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Seven top tips for the first seven days of employee sickness absence

First published by Dr Lara Shemtob in the work and health Substack to reach a wider audience on how the incentives around work and health can align.

Lara recently spoke to two of the director's of Insight Workplace Health: Chris and Liz Terry about their experience of the value of early intervention in sickness absence. Here are the highlights from the interview.

1) The basics

When someone takes sickness absence from work, they can self certify for the first seven calendar days. If they are still unwell and unable to return to some/ all aspects of their job they must see a healthcare professional for a fit note. The fit note follows an assessment and certifies the individual as ‘not fit for work’ or ‘may be fit for work with advice’, where adaptations to the role can be recommended to help them continue working through a period of ill health. The fit note can be used as evidence for statutory sick pay or corporate sick pay, when someone is too unwell to work altogether

2) Why are the first seven days so important?

When it comes to sickness absence, the earlier the intervention the better. Once someone is off for four weeks, there is already a 20% chance they will never return to work. The chance of returning to work continues to reduce with length of sickness absence. It is difficult to distil cause and effect here (someone who is very unwell and far from their baseline is likely to require a longer period of time off).

However, we know that over 90% of the time fit notes are signed as ‘not fit’ without any adjustments or advice which could help keep the individual working. Employers understanding this, and making the options clear to the employee as early as possible in sickness absence helps set the tone for dialogue, support, options and flexibility. Once off for a period of time, psychosocial barriers can be harder to overcome for return to work, even if the original health issue improves.

How can organisations act quickly when it comes to employee health?

3) One day absence calls

Some organisations have found it really beneficial to use a day-one occupational health check-in when an employee first takes sickness absence. This is great because in a brief (<15 minute) telephone appointment, an occupational health clinician can get up to speed with what is going on with that employee’s health, and provide some structure to navigate what’s ahead. Data gathered on a quick phone call can be essential to figure out:

  • Is this a work-related issue? in which case, this issue will need to be addressed for the individual to return to work, and may be affecting many others.

  • What would be useful to bring to a GP team fit note conversation? Laying the groundwork on how workplace adaptations could fit in where appropriate ahead of a GP team fit note consultation can help the individual think through what they would need to change to keep working and gives them the opportunity to have a dialogue about what can be accommodated at the workplace.

  • Is this health issue likely to be medium to long term? In this case, occupational health follow up to help support the individual with the guidance they need from a work perspective as their health changes can facilitate a safe, early and sustainable return.

4) OH input prior to planned sickness absence

Another high yield use of OH is assessments prior to planned sickness absence, such as before an employee has elective surgery with a several week recovery period. Organisations find that keeping ahead of the sickness absence and having pre-emptive conversations about work and health prior to the time off can support earlier rehabilitation to the role. Early communication is a way of keeping all parties on the same page through periods of change, and planning is key to support.

5) OH input for short term stressors

Acute stressors, such as a bereavement, can have a significant affect on an individual’s functioning and clearly there is no set timeline for recovery. Organisations that take a holistic view of workforce health have found OH support can be useful for psychosocial stressors. This is another way of keeping ahead of any support needs through difficult periods, even when it is not a specific health condition triggering a referral.

6) Who holds the cards?

Employers hold the cards. They have the scope to implement change in their organisation, to the benefit of their workforce and their productivity. Policy advocacy in occupational health is important because the issue of an unequal occupational healthcare landscape affects up to 50% of workers, and can impact on the social determinants of health. However, finding agents of change within the business leadership community will be an important catalyst to increasing uptake of work and health support.

7) Do you need occupational health expertise to implement change?

OH comes with clinical expertise and neutrality which is key to navigating the risk and safety aspects inherent to occupational health issues in the workplace. One key limitation of interventions driven by managers, Human Resources or People Operations is that the bottom line for the employer will always be workforce productivity, which is where conflicts of interest can come in. However, it is important to note that often employee and employer incentives do align. In the absence of OH support, employers can learn from these examples and implement internal policies to the benefit of their workforce and wider organisation.

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