Employer initiatives: Sweet smell of success

In the late 1990s and continuing into the 2000s, Cadbury Trebor Bassett had been experiencing high levels of sickness absence – around 6 per cent, with half of this due to long-term absence – among the manual employees at four of its UK chocolate manufacturing sites.

There was no formal scheme or policy in place to deal with these longer term health problems. Instead, they were considered on a case-by-case basis, with money to fast-track private treatment being made available in some instances but not in others.

According to Dr Paul Kanas, head of OH at Cadbury Trebor Bassett, this approach had two drawbacks. First, inconsistency in provision of early intervention could lead some untreated employees to feel resentful or unappreciated.

Second, it was slow, as budgetary approval had to be obtained before treatment could begin. This meant that early intervention tended to be exceptional, with most employees depending upon the NHS for their care. This could have a significant effect. For example, an employee with low back pain could be off work for up to three months waiting to see a consultant and then for a further five months waiting for an MRI scan – a total of eight months simply to obtain a medical diagnosis.

Delivering the solution
Following discussions with trade union representatives, Cadbury Trebor Bassett decided to introduce medical cover for 2,100 of its factory-based manual employees.

Following a competitive tender, Cadbury Trebor Bassett selected AXA PPP healthcare to provide these employees with ‘Back to Health’.
To introduce the scheme, the company wrote to all of the employees to be covered with details of its benefits and how to claim. It also ran briefings with small groups of employees to enable them to ask questions about the operation of the scheme.

Unlike most traditional corporate healthcare schemes (where employers provide comprehensive cover as a perk for senior managers), ‘Back to Health’ focuses on treatment of only those medical conditions that prevent staff from working or carrying out their normal duties.

Benefits include cover for eligible in-patient and out-patient treatment (including psychiatric care), and for out-patient consultations and diagnostic investigations (including scans). And, because of its business focus, ‘Back to Health’ – at around 150 per employee – is only about one-third of the cost of the traditional cover.

The achievement
Some striking results were obtained in the first 15 months of the scheme’s operation (December 2001 to February 2003). Over this period, 117 employees were treated, with Cadbury Trebor Bassett saving 3,400 days that otherwise would have been lost to sickness absence, equating to 1.6 days saved for every employee covered.

A comparison of NHS waiting times (obtained on a case-by-case basis by reference to the performance/waiting times section of www.nhs.uk, which provides data for individual specialists and trusts/hospitals) and private treatment waiting times (the number of days employees actually waited for consultations and treatment) for the various causes of long-term absence experienced by manual employees at Cadbury Trebor Bassett readily demonstrates the savings.

For example, for an employee with a damaged anterior cruciate ligament, the waiting time for an initial NHS out-patient consultation with their specialist was 115 days, compared with six days for a private appointment. From that point, the NHS waiting time for the operation was 315 days, whereas the employee obtained private treatment in 41 days. This equates to overall waiting times of 430 days and 47 days for NHS and private treatment, respectively – a saving of 383 lost days of work.

In another case (repair of a recurrent inguinal hernia), the NHS out-patient and in-patient waits were 42 days and 294 days, compared with 15 days and 27 days for private treatment (equating to overall waiting times of 336 days and 42 days for NHS and private treatment, respectively – a saving of 294 lost days of work).

For another employee (needing carpal tunnel release), the NHS in-patient and out-patient waits were 147 days and 280 days, compared with 10 days and 34 days for private treatment (equating to overall waiting times of 427 days and 44 days for NHS and private treatment, respectively – a saving of 383 lost days of work.).

Taking into account the cost of days lost to sickness absence, as well as the cost of reduced productivity of employees only able to perform limited duties, the overall saving to Cadbury Trebor Bassett – using its own internal ‘cost per absence day’ metrics – is as follows:



  • Cost of absence saved £779,000
  • Cost of ‘Back to Health’ £321,000
  • Total savings £458,000


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