Research and analysis

Summary: Sickness absence and health in the workplace: understanding employer behaviour and practice

Published 20 July 2021

Applies to England, Scotland and Wales

Trinh Tu, Kelly Maguire and Theebika Shanmugarasa, Ipsos MORI

1.1. Overview

This research presents the key findings from a survey of employers across Great Britain (GB) and follow-up qualitative research with employers. The research looked at employer attitudes, behaviours, support and provisions around employee health, sickness and disability in the workplace. Please note, this research was carried out prior to the COVID-19 pandemic.

1.2. Research Context

The research was commissioned by the Employers, Health and Inclusive Employment directorate (EHIE), which includes the cross-government Work and Health Unit, jointly sponsored by the Department for Work and Pensions (DWP) and the Department of Health and Social Care (DHSC). EHIE leads the government’s strategy to support working-age disabled people and people with long-term health conditions to enter, and stay in, employment.

‘Improving Lives: The Future of Work, Health and Disability’ outlined the role of employers in helping disabled people or people with health conditions stay, and thrive, in work, as well as to prevent unnecessary sickness absence, presenteeism and health-related job loss. Disabled people and people with long-term health conditions are at greater risk of falling out of work, and in 2019, Government launched a consultation seeking views on the different ways in which government and employers could take action to reduce ill-health-related job loss.

Ipsos MORI were commissioned to conduct a survey and follow-up qualitative interviews that would contribute to the current evidence base surrounding employer attitudes and behaviours around disability and health in the workplace. The aim of the research was to provide a greater understanding of employers in regard to health and wellbeing – what drives their decisions, what support they put in place for their employees, and why – as they play a key role in preventing unnecessary sickness absence, presenteeism and health-related job loss.

This report builds on the 2011 ‘Health and well-being survey of employers’ which was commissioned to provide evidence into a range of measures, including employers’ perceptions of the importance of work to health and health to work, the provision of health and wellbeing initiatives, and employers’ occupational sick pay (OSP) policies.

1.3. Methodology

A random probability telephone survey was undertaken with 2,564 employers in Great Britain (GB), between June and August 2018. The survey included GB employers with at least 2 employees. The data in this report have been weighted by size and sector to be representative of the GB employer population.

The survey data was supplemented by qualitative research with 30 employers who took part in the survey. Interviews were carried out by telephone between July and August 2019. Quotas were set to ensure a good representation of employers in terms of characteristics and health and wellbeing practices.

1.4. Findings

1.4.1. Understanding employer behaviour

Employer attitudes towards health and wellbeing were generally positive, with the majority acknowledging a link between work and the health and wellbeing of their employees. The health conditions that employers reported amongst staff generally reflected their working environment. The majority of employers agreed that there was a link between work and employee health and wellbeing (91%) and that it was an employer’s responsibility to encourage employees to be healthy (90%).

• concerns about musculoskeletal conditions and workplace injuries were more common in mainly manual or hazardous working environments, whereas predominantly office-based employers were more likely to report stress as the main health concern amongst staff
• when deciding whether or not to invest in employee health and wellbeing, employers cited maintaining the organisation’s reputation (79%) and satisfying legal obligations (69%) as the most important motivations
• employers reported that they knew what to do to improve employee health and wellbeing (83%) and that, by and large, they understood their legal responsibilities in this space (45% said they understood ‘very well’ and 48% ‘fairly well’)
• employers who had no disabled employees or employees with health conditions had mixed interpretations of the meaning of the Equality Act 2010, and the duty to provide reasonable adjustments. At a basic level, they understood that the Act was designed to ensure that all employees were treated equally
• in large organisations, dedicated Human Resource (HR) functions planned and implemented policies and processes in relation to sickness absence and employee health. Small organisations lacked dedicated support to develop policies in advance, but sometimes used HR consultants to advise on complex areas
• employers most commonly used the internet for information on how to retain employees with long-term health conditions (47%). This source was more commonly used by small than large employers (47% and 25% respectively). A greater number of large employers than small employers accessed formal, paid-for sources of advice, such as an occupational health provider (49% and 7% respectively), or legal sources (31% and 9% respectively)

1.4.2. Employer behaviours in relation to health and wellbeing

Organisation size had a direct bearing on employer health and wellbeing provision. Larger employers were more likely to provide a wider range of formal support to help prevent employee ill-health or improve general health and wellbeing. Small employers who did not provide these measures described taking a more informal approach, which they viewed as more appropriate and cost-effective for their size and culture. These employers reported insufficient demand from employees to justify the investment in formal and preventative schemes.

• to prevent employee ill-health, over three-quarters (77%) of employers invested in health and safety training or guidance; for a third (32%) this was all they provided. 1 in 6 (16%) did not provide anything, nearly exclusively small employers
• larger employers provided a greater range of formal support than small employers. This included health and wellbeing promotion programmes to improve physical activity or lifestyle (70% of large compared to 20% of small employers) and Employee Assistance Programmes (EAPs) or staff welfare/counselling programmes (76% of large compared to 14% of small employers). Employers who offered comprehensive health and wellbeing provisions also offered occupational health services, generous sick pay and other employee benefits and perks
• more than half of employers (55%) described their approach to managing employee health and wellbeing as reactive. A proactive approach was more common amongst large (72%) than small employers (44%), partly because large employers were more likely to have experienced long-term sickness absence (LTSA) than small employers (86% compared to 15% of small employers)

1.4.3. Employer behaviours in managing sickness absence

Employers took a flexible approach to sickness absence management; recognising the importance of line manager discretion in the application of policies, whilst treating employees equally and fairly. 3 in 5 employers (61%) adapted their policies depending on the employee.

• employers reported that the most common business risks relating to LTSA were covering work within the organisation (57%) and arranging cover or recruiting new staff (41%). This was followed by paying sick pay (28%) and the uncertainty of when employees would return to work and planning for this (25%)
• 2 in 5 employers (41%) had a specific policy in place to manage sickness absence (85% of large and 37% of small employers). Slightly more employers used a dedicated sickness absence management policy (29%) than a disciplinary policy (20%). Small employers used more informal approaches
• organisations adopted different approaches to the management of sickness absence. The majority (61%) delegated responsibility to line managers, but only 44% of these employers provided their line managers with training to perform this role. Findings from the qualitative interviews indicated that some employers, usually in large organisations, had centralised processes and structures to manage sickness absence, involving HR and occupational health (OH) specialists where necessary
• short-term sickness absence for minor ailments typically involved minimal contact between employer and employee. In contrast, employers had more structures in place for longer absences, including agreeing mode and frequency of contact and likely recovery times early on in the process, where possible

1.4.4. Supporting retention and return to work

Meetings with employees and phased or flexible returns to work (involving reduced hours or duties) were central to how employers supported employees with health conditions to remain in work, and/or return to work following a sickness absence.

• employers used a range of mechanisms to identify employees who needed support to manage their health and wellbeing at work. For example, through conversations or questionnaires at the recruitment stage, through employee requests, ongoing monitoring, OH recommendations, or recommendations on a fit note (where an employee had taken a period of sickness absence)
• when providing reasonable adjustments, employers focused foremost on their legal duties as well as a duty of care to support their employees. However, some employers exercised discretion if they believed the adjustments were unreasonable or too costly
• 1 in 5 employers believed that employees on LTSA should only return when they could do all of their work (21%). Employers operating in manual or hazardous environments were more likely to hold this view than those in office-based occupations (25% compared to 15%)
• 3 in 5 employers (61%) reported facing barriers in supporting employees to return to work following a LTSA. Small employers reported a lack of time or staff resources (64%) and a lack of capital to invest in support (51%). In contrast, a greater number of large employers encountered structural challenges such as a lack of flexibility in how work was organised (67%) and difficulty engaging employees in the process (61%). The latter included staff wanting to return prematurely or not wanting to return at all, staff refusing to disclose their condition and staff refusing support
• some employers lacked confidence in managing returns to work, particularly in more complex cases. These employers reported not knowing how to instigate or conduct a return-to-work conversation. These concerns were more common among employers without prior experience of LTSA and those without clear policies, dedicated personnel, or external support

1.4.5. Sick pay provision

The majority of employers paid some form of sick pay to their employees (82%). A greater number of large employers paid above Statutory Sick Pay (SSP) than smaller ones. Where employers have a sick pay (occupational) scheme, this offers employees more than SSP.

• half of employers paid SSP only (54%), 28% paid above SSP, 13% did not provide any form of sick pay and 5% did not know. Micro employers were more likely than other employers to not offer sick pay (17%). Employers also explained in the qualitative interviews that they did not pay sick pay to employees on certain types of contracts, including those on zero hours or temporary contracts
• paying only SSP was more common amongst small (55%) than large employers (16%), those in Distribution, Hotels and Restaurants (62%), as well as among employers who did not provide OH services (58%). Employers cited cost as the main reason for paying only SSP in the qualitative interviews
• employers paid above SSP to attract and retain the best employees and enhance employee engagement and productivity. The majority (78%) offered it to all their employees and 1 in 5 offered it to some of their employees (20%). The most common criteria for paying above SSP to only some was length of service (59%). Large employers had different employment contracts for employees eligible for above SSP. In contrast, small employers tended to use their discretion
• the average duration for occupational sick pay was 53 days. However, 1 in 6 employers reported that they paid OSP indefinitely (17%). Among employers that offered OSP, 3 in 10 (29%) reduced the rate paid over time, of these 4 in 10 employers (37%) reduced it to between 81% and 100% of employees’ usual wage.

1.4.6. Employers’ provision of occupational health services

1 in 5 employers offered OH services to their employees (21%) and this was more common amongst large (92%) than medium (49%) or small employers (18%). Employers most commonly used OH services to help minimise sickness absence and improve employee health and wellbeing. Those not offering OH services tended to cite a lack of employee demand (37%).

• overall, a third of employers cited cost as the main barrier (too expensive, 16%; or too few cases to justify the expense, 22%) but knowledge of actual costs amongst small employers was limited. Smaller employers only sought OH advice when they felt out of their depth or had experienced multiple cases of ill-health to warrant longer-term investment in external, formalised support
• the most common reason why employers used OH services was to help minimise sickness absence and improve employee health and wellbeing (57%). Employers also cited the influence of legal obligations on their decision to use OH services. This may explain why riskier, or more physical, workplaces had higher levels of OH provision on average
• OH provision tended to be part of a wider package of health-related support aimed at keeping employees healthy and in work, such as health and safety training, Employee Assistant Programmes (EAPs), or other measures to support staff with health conditions to remain in work or return to work following a sickness absence
• regardless of size, employers offering OH services indicated they would pay for follow-up treatments recommended by OH professionals but would make decisions on a case-by-case basis considering the importance of the individual for the organisation
• of those employers that provided access to OH, large employers were more likely to purchase long-term contracts (48%) compared to small and medium employers (24% and 26% respectively). Instead, small and medium employers were more likely to provide OH on an ad-hoc basis (43% and 63% respectively), reflecting perceptions of both employee need and cost effectiveness

1.4.7. Segmenting the employer population

A segmentation analysis on the survey data was undertaken to categorise employers into distinct groups based on their health and wellbeing provision. The analysis identified 7 different groups. The segments ranged from employers whose workplace support was largely focused on meeting health and safety requirements (the ‘Minimal Support’ and ‘Reluctant Support’ groups); to employers who offered more comprehensive, low-cost provisions such as return to work meetings, and amends to job role (the ‘Informal’, ‘Pragmatic’ and ‘Reactive Support’ groups); to employers who invested in a comprehensive and proactive package of health and wellbeing support, including workplace health promotion, OH services, and OSP (the ‘Intensive’ and ‘Structured Support’ groups).