Stress and rising workloads are blamed for above-average sickness absence in the NHS's own workforce. Mark Crail looks at who needs time off and why

Nurses have claimed for years that rising workloads are affecting their health. So have doctors.

And managers. And ambulance staff.

Now a wide-ranging study commissioned by employers and staff bodies confirms it.

Sickness absence rates of 5 per cent or more are costing the NHS£700m a year, well above the 3.5 per cent average elsewhere. The culprits are overwork, complaints, violence - and poor management.

The study, put together for a partnership of royal colleges, trade unions and NHS management bodies convened by the Nuffield Trust, claims to be the first comprehensive review of all the available evidence.

Speaking at its launch last week, Nuffield Trust director John Wyn Owen said the problems were not just physical. 'Substantial minorities in all staff groups suffer from worrying levels of psychological distress.'

The report, titled Improving the Health of the NHS Workforce , puts forward 10 recommendations. Among them it suggests ministers should ask employers to evaluate work demands and review staffing levels.

But partners in the project admitted that pressure to increase NHS efficiency and cut waiting lists did not sit easily with the call.

NHS Confederation co-chair Catherine McLoughlin said: 'The reality is there is an expectation of more work and there is no evidence that there will be an increase in resources to match.'

One way forward, she suggested, was to build on examples of good practice found in some parts of the NHS.

The study says small trusts with good communications where people control their own work have less staff sickness.

Promising to ensure that the report's recommendations were raised in national forums, Unison head of health Bob Abberley said the union was talking to employers about increasing 'flexibility in return for job security'.

Sandy Macara, chair of the British Medical Association, said the health of NHS staff was not just an issue for the government and employers.

'I don't think the BMA has ever done enough to support doctors, ' he said.

'There is a culture that when doctors are in trouble they run for cover, and other doctors cover up.

'They ought to be running for help, but they don't because they have been pretty well aware that they won't get it and their colleagues would be unsympathetic.'

The BMA was now preparing to launch a major initiative to try to ensure doctors could get help when they needed it.

Dr Macara said: 'There is a relationship between this report and waiting lists. Unless people are motivated and encouraged and supported to give of their best, then you will have less work done and the system will be less efficient.'

In the long term there was a need for more surgeons. 'But in the meantime, let's get the people we have got to do the work - otherwise this policy which has been forced on Frank Dobson will fail.'

Institute of Health Services Management deputy director Suzanne Tyler said: 'If we can tackle the stress managers are facing, we can work on their management style.'