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Health at work – Liverpool City Region Phase 1Cath Lewis July 2016
Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2ET | 0151 231 4411 | [email protected] | www.cph.org.uk | ISBN: 978-1-910725-73-3 (web)
Health at Work – July 2016
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About this report
Liverpool John Moores University was commissioned by the Liverpool City Region Directors
of Public Health to produce a report on health at work within the 6 local authority areas in
the Liverpool City Region - Halton, Knowsley, Liverpool, Sefton, St. Helens, and Wirral. As
well as a general overview of the Liverpool City Region, and a brief review of the literature,
the report includes interventions to improve health and wellbeing, and to reduce sickness
absence, in the workplace. Health and wellbeing is discussed in this report, and
worklessness will be explored in ‘phase 2’, which will be published later in 2016.
Health at Work – July 2016
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Acknowledgements
This report was prepared by Cath Lewis from the Centre for Public Health, Liverpool John
Moores University.
This work was commissioned by the Cheshire and Merseyside Directors of Public Health
through the Cheshire and Merseyside Public Health Intelligence Network and Champs
Public Health Collaborative (Cheshire and Merseyside).The authors would like to thank
Champs and the Network for their ongoing support, especially Chris Williamson, Lead
Public Health Epidemiologist, Liverpool City Council and Matthew Ashton, Director of Public
Health, Knowsley Metropolitan Borough Council and Sefton Borough Council.
This report was produced in association with the project steering group:
Helen Cartwright and Dawn Leicester, Champs Support Team (hosted by Wirral Borough
Council)
Sheila Woolstencroft, Cheshire East Council
Gillian Chamberlain, Roberta Grech, Steffan Holmes, Fiona Reynolds and Debbie
Thompson, Cheshire West and Chester Council
Martin Smith and Chris Williamson, Liverpool City Council
Linda Turner, Sefton Borough Council
Susan Forster, St Helens Borough Council
Anne Marie Carr, Warrington Borough Council
Helen Unsworth and Julie Webster, Wirral Borough Council
Also thanks to:
James Vernon, Cheshire East Council
Donna Forster, John Gallagher and Lisa Taylor, Halton Borough Council
James Bunn and David Turner, Knowsley Metropolitan Borough Council
Geoff Bates, Hannah Jones, Lisa Jones, Rob Noonan, Kim Ross-Houle and Janet Ubido,
Centre for Public Health, Liverpool John Moores University
Mark Killen, Sefton Borough Council
Mark Leach, Warrington Borough Council
Tony Williams, Wirral Borough Council
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Table of Contents
About this report ................................................................................................................... 1
Acknowledgements .............................................................................................................. 2
Summary .............................................................................................................................. 5
1 Background ................................................................................................................... 6
1.1 Overview of sickness absence literature ................................................................. 7
1.1.1 Sickness absence rates .................................................................................... 7
1.1.2 Differences in sickness absence rates .............................................................. 8
1.1.3 Economic cost of sickness absence ................................................................12
1.2 Support in the workplace ........................................................................................12
1.2.1 Overview ..........................................................................................................12
1.2.2 Current practice in absence management .......................................................12
1.2.3 Burnout ............................................................................................................13
2 Health and Work in the Liverpool City Region ..............................................................14
2.1 Health in the Liverpool City Region ........................................................................15
2.1.1 Population by age group ..................................................................................15
2.1.2 Overview of health and deprivation in the Liverpool City Region .....................15
2.2 Education, skills and employment in the Liverpool City Region ..............................15
2.2.1 Attendance and exclusion from school ............................................................15
2.2.2 Adult qualifications ...........................................................................................15
2.2.3 Employment .....................................................................................................16
2.2.4 Overview of absenteeism .................................................................................18
3 Healthy workplaces ......................................................................................................20
3.1 Approaches to improve health and wellbeing in the workplace ..............................21
3.1.1 Building workplace social capital ......................................................................21
3.2 Workplace interventions and policies to reduce sickness absence ........................21
3.2.1 Policy and legislative background ....................................................................21
3.2.2 Returning to work following sickness absence .................................................22
3.2.3 Research trial to reduce sickness absence and ease return to work...............23
3.3 Interventions to enable specific groups of people to remain in employment ...........23
3.4 Preventing and reducing symptoms associated with stress and burnout ...............24
4 Examples of local practice from the Liverpool City Region ...........................................26
5 Recommendations........................................................................................................27
General recommendations ...............................................................................................27
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Recommendations for local authorities ............................................................................27
Recommendations for GPs ..............................................................................................28
6 Conclusions ..................................................................................................................29
7 References ...................................................................................................................30
8 Appendices ...................................................................................................................35
Appendix 1 - Tables .........................................................................................................35
Appendix 2 – Examples of good practice .........................................................................39
Appendix 3 – Sickness absence data collected by Cheshire West and Chester local
authority on behalf of Champs .........................................................................................46
Table of figures
Figure 1-1. Millions of days lost by reason for absence in 2013. Source: ONS, 2014 .......... 8
Figure 2-2. Sickness absence by gender, 1993 and 2013. Source: ONS, 2014 ................... 9
Figure 2-3. Percentage of working days lost due to sickness by sector, 1994 and 2013 .....10
Figure 2-4. Percentage of working hours lost by sector, 2013 .............................................11
Figure 3-1. Highest qualification ..........................................................................................16
Table of tables
Table 2-1. Population of Cheshire and Liverpool City Region aged 16-64 ..........................15
Table 2-2. Employee jobs – Full and part time employment ................................................17
Table 2-3. UK Business Counts (2015) ...............................................................................17
Table 2-4. Civil service jobs as a proportion of employee jobs ............................................18
Table 8-1. Highest qualification, Jan 2014-Dec 2014 ..........................................................35
Table 8-2. Employee jobs by industry ..................................................................................36
Table 8-3. Employment by occupation (Oct 2014-Sep 2015) ..............................................37
Table 8-4. Sickness absence by local authority ...................................................................38
Table 9-5. Summary of sick days per FTE for Cheshire and Merseyside Local Authorities,
2014/15 and 2015/16 ...........................................................................................................46
Table 9-6. Best fit of directorates and associated sick days per FTE……………………….48
Table 9-7. Top 5 reasons for absence with proportions .......................................................49
Health at Work – July 2016
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Summary
Introduction
Liverpool John Moores University was commissioned by the Liverpool City Region Directors
of Public Health to produce a report on health at work. Health and wellbeing in the
workplace is discussed in this report, and worklessness will be explored in a further report,
‘phase 2’, later in 2016.
Background
According to the most recent report from the Office for National Statistics, published
February 2014, 131 million days were lost due to sickness absences in the UK in 2013.
Sickness absence rates were slightly higher than in 2012, but lower than they were before
the economic recession in 2008. Recurrent sickness absence costs employers around £11
billion per year and can have a significant and negative health impact on employees,
notably as it increases the risk of work disability in the future.
Population of the Liverpool City Region
According to 2014 Office for National Statistics figures, 969,000 people of working age (16-
64) live in the Liverpool City Region, which accounts for 63.9% of the population of
Merseyside, slightly higher than the national average of 63.5%.
Health at work
Figures show that the average overall sickness absence rates in English unitary authorities
was 9.1 days for each full-time equivalent worker for 2013/14, a decrease since 2012/13,
when the rate was 9.9. Levels of sickness absence were comparable between different
types of local authorities, but were lower than for Central Government and NHS employees.
Sickness absence data was collected by Cheshire West and Chester Council for all
Cheshire and Merseyside local authorities. As the data was anonymised, it was not
possible to identify which of the local authorities were within the Liverpool City Region. The
data shows that sickness absence rates were similar to the national average of around 9
days in 7 of the 9 local authority areas, and higher than the national average (around 11.5
and 12 days) in 2 areas. Musculoskeletal problems caused the greatest numbers of days
sickness absence, followed by mental health problems
Conclusion
In conclusion, available data shows sickness absence rates in Liverpool City Region local
authorities is around 9 days. There is good evidence that interventions such as those in the
evidence based Workplace Wellbeing Charter for England, can reduce both sickness
absence and presenteeism, as well as improving levels of health and wellbeing in the
workplace overall. This includes having a clear attendance management policy in place,
maintaining contact with absent employees to provide support and aid to return to work,
conducting and recording return to work interviews, conducting specific risk assessments
and making reasonable adjustments in line with recommendations made in a Statement of
Fitness for Work.
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1 Background
Key messages
2014 Office for National Statistics (ONS) data shows that 131 million days
were lost due to sickness absence in the UK in 2013
Sickness absence levels remained fairly constant through the 1990’s until
2003 before falling significantly through to 2011, and stabilising in the past
few years
Although long-term sickness absences only account for around 5% of
absence episodes, they still contribute to nearly 50% of the total working time
and associated costs lost
Focussing solely on absenteeism may mean that ‘presenteeism’ – employees
going into work despite not functioning at maximum efficiency – becomes an
issue. Presenteeism may account for up to 50% more working time lost than
sickness absence
Minor illnesses were the most common reason for sickness absence but more
days were lost to back, neck and muscle pain
Mental health problems such as stress, depression and anxiety also
accounted for 15.2 million days lost in 2013 (excluding serious mental health
problems)
Sickness absence rates are higher for women than men. They are also higher
in the public sector than in the private sector, although the gap has narrowed
in recent years
2.7% in Local Government workers hours were lost due to sickness in 2013,
compared to 3% in Central Government and 3.4% of health workers’ hours
Workers who are stressed over long periods of time may experience
‘burnout’, which is negatively related to factors such as employees’
experience of autonomy, competence and social support
Health at Work – July 2016
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1.1 Overview of sickness absence literature
1.1.1 Sickness absence rates
According to the most recent report from the Office for National Statistics (ONS, 2014), 131
million days were lost due to sickness absences in the UK in 2013, down from 178 million
days in 1993. However, focussing solely on reducing absenteeism may mean that
‘presenteeism’ – employees going into work despite not functioning at maximum efficiency
(Health at Work online) – becomes an issue. Some research suggests that presenteeism
may account for up to 50% more working time lost than absence (Ashby et al, 2010). The
findings of the CIPD report were based on a survey of 618 organisations employing a total
of 2.3 million employees. In the public sector, employees took 8.7 days per year sickness
absence on average. However, findings within the report showed that public sector
organisations are more likely than the private to record their absence levels (95% versus
75%), collect information on the causes of absence (93% versus 80%) and monitor the cost
of employee absence, (54% versus 34%).
Stress, musculoskeletal injuries and mental ill health are the most common causes of long-
term absence in the public sector and, after minor illness, are also among the top causes of
short term absence along with back pain and recurring medical conditions such as asthma.
More than half of public sector organisations reported an increase in stress-related absence
over the past year compared with just under two-fifths of the private sector. In the private
sector, according to the survey, this is due to considerable organisational
change/restructuring and workloads, followed by management style. However, 82% of
public sector employers are taking steps to manage stress in the workplace. Mental health
problems are also more of an issue in the public sector. Three-fifths of public sector
organisations report an increase in mental health problems over the last year compared
with two fifths of the private sector. Public sector organisations are twice as likely as the
private sector to have a wellbeing strategy (67% versus 33%). They are also more likely to
provide support for employees such as counselling and occupational health services, and
offer a range of benefits designed to promote health, wellbeing and work–life balance, such
as flexible working.
In the private sector, high workloads and management style are most commonly blamed for
stress. More organisations this year report they are providing leave for family circumstances
and using flexible working to manage short-term absence, perhaps a response to increased
demand for work–life balance and changing demographics which are placing increasing
care responsibilities on employees.
According to the most recent report from the Office for National Statistics (ONS, 2014), the
number of days lost through sickness absences remained fairly constant through the 1990’s
until 2003 before falling significantly through to 2011, and stabilising in the past few years.
The percentage of hours lost to sickness since 1993 has fallen more than the total number
of days lost because over the past twenty years employment has increased.
Minor illnesses are the most common reason given for sickness absence but, as shown
Figure 1, more days are lost to back, neck and muscle pain than any other cause. The most
common reason given for sickness absence in 2013, accounting for 30%, was minor
illnesses which cover sickness such as cough and colds. This type of illness tends to have
Health at Work – July 2016
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shorter durations and accounted for around 27.4 million days of the total 131 million
working days lost in 2013, whereas the greatest number of days lost was actually due to
musculoskeletal problems, at 30.6 million days lost. Mental health problems such as stress,
depression and anxiety also contributed to a significant number of days of work lost in 2013
at 15.2 million days. These mental health problems exclude things such as manic
depression and schizophrenia, which are classified as serious mental health problems and
accounted for just 1% of sickness absence. The ONS data also shows that two-thirds of
working time lost to absence is accounted for by short-term absences of up to seven days.
A fifth is attributed to absences of four weeks or more, although there are significant sector
differences.
Figure 1-1. Millions of days lost by reason for absence in 2013. Source: ONS, 2014
1.1.2 Differences in sickness absence rates
Sickness absence rates have fallen for both men and women since 1993 with men
consistently having a lower sickness absence rate than women. In 2013, men lost around
1.6% of their hours due to sickness, a fall of 1.1% since 1993. Over the same period
women have seen a reduction of their hours lost from 3.8% to 2.6%. In 2013, women were
42% more likely to have time off work through sickness than men, possibly because they
have additional family responsibilities.
24%
21%
11%
40%
4%Muscoloskeletal problems
Minor Illnesses
Stress/Anxiety/Depression
Other
Prefer not to say
Health at Work – July 2016
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Figure 1-2. Sickness absence by gender, 1993 and 2013. Source: ONS, 2014
Sickness absence increases with age but falls after eligibility for the state pension, possibly
because workers who have health problems are likely to have left the labour market.
Although sickness absence has fallen for all age groups since 1993, it has fallen least for
those aged 65 and over, perhaps because there has been a large increase in the number of
people continuing to work beyond their state pension age.
The chart below shows that, in 2013, the percentage of hours lost to sickness in the private
sector was lower than in the public sector at 1.8% and 2.9% respectively. Since 1994, the
earliest data available, the percentage of hours lost to sickness in the private sector has
continuously been lower than that of the public sector. The sickness absence rate has fallen
for each sector since 1994, 0.8 percentage points in the private sector and 1.3 percentage
points in the public sector. The fall in the public sector has been slightly greater than that of
the private sector and as such the gap in sickness absence rates between the two sectors
has declined throughout the period.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Men Women
Hours
lost
to s
ickness (
%)
1993 2013
Health at Work – July 2016
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Figure 1-3. Percentage of working days lost due to sickness by sector, 1994 and 2013. Source:
ONS, 2014
There are differences between the private and public sector which may have an impact
upon sickness absence. For example, women have more sickness absence than men and
the public sector employs a higher proportion of female workers, and there are differences
in the types of jobs between the two sectors and some jobs have higher likelihoods of
sickness than others. Those working in the private sector are less likely to be paid whilst
they are off sick than those in the public sector.
In 2013, self-employed people, at 1.2% of working hours, lost fewer hours to sickness than
employees, at 2.1%, and the rate has been lower for the self-employed since 1993. The
percentage of working hours lost to sickness has fallen for both employees and the self-
employed over time, but at a steeper rate for employees, narrowing the gap in sickness
rates. One possible explanation for the lower sickness absence rates amongst self-
employed workers is that they are more likely to lose out financially if they lose working
hours to sickness absence, and in addition they are less likely to have sick leave cover, and
are more likely to have to make up hours instead. Similarly, workers in larger organisations
with more than 50 employees had higher percentages of working hours lost to sickness
than smaller organisations – those in small workplaces may not feel able to take time off
due to work commitments and not having colleagues to cover their work.
Those working in the caring, leisure and other service occupations lost the highest
percentage of hours to sickness in 2013 at 3.2%. This group is dominated by women, who
are more likely to have a spell of sickness than men. The lowest percentage of hours lost to
sickness was for managers, directors and senior officials at 1.3% in 2013 – the ONS report
suggests that this might be because these workers may not feel able to take time off due to
commitments such as upcoming deadlines.
Using data from the Annual Population Survey from October 2012 to September 2013, the
ONS report concludes that there is geographical variation in sickness absence levels.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Public sector Private sector
Wo
rkin
g d
ays l
ost
to s
ickn
ess (
%)
1994 2013
Health at Work – July 2016
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Workers in London had the lowest percentage of hours lost to sickness, at 1.5%, possibly
because the London workforce when compared to other parts of GB has a younger work
force and a higher proportion of self-employed people, as well as a higher than average
percentage of workers managers, directors senior officials and professional occupations,
who tend to have lower levels of sickness absence. The North West of England had a rate
of 2.2%, which was below the England average.
There are also differences in absence levels between manual and non-manual occupations.
The CIPD study (CIPD, 2013) showed that average absence levels for both manual (2013:
6.4 days per employee per year; 2012: 5.7 days) and non-manual workers (2013: 5.0 days
per employee per year; 2012: 4.7 days). The gap between the absence levels of manual
and non-manual employees appears to be increasing.
The CIPD carry out regular surveys of employees and in Autumn 2013 published their
Employee Outlook: Focus on employee wellbeing that included questions on sickness
absence. Whilst the survey is much smaller than the Labour Force Survey (LFS), consisting
of 2,229 employees for the Autumn 2013 report, weighted to represent the UK workforce, it
asks information not available on the LFS. The survey found that employees in the public
sector were more likely (39%) to say they had seen an increase in ‘presenteeism’ in their
workplace over the last year than employees in the private sector (26%).
Figure 4 below shows that, of the larger public sector organisations, sickness rates are
highest for those working in the health sector, with around 3.4% of workers’ hours lost to
sickness in 2013 compared with around 3% in Central Government and 2.7% in Local
Government, according to Office for National Statistics 2013 figures.
Figure 1-4. Percentage of working hours lost by sector, 2013. Source: ONS, 2014
The CIPD study also found that four-fifths of organisations record their annual employee
absence rate, rising to 95% of public services. Only a small minority, however, measure
employee absence levels by gender and/ or age. Smaller organisations attribute a higher
proportion of their absence to short-term leave compared with larger organisations. Two-
fifths of organisations have noticed an increase in reported mental health problems (such
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Central Government Local Government Health Private
Work
ing h
ours
lost
to s
ickness (
%)
Health at Work – July 2016
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as anxiety and depression) among employees in the past 12 months. The public sector was
particularly likely to report an increase. Most organisations offer one or more initiatives to
support employees with mental health problems. The most common initiatives provided
include counselling services, flexible working options/ improved work-life balance and
employee assistance programmes.
1.1.3 Economic cost of sickness absence
Recurrent sickness absence costs employers around £11 billion per year and can have a
significant and negative health impact on employees, notably as it increases the risk of
work disability in the future (CIPD, 2010). 131 million days were lost due to sickness
absence in 2013. The average level of employee absence increased slightly between 2014
and 2015 from 6.6 to 6.9 days (equating to £554) per employee (CIPD, 2015). As a more
specific example, in the NHS in England the sickness absence rate was 4.44% between
January and March 2015, which although appears a small a rise from 4.25% between
January and March 2014 still heavily contributed to unnecessary losses in public
expenditure (Health and Social Care Information Centre, 2015). Even the cost of sickness
absence in terms of finding replacement staff can collectively cost UK businesses around
£5.2 billion per year.
Sickness absence also increases the likelihood of employees experiencing more serious
and long-lasting episodes of poor psychological wellbeing, and further sickness absence,
as part of a vicious cycle (Black & Frost, 2011). Although long-term sickness absences only
account for around 5% of absence episodes, they still contribute to nearly 50% of the total
working time and associated costs lost (CIPD, 2010). Moreover, problems related to mental
health account for around 38% of days lost to sickness absence, as well as 45% of health-
related benefit claims. Greater levels and duration of workplace sickness absence can
additionally lead to more job demands being placed on other existing employees, who in
turn may experience greater stress and poorer psychological and/or physical health
(Schaufeli et al., 2009).
1.2 Support in the workplace
1.2.1 Overview
In terms of improving return to employment after sickness, engaging with workers with poor
health in the workplace early on before they have to take long-term sick leave, or in the
early stages of their absence, is likely to have a positive impact on their return to work time.
Return to work after long-term sickness is improved by multidisciplinary interventions,
including physical training or physiotherapy and a psychological element such as cognitive
behavioural therapy (CPH, 2014).
1.2.2 Current practice in absence management
According to the CIPD study (CIPD, 2010), two-thirds of private sector organisations and
almost all of the public sector use occupational health in their absence management
approach. Most use an external provider, although a third of the public sector provide in-
house services. The current economic climate also has an impact; the study found that
nearly half of organisations report they have made redundancies in the past six months and
a quarter report they are planning redundancies in the next six months. Nearly half of
Health at Work – July 2016
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organisations use employee absence records as part of their criteria for selecting for
redundancy.
Just over a third of organisations report an increase in people coming to work ill in the last
12 months, rising to nearly half of those who are anticipating redundancies in the next six
months. Organisations that reported an increase in ‘presenteeism’ were also more likely to
report an increase in mental health problems and stress-related absence over the same
period.
1.2.3 Burnout
There is an extensive body of research which shows that many employees, when stressed
over an extended period of time, experience burnout. Burnout is defined as a “state of vital
exhaustion”, and is regarded as a problem that employees experience in relation to dealing
with a trauma or recurring stress (Maslach, 1976; 1993; Schaufeli et al.,2008). Burnout is a
prolonged response to an emotional or interpersonal stressor that is related to one’s job
(Maslach et al., 2001). The key dimensions of burnout are feelings of overwhelming
exhaustion, detachment from one’s job, and cynicism, as well as a sense of ineffectiveness
and a lack of accomplishment (Maslach, 1976; Schaufeli et al., 2008). Burnout is negatively
related to employees’ experience of autonomy, competence and social support. Employees’
experience of feeling autonomous (freedom to pursue an activity they value without feeling
controlled), competent (knowing that one’s work activities are carried out effectively) and
socially supported, including having emotional support and positive social connections from
colleagues and managers have a positive impact on their psychological wellbeing while
having a buffering effect against chronic stress and burnout (Fernet et al., 2004; 2013)
Research shows that burnout is related to time pressure, role conflict, role ambiguity, lack
of social support, lack of feedback, poor autonomy, and having little participation in
decision-making (Seidler et al., 2014). Moreover, while being a prominent concern for
physical and psychological wellbeing, burnout can have several negative impacts on
absenteeism, ‘presenteeism’, intention to leave and staff turnover (Campbell et al., 2013;
Schaufeli & Bakker, 2004). This can also lead to reduced business efficiency, profits, and
even poor outcomes for other colleagues and the families of individuals experiencing
burnout (Jackson & Maslach, 1982). Although burnout can be influenced by individual
differences in personality traits, and unique individual experiences (Langelaan et al., 2006),
one of the biggest predictors of burnout are the conditions that are experienced in the
workplace (Maslach & Leiter, 2008). This means that there is scope to positively intervene
in workplaces to reduce the risk of employees and employers experiencing negative
outcomes associated with burnout.
At present much of the literature on interventions that prevent or reduce burnout is in
relation to health care organisations and large scale work sectors, there are gaps in
evidence for interventions that look at smaller non-health related work sectors. Moreover,
different pieces of research have often used dissimilar terminology and assessment tools
related to burnout, such as chronic workplace stress, as well as measuring different
outcomes of interest (e.g. sickness absence, work engagement physical health etc.).
Nevertheless, the evidence available strongly suggests that it is worthwhile and cost
effective to implement burnout interventions in workplaces (Public Health England, 2016).
Please see Section 4 for more information on interventions to tackle burnout at work.
Health at Work – July 2016
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2 Health and Work in the Liverpool City Region
Key messages
1,526,432 people live in the Liverpool City Region, including 969,000 people
of working age (aged 16-64).
The Liverpool City Region Local Enterprise Partnership is ranked as the most
deprived in the country, out of a total of 39.
The proportion of people working in civil service jobs was higher in the in the
Liverpool City Region (2.8%) than in Great Britain as a whole (1.5%).
The Local Government Workforce Survey shows that 9.1 days per full-time
employee were lost to sickness absence in English unitary authorities in
2013/14, and 9.0 days in English Metropolitan boroughs, a decrease since
2012/13.
Sickness absence rates were similar to the national average of 9 days in most
Liverpool City Region local authorities.
Health at Work – July 2016
15
2.1 Health in the Liverpool City Region
2.1.1 Population by age group
1,526,432 people live in the Liverpool City Region, including 969,000 people of working age
(aged 16-64). The proportion of the population who are of working age (63.9%) is slightly
higher than in Great Britain as a whole (63.5%) (NOMIS, 2014).
Table 2-1. Population of Liverpool City Region aged 16-64
Liverpool City
Region (number)
Liverpool City
Region
(%)
North West (%) Great Britain
(%)
All people 969,000 63.9 63.2 63.5
Males 476,800 64.6 63.9 64.3
Females 492,200 63.2 62.5 62.8
Source: ONS Population estimates (2014) - local authority based by five year age band
2.1.2 Overview of health and deprivation in the Liverpool City Region
Life expectancy at birth for both men and women is worse than the national average in all
Liverpool City Region local authorities, according to the Public Health Outcomes
Framework (PHOF) 2012-4 figures. The Index of Multiple Deprivation (IMD) shows that in
2015, the Liverpool City Region Local Enterprise Partnership (LEP) is ranked the most
deprived in the country, in terms of proportion of neighbourhoods that are in the most
deprived 10% of areas nationally (31.3%).
2.2 Education, skills and employment in the Liverpool City Region
2.2.1 Attendance and exclusion from school
There is a clear link between good school attendance and good educational achievement.
Three Liverpool City Region local authority areas (Sefton, St.Helens and Halton) had
attendance figures that were similar to the England average of 4.7%, whilst 3 (Knowsley,
Liverpool and Wirral) were worse (PHOF 2013/14 figures). 5 out of the 6 Liverpool City
Region local authority areas had a higher proportion of 16-18 year olds who are not in
education, employment and training (NEET) than the England average, with only Wirral
having similar figures to the national average (PHOF 2014 figures).
2.2.2 Adult qualifications
Figure 5 shows the highest qualification held by the population of Liverpool City Region, the
North West of England and Great Britain as a whole. In the Liverpool City Region
qualification levels tend to be lower than the national average, with a lower proportion of 16-
64 year olds than in the North West and in Great Britain holding qualifications of NVQ4 and
above, the equivalent of a HND or degree. The proportion of people who have no
qualifications is higher in the Liverpool City Region than in the North West and in Great
Britain as a whole.
Health at Work – July 2016
16
The lower a young adult's qualifications, the more likely they are to be lacking but wanting
paid work. So, for example, around a quarter of all people aged 25 to 29 with no GCSEs at
grade C or above lacked but wanted paid work in 2010 compared to one in fifteen of those
with degrees or equivalent. The lower a young adult's qualifications, the more likely they are
to be in low-paid work (The Poverty Site (online)).
Figure 2-1. Highest qualification. Source: ONS annual population survey .
2.2.3 Employment
According to the ONS annual population survey, compared to the North West and the
country as a whole, a much greater proportion of the Liverpool City Region workforce is
concentrated within manual and service sector roles, with fewer in managerial, professional
and technical positions – see Appendix A3., professional and technical positions. Different
occupations impact upon health in different ways – back pain is more closely related to
manual work, for example (Videman et al, 1990). Manual workers experience more
sickness absence than non-manual workers, according to a study by the Chartered Institute
of Personnel and Development (CIPD, 2015 ), which showed that manual workers took an
average of 6.4 days sickness absence in 2013, compared to 5 days for non-manual
workers, and this gap is increasing.
Table 1-2 below shows the percentage of the working population who are working full time
and part time. The proportion of people who are working full time is slightly lower in the
Liverpool City Region than in the North West and Great Britain, while the proportion of
people working part time is slightly higher in the Liverpool City Region than the North West
and Great Britain.
0
10
20
30
40
50
60
70
80
90
NVQ4 and above NVQ3 NVQ2 NVQ1 Otherqualifications
No qualifications
Liverpool City Region North West Great Britain
Health at Work – July 2016
17
Table 2-2. Employee jobs – Full and part time employment
Liverpool City
Region
(number)
Liverpool City
Region
(%)
North West
(%)
Great Britain
(%)
Total employee jobs 591,900 - - -
Full-time 390,700 66.0 67.7 68.3
Part-time 201,200 34.0 32.3 31.7
Source: ONS Business Register and Employment survey (2014).
The ONS business register and employment survey (NOMIS, 2014) also shows that the
proportion of the working population working in primary services (agriculture and mining) in
the Liverpool City Region (0.1%) and the North West (0.1%) is lower than in Great Britain
as a whole (0.4%). The proportion of people working in public administration, education and
health is higher in the Liverpool City Region (33.7%) than in the North West (28.5%) and
Great Britain (27.4%). Please see Appendix 1. Statistics from NOMIS which show that, in
2015, the proportion of businesses in the Liverpool City Region that had less than ten
employees was similar to the North West as a whole, around 88%.
The table below shows that the proportion of large enterprises in the Liverpool City Region
is similar to the North West average.
Table 2-3. UK Business Counts (2015)
Liverpool City Region
number (%)
North West
number (%)
Enterprises
Micro (0-9) 32,545 (86.7) 207,195 (87.8)
Small (10-49) 4,080 (10.9) 23,765 (10.1)
Medium (50-249) 745 (2.0) 4,085 (1.7)
Large (250+) 150 (0.4) 910 (0.4)
Total 37,520 235,955
Local units
Micro (0-9) 38,050 (80.1) 234,470 (82.1)
Small (10-49) 7,520 (15.8) 41, 125 (14.4)
Medium (50-249) 1,700 (3.6) 8,535 (3.0)
Large (250+) 260 (0.5) 1,330 (0.5)
Total 47,530 285,460
Source: NOMIS, 2015
The table below shows that the proportion of people who work in civil service jobs is higher
in the in the Liverpool City Region (2.8%) than in the North West (1.7%) and in Great Britain
as a whole (1.5%). The proportion of people working part time in these jobs is higher in
Liverpool City Region (0.9%) than the North West and Great Britain averages. Both full time
and part time employment have advantages, depending on the circumstances of each
individual. For example, tax credits may be available to employees aged 25-59 who work at
least 30 hours per week, depending on income, although limits are lower for those who are
Health at Work – July 2016
18
disabled, have children or are aged over 60 (Gov.UK online). Full-time work typically means
a higher income, which research shows is linked with better health (Marmot, 2010), but part
time work may mean that employees have more time to spend family, or to pursue other
interests or undertake additional training, which may benefit future employment.
Table 2-4. Civil service jobs as a proportion of employee jobs
Liverpool City Region
(number)
Liverpool City Region (%)
North West (%)
Great Britain (%)
Total civil service jobs 16,870 2.8 1.7 1.5
Full-time 11,260 1.9 1.2 1.1
Part-time 5,610 0.9 0.5 0.4
Source: NOMIS, 2015
2.2.4 Overview of absenteeism
Data from the Local Government Workforce Survey 2013/4 (LGA, 2014) is available where
local authorities have agreed that they are happy for their data to be shared (please see
Appendix 1). Average overall sickness absence rates in English local authorities was
around 9 days, a decrease from 2012-13 when it was around 10 days. Individual sickness
absence rates for most Liverpool City Region local authority areas were not available as
part of this survey, although the overall sickness rate for Knowsley for 2012/13 was 9.7
days, which was similar to the overall rate of 9.9 days for Metropolitan boroughs, whilst the
rate for Sefton for 2012/13 was 10.7 days, which was slightly higher than the average.
The rate of short term sickness absence, which was defined as absence lasting less than
20 working days or one calendar month, was just under 4 days per employee for local
authorities in 2013/14. Information from 3 local authorities in the Liverpool City Region
Merseyside (Knowsley and Sefton) indicates that levels of sickness absence in the local
area are comparable or higher than the national average for local government.
The long term sickness absence rate was around 5 days for local authorities for 2013/14, a
slight decrease since 2012/13. Again, rates for most local authorities were not available –
the rates for Sefton and Knowsley for 2012/13 were slightly higher than average.
In addition, all Liverpool City Region local authorities supplied absence data as part of this
project. The data, which was collected by Cheshire West and Chester local authority, is
provided in Appendix 3. As the data is anonymised, it is not possible to identify which of the
local authorities were within the Liverpool City Region, and which were within Cheshire. The
data showed that sickness absence rates were similar to the national average of 9 days in
most Cheshire and Merseyside local authorities. Rates were higher than the national
average (around 11.5 and almost 12 days) in 2 local authority areas, according to 2015/16
data. Rates were broadly similar in 2014/15 and 2015/16.
Directorates with highest sick days per FTE were adult and children’s services. The
directorates not associated with schools had a proportionally higher rate of sick days.
Further analysis of the two key directorates of adults and children’s services would help
Health at Work – July 2016
19
identify the root causes of high absenteeism and may help to identify strategies to better
support employees in these areas.
Stress/mental health were the biggest cause of lost days for the majority of the local
authorities. This is in contrast to data collected by the Office for National Statistics for the
population as a whole, which shows that musculoskeletal problems caused the greatest
numbers of days sickness absence, followed by mental health problems. Comparing
sickness absence between the various local authorities was problematic, as each local
authority has its own systems for managing and accounting for absenteeism, as well as
different approaches to setting up its directorates. Standardising the way that this data is
collected would facilitate comparisons between local authorities in the future.
Health at Work – July 2016
20
3 Healthy workplaces
Key messages
Organisations can benefit from using the Workplace Wellbeing Charter, a
voluntary self-assessment scheme. The Charter provides independent
standards in 8 areas, one of which is sickness absence management.
To achieve the first level of the Charter, organisations should:
+ Have a clear attendance management policy in place.
+ Maintain contact with absent employees to provide support and aid
return to work.
+ Carry out return to work interviews, record concerns, and provide
appropriate support.
+ Conduct specific risk assessments, taking into account health status.
+ Make reasonable adjustments in line with recommendations made in a
Statement of Fitness for Work.
It is important to identify the predictors of sickness absence, and to develop
effective interventions to prevent recurrent absence and help individuals
back into work.
Investing in employee health can reduce staff turnover and associated
recruitment costs, increase productivity and enhance overall performance of
employees.
Local authorities should lead by example by ensuring that their organisation
is accredited to the Workplace Wellbeing Charter.
Share and access good practice among local authorities through the Local
Government Association and Public Health England.
Promote and increase awareness of national programmes, guidance and
legislation on employment of those with long-term or fluctuating health
conditions
Health at Work – July 2016
21
3.1 Approaches to improve health and wellbeing in the workplace
According to a report by the Local Government Association (LGA, 2016), in order to
improve health and wellbeing, organisations should share and access good practice among
local authorities through the Local Government Association and Public Health England.
Local authorities should promote and increase awareness of national programmes,
guidance and legislation on employment of those with long-term or fluctuating health
conditions. They should lead by example by ensuring that they are working with local health
services, and encourage take up of services and initiatives led by national Government,
such as the Fit for Work programme.
3.1.1 Building workplace social capital
Workplace social capital (WSC) is regarded as a long-term predictor of wellbeing and
sickness absence prevention (Helliwell & Huang, 2010). For example, research conducted
in Denmark and Finland reported a negative association between WSC and self-rated
health, all-cause mortality and risk of chronic hypertension. Social Capital in general has
been described as belonging to a social organisation (e.g. the workplace), which acts as a
positive resource and facilitates collective community action, mutual aid and reciprocity
(Kawachi et al., 2004). In the context of the workplace, work may provide an important
social unit and be a significant source of social relations, civic engagement and sense of
connectedness; largely depending on the quality of relationships employees experience
with colleagues (Baum & Ziersch, 2003; Kawachi et al., 1999).
A study by Okansen and colleagues (2008) found that WSC reduced long-term sickness
absence, and had the greatest impact on employees with a lower occupational grade.
These findings not only emphasise the importance of building WSC to promote employee
wellbeing and reduce sickness absence, but also that employees in lower grades may
experience more occupational health hazards that potentially negate the positive impacts of
WSC and lead to greater sickness absence. For example, compared to higher grade
workers, lower grade workers are generally at greater risk of long-term sickness absence,
and may experience a greater degree of stress linked to poor work life balance, unstable
finances, and physical and emotional exhaustion (e.g. burnout) (Schrijvers et al., 1998;
Toppinen-Tanner et al., 2002). Therefore, socioeconomic factors are also important to
consider when tackling the issue of sickness absence.
3.2 Workplace interventions and policies to reduce sickness absence
3.2.1 Policy and legislative background
The Equality Act 2010 protects disabled workers by prohibiting discrimination against
workers with disabilities, and means that employers need to make reasonable adjustments
to facilitate access to, return to and retention of work for disabled employees1. Adjustments
to work may include shorter working hours, different shift patterns, or transferring someone
from a physical to a sedentary post. Access to Work is a government scheme that provides
1 The Act defines disability as ‘a physical or mental impairment that has a substantial and long term adverse
effect on someone's ability to carry out normal day to day activities’.
Health at Work – July 2016
22
practical and financial support to people with a physical or mental health condition or
disability2.
In recent years, government policy has moved towards earlier intervention to prevent
people leaving employment due to health conditions. For example, on the basis of Dame
Carol Black’s report, ‘Working for a Healthier Tomorrow’ (Black, 2008), recognising that sick
notes were a barrier to patients returning to work, Fit Notes were introduced in 2010. Fit
Notes provide evidence about the advice that employees have been given about their
fitness to work (DWP, 2013) and it is recommended that they are issued as early as
possible following a period of sickness absence. A recent study examined the impacts of
new legislation in Finland (from June 2012) to introduce a ‘fit note’ in workplaces and
suggested that this may have reduced the incidence of long-term sickness absence (>12
weeks off work). More specifically, once employees had taken 60 or 90 days off work, they
were provided with a medical certificate by their physician providing practical solutions to
employers about how to help individuals back into work. Findings emphasised that a fit note,
especially when provided early (after 60 rather than 90 days), reduced further sickness
absence (Haloen et al., 2016).
Dame Carol Black’s report further prompted the introduction of a new national (UK) health
and work assessment and advisory service, ‘Fit for Work’. This early intervention service is
intended to provide occupational health (OH) assessments and general health and work
advice to employees, employers and GPs in order to help individuals stay in or return to
work.
3.2.2 Returning to work following sickness absence
In a recent review of the literature, a number of best practices were identified that can help
workplaces to effectively help employees return to work following a short or prolonged
period of sickness absence. The best practices included:
Early contact with employee to discuss concerns and sickness appropriately and
sensitively.
Concerted action and collaboration between all individuals involved in the return to
work process, including employees, employers and health professionals.
Adjustment of job demands to that they are suited the level of capability and
competence of the individual who is returning to work in light of their current or
permanent restrictions.
Gradual progressive return to work.
Active participation of the employee in the entire return to work process, including
the follow-up.
(Duran et al.,2013;2008; Shaw et al., 2008).
Similar research also suggests that effectiveness of return to work interventions partly relies
on whether they include a work-focused problem-solving component. For example, it is
important to help employees identify situations where they used to or currently face difficulty,
and to then come up with practical and suitable solutions that they can successfully
2 Includes funding towards aids or equipment, support workers, support services or travel to and in work, for
example. More details are available on the Access to Work website (www.gov.uk/access-to-work/overview).
Health at Work – July 2016
23
implement and act upon (Dewa et al., 2015). As identified in a systematic review on
occupational health, it is also important to implement workplace interventions that tackle
key issues relating to sickness absence and helping individuals to return to work (Carroll et
al., 2009). More specifically, the review highlighted findings from nine randomised control
trials conducted in Europe and Canada, each involving employees who suffered from back
pain and associated musculoskeletal conditions. Workplace interventions being assessed
included those that made work modifications for employees. Workplace interventions that
were implemented early as possible were found to be significantly more effective and cost-
effective (Carroll et al., 2009). Investing in employee health can reduce staff turnover and
associated recruitment costs, increase productivity and enhance overall performance of
employees (LGA, 2016).
It has been highlighted that line managers of employees are important in the return-to-work
process, notably as they are usually the first point of contact when individuals are not well,
while being responsible for employees’ day to day management and ensuring that issues
regarding any work adjustments are appropriately addressed. As shown on page 29, the
CIPD (2010) have reported on ways that managers can effectively enable employees
experiencing sickness absence to return to work. This includes clear examples of manager
behaviours that can support return to work.
3.2.3 Research trial to reduce workplace sickness absence and ease return to
work
Arends and colleagues (2014) reported the findings of a cluster randomised controlled trial
that allowed employees to take part in a work intervention that helped employees find and
implement solutions for problems experienced when returning to work following sickness
absence.
Employees were provided with training on the following:
Identifying problems and opportunities at work following sickness absence;
Coming up with solutions;
Noting down solutions and the support needed to implement them;
Discuss solutions and make an action plan with supervisor;
Evaluate the action plan and implementation of solutions.
Findings from the research showed that, when compared with a ‘care as usual’ group, the
odds of taking sickness absence were 60% lower in the intervention group. The intervention
group also experienced better scores on work functioning at 12 months follow-up, as well
as a higher use of positive coping behaviours.
3.3 Interventions to enable specific groups of people to remain in
employment
Whilst many interventions cover a range of disabilities and health conditions, it is possible
to identify types of intervention that are most relevant for specific impairments. This section
looks at interventions that are tailored towards people with mental health conditions, people
with learning disabilities, and people with musculoskeletal difficulties, and other physical
problems.
Health at Work – July 2016
24
A Cochrane review by Nieuwenhuijsen et al. (2014) examined interventions to help
depressed workers to resume work activities. Drawing on a small evidence base, the review
found that work-directed intervention, such as work modification or coaching, alongside a
clinical intervention reduced sick leave in the medium term when compared to the clinical
intervention alone. The review also identified evidence that providing workers with a
structured telephone or online cognitive behavioural therapy reduced sickness absence
compared to regular care. Improving primary care through quality improvement programs
for general practitioners did not have an effect on sickness absence.
A second Cochrane review examined whether workplace interventions were effective for
decreasing time to return to work across a range of causes of work disability (Van Vilsteren
et al, 2015). Considering all causes together, workplace interventions (such as working
fewer hours or lifting less) were found to be effective for enabling return to work and in
reducing the length of sickness absence. However, the strength of the evidence differed by
the cause of work disability, with evidence for workplace interventions strongest for workers
with musculoskeletal disorders.
3.4 Preventing and reducing symptoms associated with stress and
burnout
Interventions delivered in the workplace may be provided on an individual or organisational
level, or both. Review level evidence indicates that workplace interventions delivered on an
individual level that may be effective to prevent burnout and manage stress including those
that involve staff training and workshops, including elements such as stress awareness and
coping skills, and programmes based upon cognitive behavioural therapies (Bagnall et al.,
2016; Bhui et al., 2011). Cognitive behavioural therapies appear likely to be the most
effective individual level interventions to reduce stress in the workplace (Bhui et al., 2011).
There is evidence that mindfulness based interventions may have positive impacts on
reducing work-related stress, for example amongst healthcare professionals, (Burton et al.,
2016; Murray et al., 2016) and distress (Virgili et al., 2015).
Additionally, review level evidence suggests that interventions targeted at an organisational
level (e.g. workplace culture and policies) may be more effective than individually targeted
interventions alone, and may lead to greater long-terms positive effects (Bagnall et al.,
2016). Examples of relevant organisational level interventions include changes to workload
or working practice (e.g. shift patterns) enhanced by support at a managerial level (Bagnall
et al., 2016). Additionally there is evidence to support the use of organisational level
physical activity programmes to reduce absenteeism (Bhui et al., 2011).
Health at Work – July 2016
25
Source: Local Government Workforce Survey 2013/14
Health at Work – July 2016
26
4 Examples of local practice from the Liverpool City Region
Examples of local practice relating to the theme of Healthy Workplaces were received from
across the Liverpool City Region (see Appendix 2 for full details). This included examples
from local authorities, the NHS and government agencies, as well as large private
companies including the Royal Mail, Argos and Kawneer. Interventions ranged from the
development and revision of policies, including sickness absence policies, family friendly
policies and health and wellbeing strategies, to implementing screening, health checks,
health clinics and rehabilitation centres. Interventions to improve health and wellbeing also
included initiatives such as pool cycles for people travelling to meetings, and a wide range
of initiatives including on-site exercise classes and healthy eating groups, as well as free or
discounted access to gym memberships.
A range of outcome measures were reported. At several organisations, impact on sickness
absence had not yet been measured. However, several organisations reported a decrease
in sickness absence: levels had fallen by almost half to 4% (or 10 days per employee per
year) at the Royal Mail. Other outcome measures reported included increased productivity,
quality of services and satisfaction, staff reporting that they felt more supported and happier
in their workplace, and increased awareness of health and wellbeing among staff.
27
5 Recommendations
General recommendations
Organisations should benchmark performance against independent,
evidence based standards such as those provided by the Workplace
Wellbeing Charter. To achieve the first level of the Charter, organisations
should:
+ Have a clear attendance management policy in place.
+ Maintain contact with absent employees to provide support and aid to
return to work.
+ Ensure return to work interviews are conducted and recorded.
+ Conduct specific risk assessments, taking into account health status.
+ Make reasonable adjustments in line with recommendations made in a
Statement of Fitness for Work.
In order to achieve higher levels of the Charter, organisations should:
+ Collect and monitor absence rates and causes, and design and
implement specific programmes are designed and implemented to
address the issues identified.
+ Ensure that managers take part in attendance management training.
+ Ensure that the organisation’s return to work policies are designed to
support staff on long term sick leave to return to work and will support
staff with long term conditions.
Make contact with employees as early as possible, to discuss concerns and
sickness absence appropriately and sensitively.
Set up a mechanism for sharing good practice – this could be at the Liverpool
City Region or local authority level – organisations could ‘buddy up’ to work
on the Workplace Wellbeing Charter, for example.
Implement organisational level interventions, e.g. changing workplace
culture and policies, in order to reduce ‘burnout’.
Train employees to identify problems and opportunities at work following
sickness absence, and come up with solutions.
Foster a participatory environment that promotes autonomy, open
communication, feeling competent, and involves employees in planning and
implementation of policies.
Recommendations for local authorities
Local authorities should demonstrate good practice, in order to act as an
exemplar employer for other organisations in the local authority area. Access
28
support available from organisation such as Public Health England and the
Department of Health.
Standardise sickness absence data collection, to facilitate future
comparisons.
Further analysis of the two key directorates of adults and children’s services
would help identify the root causes of high absenteeism and may help to
identify strategies to better support employees in these areas.
Recommendations for GPs
Provide a ‘Fit Note’, as early as possible, showing which tasks employees are
fit to carry out.
29
6 Conclusions
In conclusion, available data shows that sickness absence in the Liverpool City Region
local authorities is generally similar to the national average of around 9 days per year for
each full-time employee or equivalent. There is good evidence that workplace interventions
can reduce sickness absence, as well as improve levels of health and wellbeing in the
workplace overall. Future recommendations would include standardising collection of
sickness absence data to facilitate future comparisons.
30
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35
8 Appendices
Appendix 1 - Tables
Table 8-1. Highest qualification, Jan 2014-Dec 2014
Liverpool City
Region
(number)
Liverpool City
Region
(%)
North West
(%)
Great Britain
(%)
NVQ4 and above 262,900 27.4 30.9 36.0
NVQ3 and above 468,600 48.8 52.7 56.7
NVQ2 and above 665,600 69.4 71.4 73.3
NVQ1 and above 790,900 82.4 83.4 85.0
Other qualifications 50,200 5.2 6.0 6.2
No qualifications 118,200 12.3 10.6 8.8
Source: ONS annual population survey. Numbers and % are for those of aged 16-64% is a proportion of
resident population of area aged 16-643
3 Other qualifications includes foreign qualifications and some professional qualifications. NVQ 1 equivalent
e.g. fewer than 5 GCSEs at grades A-C, foundation GNVQ, NVQ 1, intermediate 1 national qualification
(Scotland) or equivalent. NVQ 2 equivalent e.g. 5 or more GCSEs at grades A-C, intermediate GNVQ, NVQ 2,
intermediate 2 national qualification (Scotland) or equivalent. NVQ 3 equivalent e.g. 2 or more A levels,
advanced GNVQ, NVQ 3, 2 or more higher or advanced higher national qualifications (Scotland) or
equivalent. NVQ 4 equivalent and above e.g. HND, Degree and Higher Degree level qualifications or
equivalent
36
Table 8-2. Employee jobs by industry
Liverpool City Region
Liverpool City Region (%)
North West (%)
Great Britain (%)
Primary Services (A-B: agriculture and mining)
300 0.1 0.1 0.4
Energy and Water (D-E) 4,500 0.8 1.0 1.1
Manufacturing (C) 50,400 8.5 10.3 8.5
Construction (F) 23,800 4.0 4.5 4.5
Services (G-S) 512,900 86.7 84.1 85.6
Wholesale and retail, including motor trades (G)
96,000 16.2 16.2 15.9
Transport storage (H) 29,100 4.9 4.5 4.5
Accommodation and food services(I)
39,400 6.6 7.1 7.1
Information and communication (J)
13,400 2.3 2.7 4.1
Financial and other business services(K-N)
108,600 18.3 20.5 22.2
Public admin, education and health (O-Q)
199,200 33.7 28.5 27.4
Other Services (R-S) 27,200 4.6 4.5 4.4
Source: ONS business register and employment survey
37
Table 8-3. Employment by occupation (Oct 2014-Sep 2015)
Liverpool City
Region
(numbers)
Liverpool City
Region
(%)
North West
(%)
Great Britain
(%)
Soc 2010 major group 1-3 264,200 39.7 41.0 44.3
1 Managers, directors and
senior officials
55,500 8.3 9.8 10.3
2 Professional occupations 128,200 19.2 18.8 19.7
3 Associate professional &
technical
80,600 12.0 12.1 14.1
Soc 2010 major group 4-5 149,400 22.4 21.9 21.4
4 Administrative &
secretarial
83,000 12.4 11.3 10.7
5 Skilled trades
occupations
66,500 9.9 10.5 10.6
Soc 2010 major group 6-7 132,300 19.9 18.9 17.0
6 Caring, leisure and Other
Service occupations
66,900 10.0 10.0 9.3
7 Sales and customer
service occs
65,400 9.8 8.8 7.7
Soc 2010 major group 8-9 119,900 18.0 18.2 17.2
8 Process plant & machine
operatives
45,900 6.9 7.1 6.3
9 Elementary occupations 73,900 11.1 11.1 10.8
Source: ONS annual population survey. Numbers and % are for those of 16+. % is a proportion of all persons
in employment
38
Table 8-4. Sickness absence by local authority
Local authority
Sickness absence
(all) 2012/3, number of
days (F.T.E.)
Short term sickness absence 2012/3,
number of days (F.T.E)
Long term sickness absence 2012/3
Sickness absence
(all) 2013/4 number of
days (F.T.E.)
Short term sickness absence 2013/4,
number of days (F.T.E)
Long term sickness absence 2013/4
Mean for all English unitary authorities
9.9 4.4 5.4 9.1 4.1 5.2
Halton N/A N/A N/A N/A N/A N/A
Mean for all English Metropolitan boroughs
9.9 3.6 6.4 9.0 3.3 5.9
Knowsley 9.7 3.1 6.7 Suppressed Suppressed Suppressed
Liverpool N/A N/A N/A N/A N/A N/A
Sefton 10.7 4.0 6.7 N/A N/A N/A
St.Helens N/A N/A N/A N/A N/A N/A
Wirral N/A N/A N/A N/A N/A N/A
Source: Local Government Workforce Survey unless otherwise stated *Data was provided as part of this project
Note: Absence data was also supplied by all Cheshire and Merseyside local authority areas for 2014/14 and
2015/16 as part of this project. The anonymised data is available in Appendix 3
39
Appendix 2 – Examples of good practice
Argos
Employer with 1500 staff on site in Widnes
What was the intervention?
The work place health programme is to run for a period of 3 months, and will be a
partnership between the Halton Borough Council integrated Health and wellbeing service
and Home Retail HR with a Health Trainer in situ one afternoon per week.
As part of the programme the organisation are offering Work place Health Checks (NHS
and standard), smoking cessation, weight management advice and cancer awareness
sessions (group education as part of organised sessions with teams within the organisation
i.e. marketing and comms team, telesales team etc.
Over the 3 month pilot Argos are hoping to engage with in excess of 200 staff and
undertake 100 health checks.
Child maintenance service – Liverpool
Since August 2012, the organisation aims to maximise the number of those children who
live apart from one or both parents for whom effective child maintenance arrangements are
in place. The organisation runs two existing statutory child maintenance schemes and is
introducing a new statutory scheme.
What was the intervention?
A People Engagement Network Group that was created in January 2014. Representatives
from each team canvass staff for feedback on what is going well and what could be
improved. Survey responses are reviewed and a ‘You Said We Did’ board is created, to
show staff what has changed and also what it was not possible to change, explaining the
rationale.
The organisation decided to begin the process with the Liverpool office, which employs 85
staff, in part due to the support provided as part of the Liverpool funded scheme delivered
by Health@Work. An action plan was set to help the organisation’s progress towards
accreditation and to enhance existing provision to improve health and wellbeing. Leads for
each area of the Charter worked to involve teams of staff and make everyone aware of
existing good practice and new initiatives.
There is a weigh in club, a fruit club, and there has been a stair challenge recently. The
organisation’s employee assistance programme has been asked to undertake support
sessions with the majority of staff on mental health awareness, stress and resilience and
coping with change. The organisation have also undertaken charity events.
Staff became more interested and discussed their own experiences, which the organisation
were often unaware of. Staff were asked to create PEN pictures of what inspired them to
get fitter, stop smoking, to be healthier, and to tell their story, their outcome and how this
has impacted on their lives since. The personal stories struck a chord with staff.
40
Impact and benefits
As a large public sector employer the organisation already have excellent health, safety and
absence management procedures in place, but the challenge is always to utilise these
resources effectively for a large workforce. In working through the Charter process the
organisation fully embraced the principles of the award and involved the whole staff team
which helped contribute to a positive working environment and a Charter accreditation of a
high standard. Accreditation was seen as a positive opportunity to get all staff involved in
raising their own and collective awareness of health and wellbeing, increasing collaboration
and awareness. This created a buzz within the command and heightened awareness. The
organisation are continuing to build on this.
Contact details
If you would like more information, please contact Kevin Yip (Email:
Provider of mental health services – Liverpool
Organisation The organisation provides specialist mental health services in North West England. They
provide specialist inpatient and community mental health, learning disabilities, addiction
management and acquired brain injury services. It also provides secure mental health
services for the North West of England, the West Midlands and Wales. It is one of only
three trusts in the country that provide these services. Clinical services are provided across
more than 30 sites across Merseyside and are supported by a corporate team based in
Merseyside.
What was the intervention? The organisation revised their Health and Wellbeing Strategy in 2013. Due to a wide
geographical spread, there were pockets of good practice in relation to health promotion,
supported by organisation wide corporate initiatives such as occupational health, staff
counselling, training and development, Active Sefton and numerous policies such as
smoking support, drug and alcohol, health and safety etc. The organisation is very active in
the region participating in the North West NHS Games and other corporate games. External
accreditation provided the opportunity to review practice in relation to health and wellbeing
and learning from others.
The organisation began the charter process in 2014. Due to the size of the organisation, it
was agreed that they would be split into three directorates and evidence would be provided
for each of these against the Workplace wellbeing charter standards. The three directorates
were corporate, secure and local division. Analysis of the corporate division included
reviewing all corporate documentation and interviewing employees from this area. The
analysis identified that the organisation have a number of health initiatives that benefit their
employees and these initiatives are taken up by the employees.
41
A cross section of staff from both secure and local division were then interviewed, along
with union representatives and employee representatives. Many strengths and areas of
good practice arose during the course of this accreditation. Areas for improvement were
also identified from the accreditation. The organisation was proactive in their approach to
remedy this and immediately set about implementing an action plan to improve these areas.
Impact on sickness absence and other benefits
The organisation were successful in attaining the Workplace Wellbeing Charter and
following this created an action plan to further improve the wellbeing of its staff. They were
a great organisation to work with, full of enthusiasm and passion and clearly demonstrated
that their employees are their most important asset.
Contact details
If you would like more information, please contact Kevin Yip (Email:
Royal Mail
What was the intervention?
The UK’s Royal Mail had experienced several years of encountering issues with long-term
sickness absence, especially that related to musculoskeletal health. In 2003, the Royal
Mail’s sickness absence rates were 7% (around 16 days per employee per year) and a
daily cost of £1 million. In order to help alleviate this issue, the Royal Mail integrated a
number of measures, which included:
Free health screening
Health clinics at 90 Royal Mail sites
Speedy access to occupational health services
Free access to physiotherapy
Employee assistance programme
Rehabilitation centres focusing on improving back, neck and shoulder injuries
Gradual return to work procedures
Case management
What was the impact on sickness absence, and were there any other benefits?
Four years after these initiatives had been implemented, sickness absence had fallen by
almost half to 4% (around 10 days per employee per year), saving the Royal Mail £230
million. Moreover, there were up to 3,600 more staff available to work each day as a result,
which significantly increased productivity, quality of service and customer satisfaction
(Marsden and Moriconi, 2009).
NHS in Liverpool
42
The organisation aims to provide excellent healthcare for the people of Liverpool and
Merseyside on two city sites. It is one of the largest employers in the area with over 6,000
staff, and takes its role of leading on healthcare issues very seriously. In addition to
providing a 24/7 staff support service to staff, there is a Staff Therapy Service that allows
staff to quick access to physiotherapy, occupational therapy and gastroenterological
services. There has been an organisation wide Health and Wellbeing Strategy since 2012,
and the organisation were accredited with the Workplace Wellbeing Charter in 2012.
What was the intervention?
In the past, the organisation have invited Lifestyles staff to promote offers in foyers. They
regularly publicise the offers available through the Lifestyles team through our network,
regular publications and weekly email messages. The Workplace Wellbeing Charter
provides a really good framework to support any organisation in improving their health and
wellbeing. It helps identify areas where work needs to be focussed and the Health@Work
staff are very helpful and constructive. Events take place every week to encourage staff to
lose weight and keep fit, plus they hold monthly wellbeing events. The organisation
struggles to hold enough training courses due to the general pressure on the NHS. Any last
minute emergency (staffing levels, bad weather, major incidents,) can lead to the
cancellation of training courses or members of staff from different departments been
stopped from attending.
The organisation are working towards gaining Excellence in Mental Health when next
accredited.
Benefits
The Workplace Wellbeing Charter provides a really good framework to support any
organisation in improving their health and wellbeing. It helps identify areas where work
needs to be focussed.
Further information
If you would like more information, please contact Kevin Yip (Email:
Kawneer – Runcorn
Employer with 300 people on site.
What was the intervention?
During 2015 a Health and wellbeing day was undertaken, which was an event where staff
could get information on all health promotion topics. Following on from this around 80
health checks with staff were undertaken, and a weekly yoga session now runs, targeting
stress and musculoskeletal problems, with 12 regular attendees.
43
The Workplace Wellbeing Charter
The Workplace Wellbeing Charter (http://www.wellbeingcharter.org.uk/index.php) is a
statement of commitment to the health of staff. It is a voluntary self-assessment scheme
that was developed by Liverpool City Council, and it is open to all public, private and
voluntary sector organisations based in England, whatever their size. Organisations benefit
from using the Charter in a number of ways – they can benchmark their performance
against independent standards, and use a structure that is robust, evidence based and
receives national recognition. The Standards and toolkit material are free on the Charter
website for all organisations to use.
The Charter sets out standards for health and wellbeing, and provides access to tools for
implementation. It is relevant to all businesses, no matter how big or small they are, and
covers 8 areas – leadership, absence management, health and safety, mental health,
smoking and tobacco, physical activity, healthy eating and alcohol and substance misuse.
The focus is on 3 main areas – leadership, culture and communication – where even small
steps can make a big difference to the health of staff, and therefore the health of an
organisation.
The Workplace Wellbeing Charter comes in three levels, each containing different
standards that need to be achieved. These are commitment, achievement and excellence;
Commitment means that the organisation has a set of health, safety and wellbeing
policies in place and has addressed each area
Achievement means that steps are actively being taken to encourage employees to
improve their lifestyle, and some basic interventions are in place to identify serious
health issues
Excellence means that information is easily accessible and well publicised,
employees have a range of intervention programmes to help them to prevent ill
health, stay in work or return to work as soon as possible.
The Charter suggests guidelines that should be followed in terms of absence management;
o Commitment
A clear attendance management policy should be in place and
procedures known to staff
Contact is maintained with absent employees to provide support and
aid return to work
Documented return to work procedures are in place and followed
Return to work interviews are conducted and recorded alongside any
concerns and support provided
Specific risk assessments, taking into account health status, should be
conducted
Reasonable adjustments should be made in line with recommendations
made in a Statement of Fitness for Work
o Achievement
Absence rates and causes are collected and monitored
Interventions are undertaken where patterns indicate trends of absence
44
Managers have participated in attendance management training
o Excellence
Absence trends are monitored across the organisations and specific
programmes are designed and implemented to address the issues
identified
The organisation’s return to work policies are designed to support staff
on long term sick leave to return to work and will support staff with long
term conditions
There are organisations who can support businesses to meet the standards of the Charter.
For example, Liverpool City Council commission Health@Work to deliver accreditation of
businesses for the national award in Liverpool (http://www.healthatworkcentre.org.uk),a
registered independent charity, based in Liverpool, which offers a wide range of safety,
health and wellbeing related products and services. Health@Work provide free assistance
in acquiring the Workplace Wellbeing Charter. Health@Work provide a number of training
courses on health and wellbeing, as well as health checks. Public Health England supports
employers initiatives to improve health and wellbeing, and the Department of Health’s
Responsibility Deal provides employers with helpful information and links to other resources
to help improve a range of workplace health issues (Department of Health, 2011).
Work well the Walton way
What was the intervention?
This example of good practice is taken from the website NHS Employers4. NHS Employers
aims to be the voice of employers in the NHS, supporting them so that they can put patients
first. Work well the Walton way aims to create and sustain a happier and healthier
workforce, which has been evidenced through research to have a positive impact on
patients and the care they receive.
In consultation with employees and Unions, an action plan was put in place to address a
number of issues including obesity, smoking cessation, physical activity, alcohol and
substance misuse, health promotion and prevention, staff engagement, and training and
leadership. Initiatives that were put in place included;
Health and wellbeing champions on every ward forming a virtual group
An in-house weight management course
Zumba classes were held at appropriate times (in partnership with a local business),
as well as a cycle scheme, a running club, gym discounts and a combat aerobics
course
Revision of the following policies:
Sickness, stress, dignity at work, appraisal, induction, buying annual leave scheme,
staff recognition scheme, long service
Revision of the occupational health service level agreement
4 http://www.nhsemployers.org/case-studies-and-resources/2011/10/work-well-the-walton-way
45
Development of a trust apprenticeship scheme
Staff participation in the North West Corporate Games
Staff counselling, physiotherapy and alternative therapies.
Impact on sickness absence and other benefits
Following introduction of the strategy, staff sickness has reduced from over 7 per cent in
January 2010 to under 4%. This trend in reduction has continued for the last four months
and has resulted in a cost saving including a reduction in agency spend. The trust was the
first in the North of the country to be awarded the IIP Education and Training Award and the
Health & Wellbeing Good Practice Framework.
46
Appendix 3 – Sickness absence data collected by Cheshire West and
Chester local authority on behalf of Champs
Cheshire and Merseyside Local Authorities – Sickness absence
Summary
A comparison of sickness absence between the various local authorities has been difficult
as each local authority has its own systems for managing and accounting for absenteeism.
This combined with the fact that each local authority has different approach to setting up its
directorates make it all but impossible for direct data comparisons.
Key messages:
Difficult to directly compare some data, so estimations of ‘best fit’ used to
amalgamate data like sickness reasons and directorates.
The schools influence will reduce the number of sick days per FTE
Directorates with highest sick days per FTE are adult and children’s services.
Stress/mental health are the biggest cause of lost days for the majority of the local
authorities.
The below data summary uses a ‘best-fit’ approach to try and ensure as much data
accuracy while allowing for a comparison between different local authorities.
Sick days per FTE:
The Cheshire and Merseyside local authorities were requested to submit information
relating to the number of sick days taken for each full time equivalent (FTE) in their employ
using the BVPI 12 measure. Table 1 shows average number of sick days per FTE for the
period 2014/15 and 2015/16
Table 8-5. Summary of sick days per FTE for Cheshire and Merseyside Local Authorities, 2014/15 and 2015/16
LA1 LA2 LA3 LA4 LA5 LA6 LA7 LA8 LA9
Sick days per FTE: April 2014 – March 2015
Excluding schools
11.97 10.04 NA NS 10.50 13.28 12.80 9.41 NS
Including schools (where applicable)
9.58 8.38 10.44 9.42 8.74 11.51 10.48 11.96 17.9
Sick days per FTE: April 2015 – March 2016
Excluding schools
11.14 9.57 10.85 NS 11.58 13.41 12.80 9.26 NS
Including schools (where applicable)
9.18 8.39 9.05 9.70 9.39 11.44 10.32 11.84 17.9
NA – not available. NS – not supplied.
Source: Cheshire and Merseyside Local Authority Absence Statistics - May 2016
47
Directorate breakdown:
The following table represents a best fit approach to joining the varying local authority
structures into a generic directorate table. It is difficult to align some directorates, so any
particularly weak links are highlighted with the actual directorate name in the brackets.
Where quarterly data was supplied, totals were calculated by summing the quarters
together.
As identified in the previous section, the directorates not associated with schools have a
proportionally higher rate of sick days per FTE. Looking at the following table it is clear that
both the Adult Social Care and Children’s Services directorates have the highest
absenteeism days per FTE rate across all the local authorities that supplied the information.
It is not clear from the information supplied as to why there are such high rates in these two
directorates in particular; but a guess would be to that within these directorates are the
most stressful roles including the front line care workers and social workers.
A further avenue for investigation would be to identify the reasons behind the higher level of
absenteeism from these directories; i.e. is stress the dominant reason for sick days in these
roles as indicated by the Table 3.
It is difficult to make accurate comparisons using the data supplied due to the difference in
local authority structures.
48
Table 8-6. Best fit of directorates and associated sick days per FTE: 2015/16 year
Sick days per FTE
General Directorate* LA1 LA2** LA3** LA4 LA5 LA6** LA7* LA8 LA9
Chief Executive NS 0.0 NS 3.14
NS
NS 0.0
NS
18.1
Corporate 7.88a 5.28 9b 2.77c 9.43a 9.46d NS
Children & Families 10.34*** 10.58*** 12.1e 10.11****,f 18.47**** 13.42****,g 14.8h
Adult Social Care & Health
16.69 13.06 12.00i 16.56 20.26
30.0j
Places 9.48i 9.12 9.8k 10l 8.35m 9.46d NS
Economic Growth 6.59 NS 10.9n 1.82o 13.62p 13.81 NS
Public Health 3.89 0.95 NS 4.24 9.29 13.42g NS
Total 11.14 9.57 NS 9.42 13.41*** 12.6 17.9
NS – Not supplied. * ‘Best fit’ of Directorates (supplied directorate of best fit). ** Sum of data using quarterly data. NS – not supplied. *** Including schools. **** Not including schools. a
Corporate support. b Policy and resources. c Democratic services. d Resources and strategic commissioning. e Children and enterprise. f Children’s social care. g Families and wellbeing. h Children’s services. i Communities. j Adult services. k Community and resources. l Neighbourhood delivery. m Regeneration and housing. n People and economy. o Business, innovation and skills. p Inward investment and employment.
Source: Cheshire and Merseyside Local Authority Absence Statistics - May 2016
49
Reason for absence:
The following table provides a breakdown as to the top 5 reasons for each local authority
for absenteeism. The measures used are not necessarily the same, but they are of a similar
enough nature to allow for some comparison.
Table 8-7. Top 5 reasons for absence with proportions
Top five absence by reason (and proportion of total absences)
Number 1 reason
Number 2 reason
Number 3 reason
Number 4 reason
Number 5 reason
LA1 (including schools)
Stress (13.7%) Med Exam / Investigation / Operation (10.1%)
Depression (5.1%)
Back Pain (5.0%) Anxiety / Fatigue / Exhaustion (4.6%)
LA2 (Q4) Anxiety / Stress / Nervous Debility (25%)
Cold / Flu (18%) Joint / Muscular Disorder (12%)
Gastric Disorder (10%)
Ear / Nose / Throat (7%)
LA3 Infections, to include colds and flu (24.5%)
Stomach, liver, kidney & digestion (21.6%)
Other musculo – skeletal problems (7.5%)
Eye, ear, nose & mouth / dental (6.3%)
Personal Stress (6.1%)
LA4 Not supplied
LA5 Not supplied
LA6 Not supplied
LA7 Stress / Depression (23%)
Limb / Joints (17%)
Respiratory / E.N.T. (15%)
Digestive / Stomach (9%)
Back / Neck (7%)
LA8 Mental Health (30.1%)
Muscular / Skeletal (exc Back) (10.5%)
Medical Procedures (9.1%)
Abdominal (inc Digestive Tract) (9.1%)
Ear, Nose and Throat (8.0%)
LA9 Stress (27.5%) Depression (13.5%)
Back pain (12.5%)
Operation (12.0%)
Anxiety (10.9%)
As can be seen from the data the principal cause for absenteeism across local authorities is
stress/mental health issues. Muscular/skeletal issues account for the second highest
number of days per FTE, followed by cold and flu/depression/medical procedures and
appointments/gastric issues.
While there is probably a significant link between the reasons for absenteeism and the type
of work undertaken, such as the stressful and potentially physically hazardous roles of
social work and front line care, there is no causal link that can be identified through the data
supplied.
