsewhere) took at least one day off in the reference week prior to interview. Particular groups most likely to be
absent included women [73.3% of the Council’s workforce in 2004/05 were female]
• Absence as a Costed Issue. The Chartered Institute for Personnel Development (CIPD) estimates an average
‘cost’ of £601 per employee per year (2005 Survey of policy and practice). Days lost in the public service have an
additional cost on lost personal services to clients. The Chancellor of the Exchequer spoke of seeing a 9%
reduction in the number of days lost to injury and illhealth as part of the 2004 Spending Review
• Council Performance: The Council had failed to meet its own target of 10.8 days lost per employee in
2003/04. Out-turn data showed 12.9 days. This was a 20% increase on the 10.73 days lost in 2002/03.
12.9 was also the highest figure since data began to be collected in 2000/01:
Best Value Performance Indicator (BVPI) 12 = number of days/shifts lost due to sickness absence
Gateshead Newcastle North Tyneside South Tyneside Sunderland National Average
BVPI 12
2001/02
BVPI 12
2002/03
BVPI 12
2003/04
BVPI 12
2004/05
13.3 14.6 8.6 13.1 10.8 10.2
11.3 12.9 10.6 13.7 10.7 10.0
11.7 12.2 11.8 12.6 12.9 10.3
13.21 11.4 12.9 11.46 12.56* 9.71
[* Provided during later stages of the review. Expectations for 2005/06 out-turn are there will be a significant reduction on 2003/04 although figures were not been
concluded by the time of our last Committee meeting on 28th April, 2006]
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Report of the Policy & Co-ordination Review Committee
Absence Management
The Council was also one of only 74 out of 386 authorities where performance was ‘qualified’ by the Audit
Commission - indicating uncertainty of data. Whilst we were happy to note, in the later stages of the
review, Council progress since 2003/04, we were aware work remains - as evidenced by the Annual Audit
and Inspection Letter 2004/05. Performance also continued to slip compared to the national average
and some (but not all) Tyne & Wear authorities. Other Councils, with similar demographics, had
significantly fewer days lost. Rates exceeded those in other parts of the local economy. Our study into
Contact Centres last year, for example, heard from EDF Energy of circa 6 days lost in their Sunderland
offices per employee. Although we realise we might not be comparing like with like, there will be
similarities in terms of the catchment area of staff
Significant variations between Directorates were also mapped during the review, (eg in 2003/04 9.31
days were lost in Education and 18.63 days in Social Services).
• Improvement Elsewhere: Analysis of absence in the Civil Service in 2004 showed a headline figure of 9.1
days lost per employee - a fall of .9 days from 2003. At the same time, Council rates were rising. We
realise Civil Service jobs are essentially office-based (and a likely comparison for the Council would be
Corporate Services with a figure of 9.85 days for the same period)
• Previous Committee Monitoring: We had already expressed concern at the number of employees absent
in excess of 12 months during consideration of the Best Value review of Managing our Employees. An
Action Plan gave 12 key objectives including: aligning policy, ensuring effective ownership, having clear
roles & responsibilities, positioning the Council as the employer of choice and delivering cost
effectiveness & improved performance
• Gershon Efficiencies: The Government’s target of a 2.5% efficiency gain over the next three years is
challenging. We envisage reducing sickness absence might be a useful contribution. We see any
contribution as ‘non-cashable’, ie getting greater outputs/improved quality from the same inputs.
Absence is also a useful area of focus given there are so few other areas for improvement in the ‘Use of
Resources’ block of the Comprehensive Performance Assessment
• Healthy Workforce: The Council will always lose days to absence, but what does it do to promote good
health - and make a broader contribution to ‘a Healthy City’ ?
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Report of the Policy & Co-ordination Review Committee
Absence Management
5. Process of Review
a) Establishing a Focus …
5.1 At our meeting on 23rd June, 2005, we agreed absence management as the focus of ‘policy development
and review’ in 2005/06. Possible topics had been prepared from a canvass of all members of the Committee.
This was supported by an assessment tool to highlight corporate priorities. ‘Policy development and review’ is
one aspect of our work programme and involves detailed analysis of an issue. It provides an opportunity to
assist the Council in the development of future policy and practice.
5.2 At our 21st July, 2005 meeting, we discussed how we would approach the study and agreed we would like to
hear from a range of employees, Occupational Health and the Trade Unions (who were contacted about how
they would like to be involved). As a pre-cursor we asked for information from officers on the corporate
approach to absence management.
5.3 Given scrutiny is Member-led, we agreed Councillor Kath Rolph, Vice-Chairman, would take an active role in
preparing evidence and reporting to the full Committee.
b) Evidence Gathering …
Sizing the Issue -
5.4 A presentation to our 22nd September meeting addressed baseline information and gave an understanding
of Sunderland’s relative position. A copy of the Council’s Attendance Management Policy & Guidance was
fully set out together with a headcount of the workforce by service area, gender and salary scale. Individual
Directorate sickness rates were also detailed together with generic actions to reduce sickness absence/assist
staff. Headlines from the workforce profile were updated by a report on 23rd March, 2006.
5.5 In 2004/05 causes of sickness absence at the Council by full time equivalent days lost were:
Sickness Grouping
FTE days sickness
Vague Condition 39,839.83
Musculo-Skeletal 22,308.98
Psychiatric 21,187.11
Respiratory 14,164.06
Alimentary 8,829.40
Central Nervous System/Eyes & Ears 3,576.94
Endocrine System 3,389.17
Fractures 3,065.69
Pregnancy/Gynaecology related 2,884.57
Cardiac Condition 2,656.64
Dermatology 1,288.28
Renal 925.18
Circulatory 787.35
Haematological 316.10
Poisons 146.88
National Local Government Groupings
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Report of the Policy & Co-ordination Review Committee
Absence Management
5.6 In terms of % of time lost to the Council, this is shown below:
Poisons
Haematological
Circulatory
Renal
Dermatology
Cardiac
5.7 Due to limitations in existing management information systems, it was not possible to deliver a detailed
analysis of statistics without a manual pick of many paper records. Reassuringly, actions were being taken to
address this acknowledged organisational need in a new payroll/HR system system. Cabinet had agreed
funding and this would facilitate real-time monitoring and holistic information to managers and Corporate
Personnel. We also received updated information to our meeting on 23rd March, 2006 providing mid-year
absence statistics and projected outcomes for 2005/06.
Healthy Workforce -
5.8 A report to our 11th November, 2005 meeting focussed on the aspiration of a healthy workforce and how
corporate strategies sought to achieve this goal. The Council’s Occupational Health Service Manager set out
key issues from her 2004/05 Annual Report.
c) A New focus -
0.12
0.25
0.62
0.73
1.02
2.11
Gynaecological 2.29
Fractures 2.43
Endocrine 2.69
Central Nerv/Eyes & Ears 2.84
Alimentary 7.01
Respiratory 11.24
Psychiatric 17.34
Muscolo-Skelatal 17.7
% absence
Vague Conditions 31.61
0 5 10 15 20 25 30 35
5.9 Given difficulties in providing data to interrogate, we looked at new ways in which the principal aim of our
review - to help reduce the Council’s overall rate of sickness absence - could be delivered. On 11th
November, 2005 we agreed a new focus. This involved both qualitative and quantitative research and
provided for:
• A focus on operational practice rather than the Council’s written policy. When compared to the best
performing authorities, there appeared to be few significant differences in written policy - with the
exception of identified roles for Occupational Health and the employee’s ‘friend’ that the Council had not
set out
• Analysis of a particular Directorate (Development & Regeneration (D&R)). The Directorate includes a
broad range of job types and is ‘middling’ in terms of sickness levels - ie with no special areas for
attention. D&R also has policies in place to share best practice internally. Staff within the Directorate
were asked for their knowledge and perceptions of the Council’s approach to enable - hopefully - a candid
‘SWOT’ analysis to be considered (strengths, weaknesses, opportunities and threats). A total of 684 forms
were distributed. 18% were returned. Whilst this is disappointing, the profile of forms returned indicated
a likely cross section of staff upon which some conclusions might be drawn. A further 15 forms were
received too late to be processed. This brings the total Directorate response to nearly 20%.
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Report of the Policy & Co-ordination Review Committee
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• Best practice advice from Solihull Borough, Manchester City and St Helens Councils who were best
performing metropolitan authorities in national BVPI 12. Key questions to these authorities were:
Cultural Issues: Growing an attendance culture, quick & long-term wins, the changing pattern of absence
given interventions, remaining ‘hot spots’, the impact of family-friendly and other policies as alternatives
to time off sick and rewards for good attendance
Management Ownership & Accountability: Training/enabling managers, sanction against absentees - both
casual and perpetual - and managing contact consistently across the organisation when people are off
The role of Corporate Personnel through the Process: Who leads, Corporate Personnel or managers ?,
making full use of policies and management flexibility, available statistics and the ability to provide detail
(eg on trends)
Sustaining and Improving attendance levels: Plans for the future
Councillor Kath Rolph (centre) and council colleagus from Manchester (above) and St Helens (below)
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Report of the Policy & Co-ordination Review Committee
Absence Management
5.10 We also took the opportunity to gather information on tools that reduced sickness absence, aided
rehabilitation and promoted a healthy lifestyle from a Fit for Life, Fit for Work, Fit for the Future conference
attended by the Vice-Chairman on 6th April. Speakers included:
• Lord Hunt of Kingsheath OBE, Parliamentary Secretary of State at the Department for Work and Pensions
(‘Government Progress & Investment’)
• Dr Sayeed Khan, a Commissioner for the Health and Safety Executive (‘A Guide to Rehabilitation of Sick
Employese’)
• Judith Rasmussen, Regional Director of Sports England (‘Well at Work’)
• David Walker, Acting Regional Director of Public Health for the North East (‘Health at Work: A North East
Perspective’)
• Professor Chris Drinkwater, Head of the Primary Care Development Centre (‘GPs and Sickness Absence’)
• Dr Paul Nicholson, Director of Personnel, Proctor & Gamble (Europe/Middle East) (’Promoting Health in a
Multi-National - A Case Study’)
5.11 Timing of this event was particularly useful, as emerging themes from the review could be tested with experts.
d) Feedback and Reporting …
5.12 To ensure a dialogue with staff representatives, the Vice-Chairman met with Trade Unions at the Development
& Regeneration Directorate Joint Consultative Committee on 3rd March, 2006.
5.13 A timetable for delivering recommendations/lead for each recommendation is set out below:
Recommendation
Delivery
Timetable
Lead
1. Manager Ownership Update December, 2006
2. Healthy Workforce Update December, 2006
3. Policy Update December, 2006
4. Process Update December, 2006
Corporate Head of
Personnel
Corporate Head of
Personnel
Corporate Head of
Personnel
Corporate Head of
Personnel
5.14 Recommendations from our review were agreed by the Council’s Cabinet on 7th June, 2006 and are now
Council policy.
5.15 Copies of all our agenda papers and minutes can be found at www.sunderland.gov.uk or telephone
0191 553 1345.
5.16 As a Committee, we will monitor recommendations by update reports over 2006/07 and 2007/08. Updates
will be scheduled for timely evaluation of progress and take the form of a written report. The Corporate Head
of Personnel will be invited to present the report.
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Report of the Policy & Co-ordination Review Committee
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6. Our Findings
6.1 Findings are set out under each of the Committee’s four recommendations. We have also given an indication
of what our key aspirations are to aid those looking at delivery/future monitoring:
R1: MANAGER OWNERSHIP: The Council should support managers to take more ownership of absence in
their teams
A large part of managing absence is about ensuring staff can raise issues before they escalate. Successful
interventions appear to be based on early and informed communication with staff by line managers.
Key aspirations:
• Implementation of a new Payroll/HR System in the autumn of 2006
• Continued ownership of the Council’s policy by regularly reviewing manager application
• Data no longer ‘qualified’ by the Audit Commission
• Richer data added, eg from exit interviews
• Continued briefings to staff (including at Team meetings)
• Transferable information across service Business Plans and for exit interviews
• Manager training on absence
• Management appraisal on absence management
• Consultation with staff representatives and early roll-out of ‘what works locally’ solutions from the MACS
project
• Further work on:
- Rewards for good attendance - this is a particular issue for us
- The role of the Council as an employer of people with a disability
- Assessing the impact of major health inequalities, eg smoking in the workforce
- Contact with employees when ill at home
6.2 The Ministerial Task Force for Health, Safety and Productivity - established by the 2004 Spending Review -
provided two key recommendations on reducing both long-term sickness and self-certification of short-term
absence. These were:
• “Boards (ie the Council’s Cabinet) should see absence management as one of their functions”, and
• “In order to influence an attendance culture, absence management should be built into … performance,
efficiency plans and formal reporting”
6.3 We consider action taken by Cabinet to fund a new Payroll/HR system represents a real commitment to
providing tools to understand and manage absence. This decision goes a long way to meeting the first Task
Force recommendation above. We anticipate new and robust data will make full coding of absence possible
and enable benchmarking, target setting and auditing for compliance against policy a lot easier. It is also
envisaged Council performance will no longer be classified as ‘qualified’ by the Audit Commission. We believe
that only through effective corporate overview can the Council understand where it has a problem, the extent
of illhealth and the best way to tackle it. This is also evidenced, from the 2004/05 Annual Report of the
Occupational Health Unit where it is recognised ‘the unavailability of accurate and current sickness absence
data hampered the management of attendance from a medical perspective’. Paragraph 5.6 above indicates
the largest internal coding for illhealth is at present ‘vague conditions’. This must hinder focus in
Directorates. Although we realise coding is based on national guidance, without internal data or paper search,
in-depth data is difficult to produce and use.
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Report of the Policy & Co-ordination Review Committee
Absence Management
6.4 We also consider real-time information necessary to test equality and other policies that have a cultural (but
presently unmapped) impact on absence.
6.5 With its new system in place, the Council can produce/interrogate data to identify patterns of absence, possible
underlying causes and address ‘hotspots’ early - all evidence we consider necessary for managers and staff
themselves to reduce absence. Phase one of the new system, we understand, is for completion in ‘autumn’ 2006.
6.6 In terms of update reports to this Committee, we look forward to hearing about the impact rich data has
made on managing staff attendance. We pass on a word of caution, however, from colleagues in St Helens
who indicated that because of improved collection, absence figures might initially rise. St Helens also
highlighted that, in their experience as the best performing Council, there are no ‘quick fixes’ to be had and
improvements are likely to take a considerable number of years of consistent effort to achieve significant and
sustained reductions in absence. Focus also needs to consider organisational/cultural change issues as well
as an individual’s own absence record. In time we hope, given the flexibilities of the new system, to hear
about how other information - say from exit interview - has been added to aid holistic analysis of cultural
issues. This might assist in understanding some of the mixed messages we received about working for the
Council. As an aside, we would suggest that to make information transferable across the organisation a
standard approach is taken both in Business Plans and exit interviews with maybe divisional targets to
achieving the aspiration of fewer days lost are set.
6.7 With an umbrella of corporate information, we suggest data can be used to support an understanding of absence
‘on the shop floor’. We consider there is, for the majority of staff, a deeply engrained culture of attendance bridging
periods of constant change, re-organisation and other workplace stress. 43% of staff took no sick leave at all in
2003/04 for example and only 4% of employees took individual days off. From our research, however, we are not
certain staff understand what is expected of them, what support is available and where to go for help. Our evidence
suggests that, whilst corporate advice has been prepared, it is not always communicated or easy to source when ill.
Not all employees have access to the intranet for example - to self-teach - and D&R staff expressed a mixed picture
about if/when absence was discussed at Team meetings.
6.8 We congratulate Corporate Personnel on two awards in 2005 for delivering flexible working to staff. We also
welcome recent moves to enhance information to employees particularly through the intranet and City Talk
(that has a 75% ‘reach’ across employees (2005 Staff Attitude Survey)). We believe this demonstrates a clear
intent to give staff confidence over the corporate commitment to management of attendance, but wonder if
- as ever - more could be done to inform. From our questionnaire, only 19% of D&R staff believed they could
explain the Council’s absence policy and 60% of staff were not confident they could at all. 53% of staff
indicated they found out informally about how the policy works and only 34% indicated knowledge came
from induction.
6.9 We also note the corporate commitment to offering alternatives to the ‘nine to five’ that will better fit an
individual’s work/life balance and are pleased, from the 2005 Staff Survey, 72% of staff responding are
satisfied with flexible working opportunities. We note from our survey there appear to be ‘pockets of
dissatisfaction’ (eg around access to career breaks - that might be difficult to plan - for example), but were
generally very impressed with the way D&R had responded to the broad range of absence ‘issues’. We also
commend the service for taking management ownership at Departmental Management Team and Head of
Service level of both absence and working to support wellness/work-life balance. This has led to all managers
being provided with details of absences/long-term absence and Return to Work/‘trigger’ point interviews
being promoted through Directorate Personnel. An extension of this cascading of information in other
Directorates - based on experiential feedback from D&R - would be most welcome.
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Report of the Policy & Co-ordination Review Committee
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6.10 In terms of areas for new development, the visits to Manchester and St Helens indicated firmly to us the
importance of ownership by managers to support corporate intent. We believe managers corporately need to
have improved communication with staff in terms of both absence and well-being. There was a 50-50 split
from our D&R survey on whether staff felt managers were sufficiently trained and equipped to deliver support.
We consider that, at present, there may be under-managed sickness as a result of:
• Managers not being fully trained
• A culture in some parts of the organisation suspicious of the management of illhealth (as witnessed by
25% non-attendance at Occupational Health Unit appointments - 252 appointments in 2004/05).
We are confident there are plenty of examples of good practice internally and these need to be shared (eg
communication in D&R). 70% of D&R staff perceived Directorate Support Services to be a useful contact and
these local contacts need to be encouraged.
6.11 We welcome Corporate Personnel’s MACS Project (Management of Absence Case Study) to provide a firm
business case around manager interventions. The project compares processes in all Directorates using a ‘live’
and a ‘control’ group. Advice can then be given as to interventions, preventions and procedures that are
known to reduce absence. We consider such initiatives are crucial and are based on ‘what works’. We would
ask that messages emerging are shared widely and there is dialogue with the Trade Unions and staff as
further information is published and proposals formalised. To illustrate the impact of MACS interventions, an
outline of two real cases are set out below:
Children’s Services:
£580 Consultant Fee: This early intervention
prevented 3 months absence had the employee had
to wait for an NHS appointment. Not only did the
intervention save 3 months of sickness, it enabled an
approximate saving of £12,000 (12 weeks of supply
teaching costs at £200 per day). The early
intervention also allowed for the recovery period to
be during the summer and, as such, will not count as
sickness.
Although the employee is yet to return to work the
cost of £580 has saved at least £12,000.
Children’s Services:
£110 Consultant Fees. £580 MRI scan. There is a an
18/19 week wait for a MRI scan on the NHS*.
By funding a private scan the Council achieved a
potential saving of £20,000 (20 weeks of supply
teaching at a cost of £200 per day).
As the employee accessed an MRI scan as a preventive
measure, they had no prolonged periods of sickness
absence. Therefore, £690 has achieved a saving of at
least £20,000,
*City Hospitals Sunderland, May, 2006
6.12 To provide a corporate framework we would see, as a first step, all manager training in key responsibilities
(responsibilities likely to already be in their written contacts). There is presently no corporate approach to
manager training on absence. In terms of ‘selling’ this development, we consider managers themselves
would be key beneficiaries as they would be better equipped to manage absence actively rather than
passively that appears to be the case in a number of areas at present. We believe key inter-personal skills do
not automatically come from being appointed ‘a manager’. It is appreciated the Council operates a number
of courses managers might access (some of which address absence), but we would expect absence
management training to become mandatory so all managers are aware of support available to them and
necessary competencies around:
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Report of the Policy & Co-ordination Review Committee
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• Policies and procedures
• Their role in absence management (including well-being)
• Legal and disciplinary issues
• Significant Occupational Health inputs available to improve team health
• Operation of trigger points
• Return to Work interview
• Counselling (where they may be required to look at job roles, targets and challenges at work impacting
negatively on attendance)
We also understand that particularly for the management of long-term sickness, managers need crucial skills
to make the right interventions and maintain an appropriate level of contact. Without suitable training, it
would not be surprising if managers were unable to:
• Plan any work to return strategy
• Access professional advice guide/understand treatment or
• Co-ordinate outstanding work
We appreciate this is a big training task - significantly in excess of say the 20 ‘one-off’ sessions provided by
City Solicitors on Freedom of Information. Whilst there is no hard evidence to prove it, we also feel - from
anecdotal evidence - ‘rotten eggs stay in the basket the longest’ and perhaps without an element of
compulsion those managers ‘set in their ways’ will never change. For us there is a cultural issue here.
6.13 We would see manager responsibility also formally appraised in terms of:
• service performance over time (reflecting different pressures on each service)
• other types of leave advocated - for example compassionate leave, flexible working arrangements or temporary
redeployment as an alternative to absence
• speed of processing medical certificates and Return to Work interviews
• how staff were apprised of key issues - including specifically at induction and in contact with staff where
reminders/action are required
• how staff accessed corporate support and training
• how staff were appointed and maintained in their work
• how staff were briefed about organisatuional change so that this does not adversely impact on say
stress/illhealth
• discussion at Team meetings. Our survey of D&R indicated absence/well-being support was very rarely
discussed. There were also low levels of recognition for support already available to staff (eg 77% of
respondents were not aware of early intervention stress clinics, 54% of the Council’s stop smoking service)
6.14 We would particularly hope for monitoring and support around Return to Work interviews. These are key to
ensuring short-term problems are identified at an early stage and enable mangers to plan cover, for example,
for recovery post elective surgery. We are concerned, from the D&R survey, 47% of staff indicated Return to
Work Interviews do not take place. We accept there may be perceptions at play. However, we would
anticipate all staff would be aware of this process.
6.15 In terms of referral to Occupational Health, we note significant variations across Directorates. In 2004/05,
Education staff made up 45% of all staff (6,478) but accessed only 9% of both health surveillance screening
(24 referrals) and eye tests (68 referrals). D&R, with 5% of staff (709), accessed 19% of health surveillance
screening (49 referrals), and 26% of eye tests (186 - the largest number of referrals of any Directorate).
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6.16 We would argue that better management by managers will reduce the direct cost of absence, better maintain
the quality of public service and improve the satisfaction of other staff working within sections. There were a
number of comments from staff in our survey that particular long-term illhealth by others was having an
impact on their own work. Others thought managers needed to be ‘tougher’ on persistent absentees. We
consider that this might, again, be down to training and recognise that not all mangers have been skilled in
communicating with employees about their health and welfare.
6.17 We would hope that from establishing robust accountability with managers ‘soft’ as well as ‘hard’ information
can be obtained that might be useful in reducing absence. This can be used to promote a virtuous circle to
inform future revisions of policy and practical guidance and suitable future interventions.
6.18 In time, we hope rich information might become available on a number of areas where we feel further work is
required and where we are not able to conclude any firm findings given the need to conclude our review in
2005/06 and the lack of information available. These includes:
• Possible ‘rewards’ for good attendance. We note incentives are valued as a method of rewarding good
attendance in schools and colleges. We wonder why, when someone starts work, initiatives cease to be
viewed as appropriate. Research by the CIPD indicates only 18% of organisations use attendance
initiatives or bonuses as a tool of absence management (CIPD Absence Management: A survey of policy and practice).
Professional bodies (such as the CIPD) have detailed analysis on possible benefits and we would appreciate
more information. Our questionnaire indicated staff feel more could be done, but we wonder if this is
really appropriate. Colleagues off with say cancer or mental illhealth did not ask to be ill and is 100%
attendance a no guarantee of 100% productivity ?
• Scope for the Council to act as community leader and take more risks in say appointing a member of
staff with a limiting disability. In Sunderland 32.4% of the adult population are inactive according to the
Department for Work & Pensions. 54% of these are on Incapacility Benefit. In terms of creating a
prosperous and inclusive City (Sunderland Strategy ambitions) the largest employer in the City might want
to support more of this group into jobs. Government’s ambition is that 80% of adults should eventually
be in work, but wouldn’t this have a negative impact on BVPI 12 ?
• The impact of City health inequalities. These are already likely to be having an impact on workforce illhealth
although pleasingly 96% of respondents to the 2005 Staff Survey indicated their own state of health was
generally ‘healthy’ to ‘very fit and healthy’. We would not want the Council to be complacent about this, however,
as this may be a response based on lowered expectation given the poor heath of the background population. We
would hope the Council could progress, for example, systematic plans to address smoking cessation with staff,
diet (in restaurant meal choices) and exercise (through publicising Fitness@ membership) - all of which might be
‘costed’ in terms of long-term benefit v support cost
• Contact at home. Our D&R survey asked if employees would be happy to be contacted or visited at
home. We wanted to see from this what channels of communication were most supported. As a
development area there was some resistance, but not as much as we had expected
R2: HEALTHY WORKFORCE: The Council should seek to mainstream, across all Directorates, equal
access to work-based wellness initiatives
Employers, staff and the Trade Unions all have a role to play in establishing environments that
support healthy choices
Our key aspirations:
• A report on how consistency will be assured in accessing Occupational Health across services
• A report on how the Council will be responding to chapter 7 of the Choosing Health White Paper
• Access for all office-based staff to a Council approved health-based internet site(s), eg NHS Direct
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6.19 It is estimated individuals spend up to 60% of their waking work day hours at their place of employment
(Effectiveness of health promotion in the workplace Peersman, Harden & Oliver, 1998). It is therefore an important place in terms of
physical and mental well-being. Adults who are physically active are up to 50% less likely to develop chronic
health problems of stroke, diabetes, cancer & heart disease (British Heart Foundation). Good physical health is also
associated with reduced stress, anxiety, osteoporosis, osteoarthritis, back pain and hypertension (World Health
Organisation, 2002); all key issues for an employer reflecting on absence management.
6.20 We hear experience from across industry that there are excellent ‘business’ reasons for developing proactive
action and support - particularly through Occupational Health. Proctor & Gamble highlighted how its
approach aimed to achieve ‘zero business interruptions, maintain a productive workforce, optimise employee
productivity and ensure the flow to skills’. This is as true for the production of shampoo as it is for the
delivery of personal services. But for us, as stated at the beginning of the review, staff are our biggest
resource and any absence management framework needs to reflect this at its heart too.
6.21 We feel the Council has a big outward looking role in helping to meet the Sunderland Partnership aspiration
of a Healthy City. With 14,000 employees it can make a big impact on this goal. We recognise the Council’s
written commitment to improving the diversity and accessibility of employment for all groups. This has seen
the Council’s Human Resources Strategies and Workforce Development Plans aligned to key Sunderland
Partnership priorities of Creating a Prosperous City and Creating Inclusive Communities. For us, there remains
a natural and appropriate ‘trade off’ as Community Leader between median rates of absence and facilitating
access to work for perhaps those with a long-term medical condition.
6.22 Unfortunately the health of the North East (where the majority of staff live) is not good. It has the highest levels of
illness, reported disability and chronic disease in England. According to the Acting Director of Public Health the
region has, in many ways, the health of an eastern - rather than western - European country. This is not to say
health and social care services are poor. Hospitals have high average ‘star’ ratings, there are low/no waiting lists for
acute and elective surgery and there is easy access into primary care and dentistry compared to the rest of
England. Economic factors, a history of high levels of worklessness and longstanding health inequalities have
naturally had their impact on the local labour market. BVPI 12 gives no weight to these wider issues and will
naturally impact on Sunderland’s level of sickness absence. We feel that as an indicator BVPI is misleading. No
organisation - particularly one with circa 14,000 staff covering several thousand types of jobs - will ever reach the
‘target’ of 0 days off average per employee. In addition, the composition of the workforce varies between Local
Authorities depending on services they have contracted out.
6.23 We note too that very few workers in the local economy have access to a company occupational health
scheme (estimated by the Sunderland Teaching Primary Care Trust to be only 15% - and as low as 3% for
access to a comprehensive service). This is also likely to have an impact on the ‘pool’ of labour available to
the Council. We agree the Council’s Occupational Health Unit demonstrates a real commitment to well-being
and provides the vital tools to improve the medical management of attendance and to educate and inform
existing staff about maintaining good health. It undertakes significant pre-employment screening and health
assessments (2,720 and 215 cases respectively in 2004/05) and ensures new starters are fit for work. There
will, however, likely remain an impact on the actual level of fitness given the picture of local health
inequalities.
6.24 We welcome significant developments in the Council’s Occupational Health Service. This has seen, for
example, a counselling service from June, 2005 and service redesign to create 50% additional capacity. We
believe this new focus will likely have a major and positive impact on reducing absence. Together with
building a secure income-base from work with other authorities/businesses, including a mobile screening
unit (that visited 55 sites in 2004/05) we see a real future for the service. We are concerned, however, at the
growing waiting list for appointments. This is only to be expected as more and more access is encouraged
within limited resources. We hope there is detailed thought being given to service development and would
identify, in terms of Gershon Efficiency savings, there may be opportunities here of ‘spending to save’. We
would see a continued eye being given to management of the service and appreciate the Council is
recruiting a new medical practitioner. We also note the Council is further reviewing and seeking to
commission in collaboration with others (possibly with Gateshead MBC). This will, no doubt, give synergies
and opportunities to develop corporate intent and roll out access consistently to more and more staff.
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6.25 We are pleased to receive some positive statements on the quality of Occupational Health from D&R staff.
We wonder, however, how well known its services are. 54% of respondents were neutral in terms of how
confident they were the Unit was helping to reduce corporate absence. We would also hope Occupational
Health is not seen culturally in Directorates as ‘an end in itself’ and that managers and staff take full
responsibility to both prevent illhealth (eg time for smoking cessation courses and stabilise illhealth through
referral/attendance at musculo-skeletal injuries sessions). We have a suggestion too at recommendation 4.
to provide more detail on what staff are able to do when ill. As is recognised in the 2004/05 Annual Report,
Occupational Health needs to reflect on how it moves forward. The increased monitoring of attendance
management over the past 12 months has identified the need for a stricter and consistent ‘business
like’application by all those responsible for referral to the service. The need to improve management training
and foster closer co-operation is still very clear. The visit to Manchester City Council indicates how a more
costed approach benefited both staff (in avoiding manager passivity) and the organisation (in reduced
absence). Is it always fair to every employee to pretend they will be returning to work ?
6.26 We recognise environmental interventions are also key. The Department of Health White Paper Choosing
Health contains a chapter highlighting the importance of wellbeing at work. The White Paper sets out
‘actions for employers, employees and others to extend healthy choices by: improving working conditions to
reduce the cause of ill health related to work’ and ‘promoting the working environment as a source of better
health’. In this vein, the recent extension of the smoke-free environment to all of the Civic Centre and its
grounds is most welcome. Smoking is the biggest cause of preventable death in the City (Director of Public Health
Annual Report, 2005). We look forward to extending this to all Council buildings as soon as possible and note recent
legislative changes in this area. We also welcome the start of Council stop-smoking services and are
disappointed that despite a number of different messages so few staff accessed the service in 2004/05. We
are satisfied in relation to Health & Safety and no concerns were expressed to us by staff during the
consultation survey or discussion with the Trade Unions.
6.27 We welcome work within Corporate Personnel in 2005 to improve the level and accuracy of data on disability
and caring responsibilities. This information, we believe, will address some underlying issues in absence not
considered before. Also welcome are specific questions in the 2005 Staff Survey about staff well-being
shared with us on 20th October, 2005. Key questions measured psychological health, job satisfaction and
workload. Questions were also asked of how people felt about working for the City Council, addressing issues
of: perceptions of work/job, relations with managers, communication, equality and harassment and
organisational culture - dealing with ‘softer’, but real absence issues for employees. Information on 20th
October also highlighted the ageing workforce that (without wanting to be ageist) will naturally have an
impact of levels of attendance. In 2004/05 58.7% of staff were over 40 years (13.06% over 56).
6.29 As an example of good practice, we welcome the significant commitment of D&R to promote wellness with staff.
This has meant that all Directorate staff have been able to access Know your Numbers (providing information on
blood pressure, stress levels, cholesterol and body mass). Good use is also made of work/life balance tools -
reflecting the fact that staff do not live in a ‘work bubble’ but have carer and other responsibilities. Consultation
with the Trade Unions through the Joint Consultative Committee also provides an opportunity to share ideas and
development. It also gave us some ideas about how we might consult in the future.
6.29 We note, however, that the promotion of wellness is not standard throughout the Council and there are
varying degrees of awareness amongst staff. A pilot group of only 30 volunteers are accessing a ‘Wellness’
Programme that includes lifestyle advice and free membership to Fitness@ leisure centres. The Staff Survey
indicated also that 25% of employees were not aware of the 24-7-365 Employee Assistance Programme. For
us workplaces should not be underutilised as a setting for promoting health and well-being. This is
something that employees cannot do for themselves but need assistance from employers - and also the
Trade Unions through promotion - to deliver. The Council’s policies permit a flexible element of job and
environmental design and we note that from 2007 new ‘health’ indices will be built in to the Investors in
People Standard and look forward to seeing this integrated as soon as possible in Sunderland.
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Phil Barrett, Director of Development & Regeneration (centre) enjoys the Wellness Programme
6.30 We note a number of companies empower staff to monitor their own health through access to established
internet sites. Sites include NHS Direct, the Mayo Clinic and others. We suggest a publicised link from the
Council’s own intranet site. NHS Direct, for example, enables employees to find a doctor or dentist, check on
illness, tests and treatment and get advice on common health problems and self help. It also has interactive
quizzes and calculations on say safe drinking and smoking. Professional advice could therefore be extended
to a lot of staff at very little (if any cost) to the Council.
6.31 We note from the Vice-Chairman’s visit to Manchester and St Helens there are a range of ‘low level’
interactions that the Council could consider. These include:
• ‘Back clubs’ where staff met informally and have lunchtime walks, discussion and support (St Helens)
• Tai Chi - that had proved popular in Manchester
• Volunteer ‘Conciliation Officers’ (Manchester) to provide a ‘friendly ear’
Some of the support available in the North West was through Health Action Zone and local PCT funding - that
may be applicable to Sunderland too. We would suggest also that Directorates and the Trade Unions try and
stimulate interest from staff themselves.
R3: POLICY: The Council should consider including in its formal policy a written statement about the
role of the Occupational Health Service and the role of the employee’s ‘friend’
There are advantages in setting out the precise role of the Occupational Health Unit and the
employee’s friend
Our key aspiration is:
• Including, within Council’s policies, a statement on the role of Occupational Health and the employee’s friend
6.32 We are satisfied the Council’s policy meets its obligations under the Employment Rights Act 1999 to both
support the organisation’s business objectives and culture and set out ‘any terms and conditions relating to
incapacity for work due to sickness or injury, including any provision for sick pay’. In addition we believe it
adequately reflects the importance of developing the well-being of the workforce.
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6.33 Although there appears to be no significant difference between the Council’s written policy and those of best
performing authorities, we note both Manchester City and St Helens identify a specific role for Occupational
Health and the employee’s ‘friend’ throughout the process. Whilst we did not have time to evaluate the
statistical impact of these statements on the performance of the North West authorities, we think spelling
out formal links/standard response times in Occupational Health and the actuality of help from a ‘friend’ is
worth Personnel professionals exploring. We note the Council’s policy is under periodic review by a dedicated
Team within Corporate Personnel and look forward to hearing feedback on this idea in due course. What is
clear from all of our research is that Occupational Health needs to have a pro-active and possibly expanded
role to intervene in individual cases at the point most appropriate to that case. This is not just according to
an artificial timetable with ‘trigger points’ set at intervals that may be far too late for the employee. From our
visits, we saw that the main aim of Manchester’s Occupational Health service was to get the employee back
into work. External services were also secured to provide a second opinion for illhealth retirements. We think
this approach offers a number of lessons for Sunderland given our own Unit culturally sees itself as working
on behalf of the employee and supports them in their medical condition.
R4: PROCESS: The Council should consider reviewing correspondence with employee’s Medical
Practitioners to establish if an alternative to absence is appropriate considering the nature of the
employee’s illness
Further engagement is needed to establish what occupationally can be done to support a medical
diagnosis on a sick note
Our key aspiration is:
• A review of correspondence to ask employee’s GPs specific questions about absence
6.34 We note self-certification by staff is the commonest form of sickness absence (78% of all absence in the
Council in 2003/04). It is also where there is most data particularly when supported by a Return to Work
Interview. For GPs we appreciate there is always a duty of care to the patient who may ask for a private sick
note for a certain period of time. For the manager, there may be frustration at a lack of input - particularly if
absence comes ‘out of the blue’ when practical arrangements could have been made for say work at home, a
phased return or reasonable adjustments to the workplace. It is therefore important there is communication
between the Council and an employee’s doctor(s). This is an area relatively silent in the Council’s policies and
procedures. For us, it is best to focus on what an employee can do rather than a global statement in a sick
note of whether someone is ‘fit’ or ‘unfit’. We feel this applies equally to short and long-term illhealth based
on individual circumstances. If developed (following consultation with staff representatives, such as Trade
Unions) we feel there will be benefits for all including GPs - who we heard had concern at a ‘policing’ role for
employers. We believe strongly it will also give employees a sense they are fully appreciated even if on limited
duties and a win for the Council in reduced absence rates. It is worthy of note that in St Helens, the
Occupational Health service and employing Department do not wait until an employee is off for 6 months
before deciding whether to end an employee’s contact on grounds of ill health if there is severe ill health.
This has had a significant impact on their sickness figures
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6.35 We note from Dr Sayeed Khan, Chief Medical Adviser at the Engineering Employers Federation, 2005 research
indicated waiting for the expiry of a sick note was responsible for 26% of all absence. We also note the
importance of early intervention for all parties. If an employee is off work for six months nationally they stand
a 50% chance of returning. If the absence is for one year, there is a 25% likelihood of return and if an
employee is off for two years + there is virtually no chance of return (Clinical Standards Advisory Group report on back pain, 1994).
This is re-enforced throughout the Council’s policy & procedures and has been a particular focus for action in
recent months through Case Conferencing. In 2003/04, 4.83% of all Council absence was as a result of 32
members of staff being absent for at least one year. This mirrors the national picture. Despite long-term
absence making up 5% of all incidences of absence it accounts for a third of total days lost (Chartered Institute of
Personnel Development, 2001). Whilst every support should be given to staff, Trade Unions and other ‘friends’ to
articulate on behalf of employees in dispute, we believe what should remain central is staff provide services
to the public. Absence particularly if medium to long-term adds pressure to service delivery and presents
work pressures to colleagues.
6.36 We would suggest that Corporate Personnel reviews its Management of Sickness Absence procedures to ask
GPs to produce a letter indicating:
• What is the actual functional problem - rather than a medical diagnosis. What precisely is preventing X
from returning eg stamina, manual handling, mobility, dexterity, levels of concentration ?
• Is the illhealth permanent or temporary - if so for how long ?
• Are there treatments/investigations that might help ? Is he/she on an NHS waiting list?
• What modifications might allow a return to work ?
6.37 In essence, we believe more focussed communication between GPs (and other medical practitioners as
appropriate), managers and the Council’s Occupational Health Unit can work together to support an
employee back to work/onto illhealth retirement, etc as soon as possible as this will is only fair to the
employee.
6.38 We note that for both Short/Medium Term and Long-term ill-health procedures, medical input is available
from the Council’s Occupational Health Unit, but consider this would be assisted greatly by an earlier
indication of the precise nature of any illness and the views of an employee’s own GP. It will also empower
managers and employees to know the actual impact of illhealth on work, rather than just looking at a medical
prognosis. Given the growth of Practice Based Commissioning for GPs, there is also a likelihood more and
more rehabilitation will become available in community settings - particularly as Doctors under the Quality
Outcome Framework have a new basis for payments by broader well-being outcomes. This may, in part
reduce any pressures on the Council’s Occupational Health Service and result in local solutions nearer the
employee’s home.
6.39 In terms of further development, we heard from St Helens Council that as a result of developing a partnership
across staff, managers, GPs and Occupational Health it had been possible to have pre-surgical consultation
that would look at the time needed before a return/phased return. This would mean that the employer and
member of staff were not reliant upon a sick note; that experience had indicated was for a longer period than
might actually be necessary for the employee to return to ‘light duties’. This would also mesh with existing
policies including use of public transport/taxis if someone’s only reason for not being at work is because they
couldn’t drive.
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7. Bibliography
2004 Spending Review
(HM Treasury)
2005 Annual Report of the Director of Public Health
(Sunderland TPCT)
2005 Staff Attitude Survey Extract
(Policy & Co-ordination Review Committee 20th October, 2005)
2004/05 Annual Audit & Inspection Letter 2004/05
(paragraph 19)
Absence Management: A survey of policy and practice
(2005, CIPD)
Analysis of Sickness Absence in the Home Civil Service 2004
(RED Scientific Ltd)
Annual Efficiency Statement 2005/06 – Mid Year Review
(Cabinet report, 7th December, 2005)
Attendance Management Policy & Guidance
(Sunderland City Council)
Best Value Performance Indicator 12 for Sunderland City Council, Tyne & Wear authorities, Solihull Borough,
Manchester City and St Helens Councils
CB1-AXA Annual Survey of Workplace Absence
(2004)
Clinical Standards Advisory Group report on back pain
(1994)
Council’s Attendance Management Policy and Guidance
(2003)
Choosing Health White Paper
(2004 Department of Health)
Effectiveness of health promotion in the workplace
(1998, Peersman, Harden & Oliver)
Employment Rights Act 1996
Health of Sunderland, Director of Public Health (2004 Annual Report)
The Labour Force Survey
(Office of National Statistics)
Personnel Committee Agenda, 30th September, 2004
Releasing Resources for the Frontline: Independent Review of Public Sector Efficiency
(July, 2004, report by Sir Peter Gershon for HM Treasury, )
www.nhsdirect.nhs.uk
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