absence management and the issues of job retention and return to work

82 HUMAN RESOURCE MANAGEMENT JOURNAL, VOL 12 NO 2, 2002

Absence management and the issues of job retention and re t u rn to work

Philip James, Middlesex University

Ian Cunningham, University of Strathclyde

Pauline Dibben, Middlesex University

Human Resource Management Journal, Vol 12 No 2, 2002, pages 82-94

Strategies aimed at facilitating the job retention and return to work of sick and injure d

workers are currently the subject of growing attention. In this article the authors examine

the nature and potential signi® cance of such strategies to absence management and utilise

interview ® ndings to shed light on current employer policies and practices relating to the

management of long-term absences. They conclude that at the national level a larg e

p roportion of working days lost through sickness absence stem from relatively long spells

of absence and that the adoption of a proactive approach to supporting the return to work

of ill and injured workers can have beneficial consequences. However, they further

conclude that few organisations appear to have comprehensive arrangements in place to

handle cases of long-term absence. A number of areas where present employer

arrangements could usefully be reviewed are there f o re identi® ed.

C o n t a c t: Philip James, Middlesex University Business School, The Burro u g h s ,

Hendon, London NW4 4BT. Email: [email protected]

Each year many thousands of workers leave their employment as a result of

illness and injury. Yet little attention has been paid within the HRM literature to

the policies and strategies that organisations can utilise to minimise the scale of

such job loss. This is despite the fact that there is some evidence to suggest that

employers can put in place arrangements that will serve to enhance the return to work

and continued employment of workers suffering from potentially job-thre a t e n i n g

medical conditions.

F u r t h e r m o re, this lack of attention exists against the background of policy

developments and debates aimed at facilitating the job retention and return to work of

sick and injured workers. At the level of the European Union, for example, the issue

forms an important element in the debates that are taking place with re g a rd to how to

i m p rove the employability of workers (European Agency for Safety and Health at

Work, 2000). Meanwhile, at the domestic level, the Disability Discrimination Act 1995

places employers under a duty to provide reasonable adjustments to support the

continued employment of disabled workers ± a term that extends to include those who

a re suffering from long-term ill health (Bru y e re and James, 1997). In addition, the

government is in the midst of investigating what initiatives and actions can be taken to

reduce both absence and job loss stemming from long-term worker sickness (Lewis,

2000) and it has been proposed that the duty of employers to pre p a re a health and

safety policy be amended to re q u i re them to set out their approach to re h a b i l i t a t i o n ’

(Health and Safety Commission/Department of the Environment, Transport and the

Regions, 2000).

These and other development s, such as the publication of a TUC consultative

document on rehabilitation at work (Trades Union Congress, 2000), can consequently be

Philip James, Ian Cunningham and Pauline Dibben

83HUMAN RESOURCE MANAGEMENT JOURNAL, VOL 12 NO 2, 2002

seen to constitute attempts to broaden current employer perceptions and policies

re g a rding the issues of labour turnover and the management of longer term absence.

These attempts are, however, occurring against the background of three marked gaps in

the HR literature relating to these issues. As a result, at both the conceptual and

empirical levels, their relevance and signi® cance remains rather unclear.

The ® rst of these gaps concerns the relatively limited attention that has been paid to

the role of ill health as a cause of workforce absence ± a situation that has been usefully

highlighted, albeit indire c t l y, by A l l e g ro and Veerman’s (1998) observation that the

ª classicalº organisational-psychological approaches of sickness absence, emphasising

[such] concepts as motivation and satisfaction, fall short in explaining sickness absence

fully’. The second relates to the lack of attention that has been paid to the possible

strategies that can be used to facilitate the return to work of ill workers and the potential

e ffectiveness of them in terms of both protecting employment and reducing the working

days lost through sickness absence. Finally, the third concerns the limited knowledge that

c u r rently exists with re g a rd to how British employers do in fact handle the management

of longer term illness among workers and hence utilise such strategies.1

This article consequently attempts to address each of these gaps. It is divided into

five main sections. In the first two attention is paid, in turn, to three issues: the

importance of long-term absence and job loss stemming from ill health, the types of

actions that can be taken by employers to facilitate the return to work and continued

employment of ill employees and the potential effectiveness of these actions. The next

two provide details of a study of absence management undertaken by the authors and

examine the findings obtained in respect of the way in which employers curre n t l y

handle the management of long-term absence. Finally, a concluding section draws

together the key points emerging from the preceding analysis and discusses their

implications for future employer strategies and policies.

The signi¢cance of long-term ill health absence and job loss

R e s e a rch has long demonstrated that the causes of absence are multi-dimensional. The

widely re f e r red to model developed by Rhodes and Steers (1990) clearly illustrates this

by identifying two key sets of causal factors: those that affect the motivation of workers

and those ± such as illness, family responsibilities and transportation dif® culties ± that

have an impact on their ability to attend work.

The ® rst set has received voluminous attention in the literature. In contrast, the second

g roup has tended to receive rather less interest. In particular, despite the fact that much

absence from work is at least labelled as being due to sickness, there has, somewhat

i ro n i c a l l y, been a marked lack of studies that have sought to examine the importance of

health in explaining worker absence (Smulders and Nijhuis, 1999). The ® ndings of those

that have been conducted, however, indicate that ill health does constitute an important

explanatory factor. For example, an analysis of sickness re c o rds and self-reported health

status measures of 10,308 civil servants found a strong association, after adjusting for age

and grade of employment, between such re c o rds and status, particularly in relation to

spells of absence of more than seven days (Marmot et al, 1995).2

In a similar vein, Smulders

and Nijhuis (1999), in a Dutch study involving 1,755 male employees in a technical

maintenance ® rm, found self-reported indicators of worker ill health to be positively

related to both absence rates and frequencies, after controlling for age, education, physical

working conditions and job control and demands.3

The methodologies of these two studies can admittedly be criticised on the gro u n d s

that they not only rely on self-reported ill health data, but also do not directly take into

account the degree to which absence stems from illness behaviour’ rather than the

necessary consequences of illness. On the other hand, these methodological weaknesses

a rguably do not act to challenge fundamentally the validity of the ® ndings. Thus, the

c o n t rol variables used, such as age, employment grade and job demands, can be seen to,

i n d i re c t l y, make some allowance for diff e rences in `work attachment’ and hence illness

b e h a v i o u r. In addition, several studies have found self-reported health data to be a

s t rong predictor of mortality (Idler and Angel, 1990), while others have found sickness

absence to be a reliable indicator of subsequent serious morbidity and medical

re t i rements (Semmence, 1994).

C o n s e q u e n t l y, notwithstanding the methodological criticisms, it does seem

reasonable to conclude, on the basis of the above evidence, that ill health is a signi® c a n t

cause of sickness absence and that this is particularly the case with re g a rd to longer

spells of such absence. At the same time, particularly as a host of studies note that other

n o n - h e a l t h - related factors ± such as job satisfaction and worker motivation ± do

i n uence absence behaviour, its importance is dif® cult to quantify with any pre c i s i o n .

That said, if, as Whitston and Edwards (1990) have argued, it is reasonable to assume

that longer term spells of absence do, for the most part, stem from `real’ sickness, then

some insight into the issue could be gained by exploring the contribution that such

periods make to total working days lost through absence.

T h ree main sources of evidence can be used as a basis for such an exploration: absence

data collected from workers in England and Wales via the Labour Force Survey (LFS)

concerning the number of days that they were unable to work during the preceding week

due to sickness and injury, and the length of their last absence from work through such

causes; Department of Social Security (DSS) Statutory Sick Pay (SSP) statistics; and studies

and surveys that have collected and analysed organisational level absence data (IPD: 2000).

S t r i k i n g l y, a reasonably consistent picture emerges from these sources, namely that a

s i g n i ® cant proportion of working days lost through absence stem from relatively lengthy

spells away from work.

An analysis of the combined LFS data for 1987-1991 found, for example, that 42 per

cent of absence spells were of more than six days’ duration and that 32 per cent were of

m o re than two weeks (Clarke et al, 1995). The DSS’s statistics show that approximately a

quarter of SSP recipients in 1995-96 were absent for more than ® ve weeks and a tenth for

m o re than 13 weeks (Staff o rd, 2000), and a number of organisational-based studies have

likewise found that much absence arises from periods of two or more weeks. Thus, a

study of absence in an NHS hospital found that sickness absences of more than 20 days

accounted for more than 50 per cent of days lost, with this proportion rising to 75 per

cent in the case of domestic ancillaries (Whitston and Edwards, 1990), while in a food

p rocessing plant absences of 11 days and over accounted for around 60 per cent of total

days lost (Nicholson, 1976). Similarly, an analysis of sickness absence in the civil service

during 1996 found that spells of more than 20 days accounted for 49 per cent of days lost

(Occupational Health and Safety, undated), and data relating to such absence in the local

government sector during 1996-97 shows that more than half of it was attributable to

spells of 10 or more days (Local Government Management Board, 1997).

It would seem, then, that illness and injury does re p resent a major cause of workforc e

absence. Furthermore, there are also grounds for believing that the scale of sickness-

related job loss is substantial. For example, on the basis of follow-up interviews

conducted with a sample of LFS respondents who reported that they had suff e red fro m

a work-related illness, it was found that, of those who had such an illness and worked

in the last year, 9 per cent had been forced to change their job as a result of the

complaint. Given that the LFS data suggest, more generally, that around two million

Absence management and the issues of job retention and return to work




workers suffer from work-related ill health, it can be argued that such forced job

changes may well affect around 180,000 people annually.

As re g a rds the scale of job changes stemming from both work and non-work-re l a t e d

illnesses and injuries, no reliable statistics are available. However, some insight into the

scale of withdrawal from the labour force as a result can be gained from DSS SSP

statistics. These show that, of the 3,000 SSP claimants who transfer to incapacity bene® t

each week, 2,700 never work again4

± a figure there f o re suggesting that more than

400,000 people leave the labour force through ill health each year.

Job retention and return to work

Some countries have put in place legislative re q u i rements relating to the handling of

s i c k n e s s - related absence. In Sweden employers are re q u i red to ensure that any

rehabilitation needs are analysed as soon as possible and are obliged to undertake any

m e a s u res needed for effective rehabilitation to occur. In a similar vein employers in the

Netherlands must submit a report on a work-incapacitated employee to a social security

agency within 13 weeks and must accompany this with a `work resumption plan’.

Meanwhile, those in the Australian state of New South Wales have to establish a

workplace rehabilitation programme and, where more than 20 people are employed,

must appoint a rehabilitation co-ordinator and pre p a re return-to-work plans for

workers incapacitated for more than 12 weeks.5

Between them, such legislative re q u i rements draw attention to what are widely seen

as key elements in employer-based strategies to support the continued employment and

speedy return to work of ill workers. In short, these are the appointment of people with

responsibility for co-ordinating the return-to-work process, the laying down of clear

p ro c e d u res for handling cases, the utilisation of work adjustments which take into

account the effects of any impairments that act to limit the work capabilities of workers

and early rehabilitative intervention (see, for example, Kearns, 1997; Kenny, 1995).

To date, only relatively limited empirical evidence exists on the actual effectiveness of

these strategies. Furthermore, the studies that have been carried out focus attention on

t h ree rather diff e rent, but overlapping, categories of workers: those who have suff e re d

illness and injury as a result of work activities, those who have suff e red from ill health,

whether work or non-work related, and those who have a disability which may or may

not have stemmed from an illness or injury.6

Nevertheless, and notwithstanding their

d i ff e rent foci, the ® ndings of a number of studies do suggest that such strategies can

have bene® cial consequences in terms of limiting the length of absences, reducing their

f requency after a worker has returned to the workplace and facilitating continued

employment and hence the avoidance of job loss.

With re g a rd to the ® rst of these issues, a study of more than 3,000 workers in New

South Wales who had at least one week off work as a result of a workplace illness or

injury found that, controlling for the nature of their problem, the provision of services by

an accredited rehabilitation provider was associated with an average reduction in the

amount of time lost of 3.3 weeks (Kenny, 1994). The author of this study does, however,

caution against concluding on the basis of this ® nding that rehabilitation services have a

positive effect on return to work, given that it was not possible to take into account any

possible biases that existed concerning the referral of diff e rent categories of workers to

such services. In particular, it is noted that the study was unable to determine whether

services of this type were more commonly made available to those who had the gre a t e s t

potential to return to work.

At the same time, further support for the notion that proactive management of worker

illness and injury can yield bene® cial results comes from the ® ndings of a Canadian study

which examined the effects of various forms of work accommodation on the likelihood of

workers successfully returning to work following a workplace injury and, after re t u r n i n g ,

not having further periods of related absence. The study used survey data from 1,850

workers who had returned, on either a temporary or permanent basis, following an absence

stemming from a permanent partial impairment. Two of its key ® ndings were that, after

taking into account a range of biographical factors such as age, gender and level of

education, as well as the nature of the injuries suff e red, those who had re c e i v e d

accommodations ± such as reduced working hours and the provision of modified

equipment and light workloads ± were both signi® cantly more likely to return permanently

and signi® cantly less likely to experience further periods of absence stemming from their

impairment (Butler et al, 1995). For example, the chance of a successful return was found to

i n c rease by 35 per cent for those off e red modi® ed equipment and the likelihood of such

returners having subsequent periods of absence was reduced by 71 per cent.

The evidence from other studies, furthermore, lends weight to the above ® ndings. For

example, a recent survey of disabled workers ± a term de® ned to cover those with a

c u r rent long-term disability or health problem which limits the work they can do or has a

substantial adverse impact on their day-to-day activities ± found that more than a quarter

of those who had left their jobs felt that they could have stayed on had necessary

workplace adaptations been made (Meager et al, 1998). In addition, a comparative study

examining the experiences of workers in six countries who had been off work for more

than three months with lower back pain also points to their potential value. Thus, it

found that there was a higher propensity for Dutch workers to return to work with their

original employer and that this was, to some degree, related to the fact that they were

m o re likely to receive working hours adaptations, changes to job design/processes and

therapeutic work resumption interventions (Cuelenaere et al, 1999).

M o re generally, in a recent article Krause et al (1998) review 13 studies which had,

between them, examined the impact of a diverse range of `modi® ed work pro g r a m m e s ’

on the return-to-work experiences of workers who had suff e red either temporary or

permanent disabling injuries.7

The authors conclude that, not only do programmes of

this type cut the number of work days lost by half, but also that workers off e red such

schemes are twice as likely to return as those who are not. They do, however, note that

the robustness of these conclusions would be enhanced if a number of methodological

p roblems surrounding the studies reviewed, such as the absence of control groups, were

a d d ressed in future studies.

THE STUDY

The study undertaken here was conducted in two stages. First, a postal questionnaire

was sent to a random sample of 1,000 organisations across Great Britain, for which a 30

per cent response rate was obtained, seeking information on the nature of workforc e

absence and the policies and practices in place to manage it. Secondly, follow-up

interviews were conducted in 30 of the organisations to gain a more detailed insight into

the actual practice of absence management, particularly as it related to the handling of

cases of long-term absence. For the purposes of this article, attention is focused on the

results of these interviews in order to provide an in-depth exploration of how the 30

o rganisations handled such cases in practice.

The interviews were conducted with HR staff. Eleven interviewees were from the

public sector, 11 from private services, six from the manufacturing sector and two from the

c o n s t ruction industry. All of the organisations employed more than 100 people, with nine

having between 500 and 2,000 employees and 12 having more than 2,000. The key





® ndings, in respect of the handling of long-term absence, are discussed in relation to thre e

of the factors identi® ed earlier as being central to the effective management of the re t u r n -

to-work process: the allocation and co-ordination of managerial responsibilities, the

p rovision of workplace adjustments and the use made of other rehabilitative support.

Managerial responsibilities

The HR role in respect of absence management typically included the development and

ongoing review of absence policies, the monitoring and circulation of absence data, and

the taking of action ± such as providing training and guidance material ± to ensure that

policies were correctly interpreted and consistently applied by line managers. In

addition, in three organisations HR staff were primarily responsible for co-ord i n a t i n g

the return-to-work pro c e s s .

Most interviewees, however, reported that it was the line managers who played the

key role in the management of absence. For example, an interviewee within a

manufacturing company commented: `Personnel managers don’t run companies; line

managers run companies’ , and a local authority respondent observed that:

...managers are responsible for managing their staff or managing their

absence. I mean, you know, I take the lead in promoting the good practice

of managing absence but...the message is very clear that you, the manager,

must know what’s happening with the individual and take appro p r i a t e

action. We give advice on how to do it and OH [occupational health] will

give the advice but they have to make the decisions.

C o n s e q u e n t l y, it was stressed in all but three organisations that it was line managers

who had the primary responsibility for maintaining contact with absent employees and

exploring whether anything could be done to facilitate their return to work. However, in a

t h i rd of the organisations no clear guidelines had been provided to line managers on how

they should handle long-term absences. More o v e r, where such guidelines did exist, they

w e re often phrased in rather general terms re g a rding such matters as when an absent

employee should be either contacted or re f e r red to occupational health, in part due to a

d e s i re to allow line managers some discretion in how they handled particular cases. Thus,

in relation to when a line manager should make contact with an absent employee, a

respondent from a transport operator commented that: `We don’t prescribe that, because

you begin to get a quota if you do that. So we leave it to their discretion and that’s worked.’

At the same time, around two-thirds of interviewees noted that problems existed

with re g a rd to the way in which line managers carried out their absence management

responsibilities. In particular, attention was frequently drawn to their failure to follow

laid-down guidelines in respect of such matters as maintaining contact with employees

and exploring possible actions to help them return to work. As a result, HR staff did not

always know what was going on and often had to step in to manage cases, as the

following quote illustrates:

I would think it is the manager ® rst of all [who co-ordinates the re t u r n - t o -

work process], although I would think, because of the sensitivity to

d i ff e rent issues, we ® nd we take on that particular role, mainly because

managers are pretty inept at handling these issues. So we do the co-

o rdinating role of getting the bodies together and discussing the issues

and help save any disasters happening which could cause an employee

m o re stress. Local authority interviewee

In part, this line management failure was seen to re ect time constraints and a lack of

a w a reness of organisational pro c e d u res which, in turn, was sometimes seen to stem from a

lack of training. However, it was also considered, as the following quotes illustrate, to

re ect an unwillingness to deal with the issue and to accord it suf® cient priority:

My aim is to get line managers to manage absence, rather than the

personnel department managing the fall-out of not managing absence, if

you know what I mean ± to really equip them. I mean, some of them are

quite scared of, you know [dealing with the situation], if somebody’s

sick...it’s really getting them to understand what is good practice, what are

the things they should be doing. Financial services company interviewee

...when you do consultation with departments you still get views [such as:]

Well, if it’s sickness you can’t really do much to manage it, can you?’, those

kind of things, instead of thinking about things proactively and thinking

about how might we help this person, how might we rehabilitate them

back into work, could they come back on a part-time basis, those kind

of issues... Local authority interviewee

On a more positive note, in the 15 organisations where some form of occupational

health service existed interviewees invariably indicated that they played a valuable ro l e

with re g a rd to the management of long-term absence through such activities as the

p rovision of advice on possible return-to-work mechanisms, liaising with GPs and

carrying out medicals. This was particularly so where such services had been

i n t roduced, or signi® cantly improved, in the recent past. Thus, a respondent from a

telecommunications company observed, in relation to its new service, that:

W h e re there are problems with an employee off ill, they are dealt with in a

p rofessional manner, with support, con® dentiality and in an appro p r i a t e

individual way.

That said, several interviewees did draw attention to the ambiguous and pro b l e m a t i c

n a t u re of the role played by occupational health professionals. In particular, it was

suggested that, although such people worked for the employer, they tended to see

themselves as re p resenting employees’ interests. Furthermore, several mentioned that

referrals to occupational health services were at times viewed with suspicion by

employees because of concerns that they re p resented a first step in the process of

terminating their employment. Thus, one local authority interviewee observed that:

It used to be viewed as being punitive when people were re f e r red to OH

and we’ve had to work quite hard to turn that around and, you know, see

that it’s supportive to both the employer and the employee.

Workplace adjustments

In common with the wider survey ® ndings, two-thirds of those interviewed re p o r t e d

that changes to working hours were almost always considered as an option, and went

on to provide numerous illustrations of where such alterations had been made. For

example, people had been allowed to work two days a week, on day shifts only and

within times that would avoid the rush hour. Interviewees also often gave examples of

w h e re an employee’ s return had been facilitated by changes to job content, such as the

p rovision of light duties, and the majority additionally stated that they would be

p re p a red to buy specialised equipment or alter the working enviro n m e n t .

Nevertheless, a number drew attention to operational factors that limited the extent

to which they could adjust working hours and/or job content. For example, three of

those from manufacturing organisations indicated that it was not always feasible to

p rovide light duties or make adjustments to the working environment. In addition,





others re f e r red to the reluctance of other departments to accept the redeployment of an

employee, the dif® culties that were associated with offering an alternative job which

was lower paid and the problems arising in relation to those whose `work habit’ had

a l t e red as a result of their lengthy absence.

M o re generally, the budgetary arrangements in place appeared to exert an important

i n uence over both the willingness and ability of line managers to make workplace

adjustments to accommodate the needs of employees with short or long-term re s i d u a l

disabilities. Thus, in 22 of the 30 organisations, no centralised budget existed to cover

any of the costs associated with the making of such adjustments and, in a further thre e ,

interviewees were unsure where the money would come from. This lack of a centralised

budget was frequently considered to hinder return-to-work activities. For example, one

interviewee from a health trust explained how she was giving a presentation to

managers about carrying out workplace adjustments, but when they asked who would

be paying for these, she had to re p l y, Sorry, but you are’ , and went on to relate how,

because of the devolved budget, when a colleague needed a special chair for her back

they had to look for a cheaper alternative.

Such budgetary arrangements, when linked with the allocation of responsibility to

line managers for the handling of return-to-work issues, were a source of concern in a

number of organisations which had them. For example, a respondent from a local

authority noted how departmental autonomy acted to hinder the redeployment of

people who could no longer do their current job and went on to observe that there could

be inconsistencies across departments in terms of how people are treated’ . More

g r a p h i c a l l y, another interviewee observed that:

T h e re tends to be more sympathy for those on long-term absence from line

managers. This is even the case when patterns of short-term absences

among individuals are due to the same condition as those on long term...

Other line managers are also clouded by their desire to go for the kill with

long-term absentees. Local authority interviewee

Other rehabilitative support

Relatively few of the organisations had internal arrangements in place that pro v i d e d

employees with access to medical advice and treatment. These included thre e

o rganisations with permanent health insurance (PHI) cover, which between them

re f e r red to the actual, or possible, provision of medical treatment and counselling

t h rough their insurers , and seven that provided access to internal or external

counselling services. They also included a large public sector organisation that had an

occupational health service which employed in-house physiotherapists and

psychiatrists and would also fund, in certain cases, private hospital appointments; a

retail organisation that had established a We s t ® eld contributory health scheme where b y

cash payments were made towards the cost of everyday healthcare essentials; and

several organisations where it appeared that private medical and rehabilitation services

w e re used on an ad hoc and discretionary basis. These latter organisations included a

transport operator where an interviewee reported that the company would, in certain

cases, fund private treatment because `...it’s going to be cheaper to pay a couple of

h u n d red quid to send them to a hospital and get them treatment than it is to keep them

o ff sick for three months’.

C o n s e q u e n t l y, given the above, most of the organisations where follow-up interviews

w e re conducted relied entirely on the National Health Service (NHS) to provide the

medical treatment that employees needed to enable them to return to work. Thre e

o rganisations, however, reported problems relating to the time it took to get a diagnosis

or receive information from GPs, with a further two expressing a degree of fru s t r a t i o n

over the ease with which employees were able to obtain sick notes. A number of

interviewees also highlight ed difficulties stemming from the long periods that

employees could wait to get treatment. For example, a respondent from a local authority

re f e r red to the case of a staff member who, at the time of the interview in November

1999, had used up their sick pay entitlement and was not due to get an essential

magnetic resonance imaging (MRI) scan for another seven months. Similarly, an

interviewee from an automotive components manufacturer mentioned an employee

who had been off work for a year waiting for a plastic knee replacement, while another,

somewhat ironically from an NHS trust, stated that:

It’s generally operations that cause our long-term sickness, and obviously

waiting on waiting lists and things like that which we can’t take on.

F u r t h e r m o re, other comments indicated that such delays in medical treatment could

act to endanger an employee’ s continued employment. For example, an interviewee

f rom a local authority observed that generally speaking for the long-term people, we

would be dismissing those people around the time their sick pay was exhausted’.

S i m i l a r l y, another local authority respondent re f e r red to the case of an employee who

faced a lengthy wait to see a consultant, elected not to follow their advice and get a

private appointment and subsequently ended up being dismissed because of the length

of their absence. More generally, an interviewee from a large retailer commented that:

If appropriate (in most cases) we write to their GP and ask if they can

return to work and try to make sure their condition doesn’t exacerbate it. If

they can’ t, we dismiss them. There are two ultimate objectives, and

employees are made aware of this from day one of the process. One is to

get them back to work; the other is to get them off the payro l l .

CONCLUSION

Policy developments, both internationally and domestically, are acting to accord gre a t e r

recognition to the actions that can be taken to facilitate the return to work and continued

employment of ill and injured workers. To date, however, the nature and eff e c t i v e n e s s

of such actions has so far received little attention in the academic HR literature. This is

surprising for two reasons: first, because nationally it would seem that a larg e

p roportion of the working days lost through sickness stem from relatively long absence

spells; and, secondly, there is evidence, albeit primarily from international studies, to

suggest that a proactive approach to supporting the return to work of ill and injure d

workers can have bene® cial consequences both in terms of reducing lost working days

and securing an employee’s continued employment.

Against this background, this article has utilised the ® ndings of a recent study of

absence management, involving the holding of interviews in 30 organisations to

p rovide an insight into current employer strategies and policies concerning the

management of long-term absence. Overall, the findings suggest that few of the

o rganisations had in place comprehensive policies and arrangements for handling such

cases ± a conclusion re i n f o rced by the survey responses obtained from the same

o rganisations. They further highlight the fact that a number of operational dif® c u l t i e s

often surround the policies and arrangements that do exist. These findings, when

c o n s i d e red in conjunction with the observations made above in relation to the

importance of long-term absence and the availability of potential means of reducing its





s i g n i ® cance, there f o re suggest that there is a strong case for many employers to re v i e w

the way in which they currently approach the handling of long-term absence and, in

doing so, to consider the adoption of a more holistic approach to its management. That

is, one that not only emphasises identifying and taking action in respect of illegitimate’

absence ± an emphasis that recent re s e a rch suggests still largely dominates much

o rganisational thinking ± but also gives suf® cient priority to taking action to facilitate

the return of those who are `legitimately’ absent as a result of ill health.

In particular, these findings point to a number of areas where present employer

arrangements could usefully be reviewed. These include the allocation of re s p o n s i b i l i t i e s

between HR and occupational health staff on the one hand and line managers on the other,

as re g a rds the co-ordination of long-term absence cases. They also encompass taking action

to ensure that line managers are provided with appropriate guidance and training

concerning their responsibilities in respect of such cases, reviewing how far the costs of

workplace adjustments should be borne by local departmental budgets, and paying

attention to the adequacy of current occupational health services and the issue of how far

t h e re is a case for enabling employees to have access to speedier rehabilitative support,

whether through primary medical care or vocational re h a b i l i t a t i o n .

As re g a rds the first of these issues, it needs to be acknowledged that, given the

varying nature of the conditions that can give rise to such absences, there is a limit to

how far it is possible to lay down highly prescriptive pro c e d u res on how cases should

be handled. Consequently, in addition to putting in place appropriate pro c e d u re s ,

consideration could be given to what is widely seen as an element central to the

e ffective management of workplace disability, namely the adoption of a case

management approach under which all those with relevant expertise and managerial

responsibilities are brought together to discuss what can be done in a particular case

and how any actions identi® ed should be taken forward (Bru y e re and James, 1997).

The establishment of arrangements of this type could clearly go some way to

o v e rcoming the often ad hoc way in which, it appears, long-term absence is often

managed. It would also offer a way of avoiding the risk that responsibility in the area is

allocated to one individual, frequently a line manager, who may have neither the

expertise nor re s o u rces needed to address the issues relating to a particular case. In

addition, a further potential advantage stemming from the greater co-ord i n a t i o n

associated with such arrangements is that they could provide a means of ensuring that

cases are managed in a more consistent manner and hence in a way that does not

i n c rease the potential liability of employers under the Disability Discrimination Act.

Nevertheless, line managers will almost inevitably have a role to play in the handling

of long-term absence, not least because they will possess detailed knowledge about the

employee and the job that they do and are clearly well positioned to identify cases

requiring attention. The nature of this role can, however, potentially vary from taking

lead responsibility to having some, perhaps varying, part to play in case management

p rocesses. Unfortunately, as already indicated, the interview ® ndings indicated that

p roblems were frequently perceived to exist in the way in which line managers ful® l l e d

their absence management responsibilities.

In broad terms, these problems echoed those found in other studies which have

examined how line managers have coped with the devolution to them of greater HR

responsibilities (Cunningham and Hyman, 1995; McGovern et al, 1997; Store y, 1992).

Thus, they included, in addition to a hesitancy to get too closely involved in the

handling of cases involving serious illness, a tendency to accord absence management

a relatively low priority in relation to their other duties, a lack of awareness of existing

policies and pro c e d u res and a lack of knowledge and other re s o u rces which would

enable them to carry out their responsibilities eff e c t i v e l y. As a result, there would seem

to be a need for organisations to pay attention to overcoming these areas of weakness

t h rough such means as providing better guidance and training, making available

adequate advice via HR and occupational health staff, and providing advice on

external services, including those provided through the Employment Service.

The re f e rence made above to the provision of re s o u rces in turn raises the question of

how far line managers have the ® nancial ability to make workplace accommodations

that re q u i re expenditure to be made on additional staffing or the purchase of

equipment. As noted earlier, in around two-thirds of the organisations where interviews

w e re conducted, such expenditure was normally expected to come out of departmental

budgets. It often seemed, however, that these budgets did not speci® cally make any

allowance for such items of expenditure, with the result that line managers simply had

to ® nd scope for them within their more general operating budgets. This in itself is not

necessarily a problem if such scope is considered to be available. Unfortunately, it was

clear that this was not always the case and it was also apparent in some org a n i s a t i o n s

that reliance on local budgets was contributing to inconsistencies between the

departments in how they treated those who were long-term absent. Consequently, it

would seem that organisations need to give careful thought to whether problems of this

sort could be avoided by the establishment of a central budget to fund such expenditure

o r, alternatively, through the provision in local budgets of a `contingency fund’ that

could be used for this purpose.

At the same time, it will invariably remain the case that line managers will face

c o n icting pre s s u res on their time, with the result that there is no guarantee that actions

of the above type will be suf® cient to ensure that they carry out their responsibilities in

the way expected. Consequently, consideration also needs to be given to establishing

a p p ropriate mechanisms to monitor their performance and address any weaknesses

i d e n t i ® ed. The case management arrangements mentioned above are a potential means

of providing such a monitoring process. However, if this approach is not favoured or

c o n s i d e red feasible then thought needs to be given to how HR departments, or other

management functions, can ful® l this role.

The fact nevertheless remains that, in some cases, neither line managers nor HR staff

will have the expertise needed to adequately handle certain cases. As a result, they may

possess insufficient understanding of particular medical conditions and their

implications for future work activities and be insuf® ciently aware of the actions, such as

obtaining specialist types of equipment, that could be used to assist an employee to

return to work. Such potential problems, in turn, serve to highlight the need for

o rganisations to carefully review the adequacy of their current occupational health

p rovision in order to see if steps need to be taken to improve the support that is

p rovided to line managers and HR personnel and also to enhance present arrangements

relating to liaison with GPs and the NHS more generally.

The issue of the NHS raises the question of whether there is a case for employers to

i m p rove worker access to vocational rehabilitation and primary medical treatment as a

means of securing their speedier return to work. Possible actions could include taking

out (or expanding) private medical insurance cover, financing appointments with

consultants and using internal or external rehabilitation services that, for example, make

available stress counselling and physiotherapy.

In summary, the preceding analysis suggests that employers can act to facilitate the

return to work and hence continued employment of many workers who curre n t l y

experience job loss as a result of ill health and injury. At the same time, the interview

® ndings presented indicate that few employers currently have in place compre h e n s i v e





policies and arrangements for handling cases of long-term absence and serious illness. It

would there f o re seem that many employers could usefully review the way in which they

c u r rently approach the handling of such absence, both at the policy and operational levels.

Notes

1. For a review of the existing evidence see James et al ( 2 0 0 0 ) .

2. The health measures found to be related to absence were: probable possible ischaemia

on ECG; angina; history of diabetes; self-reported health; regular cough with phlegm

in winter; longstanding illness; number of health problems in the last year;

psychiatric symptoms; drug therapy for hypertension; and current smoker.

3. Employee health was assessed through responses to the following questions: `Have

you had any complaints about your health recently?’; `Have you consulted a doctor in

the last six months?’ ; `Do you often feel tense?’; `Are you often nervous?’; and `Are

you often downhearted?’

4. F i g u res given by Marg a ret Hodge, then Disability Minister, at the TUC confere n c e ,

C reating a Healthier Nation, held on 11 May 2000 at Congress House, London.

5. For fuller discussions of these and other national arrangements see James and Wa l t e r s

( 1 9 9 9 ) .

6. It should be noted, more generally, that surveys that have sought to assess the extent

and nature of disability and its implications have tended to de® ne the term in rather

d i ff e rent ways. For a discussion of this point in relation to of® cial British surveys, see

C o u s i n s et al ( 1 9 9 8 ) .

7. The types of modi® ed work programmes investigated in these studies varied. In

addition, some studies examined the operation of more than one type of pro g r a m m e .

Overall, 11 of the programmes covered the provision of light duties, two

encompassed the use of graded work exposure, two concerned the use of work trials,

two investigated employer- p rovided accommodations and one focused on the

p rovision of sheltered employment (involving work at a specially designated site

designed to provide work as a social service).

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