Back in April, North Yorkshire Fire & Rescue Service’s audit and performance review committee published a snapshot of its recent progress on absence management. This showed that the service had achieved a 16% drop in days lost to short-term sickness among uniformed firefighters from January to February this year compared with the previous year (although there was also a 36% increase in long-term sickness absence, due in part to a single incident), with overall sickness for all staff falling by nearly 12% in the same period.
Key to this has been its use of “absence review meetings”, where the occupational health (OH) team informed managers when sickness absence ‘trigger’ levels had been reached. Managers then set up meetings with the employee to discuss what needed to be done, with 35 such meetings having been carried out over the year.
The use of such meetings, of course, is not that unusual within the fire service, or indeed within OH more widely, even if they are sometimes given different names. It should also be stressed that the reason for focusing on North Yorkshire does not imply any specific success or failure on the part of its OH team in tackling absence and attendance, though clearly it does appear to be doing effective work.
Rather, it is to illustrate how fire and rescue services can have a tendency to work in isolation, at least when it comes to OH, largely because they are big, complex organisations in their own right.
As Gail Cotton, head of OH at Leicestershire Fire and Rescue Service, explains: “There is such a lot of good practice out there, but it needs to be much more cohesive, and we need more co-ordination in how we go about it.”
Lack of cohesion
Amanda Savage, senior OH adviser at West Midlands Fire Service, agrees. “At the moment it is all very ad hoc and each fire service does its own thing, and so the guidance it is using might be very old. Really it is mostly just about having a common-sense approach and looking at individual health. We were, for example, one of the first brigades to have firefighters with digital hearing aids back on duty,” she explains. “We get firefighters back now who have had hip and knee replacements. It is really pushing the boundaries as far as they can go.
“We have also managed to get managers on board a lot more – we have managed to get them to take more responsibility for health and absence issues. It is about getting them to recognise that they need to manage people, rather than just all the time passing things on to OH.”
In Savage’s service, for example, which has an in-house OH service, absence levels have reduced from 13% to 7% in the past four years. But it has also recently put out a new health and fitness policy, covering things such as fitness training, weight management, health screening, fitness reviews and physical training.
While there is nothing wrong with this in itself, and it covers all the bases for firefighters in the West Midlands, this serves as another example of services doing their own thing.
OH network group
Addressing this lack of cross-service communication and sharing of best practice is at the heart of a plan by the Chief Fire Officers’ Association (CFOA) to develop an OH network group, website and national strategy, where practitioners, HR and even the public can read about and share best practice on workplace health within the service.
The first step was the creation in January of a National OH Network Group under the CFOA banner, explains Ian Hayton, executive director of Cleveland Fire and Rescue Service, and the CFOA’s lead on OH. “There are a number of disparate bodies operating, so there should really be more joined up synergies between them, more bringing together,” he says.
“What we have done in that time is to pull together a number of objectives. We have established a strategic steering group and have put in place an effective communication mechanism between the various groups.”
As well as the CFOA, the network group includes the Association of Local Authority Medical Advisers, OH practitioners and individual fire and rescue services, the National Disabled Fire Association (NDFA), the Firefighters’ Charity, the Department of Communities and Local Government, and the government’s Chief Fire and Rescue Adviser’s unit.
The network group has four key goals, as Hayton outlines:
To support the development of a fitness framework for operational firefighters
The development of good practice on attendance management
To support targeted medical and OH research
To ensure the provision of consistent and up-to-date guidance on the implications of the Disability Discrimination Act (DDA) to the fire service.
But Hayton is at pains to stress this is not something that should be viewed as a threat by OH practitioners out in the field – the idea is not to crack the whip or highlight poor practice, he says, but simply to disseminate good practice and generate debate on the sorts of workplace health issues a modern-day fire and rescue service needs to be addressing.
“There are a whole load of issues out there that need to be more co-ordinated. So we need a body that takes more responsibility for disseminating good OH practice across the service and to ensure that there are consistent standards being applied,” he says.
“The idea is simply to provide a framework from which people can work. The local services within each fire authority do not have the individual resources to carry out this sort of research,” he emphasises.
For example, the network is investigating setting up a research study into heart disease within the service through the British Heart Foundation, and how that may disproportionately affect the service because of its ageing workforce. It is also looking at deaths in service over the past six or seven months to see whether there is a link with heart disease, as well as investigating the top 20 medical conditions that affect workers within the service, and then prioritising them.
“Stress is quite high on the list and musculoskeletal conditions, as you might expect, are very high,” explains Hayton.
“Heart disease is also an issue. We want to see whether our approach can be improved and whether this can also be tied more closely to attendance management and fitness standards across the service.”
The issue of the DDA is also an important one, agrees Duncan White, chair of the National Disabled Fire Association.
“You can get OH providers that have a far from complete understanding of the DDA and the way in which it should apply to the fire service,” he argues.
“The role of the occupational medical adviser should be just that – to advise if an individual needs to come in for a medical, say for their hearing, and report their findings back to the brigade, which is fine. Then the responsibility for making reasonable adjustments should be left with the brigade management.
“But what you often get at the moment is brigades asking advisers what they should do. The NDFA wants to ensure that, at the same time as revised guidance is issued, a revised Red Book [the service’s national agreement on pay and conditions] is also issued. We would also like to conduct a series of roadshows with health and safety and OH professionals.
“OH providers need to make sure that because guidelines say someone’s hearing has dropped below the guidelines so that they become protected by the DDA [that they are not off work unnecessarily]. What we have been getting is horror stories of recruits being shelved [on sick leave] for up to 24 months,” he adds.
OH practitioners working within the service should be seeing all these moves as an opportunity, agrees Leicestershire’s Cotton.
“We have got people working within the service now who have, say, asthma, diabetes or have different vision who, five years ago, would have been on the cusp of whether they could have worked for us, but who are now the norm. We have got to get some continuity in our clinical work, because it is now a nurse-led service,” she points out.
“There is more scope now for firefighters either to come in with, or carry on working with, conditions that might once have precluded them from service, such as laser surgery on the eyes, cardiology, hypertension, obesity or epilepsy,” she adds.
The ambition is that, in time, there will be data-sharing around contact lists, OH service specialists, an OH library, good practice guidance (including anonymised case studies), research, relevant links and even a discussion and debate forum. Within this there will probably be secure sections for practitioners and clinicians, and then more public areas that could be accessed by the public or HR.
Priority areas, explains Hayton, are likely to be around attendance management and fitness standards, developing the database of major medical conditions and disorders, the issue of asthma and recruitment, the building up and collating of existing medical and occupational evidence within the service, the consistency of ill-health retirements, developing DDA guidance for managers, and pushing forward the idea of research into heart disease.
“Rather than people struggling to do this or that or reinventing the wheel each time, they will be able to join up all the threads,” enthuses Cotton. “It is a way of smashing the silos and getting people to talk about occupational health within the service.
“What we want to be doing is generating better links through this central database, and we even hope in time to have a question board that people will be able to post questions up on,” she adds.
The intention is also, in time, to create closer links with groups such as the FireFit steering group which, with its aim (as it states on its website) of providing a forum to “identify, develop, communicate and promote best practice pertaining to fitness-related health issues of UK Fire & Rescue Service employees in an effort to maximise the wellbeing and efficiency of the service”, is likely to be a natural fit.
The steering group also already has a research database covering areas such as injury prevention, myocardial injury following carbon monoxide poisoning, and the health risks of obesity in some of its most recently posted papers.
Of course, with anything such as this, there is always the somewhat thorny issue of money, particularly given the eye-watering squeeze the public sector’s finances are likely to experience over the next few years as the government struggles to rebalance the books. While much can probably be achieved through goodwill and encouragement – for instance the collation and gathering of existing evidence, perhaps – it is something where the scope of its ambition makes it clear there will be at least some investment needed, as Cotton recognises.
“None of this is going to be done in a flash as we have to scope out who is going to fund the work and look at the experts needed in different areas. We have to put a good business case to the CFOA,” she points out.
But it also has to be remembered that the government has set an ambitious target for reducing sickness absence across the public sector by 30% (equivalent to an average of 7.5 days lost per worker) by 2010.
In 2005-06, according to its most recent figures (published last summer), the average number of shift days lost to sickness per person was 9.4 for full-time firefighters, 11.9 for fire control workers, and 11 for non-uniformed staff. So clearly, the service still has some way to go. Therefore anything that can help to improve and disseminate best practice and contribute to reducing absence rates and improving attendance management in a service that is and has been undergoing rapid change should, it is to be hoped, be welcomed.
What’s more, the work under way very much links back to the government’s, and director for health and work Dame Carol Black’s wider agenda to create a more evidence-based, consistent national OH service, argues Hayton. The intention, he suggests, is to work towards having a proper strategy in place by the end of this year, with the data-sharing website up and running by the autumn.
“It will simply be a framework against which the profession can utilise and measure itself against, but this will not be prescriptive.”
OH network group aims
The aim is to “develop a network to ensure effective liaison between stakeholders directly involved in delivering OH services across the Fire & Rescue Service”.
This will include:
The establishment of a strategic medical and OH network of relevant stakeholders
The establishment of an effective communication network between the stakeholders who deliver OH services, including data-sharing through an OH library, good practice guidance, ongoing research, a support centre, and a discussion forum
The provision of consistent and up-to-date guidance to practitioners, including the development of a fitness framework, good practice on attendance management, targeted medical and occupational health research, and guidance on the Disability Discrimination Act.