Sickness absence costs the NHS more than£2bn a year, with 40 per cent due to back pain and 30 per cent down to stress-related illness.

NHS sickness absence fell slightly to 4.6 per cent in 2004, compared to 4.7 per cent the previous year, according to Department of Health figures released last month. Rates of sickness vary by trust type. Ambulance trusts report the highest levels, at 6.2 per cent, compared to acute trusts, where the absence level was 4.4 per cent. The rate for the relatively small number of staff in strategic health authorities was lowest at 2.5 per cent.

By government office region, the worst hit were the North East and North West, both with sickness absence rates of 5 per cent. London and the South East had the lowest at 4.2 per cent. By individual strategic health authority, Cheshire and Merseyside had the highest rate with 5.3 per cent, while Surrey and Sussex polled the lowest with 3.9 per cent.

Dr Andrew Frank, chair of the specialist interest group in vocational rehabilitation at the British Society of Rehabilitation Medicine, says managers can reduce sickness rates through monitoring, timely interventions and effective rehabilitation.

'Some trusts are careful about sickness absence monitoring but they often can't tell how the rates break down by ward, unit or directorship, ' he says, adding that monitoring does matter - and not just to track where the bad managers might be.

'If you do not know why people are off sick how can you offer them assistance?

For example, if you see clusters of people going down with backache on a particular ward you need to check they are using the appropriate hoists or equipment.

'If a person is off sick it should trigger a strategy to get them back to work, ' he says. A response should include a visit from an occupational health nurse. If there is a back problem, the employee could be moved to work that doesn't require heavy lifting, ' he says.

The Chartered Institute of Personnel and Development says only half of managers have had training in managing sickness absence. But this is key to attendance management, says Dr Frank, along with good guidance, information and supporting staff with modern occupational services.

'Any large trust that doesn't have an arrangement with a physiotherapist or inhouse support is probably losing money.

You need to have the attitude that people can return to work if at all possible.

'If someone has a stroke, for example, they may need rehabilitation support but will still be able to return if the trust makes reasonable adjustments. But whatever you think in human resources, something different may be happening down the line. For example, a ward sister might say to the sick member of staff, 'you can't come back if You have had a stroke'. That person thinks 'That is it' and starts planning their retirement.' Staff should be told about any sickness absence policy on induction, he says. 'If your boss phones you while you are off sick at home, that may be OK. But someone from HR could be interpreted as threatening, a bit like Big Brother is watching.' Rebecca Coombes -www. dh. gov. uk