A rise in sickness absence means there is a need for alternative strategies
to address the cost of the problem to both the employer and the employee. Could
insurance policies help stem the tide?
By Graham Johnson
In an ever more competitive operating environment, organisations cannot
afford to let sickness absence adversely affect their bottom line and damage
the wealth of the company.
Increasingly, the more enlightened are looking to a cohesive approach,
involving OH professionals and group income protection insurers, to enable
employees and their employers to work together to identify mutually beneficial
Economic impact of sickness absence
Every year, millions of working days are lost in the UK due to sickness
absence. In a recent survey of 1,312 organisations, employing a total of more
than 1.7 million people, the Chartered Institute of Personnel and Development
(CIPD) reported an average rate of sickness absence of 4.4 per cent of working
time, or 10 working days per employee.1
The average cost of sickness absence to organisations in the survey was
measured at £522 per employee, a 7 per cent increase from the 2001 survey.
Although the Confederation of British Industry’s (CBI) figures from its 2002
survey showed absence levels had reduced to (7.1 days), the lowest level since
1987,2 the average cost of absence rose to its highest level for five years,
with the average direct employer costs for absence per employee estimated to be
As the Government has now issued targets to reduce the number of working
days lost per employee per 100,000 workers from work-related injury and ill
health by 30 per cent by 2010,3 there is much that OH professionals can do to
help motivate employers to improve the health and well-being of their
The reduction in sickness absence can be assisted by the introduction of a
number of key elements.
Included in these should be an integrated OH service, with strategies to
tackle sickness absence that are designed to reduce the year-on-year burden of
this workplace issue. Both employers and employees should also welcome the
introduction of ‘added value’ services to help combat the problem.
Short-term sickness absence is a complex phenomenon, often influenced by
non-medical factors. However, it is generally agreed that the management of
short-term sickness absence is the employer’s responsibility, and is more open
to effective management processes.
The use of GPs to certify employees for periods of less than seven days
absence is now being challenged.
As outlined in the Cabinet Office campaign, Managing Absence: Making a Difference
– Reducing GP Paperwork, the Government message is that to save 2.4 million
unnecessary GP appointments, plus the additional 37,000 hours of GP time each
year spent on issuing sick notes, the focus of the attention in the management
of sickness absence should belong to the employer.4
After all, it is not the GP’s fault if an employee conspires to deceive the
GP into thinking their childcare problems are a reason for requesting a medical
certificate for back pain or workplace stress, when the real diagnosis is of
And in any case, how is the GP expected to know if the employee is telling
The litigious society we live in may forbid the GP from questioning the
validity of what the employee says.
Far better then, that the employer introduces family-friendly working
policies, to allow employees to discuss their domestic circumstances with their
line manger and negotiate agreed absence times, rather than report in sick with
some superfluous self-diagnosis.
If the Government’s campaign is successful, the change from the current
system should have the objective of encouraging employers to reduce the
incidence and prevalence of short-term sickness absence.
This move – to shift the emphasis of the management of sickness absence from
the GP to employers – is likely to have a dramatic effect on employers and
require them to address how they deal with the causes of absence from work
attributed to sickness, and the causes of occupational ill health.
Long-term sickness absence
Whether employers are dealing with long-term or recurrent short-term
sickness absence, early and effective intervention strategies are a central
part of the solution. Key to these are:
– Absence management policies
– Management training on attendance management, return-to-work interview
techniques, telephone interviews, home visits and case conferences
– A comprehensive reporting system to identify trends and reasons for
sickness absence – including, where possible, the measurement of the financial
costs of employee absence – can be instrumental in convincing the financial
director of the benefits of the active management of employee absence.
Income protection schemes
Increasingly, group income protection insurance schemes funded by the employer
are designed to provide an income (after a deferred period has passed), to
normal retirement date, when medical evidence supports the claim.
These are being seen as the answer to many employers in managing the absence
of their employees and in reducing the potential financial impact of sickness
The benefits of these schemes ease the financial burden to the employee
caused by loss of income through ill health or incapacity by the payment of a
However, for the employer and the insurance company, there is a risk that
the number of claims might escalate if they leave such schemes unmanaged,
eventually resulting in increased insurance premiums.
Importantly, the schemes can also offer a means to actively encourage and
financially support a rehabilitative programme based on medical opinion and,
where available, OH services to support a gradual return to work
It is the rehabilitation of the employee and their introduction back into
the workplace that invariably has the most rewarding outcome for all parties.
Central to this process is the role of OH professionals and their specialist
knowledge of health implications in the workplace. By providing an integrated
OH service and working with the employer, employee and insurer, line managers
can be supported.
For many employees, the impact of an illness or injury can be a
career-threatening experience. Combine this with an often lengthy waiting list
for access to specialist opinions, and the problem can be exacerbated even
Utilising the benefits provided by the insurer, access can be arranged to
third party providers of rehabilitative programmes. These may include
physiotherapists, occupational therapists, counsellors, psychologists, or
referral for private medical treatment, which may not otherwise have been
The intervention of the OH nurse to co-ordinate communication among the
employee, family members (where appropriate), GP, specialist physicians, the
employer and the insurer can ensure the sick employee does not ‘get lost’ in
The added benefit of obtaining a specialist opinion can provide early access
and hopefully, a prognosis. This information, once received by the OH service,
can be interpreted and shared with the insurer and employer. Access to this
information can also assist the OH nurse in providing timely advice to the
employer on the functional capability of the employee, the likely length of
absence and the consideration that should be given to the development of a
rehabilitative programme, with the assistance from the insurer as required.
To reduce the need for duplicate requests for reports from the employees, GP
or specialist physician, the use of a joint access form – which allows the
medical reports to be disclosed to the insurer – can save precious time in the
case management of these individuals. However, this must be made clear to the
Many insurers will also be happy to consider phased returns to work, without
any effect on the benefit being paid. This has the additional effect of
reinforcing the message that the employer is concerned about its employee’s
health and well-being.
Cost benefit analysis
An example of how this approach has worked in practice is shown by
identifying the cost benefit analysis of this approach to managing sickness
absence. In this case, the OH service funded by the insurer was introduced to a
client in the service sector. The service used the resources of a qualified and
experienced OH nurse, the HR department, the manager and the insurer.
– Sector Business
– 400 employees
– Qualified OH nurse adviser one day a week
– Clinical supervision from OH physician
– Management training on attendance management
– Management referral process
– Case conferences with line managers and HR
– Case management led by the insurer, in liaison with the OH nurse, using
joint access to medical reports process.
In year four – prior to the introduction of the income protection scheme and
appointment of the OH nurse – the average absence per employee was 12.3 days,
equal to an absence rate of 5.4 per cent. This resulted in a cost of absence in
excess of £300,000.
Working with an enlightened and supportive management team, the OH nurse was
able to effect change in the management of attendance processes used by the
employer. This was sufficient to demonstrate a reduction in the number of days
absent per employee to 5.7 with an absence rate reduced to 2.49 per cent.
Sickness absence and its impact on productivity, employee morale and the
financial wealth of the company are at the forefront of many employers’ minds.
The need for alternative strategies to address the control and reduce the costs
of sickness absence is needed. Having access to the means to assist the
employer and employee in achieving an early return to work, funded at no cost
to the employee, is also an important adjunct to the diverse role of today’s OH
1. CIPD, 2002, Employee absence – A survey of management policy and practice
2. Confederation of British Industry, 2002, Counting the Costs
3. HSE, 2000, Securing Health Together
4. Cabinet Office, 2002, Making a Difference – Reducing GP Paperwork
www.dpp.org – Doctor Patient Relationship
Graham Johnson RGN OHNCert FETC is a business development manager for
Interact Health Management and a member of the Occupational Health editorial
Case study 1
Mr W, 40, veterinary surgeon
Due to an eye injury, the employee could no longer drive to
appointments. An income protection claim was submitted with an anticipated
annual employee benefit in excess of £45,000.
Following the intervention of the OH nurse and discussions with
the employer and insurer, the insurer offered to pay funds for the practice to
employ the services of a driver, thus allowing the surgeon to continue his
As a result, the veterinary surgeon could continue with his
life-long career and the practice didn’t lose an experienced and valuable
member of the team.
Case study 2
Mrs J, 44, recruitment consultant
As a result of an upper limb disorder (ULD), the employee could
no longer carry out administrative tasks involved in her occupation. Following
the intervention of the insurer, an intensive rehabilitative programme was
organised. Combined with a phased return to work and the introduction of
specialised keyboard equipment, the employee was able to return to her former