Work: in sickness and in health?

When the pandemic first broke out in March 2020 and none of us understood its implications, a story really stuck in my mind because it nailed our attitudes in the UK to illness as much as it showed our confused minds. The email came from the head of HR at a manufacturing company and it was telling staff to go home if they had Covid, but that it was perfectly fine to be sneezing or shivering in the lunch queue – as long as someone else held their tray!

Two years into the Covid crisis, and as sickness absence numbers soared due to the Omicron wave early this year, I wonder if our attitudes to sickness at work need examining? Do employers need to change how they support people to take time off to recover from illness, or to return to work with a long-term condition? What might that change look like and are we ready for it?

A productivity low

First, we must look at how sickness absence in the workplace presents in normal times. According to the Office for National Statistics, the sickness absence rate across the UK, measured as a percentage of working hours that are lost due to sickness absence, was at 1.8 per cent in 2020.

This is the lowest level since records began in 1995, but sickness absence rates have continued to fall year-on-year. Speaking to the Independent in 2018, Cary Cooper, professor of organisational psychology at Manchester Business School, explained: “It’s not real. What’s pumping it is presenteeism. If it was really a drop in sickness absence rates, you would have a productivity rise. And we haven’t seen a productivity rise in years.”

Presenteeism, defined by Cooper in 1996 as “being physically present but functionally absent, implying a reduction in individual productivity while working under suboptimal health conditions”, is endemic in Britain. In the most recent CIPD 2021 report Health and Wellbeing at Work 2021, the overwhelming majority of respondents (84 per cent) observed ‘presenteeism’, both in the workplace (75 per cent) and while working at home (77 per cent). Seventy per cent also observed some form of ‘leaveism’, such as working outside contracted hours or using holiday entitlement to work, over the past 12 months.

Life after Covid?

Many hope that the virus at the very least will stop people struggling into work when unwell. Shelly Asquith, health, safety and wellbeing officer at the TUC, tells us: “There is an opportunity for us to see occupational health and safety in a new, more positive light.” Employers who have become well versed in managing the risk of Covid have the tools to manage other infectious disease as part of their duties under health and safety law. “Supporting people to stay away when unwell reduces risk of all contagious illness spreading, but it also helps prevent work-related stresses,” she says.

Anecdotally, workers have different views. Nina, a 35-year-old PR manager, says we must learn to live with Covid: “I think it’ll be more about protecting the old and people with vulnerabilities now. The rest of us will go back to normal because if we get Omicron it’s not that bad – we could work through it.” Jim, a musician and father of two, on the other hand says: “The fear of the disease itself has all but gone for me at this point, but clearly the days of turning up with a really bad cold and just getting on with it – something of a badge of honour for musicians in the pre-pandemic era – has gone, never to return.”

The government is considering dropping isolation rules for people with Covid entirely by the end of March. Employers must therefore tighten up their policies on presenteeism, says Rachel Suff, senior employment relations advisor at CIPD: “If the isolation period is ended completely, organisations will need to make it very clear that people are not expected to work if they are still unwell.”

Long-term sickness

When it comes to more long-term conditions, our sickness absence practises also need to evolve, say experts. Long Covid has wide ranging, often debilitating symptoms that can fluctuate over many months, even years and there are currently 1.3 million sufferers in the UK, mostly people aged 35 to 69, females and those working in education and health.

The number of people with multiple conditions is rising. More than one in four adults in England lives with two or more conditions, according to the National Institute for Health Research. “Whether it’s a mental health condition or long Covid, the menopause or one of the thousands of health conditions. There are so many that need support and people might need to genuinely take short term periods of absence off,” says Rachel.

Individual support is key: “Hopefully Covid has prompted some organisations to think ‘is my sickness absence policy fit for purpose? Is it encouraging genuine reporting?’ Because we know that a lot of people may not say the real reason for their absence, for example if it’s mental health or a disability – something that needs ongoing support. We want genuine reporting, real, genuine and effective support for people and we need that flexible, individualised approach.”

In work with health issues?

Managers can be rigid in their demands when it comes to sickness – either someone is too ill to work or they are not. Will the recent changes in hybrid and flexible working force a more flexible approach to managing sickness at work?

Kevin Bampton, chief executive officer at BOHS, thinks so: “We are moving towards a more qualitative approach – that people are away from work with health as a dimension, or in work with health issues and it’s more about what’s the significance or contribution of the health issue. How do you manage it effectively? There’s lots of funding going into rehabilitation, bringing people back into work as a dimension of that.”

Rachel adds that, on a practical level, the hybrid and flexible working trends can be harnessed to support people: “Look at people’s duties, where they’re working from as well as hours – I think we’ve seen in the pandemic that most people can work productively from home if they have the right support and that’s been a real eye opener for organisations.”

The system isn’t working

How are employers to offer genuine support for people? Do our systems and processes encourage people to be honest about why they are ill and ask for the support they need? Some companies are making small changes because they believe their systems are not working.

At Charlie HR, a provider of support packages to SMEs, they have introduced mental health, or ‘personal’ days. Seventy per cent of their team were hiding the fact that mental health issues were the real reason for taking time off. “We wanted to create a positive culture surrounding mental health; one where it’s not seen as taboo but as something we all have to deal with to varying degrees – we all have mental health, some days it’s good some days it’s bad,” says Luula Abdulkadir, HR Advice Team lead at Charlie HR.

Personal days are uncapped. If a person takes many personal days they are an indicator that the line manager needs to discuss what’s going on with the individual and any reasonable adjustments. “Some people would rather be working to occupy their minds and keep ‘busy’ whereas others might opt to just have the time off,” explains Luula. “We don’t think there’s a one size fits all approach for this and it’s important to consider each individual circumstance to be able to be as supportive as you can and provide the right support.”

Others say we need to rethink the weight we give sickness absence and our prejudices against it. The first Monday in February is National ‘pull a sickie day’. At this time, press releases will arrive in my inbox with headlines like the most popular excuses to make, or how much money is lost to businesses through sick days.

Rachel Suff says: “That sort of attitude is hopefully becoming a bit outdated. Maybe we need a national presenteeism day to highlight the risks of going to work when you’re ill – the kind of effect that could have in a safety-critical role or if you had to make important decisions and you’ve got brain fog and not feeling well, that could come at a huge cost as well, not just financial but the reputation of your business.”

Shelly Asquith suggests recording worker longevity at an organisation or their contribution, rather than how much time each worker has taken off. “It’s hard to measure positive change, but we should steer away from measuring it with numbers of sick days, especially as we continue to battle the stigma of mental health. It is better to prioritise how long your workers stay on, than how much time they need off. If government were to compel employers to publish risk assessments, we could record positive approaches to safety management. We also want to see a reduced number of diagnoses of occupational illness in the coming years – including Covid!”

A shift in responsibility

More fundamental changes could be afoot. Recently, several companies including IKEA and Next announced that they would be cutting sick pay for unvaccinated workers. Kevin Bampton says the responsibility is shifting onto the workforce for their own health and wellbeing. “There are potential big ramifications for musculoskeletal diseases where people may have different levels of impact because of the things they do outside of work, or indeed in the areas of mental health.”

There are pros and cons to this: “Potentially in a post-Brexit world [rules] are going to be softened up around human rights. There is a real potential for employers to recognise the needs and vulnerabilities of their workforce in a more dynamic way but also to take into account responsibilities of the workforce for their own personal health.”

Covid has affected us all in different ways. The mass sickness absences this year led to increased waiting times in hospitals and skeleton staff are experiencing untold amounts of stress and burnout. “I can’t believe there are many organisations that haven’t been affected by absence because of Covid and long Covid,” says Rachel Suff.

The pandemic has given us an opportunity to adopt a healthier approach towards sickness absence. The starting point should be reflecting on our collective vulnerability as human beings. With staff shortages and the pressure to return to ‘normal’ that maxim will be seriously under threat and there is a danger we will learn nothing.