Employer initiatives: Why the gimmicks don't work

Recent months have seen a flurry of innovative employer initiatives aimed at tackling sickness absence, such as British Airways’ £1,000 bonus for staff taking less than 16 days sick leave over the next two years.

Other schemes have included Royal Mail’s offer of the chance to win a car as a reward for employees not taking time off for six months, and retailer Tesco’s trial withdrawal of sick pay for the first three days of absence.

Initiatives such as these are pretty much guaranteed to seize the headlines, but they run the risk of being short-term fixes penalising the genuinely ill – unless they form part of a holistic, structured approach to absence management with occupational health on centre stage.

Stephen Bevan, director of research at research body The Work Foundation, says: “Employers need to take a holistic view of employee well-being. Too many are trying to deal with absence as a cause rather than a symptom of the long-hours culture, poor job design or problems with interactions at work.”

The cost of sickeness absence

Sick leave costs business more than £11bn each year, according to the Confederation of British Industry (CBI), and the average cost of sickness absence per employee rose by 3.7 per cent to £588 in 2003, according to the Chartered Institute of Personnel and Development (CIPD) in its 2004 absence survey.

More than 90 per cent of employers consider sickness absence to be a significant or very significant cost to the business, says the CIPD.

Recent months have also seen various government drives aimed at addressing sickness absence. In November, the Health & Safety Executive (HSE) published its management standards on stress and the Government’s White Paper, Choosing Health: Making Healthy Choices Easier, urged employers to be more active in health promotion and to encourage ill employees back to work as soon as possible.

The need for early intervention was also stressed in the Department of Work and Pensions’ report Building capacity for work: a UK framework for vocational rehabilitation, published the previous month.

Against such a backdrop with sickness absence very much in the news, the pressure is on OH to come up with long-term solutions that take into account the broader picture.

TUC health and safety officer, Tom Mellish, says: “Employers need to establish whether people are off sick because of the working structure of the organisation. They need to look at things like carers’ leave and the opportunity for people to deal with domestic things, such as the boiler man coming. There needs to be more flexibility and multi-skilling so that a colleague can take the place of someone needing time off,” he says.

While it is important to have systems in place to identify and manage malingerers, most people only take off when they have genuine reasons. The TUC’s survey, Don’t be a mucus trooper, published in January 2004, says that 42 per cent of workers struggle into work when they feel too ill because they do not want to let their colleagues down.

The average number of days lost in 2003 through absence was 9.1 per employee per year, or four per cent of total working hours, a rise of 0.1 per cent on the previous year, according to the CIPD.

BA’s multi-pronged approach

Absence from work costs British Airways (BA) £60m a year. At 17 days lost through sickness per employee, BA’s yearly average was way above the national average.

The airline’s bonus offer was one part of a multi-pronged absence management initiative, aimed at slashing the yearly average to 10 days. In October, BA streamlined 20 absence policies into one to allow more equitable treatment of employees.

The airline introduced return-to-work discussions to spot any problems earlier, offering appropriate support. Employees now have to complete absence declaration forms outlining reasons for absence.

“The emphasis is on being supportive, not punitive,” says head of OH services Judy Cook. “We are now concentrating on better recording to allow us to target support much more accurately than in the past. We will be able to differentiate between illness and childcare problems, for example.”

The airline has also launched an extensive rehabilitation scheme, the Employee Care Scheme, provided by QBE, BA’s employers’ liability insurers, to help people with work-related injuries return to work. It plans to speed up OH intervention and to extend rehabilitation services to include non-work-related injuries.

More than a third of employers involve the OH profession in managing absence, particularly if the absence is long-term, according to the CIPD’s absence survey. Some 60 per cent, compared to 54 per cent the previous year, rate the use of OH professionals as an effective tool for combating long-term absence.

Long-term absence represents only 5 per cent of absence cases but 33 per cent of days lost, at a cost to British business of more than £3.8bn a year, according to last year’s CBI figures. A recent EU survey found that the UK has the second highest number of workers suffering long-term sickness.

“Lots of companies are doing very well in tackling short-term absence with return-to-work interviews, line management training and improved data control, but we are seeing a big rise in long-term absence. Managers are not equipped to deal with that and need more help from OH,” says Bevan.

Bevan warns that schemes such as Tesco’s non-payment of sick pay are designed to tackle short-term rather than long-term absence. Tesco’s scheme also came under fire from critics, such as the Chartered Management Institute, for risking low morale and high turnover rates by making genuinely sick employees feel penalised.

Other options being piloted by Tesco include store vouchers for staff not taking sick leave within a 26-week period, and three days extra holiday. Feedback from staff has so far been positive, but the success of these schemes very much rests on them being part of a larger picture.

“Yes, we offer incentives but it is about taking a holistic approach and looking at illness in the context of having an interesting job and so on. In terms of OH, it is about working out what is best for individuals,” says a Tesco spokeswoman.

Putting in place measures to reduce stressors at work and to help employees deal with problems before they take time off is a key part of any successful approach to absence management. Stress was the main cause of absence in 2003 and is increasingly responsible for absence, according to the CIPD survey. More than half of employers experienced an increase in workplace stress in 2003.

Tackling sickness absence

Three-quarters of organisations are taking steps to tackle stress, such as flexible working and improved work-life balance options (almost two-thirds of respondents); risk assessments and stress audits (more than half), and training for managers and staff (55 per cent). Half of employers surveyed have introduced staff surveys and increased involvement of OH professionals. Some 26 per cent have brought in employee assistance programmes (EAPs).

Ben Willmott, employee relations adviser at the CIPD, says that collecting and measuring sickness absence data and benchmarking against other employers, particularly those in the same sector, is essential, allowing employers to be aware of particular problems in certain departments. “Absenteeism may be high because of working conditions or the management style of a certain manager, or lack of training,” he says.

Record-keeping can help OH pinpoint a single cause responsible for causing illness. “If coughs and colds seem to be an endemic problem, it could be something such as latex causing allergies in hospitals. Perhaps the cleaning regime needs to be changed, the ventilation examined or draughts cut out,” says Mellish from the TUC.

OH consultancy Active Health Partners says that one of the reasons occupational health fails to deliver anticipated results is because intervention comes too late.

“The main problem is that managers making referrals to the occupational health department are not medically trained or equipped to execute decisions regarding the employee’s health. Often the managers’ referrals are not relevant while those employees genuinely needing assistance are often neglected and slip the net,” Simon Longley, OH manager at Active Health Partners says.

Once an employee reaches a specific trigger under Active Health Partners’ absence measurement system, a nurse conducts an in-depth telephone interview, seeking consent to provide medical data to the manager and putting forward recommendations in a case report.

The DWP’s report on rehabilitation also stresses the benefits of early intervention but points out that people with the same clinical conditions and clinical diagnosis have different rates of returning to work.

Some 18 per cent of employers offer rehabilitation, according to the CIPD’s absence survey, while 12 per cent of employers appoint individual case managers or teams for employees requiring retention and rehabilitation support.

“It is not unusual for up to 30 medical and non-medical practitioners to be involved in helping an employee back to work, so having someone to act as a case manager to co-ordinate support and represent the needs of the employee and organisation is beneficial,” says the CIPD in a separate report, Recovery, rehabilitation and retention.

This case manager can be an OH professional or even a line or HR manager, if given advice and support by OH. The manager should take into account the individual’s capabilities and job requirements, make appropriate adjustments, and stay in touch with the individual for at least three months.

Willmott stresses the need for employers to work more closely with GPs. “GPs sign people off for long periods of time but do not reassess them before they return to work. This means opportunities for individuals to return to work in a less demanding role or part-time are often missed and individuals can feel alienated and daunted by the prospect of returning to the workplace,” he says.

Cook at BA emphasises the importance of liasing with GPs. She says that her role has increased and that she now has to be “much more focused”, helping managers with health related issues, providing advice for individuals, researching OH trends and working in partnerships.

“I cannot stress enough the importance of working in partnership with HR and others, making sure managers understand what our role is,” she says.

Bevan, of The Work Foundation, urges OH to work more closely with HR on absence management. “OH and HR can do masses together in terms of preventative work and practical health promotion. OH professionals should push themselves forward more, sign an armistice with HR and work in partnership,” he says.

Case Study Plymouth Hospital NHS Trust: Stemming the sickness absence tide

Plymouth Hospital NHS Trust has introduced an employee assistance programme (EAP) to help employees tackle their problems before they lead to absence.

“We are trying to head off problems before they start to affect the workplace, preventing people who need a lawyer from taking time off, offering advice on dealing with the pressures of home life and so on,” says Simon Hill (right), head of staff health and welfare.

The EAP’s 24-hour confidential hotline offers the trust’s 6,500 employees and their immediate family telephone counselling and information services on topics such as finance, the law, eldercare, childcare and debt.

The EAP is one of a host of initiatives to tackle sickness absence launched under the banner Working Lives, following an extensive sickness absence study in July 2003. The study came up with 300 recommendations, of which introducing an EAP was one.

The EAP is run by external provider Personal Performance Consultants, and is designed to operate alongside the existing in-house counselling service, for which the trust has taken on a second counsellor, although the EAP is equipped to deal with emergencies.

The current level of usage is about 4.5 per cent of staff. Hill envisages usage will increase as staff’s trust in the confidentiality of the service grows.

The trust used staff and manager briefing sessions; internal newsletters, e-mail and personalised briefing notes to market the EAP. Staff training, induction and posters are also being used post-launch.

The trust has also introduced a stress policy based on Health & Safety Executive (HSE) recommendations.

“We’re finding this very useful. Most stress policies seem to deal with the results of stress rather than prevention, which is what we’re interested in.”

If, for example, an individual highlights a team issue as a problem, the trust may use the HSE’s first level stress risk assessment tool and work out how to resolve the problem. Difficulties among employees of one large department were recently identified, so Hill and Val Brookes, head of organisational development, designed a two-day focus group to help staff work through their organisational problems, with OH in a consultancy role.

“There is no formula solution so we have to have lots of tools in the toolbox and as issues arise, we have to be clear what we are dealing with and develop a bespoke tool to tackle them,” says Hill.

Hill says it is often little things that cause problems, such as employees being irritated by colleagues smoking outside the window, or by clutter mounting up in corridors.

Other changes have included revamping existing HR policies, such as the absence policy, recruiting a second physiotherapist and manual handling adviser, which brings up the OH team to 28 staff.

Plans for the future include buying in some absence management software, making membership of the health and leisure centre free for all staff and becoming a smoke-free site by September 2007.

Learning points

Make sure HR and line managers understand how to use OH services
Work closely with HR and line managers on health promotion activities, such as fitness campaigns
Carry out risk assessments to highlight potential causes of staff absence
Keep records of sickness levels and put in place trigger systems to identify problems and patterns
Benchmark against other employers
Carry out stress audits and consider use of in-house counsellors and an employee assistance programme to help tackle stress
Make sure ill employees have return-to-work interviews to pick up any problems as early as possible
Work closely with GPs to ensure opportunities for employees to return to work in reduced capacities are not missed
Offer extensive rehabilitation to help get employees back to work, allotting a case manager to each individual.