Getting back to business
How will new initiatives help stem the sickness absence tide? By Nic Paton.
The CBI and AXA's annual survey of workplace absence is always a significant fixture in the OH calendar. But this year, more than most, it has given the profession food for thought.
The newspaper headlines, perhaps inevitably, picked up on the findings that workplace absence had increased for the first time in five years, and is now costing the UK more than £11bn a year. Businesses, the survey warns, are also losing billions as staff take 'unwarranted' long-weekends and 'sickies'.
While the figures are certainly important, perhaps of more interest to the OH profession will be how employers are actually dealing with these rising absence rates.
What is clear from the study is that many employers, far from sitting back and wringing their hands, are finally embracing what OH professionals have been saying for years. Namely, that early intervention and rehabilitation works; that with a bit of thought and planning, absence can be managed effectively and that OH needs to be a key partner in this process.
Certainly, there is a distinct sense that firms are beginning to take a more proactive approach to absence. In May, supermarket giant Tesco grabbed the headlines when it announced that it had begun testing a scheme whereby workers would not be paid for the first three days they were off sick.
The trial, taking place in 20 selected stores, was part of a three-pronged strategy to reduce 'sickies', with Tesco also offering extra holiday, which it hoped staff would use for the odd day off when they might otherwise have called in sick, and a voucher scheme to reward those who did not take time off for illness.
Asda, Sainsbury's, Debenhams and Next announced they were to follow suit, or already had similar schemes.
A few days later, the Health and Safety Executive (HSE) unveiled the next stage in its process of drawing up management standards to help employers manage workplace stress.
The HSE published its initial draft set of standards in 2002 and has since taken soundings and run pilot schemes, which finished at the end of last year. It has now published a new set of draft standards, and launched a further three-month consultation scheme.
The standards are based on six key areas - demands, control, support, relationships, role and change - with employees asked to rate their satisfaction levels in each area. Employers must then achieve specified organisation-wide satisfaction percentages, ranging from 65 to 85 per cent.
The Tesco strategy has certainly met with a mixed response. Despite the fact that it appears to be backed by employees - shopworkers' union Usdaw supported it - organisations such as The Work Foundation have warned it will not tackle long-term absence.
The Chartered Institute of Personnel and Development, meanwhile, is worried it could make workers who are genuinely off sick for a short period feel penalised.
For OH, there are a number of worries about such schemes. Will staff on lower incomes who are genuinely sick force themselves to come into to work to avoid losing money? If so, will such schemes in fact hinder recovery and simply cause germs to be spread between other workers?
What, too, happens when the worker gets beyond the three-day period and is still off sick? If they then get backdated sick pay, might that not simply encourage workers to take more time off than they might have done otherwise?
What's more, the CBI/AXA survey points to the fact that, while short-term absence obviously does need to be addressed, it is, in many ways, long-term absence that many employers need to be more concerned about.
Long-term absence accounts for just 5 per cent of all absence among the 500 businesses polled, but is responsible for a third of the total time lost, the survey reports.
The survey also reveals that larger companies generally have higher absence levels than smaller ones and, while most companies monitor and keep records on absence, absence levels fall when senior management became involved.
It appears the vast majority of employers (85 per cent) are now taking action to reduce absence, with return-to-work interviews found to have the greatest impact on absence levels
Critically, from the OH perspective, an increased proportion of companies (from 28 per cent in 2001 to 51 per cent in 2002) now have rehabilitation policies in place. More than three-quarters of firms have arrangements, either formal or informal, to help employees suffering from stress. And most (98 per cent) use sickness self-certification, normally for the first seven days of absence.
When it comes to accessing occupational health, larger companies are more likely to use OH professionals and are also more likely to think they are best placed to assess employees' health. Of firms with 499-5,000 staff, 90 per cent use OH and rank them 4.7 on a scale of 1 to 5. But only 53 per cent of companies with fewer than 50 workers use OH professionals, tending to rely more on GPs.
"Given that many GPs do not believe they are best placed to assess employees' fitness to work for periods of short-term absence, this could suggest that further work needs to be done to educate smaller firms on the relative merits of self-certification and short-term absence management," the report concludes.
Creating a climate whereby businesses identify absence, particularly in the short-term, with 'malingerers', is missing the point, suggests Dudley Lusted, head of corporate healthcare development at AXA.
"In some organisations, there is frequent short-term absence, and OH needs to work with this, but it should not be medicalising what is probably a management issue," he says.
"Before a manager goes in with all guns firing, they should talk to OH to make sure there is not a genuine medical reason underlying it. When there is an absence problem, you need to determine what the problem is," he adds.
What is encouraging is the growing recognition among employers that short-term and long-term absence are different beasts, and therefore, health professionals, particularly OH, need to manage them in different ways. This change can be seen particularly in the spread of rehabilitation services, Lusted says.
"Two years ago, it was virtually non-existent, now two-thirds have some sort of rehabilitation service. It has gone from 20 per cent to 40 per cent and now to 60 per cent providing some level of rehabilitation for their employees," he says.
This might be as simple as offering flexible working, or more complex solutions such as offering early medical or surgical intervention. "Employers are realising that if you do not help people back, then they do not come back. Employers are taking a much more proactive stance on this," he adds.
While stress is clearly just one form of absence, the HSE's draft standards are very much about trying to push employers in this same proactive direction, argues Chris Rowe, head of psycho-social issues at the HSE.
"What we have been trying to develop for more than a year now, within the pilot organisations, is a framework that the employer feels comfortable using to tackle work-related stress. We believe that a lot of work-related stress can be tackled by organisational intervention," he says.
The frameworks could be put into place by a variety of people within the organisation, not just OH, using health and safety, risk management, HR and so on, he suggests. "Increasing stress is being seen as an issue for HR to deal with. The experience of the pilot organisations is that HR has an important role to play, either jointly with OH or sometimes taking the lead," he explains.
Therefore, one of the key aims of the HSE process is education - raising awareness among HR that stress is not just an issue to be shunted on to OH. And, among OH, that stress needs to sometimes be addressed in tandem with HR.
"OH providers are essential to support whatever needs to be put into place. We are getting more and more examples of people prepared to stand up and say 'we are prepared to tackle this in a structured way'," says Rowe. "OH can help in getting things set up."
The role of GPs in all this is central. The Government and GPs are both keen to shift sicknote responsibility to other healthcare professionals, including OH, with GPs looking to have advanced some way down that road by 2006.
The Department for Work and Pensions (DWP) has indicated it is now seriously looking at what options are feasible, and how to tackle the culture in which GPs sign people off sick far too easily. Pilots examining how such schemes might work were due to be launched in April but, as yet, appear not to have got off the starting block. Nevertheless, an initial report into the issue is due to be published by the DWP this summer.
"GPs are often in a situation where they do not necessarily understand the challenges of what people are dealing with at work, so it is difficult for them to advise what may be appropriate for them in the workplace," says Rowe. "Having occupational health's engagement early on can help."
Where workplace stress is reported, it should be sounding alarm bells, not just dismissed as an individual's problem or issue, he adds. "It's more likely there are fundamental organisational issues that need to be addressed and explored. It could be there's nothing, that it is just a dip, or there could be a set of other circumstances, but it could disguise other issues," Rowe says.
AXA's Lusted, for one, believes the profession needs to grasp the opportunity being presented by this focus on absence to make its presence felt within the workplace. This is particularly the case within small companies, where, as the report shows, there is still much work to be done to convince employers of the profession's worth and shift employers away from an over-reliance on GPs.
"Where its [OH's] role is much more valuable than that of a GP is that it makes a functional assessment," he explains. "It's not what you cannot do, but what you can do, it is recognition that it's about fitting the job to the person, until they can do what they were originally employed to do."
With GPs looking to pass on responsibility, the HSE focusing firmly on stress, and companies large and small increasingly recognising the value of intervention and rehabilitation, OH has an opportunity to take centre stage. But to do that it has to show its worth.
"OH can challenge the GP role on waiting lists and early intervention. OH can get into even more prevention and support of line managers," argues Lusted.
"But one of the things the OH fraternity needs to wake up to is the need to demonstrate value, what are you doing better, what are you doing that is benefiting the business?" he adds.
