Specialised services such as physiotherapy and psychological support work best when they have good connections with the work environment and with line managers, says Dr Olivia Carlton, head of occupational health, Transport for London.
Absence is a complex issue. For some it's simply a matter of ill health, but for many it is more complicated than that. Issues such as negative feelings about work, whether or not there are adverse consequences of not attending and the need for time to do something important, for example, look after a sick dependant, all play a part.
If sickness absence is paid while other absences are unpaid, then the cause for absence may be ascribed to sickness when this isn't the case. For this reason, employers that offer access to flexible working arrangements may see a fall in non-attendance, as the need to pretend that absence is related to illness no longer exists.
The level of commitment to work and colleagues also plays an important part in the decision whether or not to attend work when an employee does not feel 100%. Creating a sense of team spirit and high morale is increasingly seen as the hallmark of a good manager and therefore people management skills are highly valued in successful organisations.
Many employers find that sickness assessment and provision of treatment on the National Health Service (NHS) is frustrating. GPs are sometimes put under great pressure to certify sickness absence regardless of its appropriateness. They don't have much, if any, training in occupational health, they often don't have communication links with local employers and yet they are a key player in the sickness absence phenomenon. Access to NHS healthcare is also prioritised by immediate clinical need, with no particular priority given for people in work, and there are not enough resources for everyone to receive assessment and treatment quickly. Speedy access to effective assessment and treatment for common health problems such as mild to moderate depression or muscle strains and sprains is rare.
It is well-known that not being in work is likely to have a disastrous impact on the health of an individual, but the NHS has no specific strategy for preventing this due to long waiting times. Most NHS trusts do not even prioritise treatment for their own staff. The UK government is well aware of these problems. The Department for Work and Pensions, in partnership with the Department of Health and the Health & Safety Executive, has launched a Health, Work and Wellbeing strategy which recognises the importance of NHS support to working people and to those who wish to be in work.
Some employers find it best to provide access to specialised services such as physiotherapy and psychological support programmes. The best of these have good connections with the work environment and with line managers. This allows effective rehabilitation programmes to be planned and implemented.
Some employers also organise private treatment for their employees to help speed up recovery. This works well where case selection is good. Disappointing results ensue if cases are funded where the reasons for being off sick are ostensibly medical, but are complicated by issues such as poor relationships at work. My experience suggests to me that high-quality gate keeping of cases gives the best results for this type of intervention. Complicated absence cases need an assessment that takes into account all the relevant factors that are prolonging absence and a plan to address all of these.
Over-medicalising cases is not helpful. If someone is being bullied at work then the work environment needs to be addressed. While psychological support to the individual may help, it won't solve the underlying issue.
The organisations that are world leading in their approach to their people also focus on positive health and wellbeing strategies. Ideally an employer's entire approach to their business will embrace the importance of this.
The requirement to subject any major business change to an employee health and wellbeing impact assessment is surely not far away and full credit is deserved for companies already following this strategy.
• Dr Olivia Carlton, head of occupational health, Transport for London