1. Background and key developments

Levels of reported sickness absence

An annual survey by manufacturing employers’ organisation EEF, published in July 2010, found an overall fall in the levels of both long and short-term sickness absence across its members. Similarly, the annual sickness absence survey by the Confederation of British Industry, published in June 2010, found that absence rates had dropped to their lowest since the survey began in 1987. However, the Chartered Institute of Personnel and Development (CIPD) annual absence management survey of 573 organisations published in October 2010 pointed to an overall increase in reported absence as the recession takes hold, citing 9.6 days per year of absence per employee in the public sector compared with 6.6 days in the private sector.

Rise in the level of “presenteeism”

According to a survey by the Chartered Society of Physiotherapists (CSP) in its October 2010 report, Sickness costs, a quarter of workers fear being sacked or earmarked for redundancy if they take time off sick. This fear is contributing to a worrying rise in levels of “presenteeism” — meaning coming to work when ill. The EEF survey also detected a decline in the number of employees citing “stress” as a cause of sickness absence, suggesting that some employees may be reluctant to admit to mental health problems at work in an insecure economic environment.

A recent survey by mental health charity Mind confirms this trend, suggesting that millions of British workers feel forced to lie to their bosses about having to take stress induced sick leave. Of the one in five workers who admit to having called in sick because of stress, 93% claim to have given an alternative explanation for their absence. Seventy per cent of respondents said they would prefer to be able to be open with their boss about the reason for their absence.

In view of the indications that a high proportion of stress-related absence is in fact hidden from view, survey evidence collected by the CIPD pointing to a dramatic 35% rise in stress-related absence over the 12 months leading up to October 2010 should be a cause for concern.

The CSP survey found that nearly two-thirds of small to medium-sized businesses provide no access to Occupational Health Services for staff and that half of the workers surveyed believe that bosses did not care about their health. The worrying results of the CIPD survey are supported by the latest findings from the TUC’s biennial survey of safety reps published in October 2010 — 62% of reps reported that stress is in the top five of problems reported by their members and more than a quarter name it as the hazard that most concerns them.

These results are corroborated by an online survey of 19,000 NHS staff published in July 2010 which found that two-thirds of NHS workers turn up for work when they do not feel well enough to do their job, and that one in five of those surveyed believe their job to be bad for their health. The NHS survey, conducted before the announcement of the public sector pay freeze, revealed that even at that stage, 60% of staff were trying to generate extra income, working extra hours or even taking on another job.

These studies cast doubt on the CBI’s headline claim in June 2010, that an estimated “27 million working days are lost due to ‘sickies’”, representing 15% of the 180 million sick days recorded a year and costing the UK economy £2.5 billion each year. Closer examination reveals that the CBI data is based on a survey of senior Human Resources (HR) staff who were asked to estimate the percentage of bogus sick days at their organisation. These results therefore suggest a worrying disconnect between the perceptions of HR directors and the realities faced by their workforces.

Presenteeism is, by its very nature, hard to monitor, but trained reps can play a crucial role. Reps who understand the causes of presenteeism are able to notice its signals, can have open and supportive conversations with sufferers and can help access appropriate support. The TUC’s learning and skills organisation Unionlearn offers regular courses for reps on tackling stress in the workplace.

A study by the Work Foundation in April 2010 was the first to suggest a link between presenteeism and poor performance, raising the spectre of a vicious circle for workers who feel that they have no choice but to come to work when ill and who are then penalised for underperforming as a result. The three reasons offered most frequently for presenteeism in the Work Foundation study were work-related stress, perceived pressures from colleagues and managers to come to work and personal financial difficulties.

Overwork is revealed in the TUC’s 2010 survey of safety reps as the fifth most likely hazard to be identified as a major concern to reps, with 29% of reps listing it as one of their top five issues.

Initiatives like the Better Health at Work Award, supported by the TUC, could help provide a platform for combating presenteeism through workshops targeting its underlying causes. The TUC “Work your Proper Hours” campaign also works to raise the profile of this issue. According to TUC event planner Robert Holdsworth: “The TUC first organised the campaign in response to stories about the cost of people taking ‘sickies’. This implied people were skiving, so we decided to turn the issue on its head, and celebrate how committed employees are. Companies save £25 billion a year through unpaid hours and this often goes unrecognised.”

Public/private sector sickness absence — is there a valid distinction?

Some reports, such as the annual CBI survey, focus on sickness absence in the public sector, seeking to draw adverse comparisons with lower sickness absence levels in the private sector. The latest CBI figures for 2010 suggest 8.3 days per year of sickness absence in the public sector (down from 9.0 days in 2009) compared with 5.8 days in the private sector, and the CBI’s report Time for action:reforming public services and balancing the budget (May 2010), claims that matching private sector absence levels in the public sector could save £5.5 billion by 2015-16.

However, the TUC’s own research, in its 2010 report The truth about sickness absence, contradicts that of the CBI, showing that public sector workers are in fact much more likely to come to work even when sick. The report highlights how, although public sector workers may take longer periods off work, many work in stressful, public-facing and sometimes dangerous jobs that can cause injury. In addition, private sector workers are much more likely to work for employers who are quick to sack people with genuine health problems, rather than helping them return to work. The TUC’s 2010 poll found that 41% of public sector workers (compared to 36% of private sector workers) had gone into work unwell when they should have stayed off sick within the last year.

The CBI’s claims are not new. For example, in 2007, the National Audit Office reported that sickness absence in the Department for Transport was costing £24 million a year and that absence levels were highest in the Driver and Vehicle Licensing Agency (DVLA) and the Driving Standards Agency. But public services union PCS pointed out that there had been a 41% increase in the number of attacks on driving examiners over the preceding five years, and that the true story behind the sickness absence was one of stressful working conditions and job cuts leading to increased workloads.

The TUC’s 2005 report Sicknote Britain? showed British workers less likely to take short-term time off sick than their counterparts in any European country except Denmark, and that only Austria, Germany and Ireland lose less working time due to long-term absence.

In May 2007, the Advisory, Conciliation and Arbitration Service (Acas) issued a discussion paper Health, work and well-being: rising to the public sector attendance management challenge to explore “the political, workforce and employee relations context for the current interest in public sector absence”.

Acas suggests that in reality, there is no need for sickness absence to be dealt with differently in the public and private sectors, emphasising that “there are too many ‘unhealthy’ workplaces”, and that “high absence levels can often be caused by deeper organisational issues.” Acas also points to evidence from the Health and Safety Executive (HSE) that private sector employers, particularly small ones, tend not to record all absences, so that figures are not necessarily reliable.

The HSE says that workforce size explains some of the difference, with larger organisations tending to have more sickness absence than small ones. Almost all public sector organisations are large, employing more than 250 staff. In addition, the HSE found that there are more women employed in the public sector, who tend to have more frequent and longer lasting absences than men.

Long-lasting stress and mental health problems are also more prevalent among employees in public-facing roles, and these roles tend to be found in the public sector. For example, stress is the most important cause of sickness absence in local government. The 2010 TUC survey of safety reps reveals that 68% of reps identify stress as a problem in the public sector, compared with 54% in the private sector. In addition, figures within the public sector are distorted by the small number of employees who take longer periods of sickness absence.

Acas points out: “Successive rounds of workforce restructuring and organisational change, often driven by efficiency programmes, heighten the long-term absence challenge facing public sector organisations, and the health of public sector workers is at risk of harm if such change is badly handled.”

The need to uncover the underlying causes of sickness absence

Acas highlights the need for employers to uncover the root causes of sickness absence. They should examine, for example, whether sickness absence levels are higher in one particular team or at any specific time. And a number of factors, either personal or organisational, can result in absence: “If dissatisfaction with particular work issues such as poor job design, work overload, relationship conflict, ineffective line management or bullying is the real reason for the absence, it is vital that these are teased out and discussed with the employee.”

Sickness absence is just one aspect of a broader picture of worker well-being, and the real story may be the increasing prevalence in many UK workplaces of work intensification, lack of control over the pace and content of jobs, a culture of unrealistic targets, electronic monitoring and surveillance — with some workers having to ask permission to leave their work station to go to the toilet, boring, repetitive, routinised jobs, high turnover, low levels of job security and increased demands for “emotional labour” (the requirement to maintain a positive public face no matter how you feel inside). These concerns are recognised by the Work Foundation’s on-going research programme — Good Jobs, and by Unite’s Agenda for Better Jobs.

Devolution of the management of sickness absence to line managers, who have often received no training, can exacerbate problems relating to sickness absence, increasing the likelihood of employees falling victim to line management favouritism and the inconsistent application of policy.

Acas also point to the influential Whitehall II study, which demonstrates that worker well-being is not just a function of the jobs people do and of their employers’ absence policies, but is also affected by the conditions in which people live and work. In particular, evidence shows that those people on the lowest status employment grades are the most at risk of premature death due to stress and heart disease. Indeed, the government’s own data (the Choosing Health White Paper 2004) suggests that around two million people in the UK suffer from an illness they believe has been caused or exacerbated by work.

Other important trends — the growth of flexible working

Not all the news since the 2007 edition of this booklet was published is bad news. Better news comes in the form of the increased availability of flexible working patterns, as well as the growing take up of rights made available through family-friendly legislation. These can enable workers to benefit from a better work-life balance and make it easier to balance work with caring responsibilities. Increased home-working may also be contributing positively to employee health, although a recent report by the TUC in September 2010 suggests that nearly one in five workers who want to work from home are prevented from doing so by their employers.