The latest sickness absence figures released in July 2015, show an increase in overall sickness absence, rising from 4.2 percent in 2013/14 to 4.44 per cent in 2014/15. We can estimate that sickness absence alone costs:
- £1.55 billion which is equivalent to 13.7 million days lost and 60,698 FTE lost
- the 0.22 per cent rise in sickness absence cost £44 million than 2011-12, equivalent to 386,520 days lost and 1,718 FTE lost.
These figures alone are striking and are only one of the many metrics that can be used by a trust to demonstrate the need for focussed attention on staff health and wellbeing. Sickness absence is readily used to make the business case for investment in health and wellbeing as a trust can easily identify the cost and equate this to number of nurses on wards making the real link to direct patient care.
When building a business case or approaching the finance director you may want to also consider the following elements:
Open and honest conversations
Before creating any business case for investment into health and wellbeing you should always initiate an open and honest conversation with all parties involved such as your health and wellbeing lead, occupational health, physiotherapy and of course, your finance team.
It is assumed that you have also engaged with your employees and utilised surveys and available data to build a targeted, trust specific need for investment.
It is important to understand each others objectives, find a marriage between them and agree the best way forward. Having these conversations at the outset will enable positive partnership working and help you to address any potential concerns or barriers allowing you to focus on the way forward. You could use this as an opportunity to ask them what they will need to see in the business case for it to be successful, to allow you to present what you know they will be looking for.
Understand their language to present your case
The typical learning style of a finance director would be logical and detailed so it helps to keep this is mind when presenting your information. Their language can be quite technical and can differ from trust to trust so it is important you find out how your trusts reports on its financial figures and how this is usually presented. It is important to write the business case from the readers perspective which may be not necessarily be your own preferred style, but the focus is to engage the reader and demonstrate the need for your request.
Jeff Buggle, Director of Finance & Performance Management at East Kent Hospitals NHS Foundation Trust says that, "For many reasons the priority health and wellbeing is given on at board level is different across the country. How we articulate what we are trying to achieve through health and wellbeing is vital. Whilst I might instinctively believe in this, professionally it has to demonstrate a benefit to the organisation and its bottom line. Present it this way or it may fall on deaf ears."
Present the national evidence base
There is a wealth of information on NHS Employers web pages which demonstrates the need and evidence base for health and wellbeing. You can correlate health and wellbeing to some financial business benefits, for example a reduction in sickness absence rates and reduced turnover. The problem is that there isn't a direct one in, one out type of relationship. However this will still give you an indication of the costs associated with investing in health and wellbeing. This also enables a base line to allow for future review and to allow for progress to be measured.
National reports and evidence is available via the NHS Employers website such as:
Does NHS staff wellbeing affect patient experience of care? - May 2013
A report published by the National Nursing Research Unit (NNRU) which explains how good staff wellbeing links to a better patient experience. It goes into detail explaining the key points of staff wellbeing and the direct impact this has on patients. Read the report.
Fit enough for patients? An audit of workplace health and wellbeing services for NHS staff – March 2013
The Chartered Society of Physiotherapy (CSP) published this report, with their findings about rises in sick pay within trusts, and the cost of sick pay exceeding £1 billion in the last three years. Read the report.
Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence’ – Jan 2013
The Government response outlines a strategy to support the health and wellbeing of the working age population. It examines areas such as sickness absence management, support for healthcare professionals and reforms to the benefits system. Read the response.
Patients' experiences of care and the influence of staff motivation, affect and wellbeing - Nov 2012
A study by the Health Services and Delivery Research Programme with the aim of establishing associations between staff health and wellbeing and patient experiences of care. Read the full report.
Piece together the pieces and see if the whole jigsaw shows that it makes sense to invest.
In order to bring your business case to life it is wise to include some examples of where health and wellbeing initiatives have been successfully implemented. Case studies can be found on the NHS Employers website and health and wellbeing leads are encouraged to join our network of leads from across the country to learn from each other and access information and latest news stories quickly.
- what can you measure and compare from the data you collect and surveys undertaken in your trusts?
- consideration can be given to identifying hot spots to allow targeted work for maximum impact.
What is also powerful is to present evidence in terms of options, the options of investing and what the possible reduction will be, versus the option of doing nothing and predicted continued increase in associated costs.
Stephen Sutcliffe, Chief Finance Officer from the Warrington Clinical Commissioning Group suggests highlighting the risks of poor health and wellbeing to both individuals and the organisation, not only from a financial perspective but an impact on quality and the ability to deliver high quality care.
To help you with this we have studied the most recent sickness absence figures and extracted what the highest and lowest sickness absence rates are by trust type.
Before submitting your business case or engaging with your finance director you should:
- initiate conversations with the team involved
- set clear objectives
- think about the readers style and prior knowledge of the subject
- research national and local evidence
- look at what data you have readily available
- crunch some numbers! Look at the best and worst case scenario.
"I think its fundamental to providing high quality care to have a motivated well looked after workforce. all the evidence from the Berwick Review, the Francis Inquiry, and many before that suggest that actually essential to the quality of care and service we provide patients is to have a motivated, healthy, well resourced workforce and I think this is crutial to that and is part of the ethos of this organisation and lots I have worked in before."
Jeff Buggle, Director of Finance & Performance Management, East Kent Hospitals NHS Foundation Trust
"The largest asset for the NHS is our staff and there is a direct correlation between a highly motivated and productive workforce delivering improved quality and health outcomes. Not only will you reduce absence, you will improve productivity, as people go that extra mile, with the right values and behaviours."
Stephen Sutcliffe, Chief Finance Officer, Warrington Clinical Commissioning Group
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