NHS Trusts in the North West had the highest rates of staff sickness of any region in the UK this year, continuing a trend that dates back to at least 2020.
The NHS began reporting the region with the highest sickness rate in January 2020. Since then, staff working within North West NHS trusts have consistently taken a greater percentage of time off sick than any other region England – with the exception of January 2021 and April 2022, when the North West was joined by the East of England, then Yorkshire and the North East, respectively.
Psychiatric illness - including anxiety, stress and depression - is the leading cause of absences in NHS England, and in the North West 30.6% of all absences were attributed to this category between January and June 2024.
During this period, over 22.25 million - or 5.8% of NHS staff’s available working days - were lost to sickness in the North West, compared to a national rate across NHS England of 4.9%.
The highest recorded rate of sickness across the entirety of the UK’s labour market in the last 20 years was in 2004 at 2.7% (excluding figures for 2023 and 2024 which have not been released yet).
“It felt like an unsafe environment”
Helen (not her real name), a biomedical scientist in the North West, echoed the opinion of most of the sources we spoke to when she told us that schemes to improve mental health in her organisation felt tokenistic given that underlying structural and cultural issues were not being addressed.
She said: “I think sometimes it's a bit of a tick box exercise.
“It’s all about making staff more resilient - and I hate that word ‘resilience’.
“It's almost like we've got to toughen you up to cope with an environment that's incredibly hostile.”
Helen described issues including lack of time to complete training, lack of staff, and an expectation that staff would perform multiple duties at once (for example being expected to answer the phone on top of urgent laboratory work).
She said: “It felt like an unsafe environment.
“It's not like selling loaves of bread - when you're working in [emergency healthcare] and there's not enough people, I find that very, very scary.”
Mersey Care NHS Trust
Mersey Care NHS Trust in Liverpool had the highest rate of sickness in the North West, and fourth in the country at 7.5% across the six-month period.
Perhaps more alarmingly, 36.3% of sickness absences taken at Mersey Care were for mental health reasons. These absences comprised 2.7% of its available working days - the second highest in the country.
A Mersey Care NHS Foundation Trust spokesperson said that they were aware of the high rates of sickness and had taken steps to address the issue.
He said: “As an employer who has signed up to Liverpool City Region’s Fair Employment Charter, the health and wellbeing of our workforce is one of our highest priorities.
“As part of that, we have implemented a new programme which takes a preventative and holistic approach, as well as offering counselling and complex psychological interventions and has also reviewed policies.”
The spokesperson pointed to a number of contributory factors including the organisational change incurred by recent acquisitions (including the North West Boroughs Healthcare NHS Foundation Trust in 2021) and their being one of the largest community and mental health, and one of only three providers of high secure care, in the country.
He said: “Our staff will care for some of the most complex and vulnerable people in society and with this comes levels of stress that other organisations may not experience.”
The spokesperson also pointed to research published by the British Medical Journal in 2022, which investigated whether there was a link between the high proportion of Mersey Care’s workforce living in areas of high deprivation.
The report did find that there were higher sickness rates among employees living in deprived areas, but concluded that this difference was mostly associated with staff working within lower wage bands or being employed in nursing and nursing assistant roles.
It suggested that, as a community and mental health organisation, Mersey Care has a higher proportion of staff in these groups than the NHS as a whole.
“There was no time to breathe”
Philip (not his real name) told us about his experience as occupational therapist for both the NHS and local authorities in the North West.
He said that a big driver of burnout in NHS staff is the guilt attached to refusing work, either on the grounds of feeling underqualified or because they are already overwhelmed with their existing workload.
“There was no time to breathe,” he said. “When you want that catch-up time you weren’t getting it.”
He said that she once refused a case on the grounds that she had no prior experience working with children, was new to her role, and lacked adequate training.
“When I was raising it with seniors, I got the impression that they didn’t like the fact that I was questioning them,” he said.
“They made it quite difficult for me,” he continued, explaining that he was subjected to high levels of scrutiny on cases for which he had not been given sufficient probationary training.
“There were times where I didn’t want to go into work,” Philip said. “I felt anxious a lot - quite nervous that I was going to get another case that I felt I wasn’t qualified enough to do at that stage.”
North West Ambulance Service
North West Ambulance Service had the second highest sickness rate in the North West, and fifth in the country, losing 7.3% of working days to sickness.
However, this is less exceptional given that ambulance staff consistently have the highest sickness rates of any NHS staff group.
A spokesperson for NWAS pointed out that they have reduced staff absence rates over the last few years, which were over 10% during the pandemic and that their current figures are comparable with the rest of the ambulance sector.
They have also reduced the rate of mental health-related absences by 20% in the last two years.
They said: “We have improved access to well-being support through occupational health and internal well-being teams focused on mental health and physio treatment.
“We have given support and training to line managers so they can better support their teams and help those returning to work.
“We have also held events within the organisation to reduce the stigmas of mental health and highlight the support available while also identifying further areas for improvement.”
Greater Manchester ICB: "I would work 50/60 hour weeks"
Greater Manchester ICB had the lowest rates of staff sickness in the North West at 3.6%, but 39.9% of these sick days were taken for mental health reasons.
James (not his real name), who has worked at Greater Manchester ICB, told us that the transition from CCGs to the ICB had created new pressures on staff, who were sometimes vying for duplicated roles.
He said that the NHS’s Mutually Agreed Resignation Scheme (MARS) - whereby employees receive severance pay in return for their resignation - created gaps in the workforce and had increased the workload for remaining staff.
When asked about what James had told us, Chief People Officer at Greater Manchester ICB Janet Wilkinson recognised that the transition to becoming Greater Manchester ICB had been a period of significant organisational change.
She said: “We acknowledge that change can cause uncertainty, and we worked with all organisations that merged to try and minimise disruption and create an organisation with the right skills in place to improve our population’s health and wellbeing, tackle inequalities and ensure everyone experiences high quality care and support.
“The Mutually Agreed Resignation Schemes were just one of numerous measures taken to remove unwarranted duplication, with applications only being supported, and approved if teams could demonstrate that they could effectively manage their work and departments.”
However, James also suggested that the issues went beyond the structural changes incurred by the transition.
James said: “There is this culture in the NHS - and it’s always been there - that you’ve got to feel extremely grateful.
“That because you’re paid a decent amount of money that you should be available to answer emails at 10 o’clock at night.
"I would work 50/60 hour weeks, I would be expected to answer emails on a weekend - it’s an unwritten rule in the NHS."
Ms Wilkinson said that the ICB was “saddened and concerned” by the experience James described, but pointed toward existing mechanisms in place to support staff.
These include an employee assistance programme which is a free and confidential advice service for employees; a wellbeing toolkit to support people to look after themselves and others; wellbeing champions and employee networks; trade union representation and Freedom to Speak Up (FTSU) guardians.
FTSU guardians are part of a national scheme created in response to a 2015 independent review which found that NHS staff were reluctant to raise concerns about their workplace for fear of repercussions or because their concerns would not be acted upon. The guardians are trained to support staff in raising concerns and ensure that action is taken.
Ms Wilkinson said: “We value every colleague in the NHS Greater Manchester team and are continually committed to listening to their feedback.
"No staff member is expected to work beyond their contractual hours. We recognise that heavy workloads can contribute to stress and anxiety, and we encourage all staff to discuss their workload with their manager, to ensure it is manageable.
"Anyone who feels they need support is encouraged to speak to their line manager, our wellbeing champions, or a Freedom to Speak Up Guardian.”
Feature Image by Jeremy Bishop on Unsplash
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