NHS human resources managers are to have new guidance on tackling absenteeism in line with chancellor Gordon Brown's bid to cut £6bn from the public sector staff sickness bill.

In his pre-Budget statement, Mr Brown set a three-year target to cut abseenteeism and improve productivity. The NHS Executive will issue a circular this month outlining the steps HR managers should take to meet the target.

NHS staff have one of the highest sickness rates in the public sector, with an average of 9.9 days a year off sick.

Earlier this year, a Cabinet Office report called for a 20 per cent reduction in public sector absence rates by 2001.

It put the average level of sickness in the civil service at 8.5 days and in local government at 9.2 days - both lower than the NHS. Private sector absenteeism is estimated to be an average of seven days a year.

But unions and managers have both voiced concerns.

'The focus must be on unhealthy workplaces rather than a so-called 'absence culture',' said Unison general secretary Rodney Bickerstaff.

'A major problem is tackling the causes of staff sickness, including poverty pay, workplace violence and stressful workloads and staff shortages.'

The Royal College of Nursing was concerned that the initiative might become a scapegoating exercise.

'It should be about tackling some of the root causes of absence,' a spokesperson said.

'We have a lot of nurses off with back injuries who shouldn't be.'

Institute of Health Services Management deputy director Suzanne Tyler said addressing morale was important.

'An 'off with their heads' approach is unlikely to benefit anyone and could worsen the situation,' she said. 'There need to be incentives and the creation of realistic family-friendly policies.'

Mr Brown also announced plans to review the future administration of the private finance initiative. He has asked Sir Malcolm Bates, who revamped private finance initiative for Labour after the party came to power, to consider whether the Treasury taskforce should continue beyond its planned two- year time limit.

The move comes as more and more PFI schemes go on stream. NHS Confederation policy manager Tim Jones said that within the NHS the jury was still out over PFI deals. 'We are glad to see some money coming in to the system even if it is through PFI. But we need to see whether they are going to be good value in the long term.'

Health secretary Frank Dobson is expected to announce soon the full details of how the extra£250m winter pressures money for this year is to be allocated.

The NHS Confederation said the cash injection made it 'unlikely' that patients would face long waits for surgery. But the British Medical Association warned that a harsh winter could still cause 'major problems' for hospitals and primary care services.