The NHS Faces a Crisis of Sickness Absence
The National Health Service (NHS) is experiencing a significant challenge with sickness absence, which is costing taxpayers approximately £4.6 billion annually. A recent report by the Policy Exchange think tank highlights that the NHS is losing the equivalent of 80,000 staff due to sickness absence, creating a severe strain on the healthcare system and patients waiting for treatment.
The Scale of the Problem
According to the ‘NHS: Heal Thyself’ report, sickness absences have increased by over 20% within the NHS over the past decade. This crisis is so severe that the number of absent workers could fully staff 80 additional hospitals. The report emphasizes that the current sickness management practices in the NHS are financially unsustainable, operationally damaging, and unfair to both patients and staff.
Generous Sick Pay and Its Consequences
The NHS in England offers up to six months of sick leave on full pay, followed by an additional six months on half pay. In contrast, private sector employees typically receive only two to four weeks of full pay, with many receiving statutory sick pay alone. This disparity is believed to be a key factor behind the high sickness absence rate of 5.15% in 2024, which is nearly three times higher than the UK private sector average of 1.8%.
Over the past ten years, sickness absence rates within NHS trusts and integrated care boards have increased by 21%, with long-term sickness over 28 days rising by 43% between 2019 and 2024. Additionally, the number of staff going on long-term sick leave and not returning to work in NHS organizations increased by 42% over this period.
Impact on Patients and Staff
The report’s author, Gareth Lyon, head of health and social care at Policy Exchange, stated that the findings reveal a system that is not working for either NHS staff or patients. He emphasized that the health service should be an exemplar of how to support people to stay in work and return to work. Instead, tens of thousands of people are being paid to be off work for months or even years at a time.
To improve productivity, reduce waiting lists, and increase patient satisfaction, the NHS must urgently address this systemic failure.
Key Drivers of High Absence Rates
Sickness absence levels are higher among some groups of managers and administrators than frontline clinicians, but more than 8 million days of clinician time are still lost each year. The report identifies ‘exceptionally generous’ sickness pay arrangements, weak management accountability, and inadequate occupational health provision as key drivers of persistently high absence rates.
It also finds strong correlations between high sickness absence and poor staff morale, weak leadership, stress, and burnout.
Recommendations for Reform
The think tank is calling for an overhaul of NHS sickness policies and practices to bring them in line with the private sector. Recommendations include:
- Reducing the period in which staff can receive full sick pay from six months to 28 days
- Introducing a ‘day-one’ clinical assessment for NHS staff calling in sick
- Expanding the use of alternative duties and remote working to support return-to-work pathways
- Implementing more accountability measures for senior managers in poorly performing trusts that fail to reduce absence rates to a target of 2.7%
- Regular medical certification and work capability reviews for long-term absence
- Establishing a new specialist occupational health service across all NHS organizations
Former Tory chancellor Nadhim Zahawi highlighted that people are struggling to get appointments and waiting lists are out of control. He emphasized that large parts of the NHS are not working as productively as they should to serve patients or deliver value for the taxpayer.
Lord Carter of Coles, a member of the House of Lords finance committee, stated that it is unacceptable for so many people to be off sick in an organization meant to tackle illness. He suggested that NHS managers should be incentivized to bring people back into work quickly and help them stay there.
Mental Health and the NHS
Around 36,000 of the 80,000 absent staff are clinical staff. Poor mental health accounts for around a third of NHS sick leave. Addressing these issues is crucial for improving the overall performance of the NHS and ensuring better outcomes for patients.
