With sickness absence costing the economy £13bn last year, it is imperative that organisations have effective absence management policies in place. Professor Michael O’Donnell emphasises the importance of promoting rehabilitation in the workplace.

Everyone at work will probably need to take sick leave at some point during their working lives and, in most cases, this lasts only a few days. However, long-term sickness absence can have devastating effects on the performance of a business and the health and wellbeing of the employees.

The statistics are clear: in 2007, workplace sickness absence cost the UK economy more than £13bn, with more than 40% of overall time lost attributable to prolonged absence.

There are many reasons why employees call in sick and most likely it is because they have an illness and are too unwell to do their job. However, other common reasons include:

• Injury – either sustained at work or elsewhere, physical or psychological




• Social or domestic reasons – unplanned personal events or in response to personal issues such as bullying, anxiety or depression




• Apathy or poor motivation for the role




• Organisational attitude




• Unreasonable work demands – stress




• Unpleasant working conditions




• Too hectic social life

Sickness absence clearly encompasses not only elements of medicine and occupational health, but also management, human resources and interpersonal skills. So, if we treat all absences as if they were purely medical in nature, then we risk missing the point for many employees whose illness and absence is also influenced by other factors.

When a medical cause is clearly preventing an employee from doing his or her job, there are few debates about sickness absence. However, when it’s not so clear cut, the absence will be influenced by social and contractual agreements between the employer and employee. Some of these agreements, such as sick pay policies, are explicit.

Quite often, however, the agreements appear to be implicit in the organisation’s culture. For example, when someone is not feeling entirely well, does the workplace expect them to do what they can, or does it suggest to the employee that they take time off work and only come back when they are completely better?

Having income protection and private medical insurance schemes and an employee assistance programme, such as rehabilitation, in place will support both the employee and the employer under such circumstances.

It will also be necessary for the company to support managers with relevant training to ensure they keep within the employment legal framework, such as:

• Disability Discrimination Act




• Medical Reports Act




• Data Protection Act




• Statutory Sick Pay




• Flexible Working




• Human Rights Act

Promoting rehabilitation

The use of rehabilitation is a very effective way of helping to reduce overall staff absence costs and improve efficiency. Many employers assume that rehabilitation is only needed by those with severe illnesses or permanent impairment. But in reality, rehabilitation is an effective tool for dealing with illnesses and injuries of all kinds – from stress and mild psychological problems, to musculoskeletal injuries and more severe medical problems.

Rehabilitation as a term is quite unhelpfully vague – a service designed to restore an individual’s level of functioning. There is a useful distinction to be made between medical rehabilitation and vocational rehabilitation, although even here the distinctions are often blurred.

Medical rehabilitation (for example physiotherapy) focuses on the physical recuperation of the individual who has suffered the illness of injury. Vocational rehabilitation focuses on helping the individual return to the workplace. It looks not only at the impact of physical functioning, but also deals with the emotional and psychological factors associated with illness or injury. In particular, it looks at how these factors impact on functioning in the workplace.

So what makes some rehabilitation programmes successful while others are not? One thing that reliably distinguishes many of the successful efforts is that the service provided is not regimented but rather tailored to each client’s needs, drawing on the unique strengths and skills of the individual providers.

When and how should an employer intervene?

• Too early the employer may offer help to people who do not need it




• Too late, the people will not benefit




• Too heavily and then people may become more symptomatic and feel harassed




• Too lightly and then the help is insufficient and inadequate

Reducing the cost of long-term absence

The significant differences in employee absence amongst organisations demonstrate how important the management of workplace absence is for an organisation’s productivity. But, the good news is that it’s actually quite straight forward to manage absenteeism, with both immediate and long-term benefits.

Armed with the right information, managers can look at what work is affected, how critical it really is and what they need to do for business continuity. Equally important, if they have at least some understanding of the nature of an employee’s problem, they can make sure appropriate help and support is immediately made available. Businesses that take heed of their responsibility to look after the health and welfare of their staff are less likely to find themselves vulnerable to expensive court cases.

Health researchers now recognise the positive health value of being in work. Whilst the workplace was previously thought of as a place only for the fit and well, we now understand that it can actually be therapeutic for staff to be at work even when they are not completely well. Conversely, staying away from work can worsen an illness and even prolong recovery.

Leading employers are promoting this positive message to staff and implementing it in their approach to sickness absence. Instead of relying on sick notes, for example, they are asking doctors to identify which of the employee’s work activities are medically unadvisable, and which should be encouraged to help the employee recover and return to work. They are also working constructively with front-line management to identify and tackle any work issues that may be exacerbating the absence.

As many employers have discovered, there are no easy fixes to problems with sickness absence. Nor are there many universal prescriptions for best practice, as a solution which works well in one workplace may not work in another due to differences in organisational cultures.

What does this all mean? The benefits of making a positive effort to manage absenteeism are clear. The challenge for companies is to deepen their understanding of how to tackle the issue quickly and effectively – managing sickness absence does not just start when an employee becomes sick.

It’s a well known fact that the work environment plays a major role in determining people’s behaviour when they are unwell. Providing employees with access to health-related benefits is an important part of ensuring a company has an enabling approach, which means sickness absence is less likely to be prolonged.

Professor Michael O’Donnell is chief medical officer at Unum