Health and Sport Committee: 26th February 2019

Health and Sport Committee
26 February 2019
David raises questions in an evidence session with representatives of the Scottish Ambulance Service
David Stewart :
I echo my colleagues’ comments and thank all the front-line staff who do such a great job throughout Scotland.
As someone who represents the Highlands and Islands, I know how important the service that covers that area is.
I want to focus on staffing and human resources issues. I have looked carefully at the Scottish Ambulance Service’s employee engagement index score, which is the lowest of all the boards’ scores.
Its scores in the 2017 dignity at work survey were the worst in terms of the proportion of staff who experienced unfair discrimination from their manager, the proportion who experienced unfair discrimination from colleagues and the proportion who experienced bullying and harassment from their manager. Is there a culture of bullying in the organisation?
Pauline Howie:
We were very concerned about the results of the dignity at work survey, which we have been working hard to understand. You will be aware that, as part of the NHS Scotland staff experience measures, we use the iMatter staff experience index, to which you alluded. The results from that show that there was much greater participation in it: almost double the number of people in our service participated in iMatter than in the dignity at work survey.
We are, nonetheless, concerned about the findings and have been working to engage with staff across the country to understand their experience and what more we can do, because it is completely unacceptable for our staff and volunteers, who do a fantastic job day in and day out, to face violence, bullying or harassment.
As a result of the dignity at work survey that was done a couple of years ago, we set up a network of confidential harassment advisers, whom staff can contact confidentially if they are experiencing issues. We have very regular reporting through our governance committees—our health, safety and wellbeing committee and our staff governance committee—which report to our board on specific cases that we are concerned about.
We have invested significantly in our leadership and management development so that we can continue to create supportive and encouraging networks for our people. Given the amount that we are investing in their development, we want them to feel supported to work well in what is often an emotionally and physically very demanding job up and down the country.
We are absolutely not complacent. We are pleased that the participation rate in the staff experience survey continues to increase, and that teams are taking action as a result of the feedback at local level and throughout the organisation. Our performance in that regard is very strong: at 89 per cent, it is 30 per cent higher than all the rest of NHS health and social care’s participants in the survey. We are pleased that people report that they get a tremendous sense of satisfaction from their job, but we have much more to do, and we want to continue on that journey.
Tom Steele:
I mentioned that I have been the chair of the SAS board for nine months. In that time, I have been out and about a lot. I am concerned about some of the results that David Stewart mentioned, but there is conflicting information. When I talk to staff, I hear a lot of enthusiasm for the job that they do. In addition, our staff turnover of just over 4 per cent is very low, as is our vacancy level—
David Stewart:
Can I stop you there?
I am willing to be corrected, but I understand that staff turnover among ambulance personnel is the second-highest of all staff groups.
Tom Steele:
I was referring to the whole organisation.
Pauline Howie:
We monitor staff turnover monthly. According to the latest figures that we have, at the end of January, staff turnover was 4.1 per cent and we had 25 vacancies, which is the lowest number for a long time.
David Stewart:
How does your performance on that compare with that of other boards?
Pauline Howie:
I think that our turnover rate is lower than that of other boards. As Tom Steele mentioned, we work closely with the other UK ambulance services: I know that our vacancy rate is a lot lower than those of other UK ambulance services.
David Stewart:
I am sorry for interrupting you, Mr Steele.
Tom Steele:
No—your point was well made.
There is evidence on both sides. I have experience of working in many different industries and businesses. I accept that the evidence that I cited is anecdotal, but such a high level of enthusiasm is unusual. The number of paramedics and technicians who have said to me that they have the best job in the world is in double figures.
I would be keen for Donna Hendry to say a few words, if that would be okay.
Donna Hendry:
I have been in the Scottish Ambulance Service for almost 25 years. When I joined, I did not think that it would be my job for life, but thankfully it is—or hopefully, in case I say something wrong today. [Laughter.]
When I joined the service, I was one of the only females in the job, and the culture was very different then. It was pretty anti-female. If I was filling in a form then about how I felt about my job—whether I felt bullied and so on—I might have said very different things. I have seen a massive culture change in the past 10 to 15 years, and I certainly do not see any bullying or harassment. I could compare that with the situations of some of my friends in other jobs. We have policies to protect us in almost everything that we do.
We also now have opportunities to engage in all kinds of activities within our work. I am part of the health and wellbeing committee, so I do a lot of healthy working lives stuff. We arrange lots of activities including things to try to improve staff wellbeing. I certainly do not feel or see bullying or harassment, and I have been around for some time.
David Stewart:
Thank you for that.
Like Mr Steele, I have been involved in a number of organisations.
I know that another indicator of the health of an organisation is its sickness rate, which is certainly something that I would look at carefully.
You will know that, in 2017-18, the target was 5 per cent but the actual rate was 7.6 per cent.
I understand that, in day-to-day life, you meet dedicated staff such as Donna Hendry who speak positively of the organisation, but I would look at what the statistics say.
I would look at the dignity at work survey, the employee engagement index score and the accounts of bullying.
The sickness rate is a factual thing and the current rate is higher than your target.
What are you going to do to try to reduce the sickness rate in the organisation?
Tom Steele:
I will ask the chief executive to respond to that in a moment, but I absolutely agree that 7.6 per cent, which is the rate that we are still at, is a high rate of sickness absence.
All ambulance services in the UK and abroad have significantly higher levels of sickness absence than the rest of the healthcare systems, which reflects the physically demanding and mentally extremely stressful roles that paramedics and wider staff play. We are increasingly aware of that and we are responding to it in a way that will initially raise awareness and then, we hope, reduce sickness absence. The sickness absence level is of concern to me: equally, the health and wellbeing of our staff are of concern.
David Stewart:
Perhaps you could send us the comparative sickness rates for the other organisations that you mentioned.
However, if I was running an organisation and the going rate was 7.5 per cent, I would make the target 7.5 per cent.
Why did you make the target 5 per cent if you are not achieving that?
Tom Steele:
I ask the chief executive to respond to that.
Pauline Howie:
There are national targets for sickness absence in NHS Scotland, and the Scottish Ambulance Service tries to reduce sickness absence, as you would expect. The top two reasons for sickness absence in our service are musculoskeletal illnesses and mental health illnesses including anxiety, stress and depression.
As I said earlier, our staff do an outstanding job in trying and emotionally distressing circumstances. On any shift they might see the best and the worst—life and death. It is also often a physically demanding job. We have been investing significantly in new equipment and new policies and procedures. For example, we are one of the only UK ambulance services to have an ergonomics adviser who helps with advice on equipment and manual handling, lifting and so on.
We have also been paying a lot of attention to our approach to supporting the mental health and wellbeing of our staff. Other industries have seen an increase in that area, as well.
We have a number of employee assistance programmes that are well utilised by staff. Those who use the programmes report an improvement in their mental health and wellbeing, and people who have accessed our fast-track physiotherapy have reported improved outcomes.
We want to do more, particularly in relation to how we support people’s mental health and wellbeing. We are working across the UK ambulance services to understand what works in our environment, because ours is a unique environment. We are also working with the other emergency services in Scotland to understand what they are doing and how we can learn from each other and share practice where it makes sense to do so. We are absolutely—
David Stewart:
I am sorry to interrupt.
That sounds very positive, but will you meet your 2018-19 sickness absence target of 5 per cent?
Pauline Howie:
As Tom Steele said, we are sitting at a similar sickness absence rate to last year’s. We are not complacent, and we want to do more to support people to be well and to attend in the best of health.
David Stewart:
I will push you on that, because you did not really answer the question.
What is the 2018-19 rate currently sitting at?
Obviously, we have not completed the year, but you will know what the trend is from your human resources department.
Pauline Howie:
Yes, the target remains at 5 per cent, and—
David Stewart:
What is the rate now?
Pauline Howie:
As Tom Steele said, we are sitting at a sickness absence rate of 7.6 per cent at the moment.
David Stewart:
It that the same as the rate was in the previous year.
Pauline Howie:
Yes.
David Stewart:
What you have suggested seems to be a sensible management approach, but the rate has not changed at all.
What is the cost to your organisation of that level of staff absence?
Pauline Howie:
We monitor abstractions and we try to cover as many of them as we possibly can. There are a number of ways in which we can provide cover: for example, we have relief staff built in for a predicted level of sickness absence, and we can ask staff to work additional shifts.
The additional investment in our service means that we have over 500 more staff in place than we did in 2015. Our shift coverage rates have significantly increased.
David Stewart:
You might not have the figure in front of you, so it is not fair to ask you for the detail, but what difference does a 7.6 per cent sickness absence rate, rather than a 5 per cent rate, make to your budget?
I presume that a higher rate adds costs to your budget because you have to cover staff who are on long-term sickness absence.
Pauline Howie:
Yes.
David Stewart:
Has your finance department calculated the cost to your budget of having an above-target sickness rate?
Pauline Howie:
I cannot give that figure off the top of my head, but—
David Stewart:
I did not think that you would be able to.
Pauline Howie:
I can certainly get back to you, because we monitor that through our finance department.
David Stewart:
Thank you very much for that.
The Convener:
That would be helpful.