Five ideas for tackling sick leave
With limited support, those living with a long-term health condition can face lengthy periods of absence from the workplace. Here’s how we can change this.
We have all woken up feeling unwell and realised we will not be able to go to work. Depending on your company policy, you may even find yourself in the GP surgery asking for a fit note from your doctor. Usually it’s a five minute conversation that ends with a certificate to comply with HR processes.
For some individuals and their employers, these short-term absences and minor ailments are manageable and a return to work is quick. For others the story can be very different.
Every year an estimated 141.4 million working days are lost due to sickness or injury in the UK. The most common reasons for long-term absence are musculoskeletal or mental health conditions. With limited or no access to appropriate support to return to the workplace, many of those living with a long-term health condition can face long periods of absence, or even falling out of work altogether. This needs to change.
Over the past two decades several pilots and trials have tested what components of a return to work (RTW) programme are needed to effectively support people back into employment. Most recently, the government launched the Challenge Fund, awarding £4.2 million to test innovations and new ways to support people with musculoskeletal and / or mental health conditions who are in work, at risk of falling out of work, or who are off work sick.
Every year an estimated 141.4 million working days are lost due to sickness or injury in the UK
Pioneered by Social Finance, The Link was one of 19 projects selected to provide evidence of what is effective in helping people stay in work. It was awarded £230K to develop and deliver a two-site proof of concept pilot, with GP practices located in Leicester and Newcastle. The Link pilot sought to break the silos between GP surgeries, Allied Health Professionals (AHPs), the individual and their employer.
The Link achieved very positive return to work outcomes. The service was active for 12 months from March 2019 to February 2020, accepting a total of 307 referrals over 11 of those months. Impressively, over 61% of eligible and engaged clients were able to return to work, and did so on average 15 days earlier than the averages predicted by an analytics tool. Additionally, comparisons of the pilot data to UK long term sickness absence data revealed at least 11 individuals who avoided falling out of the labour market. This is an assessment of some of the quantifiable elements of the service; other successes included reduced GP workload and appointments requested for reissuing fit notes, client and employer satisfaction with the accessibility and speed of the service.
So what works?
Below are five effective elements of the Link service which should be replicated in future support programmes.
1. Anchor return to work support to the Fitness Certification system
The fitness certification scheme is an equitable and effective point to anchor return to work support and identify people who are at risk of falling out of work.
Most people who need to take more than three days off work due to sickness have to seek a fit note to receive statutory sick pay, which is issued by their GP. GPs are not always best placed to hold work based conversations and advice on work adjustments due to limited time and expertise in this area and their perceived work remit. Referrals onwards to specialists reduces GP workload and ensures clients are getting expert advice and support.
“Helped my caseload and workload as [I am] not a specialist in this area of employment law and wouldn’t have the time to act as an advocate”
— Referring GP
Using an analytics tool, the Official Disability Guidelines (ODG), to assess a client’s return to work timeline, The Link’s caseload is very similar to the sickness absence profile across the population. This suggests we’re able to reach everyone and capture those most at risk from the first fit note. We further supplemented this with an analysis of baseline fit note data, which also shows us that return to work timeline estimates increase with higher fit notes per sickness episode, age and certain conditions, suggesting fit note data (even of questionable quality) can be used to better target support.
2. Embed support in primary care
Co-locating return to work staff in GP practices is critical to driving referrals. It builds trust with GP staff, clients and has legitimacy with employers. But co-location does not have to be 100% — a ‘hub and spoke’ approach works.
“This service was referred to me by my GP, so I was more assured it would work”
— Link Service Client
In the Link Service, each site employed an AHP, such as an occupational therapist or physiotherapist, trained in vocational rehabilitation into the primary care teams. They provided personalised vocational support for individuals referred by GPs and other health care professionals. At both sites, AHPs were based at one main GP practice (the hub), and visited a number of other GP practices to see referred patients (the spoke).
The key activity of the return to work team was to offer vocational rehabilitation support and case manage their sickness absence including supporting individuals to better self-manage their health condition or other life issues, advising individuals and employers on work capacity, work adjustments and return to work planning.
3. Early intervention is key
Clients referred at their first, second or third fit note have significantly better chances of returning to work than clients who have been absent from the job market for a while. In fact, research shows the longer people are off sick, the less likely they are to return. After six months absence from work, there is only a 50% chance of a successful return; after a year, this drops to 25%.
“Patients seen quickly, very favourable option considering long waiting times for other service… before problems get worse”
— Referring GP
GPs and other health care professionals were asked to refer eligible patients seeking their first or second fit notes to the Link Service. This had additional benefits such as employers being found to be more flexible and accommodating to work place adjustments to support a quick return to work, thus, circumventing potential misunderstandings.
4. Joining up of services is critical to client’s speedy return
Return to work support services require a triage process and biopsychosocial assessments to quickly ascertain the level and intensity of support a client requires.
“Could really unpack the issue at triage, for example if [client] suffered from depression and it was related to bereavement or abuse, they could be referred through a specific pathway, often with a much shorter waiting time”
— Link Worker
The Link pilot included an element of GP time to authorise fit notes and provided additional clinical support at one site. The other site included a Link worker, who provided additional non-clinical support to people who presented with a health condition but whose challenges in work stemmed from practical issues such as debt, housing, or family problems. Both were in addition to the AHP staff. It was recognised that some clients referred to the Link had multiple non-health issues that exacerbated their health condition. At both sites the service sought to create strong links and referral pathways to the community as required.
5. The effectiveness of a return to work service is underpinned by the right staff with the right skills set
A return to work support worker needs strong vocational rehabilitation skills, case management, interpersonal and IT skills to get the best outcomes. These skills don’t sit in one workforce and could be drawn from occupational therapists, physios, link workers, police officers, or social care. It is helpful to have an AHP who can produce advisory notes to help GPs with fitness certification. The types of team make up that work best with different population/practice grouping sizes should be tested.
“The service was more detailed than we get from Occupational Health, they [OH] tick the boxes and answer the questions…”
The Link staff were highly qualified AHPs, delivering vocational rehabilitation support in line with international best practices. A Link worker at one site was also able to take over triaging to speed up onward referrals and provided good evidence that non-clinical staff with the right skills can also be part of an effective support service.
Given the impact of Covid-19, health support is more relevant than ever with many more people likely to need support to return to and stay in work. This is a crucial time for government and local commissioners to consider how they can best support people with health conditions at risk of long-term sickness absence and implement an accessible, fair and joined up service into our communities.
For more information, or for support to design outcomes based contracts to deliver health and employment outcomes, contact firstname.lastname@example.org
We have developed sustainable models to drive social change for issues such as homelessness, unemployment, mental health, learning difficulties, education, health challenges and vulnerable children. We are proud of our work on the Link Service and would welcome the opportunity to continue the conversation with you.
Thanks go out to Dr Rob Hampton, RTW Plus, Leicester City Health Federation and Newcastle Healthy Futures for their support of the Link.