Sickness absence management debate: Can absence be cured?


Mark Simpson
Medical dircetor, Axa Icas Wellbeing (roundtable chair)

Paul Nicholson
Associate medical director, Proctor and Gamble, and chair, BMA Occupational Medicine Committee

Ben Willmott
Senior public policy adviser, Chartered Institute of Personnel and Development (CIPD)

Katherine Ashby
Researcher, health and wellbeing team, Work Foundation

David Prosser
Strategic development manager, Axa

Geoff Taylor
Consultant, Axa Icas specialist services department

Do absence policies work to promote attendance or police absence?

Nicholson: One problem is the name ‘absence policy’, because that means the focus is absence, rather than improving attendance and performance. If the policy was around improving employee performance or productivity, say a ‘performance policy’, that might put the issue in a more positive light. It’s really got to be built on a foundation of trust between the employee and their direct manager.

Simpson: An absence policy has negative connotations, implying that you’re only going to manage something once it’s become a problem, rather than taking a broader organisational approach to promoting attendance in the first place.

Ashby: If you have good quality jobs where people trust their employer and they have good line management, have some control over the work, and feel that their skills are being used, the other policies you have around individual wellbeing are more likely to be effective.

Do organisations think strategically enough about promoting engagement, even in apparently monotonous, repetitive jobs?

Willmott: The CIPD’s Employee Outlook survey is seeing an increase in the proportion of people who are now actively dissatisfied. Part of that will be around what sort of change has happened, and how that change has been managed. Business in the Community has its Business Action on Health campaign, and is looking to get 75% of FTSE 100 companies reporting on wellbeing measures – they’ve exceeded their target. The challenge is to get that awareness spread across different sectors, and different sizes of organisation.

Too often you see management training used as a sort of sheep dip. If you have some form of 360-degree feedback as part of that management development, you are more likely to have lasting behaviour change.


Ashby: Often when you talk to people about the underlying causes of absence, people don’t talk about workplace-related factors and job quality issues, trust, and promoting better relationships in the workplace. It’s more about looking at individual causes or how you treat the symptoms, rather than looking at these cultural factors.

In the recession you have presenteeism – people going in to work when they feel ill enough to justify staying at home – which is hidden because it’s not often formally measured or necessarily noticed by line managers or workers. Presenteeism has often been linked to mental health issues which have become more prevalent. Understanding that absence isn’t the only indicator is important.

Prosser: One of the problems we’ve got in changing employers’ attitudes is a lack of good measures, or good data. Trying to demonstrate the benefit of a certain programme or intervention or change programme is difficult because the underlying starting data isn’t there, and that needs to change.

Nicholson: Once you get into the business of reporting sickness absence, it gets onto the stock market, and investors may think: “Well, we’re not investing in that company.” But if a company could demonstrate what it’s doing in terms of ensuring it has the right programmes in place to ensure people are working in a safe and healthy working environment, and for assessing lifestyle risk and promoting good health, it might be a better solution than reporting absence.

Companies also ought to be doing their own employee surveys. We should focus on small- to medium-sized enterprises because they don’t have the resources; they don’t have in-house HR or occupational health (OH). But there are ways they can measure employee trends. One good example is the Health and Safety Executive’s Stress Management Standard.

Taylor: Managers are often reluctant to tackle this because they don’t know how to do it. They don’t have the confidence to go and talk to the individual because they’re frightened they may open up a can of worms they can’t deal with, so they brush it under the carpet and, inevitably, it just gets worse.

Simpson: We’d rather have people with a mental health problem coming to work and recognising it and working with it. It’s about having a safe workplace designed to minimise those problems, and then early awareness and early intervention.

Do attendance bonuses work?

Nicholson: Whether it’s Royal Mail or bankers’ bonuses, any type of award should be for contributions over and above the norm. So putting out the message that you can get a bonus for coming in on the days when you should be in is the wrong thing to do.

Prosser: Royal Mail had a huge problem with absence anyway, so doing almost anything would have made a difference because it raised the visibility of [the problem]. But that wasn’t the only thing it did. It managed to get directors monitoring absences and actually being quite competitive about absence rates in different divisions. The key thing that made the difference was boardroom debate about different levels of absence across the business.

Simpson: I’ve heard of people with really quite serious injuries including amputations of digits and so forth being made to return to work that same day so [the organisation] could maintain their non-working time limit. So attendance bonuses can work in perverse ways.

What forms of absence notification work best, what doesn’t work, and what are the trends?

Prosser: The call centre approach that came out six or seven years ago was seen as being a Rolls Royce-type service and is increasingly seen as very expensive. It probably did have an impact on absence, but it has reached a plateau. Employers are now buying into the agenda that it’s about line management engagement. There’s nothing in any of these outsource solutions that actually prevents the line manager from having a conversation.

Willmott: In CIPD surveys the effective notification of absence and the involvement of the line manager are ranked very highly as being most effective. The key thing is that the line manager is notified at a very early stage during the day that someone’s taking time off. Data is also crucial, so you can identify patterns in both departments and individuals.

There should be an element in managers’ performance targets which is tied to their absence management role. Making sure that return-to-work interviews happen is important, as is making sure the manager’s employees are notifying absence in the way the policy recommends, and ensuring absence review meetings happen properly and that, where necessary, disciplinary action is initiated. If it’s not measured, there’s a danger that it won’t be managed, so you’ve got to find some way of encouraging line managers through their performance appraisals to focus on absence.

Taylor: With an automated system, at least you know it is going to be recorded.

How important is the line manager’s response to notification of absence?

Prosser: It’s got to be a mutual benefit for both employee and employer. If a service is launched on the basis that it’s not about Big Brother watching you, and that it’s actually to make sure we’re capturing all absences and not letting individuals slip through support nets, then those are absolutely the messages that you’ve got to have. We know absence is under-recorded by 25% when line managers are called upon to record it, and in many organisations there are perverse disincentives for line managers to record absence, because they may have a key performance indicator on absence.

Willmott: Return-to-work interviews are a missed opportunity to have a really positive, one-to-one conversation between a manager and an employee – not just about attendance, but actually about work, and about their job satisfaction. This can be a real opportunity to drive engagement.

What impact do work organisation, peer pressure and team-working have on reducing absence?

Simpson: It’s about how much goodwill there is in the bank for an individual worker. And where I’ve seen there is a lot of goodwill, people have gone to extraordinary efforts to actually help somebody back to work. The OH service actually has to be seen as a supportive tool for the line manager. It goes back to the point that we want to equip managers, not just to be empathetic human beings.

Ashby: Line manager training on how to make adaptations for people who have mental health conditions, and more understanding among line managers about what that means, is really important. If an issue is just outsourced to OH, the line manager isn’t involved, and there is the risk it’s not going to benefit the individual in the longer term. The idea that work can be good for certain conditions needs to be raised.

Is the fit note a solution, a cross to bear, or a path to revelation?

Nicholson: A classic example might be somebody who breaks their leg on a skiing holiday and works in a call centre. In the past they’d have been given a sick note because they couldn’t get to work. There would never have been any thought about what work they do, or whether their employer could arrange with a co-worker or a taxi company to get them into work. A lot of the solutions could be simple ones like that.

Simpson: Work done in the US looking at return-to-work timeframes for identical sport and occupational injuries shows that those with occupational injuries took four times as long to return to work. It is about motivation, and alignment of expectations.

What are GPs’ feelings about the fit note? Do they see it as an imposition?

Nicholson: There’s 100% alignment on the fit note, and the Department for Work and Pensions’ guidance for GPs was devised in partnership with the Royal College of General Practitioners and the British Medical Association’s GP committee. There was a concern about them not having trained as OH practitioners but of course, in many cases, the advice they have to give is quite simple. In terms of somebody in an office job who is rehabilitating after a hysterectomy or coronary artery bypass, then it might be no more than saying it makes sense that they return to work gradually over the next three or four weeks, for example.

One of the potential missed opportunities of the fit note was the removal of the draft tick box that was there to recommend OH referral. From my point of view, it would have raised the profile of that lack of access, and it might have made important changes in the future in terms of improving access to OH.

Willmott: I think what it will do is prompt GPs to at least have a conversation about the possibility of a phased return to work. For those people who have no interest in going back to work, it won’t make any difference. They will be signed off as usual, and will lobby their GP or exacerbate their symptoms. You can’t cater for those individuals.

Simpson: By and large, absence certification is the employee’s view of their fitness for work, rather than the GP’s view, and rarely will a GP say to an employee who wants to go back to work that they shouldn’t actually do so.

Prosser: It is only going to be a good thing because it will stop employers and employees hiding behind this document, which I’m afraid some of them do.

A version of this feature has already appeared in Occupational Health magazine

Comments are closed.