Sickness absence does not make management’s heart grow fonder

The health and work assessment and advisory service is the most eye-catching of a series of recommendations from the 2011 Health at Work review by Carol Black and David Frost.

The initiative has been welcomed, not least by the trade union representing physiotherapists (CSP), but on figures included in the Black-Frost report, it will mainly be addressing the small proportion of employees — just 4% — who have more than four weeks of absence in any given year.

That 4% accounts for 40% or more of working time lost, so it’s a very important element in the overall cost of sickness absence. But it leaves employer and union-employer negotiated absence policies to cater for the 12% who receive a medical statement (more than one week of absence), the 22% who have a spell qualifying for statutory sick pay (four or more days), or the 48% who have some sickness absence.

Shockingly, the Black-Frost report reveals that out of 330,000 people each year who “fall out of work” onto state benefits — in the form of Employment and Support Allowance — 140,000 do not have a period off sick first. These workers — typically the lower paid, less well-qualified, working for smaller firms — are being excluded from employers’ interventions to keep them in work.

So it seems clear that there is a role for the new service in workplaces of that kind and it may provide a “backstop” for employers generally. However, a Workplace Report survey of over 200 schemes from Labour Research Department’s Payline database suggests that the main focus of recent employer initiatives has been on shorter rather than longer-term absence.

There have been new targets for sickness absence; new policies on short-term intermittent absence; new trigger points for the referral of workers to occupational health services (OHS); and new disciplinary warning arrangements.

The survey also found the spread of the “Bradford Factor” system for assessing the frequency and duration of an individual’s sickness absence , with at least one in 12 schemes in the survey making use of this method.

Notification of absence

The Black-Frost report describes the first stage of an individual’s absence “journey” as usually involving a visit to their doctor, but workplace-level procedures typically kick in much sooner than that, starting with clear rules about notification of absence and the need to keep in touch.

Some employers may expect notification by an absent employee “immediately”, but it is more common for this to be within the hour after a worker normally starts work. Employer examples include electronics firm Diodes-Zetex Semiconductors and the Northern Ireland Civil Service, while at Usborne Publishing and others it is “by 10am”. Some accept notification during the first day, for example Arts University Bournemouth.

The sickness absence policy also needs to address workers on non-standard hours. And it needs to set out who can report absent employees if an employee can’t do it themself — usually their family — and how the absence is reported. The latter will involve usually a phone call. However, some policies rule out specific methods of notification, for example at Princes Soft Drinks, Bradford, text messaging or emails are not allowed.

Employers may also require a reason for the absence and as at Dorset Police Staff some estimate of how long the employee expects to be absent . This may be asked for when the worker completes self-certification for statutory sick pay (SSP) which is not payable until workers have been off for four days or more in a row. But while some employers don’t require self-certification until then, others demand it from day one.

Where an absence lasts more than a day or two, repeat notification is often required. Unity Trust Bank employees have to telephone their manager on a daily basis about their progress but elsewhere employees are given more leeway: three days at Buckinghamshire County Council; on the fourth day at Northampton University; and every five working days at Usborne Publishing.

An ongoing commitment to stay in touch is key where sickness absence is prolonged. Some absence policies clearly identify this as a management responsibility, but at Severn Trent Water employees are contractually obliged to maintain contact.

'Fit Notes'

The Black-Frost report highlighted the role health professionals play at different points in the system: providing care, advice, treatment and rehabilitation; certifying sickness of the employee to their employer; and acting as a gateway to the benefits system.

In April 2010, the sick note was replaced by the “fit note” which means doctors can advise that patients “may be fit for work” taking account of advice given. It includes space for comments and approaches to aid a patient’s return to work.

The CBI employers’ organisation is sceptical that the “fit note” has been a “catalyst” for major changes in the culture of sickness and rehabilitation. However, it does seem to be the case that some employers now expect medical supervision before a “fit note” becomes due.

Aberdeen University has recently been seeking to introduce intervention by the occupational health department on the first day of absence. And where absence is stress/anxiety/depression or cardio-related, there is automatic referral to the occupational health department for staff at the London Fire and Emergency Planning Authority.

Return to work interviews

Medical intervention may also be required when employees return to work. A final certificate of fitness to return is required at Burnley Council where an employee has been sick for more than 14 days. But most workplace policies are geared up for a quicker return than that and have introduced return to work interviews (RTW) to find out how things stand with the sick member of staff.

However there are differences of approach. Some policies see interviews as automatic, “low key” and perhaps informal. Others may be more selective about who to interview, and see it perhaps as a launch pad for a more searching assessment.

An interview after every occasion of absence is required by manufacturers Diodes-Zetex Semiconductors, tyre manufacturers Michelin and aircraft landing gear manufacturer Messier-Bugatti-Dowty in Gloucestershire. It also happens at Keele University and Wealdon District Council in the public sector.

But elsewhere a more selective approach may apply. Use of interviews depends on length of absence for technical staff at Rolls-Royce, while it is at management’s discretion at Buckinghamshire County Council. At Leicester University, interviews are carried out where a member of staff has been absent on three or more separate occasions, or more than eight days in total, during a rolling year.

Bradford University, often linked to the Bradford Factors system, uses it to determine the need for a “back to work” discussion (triggered by a score of between 2 and 19 on the Bradford Factors system).

The purpose also varies. At Nottingham Community Housing Association, line managers interview employees on their return, regardless of duration, to explore causes of absence, facilitate an individual’s return and identify steps to reduce the likelihood of future absence.

Formality varies too with the more formal schemes more likely to suggest trade union representation. At the East Lancashire NHS Hospitals Trust, interviews are about employees’ welfare and should not be used to caution employees about their attendance records formally.

A more informal approach applies at Wolverhampton University where a brief discussion at the signing of the self-certification forms will suffice in most cases.

Finally, there are differences of emphasis in how soon the interview must be held, which also convey a message about the role they are playing. It has to be day one at Princes Soft Drinks, Bradford and Glyndwr University. It can be within one or two days at Jaguar LandRover; within two working days in the Northern Ireland Civil Service; two to three days at Durham County Council; up to five days at East Lancashire NHS Trust and seven days at the RSPCA animal charity.

Short-term sickness absence

Recurrent short-term absence may not be in the frame for the planned new assessment service, but it is a major pre-occupation in employers’ sickness management schemes.

Last year, Waverley Borough Council introduced a Fit for Work Policy that set a target of eight days sickness, after which employees may face stage 2 of the Capability Procedure

Kirklees College management wanted to negotiate changes on short term, intermittent sickness, while Truro and Penwith College imposed targets for sickness. Changes involving Bradford Factors were reported at publishing company EMAP Public Sector, at Worcester College of Technology and at Doncaster College.

Many employers now use “trigger points” to prompt a response when individual absence passes certain thresholds, in either duration or frequency. It seems to be more common in the public sector, and in higher and further education.

Public sector employers typically react after six, eight or 10 days off, or between three and five spells of absence. It may be measured over a three- or six-month period or more usually over 12 months.

At the London Borough of Richmond upon Thames, the trigger point is 10 days or three periods of sickness absence each lasting three days or more. At Bassetlaw District Council, it’s eight days or three periods of self-certificated absence. And at Cheshire Fire Service it is six days or three periods of sickness in 12 months.

The London Borough of Hackney has triggers at three, six or 12 months, but also looks for patterns of absence on a certain day of the week; when seasonal events take place; or on either side of annual leave or a public holiday.

The Bank of England uses one set of trigger points for referral to occupational health (10 days/four periods in 12 months); and another for disciplinary measures if there is no single underlying cause (18 days or eight periods).

In higher and further education, triggers of 10 days or three to seven spells of absence are more common, and at London South Bank University it is 20 days or seven spells. On the other hand, employers in the sector seem more likely to use descriptive triggers: at Exeter University it is 12 days or five periods or a regular pattern of absence, such as Monday/Friday, additional days before/after holiday or regular absence coinciding with work pressures or deadlines.

Production employers may be more interested in recurrent spells (for example three periods in 12 months) or percentage absence (3%), but trigger points of 10 days or three spells are used at Severn Trent Water, Princes Soft Drinks, Bradford and BAE Systems Maritime (Naval Systems, Clyde).

Private service employers are, if anything, more diverse, using triggers ranging from five days at Nottingham Community Housing Association to 14 days or four periods of absence at Unity Trust Bank.

Employers using Bradford Factors vary on the score required. At insurance company Allianz and at Allianz Engineering Inspection a score of 64 triggers an informal review, 125 a level-1 formal warning.

Long term sickness absence

Employers do address longer-term absence and often use a definition close to the four-week threshold for the planned health and work assessment and advisory service. A minority currently use a use a longer definition: a calendar month at Meggitt Aircraft Braking Systems, six weeks at Heriot-Watt University and six months at Michelin.

The Black-Frost report acknowledged that longer-term absence — of more than four weeks — tends to be due to musculoskeletal disorders, mental health problems and severe medical conditions such as cancer, diabetes, heart disease or stroke.

Employees who suffer from these conditions can make a successful return to work, so absence management policies need to cater for continuing absence even though it may affect only a small proportion of the workforce.

Good absence policies recognise factors that can provoke sickness absence and that should be taken into account. Underlying medical conditions, a major operation or a terminal illness should be apparent.

There may be a specific recognition of disability. And where stress or depression has been identified by a GP as a cause for absence employers now seem to accept that a clear-cut response, such as early referral to OHS, is appropriate.

The availability (or otherwise) of flexible working and dependency leave can also affect levels of sickness absence. And there are well-documented demographic and work-related patterns that employers should be aware of too. In the latest CBI survey, the overall average absence rate was 5.3 days, but it is higher among manual workers.

Workplace injuries or illnesses will also be disregarded by some employers when assessing an individual’s absence record. They don’t count in the calculation of Bradford Factors scores at Koyo Bearings, for example.

EMAP Public Sector recognises that every case will be different and it takes into account the worker’s attendance record before the current illness; their job and position; the effect of absence on the business and the need to get work done; the nature and duration of the illness and prospects for recovery; and remaining entitlement to enhanced company sick pay and SSP.

Absence management procedures

Active management of absence starts with ongoing contact with absent employees, and applying the stages of any monitoring, capability or disciplinary policy fairly.

For absent employees, a periodic meeting with a representative from the employer is likely to be part of the plan. The meeting could be held at home, at work or at what Guildford College describes as a mutually acceptable location.

Subsequent steps — either OHS referrals or involving higher management — can put the spotlight on management systems themselves. In a recent change the HR department at the Bank of England is now managing the sickness absence policy centrally. Local management still have some discretion, but have to make a case to HR not to instigate disciplinary procedures when the trigger points are reached.

Procedures at Shropshire Fire and Rescue Service require long-term absence to be reviewed by the section head on a regular basis, in liaison with the line manager and HR manager.

At St Helens and Knowsley Hospitals, the HR advisor pro-actively oversees each long-term sick case with a view to working with the line manager and the work, health and wellbeing service to facilitate an early return to work, or a decision on their employment.

There are a range of possible outcomes where an employee has either triggered the thresholds for intermittent short-term absence or crossed a line into what the employer regards as long-term absence.

The London Fire and Emergency Planning Authority has a detailed programme that covers many of the potential outcomes. It starts at day 1 with notification and by days 14-17 envisages further contact with the employee, consideration of the need for a medical appointment, offers of assistance for a return to work, and preparation for an OHS referral.

From day 21, sickness is classified as “long-term” and the HR department will make an OHS referral, while the manager will contact the employee to explain the purpose. That leads to a medical outcome report between days 28-35 (approximately) that can be discussed at the first review meeting between the manager and employee.

That review meeting aims to agree contact strategy and discusses the medical interventions or support required, a return to work date and initial rehabilitation plan. Further OHS appointments are arranged for every four to six weeks, with reviews after each appointment.

There are further stages at 13 Weeks (for example, move to sick pool); 22 Weeks (impending reduction to half pay); and 26 weeks (employee sent to OHS for functional activity list assessment).

If there is no immediate prospect of a return to work a Stage 2 discipline (attendance) hearing is convened at approximately nine months, with a return to normal duties, redeployment, ill-health retirement, or resignation as the possible outcomes.

Options are explored over the final three months, and there are further checkpoints at 48 weeks and 52 weeks, but a Stage 3 hearing where the employee may be dismissed on medical grounds is likely to be convened.

Variations on these themes appear in other companies and organisations and might include penalties for non-attendance at OHS sessions; the employee’s right to a copy of the OHS report; arrangements for consultation between company doctors and the employee’s doctor; the identification of alternative work and available vacancies; and prospects for a phased return.

At Cerestar (Cargill), as at some other organisations, there could be a transfer to permanent health insurance until retirement.

The possibility that continuing intermittent or long-term absence may lead to penalties such as the loss of sick pay or the imposition of waiting days, or to dismissal, is usually explicit in absence management policies.

The policy at Shropshire Fire and Rescue Service has not altered, but management have started automatically awarding a written warning for four periods, and removing continual professional development pay worth about £650.

As Bassetlaw District Council puts it, in the event of its actions being either exhausted or unsuitable, and a further referral to occupational health not giving an indication of a foreseeable date of a return to work, a decision may be made to refer the matter to a case review hearing to consider the employee’s continuing employment. This could lead to a decision to dismiss the employee due to their incapability to undertake their job due to ill health.

As with all disciplinary-type policies, unions will want to be sure that there have been a clear and sufficient number of stages, opportunities to improve, the involvement of “independent” managers and proper trade union representation.

The thrust of the Black-Frost report was to reduce the risk of workers “falling out of work” due to ill health: If the new health and work assessment and advisory service succeeds on that count it will be welcome.

www.gov.uk/government/publications/review-of-the-sickness-absence-system-in-great-britain

www.cbi.org.uk/media/2150120/cbi-pfizer_absence___workplace_health_2013.pdf