For UK manufacturers as for many other sectors, competitive pressures have been consistently tight for so many years now that nearly every aspect of running a business is under the spotlight. Simultaneously, employers are grappling with increasingly complex employment legislation as well as the ever-present threat of personal injury litigation, including work-related stress claims, leading to the escalating cost of employer’s liability insurance and increased risk of tribunals. All of these are pushing management of attendance and improving the employees’ rehabilitation prospects higher up the business agenda.
EEF has conducted a survey which not only confirms some of what we already suspected, particularly around the issues of training and guidance for managers, but also highlights barriers to successfully dealing with sickness absence and rehabilitation that have not previously been identified or quantified. These barriers need to be addressed both by businesses and by government and are probably of importance to all sectors of business, not just manufacturing.
The apparently incongruous finding from the survey that sickness absence rates have not risen but absence has become a bigger problem is to do with the increasing proportion of absence that is long term. Businesses have historically not dealt with this subject nor collected data identifying the split between short-term sickness absence and long term.
Whilst input from occupational health professionals (as opposed to GPs providing a service) was seen to be the most effective in managing long term absence, it is the personnel and HR professionals that were the most effective function involved in total sickness absence management. There is an opportunity here for HR professionals to change the “hire and fire” mentality and develop the “added-value” functions described in recent articles in Employment Review.
The top three barriers to successful return to work in employees on long term sickness absence were, firstly, the health condition of the employee; secondly, the (lack of) capacity of the NHS to provide fast access to services such as physiotherapy and, thirdly, the employee’s resistance to take part in the offer of rehabilitation.
The interpretation of the first barrier, supported by discussions with employers, is a concern that some illnesses are considered as more serious than others and the employer doesn’t have the medical knowledge to say which is which. Although this makes sense, it highlights a flaw in employer / employee understanding of health and work – it is not the diagnosis that is important but the consequences of it in terms of what an absent employee can or can’t do (ability or disability) that needs to be understood. There isn’t an easy solution to this problem but undertaking health promotion activities in the workplace might help raise awareness of, say, how to prevent, treat and recover from back pain or, say, how long you need to be recover from common operations. There is readily available information on such matters if you know where to look but we believe that more needs to be done, particularly by Government departments, to facilitate and encourage workplace health promotion.
The founding concept of a National Health Service for all is not upheld for the working-age population. Whilst paying privately may be a financially sound business benefit and good for the employee in reducing suffering, it is philosophically unfair to the employer and employee. If philosophy is of no interest, I suspect the NHS might reassess its priorities if it looked at the cost of unnecessary sickness absence arising from waiting times for treatments, tests and hospital appointments. An initial pump-priming of a better service for employees would, in my view, becoming self-funding.
The third barrier cites employee reluctance and is even more of a challenge for businesses to tackle. The crux of this relates to incentives and disincentives to return to work faced by the employee and the beliefs held or medical advice given about his illness. Providing incentives such as full time pay for part time work whilst rehabilitating may be the reason why the survey found that almost half the employers want tax relief for the costs of rehabilitation. Reducing disincentives that might be major employee relation issues to tackle, such as generous sick pay scheme, may be part of the reason why some employers wanted legislation which could make participation in a rehabilitation programme mandatory. However, the majority of employers did not want legislation and they are right to point out that it is likely to be too restrictive and impossible to frame for all size and types of businesses.
Perhaps an unexpected finding from the survey was the strength of feeling and frustration expressed over the role and attitude of GPs. We did not list GPs as one of the eleven barriers that we identified as potential problems but the significant number of free text comments we received, without any prompting, means that the subject cannot be ignored. Furthermore, nearly two-thirds of businesses use GPs but less than 10% of them think they are most effective in helping with long term sickness absence management. All this clearly suggest a significant problem in the relationship between employers and GPs. As an ex-GP, I know there is a fundamental issue around the lack of training of GPs in occupational health matters and the difficulties that GPs face when balancing the role of being the employee’s advocate and adopting evidenced based medical guidelines on sickness absence and rehabilitation. More needs to be done at government level and with the Royal College of General Practitioners to improve relationships with employers.
Overall the barriers suggest that employers also need better practical guidance on managing sickness absence and rehabilitation that takes into account the legal, HR as well as OH advice and tackles the barriers raised in the survey. Sometimes, health, legal, and HR professionals give conflicting advice rather than come to an agreed stance to advise line managers. The findings from this survey confirm that balanced guidance is necessary and the EEF will shortly be publishing such advice for members.
The survey found that only 4.1% of employers were acting as a response to government and HSE occupational health initiatives. This further supports the view that joined up government is needed to weave together the threads of initiatives already underway around work life balance (DTI), job retention and rehabilitation (DWP), tax rules on occupational health provision (HMT) and strategies to make Occupational Health ‘the new Safety’ (HSC/E) into a meaningful picture that also incorporates other departments (DoH) and stakeholders such as the Insurers, employers groups and TUC. This could be achieved by one sponsoring department supported by an advisory group.
Changing the mindset and culture around sickness absence and rehabilitation is not suddenly going to happen and there will always be some employers and some employees who will not participate. However, for those willing to begin to knock down the barriers the rewards should be a step towards the workforce that is “healthy, happy and here” and a business that is successful and sustainable.
EEF members who participated in the survey will receive a copy of the full reports via their Regional Associations.