Workplace health: long-term sickness absence and capability to work
Last month Sammy Harbut attended a virtual NICE (National Institute for Health and Care Excellence) Committee Meeting, having registered The Pituitary Foundation as a stakeholder interested in this important topic. The NICE Quality Standard considered Workplace health: long term sickness and capability to work. Long-term sickness absence was qualified as an absence lasting 4 or more weeks, which can be reoccurring. The topic is relevant as many in our pituitary community have issues with employment during and post diagnosis and treatment, and not all employers are sympathetic to the complex needs pituitary patients have.
The focus of the review and meeting considered how to help people return to work after long-term sickness absence, reduction of recurring sickness absence, and prevention of moving from short-term to long-term sickness absence. Four key areas were considered for improvement:
a) Statement of fitness for work- the role of health services and employers;
b) Support during long term sickness absence- essential communication and the role of OH services;
c) Support to stay in or return to work- reasonable adjustments, support for returning to work and mental health;
d) Workplace culture and policy
a) Statement of fitness to work
- The statement of fitness for work ('fit note') should be completed by the medical practitioner with the most relevant recent knowledge of the person's health, reason for absence and prognosis for return to work. This may be a GP or secondary care specialist.
- Understand that reasons for sickness absence can be complex, and should consider any factors in their work or personal life that may be contributing to their current absence or causing concern about returning to work.
- Employers need information on how the employee's health condition or treatment could affect them on their return to work, and plan for their return to the workplace, considering any additional information provided (e.g. from an allied health professional's health and work report) about how their condition may affect their ability to do their role
- Consider any adjustments in the workplace that are recommended, and use any recommendations in this report as a starting point, involving line managers ad the employee in the discussions.
- Employers should discuss and jointly agree a plan for keeping in touch with employees throughout an extended absence.
b) Support during long term sickness absence- essential communication and the role of OH services
- Encourage people who are assessed as not fit for work to maintain regular contact with their workplace, as employers need information on how the employee's health condition or treatment could affect them on their return to work.
- Consider any additional information provided (e.g. from an allied health professional's health and work report) and seek information and advice on what support they might need (e.g. from Occupational Health Service). Discuss what adjustments will be needed for a return to work.
- If the person is likely to be absent from work for more than 4 weeks, consider referral to health rehabilitation and support services (eg. physiotherapy, Occupational Therapy, Counselling) and signposting to other possible expert sources of vocational advice and support relevant to their condition.
- When a statement of fitness for work indicates that a person may be fit for work, as soon as possible discuss adjustments (e.g. flexible working, phased return, reduced hours, changes to workstations/ duties) which might help them return to work.
c) Support to stay in work
- Discuss adjustments, involve employee, line manager OH and TU’s. Reasonable adjustments should be specific for returning to and remaining in work as well as exploring possible solutions and support needs. Develop an action plan and hold regular progress meetings with the person and their line manager.
- Record any adjustments agreed with the employee, with a timeframe for implementation and how long for. Use this as a written return-to-work plan for both employee and their manager. Consider informing other employees to help them understand the need for them.
- Record any adjustments agreed with the employee, with a timeframe for implementation and how long for. Use this as a written return-to-work plan for both employee and their manager.
- If the reason for absence is due to a musculoskeletal problem, consider a programme of graded activity delivered by someone with appropriate training (e.g. a physical or occupational therapist) and/or problem-solving therapy.
- A workplace assessment can be undertaken by a qualified professional to review and discuss the suitability of work tasks or any adjustments that could be made. If appropriate, arrange a meeting between employee and line manager, facilitated by someone impartial, to consider the barriers to returning to work and how they can be overcome.
d) Workplace culture and policy
- Make health and wellbeing a core priority for the top level of management of the organisation.
- When developing workplace policies for managing sickness absence and return to work, ensure they promote employees' health and wellbeing.
- Sickness absence policies and procedures should be implemented fairly, be consistent across the organisation and fit for purpose.
- Regularly review the data on trends in sickness absence to identify interventions needed to support employees' health and wellbeing. Policies/ procedures may need to be reviewed or amended to accommodate this support.