Managing sickness, absence and declared disabilities is a joint venture between staff members, team managers and the wider organisation. Supporting team members, while also making sure that the team continues to function and meet the demand for its services, is often a challenge. The purpose of this article is to help managers and team leaders to both care for their staff properly and meet service demand.
District nursing teams do not work in isolation; they are part of a larger organisation, which also has responsibilities for the health and wellbeing of its staff. In the words of Boorman (Department of Health and Social Care (DHSC), 2009):
‘Organisations that work with their staff to provide healthy and safe work combined with a caring environment perform better, and, importantly, by promoting the health of their workers rather than risking damage, they deliver reliably’.
Wider policy context
The Interim NHS People Plan (NHS Improvement, 2019) reported that sickness absence in the NHS is around 2.3% higher than in the rest of the economy. It set out the support that staff can expect from the NHS as a modern employer, including having a real voice on:
The Royal College of Nursing (RCN) (2019) has produced comprehensive guidance on sickness absence and is worth reviewing to benchmark the policies in place within various organisations.
Sickness absence rates
NHS Digital (2019) calculates sickness absence rates by dividing the total sickness absence days (including non-working days) by the total days available per month for each member of staff. The sickness absence rate for all staff in community provider trusts in England for 2018/19 set out in Figure 1 is based on NHS Digital data (2019). Some 39 of the 41 community provider trusts from which data are available report a sickness/absence rate of between 3% and 6% for 2018/19; only two trusts report this rate as exceeding 6%.
Table 1 presents data from NHS Digital (2019) showing that sickness absence varied markedly by staff grade in 2018/19, with Band 1 staff having a sickness absence rate almost twice that of their Band 7 counterparts. Team managers might find it helpful to analyse data for their own teams, to determine whether this pattern is replicated, and, if so, they should investigate the reasons. It could be that more senior staff feel they have greater control over their own workloads, they are able to arrange more flexible working arrangements and feel freer to voice health and wellbeing issues.
| FTE days lost to sickness absence* | FTE days available* | Sickness absence rate | |
|---|---|---|---|
| England Total 2018–19 | 17 730 992 | 421 649 129 | 4.21% |
| Band 1 | 594 640 | 9 635 793 | 6.17% |
| Band 2 | 3 619 503 | 58 219 158 | 6.22% |
| Band 3 | 2 853 493 | 49 733 669 | 5.74% |
| Band 4 | 1 532 031 | 33 719 288 | 4.54% |
| Band 5 | 3 354 522 | 76 158 615 | 4.40% |
| Band 6 | 3 007 849 | 72 092 418 | 4.17% |
| Band 7 | 1 316 723 | 42 008 336 | 3.13% |
| Band 8a | 389 262 | 15 716 186 | 2.48% |
| Band 8b | 132 251 | 6 513 681 | 2.03% |
| Band 8c | 64 444 | 3 512 559 | 1.83% |
| Band 8d | 30 437 | 1 825 498 | 1.67% |
| Band 9 | 10 040 | 797 865 | 1.26% |
| Unknown/medical pay grades | 825 797 | 51 716 062 | 1.60% |
FTE: full-time equivalent. *includes non-working days. NHS Digital, 2019
Table 2 shows the proportion of sickness absence attributable to stress reported by NHS Digital (2019). The data report an increased proportion of stress-related illness, and, although tempting to conclude this means that stress is increasing in the NHS workforce, it may also indicate a greater transparency about mental health issues in the workplace. Nevertheless, the 352 474 days lost to stress-related illness in 2016/17 is a significant amount of time, and, while it is possible that there may be less stigma associated with being diagnosed with stress, many people at work might find it diffi cult to talk about the support they might need and make suitable adjustments within the workplace when they return to work.
| Hospital and Community Health Services (HCHS): annual FTE days lost due to sickness absence and absence rates for community nurses in NHS England | |||||
|---|---|---|---|---|---|
| Experimental statistics | |||||
| FTE days lost from stress related sickness absence | FTE days lost from all sickness absence | Absence rate for stress-related sickness absence | Stress-related sickness absence as proportion of all sickness absence | FTE days available | |
| October 2014 to September 2015 | 322 882 | 1 277 758 | 1.25% | 25.27% | 25 862 195 |
| October 2015 to September 2016 | 330 785 | 1 234 169 | 1.34% | 26.80% | 24 673 691 |
| October 2016 to September 2017 | 352 474 | 1 227 998 | 1.46% | 28.70% | 24 224 480 |
FTE: full-time equivalent. *includes non-working days
Guidelines from the National Institute for Health and Care Excellence (2009) on promoting mental wellbeing at work have some helpful recommendations for team leaders and other managers to ensure the mental wellbeing of staff through a supportive leadership style and management practices. These include:
The Health Education England (HEE) report (2019) on the wellbeing of NHS staff and learners discusses stress factors that staff might feel when they believe they are personally failing because organisational constraints limit the amount and type of care that they are able to provide. Another factor discussed is ‘presenteeism’, for example, perceived pressure to come into work when ill; skipping annual leave; and/or, working excessively long hours.
How to manage sickness/absence
Managing sickness and absence means being empathetic while still being able to run the service. NHS Employers (2019a) has produced a helpful and comprehensive guide for NHS staff to manage sickness absence and recommends three key questions:
The reason for the absence should be recorded, as should the date, time and who received the call.
If managers notice that a staff member is becoming withdrawn and quiet, they should create an appropriate confidential environment to let the staffmember know they have noticed, and that they are concerned for their welfare. Sometimes, simply asking if someone is alright and offering an opportunity for discussion can prevent a diffi culty from escalating into a problem. Adapting the management approach used according to the staff member's concerns can also be crucial. It means managers can be sensitive where necessary and find the balance between being supportive and firm. It is worth remembering, however, that the perspective from which the manager is approaching the problem is very different from that of a clinician. Managers need to be up to date with the organisational policies and procedures for sickness and review the absence history of staff to determine any patterns. It is always helpful for them to regularly review the sickness absence patterns of staff in their team and discuss issues arising with the staff member concerned as soon as possible to identify any underlying causes. If health problems are involved, a referral to OH services should be considered.
On a more general note, health and wellbeing concerns should be raised at staff meetings as a standing item, so it becomes normal practice for staff to think of their own health and wellbeing, as well as those of other team members. If a high sickness/absence pattern persists for a staff member despite supportive management, the manager should make it clear that their attendance needs to improve, how this will be measured and the consequences if it is not.
Occupational health
OH services are a crucial component of both preventing and managing staff sickness and absence. Managers need to be aware of what OH services provide and feel able to approach and access them for support and advice when needed.
OH activities are likely to include:
Having a workplace OH service gives staff and managers rapid access to professional specialist advice, which will help protect, maintain and support staff with health issues. OH has the advantage of being able to work closely with the manager to understand the complexities of roles within an NHS organisation and can, therefore, suggest adjustments and support that someone without this knowledge and understanding may not be able to offer.
It is extremely likely that most local NHS policies for managing high rates of sickness, absence and declared disabilities in a district nursing team will include, at some point, a referral to OH. The opinion of an OH specialist may be crucial in determining how to manage a capability issue, and the opinion of an OH specialist can be key evidence in an employment tribunal claim. OH teams typically advise staff and their managers on what adjustments can be made to enable staff to undertake their role safely and effectively and, wherever possible, focus on adapting the work to suit the health needs of the staff member. The question then arises as to whether OH has the capacity, given the financial constraints in the NHS, to play its part in helping both the individuals concerned and the wider organisation to meet the declared goals of reducing rates of sickness absence and supporting staff with declared disabilities.
NHS Employers (2019b) guidance underpins the move to have all NHS OH services accredited to the standards of Safe, Effective, Quality Occupational Health Service (SEQOHS, 2019). When a service registers for accreditation, they are committing to an ongoing annual programme of quality improvement, assessment and maintenance. This offers many benefits for a service as follows:
The guidance works towards ensuring that NHS staff (and NHS organisations) have an OH service that improves health and wellbeing and provides a proactive service (NHS Employers, 2019b). NHS Health at Work (2012) published a template service-level agreement (which is being updated) for OH services to use with their providers.
In 2011, the DHSC published Healthy Staff, Better Care for Patients: Realignment of Occupational Health Services to the NHS in England. This guidance sets out recommendations aimed to help achieve the vision that suppliers of OH services to the NHS should play a key role in the delivery of safe, effective and efficient patient care through promoting and protecting the health of staff (DHSC, 2011). Alongside this, the DHSC document supporting the commissioning of OH services provides support and direction for commissioners and providers to establish OH departments that deliver services that meet the full breadth of NHS staff health and wellbeing needs (DHSC, 2011).
A crucial issue for managers and team leaders who are concerned about sickness absence and helping colleagues with declared disabilities in a district nursing team is whether the guidance discussed above is actually being put into practice within their own organisations. It would be worth reviewing local policies for managing sickness, absence and helping staff with declared disabilities to make sure that sufficient attention and resources are available for OH departments to be able to provide their much-valued and needed professional support.
Conclusion
The NHS is committed to valuing its staff, and a considerable amount of effort is being placed in producing national policy frameworks to support managers, team leaders and frontline staff to manage sickness, absence and declared disabilities. All staff have an important role to play to look after their own health and wellbeing, as well as that of colleagues. However, the organisation also has an important role to play in ensuring that the OH support provided at local level is sufficiently resourced and able to respond to the demands it faces.