Absent without leave

second article on sickness absence gives advice on how OH professionals can
positively influence an organisation’s sickness absence record.  By Linda Maynard

What are the trends in managing sickness absence today? Before this question
can be answered there is a need to understand whether sickness absence rates
are changing and to consider if the recording of absence has developed
effectively in order to provide worthwhile comparative data.

The main findings of the Confederation of British Industry’s fifth annual
absence survey, published in July 2001 shows sickness absence is still a big
problem. Data shows absence averaged 7.8 days per employee in 2000 which adds
up to 192 million days or 3.4 per cent of total working time. Public sector
workers continue to have a higher rate of absence, 10.2 days compared with 7.6
in the private sector1.

These absence rates have decreased over the past 10 years but the
Confederation of British Industry survey shows a wide difference in the
relative performance of employers. The lowest absence rates occur in
organisations which involve senior managers in the everyday management of

No consistent recording of absence

One of the problems with these "snapshots" of sickness absence
rates is that there is no consistent method of defining sickness absence
between companies. Each organisation will have its own way of recording
absence, normally the line manager’s role, which may then be fed to a central
office to produce a rate of absence. This makes comparative studies complex –
even between organisations that work in the same industry. It also means that
assessment of whether management of absence is effective is not

Dr Stuart Whitaker of the Institute of Occupational Health in Birmingham defines
sickness absence as, "Absence from work that is attributed to sickness by
the employee and accepted as such by the employer"2.

Whitaker goes on to state that probably the most common way in the UK of determining
the average (mean) rate of absence is to calculate lost hours over contracted
hours, while not adjusting for annual leave, but excluding maternity leave.
Other lost time such as doctor, dental or hospital appointments are discounted.

These rates of absence do not reflect the pattern of absence, although some
organisations do record the medical reasons for absence and this helps to
inform management of any trends. The usual method of standardising the medical
information is to use the medical coding book, the International Statistical
Classification of Diseases and Related Health Problems, ICD-10, published by
the World Health Organisation. However, this coding is thought by many to be
too complicated and of not use to managers coping with sickness absence. The
codes also do not directly take into account those absences caused or related
to work and therefore this specific information is normally not available.

Some organisations are actively working on the issue of sickness absence
data collection in order to produce statistics that are useful for benchmarking
purposes. The Black Country NHS Personnel Consortium, in conjunction with the
Institute of Occupational Health in Birmingham, is a good example, with nine
NHS trusts having agreed a common approach to recording sickness absence data.
They have a definition of sickness absence used by all the trusts involved and
have now produced data that are comparable between the nine organisations.

Trends in managing absence

Many organisations have now turned their approach to managing sickness
absence to more positive "managing attendance" policies and
programmes to help line managers deal with this issue.

Comprehensive policies may include information on proactive OH involvement,
"healthy workplace initiatives", absence management training for line
managers, return to work interviews and a more open approach to illnesses such
as mental health problems. Trigger levels are normally set relating to
"unacceptable" amounts or frequencies of sickness, at which point
early consultation with the worker should take place.

Referral may be made to the occupational health department for an
independent opinion and advice. The emphasis is on keeping individuals at work
and if necessary, temporarily redeploying them to a more suitable role or
phasing their return to employment.

If patterns of absence can be identified from the sickness absence rates,
such as the reasons and duration of sickness analysed by occupational group, or
noted after a group of similar referrals, this can help managers make earlier
referrals to OH. It also helps to take a broader, proactive approach in
reducing sickness generally. Analysis of data can help in identifying possible
causes of absence such as an unsafe practice, exposure to hazardous substances
or organisational change.

OH professionals normally see referred employees in order to offer impartial
advice concerning fitness and to assess if any appropriate interventions are
necessary to help rehabilitate the individual back to work. Workplace visits
may be required, organised by the manager, in order to assess the environment
and any relevant health and safety training.

The benefits of using this approach are usually measured using
organisational targets against which to assess the reduction or otherwise in
rates of absence.

Disability awareness

Legislation such as the Disability Discrimination Act 1995 continues to
raise employer awareness of disabled employees in the workplace. The management
of individuals who become disabled as a result of sickness, may require the
company to make "reasonable adjustments" before they can return to
the job.

Appropriate and efficient rehabilitation is a key target in the document
Revitalising Health and Safety jointly produced by the HSC, HSE, and DETR in
2000. The Government is looking to strengthen the retention and rehabilitation
services for workers who become disabled or have persistent sickness.
"Vocational rehabilitation" is defined as "the process whereby
those disadvantaged by illness or disability can be enabled to access, maintain
or return to employment, or another useful occupation"3.

So often return to work is delayed because there is a wait for NHS
therapies. Some companies will pay for an employee to have a course of physiotherapy,
for example, in order to aid the return to work. But not all organisations are
in a position to offer this help.

It is acknowledged that the longer individuals are off work the less chance
they have of returning and that few workers return to any job if they are
absent for one to two years3.

A case-management approach

Many organisations with good sickness absence frameworks now practise a case
management approach by reviewing longer-term cases on a regular basis. Case
conferences are held, usually attended by OH, the line manager and human

This provides an excellent opportunity for all parties to be kept up to
date, offer advice and agree on the appropriate action to be taken.

A recent report, published by the British Society for Rehabilitative
Medicine3 entitled Vocational Rehabilitation – the Way Forward highlights an
increasing separation of employment and health services in rehabilitating
people back into work. The emphasis has changed to a focus on promoting general
independence rather than getting back to work.

As well as NHS professionals facilitating return to employment, it points
out the potential value of OH services in this area. But there is also
recognition that there are often uneasy relationships between OH professionals,
GPs and hospitals, as well as patchy OH provision. Among the main
recommendations a call is made for closer liaison with OH services and that
early, professional and accessible vocational rehabilitation should be
equitably available early following illness or injury.

The report supports the effectiveness of the case management approach
particularly for people with complex disabilities.

One of the most effective approaches to managing sickness absence
highlighted in the CBI survey1 quoted earlier, appears to be in focusing the
human resource policies of the organisation on the actual causes of sickness
absence in the company.

But how are all the true causes identified? Wider, often interactive factors
other than disease may affect why an individual may become "sick" and
therefore takes absence from work. Whitaker2 argues that new and innovative
approaches which involve managers, the OH service, HR and workers’
representatives are needed which recognise these often non-medical psychosocial

The different perspectives, originating from different disciplines such as
sociology and organisational psychology, include:

– Social insurance systems, benefits payments and medical certification
practices. Employers are now bearing more of the initial costs of sickness
absence. In some companies employees have become self-employed making them
responsible for their own sickness absence costs

– Job security, availability of alternative employment and the economic

– Organisational factors such as the size of the enterprise, HR policies and
management procedures

– Companies with proactive policies and procedures, for example, that
promote family friendly actions may influence absence figures

– Job satisfaction, motivation to attend, workplace stress and the
psychosocial work environment

– Individual factors – personality, social support and circumstances, sex,
marital status and ill health.

OH professionals have long acknowledged that these broader issues, particularly
the human factors, may affect the health of the workers. Bailey4 states the
main interactive human factors affecting attendance at work are motivation,
personality and work design, and the perceived structure of the work climate.

He goes on to argue that by measuring the relationship between the
motivation to attend work as a satisfying experience along with the personality
of the individual employees and the design of their jobs and the work climate,
employers are better placed to introduce stress management interventions in the

In working alongside managers and other stakeholders in the business,
occupational health professionals can positively influence attendance issues.
Continuing the HSE theme "good health is good business" means being
involved if possible at a senior level and understanding the organisation and
the economic climate within which the company is operating.


There does appear to be progress in developing useful rates of sickness
absence data based on an agreed definition, which can be used to increase
awareness of patterns and inform appropriate action.

The important role of rehabilitation in returning individuals to work is at
last being acknowledged with the inclusion of the occupational health professional.

The OH role in supporting organisations also appears to be growing to enable
employers to consider the broader factors that may be having an effect on
health and absence, and to be proactive in dealing with these broader, often
external influences.

The role of occupational health in providing advice on individual cases is
valuable but the wider picture needs to be remembered.


1. http://www.cbi.org.uk

2. Whitaker, S. (2001) The Management of Sickness Absence Occupational and
Environmental Medicine 58(6), Jun I, 420-424

3. British Society of Rehabilitative Medicine (2000) Vocational
Rehabilitation. The Way Forward. London: BSRM

4. Bailey, R. (1998) Attendance Allowance Occupational Health April 23-25

A standardised approach

– The standard approach to sickness
absence used by the Black Country NHS Personnel Consortium records as follows:

1. Lost hours over contracted hours

2. No adjustment for annual leave

3. Maternity leave is excluded

4. Partial shift absences, hospital appointments, etc, are

– Data is collected by line managers and fed to a central
system in each trust

– The information collected is the most reliable comparable
sickness absence data currently available in the NHS

– HR personnel select a particular ward and time period to
audit data collected and compare to that already captured?  Results are fed back to managers, including
information on over and under-reporting of absences

– Reason for absence is currently being piloted in three of the
trusts. The system aims to capture hours of absence and medical reason for
absence. Ten categories (e.g. musculoskeletal problems, mental health problems,
etc.) subdivided into defined problems

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