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NHS staff sickness absence: a special case for treatment

Yesterday an independent review advised the NHS to focus on the critical issue of the health of its workforce.

There is insufficient evidence to confirm obese workers and those that smoke have significantly higher levels of sickness absence than colleagues who don't. Clearly, however, it is not desirable for staff to be engaging in behaviours that they are warning their patients not to do. The NHS could tackle these issues by providing support to employees that would like help with weight loss and smoking cessation, as there may be a cost benefit in terms of improvement in health and potentially reduced sickness absence.
More proactive interventions could also be offered that can have a positive return on investment in terms of offering services such as physiotherapy and counselling. But where organisations go wrong with these is they do not offer them early enough. The return on investment from physiotherapy in particular is significantly more effective when it is introduced as soon as someone reports a musculoskeletal problem, rather than waiting for a period of weeks or sometimes months. The benefit comes from getting the employee to return to work more quickly and through the provision of proactive advice and support to try and minimise the risk of the problem recurring. Organisations can also ensure that all employees have access to advice about lifestyle issues such as diet and fitness by making it a compulsory element of any occupational health meetings.
When looking specifically at managing sickness absence in the NHS we need to consider some of the environmental variables, which are not so common in other organisations. For example, staff may be more prone to physical injuries (particularly musculoskeletal) because of the nature of the jobs in helping and moving patients and unfortunately they are also more likely to be subjected to violence. There are also some extreme mental stressors in dealing with distressed and sometimes very ill patients, things that it is very hard to turn off from. We also know that due to new advances NHS staff are able to deal with more complex cases than ever before, adding to the workload and pressures on them. There is also the chance of picking up illnesses/viruses from the working environment (though this is obviously not relevant to all NHS staff).
We also need to consider the issue of presenteeism, where employees attend work when they should not be there. In any work environment this can be problematic because of health and safety risks, reduction in productivity and accuracy but in an NHS setting this could have serious consequences: that is, it could spread to patients, their families and work colleagues. There needs to be a culture where staff do not feel that they have to attend when they are unable to. I suspect that a large amount of presenteeism is self-directed because staff do not want to let down their colleagues and their department, and they also have the interests of the care of their patients at heart. This is a particular issue if we look at staff groups such as nurses where we know that there is already a shortage, yet we need a certain number to be available to ensure that all patients are cared for. NHS staff are more likely to feel loyalties towards these sub-groups rather than just to the NHS as their overall employer.
So what could NHS organisations do?


Focus on encouraging an attendance culture and ensure that this is visible (and has the buy-in) throughout all of the HR processes, from recruitment and selection to performance management and discipline and grievance.

Set out a clearly defined absence management policy where everyone knows what their role and responsibilities are

Make sure managers are well trained and supported

Be supportive to employees who are genuinely unable to work - this can help to minimise presenteeism.

Ensure that absence is managed consistently within teams and departments - otherwise it can become difficult to take action

Ensure that all return-to-work interviews are carried out by monitoring them

Make early referrals to Occupational Health


Fiona Robson is a lecturer in organisation and HR management (research and consultancy portfolio) at Newcastle Business School, Northumbria University