Long reads

How to cure the long-term sickness headache

13 Dec 2018 By Eleanor Whitehouse

They're often hard to engage with, but it is possible to get employees on long-term sick leave back to productive work – and keep them there

The fact that the sickness rate across the UK labour market is at its lowest since records began, having been in steady decline since 2003, ought to be a cause for celebration. More people in work taking fewer days off equals better productivity, after all. And yet there is no popping of champagne corks among the nation’s employers.

Our emerging culture of presenteeism, when employees go to work despite being ill, coupled with an increasing openness around mental ill-health, mean these are tumultuous times for the average HR professional trying to keep on top of their workforce’s absence levels.

Although the annual average of 4.3 sick days per worker, according to Office for National Statistics (ONS) data, is largely made up of ‘minor’ illnesses that don’t cause too much difficulty for HR, long-term sickness absence is a harder nut to crack – but employers that manage to do so will benefit from re-engaging with a valuable talent pool.

Usually defined as absence from work of four weeks or more, long-term sickness is estimated to cost employers in the private sector alone more than £4 billion per year, according to a report by the Centre for Economics and Business Research (CEBR). 

Although traditionally associated with physical conditions or injuries, mental ill-health is fast becoming a significant cause – this year’s CIPD Health and Wellbeing at Work report found that 22 per cent of employers cite mental ill-health as the main cause of long-term absence, compared to just 13 per cent in 2016. A separate report by the Health and Safety Executive (HSE) suggested that 15.4 million working days were lost to work-related stress, depression and anxiety in 2017/18, up 24 per cent on the previous year.

Long-term absence brings with it multiple costs for organisations – financial, in sick pay to the individual, staffing costs for cover, as well as possible unfair dismissal or disability discrimination awards further down the line, and in lost productivity, both from the absent individual and their remaining colleagues’ increased workload. 

Replacing that person if they are unable to return also has knock-on effects for recruitment. “There’s a lot of issues that organisations need to get to grips with in terms of long-term sickness absence,” says Rachel Suff, senior employment relations adviser at the CIPD. “It’s such a challenge because the longer someone is off, the more impact it’s going to have on the workplace, but also the harder it can be to get them back.”

“If someone goes on long-term sick, that throws an extra burden on somebody, somewhere,” adds Ivan Robertson, emeritus professor of work and organisational psychology at the University of Manchester and co-founder of wellbeing consultancy Robertson Cooper. “The smaller the organisation, the worse that is.”

With the number of people over 65 in employment doubling between 1993 and 2018 according to the ONS, it’s a burden that isn’t going away. As Suff points out: “More people are going to live longer and develop more conditions and disabilities.” So how can employers regain control of growing long-term sickness absence rates and not only get their staff back to work, but keep them there?

“The starting point for any employer is to have a sickness policy,” says Sarah Dillon, director of ESP Law. “The policy is the crux of everything, because it tells the employee what to expect. A lot of employment law is about the employee not being surprised.” 

Information that should be covered in a policy includes defined trigger points, which state when events like review meetings and medical assessments will happen; contact points, which set out how often the employee will be contacted by the employer while on sick leave; the reporting process, which stipulates when and how often the employee should confirm that they are still unwell; if any company sick pay is offered on top of statutory sick pay (SSP); and whether they will be required to give consent for the employer to obtain a medical report from their GP or other health professional.

“You can include an obligation in the employee’s contract that they will consent to a medical report,” says Dillon. “However, employees have the right to refuse medical evidence under the Access to Medical Reports Act, so employers should stress that they would need to make any decisions without the benefit of medical information, and that the employee is more likely to be dismissed.”

The importance of obtaining good quality medical evidence in managing long-term sickness shouldn’t be underestimated, as it informs the employer if the individual has a disability, and/or what reasonable adjustments can be made so they can return to work quicker. 

Referring the employee to an occupational health department – if the organisation has access to one – is something Dr Zofia Bajorek, research fellow at the Institute for Employment Studies (IES), describes as an “underused resource”. “There’s still a bit of a stigma around using occupational health,” she says. “But seeing it as a positive intervention and not something that just leads to that person leaving can help them stay in work for longer.”

Getting an expert opinion from an occupational health professional is all the more important when the individual is experiencing ‘comorbidities’ – more than one long-term condition at the same time. “Comorbid conditions are one of the biggest reasons for people going off on long-term sick – often a combination of mental and physical disorders,” says Bajorek. “So just focusing on the physical aspects of someone’s work, like giving them a better chair, is only solving half the problem. If you have a better understanding of the causes of the absence, you’ll have better knowledge of how to manage it successfully.” 

The impact of comorbidities, that include mental health conditions, on ability to work successfully is massive: a 2016 survey by The Work Foundation found that 45 per cent of those who stated they had purely physical comorbidities were not in work. When the comorbidities included a mental health condition, this figure jumped to 67 per cent.

Norfolk County Council is one organisation that has worked hard to address long-term sickness caused by mental ill-health. Should any of its 6,000 staff experience a physical health condition, the organisation has a fast-track physiotherapy scheme in place to help keep absence to a minimum. But as occupational health and wellbeing manager Paddy Lorenzen noted, there were previously no similar arrangements for those experiencing mental health problems. 

The council subsequently introduced a psychological assessment scheme, in which employees are seen by clinical psychologists, who clarify the impact of their condition on their job and what might help them return to work. “This helps managers understand exactly what is preventing the member of staff from coming back, and what can be done to help,” says Lorenzen. Thanks to the initiative, 40 per cent of staff who received support for a mental health issue since 2014 said it had stopped them taking sick leave.

But not everyone is getting it right. Employers that don’t handle the process of sickness absence appropriately – especially if it results in a dismissal – or fail to make reasonable adjustments for employees who require them, leave themselves open to legal action. “The way to avoid claims is to make sure you have a policy, and follow it. Tribunals will look at whether you’ve followed a fair process,” advises Dillon. 

“Employers should only consider dismissing someone on sick leave if a medical report isn’t able to give a realistic time frame for them returning to work, and they have considered any adjustments that can be made to help the employee back to work – and that still depends on the nature of the role.”

Employers also need to be mindful of their enhanced obligations if a medical report confirms that an employee has a disability. “The Equality Act imposes a duty on employers to implement reasonable adjustments such as changing their hours of work, making modifications to the premises, or getting them specialist equipment,” says Dillon. 

While the definition of ‘reasonable’ is open to interpretation and the cost of most adjustments is relatively low, the organisation’s size and resources will be taken into account, government initiatives such as Access to Work can offer grants to businesses that can’t afford to make adjustments for disabled employees. Unlike awards for unfair dismissal, which are capped at 52 weeks’ gross pay (up to a maximum of £80,541) and require two years’ service, disability discrimination awards are unlimited, and the employee is eligible from their first day. 

Dillon also highlights the simple but often overlooked need to treat employees on long-term sick leave with dignity. “In my experience, if people feel they’ve been treated well, they’ll be happy with the outcome – even if that outcome is dismissal,” she says. “Some HR teams don’t ever meet the employee face-to-face – they have to remember this is a real person who is probably having a really difficult time.”

Critical to ensuring any employee experiencing a long-term health condition is being able to return to work is their relationship with their line manager. However, it’s not always given enough consideration. “There are some real barriers for line managers,” explains Suff. “They have an increasing responsibility to look after people’s wellbeing, but there’s a gap in investment in training as well as a real lack of confidence in dealing with complicated cases.”

Robertson agrees. “An awful lot of line managers are terrified of talking to people about their health,” he says. “All because they haven’t had some very simple training.” The relationship between employee and line manager is especially important in spotting the signs of mental ill-health, when an employee may be hiding a condition, or may not even have recognised they have one. 

A recent report by BHSF Occupational Health found that 42 per cent of workers have called in sick citing a physical illness, when in fact the issue was mental. “If line managers have training in recognising mental health conditions earlier, they could stop a short-term sickness absence turning into a long-term one,” says Bajorek. 

However, Mike Blake, wellbeing lead for health and benefits at Willis Towers Watson, warns against overburdening line managers and blurring their responsibilities with HR’s. “The line manager can be in charge of contact with the employee, because they’ve got the relationship, but when it comes to deciding what to do about it, that goes over to HR,” he says. “They have to talk to each other, but the danger is if you push some of the specialist HR knowledge out to line managers, it’s too much for them.”

Just as important as preventing employees taking long-term sick leave in the first place is ensuring their return to work is well managed. Suff highlights that many employers see fitness to return as black and white. “There’s an expectation that you’re either fit or not, whereas organisations need to be flexible when someone might be ready to return, but not to full duties,” she says. “If you’ve been really ill, going back is a real culture shock. Rather than just carrying out a return to work interview, the return needs to be supported.”

The government’s Fit Note initiative, introduced in April 2010, aimed to ensure employers were given sufficient information by healthcare professionals to facilitate an employee returning to work following sick leave. However, it seems to have missed the mark. Robertson describes the impact of the Fit Note as a “disappointment”. “It’s a good idea,” he adds, “but GPs don’t understand most people’s jobs, yet they’re still expected to make judgements.”

A sister scheme, Fit for Work, was established in 2014 to give employers and GPs the power to refer employees for a free occupational health assessment after four weeks’ sickness absence. However, it was scrapped earlier in 2018 due to low referral rates.

This is where the issue enters the difficult intersection between personal, employer and governmental responsibility for long-term sickness. In an initiative dubbed ‘self-management’, some employers have begun providing passport-style agreements to staff with chronic conditions that outline information about their symptoms, treatment and what happens if they are too unwell to work. “Having an individual try and control the symptoms of their condition as much as they can is a great thing,” says Bajorek. “After all, the person who understands most what the illness is doing to their body is that person.”

But while better management of long-term conditions theoretically leads to lower sickness rates, the problem also needs to be tackled further upstream. Employers are increasingly waking up to the benefits of encouraging a healthy workforce – 40 per cent of respondents in the CIPD’s Health and Wellbeing at Work report said their organisation had a standalone wellbeing strategy – but are they going about it in the right way? 

“A lot of organisations are investing in health and wellbeing, but they’re not focusing on the right starting point,” explains Suff. “Initiatives like free fruit and pilates all have a place, but they have to be supported by effective leadership and a healthy culture.”

“It’s about behavioural change, moving employees out of bad lifestyle habits into better ones,” adds Blake. “Some companies find this hard because in the short term, it’s difficult to see any return on investment.” One of the main obstacles to achieving a healthier culture is getting those at the top on board, says Bajorek. “There’s so much evidence that says if you have a healthier workforce, they’re going to be more productive. The problem is, you still have people who think output is more important than wellbeing.”

Bajorek also highlights the importance of data in understanding the causes of long-term sickness, and whether an organisation has an issue with one type of condition more than others. “Don’t just go by what individual people are saying about why they’re off sick,” she advises. “Make use of data from occupational health.” 

Ultimately, Bajorek says, to be able to get to the heart of their long-term sickness issues, organisations need a better picture of what’s causing them. “We need to have a clearer understanding of what the problem of long-term sickness is,” she says. “Once we have that, we’ll be able to better identify the drivers that will help people come back to work. That’s the takeaway message for me.”

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