Beat the bug: Managing sickness absence

By Dr Trevor Smith BSc MB ChB FFOM FRCP and Dr Seamus Dagens BA BCh BAO MB MFOM, Willis Towers Watson Health & Benefits

Absence attributable to ill health is high on the agenda of many companies and is one of the top three concerns for Human Resources professionals.  Although controlling sickness absence is a key element in ensuring efficient business operation, it is not simply a matter of reducing absence but how this is achieved, since the practice and procedures are subject to legal regulation.  The two main relevant pieces of legislation are the Equality Act 2010 and, if disciplinary action or termination of employment is being considered, the Employment Act 2002.  A useful reference in this context is produced by ACAS in the form of an authoritative code of practice on disciplinary and grievance procedures. The Code of Practice is available at

With the increasing burden of legislation such as the Equality Act , and the uncertainty about medical certification into the future, managers could be forgiven for believing that the odds are stacked against them.  Nevertheless, despite the potential difficulties, it is possible to put effective strategies in place to control absence.  Such strategies are likely to work best when they involve a partnership of all interested parties, ie line managers, Human Resources, occupational health professionals and the absent employee, and are based on a systematic approach aimed at getting the employee back to work.

Capturing absence data

The first requirement of an effective absence management system is to ensure that absences are captured within the organisation and that interested parties are notified that the employee is off sick.  Typically the two most interested parties, at the beginning of the absence period, will be the immediate line manager and the HR manager.  The former will need to know about the absence as soon as possible, in order to sort out any short term manning issues, but may also be interested if the employee has a poor record of attendance.  The HR manager will undoubtedly be interested in individuals who have repeated short term absence.

There are a variety of ways in which an episode of absence can be captured.  Probably the most common method is for the employee to phone in to the company, usually to their line manager, at the start of their normal working day or shift.  Many companies believe that the necessity to speak to a line manager will deter non-genuine absence.  However, this approach has some potential pitfalls.  Firstly, the working day or shift has already started by the time notification arrives.  In tightly manned businesses with just-in-time operations, eg logistics, it would be helpful to know about impending absence before the start of the shift, so that alternative manning can be organised. 

If the business has no in-house capability to meet this requirement, an alternative option would be to use an outsourced recording system which operates 24 hours per day.  The two outsourced solutions would be either a call centre operation or a computer-based system using voice activated software.  The second problem inherent in speaking to a line manager is that the absence may not actually be recorded, particularly if the employee says that he or she is only likely to be off work for that day.  Failure to record the absence, despite notification by the employee, is probably more common in white collar operations.

Accurate capture of absences is critical in dealing with frequent short term absences, since the likely consequence is disciplinary action.  A number of different trigger points are used to initiate action on repeated short term absence.  One of the most popular triggers is the Bradford Score, which looks at both the number and duration of absences but weights the score in relation to the frequency of episodes. An alternative would be the number of episodes, say three, in a rolling twelve month period. 

Dealing with frequent short-term absence

Once the trigger is exceeded, the usual approach to dealing with frequent short term absence is to follow disciplinary procedures, ie via an escalating process of warnings which could potentially end in dismissal.  The key to making the disciplinary approach effective is to ensure that warnings stay in force for sufficient duration, such that relatively rapid expiry of a warning does not give the employee licence to take further time off.

When notification of an absence is received, it is important that the company establishes and maintains contact with the employee, ideally at intervals not exceeding four weeks for absences which become protracted.  The initial contact is important in setting the atmosphere to encourage and support a return to work.  Usually the point of contact will be the line manager, although larger organisations may consider delegating this role to the HR function, to ensure that a consistent approach is adopted.  Where closure of absence is likely to take some time, it may be helpful to appoint a case manager to plan and coordinate the delivery of appropriate management and medical interventions.

Handling longer-term issues

If absence exceeds four weeks and there is no imminent prospect of return to work, consideration should be given about obtaining advice on the prognosis of the employee’s medical condition and the possible timescales for return to work.  A report from an independent occupational health professional is often helpful, rather than simply obtaining information from the GP.  As a general guide, a GP report will be helpful to confirm medical facts such as the diagnosis and prognosis of the condition.  In contrast, a good occupational health report should add greater value than a GP report, since it should not only consider the prognosis of the condition but also offer advice on current and future fitness for work.  In particular it should comment as to whether it is possible to make short or long term job adjustments to facilitate a return to work.

Access to treatment, in terms of waiting lists, can often delay an employee’s possible return to work.  Employers may wish to look at assisting employees with funding of treatments or medical investigations, either directly or through insurers.  The insurers who have an interest in the employee returning to work as soon as possible are group income protection insurers and employer’s liability insurers.  The latter are likely to show a specific interest in cases of accidents or ill health arising through work, since consequent negligence claims have a component relating to loss of earnings.

Absence action plan

The receipt of external advice should prompt discussion between the manager and employee with the aim of establishing appropriate action.  If possible, the action should be agreed between the parties.  Regardless of agreement, the content of the discussions and action plans should be documented, so that both parties can refer back to them as necessary.  Any points of disagreement should also be discussed and differences in opinion recorded. The opportunities for temporary or permanent job adjustment should be discussed in the context of achieving a safe and sustainable return to work.  In this respect, it is the role of the manager to determine what is “reasonable” from the point of view of job adjustment, taking into account the operational and financial perspective of the Company.  Nevertheless, it is worth consulting the employee about what they find “reasonable” with respect to their own circumstances. 

Most absences will be relatively short and will not require medical advice, so there will be no need for extensive consultation on issues such as job adjustment.  Nevertheless it is important that all employees who are off work have return to work interviews.  The purpose of the interview should be to establish that all is indeed well and that there are no continuing problems which might affect the ability to work.  Where the employee has had previous episodes of absence, the manager should inquire about a possible ongoing underlying cause. 

If a medical condition does appear to be a common factor in a number of absences, it may be worth taking occupational health advice as to whether it will continue to cause episodic absence and whether any measures can be taken to ameliorate the problem.  In cases where a single cause is responsible for repeated absences, the business will need to decide whether the matter should be subject to a disciplinary process or, instead, it would be more appropriate to deal with it as an issue of capability.

Inevitably situations will arise where there is no realistic possibility of any employee returning to work or return to work is unlikely within a reasonable time frame, as judged from the business standpoint, and termination of employment will need to be considered.  Since termination is a last resort, it should only be undertaken when reasonable possibilities for job adjustment have been fully considered.  Even in circumstances where there can be no realistic prospect return to work and an ill health retirement option is possible, it is prudent to go through the process of considering job adjustment and documenting the decision making process, to ensure compliance with the Equality Act.

If termination of employment is contemplated, it is important to adhere to the three steps required by the statutory dismissal procedure.  The statutory procedure should be followed in all cases, even in situations of ill health early retirement.  Information on the statutory dismissal procedure can be accessed via the ACAS website listed in the opening paragraph.

Further information

A further source of advice on managing long term absence and incapacity at work has been published by the National Institute of Health and Clinical Excellence (NICE) at:  

The NICE document examines the evidence base for interventions which have been shown to work in managing long term absence but it does not consider employment law and practical issues to deal with absence in a wider business context.  In contrast, the measures described in this paper go somewhat further in attempting to describe current best practice solutions, without necessarily being evidence-based.

If you think we might be able to help with advice on short or long-term absence management issues, do give our in-house Occupational Health team a call on 01606 352035, request a callback or complete our contact form.