Sickness absence is a costly problem in the health service and clear steps must be taken to record and manage it, says Jog Hundle

Sickness absence from the workplace is a persistent and costly problem for the NHS.

Recent surveysshow that employees in the private sector took an average of 6.3 days off sick last year, whereas in the public sector the average annual sick leave is nine days for each employee.

The most common reason for sickness absence is musculoskeletal conditions, followed by mental health-related sickness (covering everything from feelings of mild anxiety through to serious mental impairments such as clinical depression). Research also reveals that in the public sector more than half of reported absence is described as long term.

These statistics mean managing sickness absence should be a priority for NHS organisations.

The direct costs of absenteeism include statutory and contractual sick pay and in some cases temporary injury benefit, as well as the cost of replacement staff and/or overtime and loss of productivity.

Harder to quantify are hidden costs such as the impact on managers and other staff and the dangers of creating a culture of absenteeism.

Pin-pointing the problem

Employers' responses to absenteeism can be as varied as the reasons for absence. Having people on long-term sick leave is a problem that many employers are slow to grapple with because such cases can be difficult to deal with. For example, employees who assume that a sick note entitles them simply to ignore their employer, employees who are reluctant to comply with requests for sickness review meetings, difficulties of rehabilitating employees back into work and possibly dealing with disability discrimination issues.

But if you fail to take necessary steps, you may leave the problems too late to rectify.

The more you know about the employee's condition and its cause, the better placed you will be to act appropriately. Information is particularly important if you suspect the sickness absence is not genuine. This can be dealt with as a conduct issue; genuine sickness absence needs more sensitive handling.

In a typical case, an employer receives information, often second hand, as a telephone message or GP note. Often this does not indicate the seriousness of the illness or its cause.

The trend for GPs to provide medical certificates referring to 'anxiety', 'stress' or 'fatigue' is unhelpful. Such certificates give no indication of the severity, cause or likely duration of the problem.

You need to consider:

  • What is the nature of the problem?

  • Is it work related?

  • Are there steps you should be taking to prevent or ameliorate it?

  • Has the employee raised any concerns formally or informally about work pressures?

Remember that a number of complicating issues may need to be addressed if an absence continues or is repeated. For example, the employee may raise a grievance about workplace pressures; you may want to pursue a disciplinary process if you consider the absence is not genuine; the employee may resign if they feel they cannot cope or that they are being dealt with unfairly; or you may wish to dismiss for 'capability'.

The employee may have a disability under the Disability Discrimination Act and you should consider whether what you do could lead to legal action.

To address any of this effectively, you will need to followa reasonable procedure. This includeskeeping an accurate record of what has happened and the steps that have been taken, maintaining reasonable contact with the employee and referring the employee for a medical report.

In seeking medical evidence, you must ask for the report to deal with the nature and likely duration of the illness, whether the employee will improve and over what period. Whether the employee is disabled is a management judgement to be made in the light of the evidence and any medical report should not come to a conclusion about this.

Consultation with the employee will be vital to gauge the true medical position and it will also give the employee an opportunity to raise any concerns and offer views as to appropriate steps you could take to make adjustments or improve the situation. It also enables you to ensure that the employee is aware of the impact of their absence on the department and other staff.If dismissal is a possibility, then inform the employee in writing of the steps taken and that ultimately the employee may be dismissed.

Last resort

Finally, you must ensure that the statutory dismissal procedures as well as any contractual provisions are followed.Dismissal in ill-health cases should generally be a last resort so you will need to give careful consideration to alternatives.

If the employee is disabled, this will be particularly important in view of the obligation to make reasonable adjustments. These might include altering duties or a phased return to work. Ill-health retirement might also be considered as an alternative to dismissal.

After you have completed consultation with the employee, have considered the available medical evidence and have concluded that there are no reasonable alternatives, dismissal may well be fair. The key question is whether it is reasonable to expect you to wait any longer before implementing the dismissal.

Through these relatively small measures, the employer can begin to undertake absence management and tackle both short and long-term sickness absenteeism.