Sickness absence: how employers can better manage sick leave

Christine Adeusi: Hello, and welcome to the Acas Podcast. I'm Christine Adeusi. And on this episode, we'll be unpacking the topic of sickness absence. This topic can be quite a difficult one for employers to navigate so, we'll be addressing all the impacts that both long-term and short-term absence can have on businesses. And as always, our guests will be providing you tips along the way on how you can better manage sickness absence, and therefore improve your business's productivity.

And I really do think I have the perfect guests with me on this episode to discuss this topic. So, joining me today is GP and president of the Society of Occupational Medicine, Dr. Shriti Pattani.

Shriti Pattani: Hello, everybody.

Christine: We are also joined by the managing director of the Ape Group, Alfie Payne.

Alfie Payne: Good morning everyone.

Christine: And last but certainly not least, Acas's very own area director of the South East, Paul Beard.

Paul Beard: Hello.

Christine: So firstly, when we're talking about sickness absence, I think we have to acknowledge that employers employ people to work. And it's very normal for people to fall ill. So, do you think an effective sickness absence policy has an impact at all on a business's productivity?

Alfie: I'm happy to answer that first. I think it does have an impact on the productivity of the business, because it's important to remember that something like sickness feeds into wider company culture as well and really sends that kind of message of the sort of environment and atmosphere that the company are fostering. So yes, it absolutely does have an impact on business performance through the indirect routes of embedding into company culture and helping to establish those boundaries and expectations from about day one of receiving the staff handbook.

Paul: Perhaps I can add something there. I think that the policy, a decent sickness absence policy, has to be a starting point for any employer, for managers and employees to know where they stand, as Alfie's said. We can't predict every single situation but the policy is a good starting point, and tends to set out the actions to be taken by the employer when somebody first reports that they're unwell. 

And we often talk about this in terms of absence, but sometimes it's actually somebody feeling unwell at work as well. I think the fact that there's a process in place, and people know what to do, helps with the actual practical management of the situation, which probably in turn helps productivity. 

But the bigger point around productivity is that employees realise that if they are off sick, that there is a process there, and that process is usually aimed at getting them back to work as soon as they're fit to be at work.

Shriti: May I also add there, from the other side I suppose, when you see employees within the occupational health setting, where there is a clear policy, we find that employees when they come to us generally know why they are coming to us. And they feel that they are being managed in a consistent way with other employees, and that they are treated fairly and transparently. Whereas where there isn't a policy, we often get people who feel quite ambiguous about why they feel they might have been treated differently from their colleagues. So, from our perspective, and from the medical perspective, having a clear sickness absence policy is very helpful.

Christine: Yeah, I mean, I totally agree with you all. I think like I said before, it is inevitable that at some point people fall ill. So, I think taking those productive steps like having a sickness absence policy to help managers manage sickness absence, I think it's just good for business. Yeah, I just think it's just good business. But anyway, I've been reading quite a lot of reports on sickness absence, and mental health is now the number one cause of sickness absence in the UK. So, I was wondering, are you seeing this reflect in your lines of work?

Shriti: So yes, mental health, we see much more mental health now than I ever have within my occupational health practice. And certainly, I think, over the last couple of years with Covid and isolation for some people, mental health seems to be the most prominent cause of sickness absence at the moment. And often what I find is that mental health is very much multifactorial. There's lots of things that might have led to the individual feeling the way they are. 

And of course, there's a whole spectrum of mental health conditions from one end where an individual probably has had mental health on and off for a long period of time. And for those, the support they need, and the treatment they need might be very different from those who have mental health that might have resulted, say, from environmental issues. So that could be personal situation, home situation, work situation. 

And clearly, if there's a potential work-related element, using the HSE risk assessment tool and stress risk assessment tool can be quite helpful in defining what aspects of work might be contributing to an individual's sort of mental health. 

Equally, it may well be that actually certain personal factors might be contributing, in which case a conversation about, actually can I have condensed hours so I've got at least a couple of days when I can pick my child up from school, will significantly reduce my stress. So sometimes actually these conversations can help people that are on that spectrum where life factors are precipitating their psychological symptoms.

So, there's a wide range of causes and a wide range of diagnosis for mental health. And actually, it's a minefield for employers and that's when referral to occupational health can actually help.

Alfie: Absolutely, you're absolutely right. There's a lot of challenges that people face around mental health and performance at work as a result of mental health. I think again we need to look at what preventative actions can organisations be taking outside of just reacting and supporting when there is a sort of mental health issue. Obviously, we can't prevent everything from happening, but what we can do is try and support the best we can. So for example, at the Ape Group all of our employees have access, if they need it, to coaching, counselling, or mentoring fully paid for by the business. And they're allowed to do that during work time in order to sort of talk through any sort of personal or career type issues in and above that standard sort of employee helpline.

Christine: Thanks for that Shriti and Alfie. Now, Paul, are there any overall good practices employers can do to better manage short-term sickness absence?

Paul: So, I think one of the key things that employers do that I think works well around short-term, unexpected, unplanned sickness absence is, just simply being in contact with the employee at the outset and working out what's going on, and coming up with a plan of action. While of course having regards to the fact that the employee may be too unwell to be having an in-depth discussion about work is really important in managing that first stage, and setting the expectation that actually, we want you to get better. But we also need you back as soon as you're fit enough.

Christine: Great. So now, I'd actually like to steer the conversation a little bit towards long-term sickness absence, because I think that's where some of the difficulties with employers lie. And I can imagine it being really hard for employers because they do sympathise with the employee struggling with a chronic health condition or an unexpected illness. But they also have to deal with the financial burden, and all the other things that come with that employee being off sick. So Shriti, what is the role of an occupational health provider? And when should an employer approach one when dealing with long-term sickness absence?

Shriti: The role of occupational health, if we start there, really is to advise the employer on the likely length of sickness absence, and what support the individual might need when they first come back to work. Sometimes the person might have a condition where it's possible to predict the length of sickness absence, sometimes it’s not and mental health is a good example of where it's more difficult to say how long an individual might be off for. 

So really, when we look at an occupational health assessment, what we do is look at the biopsychosocial model. So, we're looking at the individual physically, psychologically, and translate that into what they are able to do when they are back at work, how long any adjustments might need to be in place to support that individual. And on the actual rare occasion, it may be that an individual becomes permanently unable to do the job for which they're employed.

So, when I get referrals from employers, giving us as much information as they possibly can. So, how long the individual's been off sick, for example, what the fit notes have said as the reason for sickness. Have they kept in touch with the employee? Or has the employee kept in touch with them? 

What I find sometimes is that where we haven't got an informed referral, we can only use the information we have. So, unless the employee tells us what the issues have been at work, and unless the employer has also given us the full picture, we might only have one side of the story. And then it's very difficult to be objective and provide information to the employer that's actually useful.

Paul: I think just to add to what Shriti is saying, I encounter quite a few employers who say things like, well we've been to occupational health. And when I ask them exactly what that meant, what they mean is that they've done some very vague referral, which doesn't ask any specific questions. And poor old Shriti and her colleagues are expected to come up and guess what the employer was actually asking. 

So, employers need to think about what they actually want to know from occupational health. They need to be asking questions such as, can you tell us about this individual's condition? What adjustments might we need to help them improve or work successfully in the workplace with the condition that they're suffering from? 

And of course, in the most extreme cases, the question that I think employers sometimes shy away from is around whether the individual actually can either come back to work or continue to work successfully in their role. And then the employer getting all of the process around that right is really important.

Alfie: I think I would also just give a comment on accessing occupational health and the processes involved. Because I think, you know, talking to other business owner colleagues, and also reflecting on my own experiences of where occupational health could have been useful. It's not entirely clear always where to go, how to go there, is this going to cost my company money? There's a lot of questions there – I think it can be sometimes quite challenging for smaller employers to access services like occupational health.

Christine: Yeah, that's a really good point there Alfie, that maybe small businesses might not see occupational health as for them. So Shriti, whilst we have you here, do you mind addressing some of the points that Alfie has brought up?

Shriti: That's another big can of worms there. So yes, I have to acknowledge it is very difficult, actually, for small employers at the moment to access occupational health. And there are different routes that potentially can be helpful, but no clear pathway to access occupational health at the moment. 

There's an organisation called NHS Health at Work network and they have a list of all the NHS occupational health services across the country and across England. So, if you are looking for an occupational health service, if you go on to their website, they'll point you to the nearest occupational health service in the NHS. However, NHS occupational health services are also quite stretched, so they may or may not be able to take the referral.

There are multiple private providers as well. And you can pop that into Google and actually access a private occupational health provider. But it's going to obviously cost money to do that referral. 

So, I do appreciate that I don't have an easy answer for you. Although I can say that in the background, we are actually looking at provision of occupational health, actually universally to all employers. And that's some work that's going on in the background, at the moment, but still in its infancy. So watch this space. 

There is of course, Access to Work, and that's a government organisation where individuals can contact Access to Work and a disability employment adviser who can come into the organisation to give advice. I have to be clear, it's not an occupational health service. But the disability employment advisers do have experience on sort of workplace adjustments, and they can also support employers with financial support as well for the cost of those adjustments. 

And disability employment advisers can be contacted at Job Centre Plus, and that's completely free to the employer. The only caveat is that the individual needs to have a condition that's sort of classed as a disability. So, if you feel that your employee has a disability, or they think they do, then they should contact the disability employment adviser at Job Centre Plus, and they will then have further conversations with your employee.

Christine: Thank you for answering that Shriti. That was really informative and you've listed some really great resources that I'm sure the small businesses that are listening would find really helpful. So another area of concern for employers, and this can actually be quite a sensitive one, is the question of, when is it okay to dismiss an employee on long-term sick leave?

Paul: I think this must be one for me. It's often quite a sad situation when it comes to this question, because usually people have worked with an employee over a long time. And very often when someone's off with ill health, in the long term, their condition's usually more serious or more challenging. And colleagues are often upset around the question of perhaps losing a valued member of the team. 

So, the first thing is, it's really important to have that occupational health advice around their likelihood to improve, whether there are adjustments that can be made that would allow them to continue working. If that's absolutely untenable, then we move into the field of capability where effectively an employer needs to apply their capability policy, which will typically say something like, being in contact with the employee, explaining what the issue is, inviting them to a meeting to discuss options that may be alternatives to them being dismissed. 

But ultimately, if someone's unlikely to improve to a point that they can do their full normal job, and if an employer can't accommodate the changes that might need to be made in order for them to do their job, then if an employer doesn't have an alternative for them to go to, that's the kind of situation where, sadly, it may be necessary to dismiss an employee. But it's really important to follow all those steps in the capability policy through the employer's dismissal process, because if they get them wrong, then they can end up with a claim against them and in tribunal and all of the issues which that causes.

Christine: And actually, Paul, I just wanted to ask, what if an employee keeps taking sick leave? How should an employer manage this and is that grounds for dismissal?

Paul Beard: It can be. It's very important to look at each case on its own merits around repeated sick leave. So, someone may have a condition which flares up on a frequent basis and leads to lots of periods of perhaps slightly shorter sickness, which can be quite disruptive for an employer. 

And I come back to that question of the employer having to ask themselves: can I actually bear this pattern of sickness absence or not? And actually, it doesn't matter whether it's a number of days over a period of time, or whether it's extended sick leave over months, it comes back to that question of can the employer actually, employer's business, wear that pattern of sickness absence? And once they've answered that question, then they can move into those processes that I was talking about, which could ultimately lead to somebody being dismissed.

What's really important is not to rush into a dismissal. It's really important to think through all of those issues that I've been talking about, seek advice from occupational health and then apply the procedures properly.

Christine: Thank you for that Paul. So, one of the last parts of the sickness absence process is returning back to work. And employees can often feel anticipation when returning, especially if they've been out for a long time. So, what do you think are the key ingredients to a good return to work policy?

Shriti: I think going back to the earlier point is actually about keeping in touch regularly with the employee who is off sick, and actually inviting them to come in whenever they can, to keep in touch with their colleagues. And also, you know, I've always advised people who were off long-term sick, when I see them in occupational health, and advise the manager, that actually it might be quite nice for the individual to come in, and come and meet the colleagues just to have a cup of tea or coffee, if they are able to. And I think that's really important.

It's the employee feeling empowered that actually the job they're going to be doing when they first come back, so the adjustments that are put in place, are adjustments that are going to facilitate their return to work. So, for example, it might be something very simple, like somebody who's been off, say, with back pain for a while. When they first come back to work, it may well be that actually they can't travel at peak times, because they may not get a seat. So, you know, can they come in a bit later for the first couple of weeks so that they can get a seat on public transport? And, you know, they might work reduced hours as another example, just to get them back into the work routine. So, it's also giving the individual confidence that actually the return to work plan that's made for them, they are likely to be able to manage.

Christine: Thank you. And Alfie, are there any good practices or reasonable adjustments which have helped reduce sickness absence in your business?

Alfie: I think it's about being firm, fair and consistent, as always in leadership and management, but it's about being really clear on what is appropriate for the individual case. And it's looking outside of that sort of 'this is what the handbook says', it's really taking that specific case-by-case basis, not just on sickness, but also across other types of leave – across bereavement, paternity, maternity, shared parental leave, whatever it is. It's really making sure that we're looking at it on a case-by-case basis. And also, doing what you can throughout the culture, to make sure that people recognise and understand that if you are ill, you are ill, and you know, the business will function without it and your health is your number one priority.

Christine: Thanks, Alfie. So, as a whole, and overall, what are the biggest mistakes that employers make regarding sickness absence? And what can be done to fix them?

Paul: I think the biggest mistake that I see with employers is just losing contact with somebody who's off sick over an extended period of time. It's a huge mistake because actually, the employee feels a bit neglected. So, establish a contact routine and make sure that it actually happens. 

And I have one final bit of advice that I would add actually, that often people have conditions and situations that don't quite work. They're not a perfect fit with those policies and procedures. So if as an employer you're struggling with how to apply those in a given case, then please do actually seek advice from organisations such as Acas, because we recognise that the complexities of life often go a bit beyond a perfectly drafted policy, and we can help you apply them in ways which will hopefully keep you out of trouble.

Shriti: I think Paul said it all there. It's actually about keeping in touch, communication, following your own policies and processes.

Christine: Yeah, I mean, communication is so important. I think that's what's helped me have a good relationship with my manager. So once again, thank you for answering that.

And I think that is a great point to end on. This has been such an informative episode and I hope that everyone listening has found this really helpful. So, I'm going to end this by thanking you all for joining me today.

Alfie: No worries. Thanks so much for having me on. It's been great.

Shriti: Thank you, Christine, and thank you all for listening.

Paul: Thank you.

Christine: Well, this has been the Acas podcast. For more information on how you can better manage sickness absence in your workplace, please visit our website at acas.org.uk. All related links will be included in the episode notes below. Thanks for listening.