Editorials |
Sickness absence in the UK: welfare reform, measurement and statutory sick pay
University of Liverpool—Primary Care, 2.14 Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK
e-mail: ammartin{at}liv.ac.uk
The UK Government is significantly reviewing and reforming welfare policies relating to sickness absence, incapacity for work and employment. The green paper ‘A new deal for welfare’ [1] outlined the main aims of the reform, while ‘Working for a healthier tomorrow’, published 2 years later, filled in the detail [2]. The key proposals for reform are preventing ill-health and long-term sick leave from occurring, keeping people in work, greater intervention by health care professionals when ill-health arises and the development and maintenance of a rigorous evidence base, from which to monitor and assess the impact of the changes.
Over the course of the next decade, the UK Government is aiming to remove 1 million people from sickness-related (state payable) incapacity, benefits help 300 000 lone parents into work and increase the number of older workers by 1 million [1]. Such major reform requires robust evaluation embedded within the policy to ensure its impact can be tracked. However, past experience suggests that such aspects are ultimately downgraded at the 11th hour, or that initiatives may not be designed to incorporate such rigorous baseline monitoring tools from inception. It is possible that the ‘new deal for welfare’ policy evaluations may suffer the same fate. Though, if the government is serious about ‘the development and maintenance of a rigorous evidence base’, this will require substantial investment and resources. As part of the review, a number of exploratory studies have been commissioned by a government agency, the Department for Work and Pensions. This editorial will focus on the findings of one such study to report on the extent of large-scale data sources on sickness absence and the feasibility of using statutory sick pay data to monitor employment change [3].
Currently, a patchwork of surveys contribute to sickness absence measurement in the UK, as no single one is able to report comprehensively on key issues such as: work and non-work-related reasons for absence, length of absence, costs incurred, benefits paid and the nature and costs of occupational adjustments made by the employer. The two main sources are government agencies, which tend to be more rigorous in design and sampling, and employers’ organizations, whose surveys are less rigorous, though they ask a more comprehensive range of sickness absence-related questions [3]. Consequently, trying to assess the whole picture on sickness absence from work in the UK using surveys is difficult due to a lack of standardization of key concepts, differing reporting periods, the variety of sampling methods and study foci [4]. These difficulties are compounded by a relatively short history of measuring absence from work using large-scale surveys. If we explore these points using more rigorous governmental sources, the annual General Household Survey has only monitored long-term sickness absence since 1971. The quarterly Labour Force Survey has reported short-term sickness since 1992. The Health & Safety Executive is currently conducting a number of large-scale surveys (2005–15) focusing on work-based/induced accidents and ill-health. The Department of Enterprise, Trade and Investment undertakes occasional Workplace Employee Relations Surveys on a broad range of industrial relations and employment practices, though not directly on sickness absence.
Adding questions to one of these pre-existing surveys could provide further information on movements between employment and incapacity benefits. This would undoubtedly have advantages, for example, reducing time and costs through the utilization of existing resources, i.e. a representative sampling frame. However, it is doubtful that all groups would be reached with one survey, for example, occupational health professionals, employers, human resource staff, employees, those on long-term sickness benefits, as well as differing sectors, industries and regions. One solution could be multiple, stand-alone surveys conducted on a periodic basis, though these would carry resource implications and require a standardizing of key concepts across current and future surveys, i.e. measurement of direct and indirect costs and length of time associated with absence from work. Another solution would be to design a single survey, which addressed all of the relevant issues. Again, there would be considerable resource and sampling implications.
As part of our research project, we explored the feasibility of using statutory sick pay data to monitor employment changes. Statutory sick pay is the minimum legal entitlement that employers have to pay qualifying employees when they are off work due to sickness [5]. Although not designed for this purpose, there are clear advantages to utilizing these data. Employers are required to keep records, which would be needed should a claim for state payable incapacity benefit occur (after the 28-week statutory sick pay period has ended). The records contain specific information on an individual employee as well as more general data including an individual's employment history, dates of sickness lasting 
4 days in a row, periods of incapacity for work reported by employees, all payments made during a period of work incapacity, dates for which they did not pay statutory sick pay and the reasons why, copies of medical evidence, i.e. self-certificate or doctor's note, tax and national insurance contributions (levied on wages and salaries to finance UK state benefits) and previous periods of linked absence. Employers who choose to opt out and pay occupational sick pay must still keep all dates of employee sickness lasting for 4 days in a row and all payments of earnings or occupational sick pay made during each period of incapacity for work [5].
Statutory sick pay data can provide comprehensive and relevant information; however, it does have its flaws. First, there are gaps in the data. Periods of absence accounting for 
3 days are not recorded; however, short-term absence is more prevalent than long-term absence [4]. Data on those who are ineligible for a claim may not be recorded either, i.e. very new starters, people who may earn less than the lower earnings threshold, or those who may be in employment over the age of 65 and not in receipt of occupational sick pay. Second, even if these are addressed, our findings indicate that the data itself will not be easy to access.
Very few large-scale absence surveys in the public domain ask statutory sick pay-related questions, those that do are very limited in nature and rarely presented in conjunction with other key variables. There are a number of reasons for this. When the policy was set up in 1983, no systematic methods of recording or reporting were included in the initial legislation or administrative systems [6]. Further deregulatory changes introduced in 1996 mean that there is no centralized or detailed database to draw on. Some information is available from the government, but only for auditing purposes, therefore any detailed information will have to be gathered directly from organizations. This will pose a number of challenges. When we interviewed human resource staff about their experiences of recording statutory sick pay-related data on a simple spreadsheet, most did not complete the task. Organizations differed widely on their sickness absence recording systems and the staff which were used to perform these tasks. For example, larger companies either paid other organizations to record and manage the data for them, held the data in different locations or used multiple systems, which were not always compatible with each other. There were also time–pressure issues, with the needs of the business coming first, meaning there was little time left to record our data. Therefore, the development of supportive mechanisms and employer benefits will have to be considered to secure the necessary information.
The UK Government has put forward key welfare reforms. If they are serious about developing a rigorous sickness absence/policy assessment tool, then a number of issues will have to be addressed including which data gathering sources to use, reporting methods, i.e. self or employer, the standardization of key concepts, how best to support organizations to record and report the information and when to collect it. However, this only addresses part of the discussions that need to take place. We should also be asking ourselves what the purposes of an enhanced absence measurement tool would be? Some may argue it is part of increasing movements towards the monitoring of individuals by the state, others that the policies are part of ongoing welfare cost-cutting measures. While these ideas warrant closer inspection and debate, they do not paint the whole picture on sickness absence management. A nationally comprehensive, rigorous measurement tool could provide a more accurate assessment of the quality and costs of current policy provision, inform future welfare planning and provide more specific information for general practitioner training and monitoring, for example, emerging patterns of ‘fit for work note’ provision. It would also be a more accurate absence assessment tool for employers and might improve the accuracy of employer organizational survey headlines that appear in the British media [7].
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References |
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 Top References |
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- DWP. A New Deal for Welfare: Empowering People for Work (2006) Norwich: Department for Work and Pensions, Crown Copyright TSO. 1–112.
- Black C. Working for a Healthier Tomorrow: Review of the Health of Britain's Working Age Population, Health, Work and Well-being Programme (2008) London: TSO. 4–125.
- Woolf S, Martindale A-M, Stanistreet D, Gabbay M, with Sapsford D. DWP Project on the Feasibility of SSP Data Collection. Research Report 427. Department for Work and Pensions, Corporate Document Services (London): 2007; 1–53.
- Barham C, Begum N. Sickness Absence from Work in the UK (2005) National Statistics Feature, Office for National Statistics, Labour Market Division. 149–158.
- Department for Work and Pensions. Statutory Sick Pay (SSP). http://www.dwp.gov.uk/lifeevent/benefits/statutory_sick_pay.asp#what (17 November 2008, date last accessed).
- The National Archives. Revised Statute from the UK Statute Law Database Social Security and Housing Benefits Act 1982 (c. 24). Crown copyright 2002–2008 (17 November 2008, date last accessed).
- BBC Business News. Sickies Make Up 12% of Absences (2007) http://news.bbc.co.uk/1/hi/business/6539877.stm (17 November 2008, date last accessed).
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