NHS staff - 50% higher rate of sickies

[????]

From my own viewpoint, experience and prejudice. The three people I know well who work in the public sector, one in the NHS, one in Local Government and one a copper, DO admit that the sickness allowance (is it 2 weeks?) is routinely and to a certain extent institutionally taken as 'holiday'. A letter in today's Independent from a police sergeant said it was common practice in his station to work double pay days - eg Bank Holidays - as overtime and then make up for it by going 'ill' afterwards AND absenteeisn and sickness days in the public sector are twiceish(?) as high in the public sector. Now, I don't want to get involved in some kind of them V us debate, and of course many people in the PS do fantastic and vitally important jobs with little thanks (amd in many cases reward) but equally as well this is why many in the private sector who face little job security, worthless pensions and aren't all city folk on mega bucks with expense accounts are questioning the PS, its rewards and funding.

Edited once I got to PC without half its keyboard missing

[LuLu Too]

I work in a frontline health care setting. I am a clinician but also manage a service.

I have spent all of my adult life working in the NHS.

In recent years I have noticed some changes in how sickness/absence & performance are managed within the NHS.

Certainly monitoring is much more rigorous - return to work interviews are undertaken and documented after even only 1 days sickness or absence. This is how it should be. I can honestly say, in almost 20 years of NHS clinical work, I have never met or managed a clinician who felt that they were "owed" or somehow "institutionally obliged" to take a set number of sick days in a year (as some sort of holiday/leave entitlement as seems to have been suggested by previous posters).

I do accept that there are issues around pay and performance within the NHS.

Pay scales/grades for most NHS Clinicians & ancillary staff are set nationally. Thus once you are within a certain pay grade,there can be little incentive for some people to perform to the best of their ability. There are no pay bonuses to gain or lose. There is no negotiation over your individual pay within your grade. Individual excellence is not rewarded. The flipside is also that individual shortcomings are also not always addressed adequately in a way that they should be.

This is something that I believe we in the NHS could learn from Private Sector colleagues. But then again, as an HR Manager pointed out to me - we do have the necessary HR/Performance/Disciplinary policies etc, but perhaps we don't implement them enough.

But back to sickness rates.

I have some thoughts as to why this is higher in the NHS compared to other private sector services; Essentially what Annaj said. But also ironically, we in the NHS do not usually offer any specialist fast track health services or support to our sick colleagues - I think this has been raised in the report. I am thinking of things such as Physio,Counselling,CBT.

I also believe many of our working environments are quite poor. Often public sector buildings are old, poorly equipped and in less than desirable locations, with inadequate transport links (especially in relation to shift work) - all of which contributes to a more difficult working environment - and if the service is a frontline, clinical one, involving incredibly unsocial hours, difficult & demanding work, a tipping point in one's health and wellbeing can be reached. All small, incremental factors that effect sickness & absence rates.

But please know, that most NHS staff , work above & beyond their call of duty, with little recognition or thanks, dealing with more difficult, distressing and in some cases tragic things, that I know I would at times struggle to even imagine if I didn't have the job I do.

I think I've gone on enough for now. I don't often venture into The Drawing Room. This evening I'm glad I did.

[SeanMacGabhann]

So am I lulu. Fine stuff

[Tony.London Suburbs]

Your post makes me wanna shout, Lulu.

Good posting.

[MrBen]

Nice post Lulu and informative. Thanks. And you are the first to calmly address my original question about learnings from the private sector and what could be done - without the knee jerk hysteria from BN5 which I thought was not entirely proportional to the admittedly rather provocative manner in which I presented the case. Also appreciate the fact that you have not called me " a dick" for even daring to suggest that large parts of the NHS are plagued with dishonest absentees - yes skivers- and that tax payers might have an issue with this. Why should we all just accept it?

I've found some other stats from 2005 survey that indicate a sickness rate of about 50% more is indicative of the wider public sector costing the economy ?4.1 billion which casts doubt over specifics to the NHS such as higher concentration of viruses in the workplace (although it does mention long term working conditions are generally poorer). And if we're honest, surely heavy lifting, whilst also a factor, is a task not entirely exclusive to hospital workers?!

It's good to hear that there are new procedures in place for monitoring the problem but this report and these stats are recent, and if correct perhaps the fruits of these new efforts are yet to be seen. I suspect it may take longer to change something so deeply ingrained into public service culture. But I hope not.

[LuLu Too]

MrBen - I do have to pull you up over some of your more hyperbolic statements - whether your intent is meant to be deliberately provocative in a Daily Mail style or not!

Whilst I do agree that, yes, we can learn from Private Sector services, I have to stongly disagree (based on my experience) that there is widespread dishonest absenteeism (as you say - skiving), within the NHS. Obviously I cannot speak for all Public Sector agencies, only those I know well (specifically health & social care). It is simply not my experience that there is the ingrained culture that you describe.

There is a higher rate of sickness absence (for various reasons previously discussed), yes it should be monitored & managed better but no, there is not some 1970's heavily unionised closed shop in operation within the health service.

I am a professional - I work with and manage fellow professionals. We do a professional job with the necessary commitment and work ethic that this involves. I wouldn't expect or accept anything less.

[Keef]

In my experience, all public sector agencies are doing what you describe about the NHS, and really tightening up on sickness. This has been going on for the last 4 years or so. I have certainly never felt that I have a quota of pick days to use up!

[annaj]

Great posts Lulu.

But I have to object to this...

you are the first to calmly address my original question

My first post was entirely calm and if it didn't address your question it's because I'm not sure where your question comes from. What is your evidence, apart from the year you spent as a junior IT working in one organisation, that the majority of the additional sick days are dishonest? Unless you can show some evidence, other than your hunch, that most of the extra sick time is "skiving" then I don't think you're asking the right question and so won't address it.

Like Lulu I have worked my entire career, ten years so far, in the NHS and I have never encoutered the culture of a set number of sick days being allowed or expected. I'm not saying I don't believe Quids or TLS, but certinly isnn't true amongst doctors, far from it. Until recently there was a culture amongst doctors that taking a sick day was a failure in some way and letting the team down. When I first started work it was seriously frowned upon to take any time off sick, which is a very unhealthy way to work and is, thankfully, changing.

Quite apart from the questions I have already raised about these figures (who is the NHS being compared with and who is taking most of the sick time?) there is another consideration. Simply counting the number of sick days doesn't tell the whole story it is equally important to look at the pattern. In my department the clinical director uses the Bradford score, which is esstentially (this is from memory so if I'm wrong, sorry) the number of episodes squared and multiplied by the number of days. A Bradford score over 100 over a year indicates that there may be a problem - eg. stress, recurrent illness or dishonesty. So, for example, I had two weeks off for an operation, my Bradford score is (1x1)x14 = 14. But if someone else had taken 14 different Mondays off their score would be (14x14)x14 = 2744. And a nurse who has two months off with back pain would be (1x1)x60 = 60. The score highlights the problematic absenteeism without punishing genuine sickness.

I'm not saying that the factors I've mentioned account for all the sickness, but they do contribute, and I simply don't see what suggests that most of the sickness is dishonest.

And your complaint that responses have been hysterical and rude is, in my opinion, unjustified. I think you brought that on yourself and I think you did so knowingly, you said as much in your second post. You came on deliberately strong in order to provoke a strong response and that's what you got. You're doing the debate equivalent to what I used to do to my older sister when we were children - quietly poke her until she hit me then scream "Muuuuummmm she hit me!"

[brum]

Annaj and Lulu - excellent posts. For what it's worth, I can say that sickness/absent monitoring in my profession (the emergency services) is also much more stringent than a few years ago and the culture of 'throwing sickies' is long gone. In my opinion tax payers can feel assured that overall they get fantastic value for their money from the NHS/emergency services and other public sector organisations.

[????]

Brum, so that's all alright then? - you sound scarily like Gordon Brown. So why still such a sigbificant gap in sickness accross all the public sector compared to the private sector? Added to that the better job security and copper bottomed guaranteed final salary pensions and perhaps you can see why we in the private sector are asking these questions especialy when much of the increased 'investment' in the public sector over the last ten years is accouned for by a significabt increase in pay. Sorry, I don't feel assured.

[annaj]

Ok, in order to answer some of my questions I've just had a look at the actual report...

NHS Health and Wellbeing Interim Report.

I'll admit that I haven't read it all yet, but what I have read is very interesting. Firstly, it's worth pointing out this was a report compiled from a survey, a call for evidence and workshops. People who have experienced problems relating to sickness are more likely to take part in a survey about it and so there may (or may not, it's hard to say) be an element of bias and the sample may not be representative of the whole population.

Looking at the section of the results of the survey the majority of sickness is due to musculo-skeletal problems, some of which will have been contributed to by moving and handling. As an aside, to answer one of Mr Ben's earlier points about other industries involving heavy lifting, they do, of course, and injuries occur in those industries too. The thing about moving and handling of patients' is that it often happens in emergencies and in less than ideal situations. If a patient faints in the toilet that is where they have to be lifted from even if that means doing an unsafe lift around a toilet bowl. The second most common cause of sickness is stress and anxiety and alarmingly high rates of harassment, from patients, relatives of patients, colleagues and seniors, were reported. Infectious diseases do feature, but not very prominently, so I'll admit I was obviously wrong about that being a major contributor.

The pattern of absence is interesting too. Most absences are in the 1 week - 1 month bracket and very few are the single day absences more typical of duvet days.

The figures have been compared to current figures for other public sectors industries, with the NHS coming out slightly, but not much, worse than most. They have then (I think, as I say haven't read every word, please correct me if I've misunderstood) been compared to the whole of private industry, not private healthcare, which is where the big headline grabbing 50% comes from.

So, now that we have some actual facts, would anyone be interested in a debate about how we can improve the health of NHS workers or do you want to go on with finger pointing and ill-informed generalisation?

Edited for typos

[????]

Come on Anna, it's not finger pointing and generalisation, the facts do show on a consistent basis by lots of different measurements that public sector workers on average take significantly more sickness than private sector workers - we do appreciate that many in the PS are genuinely more altruistic and caring but we in the private sector are allowed to question this surely? Do you not think that there are not numerous jobs in the private sector which are hugely stressfull, involve exposure to risk and involve heavy manual labour too? You may be correct vis-a-vis private healthcare, but that's a red herring...in fact overall Public Sector Versus Private Sector absenteesim came out at 55% more sickdays in 2007 for instance...now that's more headline grabbing. I think MrB was being deliberately over provocative in his delivery but nevertheless there is a lot of truth behind what he says - I'm sure you do a f*cking good job - far more meaningful than mine, for sure - and work extremely hard - But the public sector and indeed the NHS shouldn't be sacred cows and all of us have a right to question and make sure we are getting value. For instance, do you really think a local governemnt officer with a nice pension and relatively normalised hours taking 55% more sick leave than a private sector worker sounds right?

[annaj]

At no point have I said that the higher level of sickness is ok or doesn't need addressing, what I have said is that there's no evidence that it's caused by skiving. And I still haven't seen any.

[????]

Well, statistically it's odd then, so either it's

1) PS work is more adverse to your well being healthwise

2) The PS attracts people who are more likely to be sick

or....3) It's 'skiving'

[annaj]

So, you are entirely dismissing every contributory factor I and anyone else has raised?

You do not accept that there is anything about working in the NHS, rather than another organisation or industry, that contributes to sickness?

Have you even looked at the report?

There is an important discussion to be had here about the health of workers in the nation's largest employer and improving services for everyone, but it's very difficult to have it if you insist on ignoring the facts.

[macroban]

The private sector statistic of "6.4 days" used to calculate the alleged 55% deviance looks suspect to me.

The source is given on page 27 of the NHS Health and Wellbeing Interim Report as "the most recent absence management survey conducted by the Chartered Institute of Personnel and Development (CIPD)."

So we have the NHS data from real staff absence records and "private sector" data from a vested interest survey of unknown scope and accuracy.

Looks like chasing shadows to me.

[????]

Anna - I am talking PUBLIC SECTOR please read my posts and not get stuck on the OP and your emotional defense of the NHS. Besides which what part of my last post is dismissive? It has to to be explained by one of those three surely?

WE, all of us, are never going to get any sensible debate on this with the massively defensive default position taken up by practically anyone who works in the public sector to any questioning about funding, pay, performance, pensions, etc...

[Keef]

Quids, the pensions are not what they were, and lots of people are losing out. I know that's still better than a lot of private sector stuff, but we're not all assured big final salary pensions.

[????]

Macroban - Why a vested interest?

Plus All the big employers in the private sector (who are more directly comparable to the Public Sector) have rigourous record keeping on sickness/absenteeism. And if you think you small companies - let alone the self-employed - are relaxed about employee sickness then you must inhabit a very different world to me. Sorry - the Public Sector is a sacred cow and still unimpeachable to practically everyone who works in it (turkeys and Christmas etc) and many who don't as this thread is demonstrating

[macroban]

> Macroban - Why a vested interest?

What do CIPD members sell in the way of expensive consultancy?

[????]

Keef - a pension pot of ?100,000 buys you an annuity of about ?6,000 at the moment. So to even have a pension of say ?30,000 pa, not a huge amount to run a car, go on holiday, travel and live on will require a private pension holder to have accumulated a pot of ?500,000! Now, let's compare that to a pension of a copper, NHS worker, er MP, etc etc

[????]

more right wing vested interest propaganda no doubt...

http://www.telegraph.co.uk/health/healthnews/6066181/NHS-staff-paid-overtime-when-off-sick.html

[annaj]

Quids, I don't think I'm being overly emotional or defensive. I am challenging an assumption that the increased rate is down to skiving and asking people to look at the evidence, so that we can understand why rates are higher and what we can do about it.

So, yes, to go back to your last post it does have to be down to one of those three things and I think it's 1. PS work is more adverse to your wellbeing healthwise (although the report is mainly about the NHS so I hesitant to extrapolate to the rest of the public sector.

If you look at the section on factors associated with absence working shifts of more that 8 hours, being pressured to return to work and being a carer (away from work) are all factors. Being female is also a factor associated with absence, which may relate to being a carer, as the majority of carers (although of course not all) are female. Since a high proportion of NHS employees are women, this is having a major impact.

So, what can be done about all or any of those contributors? I honestly don't know the answer, but the recommendations for improvement in the report focus on developing better occupational health services and staff health initiatives (exercise, stop smoking etc). The report suggest that a blame and bullying culture within the NHS (see, no rose tinted view here) is part of the problem and it strike me that widespread reporting about "lazy" NHS staff will only make that worse.

The other thing the report covers is (made up word alert) "presentism" which is working when you're really to sick to do so and it suggests that this is also a major problem.

How acurate the figures are I don't know. Statistically and academically I have some concerns about how robust the data is, but in a sense that doesn't matter. This is an important issue and needs to be addressed, I just think it's sad that it's being used as an opportunity to criticise rather than an opportunity to improve.

So, to go back to the OP, calmly as I have been throughout, what is the private sector doing differently? Do those of you in the private sector feel supported? Or do you feel bullied and pressured to return to work or work when sick? If you're supported how is this done? Is sickness lower through the carrot of support or the stick of punishment?

[LuLu Too]

???? Wrote:

-------------------------------------------------------

> Well, statistically it's odd then, so either it's

>

> 1) PS work is more adverse to your well being

> healthwise

> 2) The PS attracts people who are more likely to

> be sick

>

> or....3) It's 'skiving'

Quids (sorry my Pound sign appears to be non-existent),

There may be some validity to points 1 & 2. Of course some absence is due to skiving - this is true of all services, Public & Private.

There is evidence that shift-working is detrimental to your health. Many NHS jobs involve working shifts & unsocial hours for years on end. This does have a negative effect on wellbeing and is probably a contributory factor to sickness absence.

Does the Public Sector attract people who are more likely to be sick? Quite possibly it does. I can only really speak about the NHS & Social Services (where I have experience). People have all sorts of reasons for choosing careers in Health (and Social Care). It can be due to past experiences the individual has had in being in the receiving end of care/service delivery. Often Public Sector employers are seen to be more supportive of those employees with disabilities or special health needs. For example my Trust has specific policies of employing individuals in certain posts who have themselves suffered from mental illness.

I do not think the NHS or other Public Sector services are some sort of sacred cow - beyond challenge or questioning.

I do think Public Sector services are not easily comparable with Private Sector services.

And I also think some things need to continue to change & develop. But this process started several years ago and is ongoing.

[macroban]

Well called, ????.

And it seems like Rebecca Smith is an innumerate and sloppy journalist too.