NICE work if you can get it

The National Institute for Health and Clinical Excellence (NICE) has turned its hand to the management of long-term sickness absence with a consultation on best practice.

This promises to shed further light on a perennial problem area. Nic Paton reports.

There needs to be a fundamental shift in how employers and healthcare professionals think and talk about sickness absence, with primary care providers playing a more central and better informed role in deciding fitness to work. There even needs to be a reconsideration of the current overly simplistic two tier definition of absence as being either short-term or long-term.

This is some of the ‘blue sky’ thinking submitted by AXA PPP healthcare to a wide-ranging consultation being carried out by the government’s standard setter for guidance on promoting good health and preventing and treating illness, NICE – which is drawing up new guidance for employers and primary care on managing long-term sickness absence and incapacity for work. For more information visit:

The ideas also feed into the wider debate about the future direction of workplace health provision and intervention kicked off earlier this year by national director for health and work Dame Carol Black in her review Working for a healthier tomorrow – the government’s response to which is expected this autumn.

Key issues

The NICE guidance, due to be published in March 2009, will attempt to establish the effectiveness and cost-effectiveness of the following:

  • Preventing or reducing the number of employees moving from short-term sickness (fewer than 20 working days) to long-term sickness (20 working days or longer), including activities to prevent or reduce the re-occurrence of short-term sickness absence episodes.
  • Helping employees who have been on long-term sickness absence to return to work.
  • Helping to reduce the re-occurrence of long-term sickness absence.
  • Helping those in receipt of incapacity benefit to return to full or part-time employment.

But Dudley Lusted, head of corporate healthcare development at AXA PPP healthcare, feels that NICE’s predilection for having just two definitions of absence is too blunt. He thinks that short-term absence needs to be defined as up to five working days, long-term absence to remain as 20+ days and a third category – medium term – should be used for workers off for from six to 19 days.

“Managers need to be managing their short-term absence in a very different way to long-term absence,” he argues. “The vast majority of short-term absence could then be provisionally assumed to be self-limiting and requiring no intervention at this stage – unless it involves repeated absence, for which there may be a conduct issue to address.”

‘There needs to be a fundamental shift in how employers and healthcare professionals think and talk about sickness absence.’

However, on the sixth day it would be appropriate to undertake a simple low-cost assessment to enable the employer to determine whether there was a risk of it becoming a long-term problem. “Chasing people in the first few days of absence is generally a waste of time and money. But if you are leaving it for 20 days, you may miss an opportunity for effective intervention,” continues Lusted.

See also: How to deal with absence in the workplace

GPs and occupational health

The AXA PPP healthcare submission also argues that, building on Dame Carol Black’s recommendation for better integration of care and occupational health providers, GPs should be given a more prominent role within occupational health. Given that GPs are already the first port of call for most workers and managers and that there is already a national network of care facilities in place, it makes sense for this initial assessment to be done by GPs with a special interest or competency in occupational health. Undertaking this new role in a primary care setting will mean a big culture shift for GPs, who by and large have not shown much of an appetite for becoming actively involved in sickness absence management. But useful ‘carrots’ might be to make sickness absence management a targetable performance objective for GPs so that patients’ sickness absence levels and the issuing of sick notes become key performance indicators.

Necessary incentives

Lusted recognises that the key carrot for GPs will need to be increased resources, especially funding, and he reiterates AXA PPP healthcare’s call for more financial incentives from the government to encourage employers to invest in employee health and wellbeing. He cites three ‘fiscal imposts’ that currently deter employers from providing, and employees from accepting, provision of private medical care.

These are:

  • that ill or injured employees whose employer pays for private treatment are obliged to pay Income Tax on the cost, which is then treated as a benefit in kind
  • that employers are obliged to pay National Insurance on the benefit, and
  • that where employers fund treatment through an insurance scheme, they are obliged to pay Insurance Premium Tax.

Willingness needed

AXA PPP healthcare’s submission also points out that those involved in sickness absence management should be wary of the pitfall of medicalisation of what are often people management issues. For example, poorly trained or badly behaved line managers can demotivate employees and cause stress. The draft guidance also seemed somewhat naïve in treating patients like passive agents, and it’s important to remember that, without a willingness to return to normal and back to health, vocational rehabilitation may be on a hiding to nothing. Compelling reluctant employees to participate in medical treatment may help but it won’t turn a bad job into a good one. Nic Paton is a writer specialising in workplace management and a regular contributor to the enterprise, occupational health and people management media.

Key points
• NICE is consulting on best practice in long-term sickness absence management.
• Short-term absence should be managed very differently to long-term absence.
• Chasing people in the first few days of absence is generally a waste of time and money.
• AXA PPP healthcare feels GPs should be given a more prominent role within occupational health.
• There is a danger in medicalising what are often people management issues.

Related Topics

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