Occupational Health

by Anna Harrington

Managing long-term absence

There are similarities between managing short-term and long-term absence, but once the absence reaches a certain length of time, specific evidence-based interventions are recommended to bring the individual successfully back into work. Any disciplinary procedures must be implemented promptly, fairly and consistently.

The legislation which controls the dismissal of employees and guides the management of sickness absence is found in the Employment Rights Act, 2008 and the Equality Act 2010. There is substantial case law concerning the principles of fairness and reasonableness, the principal case being East Lindsey District Council v Daubney [1997] ICR 566, where the following standards of action were extracted:

  • Consultation with employees
  • Medical investigation
  • Consideration of alternative employment.

Management is required to investigate the problem, aiming to try to understand the cause. Solutions will then need to be found, offered and implemented. Regular reviews should occur to evaluate the effectiveness of the solutions.

The questions which the manager has to answer are

  1. When do procedures as detailed in the organisation’s absence policy need to be implemented?
  2. Is the absence justifiable on medical grounds and, if so, is there anything that the organisation can do to facilitate a return to work?
  3. Are there other reasons for the absence apart from health, such as family/relationship commitments, employee motivation issues, and workplace relationship issues?

It is necessary for the manager to have documented evidence of the absence and to use this data to get an understanding of the problem. Different measures of absence focus on different aspects of measuring time lost, such as the Bradford Factor, lost time rate and frequency rate.

It is essential to remain in contact with the employee so a level of engagement remains. Usually, it would be the role of the line manager to remain in contact, but a suitable alternative individual may be able to undertake the task.

The majority of cases will return successfully after a four-week absence; however, beyond this time, further interventions and a more thorough investigation of the barriers to work will be necessary. Barriers to work are the conditions or situations that prevent or make it difficult for the individual to return to work. They could relate to the social context in which the individual exists; for example, do family and friends encourage the person back to work or feed the individual messages about imagined harms that work may do? Analysis of the barriers will identify where adaptations and adjustments could be made. It is likely that the employer will need to be flexible to enable a return to work.

Barriers to work

There is a growing amount of evidence that points to the value of an alternative model for the management of long-term ill health. Historically a medical model has been used in which a medical diagnosis is made, treatment given (medication, therapy and/or surgery) and the individual is expected to return to work with no further ado. There is now an understanding that chronic problems and work incapacity relate to wider issues. It is recognised that an individual and his/her capacity to work are affected by social, biological and psychological factors.

Bio-psychosocial model

  • Biological – relates to the physical or psychological health condition, in otherwise function, condition and presence or absence of disability and/or illness.
  • Social – recognises the pressures, drivers and constraints of the community, social and family context in which the individual inhabits.
  • Psychological – recognises the beliefs, thoughts, emotions and methods of coping that the individual has developed.

From these, a flag system to assess and analyse each of the domains has been developed. This is widely used and recommended, especially in relation to musculoskeletal disorders:

  • Yellow – person; thoughts, feelings and behaviours
  • Blue – workplace; a perception that work may cause harm and further injury, making a return to work unlikely and causing poor job satisfaction
  • Black – context both the workplace social community, and society as a whole.

It is necessary to investigate each of these domains to understand the cause and find solutions. Co-ordination and positive communication is essential between all involved parties. It will be necessary for the workplace to be flexible in being able to make changes, such as facilitating home working, arranging transport to work and adapting hours.

Involvement of specialists

It may be necessary to involve specialists, who can make detailed assessments, provide solutions and assist in the implementation. Below is a list of possible specialists who may be called upon:

  • Ergonomist – applies scientific information to the design and use of objects and systems
  • Occupational psychologists – specialist psychologists who analyse behaviour at work
  • Occupational hygienists – determine levels of risks to individuals, populations and the environment from workplace hazards
  • Psychologist – a scientist who specialises in analysing cognitive processes, thoughts, behaviours and social interactions of individuals
  • Disability employment advisor – usually attached to a job centre, assists individuals attain and remain in gainful employment
  • Occupational therapist – assists individuals to be independent and engage in activities which are part of everyday living.
  • Physiotherapists – assist individuals maintain and restore maximum physical function.

Case management

This is a collaborative process designed to assess, plan, implement, co-ordinate, monitor and evaluate the options and services required to meet an individual’s health, social care, educational and employment needs, using communication and available resources to promote quality cost-effective outcomes (www.cmsuk.org). In complex cases, it may-be necessary to use the services of a specialist case manager.

See Attendance Management.

Vocational rehabilitation

Vocational rehabilitation is a process that enables people with functional, psychological, developmental, cognitive and emotional impairments to overcome barriers to accessing, maintaining or returning to employment or other useful occupation. The process may include assessment, goal setting, intervention planning, case management, intervention evaluation (for more, see www.vra-uk.org). The benefit to employers is that they retain valued staff, and are seen as an employer who cares, which affects recruitment and retention. Vocational rehabilitation can cut between five and eleven weeks from absence.

Before six weeks’ absence, the manager should just employ basic return-to-work principles: keeping in touch and encouraging active participation in the workplace. Beyond six weeks, for common health conditions, more is required: identifying barriers, communication, co-ordination and ensuring effective treatment and goal setting. The evidence of the effectiveness of these measures is stronger for physical conditions than for psychological.