Occupational Health Review: Dossier

Cancers and mental ill health dominant causes of Civil Service absence


The total cost of the 4.12 million days’ absence taken by civil servants in 2006/07 was £393 million, or £887.66 per member of staff per year, according to the latest annual analysis1 of sickness data – 4% up on adjusted data for the previous financial year.


Long-term absence remains the most significant issue for the civil service, particularly in larger government departments – although just 5%-10% of civil servants had spells of long-term sick leave last year, these spells account for around 50%-60% of all days lost in the period. Long‑term absence accounted for more than 60% of total sick leave in several departments – including the Scottish Prison Service (69% of sick leave due to long-term absence), DVLA (68%) and the Vehicle and Operator Services Agency (66%). The average duration of a spell of absence rose from 5.7 days to 6.01 days last year, and the proportion of absence that is certificated (an indication of long-term absence) rose from 20.7% to 23.7%.


Recent trends in the headline figures for average working days lost per staff year are complicated by several factors, including a change in the reporting year from calendar to financial in the latest analysis and ongoing changes in the “machinery of government”, which make true year-on-year comparisons difficult. In addition, and significantly, one of the largest government departments, the Inland Revenue, did not submit usable data for the latest analysis due to the introduction of a new HR reporting system halfway through the period under review. Inland Revenue staff normally represent around one-fifth of the civil service population covered by the annual reviews of absence.


On average, civil servants were absent for 4.1% of working time in 2006/07, down slightly on the figure for the previous financial year, but up slightly if the Inland Revenue’s data is removed from the previous period.


The authors of the latest analysis also believe that the average working days lost figure for 2006/07 would have been higher if the Inland Revenue figures had been included, as this department’s staffing is more heavily weighted towards both female and younger staff, groups with historically higher than average absence. Despite this, and the other factors confusing the headline story, the analysts do conclude that overall, there is “some indication that there has been a reduction in average working time lost by civil servants since 2005″ (although their figures suggest that this reduction is very marginal – from 9.4 days to 9.3 days on average, adjusted, per staff year).


Just 7% of absences lasted more than a month, but it is these absences that have the biggest individual impact on the headline figures. Cancers and mental ill health continue to dominate the list of causes of long-term absence. Circulatory system conditions and musculoskeletal disorders (MSDs) dominate the list of medium-term absences, while respiratory system problems, including colds and ‘flu, were the most common reason for absence overall, accounting for 13% of all days lost despite tending to result in shorter duration absences than mental ill health and MSDs. A significant proportion of absence spells had an unknown cause, or were classified as “symptoms ill‑defined” – averaging between 10% and 20% of all days lost, but rising to 100% of all absence in the case of the government’s covert listening service, GCHQ.


A return to work on a Monday after absence is much more likely to result in a repeat spell of sick leave within two weeks, particularly in the case of long‑term absence, the report suggests. “Complications in pregnancy” is one of the absence categories with the highest number of repeat spells, indicating that for those pregnancies where there is a problem, these problems tend to re-occur.


This year’s analysis examines the causes of absence by department, showing a broadly consistent pattern: mental disorders account for the largest proportion of absence, followed by MSDs and respiratory system conditions. For example, mental disorders accounted for 26% of days lost by Job Centre Plus staff in 2006/07, while 16% and 12% were accounted for by MSDs and respiratory conditions respectively. Similarly, 23% of absences amongst Ministry of Defence staff were due to mental disorders, followed by 14% each due to the two other main causes. The authors of the report suggest that MSDs and mental disorders “have some of the highest chances of preventability and effective management of return to work”.


Reference


Analysis of sickness absence in the civil service 2006-07, Cabinet Office


Employment law and the BPS model of occupational ill health


The title of a recent Royal Society of Medicine occupational medicine seminar posed the question: “Sickness absence management in the 21st century – an insurmountable challenge for employers?”1 It considered how employment law is increasingly constraining employers’ freedom of action in the field of sickness absence management.


Unfair dismissal and disability discrimination law as it affects sickness absence management has become complex and difficult for employers, according to Anne Pritam, partner of legal firm Harewood Stephenson, who explained to the meeting some recent judgments in the UK courts, as well as decisions of the European Court of Justice’s advocate general, that were relevant to sickness absence management decision-making.


While employers’ freedom of action was circumscribed as a result, Pritam said, those that end up in litigation are typically those that are unwilling to sacrifice time to absence management. Their corporate culture, especially amongst senior management, could be characterised as “impatience” with long-term sickness absence, and often a refusal to accept stress is a factor to be taken account of. Companies sometimes shy away from managing such situations directly, hoping instead that consistently poor performance appraisals and low pay awards will persuade an employee to move on to a new job. Not knowing the correct procedures for dealing with sickness absence is common, especially in companies that lack a human resources department. “These factors often lead to corporate grief at an employment tribunal,” Pritam said.


She explained the very important new distinction in disability discrimination law between disability and “reasons related to disability” as reasons for dismissal. There is a duty on employers not to treat a person less favourably for either reason. But whereas discriminating against an employee cannot be justified on grounds of disability, it may be justifiable for reasons related to disability. The upshot is that dismissal for poor attendance or long-term sickness absence may be justified in law. However, the law may require, among other things, that employers consider the feasibility of so-called “reasonable adjustments” to accommodate individuals whose fitness for work is compromised in some way.


The widening of the scope of what may be considered a detriment was also explained. Perception and reasonableness are key concepts under UK employment law and these have recently become “double-layered and much tougher”, Pritam said. For example, if an employee can claim to have been victimised following their assertion of a discrimination right, employers can find themselves in very dangerous water.


Psychosocial factors are the most important in managing sickness absence and return to work, Professor Mansel Aylward, director of the Unum Centre for Psychosocial and Disability Research at Cardiff University, told the RSM meeting. Although the biological model is the established paradigm for occupational health, it has very little to do with absence management and even less with getting people back to work.


“The barriers to recovery and return to work are primarily personal, psychological and social and are not principally health‑related or medical problems,” Aylward said. Non‑medical issues related to employees’ personal lives were relevant to the new occupational health agenda because unemployment is such a significant risk to public health – “equivalent in terms of increased risk to health to smoking 10 packets of cigarettes a day”. Long-term worklessness increases risk of suicide in young men by a factor of 40 and the risk to health and life expectancy is greater for worklessness than for many killer diseases and poses a greater risk than most dangerous jobs.


Early intervention was a key requirement, Aylward said “in the first fortnight, if not the first week”. It should be friendly, supportive and professional. In particular, it should be tailored to each individual: generic approaches do not work. Companies must strive to understand the personal, psychological and cultural obstacles to return to work, and focus on the individual as well as on organisational change.


Concluding the seminar, the TUC’s senior health and safety officer Hugh Robertson said long‑term sickness absence is the most costly for employers and stress is currently the single largest cause.


Early response to absence should be a key component of the responsible employer’s sickness absence management policy – together with keeping in touch with sick employees, effective access to OH services and adjustments to facilitate return to work. “Simply focusing on employee attitudes does not work and organising yoga classes is not an answer to workplace stress,” Robertson concluded.


Reference


“Sickness absence in the 21st century – an insurmountable challenge for employers?” RSM occupational medicine section, 19 February 2008, London.


Practitioners need to engage with emotional labour


Emotional labour at work and its product – burnout – cannot be managed in the same way as traditional stressors, such as those defined in the HSE’s management standard approach, and practitioners need to engage more with the concept of emotional labour when considering how work affects wellbeing. Emotional labour can have very positive and very negative features, so should not be treated as something “to be simply controlled or reduced”.


These are the conclusions of a new HSE-sponsored study1 of emotionally demanding occupations and the links between psychosocial job characteristics and wellbeing. Emotional labour is defined as the requirement on workers to regulate both feelings and the expressions of these feelings for organisational goals – for example, when working in a targets-driven call centre or healthcare environment. The report explores the links between the emotional demands inherent in “human” (health and other social care workers) and “customer” (call centre) service jobs and burnout, focusing on emotional exhaustion, depersonalisation (often labelled “cynicism”) and accomplishment at work (also called “professional efficacy”).


A literature review examined the relationship between emotional demands in jobs and burnout in these two groups of emotionally demanding occupations. It concluded that certain demands, such as the sheer volume of customer interactions in such jobs, do not relate to burnout but other demands, such as emotional dissonance, do seem to be associated.


Research into burnout interventions suggests that they can be effective, although the report cautions that a general lack of longitudinal evidence about the causes of burnout, or the processes through which it develops, mean it is not yet possible to develop targeted interventions.


The HSE used a questionnaire survey to examine the level of burnout and wellbeing in human service jobs and the key associated variables. Personality type, demographic factors and traditional job stressors are very strongly associated with burnout, while emotional demands tend to be only quite weakly related, after controlling for these other variables – in other words, it is traditional job characteristics, rather than emotional labour, that largely account for differences in levels of burnout. It is not possible to generalise, therefore, about how emotional demands associated with emotional labour affect employee wellbeing.


Daily diaries kept by teachers and care workers as part of the research suggest that some types of emotional work are viewed as difficult but rewarding, particularly if participants were able to turn a very negative situation into a positive one and help resolve clients’ problems. Conversely, other types of emotional labour, such as situations where teachers and social workers felt they had to suppress anger or were unable to voice their opinions, were seen only as difficult. The researchers from Birkbeck College conclude that, although all job characteristics depend to some extent on their context, emotional labour has differing effects depending not only on the context, but the specific nature of the events and episodes encountered by employees.


Reference


The nature, causes and consequences of harm in emotionally demanding occupations, HSE research report 610

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