Summary

This SIM informs FOD inspectors about inspection priorities in public sector organisations in 2008/09 and the suggested intervention approach. The core effort should be to continue the PSP1 project of 2007/08 and following up on the Healthy Workplace Solutions (HWS) workshops. The SIM also outlines other priorities and initiatives that may be relevant. FOD interventions should concentrate on managing work-related stress, the prevention of other causes of injury and ill-health, and where applicable, other key risks in line with local exercise of discretion agreed as part of fine-tuned plans.

Background

1  The public sector employs over 4 million workers across Great Britain and effective interventions will potentially make a major contribution to the Fit3 days lost and ill health targets.

2  The business case for tackling the principal causes of sickness absence is strong: the annual cost to the public sector has been estimated at about £4 billion.  Musculoskeletal disorders (MSDs) and mental ill-health between them account for some 80% of the total and stress is the single biggest cause.  It is estimated that 15 – 40% is work related, depending on the occupation. In contrast, the main causes of work-related injuries across the public sector are manual handling, slips/trips and violence. 

3  In 2006/07, HSE delivered a GB wide programme of promotional activity culminating in a series of Healthy Workplace Solutions (HWS) workshops targeted at those parts of the public sector with the highest  incidence of sickness absence and work-related stress - NHS, local and central government and education.  Their aim was to help public sector employers to implement the HSE Management Standards for work-related Stress or an equivalent risk assessment approach, and to encourage good practice on managing sickness absence and return to work (MSA/RTW).

4  In 2007/08, the HWS workshops were followed up by further “Masterclass” events to provide targeted advice on aspects of the Management Standards where organisations indicated they needed further help.

Follow up to the HWS workshops

5  This work continues the PSP1 project of 2007/08.  The key objectives of visits in 2008/09 are:

1. To make the business case for preventing the main causes of ill-health and
   days lost such as stress, violence, slips, trips and falls and MSDs, together    
   with the policies and arrangements for managing these.
2. To ensure that the organisation has completed or is completing a suitable
   and sufficient risk assessment for work-related stress using the
   Management Standards approach, or an equivalent and to assess its
   progress.
3. To discuss progress with existing and / or agree new action plans to
   address other areas of high risk (see paragraphs 5.12 and 5.13).

Targeting

5.1  The targeting of these visits should be agreed at divisional level. The size of the organisation and sickness absence rates are influential factors but so is local knowledge.  Divisions can continue to use the targeting lists produced by the sector in 2007 to inform their decisions (available in TRIM record number 2008/12343).  An indication of whether organisations attended a HWS workshop is included in the lists. Contact details of individuals who attended workshops can be found in TRIM record number 2007/347928). Although this is the best available data, inspectors should still confirm attendance when making contact with dutyholders.

Inspection approach

5.2  Further visits should be made as necessary to organisations that were inspected in 2007/08 to monitor progress and the follow up intervention should be recorded on the PSP proforma. See para 8 for further recording instructions. 

5.3  When an organisation is being inspected for the first time in 2008/09, interventions should start with discussions on the business case for managing work related ill-health and days lost, referring to the Ministerial Task Force-commissioned guidance on The Well Managed Organisation [145KB]. Inspectors should draw on local knowledge and the organisation’s own analysis of sickness absence and injury data to agree areas for management inspection. While discussion of work-related stress with HR managers is likely to be central to this, other matters will involve dealing with personnel from other parts of the organisation, too. 

5.4  Inspectors should continue to use the inspection tool to assess performance in tackling work-related stress. This is extremely important not only to maintain consistency of approach and reporting but also to demonstrate the speed and detail of progress in dutyholder performance. The inspection tool and all the necessary background information can be found in the Stress Topic Inspection Pack [211KB] A5-sized laminated, ring-bound copies of the inspection tool are available from Allison Spears telephone number: 0131 247 2114 or VPN 520 2114.

Note: Local authorities

5.5  Some LAs were invited to attend three workshops: a general LA-wide workshop; one for Education Departments / Children’s Services Directorates (CSD in England only, previously known as LEAs) and one specifically for Adult Social Services Departments (SSDs in England only). Where relevant, LA follow up visits should include all functions. Where SSDs are identified for inspection, it is recommended that close attention is paid to the work undertaken by care assistants. They account for over three quarters of the RIDDOR reports and have the highest sickness absence rates.

Note: State maintained education

5.6  HSE’s approach to state maintained and secondary school education has been to work in partnership with Worklife Support (WLS)* who have a well established and respected pro-active organisational approach to tackling work-related stress in schools - the National Well-being Programme (NWP).

* WLS has a low coverage in Scotland with two LAs participating in the pilot.

5.7  HSE encourages organisations to implement the Management Standards approach but considers the WLS product to be broadly equivalent. Encouraging the uptake of the NWP is a realistic way of getting Education Departments / CSDs to manage work-related stress at the individual school unit level.

5.8  In 2008/09, inspectors are not asked to complete a detailed inspection of the individual schools for which Education Departments / CSDs have responsibility, in relation to stress / managing sickness absence, unless complaints are received or other local intelligence indicate that this is necessary.

5.9  However, as part of the overall LA inspection, inspectors should determine and record:-

1. Whether Education Departments / CSDs are rolling out the Management
   Standards approach in their schools, and if so, the proportion of schools
   using that approach;
2. Whether Education Departments / CSDs are involved in the NWP and
   where they are, what degree of penetration there is i.e. percentage of their
   schools participating; and
3. What arrangements or plans are in place to manage work-related stress
   within schools that are not using the Management Standards or
   participating in the NWP.

Further information on inspection approach in state maintained education and the NWP can be found on the public services sector online community.

Note: NHS organisations

5.10  Further information on the background issues within the health and social care sector, including initiatives on managing sickness absence and stress can be found on the public services sector online community.

Note: Ambulance services

5.11  Inspectors should note that the Ambulance Services Association * (ASA) have a well-established system for the assessment and management of stress, and some ambulance trusts may have already signed up to it. The system appears to be broadly equivalent to the Management Standards approach. 

*Please note that the ASA does not represent the Scottish Ambulance Service

Main causes of injury and ill health resulting in sickness absence

5.12  Analysis of injury and sickness absence data in the public sector highlights the following main causes:

• Stress;
• MSD – patient moving and handling, training in control and restraint, DSE, LAs involved in kerb and manhole handling;
• Violence and Aggression – health and social care, education;
• Slips and Trips; health and social care, education; and 
• Falls – low falls in education.

Other matters of concern

5.13  There are other matters of concern that are relevant across the public services sectors which may be appropriate to include in the management inspection.  Standards and enforcement guidance can be found in the relevant topic packs and on the public services sector online community e.g.

• Duty to manage asbestos [676KB]
• Legionella
• Control of infection – health and social care and LA environmental services
• Migrant workers – particularly in health care but any organisation with large cleaning and catering contracts; and
• Suitable, integrated occupational health provision

 FOD interventions in other parts of the public services sector

6  The targeted approach to health, social care, education and local government sectors offers the greatest likely yield and impact on the PSA target for days lost. Within individual regions, where Operations Managers see opportunities to apply local discretion more effectively and/or efficiently, sector staff will be pleased to discuss proposed interventions in other areas.

Police

6.1  No new interventions to forces by the national police inspection team (and police team in Scotland) are planned in 2008/09. Follow up work with forces inspected in 2006-2008 and reactive work should continue as planned.

Fire and rescue

6.2  Interventions with the Fire and Rescue Service (including Scotland) will not start until Q3 2008/09 and it is proposed to create a national inspection team based on the police model. The focus of these inspections is likely to be on operational/safety critical issues.  Further information will be issued on this later in the year and briefing will be provided by the sector to the FOD teams involved.

Prison service

6.3  No centrally determined proactive inspections are planned but the sector will be pleased to discuss any proposed local initiatives.

Central government

6.4  Following a recent censure, HM Revenue and Customs (HMRC) have been notified of FOD’s intention to carry out a management inspection later in the work year led by Wales and South West Division. This will be used as a model for future nationally managed interventions with central government departments and agencies. The sector are assembling profiles for departments and agencies to support FOD selection of departments for intervention in 2008/09. Ongoing HSL work with DWP to review their approach to well-being and implementation of the Management Standards will conclude in May 2008. The findings from this work will be reviewed before planning any central interventions with DWP.

Other initiatives

7  Other new and ongoing initiatives in public sector organisations involving FOD contribution are outlined below.

SIP1 project

7.1  Wherever possible, the high level of support given to SIP1 organisations by HSE stress partners to assist them in implementing the Management Standards should be concluded or reduced to a level in line with HWS follow up inspections.

Electric Profiling Beds (EPBs)

7.2  The Public Services Sector recently concluded a series of conferences targeted to the NHS around GB raising awareness with dutyholders of the need to consider, where appropriate, electric profiling beds (EPBs) as a suitable control measure as part of their manual handling arrangements.  The Sector are currently developing 3 national implementation plans for the NHS England, Scotland and Wales to promote awareness and set out the rationale for ensuring that EPBs are considered, where appropriate.  Further information will also be made available on the public services sector online community site as the initiative develops.

Healthcare associated infection (HAI)

7.3 Plans are being developed to take forward upto 2-3 pilot audits in Scotland and work with healthcare regulators in England and Wales on their HCAI prevention and control programmes.  Audits will be led by nominated FOD inspectors with specialist assistance from HID SI4 and co-ordinated in partnership with other healthcare regulators.  Further information will be available on the public services sector online community.

Working with the Healthcare Commission

7.4  Following on from activities 2007/08, the Sector would welcome FOD assistance in participating in regional/local Risk Summits which have been established to take forward our Concordat obligations and to help foster greater collaboration on areas of mutual interest.   Feedback from FOD colleagues last year indicated that these Summits were a useful forum for sharing intelligence and data on various dutyholders, and in turn informed better targeting. Further information will be available on the public services online community.

Corporate care providers

7.5  The sector is liaising with FOD to establish a lead Principal Inspector arrangement for the large corporate providers of social care. Further information will be available on the public services sector online community.

Care homes

7.6  The sector will be developing an information pack to advise of the key causes of ill health and injury in the care home sector – MSDs, slips and trips in particular, and to raise awareness of the need to consider electric profiling beds as a control measure where appropriate (see 7.2).  This material will support proactive inspections in 2009/10.   The sector is also working with the Midlands Division to support a local workshop for care homes, which may provide the model for further FOD workshops in 2009/10.  Further information will be made available on the public services sector online community.

Duty to manage asbestos in CLASP and other system buildings

7.7  The majority of this work should have concluded in 2007/08. Information is included in SIM 07/2007/04 to inform any ongoing or reactive work.

Waste and recycling programme

7.8  FOD should be aware that the manufacturing sector will be communicating with LA environmental services directorates in relation to contract specification and safety culture in Direct Labour Organisations. 

Recording

8  A proforma, which should be used to record the outcomes of the stress / MSA visits, can be found in TRIM, record number 2008/13003. Inspectors should consult the FOD work-recording instructions for 2008/09 for advice on how to record time spent against stress and other topics, and how to save the proforma on COIN.  

Contacts

9  Inspectors are encouraged to contact sector staff for advice / guidance on inspections and investigations in public sector organisations. Sector staff are happy to provide input into any relevant local initiatives in the public sector.  Please direct your enquiries as appropriate to the named contacts below or contact the ‘publicservices’ general e-mail account.

Contact	Lead Responsibility
Simon Longbottom 01582 444 285 or VPN  508 4285	Team Leader - Government, Disciplined Services Unit
Jo Gravell 01582 444 293 or VPN 508 4293	Acting Team Leader – Health and Social Care Services Unit (HSCSI)
Ian Strudley  01256 404 085 or VPN 502 4085	Healthcare Associated Infection project (Til 08/08); HSCSI Team Leader onward.
Andrew Strawson 0207 717 6360 or VPN 522 6360	Team Leader - Police and Fire and Rescue Services (end December 2008)
Specific sector topic/organisation leads:
Allison Spears 0131 247 2114 or VPN 520 2114	Stress & MSA/RTW
June Cairns 0131 247 2063 or VPN 520 2063	General PSP work in Scotland
Ruth Sleigh 01604 738369 or VPN  509 8369	Local Authorities
Vicky Fletcher 01245 706250 or VPN 507 6250	Social Care
Lorraine Shepherd 01245 706 6261 or VPN 506 6261	Education, central government
Suzanne Denness 01256 404044 or VPN 502 4044	Police & prisons
Ian Copland 0113 283 4243 or VPN 515 4243	Fire & rescue; MoD
Amanda James 0121 607 6204 or VPN 510 6204	MSDs / V&A – Health
Lorraine Shepherd 01245 7066261 or VPN  507 6261	Asbestos in schools
Ruth Sleigh 01604 738369 or VPN 509 8369	Waste and recycling (LAs)
Eleanor Keech 0207 7176688 or VPN 522 6688	Healthcare associated infection project