Do first-day absence schemes really work?

As we consider innovations in attendance management, it is important that we examine the reality, not the marketing hype.

First-day absence schemes – where staff who phone in sick are asked a range of questions about their symptoms on the first day of absence by nurses based in a call centre – have been the focus of considerable media interest. However, there is no robust or independent evidence that these schemes make a worthwhile contribution to attendance management. Worse still, there is some early evidence that these schemes have the potential to divert management attention away from effective attendance management.

Most prominent among the organisations offering these services have been Active Health Partners (AHP) and FirstCare (FC). They have been highly effective in getting the media’s attention – for example, being featured in an episode of Tonight with Trevor McDonald earlier this year.

The unsubstantiated claims of AHP were also repeated in the recent National Audit Office report on managing attendance, giving the claims an air of legitimacy.

These organisations claim that first-day absence schemes have reduced absence rates by up to 30% (AHP) and 40% (FC) – impressive claims that capture our attention.

However, it is important to note that there is no data to suggest that schemes of this type have been successful in the US or Scandinavia or anywhere else where they have been used. There is nothing in HR or health literature, and there is no such evidence presented on the websites of the first-day-of-absence service providers themselves.

Publicity v reality

The most well-publicised UK scheme is the first-day absence scheme at York Council. It used the services of AHP, which reported “27% less frequency in absence during first three months”, while York Council described the scheme as “successful”.

However, the reality was that after five months, as York Council reports, “the number of days actually lost to absence increased by 3.3%”, which was attributed to an increase in long-term absence.

This scheme has not been without its critics. The York pilot scheme, first introduced in 2004, was extended in December 2005. It has been reported that absence rates had changed from 25.8 days a year to 23.2 days after the scheme was introduced. In December 2005, Unison threatened a ballot if the scheme continued, and suggested that the change in absence rates was “largely due to HR addressing long-term sicknesses.”

In another report in March 2006, more than 18 months after the scheme began, the council reported that absence was still “unacceptably high”. It seems likely that the absence rate for York Council may be less than 12 days per annum in the current year 2005-06 (compared with 12.2 in 2003-04). After pressure from unions, the council is now reviewing its attendance policy.

It is extremely difficult to obtain robust data that measures the contribution of these schemes. There is virtually no information available from schemes other than York Council, although the list of organisations trying this approach continues to grow.

The Warwick University study that was commissioned by the Department of Health and which included a review of some of AHP’s work has not been published in open literature.

The risk

In an interview on Channel 4 News, the managing director of one of the providers said: “It’s the manager’s responsibility to manage absence within a business. We don’t get in the way of that.” While the manager’s responsibility is not disputed, there is a substantial risk that schemes of this kind get in the way of effective attendance management.

In the York pilot, although episodes of absence decreased, absence rates actually rose. The reasons for this are not reported, but these statistics highlight the significant risk that outsourcing the responsibility to receive and consider absence reports could lead to managers seeing absence as someone else’s problem.

The initial increase in absence at York appears to have been caused by a lack of focus on longer term absence while the recent small improvement has been due to an increased focus on this (at least according to Unison).

There is no evidence that first-day absence schemes make a worthwhile contribution to attendance management (especially where current policy requires employees to report absence to managers). And there is no reason to believe that first-day absence schemes will make a significant contribution to attendance management where the primary issues for an employer are medium- and long-term absence.

<Dr Richard Preece is head of clinical leadership team at Atos Origin OHCSS.


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