Lancashire County Council
Lancashire County Council has about 46,000 employees, and delivering an effective absence management policy is made even more complex by the fact that they work over a wide geographical area, carrying out diverse roles which are often highly specialised.
In April 2007, Atos Healthcare started working with the council, with the remit of reducing sickness absence. The council wanted a proactive service with a systematic approach and rapid turnaround of OH appointments.
“OH was seen as a function that could help boost productivity,” says Marcella Bailey, consultant occupational physician at Atos.
The council wanted OH to be seen not as a last port of call for employees with health problems, but as a dynamic department with a positive contribution to make to the organisation.
For Atos, the first step was to assess the system the council already had in place, and how effectively it worked. It then focused on the issues that needed to be addressed. One area of concern was the time taken to deal with cases: staff were waiting for up to 16 weeks for a first appointment with OH.
“We looked at why such a backlog had built up,” says Bailey. “We went through medical reports and calls and appointments, and got on top of that logjam in six weeks. We also went through the filing cabinets and got rid of everything that was inoperative.”
All cases are now seen within 10 days of referral, and reports are completed and returned on the day of the appointment. The equivalent of six full-time advisers were put into post, but the scale of the council’s operation was still a challenge.
“Lancashire employs such a wide range of staff from care workers to solicitors – and you can’t improve an absence policy until you know what people do in an organisation,” says Bailey. “So we went out and about, talked to people, went out on the care bus with care workers, visited school kitchens and gathered as much information as possible.
“We wanted to be sure that we could assess whether a particular person was fit to do a particular job. For example – how would you do a fitness-to-work assessment for someone who works on street lighting?”
All OH staff shadowed workers undertaking various roles within the organisation.
Training line managers was another priority. “We gave line managers training in dealing with absence management, so that we can work alongside them – knowing that they have a good understanding of the role of OH.”
Direct communication between line managers and OH staff can make all the difference, Bailey believes. “Occupational health is not something that HR can explain. It should not be used as a go-between. OH and line managers should talk to each other.”
Case conferencing has also been introduced, with the contact details of the practitioner included in the case management system from the start, so there is always a point of contact for staff wanting to get in touch with OH. This helped bring managers into the process in a coherent and systematic way. Each of the council’s directorates has also been allocated a named lead OH adviser, and all staff are subject to an audit review on a monthly basis.
Good communication means that staff understand when it is appropriate to come to work. There may be instances when they may feel well enough, but their level of infectiousness presents a risk to colleagues and – if they are in a customer-facing role – members of the public. Both the flu virus and the norovirus come under this category.
“Our message is: don’t come back if you are not fit to do so,” says Bailey. “For instance, if you work in a school canteen, it is not appropriate to return to work until you know you are no longer infectious. Good ‘back to work’ policies are not just about getting people back into work as soon as possible, they are also about telling employees – when it is appropriate – to stay away.”
Atos Healthcare staff also attended the training sessions for managers on the new sickness absence standards, and had an input into this.
Cases that had hit problems in the past were analysed and used as models of ‘how not to do it’. Negative role models are regarded as being just as useful as positive ones, if they are used properly.
The fact that a new HR director came in at the same time as the new absence management system has proved very useful. “Part of her remit was to implement change and bring the organisation forward,” says Bailey. “Staff often feel threatened by change – there is a tendency for them to say: ‘we have always done it this way’. It can be difficult to demonstrate why change is needed, or show how a new system would be more effective.”
But the alliance between the two sides proved useful. “We needed to break the negative image of OH. One way was to take any opportunity to raise the profile of OH – taking part in ergonomic road shows, wellness and health events, doing intervention pilots, and so on.
Atos has run two pilot schemes with the council over a period of six weeks and three months. A third pilot – with the adults in the community social work department – is now ongoing.
“At Atos, we work to a specific standard, but we do adapt this to the individual needs of organisations,” says Bailey. “This includes looking at the medical issues, giving a prognosis, and offering advice.
“Our aim is to empower managers as well. It is very easy to medicalise issues which are really management problems. Now we have a system in which OH staff report back on absent employees in 14 days. This is done locally, and staff can see an OH professional in two or three days. But to get this right, we do have to be more flexible and interface with customers so we know how to make this service relevant to their area of work.”
Atos is now a well-established partner of the council on workplace health issues, attending senior management meetings, reporting to HR on a quarterly basis, and working on the development of a new wellbeing programme.
Royal Mail Group
Royal Mail Group (RMG) has been using Atos Healthcare to provide an OH service since 2002. But when its contract came up for renewal last year, Atos wanted to improve its performance on cutting sickness absence. The aim was to improve communication between RMG and OH professionals, moving away from a system which relied heavily on paper, and towards a more direct relationship between the two sides.
“We wanted to focus on developing the relationship between provider and client, and a case management system,” says Dr Lucy Wright, consultant occupational physician at Atos, who is working with RMG. “Royal Mail is changing very quickly at the moment, things change from month to month, and we need to be as flexible as possible.”
One way of addressing this was to look at the role of area health advisers, and their knowledge of different teams within the business. “We looked at issues such as: do they understand the causes of absence?Are they getting any hidden data?Are there any specific illnesses being revealed?”
Area health advisers can also help Atos take preventive action by updating OH about any changes or specific temporary problems, such as sites being closed, or specific changes implemented in a particular part of the business.
None of this would work without the full commitment of RMG, says Wright. “Royal Mail has always been at the forefront of looking at absence management. A lot of this experience is reflected in the Carol Black review.“(Both organisations have had an input into this review.)
“As an organisation, Royal Mail is very good at managing change, and has been through a great deal in its 150–year history,” she adds. “Succeeding in doing this in an environment in which it had industrial relations problems – as it did last year– is very challenging.”
Best practice approaches at the organisation include physical interventions, work with Remploy to provide career guidance for disabled staff and those returning to work, and a disability centre to help make adjustments for staff.
Wright believes that one of the keys to success is that it has built relations with OH practitioners and the organisation at different levels – not just at contract manager level, but also between area health adviser, RMG’s management team, and the managers of regions. At a higher level again, Atos has also developed relations with RMG’s management team and service manager.
“There are perennial barriers – line managers and OH speak different languages,” says Wright. “If you just communicate by letter, the language barrier becomes enormous.But if you speak on the phone or meet face to face, you realise the communication issues are not so serious.“
Another key factor is that Royal Mail does not run absence management as a stand–alone function: it is integrated into wellbeing, health fairs and overall health provision.
The employee assistance programme (EAP) also helps make the absence management scheme more effective by encouraging co-operation between OH and the employee assistance provider without breaching confidentiality for the EAP. “There are Chinese walls between any employee assistance provider and OH, but there is an overlap,” Wright points out.“We take anonymised samples, and find out what issues are coming up in the EAP. This helps us understand what is causing absence. For instance, we can find out where there are pockets of bullying and harassment.”
RMG also puts the emphasis on keeping staff well at work, as well as keeping absence figures as low as possible. For example, it provides physiotherapy and functional capacity rehabilitation in three different locations.
For Norma Spence, supplier manager, corporate responsibility and engagement at RMG, one of the key improvements is the streamlining of communications related to absence management. “Previously, all our OH staff had to e–mail in referrals. This was a bit of a barrier – some did, but those who weren’t familiar with the system didn’t bother to use it.”
This has been changed to a new system in which OH staff make referrals in a phone call, which speeds up the system. Atos then records the information and this is sent off as an e–mail.Line managers with a large workforce are still able to use the e–mail system, as long as they have the expertise and the knowledge to do so.
“We didn’t anticipate this – telephone was the sole system in mind, but we do try to be flexible, and we were responding to what staff were telling us.This was the consensus and the feedback from people.”
The speed of interventions has also made a difference. Within the first three days of absence, employees will get two calls from Atos. The first is an appointment, handled via the telephone or face to face, and the second is from the nurse who can talk to them in more detail about their condition, and may offer guidance right away.
A small minority of staff find this intrusive, says Spence, but the majority are happy with the new system.And a case management system in which they have one key contact person who knows the case from start to finish has helped win staff round. “Before we changed to the new system last February, any time an employee was referred, they would be dealing with a different person,“ says Spence.
Changes in the pipeline at RMG include a review of the role of its area health advisers, putting more emphasis on their work with the senior management team at strategic level, which would help the organisation to understand absence, track developments and try and keep absence down.
Health promotion is also in the works, to tackle the issue of presenteeism and boost workplace performance.“We want to be more proactive about that, so we can do things that are good for morale, and make people feel cared for.“
This will build on existing wellbeing programmes, which include a women’s health event, run on 120 sites. It includes health checks covering blood pressure and body mass index, and it is always over–subscribed.A men’s event is equally popular, and the ‘health bus‘ which travels to different RMG sites is so popular that it is being refitted with extra partitions to cater for more people.
“This is about making health issues more accessible, not just a dry process,” says Spence.“For instance, we have a ‘Know your numbers‘ initiative, asking people to get specific data on their blood pressure andBMI, and to know what these are. And we have an IT–based system called ‘Feeling First Class‘. Staff have an online account and can get advice on fitness, diet, nutrition and so on”.
Absence rates at RMG are 4.5% on average, though this figure does fluctuate, and is higher in some parts of the business.
The success is the result of working in partnership at all levels, says Spence. “I think there are people who think that I work for Atos,” she laughs. “We work extremely well together. Case management is key.Not only to win line managers round, but also, if something is not straightforward, we will call the employee and say: ‘Do you understand the report?Are you happy?”.”