A new breed of outsourced sickness absence management services is coming into the marketplace. Will they threaten the role of OH professionals, or be seen as a partner?

The value of a coherent absence management system is often underestimated by employers. They fail to appreciate that absences due to interpersonal conflict and capability issues are management problems, rather than clinical ones; that if referrals are made earlier, then absences can be managed more effectively, and that resolving employee absence can often require a multi-disciplinary approach, of which OH is a key part.

Although still in its infancy, the outsourced approach to sickness absence could have some interesting implications for existing OH services within organisations. It could be argued that there is a real opportunity for an OH department to become embedded with the newly-emerging approach to the management of absence and employee health, facilitated by the use of this new breed of outsourced sickness absence management services. The potential gains for OH services are improvements in tactical efficiency, linkage to a more readily-measurable, bottom-line effect, and a clear role within a more coherent strategy for employee health.

Outsourced services

There are some differences in the profiles of the six or so suppliers of outsourced absence management services. Some suppliers insist that employees call in sick from the first day of absence, and line managers are then notified by e-mail or telephone. Others notify by fax or text – but the Data Protection Act (1998) implications of this approach should be carefully assessed. Some providers only want to get involved after seven or 14 days’ continuous absence, when staff are called by telephone as the entry point for a nurse-led telephonic management service. While this may increase the use of OH input, the boundaries and interactions with any existing OH services will need to be carefully defined.

With ‘day-one’ service providers, one key service issue concerns deciding who is best placed to take the calls. Some have 24-hour contact centres manned by experienced listeners who gather information, while others have limited opening times but prefer nurses to take the calls as a direct lead in to case management activity. In theory, the nurse-led approach, although limited in accessibility, should be the more valuable service, but there are some strong counter-arguments.

With 80-90% of absence calls involving flu/cold, migraine/headache, food poisoning/tummy upsets etc – which may be hiding a multitude of real reasons such as absence indifference, entitlement mentality, eldercare/childcare issues – there is little value in having nurses take such calls. And if there is already a good OH service in place, is there any value in having a further layer of assessment/case management at this early stage? Some trade unions are concerned that the investigative/clinical assessment approach may be overly intrusive – the TUC, for example, says it may inhibit dialogue between employee and employer.

Although a first-day intervention is useful in some cases, only certain conditions should qualify. For example, an OH service may want to be notified of all back pain or stress cases on a weekly or monthly basis, and on a daily basis where the prognosis is an absence period of two weeks or more. For a long-term absence, an organisation should be able to identify the optimum time at which OH would be involved (for example, at 28 days). For persistent short-term absences, where a consistent reason is given – for example, three migraines within a three-month period – then the line manager could be prompted to make a health assessment referral before instituting a disciplinary or continued monitoring approach. Such interventions could result in the prevention of a long-term absence and would ensure that the employee is well supported.

As well as getting OH involved at the right time, some of the providers have developed their IT systems to ensure that the right paperwork is provided to the line manager, HR, or whoever is responsible for progressing the employee contact process. For example, it may be agreed that the OH Access to Medical Reports Act (1988) MRA/medical consent form is sent for completion by the employee at say, day 14 of the absence, in anticipation of an OH intervention after 28 days. At that point, the line manager could be supplied with a reminder to refer the case to OH. A pre-populated letter addressed to the employee advising of the referral and describing the role of OH could also be included with the reminder information sent to the line manager, and this could help to allay employee concerns regarding ‘being managed out’ or other preconceived notions about OH.

The interface between the absence recording/management service and OH should be carefully configured at the outset, with OH specifying the timing and content. Not only will this approach increase the output of cases to OH, but also enhance the likelihood of case resolution.

One of the key challenges for OH as an industry is the problem of persuading organisations to ‘invest to save’ in employee health.

The strategic relevance of an OH service can be enhanced by the management reports that come out from the sickness absence supplier. The first is that absence may be quantified more accurately, and a reduction in the number of reported absences become a business efficiency target. As part of this increased resource for OH, payment of private medical treatment costs (subject to clear rules) would be more straightforward than when the cost was invisible. It is often frustrating for OH professionals when organisations are unwilling to pay for a procedure that could get staff back to work, particularly when sick pay could cost more than the actual treatment.

As an example, the reported figures on absences based on flu could lead to the organisation investing in work-site flu jabs. Figures would reveal that last year, it lost X days because of flu, costing X and this year it spent X and has reduced absences by X days – a saving of X.

At a more advanced level, in a division that is revealed to have a high number of reported incidences of back pain, additional manual-handling training and even physiotherapy support may be offered, enabling expenditure to be targeted to where it is needed most. With limited budgets and a limited OH resource, a targeted approach may improve the business impact.

Some employer liability insurance (ELI) companies will give up to 20% discounts where a good OH or health and safety service exists. Because these insurers often wish to be kept informed of all work-based absences, having an outsourced absence service provider will also enable an employer to demonstrate that all work-related absences have been addressed from the first contact.


The new breed of outsourced sickness absence services represents both a threat and a positive revolution for OH, at both strategic and tactical levels. Where there is no clinical intervention via a telephonic nurse approach, the potential for OH services to have a massive impact on both individuals and the corporate bottom line should not be underestimated. The worst-case scenario would involve nurses replacing or marginalising the need for an OH service in an employer’s mind. This means that where there is a nurse-based interface, either taking calls or undertaking case management, the role of OH will have to be redefined.

In both cases, the potential for the right information being provided at the right time and the involvement of educated line managers and employees must be the paradigm that OH practitioners have been seeking.

Looking at the potential for OH to carry out preventative work, based on the statistical evidence of the outsourced service, OH working in partnership with outsourced sickness absence services could lead to the easier management of case loads, increased value to the organisation, and the potential for more revenue for OH.

Paul Avis is a director at Employ-Mend Limited.

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