Local authorities: An absent problem

Brent Council’s occupational health service has been transformed over the past few years, and the results are reflected in the dramatic reduction in its sickness absence rates.

Brent Council doesn’t have an internal OH department. Before 2002, OH was provided in a relatively ad hoc manner, with several occupational health providers working with different sections of the council. It provided a fairly sparse set of services, such as pre-employment screening and medical opinions for staff on long-term sick leave.

The relationship between Brent and the providers was not close, so key corporate objectives – chiefly employee wellbeing and driving down sickness absence – were not knitted in to OH services. Workers did not benefit from continuity – for example, they would see different doctors in different locations – and the message was not getting through about the importance of workplace attendance.

A new approach

When Brent designed a new approach to OH, we sought to address these shortcomings. The council looked for a single contractor able to work with a big, complex organisation such as a local authority. The two organisations then worked together to draw up a contract covering the kind of services the council needed and the roles and responsibilities of each party.

The essential thing was to have joint objectives, and the starting point for this was shared enthusiasm to create a better service. Occupational Health Westminster, the first provider appointed by the council, was keen to take the service to a new level. It felt that if it had a contract that specified the standard of service and how this should be monitored, it could produce a big improvement.

The council’s objectives included driving down sickness and reducing the associated costs, creating and maintaining a healthy workforce that was informed about illness and lifestyle, and improving opportunities for disabled people.

Achieving all this saves the council considerable sums of money, in line with the public sector’s efficiency agenda. It also contributes to a wider drive to perform well – high sickness rates equate to poor motivation, while an integrated and effective OH service demonstrates the council’s corporate strength and focus.

The biggest change that came out of the contract was in relation to sickness absence. Now, employees who hit the ‘trigger’ – a number of short absences, or more than nine days off in a year – must undergo a medical examination.

People on long-term sick leave are not left at home for six months – they are seen by a doctor after four to six weeks of absence. The doctor will give an opinion on the likely duration of the illness, whether or not the person will be able to return to regular and efficient service, and how they could be redeployed if required.

The council now has a counselling service, which is very popular. People can talk about anything that is on their minds – stress or conflict at work, health issues, personal problems such as divorce or bereavement, or financial problems.


Another aspect of the contract is management support. This is key in really complex cases, where staff have been off work for a long time, and their return to work is not straightforward. The council holds a case conference with the sick person, a family member or friend, the HR manager, the head of the OH service and a doctor from the service. All parties can voice their opinions and a joint decision is made about the employee’s return to work.

Other management support is broader. The OH service gives Brent general advice when it is drawing up policy in areas such as sickness, disability or legislation. It will also meet with service managers to look at trends, discuss the effect of management practices and think about ways forward.

At a quarterly meeting between myself and the provider, we examine how much the service has been used, and the main causes of sickness absence. We identified that up to 50% of referrals were stress-related, and out of this came a training programme for managers and workshops for employees. This was greatly appreciated, and we believe it was ground-breaking.

These services are expensive, but they are included in the cost of the contract, thus making the cost manageable.

Moreover, average annual sickness has fallen by more than three days to 8.56 in the year to April 2006 from 12 in 2003. This compares with a national average for large local authorities of 11.5 days per year in 2004-05. We have already saved an estimated £1.5m in payments to staff on sickness absence, and this would be perhaps two-thirds higher if we included savings on temporary cover and management time.

One policy the council has not yet put in place, but is very interested in, is a requirement for staff to go to an occupational health nurse for a sicknote. This appeals because an occupational health nurse typically spends up to half an hour with the employee, knows their history and has that crucial connection with the employer. By contrast, a GP spends about 10 minutes with the patient, will only see the situation from their point of view, and will often issue a sicknote more or less automatically.

Changing to OH-based sickness certification would have cost implications, but it might be possible to find a contractual basis for this service. Brent Council would be interested in piloting it for local government.

We have now moved to a new provider, National Britannia, purely on cost grounds, after a re-tendering process. The service it provides is broadly similar to the previous supplier. However, because this is a completely new relationship, we want to make it even closer, making sure our organisational objectives are even more thoroughly incorporated into what OH does.

The new provider started in April and in advance of this we revisited the key issues, such as stress and sickness absence. For example, we are planning a far-reaching change programme – the People Management Strategy.

Major transformational programmes can cause more sickness absence, so we want to plan how we manage change. We would also like to get the new contractor and the trade unions together – both have said they want to meet. Finally, we want concerted internal communications about healthy lifestyles, making use of the web, health promotion days and so on.


The new contract gives Brent an opportunity to be in the driving seat. There is a perennial issue that occupational health staff are strong, assertive professionals who may not fully take on board the objectives of the employer they are working with. However, we have considerable experience under our belt and it has been good. We are therefore looking forward to building an even closer, more balanced and more integrated relationship with our new occupational health provider.

Pat Keating is head of employee relations at Brent Council

Contacting the external OH service

Employees are referred to occupational health through their managers if their illness is affecting their work. The manager talks to an administrator first, then usually a nurse and, if necessary, an appointment is made. The service is nurse-led, with employees consulting a nurse first who decides whether the employee needs to see a doctor for a clinical decision about, for example, mental health.

Staff who want counselling can either contact the OH service directly on the day of the week that the counsellor is available, or make a series of appointments through their manager.

Rehabilitation case study

I was helped back to work at Brent Council by occupational health. I was off for six months in 2005 after I suffered from severe mental illness, best described as acute depression.

At work, I had lost all confidence and concentration. I began to lose weight and my ability to work to an acceptable level rapidly deteriorated. I finally broke down at work and disappeared for the better half of a day before colleagues found me. I was feeling desperately low – it was real heavy duty stuff.

I didn’t go to occupational health – it did occur to me, but I had already reached a point where I was so ill it didn’t seem to matter.

After I went off sick, I was hospitalised. As I gradually got better I realised how ill I had been, and I never thought I would be well enough to return to work.

However, the occupational health doctor gave me a great deal of support and encouragement. In particular, she was confident I was recovering and would return to work – that was very reassuring. I recognised she was representing the council, but she also had my interests at heart as well. She was very much a bridge between the council and me.

We did have a case conference, which I found quite nerve-racking. But the occupational health department went out of its way to make my wife and I feel comfortable. There was an expectation aired that I would return to work, and that there would be a satisfactory outcome.

I returned to work part-time, the hours increasing over several months. Brent was very cautious about the hours initially. My work is unpredictable, and I have a lower tolerance of uncertainty than I used to. Senior managers were supportive in trying to identify work which might be more suited to my skills.

I am relieved to be back. I’m still a little bit nervous, although everyone is saying I’m doing fine. Right now, I don’t use the occupational health service, but I know that it is available should I need it.


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