POLICY & RESOURCES SCRUTINY COMMITTEE

TASK & FINISH GROUP 2009/10

FINAL REPORT

REVIEW OF SICKNESS ABSENCE MANAGEMENT

TABLE OF CONTENTS

SECTION

PAGE

1.0

CHAIR’S FOREWORD

3

2.0

BACKGROUND

4

3.0

OBJECTIVES & SCOPE

4

4.0

APPROACH

5

5.0

EXECUTIVE SUMMARY

6

6.0

SICKNESS ABSENCE – MAIN REPORT

16

7.0

MANAGEMENT OF SHORT-TERM AND LONG-TERM SICKNESS

23

8.0

DATA-CAPTURE AND INPUTTING

31

9.0

SICKNESS REPORTS AND MONITORING

33

10.0

APPENDICES

44

11.0

GLOSSARY OF TERMS

57

1.0 CHAIR’S FOREWORD

2.0 BACKGROUND

2.1 Policy & Resources Scrutiny Committee has a key role to play in monitoring the effectiveness of the Council’s approach to sickness absence.

2.2 Departmental sickness absence rates are reported to the Policy & Resources Scrutiny Committee on a quarterly basis.

2.3 While the overall sickness absence rate for the authority has been reducing in recent years, the Committee has been concerned about the need to identify the true costs of sickness absence.

2.4 In November 2009, the Committee decided to establish a task and finish group, recognising that this area has the potential to contribute significantly to the Council’s challenging efficiency agenda.

3.0 OBJECTIVES & SCOPE

3.1 Objectives

3.1.1 To evaluate the effectiveness of the application of the current sickness absence policy.

3.1.2 To identify the principal causes of sickness absence.

3.1.3 To identify the total costs of sickness absence to the Council.

3.1.4 To identify key data trends in relation to sickness levels over previous years – corporate and by department.

3.1.5 To evaluate the effectiveness of the systems and processes for the capture, reporting and monitoring of sickness absence data.

3.1.6 To evaluate the effectiveness of the resources and initiatives for managing and preventing sickness absence.

3.1.7 To identify best practice or alternative approaches to the management of sickness absence.

3.2 Scope

3.2.1 The review will include the approach to sickness absence across all Council departments, including schools.

4.0 APPROACH

4.1 The Task & Finish Group was established in January 2010.

4.2 The terms of reference and scope of the review was agreed by the Policy & Resources Scrutiny Committee at its meeting in March 2010.

4.3 The membership of the Group consisted of:

4.4 The Scrutiny & Consultancy Unit within the People Management & Performance Division assisted in the coordination and planning of the review process.

4.5 Ms. Heidi Font, Fitness for Work Manager acted as specialist adviser to the Group.

4.6 A range of internal and external participants were invited to give evidence to the Group over a series of meetings between February and December 2010.

5.0 EXECUTIVE SUMMARY

5.1 Key Findings

5.1.1 The Council is making progress in reducing sickness absence levels and sickness absence rates have been declining in recent years, from 12.6 full time equivalent (FTE) days lost in 2007/08 to 11.1 FTE days lost in 2009/10. However, this still equates to over 78,000 working days lost to sickness (the equivalent of 334 employees being off for a full year), and although the Council’s absence levels remain about the average for other Welsh councils, they are higher than other public sector (9.6 FTE days) and private sector bodies (6.6 FTE days); this shows that there are considerable opportunities to reduce sickness levels further.

5.1.2 The review has identified that sickness absence costs the Council over £8.6 million pounds a year. For many services, this is just a notional cost (where the employee is not replaced); but for some front-line operational services, sickness absence will result in additional expenditure being incurred, and therefore reducing sickness levels in these areas could result in a financial saving for the Council and schools. However, even where sickness absence does not result in additional costs associated with the replacement of staff, it can still have a significant impact on the productivity and efficiency of services and can lead to additional pressure on colleagues, which in turn can lead to further cases of sickness absence.

5.1.3 It is estimated that front-line operational services account for nearly two thirds (£5.6m) of the £8.6 million estimated costs of sickness absence. It has proved difficult to provide an accurate picture of the additional costs of sickness absence, as even in front-line services, not all sickness absence will result in additional costs being incurred. However, if we assume that, even in front-line services, only 40% (industry norm) of sickness absence results in a person being replaced, this still equates to £2.24 million of additional expenditure being incurred as a direct result of sickness absence.

5.1.4 Some services may be required to pay overtime and bring in casual/temporary or relief staff to cover staff that are absent due to sickness absence. In 2009/10 the authority paid out over £2.9m in overtime payments and £1.2m through the employment of agency workers; front-line services account for the bulk of this expenditure. However, it is not currently possible to identify how much of this expenditure is specifically due to sickness absence, as some costs relating to the payment of overtime, use of temporary staff and agency workers will also be incurred to cover annual leave, or to cater for increased demand and specific service pressures. However, it is estimated that these costs could add up to 30% (industry norm) to the costs of replacement, which would bring the estimated additional costs of sickness absence in front-line services closer to £3million.

5.1.5 Therefore, while these figures do not provide for a totally accurate picture of the total additional costs being incurred by front-line services as a result of sickness absence, they do provide an indication of the actual cost being incurred and the potential savings to be achieved.

5.1.6 In areas of the Social Care services, the situation is accentuated by the fact that current terms and conditions mean that a person on sick leave will be paid at an enhanced rate if they were due to work at a weekend, while the replacement member of staff will also be paid at an enhanced rate. This issue is currently being reviewed as part of Single Status negotiations.

5.1.7 The departments with the highest rates of sickness absence rates are Social Care, Health & Housing and Technical Services, with FTE absence levels of 16.8 and 13.5 respectively during 2009/10; above the authority average of 11.1 FTE. An analysis of sickness by service area again shows that front-line operational services appear to have the highest levels of sickness absence:

5.1.8 In analysis of sickness data for 2009/10 indicates that 26% of staff were responsible for 80% of the sickness recorded. Of the 26%, 43% worked in Education & Children’s Services, 30% in Social Care, Health & Housing and 17% in Technical Services and there also appears to be high levels of sickness rates for new starters which highlights the importance of raising awareness of sickness absence procedures and responsibilities as part of the employee induction process.

5.1.9 Of the 78,460 days lost to sickness during 2009/10, 32% (25,425 days) was due to short-term sickness absence and 68% (53,034 days) due to long-term. The ratio of short-term (ST) / long-term (LT) absence is approximately 45% (ST) / 55% (LT) for departments such as Chief Executive’s and Resources, while longer term sickness appears to be greater in front-line service departments such as Technical Services and Social Care, Health & Housing [25% (ST) / 75% (LT)]. Older People’s services accounted for 20% of the total number long-term sickness days lost by the authority as a whole during 2009/10.

5.1.10 However, short-term/intermittent absence appears to be more of an issue for schools; this accounted for 42% of sickness for non teaching staff and 39% for teachers. Schools (teachers and non teachers) accounted for approximately 12% of the total short-term sickness for the Council as a whole.

5.1.11 Musculo-skeletal, stress mental health/fatigue and infections appear to be the main causes of sickness absence. Infections such as cold and flu are the main causes of sickness absence within departments such as the Resources and Chief Executive’s Departments, whereas in departments with front-line operational staff, it is musculo-skeletal followed closely by stress. However, 10% of the sickness recorded during 2009/10 did not have a specific reason identified, which suggests that data is not being properly captured at source. (Over 7,000 days were recorded without a specific reason within the Education & Children’s Services Department).

5.1.12 The Council has developed proactive strategies to deal with the main causes of sickness which include a stress management programme making use of cognitive behavioural therapy; a proactive stress and well-being programme targeted at services with highest rates of sickness due to stress; manual handling programme and a flu vaccination programme.

5.1.13 The current sickness absence policy is now considered to be out of date in respect of its use of terminology, data and references to legislation and could also be made more user-friendly.

5.1.14 There is a concern that the current approach to short-term sickness is not sufficiently robust and that some staff ‘know how to play the system’. For example, there is a perception that some staff under review for sickness absence, wait for such review periods to end before taking more sickness leave. HR has attempted to address this situation by introducing an option to re-open a sickness case at a specific stage, rather than having to start the review period from the beginning; but this is not currently formalised within the policy.

5.1.15 The approach to short-term sickness absence could also be strengthened by reviewing the current trigger points within the policy; to make them simpler, easier to apply but more effective in dealing with frequent, short-term absences which can often cause greater disruption than those caused by occasional long-term absences. This may also allow for greater manager discretion to be built into the application of the policy; as for example, a points based approach would not require action to be taken where an employee is off for a absence period of 10 days due to flu or broken limb, but would require that action is taken where an employee had been absent on 5 separate occasions of 2 days.

5.1.16 The review was not able to obtain figures on the numbers of staff whose contracts had been terminated for persistent short-term absence as these figures are not currently collated on a corporate basis.

5.1.17 While the management of short-term sickness in theory should be more difficult to manage, some managers had more concern about the Council’s approach to long-term sickness absence management and the role of Occupational Health in supporting line managers through this part of the process. These concerns were mainly centred around the quality of occupational health reports and the lack of clear direction given in specific cases (although during the course of the review managers did note an improvement in the quality of these reports); time-scales for resolving cases and also a perception that the application of the policy by occupational health physicians was too far weighted towards the interest of the individual and did not consider the needs of the business. Some services also identified service delivery and the budgetary impact of having to find alternative lighter duties for those staff that were deemed unfit to continue in their substantive roles. However, Trade Unions consider the current application of the policy to be too draconian and some line managers believe that it does not take into consideration employees who suffer from chronic conditions, and as such, the approach can be seen as ‘unsympathetic’.

5.1.18 Occupational Health Physicians interviewed as part of the review suggested that early intervention in long-term sickness management was critical to achieving a successful outcome and a quicker return to work, and that referrals to occupational health are a key element of this early interventionist approach. However, the review identified that only 33% of staff on long-term sick had been subject of a referral to occupational health; this suggests that there is a need to educate managers about when to refer staff to occupational health and to strengthen and improve the level of information provided by managers as part of the referral process.

5.1.19 Due to the current financial challenges facing local government, some UK Councils are looking to review the levels of sickness pay and reducing the periods of sick pay entitlement. For example, by reducing maximum entitlement from 6 months to 3 months or not paying for the first 3 days of sickness. This appears to be an attempt to bring local authorities in line with private sector companies.

5.1.20 There is a need to ensure that long-term absence cases, which have been confirmed as issues relating to management or capability and not ‘medical’, need to be acted on more promptly and HR services need to ensure that managers are supported in this regard.

5.1.21 The previous sickness management pilot within Social Care services identified the benefits of using case reviews and case conferences to deal with specific long-term absence cases. Case review meetings involve the line manager and representatives of HR and Occupational Health meeting to review the status of a case and potential strategies to move the case forward. Case Conference meetings will also include the individual and Occupational Health physician in the discussions. The use of case reviews and case conferences could be further developed by introducing automatic trigger points within the long-term sickness management process to determine when such meetings should be held.

5.1.22 The review also considered the various stages within the overall sickness management process, including notification of sickness, the capturing and inputting of sickness data and the way that sickness absence is monitored and reported.

5.1.23 In respect of the notification of sickness absence, the current sickness absence policy requires that ‘on the first day of absence the employee will notify their line manager/supervisor if they are unable to attend for work due to illness or injury’. The majority of managers interviewed stated that in the main, staff were complying with the policy. Early notification was considered to be critical in front-line services, due to the need to provide adequate cover and possibly find replacement staff. Other local authorities and public/private sector bodies have prioritised the notification process as one of the most important stages in the whole sickness management process and make use of a specialist private company to receive the initial notification from the employee. Authorities have been reported to have achieved significant savings from this approach by adopting this system in all or part of their business.

5.1.24 ‘Return to work interviews’ are another essential component of the overall sickness management process and should be undertaken by the line manager immediately following an employee’s return to work. The interview provides the opportunity to make sure that the employee is fit to return to work and to discuss the nature of the illness and any patterns of sickness which may be occurring. Data gathered as part of the review suggests that approximately 90% of ‘returns to work interviews’ are carried out. The main areas of non-compliance appear to be in parts of Social Care, Health & Housing and Education & Children’s Services Departments. The main hot-spot areas within these two departments appear to be Older People and Physical Disabilities where only 29.2% of return to work interviews were completed and 36% for teachers and 34.4% for non-teaching school staff (although concerns have been expressed about accuracy of this data).

5.1.25 The review has identified concerns over the robustness of methods for capturing sickness absence which in turn has led people to question the accuracy and timeliness of information. For example, some line managers do not appear to be capturing the reasons for sickness and for office based staff, sickness data is only inputted on a monthly basis. This could be addressed by reviewing relevant forms and documentation and moving to direct inputting of sickness by managers. One of the other key benefits of moving to such an approach is that it could make use of mandatory fields to ensure that ‘return to work details’ and the ‘reasons for sickness’ are recorded properly and the system also has the capacity to allow for the use of automatic prompts to appear on a line managers computer reminding them of the need to undertake a return to work interview and highlighting where a trigger point in the policy has been reached.

5.1.26 One of the consistent themes that emerged via the feedback from line managers and Heads of Service is that the current method of reporting sickness absence to departments does not appear to be adding value to the management of sickness across the authority. These concerns mainly relate to the complexity of the reports, the accuracy, timeliness and level of reporting. There are also issues relating to the confidentiality of data and some line managers do not appear to be receiving reports at all. The current method and format of reporting does not appear to be supporting the effective monitoring and management of sickness absence, particularly at business unit level. The development of the ‘Insight’ reporting tool has considerable potential to improve the monitoring and management of sickness absence data. This tool makes use of graphical representation of data to provide sickness information in a more user friendly method. This facility should be made available to all Directors, Heads of Service and managers who will then be able to run a range of reports from their own PC in relation to the levels of sickness, trends and causes and staff who have hit trigger points within the policy.

5.1.27 The Council’s Occupational Health Unit has a key role to play in the overall sickness management agenda and this role is both reactive and proactive in nature. In terms of its reactive role, the review has already highlighted the concerns of some line managers in relation to the role of the unit in supporting the long-term sickness management agenda, particularly in relation to the standard of reports and case management and where improvements could be made to the referral process. However, Occupational Health has taken action to address concerns over the standard of physician reports and this has been recognised by managers. The turn-around times for referrals and reports have also significantly improved.

5.1.28 A number of managers were also very complementary about the excellent level of support that they receive from the unit and this was also endorsed by Trade Unions representatives. The unit consistently receives external recognition for its work in supporting the overall work-place health agenda. The Wales Audit Office has identified the work of the unit as ‘good practice’ and the Council has won numerous awards as a result of this work. This work undertaken by the unit has been key to the authority achieving the Gold and the Platinum Health Standard and the unit has also recently been nominated for a national occupational health award. Best practice comparisons undertaken as part of the review clearly demonstrate that Carmarthenshire appears to be one of the leading authorities in this field.

5.1.29 However, the high staff turn-over within the unit in the last few years does appear to have compromised the service’s ability to undertake the ‘added value’ work in supporting services in strategically managing sickness absence (e.g. use of case conferences and reviews). There are also opportunities to strengthen links with GPs in the county to encourage information sharing in relation to specific cases and to develop a referral process from the GP to the Council’s Occupational Health Unit.

5.1.30 In line with good practice, the unit has been carrying out health promotion and awareness among employees, recognising that this can play a key role in preventing sickness from occurring in the first instance. However, as with many preventative agendas, it is difficult to demonstrate tangible benefits of this approach in the short-term, but it would be beneficial during times when all budgets are coming under increasing scrutiny, that some method is developed to evaluate the impact of such initiatives on an on-going basis.

5.1.31 A sickness absence pilot undertaken in Social Care services during 2005/06 demonstrated the impact of additional occupational health resources on sickness levels within front-line services. At that time, sickness absence rates within Social Care services had reached 8.4%. This pilot increased investment in staffing resources and initiatives to provide a greater focus for the management of sickness within Social Care services. Additional funding of £120,000 was provided by the Council’s Risk Management Group, but this funding was only temporary for one year. This funding supported the appointment of a dedicated Occupational Health Adviser, part-time HR Officer and involved the fast-tracking of employees for physiotherapy and consultants appointments, use of case conferences between occupational health, line management and HR to enable decisions to be made and closure of long-term sickness case. It also involved the introduction of health and life-style screening to promote and encourage employee involvement in their own health and well-being. A post evaluation of the impact of these initiatives indicated that, following he commencement of the project in October 2005, sickness absence fell from 8.4% to 7.2% by April 2006, a reduction of 15% over a 6 month period The Wales Audit Office estimated that this resulted in a notional saving of £500,000 to the Council from the whole project.

5.1.32 However, as stated previously, the funding to support these initiatives was only temporary, and when the funding ceased in 2006, many of the initiatives were reduced or withdrawn all together. The high turn-over of staff in key positions within Occupational Health also impacted on the unit’s ability to maintain the focus in these areas.

5.1.33 Human Resources has a critical role to play in the overall sickness management process. Over the last year, HR has been attempting to develop more of strategic approach to the delivery of HR support as part of a move to a ‘business partnering’ approach with departments. In terms of sickness management, this means that HR no longer has capacity to attend sickness absence review meetings and will now only attend for the 3rd stage interview. Some managers have expressed concern about this change as they feel that absence reviews no longer carry the same impact if HR are no longer in attendance. It is critical that HR effectively communicates the change in role and the benefits that this can have on the overall sickness management process.

5.1.34 Generally, line managers found HR to be helpful and supportive and good practice was identified where some HR Officers meet with a manager on a monthly basis to discuss trends, patterns and the approach to specific cases. This could be replicated for all sickness hot-spot areas or across all operational/front-line services. The review has already identified the need to improve management information relating to sickness and this will be key to the success of the HR Business partnering role. HR will need to be equipped with this information to strategically advise departmental teams/Heads of Service and Line Managers in relation to the management of short and long-term sickness. Stronger links could also be developed between HR and Occupational Health to share intelligence relating to trends and specific cases and to evaluate the impact of specific initiatives.

5.1.35 The review recognises that a comprehensive training programme for managers has been implemented in the past. Most recently, an "Attendance Management" management development course, comprising of e-learning and half-day instructor-led course has been developed, with courses due to commence in December 2010. The completion of this course should be made mandatory for all managers and could be followed by targeted training in key sickness hot spot areas and where there is evidence that the policy and its respective procedures are not being properly applied. The review understands that funding has been allocated to support the training of all line managers over the next year, but does not cover schools.

5.1.36 Aspects of the corporate management of sickness absence could also be strengthened such as more consistent approach to monitoring across management teams, improved sickness reports to CMT/Scrutiny, more use of target-setting and the identification of costs of sickness within reports.

5.2 Conclusions

5.2.1 The review concludes that the Council is making progress in reducing sickness absence levels, but there are opportunities to make further improvements to bring the Council’s performance in line with other public and private sector bodies.

5.2.2 Further reducing sickness absence levels will realise significant financial savings for the authority. The review has identified that sickness absence cost the Council approximately £8.6 million during the last financial year. Although this figure is a ‘notional’ cost to the Council, a certain element of this figure will be an additional cost, particularly in front-line, operational services (including schools), who will be required to cover any absence through use of relief, temporary staff or the payment of overtime; this is estimated to be in the region of £3 million. Therefore, reducing sickness absence levels by 20% in front-line services, could potentially deliver cash savings of over half a million pounds.

5.2.3 The review has identified that the current sickness absence policy needs to be strengthened and improved in a number of areas; but of greater importance, is the need for more consistency in terms of the its application by line managers. A robust and consistent application of the policy, even in front-operational services with large numbers of staff, can assist in changing the culture and attitude towards sickness absence. The current sickness absence policy could be improved by, for example; reviewing the trigger points within the policy and monitoring periods following absence reviews. These could support a more robust application of the policy, particularly in relation to short-term absence.

5.2.4 The overall approach to sickness management should be strengthened by improving the way that sickness absence data is captured and reported. This could include ensuring that all return to work interviews are undertaken; moving to direct inputting of sickness by line managers and enhancing the level of sickness absence management reporting to line managers, departments, CMT and elected members. These reports should in future incorporate the costs of sickness absence as this will assist in highlighting the budgetary impact of sickness absence on specific services.

5.2.5 HR Services and Occupational Health have a vital role to play in supporting the sickness management agenda and the review has identified areas where this could be further improved, particularly in relation to long-term sickness absence. Both HR Services and Occupational Health should consider focussing resources on hot-spot sickness areas within front-line, operational services where financial savings could be saved by reducing levels of sickness absence. A previous initiative within Social Care services during 2005/06 identified the impact of deploying additional resources in front-line services. The review suggests that further initiatives of this nature should be considered on an ‘invest to save’ basis and that a suitable business case is developed for further consideration by CMT/Executive Board.

5.2.6 Due to the significant financial challenges facing local government, some local authorities are looking to review their sickness absence policies with a view to reducing the levels of occupational sickness pay and periods. The Task & Finish Group are confident that many of the proposals included within this review, if implemented, will assist in driving down the costs of sickness absence and therefore would not require the Council to consider these more radical options at this point in time.

5.3 Recommendations

5.3.1 Review and update the Council’s sickness absence policy to include an ‘easy to use’ guide, outlining the key responsibilities of manager and employees.

5.3.2 Review the current trigger points within the sickness absence policy and consider a move to a points based system.

5.3.3 Consider extending the monitoring and review periods that arise from sickness absence review meetings.

5.3.4 Incorporate a greater degree of flexibility within the policy to support its application in front-line operational services (e.g. conducting return to work interviews over the telephone).

5.3.5 Ensure that the entire policy is able to accommodate a degree of manager discretion.

5.3.6 Highlight to managers the potential links between the sickness absence policy and the Council’s capability policy.

5.3.7 Ensure that sickness absence policy and procedures form a key element of the corporate and service induction processes (and through on-going development initiatives) for new staff and line managers.

5.3.8 Promote the welfare role of managers and early intervention in sickness absence cases in respect of both short and long-term sickness as part of future training programme for line managers.

5.3.9 Further review and communicate guidance relating to the referrals to occupational health.

5.3.10 Review all forms and documentation used as part of the ‘return to work’/data-capture process to reduce duplication.

5.3.11 Review the categories of sickness included within return to work/self-certification forms.

5.3.12 Further strengthen data capture processes by developing the ‘gate-keeper’ role of current departmental/central data inputters and ensure that all sickness information is captured via the monthly sickness recording form.

5.3.13 Complete the roll-out out of the ResourceLink self-service module across the authority and pilot the direct inputting of sickness data by line managers.

5.3.14 Undertake a review of all the authority’s IT systems used in the sickness management process, in order to ensure compatibility and removal of duplication.

5.3.15 Make use of mandatory fields within the data inputting process to ensure that key sickness information is captured (e.g. return to work interviews).

5.3.16 Make use of electronic prompts to remind managers of the need to undertake return to work interviews and sickness absence reviews and highlight where trigger points have been reached.

5.3.17 Refocus the work of the centralised data team to support the strategic management of sickness absence.

5.3.18 Improve the quality of sickness reports provided to departments by highlighting trigger points and making use of trends analysis.

5.3.19 Develop more use of case/review case conference approach to support the management of long-term sickness.

5.3.20 Conduct regular audits to ensure that all long-term sickness cases are referred to occupational health.

5.3.21 Focus occupational health/fast-tracking resources on hot spot areas/front-line services.

5.3.22 Develop a business case to support an ‘invest to save’ initiative to target occupational health resources at reducing sickness in key front-line operational areas.

5.3.23 Further develop the HR Business Partnering role and develop a comprehensive suite of management information to support this role – to advise departments on key trends and monitoring compliance with policies and procedures.

5.3.24 HR Services hold monthly meetings with Managers to review cases in key sickness hot-spot areas.

5.3.25 That HR Services target support to cases which are ‘non-medicalised’ by occupational health.

5.3.26 Establish closer links between Occupational Health and HR to share intelligence in relation to trends and specific cases (i.e. via case review meetings).

5.3.27 To review the funding base for the Occupational Health Unit to ensure that all posts are core funded.

5.3.28 Develop mechanisms to evaluate the benefits of health promotion initiatives.

5.3.29 Consider providing incentives for department to reduce sickness through the introduction of departmental targets and opportunities to keep a percentage of any savings achieved through reducing their sickness costs.

5.3.30 Ensure that sickness absence is monitored at all departmental, divisional and business unit meetings.

5.3.31 Improve the availability of management information reports in key areas (e.g. number of terminations due to short-term sickness absence).

5.3.32 Strengthen sickness reports provided to Scrutiny Committees to include the use of graphs, percentages, comparative information and costs of sickness.

5.3.33 Roll-out the ‘Insight’ reporting tool for Directors, Heads of Service, managers and schools.

5.3.34 Include the costs of sickness within sickness absence monitoring reports to Senior Management, Departments and Scrutiny Committees.

5.3.35 Improve benchmarking to allow for like for like comparisons of sickness data.

5.3.36 Undertake further training with managers/head teachers on all aspects of the sickness management policy and processes, highlighting the welfare role of managers and the need for early intervention.

5.3.37 Develop closer links with GPs within the county to raise awareness of the Council’s Occupational Health Unit and to share intelligence in relation to specific cases.

5.3.38 Further explore opportunities for joint working with other public sector partners in relation to the delivery of occupational health services.

5.3.39 To monitor national developments in relation to the Part 2 of the Green Book (Sickness Payments) via the work of the HR Directors Network, Welsh Local Government Association (WLGA) and the Local Government Employers (LGE).

5.3.40 In the medium-term, consider outsourcing notification/data-capture element of process – use of centralised unit to receive initial phone call, supported by enhanced monitoring and reporting.

MAIN REPORT

6.0 SICKNESS ABSENCE

6.1 Impact of Sickness Absence

6.1.1 Over the last 5-10 years, there has been a consistent drive across the public sector to reduce sickness absence levels following a number of studies which identified the impact of high levels of absence on both productivity and costs, and which also identified the relatively high levels of sickness absence within the public sector when compared with those in the private sector.

6.1.2 The Council’s current sickness absence policy attempts to define the impact of sickness absence on the organisation and states: ‘high levels of attendance at work are crucial if Carmarthenshire County Council is to meet its commitment to the economic, effective and efficient delivery of high quality services. Sickness absence has a detrimental effect on the ability to meet this commitment. Employees who are not at work do not make any direct contribution to the organisation; therefore, in addition to the costs of occupational sick pay and replacement staff, sickness absence costs the Council millions of pounds each year in terms of productivity which affects the provision of services’.

6.1.3 Performance information reported to the Council’s Policy & Resources Scrutiny Committee indicates that Council’s sickness absence levels have reduced over the last 3 years from 12.6 FTE days in 2007/08 to 11.1 FTE days in 2009/10.

6.1.4 However, for 2009/10, this still equates to over 78,460 FTE days lost to sickness absence.

6.1.5 In comparison with other Welsh local authorities, Carmarthenshire’s sickness absence levels are just above average. However, a Chartered Institute of Personnel Management (CIPD) absence management survey for 2010 indicated that sickness absence levels within the public sector was 9.6 days per employees, while in the private sector the figure is reported as 6.6 days per employee. 1

6.2 Costs of Sickness

6.2.1 A recent Confederation of British Industry report ‘On the Path to Recovery – Absence and workplace health survey 2010’ estimated that in 2009, the costs of sickness absence across the economy as a whole in the UK was approximately £17billion.2 The average direct cost of absence per employee was identified as £595 per employee per annum. However, absence costs vary across sectors, but sickness absence costs in the public sector were 50% higher than the private sector.

Average direct cost of absence per employee by economic sector (£)

Public Sector

784

Other services

602

Private Sector

524

Professional Services

500

Manufacturing

381

6.2.2 One of the key drivers for undertaking this task and finish group review was to attempt to identify the true cost of sickness absence to the Council and then to identify measures which could help reduce sickness absence levels and associated costs. However, the review has identified that there were no existing mechanisms to calculate or report on the costs of sickness to the Council or its individual services on an on-going basis and that this is an area for improvement that could add value to the management and monitoring of sickness across the organisation and also act as a useful financial management indicator.

6.2.3 This Council is not alone in lacking information in this area:

6.2.4 However, through work undertaken during the review process, it has been possible to arrive at a nominal cost of sickness absence for the last financial year which is estimated to be in the region of £8.6 million pounds, which equates to approximately £938 per employee. However, this only provides an indication of the notional costs of sickness, and while this is a useful indicator which can be used to estimate the potential costs of sickness and loss of productive time, this does not provide for a calculation of the true actual costs of sickness (i.e. the sickness which results in a direct and additional cost to the Council, which if reduced would result in financial savings being achieved).

6.2.5 It is important to distinguish between the notional and additional costs of sickness as the identification of the latter became a major focal point for the remainder of the task and finish review. The majority of staff working within back-office type functions will not be replaced if they are absent due to short-term sickness and their duties will either be covered by colleagues or left until they return to work. The individual will be paid their normal salary rate as if they had attended work; no replacement costs have been incurred and therefore there is no additional cost to the Council. The main cost to the service in this instance is the loss of ‘productive’ time. Sickness only usually becomes an additional financial cost for these services when it becomes long-term in nature where the manager may be required to organise temporary cover, either by other staff working over-time, employing temporary staff or employing agency workers.

6.2.6 However, for many front-line operational services such as cleansing, refuse, domiciliary care, care homes, street-cleaning, catering and building cleaning; any form of sickness, whether it be short or long-term in nature, can result in additional costs being incurred. Many of these services are involved in the delivery of key front-line functions where any interruption or reduction in service will have an immediate and noticeable impact. For example, care homes have a statutory requirement to ensure that a certain number of staff are on duty at any given time; the delivery of school meals and meals on wheels cannot be deferred until the next day just because of a shortage of staff, and there would be health and safety implications if parts of our buildings and schools were not cleaned on a daily basis. Finding adequate cover to maintain service delivery in these areas is critical and while even some operational services may have some degree of flexibility to re-allocate resources without incurring any additional cost; for many, occasions of sickness will impact on the services’ budget. This may be due to the need to pay overtime or employ temporary cover either through the use of casual, relief, temporary or agency staff.

6.2.7 A break-down of the annual costs of sickness absence (based on actual salary costs) for key front-line services is included below.

Service

£

Schools – Teaching staff

2,600,000

Schools – Support staff

940,000

Social Care Provider Services*

790,000

Property Services

355,000

Refuse and Street Cleaning

235,000

Catering

235,000

Highways

235,000

Building Cleaning

118,000

Contact Centre/Customer Service Centres

50,000

Total

£5.600,000

6.2.8 It is estimated that front-line services account for nearly two thirds (£5.6m) of the £8.6 million costs of sickness absence. It has proved difficult to provide an accurate picture of these additional costs of sickness absence, as even in front-line areas, services may not always replace someone who is off sick and therefore some of these costs will be ‘notional’. However, if we assume that front-line services 40% (industry norm) of sickness absence results in a person being replaced, this still equates to £2.24 million of additional expenditure being incurred as a direct result of sickness absence.

6.2.9 Replacement costs will be incurred where services bring in relief or temporary staff, pay overtime or employ agency workers, especially to cover cases of long-term sickness absence. In 2009/10 the Authority paid out over £2.9m in overtime and £1.2m through the employment of agency workers. It is not currently possible to identify how much of this expenditure is due to sickness absence, as some costs relating to the payment of overtime, use of temporary staff and agency workers will also be incurred to cover annual leave, long-term vacancies or to cater for increased demand and specific service pressures. However, it is estimated that these costs could add up to 30% (industry norm) to the costs of replacement, which would bring the estimated actual additional costs of sickness absence in front-line services closer to £3 million.

6.2.10 In areas of Social Care, the situation is accentuated by the fact that current terms and conditions mean that a person ‘off on sick’ will be paid at an enhanced rate if they were due to work at a weekend, while the replacement member of staff will also be paid at an enhanced rate. One manager referred to a case when a person covering long-term sickness also went on long-term sick. A third worker had to be brought in to cover and to the authority was paying three workers at double time, even though two were off ill.

6.2.11 Another indicator of the potential additional cost being incurred is the expenditure on supply teachers within schools. Staff absences in schools are covered by a ‘Staff absence Insurance Policy. Often these policies do not cover the first 3 days of sickness and the annual insurance premium can rise quite dramatically if a school has a number of long-term absences. In 2009/10, Carmarthenshire’s schools spent over £ 1.67m on supply teachers (includes insurance costs of £938k).

6.2.12 Although these figures do not fully provide for a totally accurate picture of the total additional costs being incurred by front-line services; they provide an indication of the actual cost being incurred and more importantly the potential savings to be achieved.

6.3 Nature and Causes of Sickness

6.3.1 The highest rates of sickness absence appears to be in departments such as Social Care, Health & Housing and Technical Services with FTE absence levels of 16.8 and 13.5 respectively.

6.3.2 A further analysis of sickness by service area again shows that front-line operational service appears to have the highest levels of sickness absence.

6.3.3 An analysis of sickness data for 2009/10 indicated that 26% of staff were responsible for 80% of the sickness recorded. Of the 26%, 43% worked in Education & Children’s Services, 30% in Social Care, Health & Housing and 17% in Technical Services, with the remaining 10% distributed among other Council departments.

6.4 Long/Short-Term Sickness

6.4.1 Of the 78,460 days lost to sickness during 2009/10, 68% (53,034 days) were classed as long-term and 32% (25,425) was classed as short-term (long-term sickness absence is defined as ‘continuous absence of 4 weeks or more’).

6.4.2 The ratio of short-term(ST) / long-term(LT) absence is approximately 45% (ST) / 55%(LT) for departments such as Chief Executive’s and Resources while the proportion of staff on longer term sickness appears to be greater in departments within front-line services such as Technical Services and Social Care, Health & Housing 25% (ST) / 75% (LT).

6.4.3 In schools, short-term absence accounted for 42% of sickness for non teaching staff and 39% for teachers. Schools (teachers and non teachers) accounted for approximately 12% of the total short-term sickness for the Council as a whole.

6.4.4 Older peoples services accounted for 20% of the total number long-term sickness days lost by the authority as a whole during 2009/10

6.5 Causes of Sickness

Reason

Number of days

%

Musculo- Skeletal

15,921

17%

Stress, mental health and fatigue

13,680

15%

Infections (including Colds and flu

12,697

13%

Medical Problems

11,259

12%

Stomach, liver bowel and digestion

9,876

10 %

Not specified

9,320

10%

6.5.1 The table above indicates that musculo-skeletal, stress mental health and fatigue and infections accounted for nearly 45% of all causes of sickness during 2009/10. The main causes of sickness are consistent with the findings of a CBI survey of sickness absence conducted in 2010.

6.5.2 A trend analysis in relation to the causes of sickness has identified that cases relating to ‘musculo-skeletal’ has increased by 10% over the course of the last 2 years, while days lost to stress reduced by almost 12%. However, it is anticipated stress related absences will increase over the next two to three years due to worries about job security and change within the organisation as a result of the financial challenges being faced by the Council.

6.5.3 Infections such as cold and flu are the main causes of sickness absence within office based departments such as the Resources and Chief Executive’s Departments, whereas the main causes in departments with front-line operational staff is musculo skeletal followed closely by stress.

6.5.4 It is also important to note that the causes of sickness should not be seen in isolation and that very often the causes of sickness are linked.

6.5.5 Ten percent of the sickness recorded during 2009/10 did not have a specific reason identified which suggests that data is not being properly captured at source. This issue will be covered in more detail in the section of the report covering data capture and recording.

6.5.6 Musculo-skeletal (7,359) is the second main reason for absence in the Education & Children’s Services as the main reason was ‘not specified’, which was recorded for over 7,900 instances of sickness.

6.6 Sickness Absence Policy

6.6.1 The Councils current Sickness Absence Management Policy was adopted in 2004 and one its key policy commitments states:

6.6.2 The Council’s sickness absence policy provides a definition of sickness absence, including short-term and long-term; a description of roles & responsibilities and procedures to support the application of the policy, including the notification of and recording of absence; return to work interviews; monitoring and reporting, the stages for managing short and long-term sickness and referrals to occupational health.

6.6.3 Overall, managers appear to be generally aware of the policy and find it easy to apply and some services such as Street-Scene and Building Cleaning have managed to reduce their sickness absence rates through a robust and concerted effort to apply the policy consistently.

6.6.4 However, since the current sickness absence management policy was last updated in 2004, it is now considered to be outdated in relation to its use of terminology and data.

6.6.5 Feedback from managers also suggests that the document could be made smarter and more user-friendly, making use of a summary/quick guide which highlights the key features and the roles and responsibilities of staff, line managers, HR and occupational health. Some services issue coloured cards to new staff as part of induction which outlines their main responsibilities in relation to sickness absence notification procedures.

6.6.6 There also appears to be some confusion over the stages for the management of short and long-term sickness which will need to be addressed.

6.6.7 Feedback suggests that the policy should incorporate a greater degree of flexibility to allow managers more discretion in relation to how the policy is actually applied. For example, the requirement to undertake absence reviews for employees who have reached trigger points due to separate causes of sickness (e.g. absence due to flu and then another period of absence due to a broken limb would require an absence review meeting to be held).

6.6.8 It was suggested that the policy could also be more flexible to recognise the difficulties that some operational services have in fully complying with the requirements of the policy; for example, in respect of conducting face to face return to work interviews, it was suggested that this could be made easier by conducting return to work interviews over the telephone.

6.6.9 Other feedback suggested that the criteria and guidance in relation to referrals to occupational health also needs to be clarified as some managers appear unsure when to make a referral. This appears to be supported by further evidence gathered during the review which indicated that only 33% of staff on long-term sick had been referred to occupational health for assessment and advice.

6.7 Sickness Pay

6.7.1 A recent CIPD study (Sickness Absence Survey 2010) suggested that, although the highest levels of sickness absence are reported in the public sector, employers in this sector are far less likely to take action through restricting sick pay and using appropriate levels of disciplinary action.5 However, due to the current financial challenges facing local government, some English local authorities are looking to review the levels of sickness pay and reducing the periods for which sickness is paid for. For example, reducing maximum entitlement from 6 months to 3 months or not paying for the first 3 days of sickness absence. This appears to be an attempt to bring local authorities in line with private sector companies.

6.7.2 The authority’s current policy in terms of sick pay and periods is set out in terms and conditions of employment which are agreed nationally via the National Joint Council and incorporated into part 2 of the ‘green book’ and constitutes a standard throughout the UK. Employees are entitled to occupational sickness pay and will receive this for the following periods.

6.8 Other policies

6.8.1 A separate sickness policy has been developed for schools, and although the schools are free to develop and adopt their own policies, most have in fact signed up to the county policy.

6.8.2 The Council has sought to introduce a number of other policies to support and complement work on sickness absence (e.g. flexible working policy; parental leave, time off for dependents and the agile working policy).

7.0 MANAGEMENT OF SHORT-TERM AND LONG-TERM SICKNESS

7.1 Short-Term Sickness

7.1.1 The current policy describes short-term sickness as ‘intermittent or persistent short-term absence which is usually sporadic, and attributable to minor ailments, in many cases, unconnected, which are frequent or unacceptable.

7.2 Use of Trigger Points

7.2.1 The Current procedure for managing sickness absence makes use of trigger points and the procedure will be triggered by one or a combination of the following:

7.3 Absence Reviews

7.3.1 When concern is expressed about an employee’s attendance level in any one of, or a combination of the trigger points has been reached, the employee will be required to attend an absence review meeting with his/her line manager/supervisor. The purpose of the initial absence review meeting will be to further investigate the employee’s absence which will have been discussed and recorded during return to work interviews, inform the employee of the consequences of such absence and to develop a personal strategy to address the situation. A review period will usually be agreed where the line manager will closely monitor the employee’s attendance. If, having the reviewed attendance over the review period, there is no evidence of improvement and/or a further trigger point has been reached, then a second absence review meeting will be held. The line manager will formally caution the employee that unless there is a marked and sustained improvement, further sustained absence during the review period could end in dismissal. Again, if the employee’s absence shows no improvement this can lead to a third and then a final absence review meeting, which could lead to the dismissal of the employee with immediate effect.

7.3.2 Managers indicated that frequent short-term sickness absence is more difficult to manage than long-term absence as the disruption caused by frequent short-term absences is often greater than that caused by long-term absence. However, some managers have suggested that the current policy does not provide for an effective approach for dealing with short-term sickness and there is a need to review the use of trigger points and monitoring/review periods between sickness absence review meetings.

7.3.3 For example, there were concerns that some staff were ‘playing the system’, by waiting for review periods to end before taking more sickness leave. HR have attempted to address this situation by introducing an option to re-open a sickness case at a specific stage, rather than having to start the review period from the beginning; but this is not currently formalised within the policy. Some managers suggested that the monitoring/review periods could be extended to prevent abuse of the policy.

7.3.4 Data captured during the review has brought into question the effectiveness of the current approach to the management of short-term sickness absence. An analysis of short-term sickness trends undertaken during the review identified that over approximately 500 staff had been absent from work on five or more separate occasions during 2009/10. Over two thirds worked within the Education & Children’s Services Department.

7.3.5 Currently, there are no mechanisms in place to identify the number of staff whose contracts have been terminated due to short-term sickness and therefore it is difficult to provide a formal evaluation the robustness of the current policy.

7.3.6 Other authorities have sought to tackle short-term sickness through the operation of a points system, many of which are based on the Bradford Factor. The Bradford Factor measures an employee’s irregularity of attendance by combining measures of frequency and duration. These measures indicate whether the composition of an individual’s sickness absence record comprises a few, or many, spells of short or long duration. They can be used to monitor trends in sickness absence, to provide trigger points and for comparison with absence rates.

The basic formula for calculating the Bradford score is:

7.4 Long-Term Sickness Management

7.4.1 The Council’s Sickness policy defines long-term sickness absence as ‘continuous absence of 4 weeks or more.’

7.4.2 In 2009/10, over 53,000 FTE days were attributed to long-term sickness and this accounts for 68% of the total number of days lost across the authority.

7.4.3 An analysis of long-term sickness absence cases conducted during the task and finish review identified that 85 staff were off work for 6 months or more.

7.4.4 While the management of short-term sickness in theory should be more difficult to manage, some managers had more concerns about the Council’s approach to long-term sickness absence management and the role of occupational health in supporting managers through this part of the process.

7.4.5 Some examples of the type of feedback received by managers is included below:

7.4.6 Some managers also had concerns about the way the policy is applied, especially in relation to the use of ‘phased return to work’ arrangements and the need to find ‘alternative, lighter’ duties. Phased returns were reported to be particularly difficult to manage in schools, while managers in front-line operational services also had significant concerns about the impact of finding lighter duties on service delivery and finances. For example, Street-Scene services indicated that they had almost reached saturation point through having to find alternative lighter duties for staff that were no longer able to carry out their substantive role.

7.4.7 Evidence received from the Trade Union representatives also in the main focused on the approach to long-term sickness and the application of the policy in this area. It was suggested that the policy did not achieve the right balance in terms of a providing a duty of care and that members found it ‘oppressive and intimidating.’ They also were of the view that some managers were not implementing the policy in a ‘fair and consistent’ manner and cited examples where members of staff had to leave the authority as there were no opportunities to redeploy them to lighter duties; yet they were aware that the authority was employing agency staff to undertake litter picking, considered to be an area of work suitable for lighter duties. The Trade Unions also suggested that the time-periods for undertaking sickness absence reviews could be relaxed and made more realistic in respect of long-term sickness.

7.4.8 As part of the review process, the issues highlighted above were put to the Senior Occupational Health Physician. In response to the concerns that the current policy and its application is overly weighted in favour of the individual, the Senior Occupational Health Physician suggested that managers’ have unrealistic expectations of the occupational health unit and this in turn leads to disappointment and negative feedback.

7.4.9 It was also suggested managers needed to improve the level of information provided as part of a referral and this would assist physicians in gaining a clearer understanding of the situation. It should be noted also, that during the course of the review managers did highlight that there had been an improvement in the quality of reports being produced by Occupational Health.

7.4.10 HR has recognised the need to make a more formal link between sickness absence policy and the capability policy. For frequent periods of long-term ill-health, in some cases the authority’s capability policy could be applied, as frequent absence for long periods of time brings into question whether a person is capable of fulfilling the requirements of the post.

7.4.11 The Senior Occupational Health Physician also advocated early intervention in order to reduce sickness numbers and associated problems, but the current referral process did not appear to be supporting this approach. A major concern highlighted by the review is that a majority of staff (two thirds) who were on long-term sickness leave had not been referred to occupational health. This indicates a need to educate managers in relation to the effective use of the referral system to occupational health. The Senior Occupational Health Physician suggested that the current cost of a referral of £110 may be deterring some managers from referring staff to occupational health and that there was no self-referral process in place.

7.4.12 The Senior Occupational Health Physician also highlighted the critical welfare role that line managers need to undertake when dealing with short and long-term sickness. The current policy requires that ‘managers/supervisors will maintain reasonable contact the employee throughout the period of sickness’. The welfare role that should be undertaken by managers is considered to be critical in managing cases of long-term sickness. Regular phone calls and visits can play a significant part in ‘improving morale and motivation of those staff, making them feel part of a team and valued by the employer.’

7.4.13 The following table shows the number of ill-health retirements has declined in number from 62 in 2005/06, to 36 in 2009/10. However, these figures do not take account of those employees who may have been dismissed on capability grounds and did not have access to the appropriate ill-health pension scheme. It should be noted that on the 1st April 2008 the regulations regarding access to ill-health pension scheme changed for Local Government Pension scheme members and similar changes have been made to the regulations governing teachers’ ill-health pensions.

7.4.14 When managing short and long-term sickness absence, the current sickness absence policy requires that line managers fully consider the implications of the Disability Discrimination Act 1995, since the protection of people with disabilities under the Act requires employers not to “give less favourable treatment for a reason related to their disability” or “fail to make reasonable adjustment to workplace or practices unless justified”. These requirements have now been incorporated into the Equalities Act 2010.

7.5 Notification of Sickness

7.5.1 In respect of the notification of sickness absence, the current sickness absence policy requires that ‘on the first day of absence the employee will notify their line manager/supervisor if they are unable to attend for work due to illness or injury’. The use of text messages or messages via colleagues is not considered to be acceptable. However, in view of the advances in technology, this is something that could be considered as part of the review of the overall policy.

7.5.2 The majority of managers interviewed stated that in the main, staff were complying with the policy.

7.5.3 Early notification was considered to be critical in front-line services due to the need to provide adequate cover and possibly find replacement staff. Some services reported that they take this issue so seriously that they issue a verbal warning if the policy is not adhered to.

7.5.4 Occupational Health has developed a sickness absence notification form to assist with the capture of sickness data at first point of contact. However, although the form is available on the authority’s intranet site, there appeared to be a general lack of awareness of the form among managers.

7.5.5 It is critical that this element of notification stage of sickness process is as robust as possible as a Wales Audit Office Best Practice study concluded that up to 10% of sickness will go unreported.8

7.5.6 Other local authorities and public/private sector bodies have prioritised the notification process as one of the most important stages in the whole sickness management process and have set-up a centralised unit to receive the initial notification from the employee:

7.5.7 However, the majority of line managers interviewed as part of this review had reservations about the benefits of such an approach and highlighted the risks of taking the initial point of contact away from the line manager, as this could impact on the vital welfare role that managers play in the overall sickness management process, which usually starts at the first point of contact and also the danger of introducing another potential delay within the communication chain which could have serious consequences for front -line services when trying to find cover for staff on sick leave.

7.6 Return to Work Interviews

7.6.1 ‘Return to work interviews’ are another essential component of the overall sickness management process and should be undertaken by the line manager immediately following an employees return to work. The interview provides the opportunity to make sure that the employee is fit to return to work and to discuss the nature of the illness and any patterns of sickness which may be occurring. The policy states that this should also be an opportunity to discuss any perceived work related problems, identify any underlying problems which may be contributing to the employee’s absence and to consider any reasonable support to assist the employee.

Department

% of return to work interviews completed

Chief Executive’s

90.8%

Education & Children’s Services

39.5%

Regeneration & Leisure

94.9%

Resources

93.2%

Social Care, Health & Housing

47%

Technical Services

91.1%

7.6.2 Information shown in the table above indicates that in the most departments, 90% or above of ‘return to work interviews’ are carried out. The main areas of non-compliance appear to be in parts of Social Care, Health & Housing and Education & Children’s Service Departments. The main hot-spot areas within these two departments appear to be Older People & Physical Disabilities Division, where only 29.2% of return to work interviews were completed, and in schools where 36% of return to work interviews were completed for teachers and 34.4% for non-teaching school staff.

7.6.3 Some managers working within these services have raised concerns over the robustness of the data. This suggests that while return to work interviews may being undertaken, this data is not being recorded on monthly sickness recording sheets. This suggestion is supported by evidence received from Schools HR Officers suggest that the low completion rate in schools may due to the fact that return to work interviews are not being undertaken formally and therefore this information is not finding its way into the formal sickness recording process. Time constraints, the lack of administrative support in some small schools and confusion over reporting lines for non-teaching staff with dual roles were identified as reason for poor completion rates for return to work interviews within the school environment.

7.6.4 Feedback from front-line managers suggested that there should be more flexibility within the policy in respect of undertaking return to work interviews to reflect the fact that many managers or supervisors in front-line services have large numbers have staffing reporting to them, often dispersed across the county.

7.6.5 The current policy acknowledges the fact that conducting interviews on the first day of return from sickness may not be possible for some categories of employees (shift workers), and in such cases interviews should be conducted at the earliest opportunity. However, some managers stated that this flexibility should be extended to allow return to work interviews to be conducted over the phone, rather than on a ‘one-to-one’ basis as required by the current policy.

7.6.6 Some managers suggested that the policy could be changed to place the responsibility on the employee for organising return to work interviews.

7.6.7 Feedback from managers also indicates that there is a need to review the current forms and documentation used within the return to work interview process (e.g. return to work interview form and the self-certification of absence as same information is required for both forms).

8.0 DATA-CAPTURE AND INPUTTING

8.1 Data-Capture

8.1.1 The main method of capturing sickness from services is via a monthly sickness recording form which is then collated at business unit/divisional level before being submitted to designated data inputting staff who will then input this information into the authority’s integrated HR/Payroll system – ResourceLink (RLink).

8.1.2 The majority of services (including schools) appeared to be aware of this form and are using it to record their sickness information to be then sent for central inputting.

8.1.3 The review has already identified the significant number of sickness absence days which cannot be attributed to a particular cause. Over 9,320 days are recorded with ‘no reason’ specified as managers don’t appear to be recording sickness properly. This may be due to the fact that this data is not being captured properly via the ‘return to work’ process and there is a need to review the categories of sickness included on the self-certification forms to ensure that all instances of sickness are properly categorised.

8.2 Data Inputting

8.2.1 Currently, 37 staff across the authority are involved in the process of inputting sickness data. Almost half of these staff are located in the central Payroll Team who input returns on behalf of other departments. Other staff are located in the Technical Services and Chief Executive’s Departments and other parts of the Resources Department.

8.2.2 The review has highlighted concerns over the number of IT systems in existence across the authority and the lack of linkages between systems resulting in the ‘double handling’ of data. For example; home care services make use of a system called ‘Jontek’ to assist with scheduling of work. Time-sheet information is inputted directly into the ‘Jontek’ system, but sickness details are then sent to the central payroll team for further direct inputting into ResourceLink. Within Street-Scene Services, operational staff complete time-sheets on a weekly basis which are then inputted into a system called ‘TASK’ for job costing purpose. A file is then created which is fed automatically into ResourceLink for pay purposes. However, sickness information is taken from the time-sheets and inputted separately into ResourceLink.

8.2.3 For the majority of office based employees, sickness information is collated and inputted on a monthly basis and any further delays receiving in information from managers can result in sickness being inputted two to three months in arrears. This has led to managers questioning the validity and robustness of reports and can result in delays in the managing sickness cases, especially short-term sickness.

8.2.4 The review has already identified concerns that sickness data, especially the reasons for sickness, is not being captured at source.

8.2.5 These concerns, together with concerns over the timeliness of data could be addressed by moving to direct inputting of sickness by managers at source, via the further development of the ResourceLink self-service module. On receiving notification of sickness, this would mean that the line manager, instead of manually recording this information, would then be able to input this directly into the system. When the employee returns to work, the line manager will be able to complete the relevant fields to categorise the causes of sickness. This information will then be ‘live’ within the system and provide for more accurate and up to date reporting of sickness data.

8.2.6 One of the other key benefits of moving to such an approach is that it could make use of mandatory fields to ensure that ‘return to work’ details and the ‘reasons for sickness’ are recorded properly and the system has the capacity to allow use of automatic prompts on a line managers computer reminding the manager of the need to undertake a ‘return to work’ interview and highlighting where a trigger point in the policy has been reached.

8.2.7 Within some front-line operational areas, this data inputting could carried out by administrative functions on behalf of managers (similar to the role that they currently carry out for manual recording) or by clerks in residential home and eventually, this could also be extended to schools.

8.2.8 The move to direct-inputting of data at source could help free up resources in the centralised units currently inputting data on behalf of other departments

9.0 SICKNESS REPORTS AND MONITORING

9.1 Sickness Reporting

9.1.1 The responsibility for the production of sickness monitoring reports lies with a business support team within the People Management Division who produce a range of sickness reports on a monthly and quarterly basis for use by departments and for other forums such as Policy & Resources Scrutiny Committee. This data is obtained via the ResourceLink HR/Payroll system, but further intervention is required to format reports before they are sent to departments.

9.1.2 Departmental sickness absence monitoring reports are sent to departmental co-ordinators on a monthly basis who are then expected to cascade the information to Heads of Service. These reports will include a cumulative record of individuals sickness levels over the course of a financial year and an overall divisional sickness absence rate expressed as a percentage and as a full time equivalent, but these reports are not broken down to show the levels of short/long-term sickness. Departments also receive an overall summary of the causes of sickness.

9.1.3 One of the consistent themes that emerged via the feedback from line managers and Heads of Service is that the current method of reporting sickness absence to departments does not appear to be adding value to the management of sickness across the authority.

9.1.4 The main concerns and suggestions for improvement are summarised below:

9.1.5 As a result of these problems, many services have resorted to setting up their own individual and business unit sickness monitoring systems which have been developed to suit the specific needs of individual services and managers and include other elements of the sickness management process (e.g. use of trigger points and the status of referral to occupational health).

9.1.6 Schools do not currently receive any sickness monitoring reports at all from the Council and have to rely on their own systems which are then used to provide reports to management team and school governor meetings.

9.1.7 There are gaps in management information which does not support the effective management of sickness at a corporate level. For example, no monitoring is undertaken in relation to the numbers of sickness reviews undertaken compared to trigger points, the number of referrals to occupational health and the number of frequent short-term absence resulting in contract terminations.

9.1.8 The roll-out of ResourceLink self-service absence management module is helping to provide greater access to sickness absence information as line managers are now able to view their unit’s sickness record via their own PC. However, self-service has yet to be rolled out across the whole authority.

9.1.9 The development of the ‘Insight’ reporting tool has considerable potential to improve the monitoring and management of sickness absence data. This tool makes use of graphical representation of data to provide sickness information in a more user friendly format. This facility should be made available to all Directors, Heads of Service and managers who will then be able to run a range of reports from their own PC in relation to the levels of sickness, trends and causes and staff who have hit trigger points within the policy. This tool also has the potential to report on the costs of sickness absence which is not currently being routinely identified or monitored at a corporate or departmental level.

9.1.10 This could also assist with a shift in approach to the monitoring of sickness at a business unit/service level. Currently, it appears that there is an inconsistent approach to the monitoring of sickness data and sickness is not discussed regularly at all team meetings. Where sickness is discussed, the focus is said to be more on more ‘about dealing with consequences of sickness (impact on service delivery) rather than discussing proactive strategies to deal with the trends and nature of sickness and the management of specific cases’.

9.1.11 The development of this new reporting tool could also assist with the strategic management and monitoring of sickness absence at a corporate level. Currently, the central reporting team within the People Management Division spends a considerable amount of time in manipulating sickness data into departmental and divisional reports. If more of these reports could be totally automated , this then could then create capacity within the unit to further develop and enhance the strategic monitoring of sickness (e.g. identification of hot-spots and trends and monitoring of compliance in relation to the application of the policy). Evidence received as part of the review suggests that this type of approach has proved to be very successful in Cardiff Council.9

9.1.12 The availability of high quality, up to date and accurate sickness information will be key to supporting HR’s move to business partnering and adopting more of a strategic approach in supporting the management of sickness absence. Again, the current method of reporting does not support this approach due to some of the reasons already outlined above. For example, reports covering sickness absence in schools received by Education HR Officers only list the name and designation of the member of staff and do not even highlight which school they work at. This current method of reporting makes it difficult to focus on trends and potential problem areas.

9.2 Role of Occupational Health

9.2.1 The authority’s occupational unit was established in 2002 and the main functions of the unit include:

9.2.2 The unit has 7 posts on its organisational structure:

9.2.3 The total costs of the provision of the occupational health unit during 2009/10 included:

9.2.4 The unit only has a core staffing budget of £63,958 and the remaining short-fall is funded via re-charging to departments. Costs relating to the use of physicians, CBT/Counselling service and fast-tracking are also all re-charged back to departments in addition to £78, 259 of staffing costs to make up for the budget short-fall in this area.

9.2.5 Only two of the posts within the structure are permanently funded, and in recent years other temporary funding streams (via risk management) have been used to fund other posts within the structure, now recovered by charges to departments. The temporary nature of the funding for posts and associated insecurity has led to a high turnover of staff within the unit and resulted in recruitment difficulties to key posts. This has inevitably impacted upon the service’s ability to undertake the ‘added value’ work in supporting services in strategically managing sickness absence.

9.2.6 The previous sickness management pilot within Social Care services identified the benefits of using case reviews and case conferences to deal with specific long-term absence cases. Case review meetings involve the line manager and representatives of HR and Occupational Health meeting to review the status of a case and potential strategies to move the case forward. Sickness Absence Case Conferences meetings will also include the individual in the discussions. The use of case reviews and case conferences could be further developed by intruding automatic trigger points within the long-term sickness management process to determine when such meetings should be held.

9.2.7 The unit dealt with over 3,134 referrals during 2009/10 and over two thirds of these referrals were then referred either to the Occupational health adviser or physician and the remainder to CBT service, fast-tracking and physiotherapy.

9.2.8 Feedback from managers indicates that access to the service has improved during the last two years. The average waiting time for receipt of a referral to consultation is 1.5 weeks (although the unit does cater for emergency cases) while the turn-around times for consultation reports has improved from 2 weeks to 2/3 days.

9.2.9 The review has already identified that the cost of referrals to occupational health may be deterring managers from referring members of staff and there may be a need to consider re-establishing a mechanism to allow staff to refer themselves to occupational health, particularly whether the relationship between the manager and the member of staff may have broken down.

9.2.10 Since December 2009, the unit has been working in partnership with the Local Health Board to offer Cognitive Behavioural Therapy support in relation to stress management cases. This is considered to be a more effective method for dealing with stress and anxiety than traditional counselling techniques.

9.2.11 The work of the unit in respect of health promotion and awareness has been identified as good practice by the Wales Audit Office and the Council has won numerous awards as a result of this work. These initiatives were also key to the authority achieving a Platinum Health Standard which required the Authority to demonstrate that it was still achieving gold standard performance in respect of its approach to work place health.

9.2.12 This work is a key element of the overall sickness management agenda as early intervention via health surveillance and general education of health issues can play a critical role in preventing long-term sickness. However, the unit does not have a budget for health promotion. A recent CIPD study of sickness absence identified that the public sector is more likely to adopt procedures to reduce sickness absence through promoting good health and flexible working than the private sector.10 Despite the pressure on organisations to cut costs, nearly a quarter had increased their spend on well-being initiatives and often these had introduced mechanisms to evaluate the benefits of such initiatives, suggesting that investing in well-being does pay off.

9.2.13 There are opportunities to strengthen links with GPs in the county to encourage information sharing in relation to specific cases and to develop a referral process from the GP to the Council’s Occupational Health Unit.

9.3 HR Support

9.3.1 Human Resources also have a critical role to play in the overall sickness management process. Over the last year, HR has been attempting to develop more of a strategic approach to the management of HR support as part of a move to a business partnering approach with departments. In terms of sickness management, this means that HR no longer has capacity to attend all sickness absence review meetings and will now only attend for third stage meeting.

9.3.2 Some managers have expressed concern about this change as they feel that absence reviews no longer carry the same impact if HR are no longer in attendance. It is critical that HR effectively communicates the change in role and the benefits that this will be to the overall sickness management process to ensure that HR and Managers are clear about each other’s roles.

9.3.3 The review has identified good practice where some HR Officers meet with a manager on a monthly basis to discuss trends, patterns and the approach to specific cases. This could be replicated for all sickness hot-spot areas or across all operational/front line services.

9.3.4 The review has already identified the need to improve management information relating to sickness and this will be key to the success of the HR Business partnering. HR will need to be equipped with this information to strategically advise departmental teams/Heads of Service and Managers in relation to the management of short and long-term sickness.

9.3.5 Stronger links could also be developed between HR and Occupational Health to share intelligence relating to trends and specific cases and to evaluate the impact of specific initiatives.

9.3.6 The review recognises that a comprehensive training programme for managers has been implemented. Most recently, an "Attendance Management" management development course, comprising of e-learning and half-day instructor-led course has been developed, with courses due to commence in December 2010. The completion of this course should be made mandatory for all managers and could be followed with training in key sickness hot-spot areas and where there is evidence that the policy and its respective procedures are not being properly applied.

9.4 Corporate Management and Reporting

9.4.1 The Sickness absence performance indicator has been adopted by CMT as one of its key corporate health indicators and this is monitored on a quarterly basis.

9.4.2 Sickness absence is also reported to the majority of departmental and divisional management teams meetings, although the frequency of reporting in some cases is inconsistent. Monitoring at this level is mainly confined to the overall sickness absence for the division/department; however, there are some examples of robust and rigorous management in place where DMTs will check progress on specific cases or whether trigger points have been acted upon.

9.4.3 Improvements to sickness absence monitoring and the roll-out of the Insight reporting tool will also help support a more robust approach to the management of sickness across all service areas.

9.4.4 Monitoring at a service level could also be strengthened through the more effective use of benchmarking data to help services benchmark themselves with similar functions in the public or private sector.

9.4.5 The Task & Finish Group also considered the way that sickness information is reported to Policy & Resources Scrutiny Committee and suggested that current reports could be strengthened and improved. For example, the reports could make more use of comparative data, both to previous years and to national sickness levels; sickness absence levels to be expressed as a percentage as well as an FTE figure and more graphical representation of data.

9.4.6 The review has already identified that the authority does not routinely identify or report on the costs of sickness and that the costs of sickness should be included as part of all future sickness monitoring reports.

9.4.7 The Council used to previously set individual sickness targets for each department as an incentive to reduce their sickness levels; these targets varied depending on the department and the make-up of the workforce. Currently, the Council only sets an authority wide target.

9.4.8 Over the last two years, the Policy & Resources Scrutiny Committee has suggested that more challenging targets be set in relation to this indicator. A target of 10.5 FTE days has been set for the current year and half year performance suggests that the Council is on target to achieve this figure.

9.4.9 The Council could consider the use of incentives to reduce sickness levels, either for services or for individuals. For services, it could offer a financial incentive by allowing services to keep a percentage of any savings to be achieved through reducing the costs associated with sickness absence. In relation to individual members of staff, some authorities award staff certificates additional days leave for good attendance.

9.5 Impact of Initiatives

9.5.1 Following a sickness absence management review undertaken by external consultants in 2005, the Council decided to implement a sickness management pilot initiative within Social Care services. At that time, sickness absence rates within Social Care services had reached 8.4%.

9.5.2 These pilot increased investment in staffing resources and initiatives to provide a greater focus for the management of sickness within Social Care services. Additional funding of £120,000 was provided by the Council’s Risk Management Group but this funding was only temporary for one year.

9.5.3 Some of the key features of the pilot included:

9.5.4 A post evaluation of the impact of these initiatives indicated that, following the commencement of the project in October 2005, sickness absence fell from 8.4% to 7.2% in April 06, a reduction of 1.2% over a 6 month period. The Wales Audit Office estimated that this resulted in a notional saving of £500,000 to the Council from the whole project.

9.5.5 However, as stated previously, the funding supporting these initiatives was only temporary and when the funding stopped, many of the initiatives were reduced or withdrawn all together. The high-turn over of staff in key positions within Occupational Health also impacted on the unit’s ability to maintain the focus in these areas.

9.5.6 As a result, sickness levels within Social Care services started to increase again and is still one of the highest rates within the authority.

9.6 Statement of Fitness for Work or ‘Fit Note’

9.6.1 In April 2010, the Government introduced a Statement of Fitness for Work or ‘Fit note’ as a new medical statement that replaces the old ‘sick note’ and aims to focus on what an employee may be able to do at work rather what they cannot do.

9.6.2 In the past, GP statements either said that ‘you should refrain from work’ or ‘you need not refrain from work.’ The fit note added in a new option ‘may be fit for work taking into account of the following advice’.

9.6.3 A GP will be able to suggest ways of helping an employee get back to work which could include a phased return, flexible working, amended duties, work place adaptations.

9.6.4 This aims to recognise that reducing levels of sickness absence is about developing a partnership between the line manager, the individual, the GP, occupational health and the HR.

9.6.5 The review has attempted to evaluate the impact of the new fit note but overall it is considered too early to make an accurate assessment.

10.0 APPENDICES

10.1 Appendix 1 – List of Internal and External Witnesses

10.2 Appendix 2 – Local Government Scrutiny Reviews

10.3 Appendix 3 – Other Sickness Absence Reviews

10.4 Appendix 4 – Sickness Absence Policies / Initiatives

10.5 Appendix 5 – News Articles / Press Releases

10.1 Appendix 1 – List of Internal and External Witnesses

The following external and internal witnesses attended various Task & Finish Group meetings during 2010:

Name

Job Title / Dept. / Organisation

Subject / Issue

Meeting Date

Lynne Lawrence

Workforce Planning Manager, Chief Executive’s Department, CCC

ResourceLink

Sickness Absence Management / Reporting

Update on ResourceLink

HR options in relation to managing sickness absence

8th March 2010

2nd July 2010

27th July 2010

1st November 2010

David Richards

HR Projects Manager, Chief Executive’s Department, CCC

ResourceLink

Update on ResourceLink

8th March 2010

27th September 2010

Kevin Jenkins

Payroll Manager, Resources Department, CCC

ResourceLink

8th March 2010

John Gravelle

Revenue Services Manager, Resources Department, CCC

Sickness Absence Management / Reporting

14th May 2010

Catherine Poulter

SCH Area Manager (Llanelli), Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

14th May 2010

Robert Young

Deputy HR Manager, Chief Executive’s Department, CCC

Sickness Absence Management / Reporting

Capability Policy

14th May 2010

4th January 2011

Colleen Evans

HR Officer, Chief Executive’s Department, CCC

Sickness Absence Management / Reporting

14th May 2010

Debbie Smythe

Business Support Manager, Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

16th June 2010

Mike Rogers

Head of Policy & Performance, Technical Services Department, CCC

Sickness Absence Management / Reporting

16th June 2010

Alan Howells

Business & Development Manager, Technical Services Department, CCC

Sickness Absence Management / Reporting

16th June 2010

Robert Rees

Administrative Officer, Technical Services Department, CCC

Sickness Absence Management / Reporting

16th June 2010

Lyn Walters

Business Support Manager, Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

2nd July 2010

Tracey Lewis

Team Leader, Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

2nd July 2010

Mario Cresci

Area Manager (East), Technical Services Department, CCC

Sickness Absence Management / Reporting

2nd July 2010

Huw Morgan

Area Manager (West), Technical Services Department, CCC

Sickness Absence Management / Reporting

2nd July 2010

Maureen Isaac

Senior Management Support Officer, Chief Executive’s Department, CCC

Sickness Absence Management / Reporting

2nd July 2010

Jan Lewis

Management Support Officer, Chief Executive’s Department, CCC

Sickness Absence Management / Reporting

2nd July 2010

Elin Cullen

Head of Business & Specialist Services, Education & Children’s Services Dept., CCC

Sickness Absence Management / Reporting

27th July 2010

Sandra Weigel

Catering Services Manager, Education & Children’s Services Dept., CCC

Sickness Absence Management / Reporting

27th July 2010

Julie Hall

Operational Support Manager, Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

27th July 2010

Dr. Massoud Mansouri

Consultant Occupational Health Physician (CEX)

Occupational Health Process

14th September 2010

Jane Morgan

Human Resources Unit, Cardiff Council

Sickness Absence Management in Cardiff Council

27th September 2010

Lynne David

Human Resources Unit, Cardiff Council

Sickness Absence Management in Cardiff Council

27th September 2010

John Hogg

Environment Agency Wales

Sickness Absence Management at the Environment Agency

27th September 2010

Ted Evans

Trade Union Representative (UNISON)

Trade Union perspective on sickness absence

8th October 2010

Bryan Jones

Trade Union Representative (T&GWU)

Trade Union perspective on sickness absence

8th October 2010

Mark Preece

Trade Union Representative (GMB)

Trade Union perspective on sickness absence

8th October 2010

Nadira Bullock

Head of Sales & Marketing, First Care Absence Management Service

Presentation by First Care Absence Management Services

8th October 2010

Gari Le Piquet

Sales & Marketing Team, First Care Absence Management Services

Presentation by First Care Absence Management Services

8th October 2010

Rebecca Jones

Corporate Development Advisor HR Policy (CEX)

Profile of Carmarthenshire County Council’s Occupational Health Services

8th October 2010

The following external and internal witnesses were interviewed by officers outside the formal Task & Finish Group meetings:

Name

Job Title / Dept. / Organisation

Subject / Issue

Interview Date

Julie Griffiths

Head Teacher, Tre-Gib Comprehensive School, Ffairfach (nr. Llandeilo)

Sickness absence management and reporting in schools

6th May 2010

Phil Sexton

Head of Audit & Risk, Resources Department, CCC

Sickness Absence Management / Reporting

21st June 2010

Penny Graepel

Customer Services Manager, Chief Executive’s Department, CCC

Sickness Absence Management / Reporting

29th June 2010

3rd Tier Managers

3rd Tier Manager Meeting, Chief Executive’s Department

Sickness Absence Management / Reporting

30th June 2010

Helen Evans

Support Services Manager, Education & Children’s Services Dept., CCC

Sickness Absence Management / Reporting

6th July 2010

Barbara Edwards

Cleaning & Caretaking Services Manager, Education & Children’s Services Dept., CCC

Sickness Absence Management / Reporting

14th July 2010

Gareth John

Head of Mental Health & Learning Disabilities Services, Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

28th July 2010

Lesley Heger

Principal HR Officer (Schools), CCC

Sickness absence management and reporting in schools

9th September 2010

Misty Misstear

Tawelan Care Home Manager, Dept. Social Care, Health & Housing, CCC

Sickness Absence Management / Reporting

16th September 2010

Chris Derrick

Operational Support & QA Manager, Technical Services Department, CCC

Sickness Absence Management / Reporting

29th October 2010

The following schools responded to the sickness absence questionnaire for head teachers in September 2010, circulated via the AMDRO website:

Name

School

Category

Date of Response

Meryl Davies

Bro Banw CP School, Ammanford

Primary

20th September 2010

Kim Sherlock

Copperworks CP School, Llanelli

Primary

21st September 2010

D Griffiths

Llandybie CP School

Primary

28th September 2010

Martin Griffiths

Richmond Park CP School, Carmarthen

Primary

4th October 2010

Tania Morgan

Bynea CP School, Llanelli

Primary

4th October 2010

Helen Jacob

Pembrey CP School

Primary

5th October 2010

Ann Humphries

Whitland CP School

Primary

12th October 2010

Steven Jones

Glan-y-Môr Comprehensive School, Burry Port

Secondary

21st October 2010

J Broderick

Y Fro CP School (Llangyndeyrn and Idole)

Primary

1st November 2010

G Taylor


Cefneithin CP School

Primary

22nd November 2010

Gareth Rees

Tumble CP School

Primary

24th November 2010

S P Lewis

Llechyfedach CP School

Primary

25th November 2010

B Owen

Gorslas CP School

Primary

29th November 2010

M Langabeer

Llannon CP School

Primary

30th November 2010

10.2 Appendix 2 – Local Government Scrutiny Reviews

10.3 Appendix 3 – Other Sickness Absence Reviews / Research / Reports

10.4 Appendix 4 – Sickness Absence Policies / Initiatives

10.5 Appendix 5 – News Articles / Press Releases

11.0 GLOSSARY OF TERMS

1 The Chartered Institute of Personnel and Development (CIPD) Absence Management Annual Survey 2010

2 On the path to recovery: Absence and workplace health survey 2010, Confederation of British Industry (June 2010)

3 Costing Sickness in the UK – Institute for Employment Studies Report 382 by S. Bevan and S.Hayday, 2001

4 Carmarthenshire County Council Sickness Absence Management Policy (March 2004, Para 8.1 updated Sept 10)

5 The Chartered Institute of Personnel and Development (CIPD) Absence Management Annual Survey 2010

6 Costing Sickness in the UK – Institute for Employment Studies Report 382 by S. Bevan and S.Hayday, 2001

7 Staffordshire County Council’s Managing Attendance at Work Policy, September 2008

8 Managing Sickness Absence: Good Practice Exchange, Wales Audit Office

9 Sickness Absence Management and Policy at Cardiff Council – Task & Finish Group meeting 27th September 2010

10 The Chartered Institute of Personnel and Development (CIPD) Absence Management Annual Survey 2010