Which NHS staff group smokes the most, and which drinks the least? And why are sickness absence rates so high? Mark Crail reports on a Health Education Authority survey

NHS staff smoke less, drink less and are less likely to be overweight than most people - yet still have some of the worst sickness absence rates, according to a study published by the Health Education Authority.

But the research also suggests that although 'some managers might believe' that high levels of sickness are part of an absence culture among NHS staff, such theories have 'no factual basis'.

And it casts doubt on the degree to which employers can realistically expect to influence sickness absence through health promotion initiatives.

The study, Working for Your Health, was carried out by the Institute of Employment Studies for the HEA as part of its Health at Work in the NHS programme and is based on a survey of more than 8,500 staff in 14 trusts.

Its findings were compared with the HEA's Health in England 1995 report and the 1990 National Fitness Survey conducted by the HEA and the Sports Council to put the health of NHS staff in a broader context.

The survey found that, overall, more than half (57 per cent) of the NHS staff surveyed were of optimum body weight; but almost a third (27 per cent of women and 35 per cent of men) were overweight or obese.

Of these, nurses and professionals allied to medicine were least likely to be overweight, while around a quarter (24.1 per cent) of general and senior managers were overweight, with a further 6.7 per cent classified as obese.

Just under one in five (19 per cent) admitted to smoking. Doctors (10 per cent) and PAMs (9 per cent) were least likely to smoke; ancillaries (31 per cent) and works staff (28 per cent) were most likely to do so.

More than half the smokers (58 per cent) thought it had little or no effect on their health, but half said they planned to give up over the next 12 months.

Nine out of 10 respondents (88 per cent) reported drinking alcohol, with 7 per cent of women and 17 per cent of men drinking more than recommended sensible drinking levels.

Managers drank most on average (10.3 units of alcohol a week), followed closely by doctors and dentists (9.7 units); ancillary staff (5.1 units) and administrative and clerical staff (5.3 units) drank least.

In comparison with the public as a whole, health service staff were less likely to smoke (19 per cent compared with 28 per cent), were less likely to drink - and drank less (6.5 units compared with 12.4 units), but also exercised less.

One in four staff in the NHS sample reported taking sufficient exercise to minimise mortality, compared with one in three in the general population, and the gap was greatest for men (25 per cent in the NHS; 41 per cent generally).

Most respondents (59 per cent) said they normally ate a meal at their workplace; 24 per cent used the staff canteen or restaurant, and 17 per cent made other arrangements.

One-third (34 per cent) said they 'frequently' ate while working or took no meal break, with 40 per cent saying this happened less often. Senior managers (59 per cent) and doctors (53 per cent) were most likely to skip meals.

A little under half of those surveyed (46 per cent) reported that they had been absent from work because of their own sickness or injury in the past six months, ranging from 27 per cent of doctors to 53 per cent of PAMs.

Most absences (68 per cent) were of up to five days, though 5 per cent said their last absence had been for 20 days or more, and 0.5 per cent had been absent for 100 days or more.

Women (49 per cent) were more likely to have been absent than men (37 per cent), with the incidence of absence decreasing with age - although older staff were away from work for longer periods when they did fall ill.

The survey found that obese staff were more likely to have been absent through illness, as were smokers. Heavy smokers were more likely still to have been off, and reported longer sickness absences.

Asked what their trust could do to improve health at work, 66 per cent of respondents asked for more open communication with staff, and 64 per cent said managers should be more sensitive to employees' concerns.

The researchers used survey responses to examine each staff group's level of identification with their trust, the extent to which they thought it had a culture of openness, the level of workplace stress and the support they felt they were offered.

In each category, general and senior managers scored a higher rating than any other staff group, while maintenance and works staff scored lowest.

Drawing lessons from the results, the report notes that many managers cite the level of sickness absence as a central concern in health promotion work, often placing it at the centre of their business case for such activity.

The survey, it suggests, highlights four facets of sickness absence for further study:

why fewer than half those surveyed accounted for all the sickness absence;

why some respondents reported frequent but short bouts of sickness absence;

whether the duration of absence - which appeared to be linked to lifestyle - should be included as a measure of effective health promotion activity;

the apparent finding that the absence culture has no basis in fact.

Working For Your Health: a survey of NHS trust staff. Available from Abingdon Book Services, PO Box 269, Abingdon, Oxfordshire OX14 4YN. Free.