Asking NHS staff to call a medical hotline — rather than their boss — when they feel ill has cut ‘sickies’ by a quarter. Martin Vander Weyer meets the man behind the scheme
It’s Monday morning and you’re feeling a bit below par. Maybe it was last night’s kebab, maybe it’s the bug that’s going round your children’s school. You ring a workmate and ask her to tell the boss you won’t be in and you’re not sure when you’ll be back. On Tuesday, still off colour, you try to get an appointment with your GP — but the receptionist blames staff shortages at the surgery for not booking you in until Wednesday evening. When you do see the doctor, he tells you to take paracetamol and drink plenty of water — and wearily agrees that it might be sensible for you not to go back to work until Monday.
It’s a familiar tale, in every family and every workplace. It’s not blatant shirking, but it’s a pattern that all too easily turns a minor upset or a major hangover into an un-necessary week off. And survey after survey indicates that it is far more prevalent in the public sector than the private sector, despite recent claims by the TUC that the ‘sicknote culture’ is a myth and public servants are ‘more likely than their private-sector counterparts to carry on working when they feel ill’.
Even if that last assertion were true (the TUC used a rather small survey), absenteeism is a particular problem in the NHS — and if it is not down to what used to be called ‘old Spanish practices’, then you might assume it must be due to the constant exposure of frontline staff to infection. But it turns out to be just as bad among NHS finance assistants, and bizarrely at its worst among staff of NHS Direct, the call-centre service whose operatives never meet patients at all.
In the private sector, on average, 5 to 7 per cent of staff are absent at any time; public-sector absences are typically about one fifth higher. But at NHS Direct in March the absence rate was running at 11.4 per cent, equivalent to 23 days off per year per employee, and at its winter peak it hit almost 15 per cent.
This is an issue that has long been swept under the carpet by many NHS managers. And there is a dismal circularity to it: the higher the level of absenteeism, the less efficient the response to patients, including those who actually work in the NHS; so the more time they’re likely to be off sick. Elsewhere in the public sector, absenteeism has at least been tackled by disguised forms of bribery: firefighters and postmen win cars just for regularly turning up to work. But in the dysfunctional, demoralised, overstretched NHS, it has largely come to be regarded as a fact of life — whatever its un-necessary cost to the taxpayer.
When Alistair Darling in his March Budget claimed that Labour would save a £555 million drop-in-the-deficit-bucket by better management of NHS staff absences, his listeners groaned, assuming this was just one more number plucked from the air and probably never to be mentioned again. But he had in fact adopted that rather precise figure from an independent review published in late November by an occupational health expert, Dr Steve Boorman. And it was swiftly challenged by an entrepreneur in the little-known sector of ‘absence management’, who said the saving could actually be £760 million in the first year, rising to £1.2 billion two years later.
Multiply that across the whole public sector, from Whitehall mandarins to the bin-men of your district council, and it suggests a potential saving of £4 billion or more — with no service cutbacks, and redundancies only where reduced absenteeism reveals surplus staffing. The people to suffer most would be the owners of the agencies that provide expensive temps at short notice to fill all those extended absences.
Who is this entrepreneur with a £4 billion magic wand? His name is Aaron Ross, and he is the energetic 30-year-old chief executive of Firstcare, a business whose results can speak for themselves. Working for 17 NHS trusts across the country, Firstcare has reduced absences by 26 per cent in the first year. In the private sector, the service achieved a remarkable one third reduction for the UK arm of Coca-Cola in 2008.
‘Bring a hard hat and a hammer,’ Ross said when I invited myself round to his office, high up in a down-at-heel tower block opposite Waterloo station. He was busy supervising a doubling of Firstcare’s floor space, the better to accommodate rapid organic growth plus the recent acquisition of its main rival, Active Health Partners. He took a break to explain how the service works.
An employee of a Firstcare client who decides for any reason not to go to work — let’s say he’s a hospital catering worker — is obliged to ring Firstcare’s call centre, rather than simply sending a message to his supervisor. If the problem is medical he is offered the opportunity to speak to a nurse who performs a ‘triage’ function, asking questions to establish whether he needs to take an aspirin, see a doctor or even call an ambulance, and how long he’s likely to be off. The absence is then ‘managed’ to keep it to a sensible minimum: for musculoskeletal problems, that means recovery in an average of 22 days, compared to 43 days for an NHS worker outside the Firstcare net.
The key to Ross’s business model is that he employs experienced NHS nurses, working in the Waterloo call centre or from home, either side of their hospital shifts. They know what they’re talking about, and they provide him with such flexibility (far more of them are needed on Monday mornings than Thursday afternoons, for example) that his cost per call is only around £2, whereas NHS Direct costs the taxpayer £25 per call. ‘I just couldn’t physically spend that much,’ he says.
Throughout our conversation, Ross repeats a mantra that we don’t believe there’s any such thing as ‘a sickie’. Absence management is all about providing ‘a better path back to health’, he says, which is why public-sector unions love it, whatever the spin in the TUC press releases. But it’s also clear that Ross’s system acts as a powerful deterrent to shirking. With 115,000 employees in its database, Firstcare watches in real time as absences blip up to coincide with big football matches or changes of weather. Its monthly data reports for clients identify employees with the most repetitive absence records; in one NHS trust, this highlighted a cleaning team who were taking it in turns, with their manager’s connivance, to collect the maximum six-months’ sick-pay. And it can even spot mass hypochondria: during the swine flu panic, its call-centre screens lit up every time the pandemic-that-never-was made the top of a BBC news bulletin.
According to TUC general secretary Brendan Barber, ‘It’s a myth that there are big, quick and easy savings from new policies that assume sickness absence is mostly skiving.’ But that misses the point Firstcare’s data makes so eloquently. You don’t have to make any assumption about the nature of absenteeism, in the NHS or anywhere else; you just have to manage it intelligently in order to minimise time off work, and there are billions of pounds of taxpayers’ money to be saved by doing so.