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ment of long-term sickness and incapacity for work5

(see Figure 2)

which included the following recommendations about effective and cost effective interventions.

INITIAL ENQUIRIES Employers should identify someone who is impartial to undertake initial enquiries with the employee to: Identify reasons for sickness and barriers to returning to work. Discuss the options for returning to work and jointly agree what action, if any, needs to be taken. If necessary, employers should appoint a case worker(s).

DETAILED ASSESSMENT Only if needed, arrange for a relevant specialist to carry out a detailed assessment. This could include: Specialist advice on diagnosis and treatment. Use of a screening tool. A combined interview and work assessment. Development of a return-to-work plan, including, if needed, interventions or services.

INTERVENTIONS (IF NEEDED) Ensure the employee is consulted and jointly agrees to all planned interventions, services and the return-to-work plan. Coordinate and support delivery of planned interventions and services.

LEVEL OF INTERVENTIONS (IF NEEDED) In addition to usual treatment and care consider: ‘Light’ interventions for those who are likely to return to work. An ‘intensive’ programme of interventions for those who are unlikely to return to work.

Specific interventions recommended by NICE included offering

packages of support to staff, such as cognitive behaviour therapy and management of low back pain.

IMPLEMENTING GOOD PRACTICE NICE has produced a range of implementation tools, which can be found on its website, including a business case excel spreadsheet6

Almost all managers were required to make appropriate enquires that have been shown to support an earlier return to work and to agree a return to work plan with the employee. Over 90% of trusts, on a regular basis, identify staff who are on long-term sickness using a central system and monitor trust trends. However only 33% of trusts record absence in real time (e.g. through ESR). Only 19% of trusts monitor the timeliness of all components of the occupational health care pathway. This includes: time from start of absence to referral. time from receipt of referral to appointment with Occupational Health clinician, and time from appointment to issue of a report to the referring manager.

‘The additional cost of treating health conditions that keep people out of work is estimated to be £5-11 billion per year’

According to report authors, the audit results suggest that not

all trusts have fully implemented evidence-based sickness absence management practices.

CONCLUSION Every employee and employer within the NHS needs to actively manage long-term sickness. In my own workplace I actively do the following: Champion and promote workforce wellbeing programmes. Lead by example by maintaining a healthy lifestyle. Monitor my sickness absence and that of my staff. Use the NICE checklist for managing long-term sickness and incapacity8

and Unison to help managers and employees to actively manage sickness as a partnership.

which calculates how much an organisation will

need to invest in order to implement the guidance and how much it can expect to save as a result. So how well is the NHS doing in implementing its own advice?

The Royal Colege of Physicians (RCP) and the Faculty of Occupa- tional Medicine (FOM) carried out a national audit7

of the imple-

mentation of six pieces of National Institute for Health and Clinical Excellence (NICE) public health guidance relevant to the workplace within the NHS.1 The audit assessed data from 282 NHS trusts which covered approximately 900,000 NHS employees in England.

IN RELATION TO LONG-TERM SICKNESS ABSENCE 100% of trusts had a policy for the management of long-term sickness absence. NICE recommends that employers make an initial enquiry into their employees’ health early in a period of sickness absence; 95% of trusts required their managers to contact staff who were absent due to illness. However the timescale for making contact was not always specified in the policy.

REFERENCES 1. HM Government. Dame Carol Black’s Review of the health of Britain’s working age population. Working for a healthier tomorrow. Review of the health of Britain’s working age population. London: TSO; 2008. Available at: tomorrow.pdf

2. Department of Health, NHS Health and Well-being Final Report. Department of Health; 2009.

3. Marmot M. The Marmot review final report – Fair Society, Healthy Lives – proposes new ways to improve everyone’s health and reduce inequal- ities that it describes as ‘unfair and unjust’. London: University College London; 2010.

4. Audit Commission. Managing sickness absence in the NHS. Health briefing, February 2011. London: Audit Commission; 2011.

5. NICE. Management of long-term sickness and incapacity for work (PH19). London: NICE; 2009.

6. NICE. Management of long-term sickness and incapacity for work (PH19). Business case. London: NICE; 2009.

7. RCP and FOM. Implementing NICE public health guidance for the workplace: a national organisational audit of NHS trusts in England. London: Royal College of Physicians and Faculty of Occupational Medicine; 2009.

8. National Institue for Health and Clinical Excellence. Management of long-term sickness and incapacity for work (PH19). Business case. London: NICE; 2009.

. It is a tool developed in partnership with the CIPD

Nursing in Practice March/April 2012 31

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