Tuesday 11 January 2011

Does Scotland Need Private Absenteeism Management?

An average of 6,500 Scotland's NHS staff were off sick every day last year.  In September 2009 the NHS employed 168,976.

The Scottish government pointed out that absence in the NHS has dropped considerably in recent years. 'The proportion of absenteeism from 2006/7 to 2009/10 decreased by 14%'.

This isn't a good enough explanation for Derek Brownlee, the Scottish tories finance spokesman though.  He proposes a system of 'absence management' used by such firms as FirstCare (note the URL), with central reporting and immediate clinical assessment of absentees to return them to work as quickly as possible.  FirstCare, a private equity-backed management company, claim to have reduced absence levels by an average of 26% within a year during trials with 17 NHS trusts in England.

The system includes a nurse-led contact centre for staff to contact at the first sign of illness and Mr Brownlee insists such radical measures were needed to tackle absenteeism in Scotland.
"Many people rightly question why absenteeism is so much lower in the private sector than in the public sector".

He does have a point insofar as absenteeism is higher in the public sector than the private sector but is this system the way the Scottish NHS should be heading?  Would the management costs of a scheme like FirstCare outweigh any savings? 

Why is it I get the feeling that the nice Mr Brownlee is championing FirstCare on behalf of his boss in Westminster?  Maybe it's the .eu which motivated me to have a dig around to see what I can find out about the company.  It would appear the new chairman, Richard Burrell formed Mathieson Capital in September 2010, a private equity investment business which will be investing in FirstCare at its next funding round.

I'm certainly not suggesting that FirstCare is anything but a highly professional business offering a highly professional service, but it doesn't make sense to outsource an administrative section of the NHS when the Scottish government states the NHS are coping well with the issue and a reduction of 14% absenteeism in the past 5 years shows definite progress.

We have enough organisations involved in NHS Scotland without another jumping on board.



Weekend Yachtsman said...

The NHS' own management should be tackling this, but are not.

From personal knowledge I can assure you that the situation is chaotic, unmanaged, and wide open to abuse - plenty of which goes on.

One of the problems, perhaps the biggest, is that nobody is actually in charge. Nobody has the authority to say "You - perform or else - these are the sanctions".

This, of course, is practically a definition of a nationalised industry, which is what the NHS is.

Nothing will change while it's run by the State.

Third-party companies will be a waste of time and money because they won't be allowed to do the job properly, and they will just learn to milk the taxpayer like everyone else.

Private, profit-making provision is the only way to get decent performance. But we knew that.

Richard T said...

It's easy to be glib about absence rates in the public sector. There are causal factors which do push sickness absence rates higher there - much of the work in the NHS, social work and education is with other folk and in the first two instances often sick or vulnerable folk. So if you work in an office and have a heavy cold but get into work you might infect your colleagues but it's not dangerous. You work in a hospital or as a care worker and infect someone old and or sick...; the same applies to any d and v infection. That's why such workers have to stay off until all symptoms have gone.

That's not to say that this explains the lot - there is obviously slackness elsewhere but NHS Scotland is pushing to get its sickness absence rate down to 4%; the same pressure applies elsewhere.

JRB said...

Hasn’t the laddie done well – in this, an election year - wee Derek Brownlee has managed to get himself some publicity. Just a pity it is with such an outlandish and ludicrous scheme.

FirstCare is a joke, but a dangerous joke, a joke with worrying right wing overtones.

If an NHS employee is off sick it is proposed that they will report to a qualified FirstCare nurse. Excuse me, but am I missing something – isn’t the highest concentration of nurses to be found within the NHS?

If an NHS employee is off sick, on more than one occasion it is proposed that they will report to a qualified FirstCare clinician. Excuse me, but am I missing something – isn’t the highest concentration of clinicians to be found within the NHS?

For any MSP to propose that a cash strapped NHS fork out money to a private concern for something it could and should be doing itself is – madness, or, perhaps more likely, privatisation of the Health Service by whatever means possible.

subrosa said...

Now that's interesting Weekend Yachtsman because the SG say it's down 14%. I thought that showed the internal system had improved.

Isn't it sad, when we're churning out more graduates than ever before, that we can't find enough brains to put together a workable and efficient system.

Was always thus though in the public service. Too many egos and not enough responsibility and common sense.

subrosa said...

So Richard, you're saying that if I worked in the private system, say in a private nursing home, that I'd go into work and pass my germs around, whilst if I worked for the NHS I wouldn't and that's why the absenteeism is higher?

Naw Richard. Let's be honest here. Most folk, given the chance, will swing the lead a bit. In private business there a word called control. According to WY there is no accountability - no one making decisions.

Most of my working life was spent in private business. I picked up the same germs as anyone working in the public sector.

subrosa said...

Morning John. Bright day and slight thaw.

I don't know if it's a right-wing setup John, but I do know it's one of these businesses which likes to keep the structure well hidden.

Aye it's a shame Derek picked this subject to get his name in the papers but I suppose, to a politician, no publicity is bad publicity.

We should be doing it John, but according to Weekend Yachtsman we aren't. The internal system needs to be more efficient and, I agree with you, giving money away to a company to do this is just wrong.

Doesn't it amaze you at times John, that these days we have more graduates than ever before, yet we can't seem to employ many with common sense in the NHS? Or do the people who are employed get an attack of the 'NHSs' upon joining and lose their abilities? Like politicians when they are elected to office perhaps?

Richard T said...

No subrosa that's not what I said and you ken well. In the public sector part of carework, you are required not to return to work with infectious conditions until 24 hours after the last showing as it were. I assume the same applies in private homes. So compare the private and public care sectors fine but don't generalise across the whole of the private and public sectors please. The argument is the same in nature as in England over school pass rates - the crude figures can mislead.

Clarinda said...

I agree - as Weekend Yachtsman perceptively states - that, now nobody is or appears to be in direct charge or accountable. I recall in the 'old days'(1960/70s) of the NHS there was much more of an ethos of commitment, loyalty, pride and satisfaction...and respect for well deserved authority wielded by the Ward Sister and Senior Staff Nurses. This was held to good account by the sole authority of the Matron of every hospital and her Deputies and Assistants. Even stronger was the close bond between staff (nursing and medical in particular) that taking time off without due reason was - letting the side down! Today I'm sure I would be criticised for implying that today's nurses are not still the same but the internal ethos has changed dramatically with the advent of poor and lack-lustre 'management' and distant disseminated 'authority'.

In my day if a nurse was sick they were admitted to the Nurses Sick Bay or if resident outside hospital, visited by a Home Sister! Today that would be regarded as harrassment and no doubt an infringement of Human Rights? Later, in my almost 40 year NHS/teaching career, nurses were 'counselled' if they accrued more than two short absences within a three month period. This was also abandoned as too invasive although nurse students were informed that all absenses would be noted on any reference for employment interviews.

I suspect that it is not major illness or even minor colds that affect staff absences but stress and indifference linked to working conditions. Mix this unhappy lot with a disconnect between staff strangled with paperwork, trivial nonsense over irrelevant non-clinical working practices instead of major concerns ... and their employers (NHS and political).

It might be interesting but tricky to compare absenteeism in wards or units that have an internal subjective reputation of a competent and happy communal working relationship with those that have a poorer reputation? I think I might know the answer as I've increasingly experienced the result for the last twenty years. I wonder what the nursing absenteeism rates are in the private sector?

Re-instate the superiority and clinical stature of the professional criteria for Registered Nursing and their Code of Practice which outshines any latest managerial flight of redundant fancy. However there are dangers in handing back such responsibility and authority to clinical nursing staff as they might not need the swarms of managers and adminstrators and their unnecessary invented non-productive desk jobs.

The numbers of doctors and nurses leaving the NHS for other work or to follow their careers abroad run into the thousands every year and it's getting worse while the NHS advertises abroad for replacement staff - particularly down south. There are differences in working NHS practices north and south in the UK - but there is definitely room for great improvement - or even more of our expensively educated doctors and nurses working abroad won't be back anytime soon.

subrosa said...

Sorry if I misunderstood Richard, but I do think you've not had much experience of private business. Common sense is used there and there's much more a sense of loyalty it would seem. No private business wants infection employees at work. It's not good for business. If that's generalising then fine, I'm generalising.

There's nothing special about NHS staff. They're human the same as the rest of us. Plenty private businesses have very regular contact with the public the same as NHS staff. There shouldn't be a difference in attitudes towards absenteeism.

subrosa said...

Excellent points Clarinda. It would be worth knowing the rate within private nursing.

Didn't Nicola Sturgeon say Matrons were to be reinstated? I haven't heard more about it.

Therein lies the rub. The unions wouldn't want anyone to lose their job, whether management or front line staff. I do wish the MSM would take up the issue about medical staff leaving to work abroad. It seems to be the elephant in the room as far as healthcare in the UK is concerned.

Wrinkled Weasel said...

Weekend Yachtsman is correct. I know.

subrosa said...

Well WW you have first hand information. However, I'd like to hear how the present SG reduced the level by 14% before it's considered we put the problem in the hands of a private equity company.

Unknown said...

Anyone working with people is liable to pick up various viruses and infections - just ask teachers. they pick up every single germ going from their kids.

But NHS and care staff have to be particularly careful because they come into close contact with people who are particularly susceptible to infection. That is why, for example, NHS staff are given the flu vaccination while other groups of workers are not. If you pass on your cold germ to someone who is healthy that person just gets a cold. But if you pass it on to someone who is already seriously ill that is another matter.

Unknown said...

Incidentally the reform Nicola Sturgeon has brought in gives senior charge nurses greater responsibility for cleanliness and infection control on wards. But there wouldn't be a lot of point in improving cleanliness and infection control if staff were allowed to go about coughing and sneezing over patients, would there?

Wrinkled Weasel said...

Sorry, but the NHS takes a very dim view of whistleblowers. The Consultant Anaesthetist in the Bristol fiasco was a personal aquaintance and he ended up having to work in Australia.


These people play very, very dirty.

Unknown said...

Maybe I am being obtuse but what does the Bristol case have to do with absence management in NHS Scotland?

I agree there may have been a historical problem with absenteeism but it seems that management have got on top of it in recent years by adopting some pretty straightforward policies - such as phoning people who are off sick at home every day they are off sick (meaning that the sick employee has to be at home all day and every day they are off as they don't know when the call will come.) Measures like that seem to have been pretty effective, they are not costly and they don't involve this slightly bizarre idea of sending NHS staff off to see this, that and the next person if they fall sick rather than just going to their GP!

Wrinkled Weasel said...

K I am talking about what it means to tell the truth about the NHS. It is the same in Scotland as it is in the rest of the UK.

Your assertion that people are phoned at home is nonsense, but I have nothing further to say on this since it is not worth the personal aggravation I will get if I do.

Unknown said...

It is not nonsense, The approach was piloted by NHS Lanarkshire and is being rolled out by other health boards now - including NHS Tayside which is Subrosa's local health board. It cut the days lost to sickness by half in NHS Lanarkshire. Google it.

Jo G said...

Bringing in private companies to "manage" sickness absence would be madness. Companies like Atos are already paid by the taxpayer to undermine GPs and Hospitals who believe people are too ill to work. In the last full financial year Atos were paid a whopping £131 million for these "services". The end result of course is that they kick people off sickness benefits. We don't need yet another "private" company setting up another gravy train.

I think it is certainly the case that "sick leave" is widely abused. I don't think anyone would challenge this. Unions did not win better conditions to cover times of illness for people to add - say - 10 days a year on to their holiday entitlement yet that is the way some treat it.

A lot of mothers also abuse the facility by taking "sick leave" if their children are ill. In situations like that annual leave should be used, not sickness absence.

Brian said...

When I was signed off sick from the JobCentre with depression it might as well have been ebola for all the contact I received from management and colleagues. Looking back on the episode, I am glad because it convinced me to apply for voluntary redundancy. That and the compulsory meeting with the Regional Director for all those who expressed an interest in volunteering. Despite me wearing my mandatory name badge, she called me Neil throughout. Nice.

subrosa said...

The are thousands working in the NHS who don't come into contact with the public K and there are thousands in the private sector who do come into contact - and with vulnerable or frail people.

NHS staff aren't special. All of us are.

What about those who care for the ill or frail in the home. Family/friends I mean. Oh of course, they don't matter because they're unofficial.

subrosa said...

K, very recently there was a report about some wards in Ninewells Dundee. It was scathing, so don't tell me that cleanliness and infection control has improved.

Until they ensure, as in many continental hospitals, that each patient has access to their own private facilities it won't get better.

Sharing a toilet and shower with another 5 people, all with different problems, is a sure fired way of cross-infection.

subrosa said...

He'll have a better quality of work in Australia WW I believe. Just sometimes whistleblowers receive a thank you for their good work. This was a delayed one but I'm sure he's content now.

subrosa said...

K, you'll have read Clarinda's post. She's a person with many years of experience at the top end of the NHS. I suggest you read her comment.

subrosa said...

I've tried to check that out K yet nobody within the Tayside trust seems to know anything about it. Maybe it hasn't started as yet.

subrosa said...

I'd agree annual leave should be used. I always had to do that but then, I had a backup organised of those situations Jo - not family as they were too far away but people qualified to look after sick children. It cost me but it was important that I didn't let myself or my employer down.

subrosa said...

Do you feel better now you've 'retired' Brian? Some people do because the job can be the cause of a lot of the depression.

Brian said...

SR, I still experience periods of anger and sadness at having to leave a job that I enjoyed, that actually helped people but which was made increasingly difficult by managers who swapped initiative and bespoke service for standardised service (except for the usual suspects) and set meaningless performance targets. It was so frustrating not being able to offer claimants effective help.

Clarinda said...

I have spent a large part of this afternoon reading peer reviewed research on the reasons behind rates of short term absence in health care. It would appear throughout 'western' global studies that 'sickies' are distinctly higher in association with micro-management, lack of or removal of professional autonomy and adherence to non-clinical targets and outcomes. Where staff are given resonsibility to use their professional initiative, judgement and act upon it with reciprocal recognition from senior clinical staff - sickness rates are significantly reduced.
It is also demonstrated that stress related 'sickies' only exacebate the problem as the worker returns with little difference to their mental status or working environment. It appears the politically motivated actions to deprofessionalise clinical staff via constantly changing management/'modernisation' initiatives and the attempts to replace the effective narrative tradition of interprofessional exchange via time wasting IT and ridiculous paperwork has stalled clinical ambition and proficiency.
The herd of elephants in the room is not coughs and colds but the inadequate ethos of work generated by desperately poor management. Manager heal thyself?

K - I cannot find anything on Tayside using the system you refer to - in any case that is hardly the manner to deal with a problem that is not necessarily each 'sick' person's fault? Perhaps the sick person would be better served phoning the manager to question their working practices leading to the stress and resultant absence. The evidence is all on the side of the clinical staff! The NHS doesn't need to employ another layer of private management consultants to deal with this 'problem' it just needs to read the clear research evidence and knock current management into shape. Good reports from parts of Australia where this has been successful.

subrosa said...

Brian, sometimes it becomes just too much to fight from within. Your health is far more important.

Unfortunately these days managers are paid far too much and I think that is so as they ensure 'orders' are implemented.

subrosa said...

Clarinda, I wouldn't expect you to do anything else other than spend hours delving into the dark recesses of the NHS. :)

Would the words 'administration stress' cover some of the absences?

I think you've hit the nail on the head with 'deprofessionalise clinical staff'. Once your pride in a job is removed then the interest is lost. Constant targets is the quickest way to demoralise people and accuse them, inadvertently, as sub-standard.

Off to find the Australian method if I can.

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