Published: 10/03/2005, Volume II5, No. 5946 Page 35

Sick leave costs the NHS millions, but applying the expert patient programme to its own staff themselves could prove just the tonic it needs.

Sickness absence rates in the NHS fell by 6 per cent in 2003-2004, according to a recent NHS Partners survey. However, the average organisational cost of sickness absence in the same years was£3.27m.

Meanwhile the pension scheme review consultation document published by NHS Employers predicts that the annual loss from the NHS nursing workforce will rise from around 15,000 in 2004 to 25,000 in 2015 as a result of the ageing profile. And as staff age they are more likely to develop long-term conditions. What can be done to start addressing this from a workforce perspective?

The cross-Whitehall ministerial taskforce for health, safety and productivity aims to reduce the current level of 10 days sickness absence on average per person to 7.5.

One avenue worthy of exploration is provided by the expert patient programme. Research on people living with long-term conditions over the past 20 years has shown that self-management improves quality of life and reduces use of health and social care services. It also increases self-efficacy and the possibility of returning to work, as well as allowing people to develop confidence and skills to manage their lives.

Given the success of the EPP approach, two pilots, (sponsored by NHS Plus and co-ordinated by NHS Partners) were set up in 2004 to test whether such a programme was transferable to NHS staff.

The EPP was offered to NHS employees in two strategic health authority areas, Bedfordshire and Hertfordshire and Cheshire and Merseyside. Those eligible included employees who managed staff with limiting long-term conditions, or had been on long-term sick leave but had returned to work.

The programmes were co-ordinated by the two workforce development confederations under the 'improving working lives' badge, run by the local EPP senior trainer, and supported by a second facilitator with a long-term condition. It took the form of six weekly sessions of 2.5 hours or two sessions a week over three weeks. In total, 14 people took part.

Success criteria included improving the participants' wellbeing, which was gauged by qualitative assessment, and connection to Improving Working Lives projects. Other potential benefits for the longer-term were avoiding lost working days and retaining skilled staff.

Overall this was a successful pilot. The evaluation concluded that the EPP could make a considerable impact in improving the working lives of staff with long-term conditions. Key learning points included:

Ensuring participants are aware that the course is about them as employees working with a long-term condition, not them as health professionals caring for people with long-term conditions.

Focusing discussions in the context of the workplace.

Enabling the employer to work on perceptions relating to supporting staff with long-term conditions.

Providing information about the help that is available to employees (eg, workplace assessments) and making connections to other programmes and organisations such as Remploy and the Employers' Forum for Disability.

Ensuring that organisations promote the benefits of the expert patient approach across all levels of management.

Improving organisational networks for managers to ensure they can access the resources to support existing staff and recruit others with long-term conditions.

It is clear that the NHS can do more to improve the quality of working lives for staff, and in managing staff sickness, as well as making the connections from this to recruitment and retention. The expert patient approach is transferable to groups of NHS staff and is one of a range of tools that can be used to support staff with long-term conditions.

Keith Johnston is executive director of NHS Partners. Jane Keep is an independent consultant and a visiting senior fellow at Birmingham University's health services management centre. Jim Philips is principal trainer with the national expert patients programme.

Sick list

The findings of the NHS Partners survey into NHS absence in 2003-04 included:

The groups of staff with the highest reported level of sickness was ancillary with 7.2 per cent and HCAs/unqualified nurses with 7.4 per cent . The lowest reported level of sickness was in medical and dental with 1.4 per cent . The main reasons for sickness were stress at 12.5 per cent and musculoskeletal at 11.9 per cent.

Find out more

www. nhspartners. org. uk

www. expertpatients. nhs. uk

www. employers-forum. co. uk

www. remploy. co. uk