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Managing Sick Leave in the Workplace for People with Chronic Pain

 Study report: Managing sick leave in the workplace for people with chronic pain                    April 2012

Key findings:

What is most helpful for me? Employers’ views

  • Consistent organisational procedures; employers’ line management supporting decisions
  • Minimising the effect on the team of the absent colleague by spreading out their workload fairly, getting extra temporary help if necessary, and recognising the efforts team members were making
  • Teams were more supportive if the absentee was a valued employee; it became harder for managers to ameliorate the effect of absence on remaining staff if not. Small teams were easier to manage as one knew all members well, but this was less important than how the absentee was viewed
  • Larger companies reported the ability to implement return-to-work modifications more easily than smaller ones. All large companies felt they already had good systems in place to promote successful return-to-work, so the fit note had not changed their practice in that regard. However, managers still said the positive impetus of the fit note was useful (or ought to be, if doctors completed it in detail)
  • Investing in an organisational culture which promotes healthy lifestyles, by providing good food, exercise opportunities and health screening. Several companies said this promoted resilience and goodwill, leading to positive interpersonal relationships which helped when negotiating sick leave
  • Working to get local doctors to visit the organisation and see its occupational health facilities; several larger companies had invited doctors to visit, with very varying responses. One had developed excellent links with local GP surgeries, which helped promote the idea within their workforce that appropriate work can enhance health and wellbeing. Some other companies were very disappointed that GPs had not responded to invitations to visit their workplace

What is most helpful for me? Employees’ views

  • Simply being believed, not judged. Having a long track record of good work within an organisation was initially perceived as very helpful although as time of ill-health lengthened, this could be diminished
  • Flexi time/compressed hours and flexibility within a job description such as grouping weekly targets into monthly ones to accommodate fluctuating health status
  • Physical adjustments: taxis to work via the Access to Work scheme; ergonomic chairs/desks
  • Regular, brief meetings with line managers to stay on top of how things are going
  • Being able to afford to go part-time had greatly helped the few participants who had chosen to do this
  • The size of the organisation was perceived as helpful in terms of accessing OH advice and resources. Yet the quality of the interpersonal interaction between stakeholders was seen as more important. Some employees could not praise enough the supportive, timely contact from their employer
  • When GPs complete the fit note properly, and organisations actively use its advice

Employers’ suggestions for improvements

ü  Where possible, make people’s skill sets multiple so that they can move around roles in order to cover absence more easily (this is impossible in some organisations)

ü  Middle managers wanted stronger messages from the top of the organisation that work is good for us and that one does not have be 100% fit to work

ü  Better communication via popular radio and television culture that work is a positive entity as well as more effective communication from Government and trade unions

ü  Access to Work and other support services should be more efficient e.g. AfW was criticised for taking too long to repay organisations for special chairs etc.

ü  Clearer legal guidance around the fit note for both organisations and doctors

ü  Better communication with doctors about the workplace and how it may/may not be adapted

ü  More use of charities to build working habits and confidence in people who don’t work, without losing benefits, to promote a generally more resilient, work-friendly society

ü  In principle, the fit note was seen as a positive step forward. Yet employers were concerned about legal issues around liability and wanted clear guidance. They also said they literally cannot read doctors’ handwriting and that doctors must write more detail

Employees’ suggestions for improvements

ü  More understanding and awareness of the effects of living with chronic pain, from managers and also from society in general (although many commented that it is very hard to communicate the full effects of living with chronic pain to others).The biggest issues were pain’s fluctuating nature and how it can be much less visible than other conditions, leading to people making few allowances for the sufferer

ü  Specific training for HR, OH and line managers on how to manage employees with chronic conditions

ü  Some employees were willing to divulge the nature of conditions to co-workers and then wanted their colleagues to be shown how to help e.g. that it may be more effective to allow the newly returned worker to complete tasks sequentially rather than presenting more than one task at one time

ü  Case studies of successful return-to-work stories to be more widely disseminated

ü  Doctors to put more details on the fit note to help the employer understand what is needed


All participants agreed in principle that work is good for us, but experienced real-world problems implementing return-to-work procedures and interpersonal conflict. When stratifying results, interpersonal relationships mattered more than company size, team size, and length of time working for the organisation. Managers were also helped by consistent organisational procedures around sick leave, combined with an organisational culture which valued wellbeing. Employees wanted wider societal recognition of the impact of living with chronic pain. Both parties were sympathetic to doctors’ difficulties but wanted their fuller engagement. The fit note was seen as positive but not yet as solving these issues.

Key facts:

Recruitment: carried out via joint business and University of Bath wellbeing events; business and research contacts; and an internet advert placed with several pain charities’ websites and a chamber of commerce.

Organisation types: very varied, including manufacturing, retail, insurance, schools, universities, the NHS, software developers, a council-run library, a health and safety consultancy, a nuclear decommissioning company, an airline, the Armed Forces and the Civil Service.

Managers’ roles: most worked in Human Resources (HR) and Occupational Health (OH). Some had managerial roles in specific teams and were in contact with HR and OH over sick leave procedures.

Employees’ roles: varied according to organisation: included engineer, teacher, administrator, and clinician.

There were three sets of employer-employee pairings: employees suggested we interview their bosses in two cases and in the third instance, the manager suggested we interview one of their team.

Chronicity and pain conditions: the median time living with pain was 4 years, and many employees had more than one condition. These included back pain and sciatica, fibromyalgia, osteoarthritis, joint hypermobility syndrome, neck, spine, hip and knee pain, and general undiagnosed pain.

Interviews: 13 employers and 13 employees were interviewed (n=26). Interviews were one-to-one, lasted approximately 40 minutes and were either over the phone (21) or in person (5). Interviews took place January – April 2011. Important participant characteristics are summarised below:


Employer   n=13

Employee   n=13



M 4

F 9

M 5

F 8

M 9

F 17

Organisation   size*: Micro (1-9 staff)

small   (10-49) and medium (50-249)





Organisation   size: Large (250 plus staff)





Years in management   role** (employer) or years worked in organisation (employee)


Mean: 7.69



No. of people line managed (employer) or no. in   team (employee)


Median: 9

Median: 6


Works full   time, part time or on sick leave



FT: 9. PT:   2.

SL: 2


Years   living with chronic pain





*Using sizes from the EU Commission Recommendation 2003

**means are reported where datasets are normally distributed and medians where they are not, to get a more accurate reflection of the average value.

Research team:

Ms Elaine Heaver Wainwright:                PhD researcher and report author, the Bath Centre for Pain Research
Professor Christopher Eccleston:           Director of the Bath Centre for Pain Research
Dr Edmund Keogh:                               Reader, Department of Psychology
Dr David Wainwright:                             Senior Lecturer, Department for Health

Future directions: We plan to publish a fuller account in a peer-reviewed journal: both this report and any fuller publication will be sent to DWP and research contacts. Please email any comments to Elaine at: This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.. Thank you for sharing your invaluable knowledge and experience.

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