Readers may find provisional guidance from the National Institute for Clinical Excellence (NICE) useful in considering their long-term sickness absence policies. The guidance was subject to a consultation period (now closed) and will be reviewed. However, the general information is unlikely to differ too much from the consultation. The review defines long-term sickness absence as a length of four or more weeks has been chosen (there being no accepted universal definition).

Prompt assessment

Within 12 weeks (ideally between two and six weeks) of a person starting sick leave they should be assessed. The assessment should be undertaken in conjunction with the employer and carried out by a suitably trained person (for example, a GP or a specialist such as occupational health nurse or physician or by a suitably trained case worker/manager/team).

The assessment should include:

• initial enquiries to determine the reason for the sickness;
• identifying whether a case worker/manager/team is needed if they have not already been appointed;
• screening questions to determine: the person’s likelihood for returning to work and the level of interventions required, and their type and frequency;
• discussion and agreement with the employee about the proposed interventions.

The assessment could also include one or more of:

• an examination by a GP or appropriate specialist to determine the person’s diagnosis, treatment and need for further tests or further sick leave;
• use of a screening tool (in addition to the screening questions) to determine the prognosis for returning to work.

In addition it could include a combined interview and workplace assessment to evaluate the person’s:

• current social and employment situation;
• current or previous rehabilitation experiences;
• work tasks and their functional capacity to perform them (covering issues such as mobility, strength and fitness);
• the need for any work modifications, including ergonomic modifications.

Potential interventions

‘Light’ interventions that could be considered include usual care plus short sessions providing, where appropriate, one or more of the following:

• tailored information;
• advice and training;
• encouragement to be physically active;
• referral to physiotherapists and/or psychology services. ‘Intensive’ interventions that could be considered include usual care plus a programme of multidisciplinary interventions over several weeks (for example, daily sessions for four weeks) including one or more of the
following:
• cognitive behavioural therapy;
• education on physical and mental coping strategies for work and everyday activities;
• exercise;
• workplace modifications.

A return-to-work or rehabilitation programme might comprise:

• a gradual return to the person’s original job using staged increases in hours and days worked (for example, starting with shorter hours and/or less days and gradually increased);
• a return to partial duties of the original job or temporary/ permanent redeployment to another job;
• modifications to the workplace or work equipment.

Other possible interventions could include:

• individually tailored information and advice on how to manage daily activities at home and at work;
• exercise programmes;
• counselling about returning to work;
• physiotherapy;
• referral to vocational rehabilitation (including training).

Potential psychological interventions

Cognitive behavioural therapy (CBT) may be useful for:

• women with musculoskeletal pain;
• women and men with adjustment disorder or stress (when combined with contact with the employer);
• women experiencing low back pain when used with problem-solving therapy combined with behavioural graded activity and liaison with the workplace to discuss ‘a return to work’ plan.

In addition it may be useful to have:

• group sessions focused on finding solutions for people with psychological or musculoskeletal pain;
• progressive goal attainment programmes combined with physiotherapy or multimodal programmes for those with whiplash injuries.

The draft ‘Managing long-term sickness absence and incapacity for work’ can be obtained from www.nice.org.uk/nicemedia/pdf/LTSADraftGuidanceAug08.pdf