Individual research recommendation details

Recommendation ID

NG146/1

Question

What interventions are effective and cost effective in supporting return to work, in all workplaces including micro-, small- and medium-sized organisations, after long-term sickness absence in the UK?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
Evidence from the UK showed that workplace policies on sickness absence and return to work may help to reduce uncertainty around the process of enabling return to work for employees and employers, but only if they are properly implemented. The committee agreed that it is important for all sizes of organisation to clearly communicate policies and procedures to staff.
However, smaller organisations may not have formal policies in place. The committee agreed that in these situations it is important that all employees are aware of the procedures for reporting and managing sickness. Regularly reviewing these policies and procedures would be good practice to ensure that they are appropriately applied and fit for purpose.
The committee discussed testimony from experts in occupational health and in employment research. The expert in occupational health was asked how the occupational health service in their NHS trust had contributed to achieving and maintaining a relatively low sickness absence rate and the barriers and facilitators to doing so. The expert in employment research was asked about common and more innovative measures used by organisations to reduce sickness absence rates.
The testimony provided by the experts identified that a commitment to employee health and wellbeing, proactively and strategically led from the top levels of management, should underpin sickness absence and return-to-work policies. The committee discussed the importance of these policies being part of a wider culture that values and promotes employee health and wellbeing.
The committee discussed that inappropriately applied return-to-work policies can result in presenteeism or longer absences from work. They highlighted the importance of ensuring that everyone is treated fairly. For this reason, they thought it important to regularly review how policies are implemented across the organisation, to ensure that those who are off work or planning a return to work are treated consistently.
The focus of this guideline is on managing sickness absence among all employees, regardless of whether they have a disability or long-term condition covered by the Equality Act 2010. Although the committee were aware that organisations should also have policies and procedures in place for managing disability leave, this area is not included within the scope of this guideline. The committee noted that there are legislative requirements about health and disability for employers and that the recommendations in this guideline should be considered alongside those requirements.
There is a small amount of low-quality evidence that employers providing early access to interventions, for example through an occupational health provider or employee assistance programme, can benefit both employees and employers. There is also some similarly limited evidence that accessing interventions early may help to reduce sickness absence rates and promote a more sustainable return to work.
Testimony from an expert in occupational health supported the evidence that was found on providing early access to interventions, when appropriate. Furthermore, the committee noted that guidance for employers on commissioning an occupational health service is available from the Society of Occupational Medicine. The committee discussed the limitations in the evidence and, in particular they noted that micro-, small- and medium-sized organisations are not represented in the evidence and may not have access to such services.
The committee also heard from experts, particularly the expert in occupational health, that organisations that are considered to be examples of good practice collect detailed data on trends in sickness absence according to factors such as job type and location. This detailed non-identifiable data can help the organisation target specific interventions and resources where they are most needed. It may also help to highlight any inequalities and identify policies or procedures that may need to be reviewed or amended.
The evidence seen by the committee focused almost entirely on supporting people to return to work after a period of long-term sickness absence (4 or more weeks). No evidence was found on preventing recurrent short-term sickness absence (of less than 4 weeks per episode) or on preventing people moving from short-term to long-term sickness absence.
Despite the lack of direct evidence the committee agreed that, in practice, interventions that were effective in supporting people to return to work after long-term sickness absence may also help to prevent recurrent short-term absences and to prevent people moving from short to long-term sickness absence. This is because they may have to overcome similar barriers and need similar support when returning to work. The recommendations therefore do not distinguish between supporting people returning from long-term or recurrent short-term sickness absences.
Because no evidence was found on preventing recurrent short-term sickness absence, the committee recommended research in this area (see research recommendation 2). They also agreed that research is needed on supporting people to return to work after long-term sickness absence in a UK context (see research recommendation 1). Most of the evidence they considered was not from the UK, but from countries with different systems for managing sickness absence. The committee therefore agreed there was a need for more evidence that was directly applicable to the UK population. The committee considered that alongside data on supporting return to work it would be helpful if studies collected data on the impact of absenteeism and presenteeism.
Although there was no evidence on preventing the move from short-term to long-term sickness absence, the committee did not make a research recommendation in this area. This is because of the potential difficulties of identifying people with short-term sickness absence that may become long-term sickness and the feasibility of recruiting them to take part in research trials before they cross the 4‑week threshold into long-term sickness absence.

How the recommendations might affect practice
The recommendations reflect good practice. Larger organisations are more likely to already have formal policies and procedures, but they may need to develop procedures for regularly reviewing them and how they have been implemented.
The resource implications are likely to be greater for micro-, small- and medium-sized organisations that don't have formal policies or provide access to occupational health or employee assistance programme services. Larger organisations are more likely to have these in place, but the committee heard from an expert in employment research that this may not always be the case.
The committee noted from their experience that it would be good practice for smaller organisations that do not currently have access to such services to explore where additional services (such as occupational health) may be available to provide support. This would be part of a proactive approach to promoting employee health and wellbeing. If recommendations are widely implemented, it may result in a larger number of employers having appropriate policies and procedures in place and may help to encourage the spread of good practice. Implementing the recommendations may need resource input initially, but over time may result in a reduction in the costs of sickness absence and improved productivity.
Full details of the evidence and the committee's discussion are in evidence review C: facilitating return to work from long-term sickness absence.

Why the committee made the recommendations
Evidence from the UK showed that workplace policies on sickness absence and return to work may help to reduce uncertainty around the process of enabling return to work for employees and employers, but only if they are properly implemented. The committee agreed that it is important for all sizes of organisation to clearly communicate policies and procedures to staff.
However, smaller organisations may not have formal policies in place. The committee agreed that in these situations it is important that all employees are aware of the procedures for reporting and managing sickness. Regularly reviewing these policies and procedures would be good practice to ensure that they are appropriately applied and fit for purpose.
The committee discussed testimony from experts in occupational health and in employment research. The expert in occupational health was asked how the occupational health service in their NHS trust had contributed to achieving and maintaining a relatively low sickness absence rate and the barriers and facilitators to doing so. The expert in employment research was asked about common and more innovative measures used by organisations to reduce sickness absence rates.
The testimony provided by the experts identified that a commitment to employee health and wellbeing, proactively and strategically led from the top levels of management, should underpin sickness absence and return-to-work policies. The committee discussed the importance of these policies being part of a wider culture that values and promotes employee health and wellbeing.
The committee discussed that inappropriately applied return-to-work policies can result in presenteeism or longer absences from work. They highlighted the importance of ensuring that everyone is treated fairly. For this reason, they thought it important to regularly review how policies are implemented across the organisation, to ensure that those who are off work or planning a return to work are treated consistently.
The focus of this guideline is on managing sickness absence among all employees, regardless of whether they have a disability or long-term condition covered by the Equality Act 2010. Although the committee were aware that organisations should also have policies and procedures in place for managing disability leave, this area is not included within the scope of this guideline. The committee noted that there are legislative requirements about health and disability for employers and that the recommendations in this guideline should be considered alongside those requirements.
There is a small amount of low-quality evidence that employers providing early access to interventions, for example through an occupational health provider or employee assistance programme, can benefit both employees and employers. There is also some similarly limited evidence that accessing interventions early may help to reduce sickness absence rates and promote a more sustainable return to work.
Testimony from an expert in occupational health supported the evidence that was found on providing early access to interventions, when appropriate. Furthermore, the committee noted that guidance for employers on commissioning an occupational health service is available from the Society of Occupational Medicine. The committee discussed the limitations in the evidence and, in particular they noted that micro-, small- and medium-sized organisations are not represented in the evidence and may not have access to such services.
The committee also heard from experts, particularly the expert in occupational health, that organisations that are considered to be examples of good practice collect detailed data on trends in sickness absence according to factors such as job type and location. This detailed non-identifiable data can help the organisation target specific interventions and resources where they are most needed. It may also help to highlight any inequalities and identify policies or procedures that may need to be reviewed or amended.
The evidence seen by the committee focused almost entirely on supporting people to return to work after a period of long-term sickness absence (4 or more weeks). No evidence was found on preventing recurrent short-term sickness absence (of less than 4 weeks per episode) or on preventing people moving from short-term to long-term sickness absence.
Despite the lack of direct evidence the committee agreed that, in practice, interventions that were effective in supporting people to return to work after long-term sickness absence may also help to prevent recurrent short-term absences and to prevent people moving from short to long-term sickness absence. This is because they may have to overcome similar barriers and need similar support when returning to work. The recommendations therefore do not distinguish between supporting people returning from long-term or recurrent short-term sickness absences.
Because no evidence was found on preventing recurrent short-term sickness absence, the committee recommended research in this area (see research recommendation 2). They also agreed that research is needed on supporting people to return to work after long-term sickness absence in a UK context (see research recommendation 1). Most of the evidence they considered was not from the UK, but from countries with different systems for managing sickness absence. The committee therefore agreed there was a need for more evidence that was directly applicable to the UK population. The committee considered that alongside data on supporting return to work it would be helpful if studies collected data on the impact of absenteeism and presenteeism.
Although there was no evidence on preventing the move from short-term to long-term sickness absence, the committee did not make a research recommendation in this area. This is because of the potential difficulties of identifying people with short-term sickness absence that may become long-term sickness and the feasibility of recruiting them to take part in research trials before they cross the 4‑week threshold into long-term sickness absence.

How the recommendations might affect practice
The recommendations reflect good practice. Larger organisations are more likely to already have formal policies and procedures, but they may need to develop procedures for regularly reviewing them and how they have been implemented.
The resource implications are likely to be greater for micro-, small- and medium-sized organisations that don't have formal policies or provide access to occupational health or employee assistance programme services. Larger organisations are more likely to have these in place, but the committee heard from an expert in employment research that this may not always be the case.
The committee noted from their experience that it would be good practice for smaller organisations that do not currently have access to such services to explore where additional services (such as occupational health) may be available to provide support. This would be part of a proactive approach to promoting employee health and wellbeing. If recommendations are widely implemented, it may result in a larger number of employers having appropriate policies and procedures in place and may help to encourage the spread of good practice. Implementing the recommendations may need resource input initially, but over time may result in a reduction in the costs of sickness absence and improved productivity.
Full details of the evidence and the committee's discussion are in evidence review C: facilitating return to work from long-term sickness absence.

Source guidance details

Comes from guidance

Workplace health: long-term sickness absence and capability to work

Number

NG146

Date issued

November 2019

Other details