Sickness absence: Diagnosing the causes

If you read nothing else, read this …

• Causes of absence, especially mental health problems, can be hidden because many employees are worried about the consequences of disclosing them.

• Early intervention can ensure an employee feels valued and help their return to work.

• Line manager training is essential to enable them to deal with sickness absence.


Getting to grips with sickness absence calls for a varied approach by employers, including early intervention, formal procedures and line manager training

Sickness absence is a major challenge for employers and finding ways to reduce it is essential. In 2010, lost working days cost the UK economy £17 billion, according to the Confederation of British Industry/Pfizer Absence and workplace health survey, published in May 2011.

The first step in managing sickness absence is to understand its causes. Minor ailments such as colds, coughs and stomach upsets tend to be the reason for the odd day or two of absence, but longer-term absence has a variety of causes. Ann Dougan, marketing director at Cigna HealthCare Benefits, says: “The experience we have with clients suggests musculoskeletal problems are the most prevalent cause of absences that fall between short and long term but, when it comes to long-term absences, many see mental health disorders as the key cause.”

However, there can be problems in identifying the real causes of sickness absence. Statistics can often mask the truth, with mental health problems, in particular, likely to be hidden behind other conditions. Amy Whitelock, senior policy and campaigns officer at mental health charity Mind, says: “It is not always clear cut what the causes of absence are. Lots of people who report back pain or other musculoskeletal disorders may actually be experiencing depression or stress that is manifesting itself in a physical way.”

Work itself can also be a cause of absence, such as issues with managers or colleagues and the employee’s role and responsibilities. This is something that Janine Sparks, reward manager, employee benefits at British Airways, recognises. “Employee engagement and line manager capability are important here,” she says. “If you have not got those right, then people are not going to want to come into work because the environment is not welcoming. I see this as a key cause of short-term absence, in particular.”

Necessary processes

The way employers deal with sickness absence is important, because although some absence is inevitable, some is avoidable or could be reduced. Short-term absence is widely seen as easier to deal with than long-term, largely because its frequency means it is easy to gain experience of it and put the necessary processes in place to manage it. “Long-term cases can be difficult to handle and require particular skills to manage,” says Sparks. “This is where managers tend to struggle and need more support.”

Having a set framework to refer to when dealing with absence is seen as essential. This needs to be able to inform dialogues but have enough flexibility to allow each case to be treated individually.

Dr Chris Sharp, a consultant occupational physician and managing director of WorkFit, says it is important to treat each employee as an individual when tackling sickness absence. “The solution comes in treating the person as an individual rather than a disease or health condition. Mental health problems can arise when people think they are just one cog in the machine. This can erode their self-worth.”

To ensure each case is treated individually, it is essential to involve an employee in their return-to-work plan. Whitelock says employers should offer the same process to ensure staff are treated equally, but ensure the dialogue is personal. “Ask them how they are as a starting point,” she says. “Then [employers] could use a common tool, such as a wellness recovery action plan, to talk to them about what solutions work for them. This allows [employers] to have a case-by-case approach while making sure they treat everyone within the same framework.”

Common framework

As well as having a common framework to deal with sickness absence, early intervention is seen as a key way to support employees and help them return to work. This is particularly important because there is such a close link between long-term absence and mental health problems.

Thomas Humphris, head office HR and UK reward director at Informa, says that if an employee is absent because of conditions such as musculoskeletal disorders, stress or mental health issues, they will automatically be referred to occupational health. “It is so important to create this dialogue at the earliest opportunity,” he says. “The employee can talk to the occupational health specialist in total confidence and, by reassuring the employee that the employer wants to help them, they feel able to disclose information that can be used to help them. It significantly reduces long-term absence.”

Whether or not an employee can return to work quickly, it is essential to keep the dialogue open. Gary Cox, employee relations and immigration manager, UK and Ireland at American Express, says that alongside occupational health, his firm is keen to remind staff that work is good for them. “We have done a lot of work with return-to-work programmes and flexible working plans to encourage people to come back,” he says.

Line managers are seen as playing a critical part in helping employees return to work. In many cases, the line manager will be the main contact for the employee, especially in the first few days of absence. “Line manager capability is key,” says Cox. “You need to give them the tools to have an open dialogue with the employee and address those issues before it turns into a long-term absence case.”

Feel uncomfortable

But, unfortunately, line managers are not always best prepared to deal with sickness absence. Ksenia Zheltoukhova, researcher at The Work Foundation, says many line managers feel uncomfortable talking about sickness absence.

“There is a stigma about certain conditions and absence in general,” she says. “So many managers are not trained to speak about this because it is seen as such a sensitive issue.”

But some employers have recognised the important role of line managers. “They have to be trained on what you can say, what you cannot say and what you can do to support the employee,” says Informa’s Humphris.

He adds that although facilities and services from his company’s group income protection provider can be extremely valuable, if the line manager does not know it is available, it is worthless.

Proactive role

American Express encourages its line managers to take a more proactive role in managing absence, says Cox. “Our most successful cases are where the line manager has had a good relationship with the employee. This has enabled them to have a good understanding of how the condition has impacted on the individual and allowed them to take ownership of the process, rather than deferring to the GP. Other services are great, but it is line manager involvement that really improves return to work.”

But others think line managers are already under too much pressure without these extra responsibilities. Martin Todd, head of reward at Grant Thornton, says: “I often hear we are putting more and more on to line managers and it makes me wonder how much more they can do. As long as they are aware of how the company wants to deal with these issues and have people they can turn to, whether inside the company or external support, that is fine. We encourage this approach because we want our managers to manage their people by using the facilities we give them.”

Making adjustments, whether to the workplace, workload or hours, should also be considered to help an employee stay in work or return to work more quickly. Under the Equality Act 2010, it is a legal requirement for employers to make reasonable adjustments to enable a disabled person to continue working.

But this is rarely the case, says Zheltoukhova. “The latest research shows only 19% of employers are prepared to make organisational adjustments. The adjustments required can be so simple, for instance changing working hours, but they could be enough to prevent long-term absence.”

WorkFit’s Sharp says many employers will ask occupational health professionals whether the Equality Act applies to a certain individual. “If there is an adjustment that can be made, whether or not they meet the legislative requirements, it should be made,” he says. “The definition is artificial and, in the end, you get into a legal field that is unhelpful to the employer and the employee. The employee’s welfare is what is important.”

Read more from the sickness absence roundtable