Earlier in the week we did a presentation at an event on Inflammatory Bowel Disease (IDB) which was hosted by a patient and clinician led group who want to raise the profile of the disease and what help there is available.

We are asked if we could produce some information that patients can use on returning to work after a period of sickness absence. What we did was work with patients and clinicians to put together a IDB wellness action plan. The feedback we got from people who attended the event, liked it and thought it would make it easier for IBD patients to return to work and keep them in employment. You can download below.

When I speak to employers of all shapes and sizes about sickness absence and the effect it has on productivity, they hardly ever talk about presenteeism, either in its physical or virtual forms. Maybe they read the article that came out some time ago that said that presenteeism had all but disappeared….. The data we have at SOHAS shows that it’s alive and well in both forms and it could be increasing.

I put together the data below some time ago for a different article that didn’t get published on the blog site. It might be slightly out of date, but it is good at comparing rates of SSP across Europe. Here are the stats:

What does the data show us about SSP?

Statutory Sick Pay in the UK;

• You can get £109.40 a week Statutory Sick Pay (SSP) for up to 28 weeks.
• If you’re eligible, you’ll be paid SSP for all the days you’re off sick that you normally would have worked, except for the first 3 days.
• Average weekly pay in the UK in February 2023 was £638 for full time work or £596 for regular work (ONS).

SSP equates to 18% of the average wage compared to 34% when it was introduced in 1983.

If you compare this rate with other European countries, the UK is ranked 40^th out of 42, as shown in the table below.

Here are some examples of how SSP equivalents work in other countries.

Sweden

Sweden companies usually provide sick pay instead of the usual wage for the first two weeks an employee is ill. After two weeks, workers can apply for Försäkringskassan’s illness benefits. Sweden’s employees can receive between 25% and 100% of their salary for a maximum of a year.

Norway

Norway offers sickness benefits for up to a year. Workers that still cannot work after this time might receive additional assistance. Employers will cover the first 16 days.

The European Commission’s Employment, Social Affairs & Inclusion determines the amount paid to sick employees based on their salary from the previous three months. They might receive up to 100% of their pay for at least 31 days.

Denmark

According to the European Commission, the maximum amount of sickness benefit per week that Danish employees are entitled to, is DKK 4,550 (£512.37). This calculation is based on the employees’ weekly hours and average hourly income over the previous 3 months. As a result, workers receive up to DKK 120.54 (£13.91) hourly compensation. This may extend up to 22 weeks or longer, depending on the situation.

Germany

Germany follows similar rules as other countries connected to the European Commission.

Workers may receive sick pay during the time when a medical expert has confirmed an inability to work. This could occur for about 78 weeks over a three-year period per sickness. An employee might receive additional paid sick leave time under certain conditions, including new illnesses.

What are the rates of sickness absence in the UK and how does that compare to other European countries?

• In 2022 there were 185.6 million working days lost to sickness absence in the UK. This is an average of 5.7 days off sick per employee per year.
• By comparison in Germany (a country, that is on average 16% more productive than the UK) lost 18 days off sick per employee per year.

The UK has the 4^th lowest average number of employee sick days in Europe.

What does having such a low rate of SSP mean in the UK?

If you look at the figures above, then it seems that having a much lower rate of SSP isn’t a problem, if the average UK worker only takes a few days off sick a year. However, the issue in the UK appears to be that workers are coming into work whilst they are ill and are also using their holiday entitlement when they are unwell. This masks the real level of sickness absence, some of which will be work-related.

Presenteeism and Leaveism are not on the radar of most employers, where the only metric they record is the time employees are off sick. These issues are contributing to lower productivity and efficiency rates in the UK compared to other countries. This may be the reason why German employees take nearly three times as many days off sick but are still more productive than UK employees. Cary Cooper suggests that Presenteeism costs employers twice as much as sickness absence. CIPD (2018) also suggest that a third of UK employees have used annual leave instead of taking time off sick (Leaveism).

However, a survey conducted by the CIPD in 2021, does suggest that employers (including SMEs) are concerned about SSP, with 62% agreeing that the rate is too low.

In their report ‘Too ill to work, too broke not to’ Bond and Braverman (2018) argue that being on SSP creates an ‘income shock’, which can have a three fold impact of, exacerbating mental health conditions and prolonging recovery, encouraging employees to return to work from sickness absence too quickly or to not take the time off at all and finally, people can get stuck in a destructive cycle of sickness absence, worsening health and debt, where they lose their employment and some fall out of the labour market all together. I think that if the same report were to be run today, I suspect that there would be more people in the destructive cycle talked about above.

It could be argued that having a low rate of SSP, along with the 3-day qualifying period is one of the reasons why UK employees are coming into work when they are sick; they just cannot afford to be off sick from work. Those employees who do take time off sick from work are significantly financially impacted, which contributes to poorer health outcomes and impacts on the job market. 43% of workers would go into debt or be unable to pay their bills within two weeks of claiming SSP. 3 in 5 employees said that the reduction in impact from SSP had a negative effect on their mental health. Again, I suspect that this will now be higher than when I originally wrote the article.  

The rate of SSP in the UK drives further economic inequalities and marginalises disadvantaged groups further. 17% of workers (who are the lowest paid and most vulnerable) do not quality for SSP at all. In turn, 70% of employees who do not qualify for SSP are women. In the UK occupational sick pay schemes concentrate mostly on higher paying sectors, so those in low income or insecure roles are only eligible for SSP (if eligible at all, due to their working hours). Women, ethnic minorities, and disabled people are the biggest victims of the SSP crisis.

So, while this isn’t an academic paper, I think it’s reasonable to say that presenteeism is being driven in part by the low rate of SSP in the UK. The cost of living crisis has also had an impact, but it looks like there are employees who are unwell, who a few years ago would have been signed off sick by their GP, are coming into work. I don’t think that this is helpful for the employee or for the employer.

So, what we could to improve the issues around SSP? Here are some suggestions:

• Bring back the Percentage Threshold Scheme (PTS) This was abolished in 2014 to pay for the failed Fit for Work pilot and then never reinstated. This allowed employers to reclaim part of the cost of paying SSP. It wasn’t perfect, but it meant for small organisations, they could afford to partially backfill posts for staff who were off sick. It did have a sort of a comeback during the pandemic and then disappeared again. The cost of PTS was around £40m per year before it was abolished. Change it and bring it up to date to make it responsive to the needs of employers. 

• Pay SSP from day one and scrap much of the qualifying requirements; it makes no sense for someone on the minimum wage not to claim it from day one. It discriminates against and disadvantages the most vulnerable employees. 

• Increase the rate of SSP……£437.60 a month does not pay the bills for anyone.

• Redesign SSP to reduce the equality disparity for women, people with disabilities and certain ethnic communities, when they are off sick from work

• Look at the role of the insurance industry can play in bringing effective products to the market that are affordable for small businesses. I’ve looked and spoken to insurance brokers and the products on offer are not aimed at small businesses.  

• Support employers (especially micro or small employers) to think about health. At SOHAS, we are seeing a growing disconnect between employees and employers, around the support employees need maintain their health at work, and what employers are prepared to do to give them the right kind of support. For the majority of employees we give advice to, the adjustments they need to improve their workplace health are quite simple and often don’t cost a lot of money to implement. If more employers engaged with their employees about health and tried to adjust, then the issues about SSP are going to be reduced.

In this blog, SOHAS Adviser Emma Hobson gives some practical advice on how to support employees with ADHD and provides some useful resources

ADHD and Workplace Adjustments

SOHAS is steadily seeing more patients who have an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis, who are waiting for a diagnosis or who believe that they have ADHD [self-diagnosed]. This increase is reflected nationally and locally throughout the partner services we work alongside.

Many of these patients have waited many years for a formal diagnosis and often have suspected for much of their lives that they may be struggling with an undiagnosed condition. Similarly, I have patients who were not aware that they might have ADHD and so their diagnosis or the suggestion of a diagnosis comes as a surprise. I am seeing an increasing number of parents who have decided to embark on the diagnosis route themselves, due to displaying similar traits as their child, who has received an ADHD diagnosis.

The NHS suggests that the symptoms of ADHD can be split in to two areas;

1. Inattentiveness (difficulty concentrating and focusing)
2. Hyperactivity and impulsiveness

Most people have symptoms that fall into both areas but not everyone will do so. Patients who have Attention Deficit Disorder rather than ADHD, can often go undiagnosed as their symptoms are not so obvious. There is a lack of research about ADHD in adults and symptoms often become more subtle or better managed/masked, as people age.

Feedback from the patients we work with, and from their employers, is that ADHD in adults seems to be a misunderstood condition, especially in a workplace setting. Most employers do not know how to support somebody with ADHD and most employee support services, such as Occupational Health, have little evidence-based guidance to advise employers about how best to support their employees with ADHD.

This needs to change, as adults with ADHD are more likely to lose their job, be stressed at work and be less productive than their neurotypical counterparts. There is also evidence to suggest that they have an average lower household income, which impacts on quality of life and affects their whole family.

I find the positives of having ADHD are often forgotten in these processes, where there is focus on improvement or someone’s ability to ‘fit in’ to what might be considered ‘normal’ working practices. Employees with ADHD are individual (and should be treated as such) but they are often creative, focused, innovative, flexible, detail driven and their input adds value rather than detracts from this, in the workplace.

When supporting an employee with ADHD, I often find that small changes can go a long way to improving wellbeing and supporting performance at work. Adjustments should be considered with or without a formal diagnosis and although people with ADHD may share similar traits, adjustments should be made on an individual basis, taking into consideration the individual’s role at work. Adjustments could include:

• Having a structured day with flexibility
• Regular feedback – increased 1:1s
• Provide written information
• Reduction of memory burden – lists, breaks down of tasks, reminders and prompts
• Supporting hyperfocus on tasks
• Removal/support of admin hurdles that might stop the whole job getting done, timesheets, expenses form etc
• Stimulation – avoiding boredom and having a good ‘job fit’ to prevent this
• Environmental considerations – lighting, noise, temperature, working from home/hybrid working, headphone, separate office space etc

It is likely that if the employee has ADHD then they will be covered by the Equality Act 2010, which means that employers have to think about the above as reasonable adjustments. However, it makes sense to adjust without thinking too much about whether the employee is covered by the law or not.

This is not an exact science.  With many patients that I support with ADHD, we embark on a ‘trial and error’ approach to adjustments with the support of tools, such as a Wellness Action Plan which you can find here: https://sohasworkplacehealth.com/2023/07/27/a-new-wellness-action-plan/ or a workplace disability passport. These are used to record agreed adjustments, review their effectiveness and then make changes when things don’t go as planned or hoped.

For more information, please see the following;

www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/

www.adhdfoundation.org.uk/wp-content/uploads/2022/03/An-Employers-Guide-to-ADHD-in-the-Workplace-Scottish-ADHD-Coalition-1.pdf

www.adhdandyou.co.uk/assets/pdf/adhd-employers-guide.pdf

adhdatwork.add.org/impact-of-adhd-at-work/

adhdaware.org.uk/what-is-adhd/getting-nhs-diagnosis/right-to-choose/

www.gmb.org.uk/sites/default/files/neurodiversity_workplace_toolkit.pdf

www.ncbi.nlm.nih.gov/pmc/articles/PMC7543022/

I think it’s fair to say that technologies such as AI, automation and digitisation are beginning to change working conditions across a broad range of jobs. We’ve seen job roles including call centre workers, copywriters and music producers being augmented or replaced. While you can argue whether this is a good or a bad thing, new technologies are creating new circumstances for organisations, businesses, and individuals, as well as new challenges and problems companies and employees.

SOHAS is beginning to give people advice on the increasing introduction of AI, automation, and digitisation into their jobs within our job retention service. People are concerned that new technologies are affecting their psychological workplace health and they are being stressed by the technological elements of their job, which results in Technostress.  Until a few weeks ago, I hadn’t heard of the term “Technostress”. When I first heard it mentioned I thought it might have been a name of a Kraftwerk song, but the term was first coined in China in the early 2000’s and I think we are going to hear the term being used more widely in the future.

Technostress is anxiety, tension, or distress caused when a person is overwhelmed by new technology. It occurs when they are unable to adapt and learn to use technology in a healthy, productive way.

While we believe the increasing introduction of AI, automation and digitisation into more jobs is going to be positive, there are some challenges for organisations who want to go down this route. For clarity here are some definitions

• AI – a system that shows “intelligent” behaviour, that can perceive its environment, take its own decisions to achieve a specified goal and can develop its own capabilities, mainly based on large amounts of data.
• Automation – machines (mechanical or digital) that perform work according to specified algorithms
• Digitalization – the use of digital tools in work tasks.

And some examples of their roles in the world of work:

• The widespread use of chat bots on websites around customer service roles
• A supermarket ordering stock using a computer model of trends and past history rather than a manager deciding what to order.
• The use of Video technologies for working from home.

I think most of us have experienced technostress at some time, in my case trying to order a part for a computer from a supplier where I had to ask “can I speak to a human being” because the bot couldn’t relate a part number to the part I was looking for.

So, what can be done when companies are looking to introduce new technologies if they are going minimise the impact on their employee’s mental health and wellbeing?

I think a key area that organisations often struggle with is about the design of a job role. Whether that’s the initial design or making sure that the role is updated in line any changes to someone’s job role. How many of us have a job which is out of date when you compare what you do now and what it is says on your job description

When we give advice to people who want help on their workplace health issues, we are often told that people don’t feel that they have sufficient control of their job role. The Goldilocks principle comes in here, as there is evidence that people don’t want too little or too much control in their job, they want something in the middle.

So, could giving employees a role in how a job that is designed and implemented when it involves AI, automation, and digitisation, be a way of minimising technostress?

I think it could, when technostress can be caused by employees that are unable to adapt and learn to use technology in a healthy, productive way.

While it’s easy to say “give the employee a role in job design” how can you do that?

I think the answer can be found in job crafting. Job crafting is a term that not that many people are familiar with, but it is something that lots of people actively do without relating it to the term. Here’s the definition:

Job crafting is a means of describing the ways in which employees utilise opportunities to customise their jobs by actively changing their tasks and interactions with others at work. Breaking down job crafting, there are two components that illustrate how this could be done.

• Task crafting: employees modifying their tasks by changing levels of task variety, adding, or removing tasks, or amending how tasks are completed.
• Skill crafting: employees acquiring new skills or enhancing existing ones to improve technology competence.

Adopting these principles could help in help to minimise any impact that AI, automation and digitisation may have on employee’s health and wellbeing.

While automation and digitisation of jobs and roles have been around for a long time, AI is what employers focus appears to be on. I’ve spoken to people who are using AI that enables them to work more efficiently and to increase the quality of their work output. If you want advice on work and health issues from SOHAS, are you going to end up talking to bot? No, you aren’t, but we are already using AI in delivering our advice services and this will increase over the next few months.

AI, automation and digitisation are going to increasingly more prevalent in the world of work and we should embrace them, but their introduction has to be thought through and implemented in the best way possible or in the future we are going to create another layer of issues that will affect employee’s productivity and their health and wellbeing.

We have been asked by women and employers about what is a good way of supporting women in workplace on issues around the menopause.

We’ve found that this support plan can be useful in identifying what kinds of reasonable adjustments are needed in the workplace to keep an employee at work. The plan can be filled out by the employee or together with their line manager and placed on their personnel file so it is accessible as a record of the kind of help is need to maintain someone’s workplace wellbeing.

We can provide one to one advice to women who live in Sheffield and help and support SME’s who want to engage with their employees about women’s reproductive health issues that are affecting their work. If you are an employer or employee, it’s easy to get in touch us, go to our website www.sohas.co.uk and use the “can we help you” tab to send a message to our secure email address and we will get in touch with you asap

As we started our women’s wellbeing project in partnership with Heeley Trust, we realised that people don’t have a good understanding of women’s productive health issues. We thought it would be useful to give some basic information on the 4 most common issues with some links to further information.

The project which runs until April 2025, provides help and support to women and employers on women’s workplace wellbeing. We can provide one to one advice to women who live in Sheffield and help and support SME’s who want to engage with their employees about women’s reproductive health issues that are affecting their work. If you are an employer or employee, it’s easy to get in touch us, go to our website www.sohas.co.uk and use the “can we help you” tab to send a message to our secure email address and we will get in touch with you asap.

Health Issues

PCOS: polycystic ovary syndrome is a common condition that effects a women’s ovaries work. The 3 main features of this condition are:

• Irregular periods as the ovaries don’t regularly release egg known as anovulatory in the processes of ovulation.
• Excessive androgen – high levels of the “male” hormone in the body which can result in excessive facial or body hair.
• Polycystic ovaries- ovaries get enlarged and have fluid filled sacks that surround them.

Some common symptoms of this condition that can affects some women are:

• Irregular periods / painful periods
• Difficulty getting pregnant
• Weight gain
• Thinning hair or hair loss
• Oily skin and acne
• Depression and anxiety
• Mood swings or low mood.

PCOS is also associated with an increase risk of developing health problems such as type 2 diabetes and high cholesterol. PCOS is related to abnormal hormone levels in the body including high levels of insulin as many women with PCOS have insulin resistance hence making their bodies produce higher levels to combat this. This also happens in overweight or obese patients with PCOS thus increasing the risk of the other health problems.

You can get support and guidance from http://www.verity-pcos.org.uk/

Menopause- This is a condition that occurs after women stop having their periods due to reduced hormone levels. Usually is found to happen when women reach the age of 45-55 however can sometimes occur earlier naturally, due to surgery such as hysterectomy where a women’s ovaries and uterus are removed, cancer treatment like chemo or a genetic reason however sometime the reason can be unknown.

Women can also have perimenopause this is when women have symptoms of menopause without stopping their period.

Some common symptoms of both perimenopause and menopause condition that can affects some women are:

• Anxiety
• Mood swings
• Brain fog
• Hot flushes
• Irregular periods
• changes in mood – such as low mood or irritability.
• changes in skin conditions, including dryness or increase in oiliness and onset of adult acne.
• difficulty sleeping – this may make you feel tired and irritable during the day.
• discomfort during sex.
• feelings of loss of self

You can get support and guidance from https://menopausesupport.co.uk/

Endometriosis- In this condition tissue that is similar to the lining of the womb grows in other places such as the ovaries and fallopian tubes. This condition affects women of all ages. The long-term effects of this condition can have significant impact on women’s lives however treatment is available that can help with symptoms.

Some common symptoms of this condition that can affects some women are:

• pain in the lower back and pelvis and tummy
• periods pain that stops them doing everyday task and jobs
• pain during sex
• vomiting or feeling sick
• pain peeing and opening bowls
• constipation, diarrhoea or blood in your wee and faeces
• difficulty getting pregnant
• heavy periods where you may need multiple pads, tampons or change of clothes
• depression and anxiety.

You can get support and guidance from https://www.endometriosis-uk.org/

IVF- invitro fertilisation is more of treatment rather than medical conditions. This is a treatment for women who struggle to conceive naturally due to some of the conditions mentions about. During this condition the egg from a woman and the sperm from the father are medically removed and fertilised together in a lab and placed back in the woman’s womb. This can be done with parents own egg and sperm or with donated egg and sperm.

Someone women can have the treatment on the NHS however other need to pay for it them self with cycles costing up to £5000.

The 6 stages of IVF:

1. Suppressing the natural cycle
2. Helping your ovaries produce extra eggs
3. Monitoring your progress and maturing the eggs
4. Collecting egg
5. Fertilized eggs
6. Transferring the embryos

This treatment can cause patient to have: anxiety, stress, mood swings Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer, breast tenderness due to high estragon levels, mild bloating, mild cramping and constipation.

You can get support and guidance from https://fertilitynetworkuk.org/

Please note that we have no relationship with any of the websites that we given links to in the blog post.