When the Health and Safety Executive’s (HSE) long-term strategy for occupational health (OH), Securing Health Together, was published five years ago, its preface clearly stated that OH professionals working in isolation from other stakeholders were not going to make the necessary difference to workplace health.
The most critical relationship essential to address health in the workplace is probably the partnership between OH and HR, but this relationship does not appear to be working as well as it might. Why is this, and how can the two work together more effectively to secure better workplace health?
In 2005, the Chartered Institute of Personnel and Development’s annual Absence Management Survey of Policy and Practice demonstrated that if workplace health is to be managed effectively, there is a clear need for OH and HR to work together.1
The report identified a number of issues that were critical to the management of absence (see Table 1). It also looked at the improvements that had been made in the management of sickness absence and found that a number of factors were identified as most influential in reducing levels of sickness absence (see Table 2).
Where organisations had access to OH support, most of the referrals were made at the discretion of HR and line managers (61%), while others were automatically triggered from HR absence management information, where there were recurring short-term absences or long-term absences of more than a month.
Given this important employee health and welfare role for HR, OH professionals might be surprised that sickness absence management is not seen as a priority for HR. In a study of more than 1,000 HR professionals,2 absence management was not cited as one of the key priorities.
The focus for HR is on business issues, such as improving employee focus on achieving business goals, increasing employee competencies and retaining key staff. Indeed, in many organisations, the management of employee health and wellbeing has been moved to line managers, with the HR specialist only being available via a remote personnel helpdesk.
In many organisations, sickness absence management has become something of a Cinderella role for the HR function, with high-flying HR professionals being more interested in gaining experience in such areas as recruitment, training and development and organisational development.
The problem with HR…
When talking to OH professionals about the difficulties they face in delivering an effective service, the main areas of dissatisfaction relate to the perceived failures of HR. However, instead of groaning about HR’s failures, it may be more fruitful to look for the reasons for the problems and identify the solutions. Here are some of the most common complaints:
Problem: “HR keeps referring cases to me that are management’s responsibility.”
An employee had been referred following a period of absence that was identified as being due to work-related stress. The issue turned out to be the bullying behaviour of the manager combined with an unclear job description. The employee was under-performing and was sent to OH to solve the problem. Nothing had been done about the previous OH report, which had requested a review of responsibilities, workload and team behaviours.
Consideration: OH professionals should make sure their original report is clear in what it recommends. They should ask: “Could the reason for the problem be that the HR team was overstretched and stressed? Do they need to be stress audited?”
Problem: “HR expects OH to tell them everything about the employee. It doesn’t understand medical confidentiality.”
The director of HR contacted an OHA to ask about a senior manager’s medical report that had been requested. He wanted to know what was in the report, as he needed to decide whether to retain the manager in his current role. When told that this information was confidential, the HR director said that he wanted the information for himself, and that as the information was not to be written down, it did not breach the rules.
Consideration: OH should take care that the reason for medical confidentiality has been explained. Do you have a confidentiality policy? Are you providing advice and information that allows managers to manage difficult situations?
Problem: “After HR has made a mess of handling an employee, they expect OH to pick up the pieces.”
An employee had taken out a grievance against a manager. The investigation took a long time but, eventually, the decision was taken to move the employee to a different unit and to provide training for the manager. A few months later, nothing had been done to implement the findings, and the same situation arose again with a different employee. At this point, OH was asked for advice.
Consideration: Has OH been involved in the development of HR policies? Does it take a strategic outlook or is it too busy on tasks?
Problem: “HR is resistant to trying to find alternative duties – it would rather have people off work.”
An engineer has been off work with a musculoskeletal problem. He is able to return on restricted duties but no-one is willing to take him back unless he is able to undertake full duties.
Consideration: Did the OH report really address the difficulties faced by the line manager? Did the OHA actually understand the employee’s role and take account of the difficulties that might be encountered?
Problem: “HR is turning OH into the sickness absence police.”
An employee wants to bring her union representative with her to the consultation. She tells the OHA that everyone she knows that has been sent to OH is put on a warning to improve their attendance or get the sack.
Consideration: Have you spent time with management to promote the cost-benefit arguments for other services, particularly those that are preventative rather than reactionary?
Problem: “Why doesn’t HR get OH involved earlier so that we can reduce the impact of organisational change?”
An organisation has been involved in planning a fundamental change in the way the business is to be run. Roles and responsibilities will be changed and some offices are to be closed. Despite requests, OH has never been consulted at the time the strategy is being discussed and, as a result, a large number of employees suffer from stress. Some simple alterations in the change plan could have made a significant difference to the employees.
Considerations: Have you anticipated the issues that might arise and offered solutions even when these have not been directly requested?
Problem: “HR wants everything on the cheap. Now that HR has to pay for services, I am finding that managers are leaving things until they are really serious before they get in touch. By the time I hear about something, it is too late and there is little that I can do to help.”
Consideration: Are you really promoting the benefits of the range of OH products? Do you have the figures to demonstrate the financial benefits of what you do?
The problem with OH…
For HR practitioners, there can be difficulties when dealing with OH. Here are some of the main complaints:
Problem: “Why doesn’t OH tell me what an employee can do, rather than what they cannot do?”
Many OH reports concentrate on limitations rather than abilities. This probably reflects the approach taken by most GPs and hospital consultants, who tend to send reports listing the complaints or features of a condition, rather than addressing functionality. This failure leaves the HR practitioner with the difficult task of deciding whether a particular rehabilitation programme is suitable.
Consideration: The World Health ICF code provides a means of establishing functionality taking account of personal and environmental factors.3 It would be helpful for OH to request reports based on the principles set out in this code.
Problem: “What I want is a prognosis, not a diagnosis.”
Although many in OH deny that inappropriate medical information is given to HR, I have ample evidence from my work in a number of organisations to show that many OHAs are happy to provide the most intricate information on medical procedures, when what is really needed is information to help manage a return to work.
Consideration: It is not good enough to give descriptions of an operation and the required post-operative treatment and not to give an indication of when the employee can return to work, whether they will be able to do their previous job or what additional support they may need.
Problem: “I have no idea what this report means. Why doesn’t OH use plain language instead of medical jargon?”
We all have our professional jargon, but the medical profession seems to take pleasure in speaking in a language that is totally incomprehensible to HR. What is required is simple information and advice.
Consideration: Remember that, like you, the HR professional is busy, and where possible, they would like to be able to pass on your advice directly to the responsible line manager.
If you fill reports with unnecessary medical terms that require a medical dictionary to translate, then you are not going to win any friends.
Problem: “It feels as though OH has no idea about what is going on in the organisation. How does OH expect HR to sell a treatment that costs thousands of pounds with no indication of the benefits to the business?”
Over the past few years, HR has been forming partnerships with its customers in business. It has to be accountable and demonstrate benefits to its activities. There is nothing more irritating than to be faced with an OHA who is totally focused on the needs of the employee, with little recognition of the business context.
Consideration: Many organisations are not interested in interventions unless they save money or have a tangible benefit. It is vital that OH considers what it is doing, and wherever possible puts in systems to evaluate interventions and demonstrate its value to the business.
Problem: “The advice given is just not practical. Has OH no idea what it is like in the real world?”
While there may be an ideal solution to an employee’s needs, this has to be tempered with reality.
Consideration: Before giving advice, OHAs should take time to look at the constraints that may operate and try to find solutions that will work for the employee and the business.
As HR becomes more business-focused with much of the work being undertaken by line managers, it is important for OH practitioners to adjust their advice and support. The government has set organisations stretching targets to reduce sickness absence,4 which will only be achieved if the key players engage effectively.
In practice, this means that OH practitioners will need to be more focused in their advice to HR.
However, one of the problems faced by OH is the almost total focus on sickness among many GPs and consultants.
At the very least, OH practitioners should look at their letters requesting reports to make sure they are clearly asking for an opinion on current and future capabilities and functions, rather than a report on current physical or psychological symptoms.
David Coats says:
OH has a better understanding than HR of what makes people sick, and this expertise could have a real impact on preventive measures as well as on rehabilitation. Sadly, with all the rhetoric about empowerment, the degree of control people have over their work has actually declined. OH can help HR look at the way that control and autonomy can have an impact on reducing stress.
HR can find it difficult to deal with staff with long-term sickness problems, and relies on OH to get people to return to work, offering expertise on issues like workplace adjustments. Both sides can make the workplace healthier in terms of job design, ways of working, and minimising the negative effects of work. We need a more explicit understanding of how to achieve this.
Both HR and OH need to be preventive and strategic, and look at the way jobs are designed, so that risks of levels of ill health are reduced. Then there will be fewer of these difficult, long-term cases for them to deal with.
Prevention is most important here. Organisations need to look at the next three to five years. Health promotion is one facet – such as healthy eating and workplace gyms. Motivation is another – how people do their job, what contributes to job satisfaction, the way they are treated by managers, whether they feel they are treated fairly.
David Coats is the co-author of Healthy Work: Productive Workplaces, with Catherine Max of the London Health Commission
Pat Keating says:
Our aim is to be excellent in terms of having a healthy workforce: we want to reduce sickness absence, work-related ill health, create a healthy workplace and workforce, and make sure we are compliant with statutory screening requirements.
Overall, we have a good relationship with OH. But one ongoing area where there is room for improvement is the feedback managers get from OH about cases of individual staff members with health problems. A perennial problem across the field of OH is a perception that feedback is not geared to management requirements.
OH may see the situation from the employee’s point of view, and may be party to confidential information that the line manager is not privy to.
There is also a tendency for OH to give a medical judgement, and expect managers to draw conclusions from that.
Sometimes the OH doctor or nurse will put their recommendations into a letter, which is seen by the employee. This might suggest the employee works in a different way, or does a different job, and the employee might then see this as a fait accompli. But the organisation may not be able to put the recommendation into practice. It would be helpful if OH could talk informally to managers before putting such recommendations down on paper.
At Brent, we are aiming at reaching the middle ground, with an integrated approach, but one that would not breach OH’s codes of practice.
Ultimately, OH works best where there is this integrated approach, with both the OH service and the employer working to the same goal – to rehabilitate staff on long-term sick leave and improve staff health and wellbeing.
Pat Keating, employee relations manager, Brent Council
Lousie Kirk says:
The distance between OH and HR can cause problems when OH doesn’t accept that HR sometimes makes tough decisions, based on the information they give us. But these decisions ultimately benefit the employee as well as the organisation. It doesn’t help someone with depression if they are working in a stressful job, and many of our staff work in our call centre collecting debts from difficult people who don’t want to part with their money, and we expect high levels of both the quality and the quantity of the calls they make. Leaving a job that is adding to existing mental health problems can lead to better things for the employee: it’s not only the organisation that benefits.
OH also has a tendency to focus on what employees can’t do. I once worked with an OH nurse who was so pro-employee that she spent a lot of time advising a pregnant employee about the fact that her pregnancy would make her feel tired, and saying that she would be entitled to flexible working arrangements. But this was an employee we were already having problems with in terms of her lateness.
Assuming their first loyalty is with the employee also raises confidentiality issues. One OH practitioner told a staff member with carpel tunnel syndrome that she was recommending that we purchase voice-activated software. But this was before the company had been able to review the recommendation and take a decision on what we considered reasonable or appropriate to the job and the duration of the condition.
Louise Kirk, HR manager, consumer debt collection agency
Ben Willmott says:
HR’s role depends on how the organisation manages occupational health issues, and how proactive line managers are. Where they are trained and given advice and support, HR doesn’t have to ‘own’ the process. But where the process is not so evolved, HR may need to police it. For instance, there needs to be a trigger process for staff absence, so that if someone is away for more than three months, OH is automatically involved in managing their return.
HR needs advice from OH about rehabilitation and returning to work, and should be given the right information to organise a suitable work programme for those returning after a long absence: whether it’s a phased return, a different role, training for the line manager or organising a supportive environment.
The more ad hoc the provision, the greater the role for HR. For instance, OH might be brought in when an employee had been absent for more than two months. But back problems can benefit from an intervention within days, as well as advice about different ways of working if they are to avoid future problems. There is definitely potential for a closer relationship between OH and HR on such issues.
There are clear connections between an effective OH strategy and business effectiveness. OH departments are partly responsible for absence rates, long-term absence and the success of returning to work. If OH intervenes successfully, staff productivity should improve, and prove the business value of OH staff.
Ben Willmott, employee relations adviser, Chartered Institute of Personnel and Development
Julian Topping says:
One of our main concerns around the relationship between HR departments, line managers and OH providers is the failure to communicate about staff who go sick – particularly those with musculoskeletal or stress problems, which accounts for 70% of NHS sickness absence.
Research shows that the sooner an employee can begin rehabilitation, the quicker they can be back at work and the better it is both for them and their employer.
These gains rely on fast and effective communication between HR and the OH department, so that OH can get on with their job. Failure to inform OH of staff absences as early as possible builds delay into the system and increases the possibility of staff failing to be picked up by OH until their health has deteriorated further.
Most sickness absence in the NHS is long-term sickness, which reflects our failure so far to address the issue of rehabilitation and redeployment of staff in a sufficiently robust manner.
As part of the wider public sector campaign to improve rehabilitation and redeployment, NHS Employers will be working with NHS colleagues this year to identify best practice and develop tools for managing long-term absence.
One of the first areas we will look at is the link between HR and OH, and the need to ensure that staff are cared for as early as possible. Only then will we be able to stop them progressing from a minor musculoskeletal disorder to early ill-health retirement.
These issues will also be addressed as part of a partnership review of ill-health retirement, injury benefit and sickness absence being carried out by NHS Employers with NHS trade unions.
The review is due to make recommendations to ministers in the autumn.
Julian Topping, head of workplace health and employment, NHS Employers
Noreen Tehrani has worked as a medical researcher, personnel assistant and retail operations manager before qualifying as an occupational health and counselling psychologist. She is a member of the Chartered Institute of Personnel and Development and a member of its Counselling and Career Management Forum
Supporting interviews compiled by Sally O’Reilly
1. CIPD (2005) Absence management – a survey of policy and practice
2. CIPD (2003) HR Survey Where We Are, Where We’re Heading, www.cipd.co.uk/subjects/hrpract/hrtrends/hrsurvey.htm?IssrchRes=1
3. WHO (2001) International Classification of Functionality, www.who.int/classifications/icf/en
4. HSE (2003) Delivering Health & Safety in Britain, Health & Safety Targets, Sudbury, HSE Books
Table 1: Absence management
- Average absence is 8.4 days per employee per year
- Cost of absence is £601 per employee per year
- Stress and mental illness are the top causes of long-term absence for non-manual workers
- OH is seen as the most effective method of managing long-term absence, but is only used by 62% of organisations
- Only 30% of employees have co-ordinated rehabilitation programmes
- 18% of organisations have attendance initiatives
- 25% of organisations appraise their managers on the management of sickness absence
Source: CIPD, 2005
Table 2: Reasons for the reduction in sickness absence
- Better attendance policies
- Changes in sickness recording
- Increased management buy-in to absence management
- Changes in work organisation (for example, shift patterns, flexibility, self-managed teams)
- Changes in workforce composition
- Changes to workload
- Changes to the number of long-term sickness cases
Source: CIPD, 2005