How to reduce sickness absence and move from compliance to wellness

Paul Avis

Corporate Development Manager, LifeWorks

Introduction• Paul Avis

• 18+ years experience

• Risk and healthcare

• U.K. and International

• Focused on absence management &

integrated/total/comprehensive health programmes since 2000

• Now within LifeWorks (Ceridian’s Employee Assistance Programme) to help build and deliver our proposition

Agenda

• What are current trends in sickness absence? Causes of absence Increasing costs/litigation

• How do other organisations manage it? Absence & associated policies Line managers Services Benefits

• What should employers consider? Set budget Integrate all aspects and optimise expenditure Move from absence management to wellness

Trends in sickness absence:

Causes of absence

Causes of short term absenceSource: Swiss Life 2002/Back Care

0

5

10

15

20

25

30

35

40

45

50

Total asrespondents

Total as %

Cold

Stomach

Migraine

Back paininjuryStress

Other

Accident

Conditions responsible for long-term absence (more than 20 days) Source: OH Review 9/2001

0

10

20

30

40

50

60

70

80

90

Condition

Back pain

Other MSD

Mental ill-health

Stress

CVD

Surgery

Major illness

Terminal illness

Bereavement

Of the 2.7 million IB claimants 900,000 now off with mental ill healthSource: DWP, 2004

050

100150200250300

Appoin

tmen

ts & O

ps

Back

& Neck

Chest,

Asthm

a, H

ayfe

ver

ENT & D

ental

GU, Men

strua

l,PM

T

Heart/B

lood D

isord

ers

Infe

ction

s Cold

, Flu

Mus

culos

kelet

al

Neurolo

gical

Non Sick

ness

Rela

ted

Other

Hea

lth P

roble

m

Pregna

ncy R

elated

Stomach

, Abdo

mina

l

Stress

, Men

tal H

ealth

Absence Incidences/1200 Employees

0200400600800

100012001400

Absence Days Lost/1200 Employees

occupation? Source; Unum Limited 2003

The employee

So how do we treat mental health in the workplace?

U.S. stress/mental average 14 Months Canada 4 years UK ??????

Clue! In 50% of all stress/mental claims therehas been no referral to a specialist (usual point of receipt 28 weeks!)Source: Unum Limited 7/2000

STRESSIS

WHAT HAPPENS TO YOU WHEN YOUR GUT SAYS

NO!!

AND YOUR MOUTH SAYS

“OF COURSE, I’D BE GLAD TO”

God put me on earth to accomplish a

certain number of things. Right now I am so far behind I will never die

Living business index Source: BT Cellnet 10.01

Rank City Hours Holiday p.a.

1 Edinburgh 46.8 17.5

2= Bristol 48.8 16.9

2= Manchester 50.1 17.5

4 Leeds 50.2 18.6

5 Birmingham 50.2 17.3

6 London 50.4 15.7

7 Plymouth 51.3 15.4

10 Cardiff 51.1 16.3

Is this work-life balance?

Clinical or management?

• Over promotion-capability and skills?

• Inter-personal-post appraisal, disciplinary, investigation etc.

• OH are only clinical.

• De-clinicalise mental health management and emphasise proactive management, without fear!

Trends in sickness absence:

Increasing costs & litigation

• CIPD survey – average rate 4% (9/10 days) - cost £600 per employee every year. 2

• Confederation of British Industry (CBI) 160 million working days were lost through absence.1 Estimated cost at least £13 billion.

• HSE say stress & musculoskeletal are £18 billion per annum. 3

• NU Healthcare estimates costs to be as high as £39 billion. 4

Does anyone really know? Do you know your absence cost?1 CBI – AXA Absence and Labour Turnover Survey 2006

2 CIPD Annual Survey Report 2005, Absence Management – A Survey of Policy and Practice, July 2005.

3 HSE 2000 4 NUHC Managing Absence & Employee Healthcare2001

Absence: challenge at many levels-Quantification of costs

Absence: A challenge at many levels-does size matter?The larger the organisation…the greater the cost!Source: CBI Absence & Labour Turnover Study 2005

0

1

2

3

4

5

6

7

8

9

10

1 emp-49 emp 50 emp-199emp

200 emp-499emp

500 emp-4,999 emp

5,000employees

PublicSectorPrivateSector

Absence: a challenge at many levels-More than just the absence rate…

Source: IES 9.01

Medium retail store £ 465 6.8%Retail group £ 497 6.5%Regulatory body £ 809 2.2%Law firm £ 837 1.8%Small retail store £ 861 11.2%Insurance company £ 991 4.7%Large retail store £1,268 16.4%Financial services co. £1,677 7.8%Local authority £2,261 8.2%

•Employer liability costs:

2002 Average increase: + 50%

2003 Average increase: + 35%

2004 Average increase: + 23%

2005/06/07 Smaller increases on the way!Source: EEF 2004

•Cannot operate without it….

•Discounts of up to 20% for enhanced accident/incident reporting & management and proactive employee health management

Absence: A challenge at many levels-If line managers enforce policy badly who picks up the tab?

How do other organisations manage sickness absence?

Policies needed to support absence

So how is absence managed?

Absence policy Accident investigation policy Bullying & harassment Business continuity Communications Crisis management/disaster plan Data protection (corporate Information + security) Disability support Employee satisfaction survey Equal opportunities Flexible working Health education policy Health & safety policy Medical retirement

So how is absence managed?

Post incident/trauma policy Risk assessment & management Sick pay Special leave Substance abuse Training & developmentSource: CIPD rehabilitation guide/January 2004

+ a few more I have encountered….. Redeployment policy & register Rehabilitation and OH policy Recruitment & selection policy Disciplinary/grievance Violence/aggression policy Appraisal policy Specials e.g. blood born /infection policy

How do other organisations manage sickness absence?

The role of line management

‘I am a simple soul and need a 1-10 guide and there is no clear guidance in the current absence policy’‘Not sure what the content (of the absence policy) is’ ‘I am often too late and I read the policy but I am none the wiser’ ‘Without flagging up of absences we never know what stage of the absence policy we are at’ ‘I have no idea from the policy how soon I can begin to tackle short term absence.’‘I know where it is and when to use it but I do not look at it that often-my priority is to cover the shift and worry about the absence later!’

Absence: A challenge at many levels-Do line managers enforce policy?

Absence: A challenge at many levelsHow should line managers enforce policy?

• Consistently

• Prescriptively

• Confidently

• Professionally

• Supportively

• Depersonalised

Barriers to work reintegration & recovery Source: (IRS survey 2001)

0

5

10

15

20

25

30

35

40

45

Principal barrier

Persuading linemanagers

Employeeresistance

Limited capacity ofNHS

Lack of OH services

Lack of board levelcommitment

Elements of successful work reintegration strategy Source: (IRS 2001)

0

10

20

30

40

50

60

70

80

90

Elements

Early intervention

Maintaining contact

Phased return

Medical exam

Private treatment

Workingarrangements

Modify tasks

Absence: A challenge at many levelsHow should line managers enforce policy?

• Own the problem• Even when work related• Do not be afraid

Achieved By:• Read & act on absence policy• Use services (OH, H&S, EAP)• Use the benefits (PMI/cash plan/GIP)

Services (or are these benefits too: they should be!)

• Employee Assistance Programme & online support/wellness Assessments

• Occupational health

Too late

Bad administration

Employee stigma

• Health & safety

• Physiotherapy

How do other organisations manage sickness absence?

Benefits

Benefits

• Private medical insurance/cash plan PMI is expensive-PAYG? Cash plan £1/2/3-consultant/scan

• Group income protection Get in early-3-6 weeks ‘Free’ vocational rehabilitation services Care with claims/absence resolution

• Group critical illness

• Group PA & sickness

What should employers consider (& do!):

Budget

  

Service Description: Cost (exclusive of VAT):

Out-sourced absence management programme £40

Cash Plan £52

Wellness Screening Programme £40

Limited Payment Group Income Protection/PHI £50

EAP Service £25

1x Salary Critical Illness £40

GP 24/7 Helpline £3

What should the ambition be?

Compliance with legislation?

Integrate & optimise expenditure

EmployerNotification

Work Related

H & S Manager

CONTACT CENTRE

Line ManagerAttendance

Management Interview/Meeting

Continued Monitoring

Disciplinary

OH Referral

OccupationalHealth

In-houseOut-sourced

EmployeeNotification

Persistent Short Term AbsencePayroll

The availability of comprehensive management information means that preventative measures and healthcare expenditure can be better targeted and managed

Day 1Absence NotificationSelf Certification Form

Day 7Return to Work Meeting Form

Day 14Medical Consent Form

Day 21Face to Face Meeting

Day 28Occupational Health Referral

Week 6Case Conference

Monthly ThereafterContact Log

Week 26Incapacity Benefit Forms

Week 48Absence Resolution ReminderC

ON

FIG

UR

AB

LE O

PTIO

NS

What should you try to achieve?

From management to wellness

Organisational responsibility:

Personal responsibility:

Pre-sickness Post-sickness

Exercise, diet, sleep, coping strategies,disease risk management, work/lifebalance, nutrition, presenteeism, stress,attitude, training attendance etc.

HR e.g. absence policy & procedure, line management training, H&S, benefits e.g. PMI, GIP, GCIC, PA&S,services e.g. counselling/EAP, OH

Organisational response:

Personal response:

Prevention is better than cure! Best practice on each and every absence

Onset of sickness/disability

Return to work programme, retraining, redeployment, attending assessments,ongoing contact, state benefit support,medical referrals, case conference etc.

Absence policy enforcement, GIP,PMI, PA&S, usage, assessments, vocational rehabilitation,disability discrimination compliance

OH, EAP & H&S

Integrated employee health & wellbeing

Wellness Sickness

Persistent short term absence

Flexible benefits wrapper

Time & pay Long term absence

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