Getting back to business

How will new initiatives help stem the sickness absence tide? By Nic Paton

The CBI and AXA’s annual survey of workplace absence is always a significant
fixture in the OH calendar. But this year, more than most, it has given the
profession food for thought.

The newspaper headlines, perhaps inevitably, picked up on the findings that
workplace absence had increased for the first time in five years, and is now
costing the UK more than £11bn a year. Businesses, the survey warns, are also
losing billions as staff take ‘unwarranted’ long-weekends and ‘sickies’.

While the figures are certainly important, perhaps of more interest to the
OH profession will be how employers are actually dealing with these rising
absence rates.

What is clear from the study is that many employers, far from sitting back
and wringing their hands, are finally embracing what OH professionals have been
saying for years. Namely, that early intervention and rehabilitation works;
that with a bit of thought and planning, absence can be managed effectively and
that OH needs to be a key partner in this process.

Certainly, there is a distinct sense that firms are beginning to take a more
proactive approach to absence. In May, supermarket giant Tesco grabbed the
headlines when it announced that it had begun testing a scheme whereby workers
would not be paid for the first three days they were off sick.

The trial, taking place in 20 selected stores, was part of a three-pronged
strategy to reduce ‘sickies’, with Tesco also offering extra holiday, which it
hoped staff would use for the odd day off when they might otherwise have called
in sick, and a voucher scheme to reward those who did not take time off for

Asda, Sainsbury’s, Debenhams and Next announced they were to follow suit, or
already had similar schemes.

A few days later, the Health and Safety Executive (HSE) unveiled the next
stage in its process of drawing up management standards to help employers
manage workplace stress.

The HSE published its initial draft set of standards in 2002 and has since
taken soundings and run pilot schemes, which finished at the end of last year.
It has now published a new set of draft standards, and launched a further
three-month consultation scheme.

The standards are based on six key areas – demands, control, support,
relationships, role and change – with employees asked to rate their
satisfaction levels in each area. Employers must then achieve specified
organisation-wide satisfaction percentages, ranging from 65 to 85 per cent.

The Tesco strategy has certainly met with a mixed response. Despite the fact
that it appears to be backed by employees – shopworkers’ union Usdaw supported
it – organisations such as The Work Foundation have warned it will not tackle
long-term absence.

The Chartered Institute of Personnel and Development, meanwhile, is worried
it could make workers who are genuinely off sick for a short period feel

For OH, there are a number of worries about such schemes. Will staff on
lower incomes who are genuinely sick force themselves to come into to work to
avoid losing money? If so, will such schemes in fact hinder recovery and simply
cause germs to be spread between other workers?

What, too, happens when the worker gets beyond the three-day period and is
still off sick? If they then get backdated sick pay, might that not simply
encourage workers to take more time off than they might have done otherwise?

What’s more, the CBI/AXA survey points to the fact that, while short-term
absence obviously does need to be addressed, it is, in many ways, long-term
absence that many employers need to be more concerned about.

Long-term absence accounts for just 5 per cent of all absence among the 500
businesses polled, but is responsible for a third of the total time lost, the
survey reports.

The survey also reveals that larger companies generally have higher absence
levels than smaller ones and, while most companies monitor and kept records on
absence, absence levels fall when senior management became involved.

It appears the vast majority of employers (85 per cent) are now taking
action to reduce absence, with return-to-work interviews found to have the
greatest impact on absence levels

Critically, from the OH perspective, an increased proportion of companies
(from 28 per cent in 2001 to 51 per cent in 2002) now have rehabilitation
policies in place. More than three-quarters of firms have arrangements, either
formal or informal, to help employees suffering from stress. And most (98 per
cent) use sickness self-certification, normally for the first seven days of

When it comes to accessing occupational health, larger companies are more
likely to use OH professionals and are also more likely to think they are best
placed to assess employees’ health. Of firms with 499-5,000 staff, 90 per cent
use OH and rank them 4.7 on a scale of 1 to 5. But only 53 per cent of
companies with fewer than 50 workers use OH professionals, tending to rely more
on GPs.

"Given that many GPs do not believe they are best placed to assess
employees’ fitness to work for periods of short-term absence, this could
suggest that further work needs to be done to educate smaller firms on the
relative merits of self-certification and short-term absence management,"
the report concludes.

Creating a climate whereby businesses identify absence, particularly in the
short-term, with ‘malingerers’, is missing the point, suggests Dudley Lusted,
head of corporate healthcare development at AXA.

"In some organisations, there is frequent short-term absence, and OH
needs to work with this, but it should not be medicalising what is probably a
management issue," he says.

"Before a manager goes in with all guns firing, they should talk to OH
to make sure there is not a genuine medical reason underlying it. When there is
an absence problem, you need to determine what the problem is," he adds.

What is encouraging is the growing recognition among employers that short-term
and long-term absence are different beasts, and therefore, health
professionals, particularly OH, need to manage them in different ways. This
change can be seen particularly in the spread of rehabilitation services,
Lusted says.

"Two years ago, it was virtually non-existent, now two-thirds have some
sort of rehabilitation service. It has gone from 20 per cent to 40 per cent and
now to 60 per cent providing some level of rehabilitation for their
employees," he says.

This might be as simple as offering flexible working, or more complex
solutions such as offering early medical or surgical intervention.
"Employers are realising that if you do not help people back, then they do
not come back. Employers are taking a much more proactive stance on this,"
he adds.

While stress is clearly just one form of absence, the HSE’s draft standards
are very much about trying to push employers in this same proactive direction,
argues Chris Rowe, head of psycho-social issues at the HSE.

"What we have been trying to develop for more than a year now, within
the pilot organisations, is a framework that the employer feels comfortable
using to tackle work-related stress. We believe that a lot of work-related
stress can be tackled by organisational intervention," he says.

The frameworks could be put into place by a variety of people within the
organisation, not just OH, using health and safety, risk management, HR and so
on, he suggests. "Increasing stress is being seen as an issue for HR to
deal with. The experience of the pilot organisations is that HR has an
important role to play, either jointly with OH or sometimes taking the
lead," he explains.

Therefore, one of the key aims of the HSE process is education – raising
awareness among HR that stress is not just an issue to be shunted on to OH.
And, among OH, that stress needs to sometimes be addressed in tandem with HR.

"OH providers are essential to support whatever needs to be put into
place. We are getting more and more examples of people prepared to stand up and
say ‘we are prepared to tackle this in a structured way’," says Rowe.
"OH can help in getting things set up."

The role of GPs in all this is central. The Government and GPs are both keen
to shift sicknote responsibility to other healthcare professionals, including
OH, with GPs looking to have advanced some way down that road by 2006.

The Department for Work and Pensions (DWP) has indicated it is now seriously
looking at what options are feasible, and how to tackle the culture in which
GPs sign people off sick far too easily. Pilots examining how such schemes
might work were due to be launched in April but, as yet, appear not to have got
off the starting block. Nevertheless, an initial report into the issue is due
to be published by the DWP this summer.

"GPs are often in a situation where they do not necessarily understand
the challenges of what people are dealing with at work, so it is difficult for
them to advise what may be appropriate for them in the workplace," says
Rowe. "Having occupational health’s engagement early on can help."

Where workplace stress is reported, it should be sounding alarm bells, not
just dismissed as an individual’s problem or issue, he adds. "It’s more
likely there are fundamental organisational issues that need to be addressed
and explored. It could be there’s nothing, that it is just a dip, or there
could be a set of other circumstances, but it could disguise other
issues," Rowe says.

AXA’s Lusted, for one, believes the profession needs to grasp the
opportunity being presented by this focus on absence to make its presence felt
within the workplace. This is particularly the case within small companies,
where, as the report shows, there is still much work to be done to convince
employers of the profession’s worth and shift employers away from an
over-reliance on GPs.

"Where its [OH’s] role is much more valuable than that of a GP is that
it makes a functional assessment," he explains. "It’s not what you
cannot do, but what you can do, it is recognition that it’s about fitting the
job to the person, until they can do what they were originally employed to

With GPs looking to pass on responsibility, the HSE focusing firmly on
stress, and companies large and small increasingly recognising the value of
intervention and rehabilitation, OH has an opportunity to take centre stage.
But to do that it has to show its worth.

"OH can challenge the GP role on waiting lists and early intervention.
OH can get into even more prevention and support of line managers," argues

"But one of the things the OH fraternity needs to wake up to is the
need to demonstrate value, what are you doing better, what are you doing that
is benefiting the business?" he adds.

What the CBI said

– Total number of working days lost to absence rose for the
first time since 1989, caused by an 8 per cent rise in service sector absence

– Total days lost rose from 166 million in 2002 to 176 million
in 2003 – an average of 7.2 days per employee, up half a day, or 6 per cent

– The overall cost of workplace absence was £11.6bn in 2003, or
£475 per employee, covering salaries of absent workers, overtime and temporary

– Public sector staff took an average of two extra days sick a
year than their private sector colleagues, averaging 8.9 days a year and
costing £566 per employee

– Long-term absence accounted for5 per cent of all absence, but
was responsible for a third of the total time lost

– Manufacturing reported higher absence levels than the service
sector (7.4 days compared with 6.4), although service sector absence had gone
up 8 per cent, from 5.9 days last year

– Absence was highest in the North West (10.1 days), followed
by the east and north of England (8.1 days), Northern Ireland (8 days), Wales (7.8
days), east Midlands (7.3 days), southern England (7 days), south west and
south east England (6.9 days) and west Midlands (6.6 days)

– Lowest absence rates were in Yorkshire and Humberside (6.3
days), Greater London (6 days), and Scotland (5.6 days).

– Manual workers had significantly higher absence rates (8.7
days per employee) than non-manual workers (5.9 days).

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