Are you a mucus trooper, a stoic, a model patient, a walking epidemic or a shirker? A January 2004 TUC poll has found three out of every four staff have been to work when ill.

The TUC findings, based on a telephone poll of 1,001 people, found that as many as one in five say they have been to work when too ill in the previous month, and nearly half say they have in the last year.

TUC says that too many people may now be going to work when they would be better off recovering at home, rather than infecting their colleagues.

The most common reason people soldier on when ill is that "people depend on the job I do, and I don't want to let them down" (42 per cent). The poll found 1-in-6 dragged themselves into work because they "would have lost pay, and couldn't afford it" (16 per cent).

"We are not the nation of malingerers that some paint," commented TUC general secretary Brendan Barber, "in fact we struggle into work even when we are too ill to do so because we don't want to let people down. It's all part of our long hours culture. Indeed long hours, stress and increasing workloads make people sick.

"Of course employers will want to deal with malingerers, but they should also make sure that people who are genuinely ill stay at home. The rest of us don't want to do extra work for those pulling a 'sickie', but nor do we want to pick up germs from colleagues or those with whom we share overcrowded public transport.

"The TUC's message is don't be a mucus trooper. Look after yourself properly."

TUC news release

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One in eight US workers is in pain, losing productive time at work, at a cost to business estimated at $61.2 billion (£36.6bn) each year, according to a study in the Journal of the American Medical Association.

The study, which randomly sampled 28,902 working adults over the course of a year, found workers in pain lose an average of five hours a week in productivity, said Dr Walter Stewart, the lead author. Threequarters of them lose productive time due to reduced performance, not due to absence, the study found, a phenomenon dubbed "presenteeism." Given that 97 per cent of US workers are on the job on a daily basis, employees go to work in pain more often than not, he said.

"There's a myth about people with pain conditions that they will take off time at the drop of a hat," he said. The Pain in Europe study, published in October, found in Britain around one in seven adults - or 13 per cent - suffers from chronic pain. One fifth of the European workers questioned said they had lost a job as a result of their pain.

Walter F Stewart and others. Lost productive time and cost due to common pain conditions in the US workforce, JAMA, vol.290, no.18, pages 2443-2454, 12 November 2003 [abstract]

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Workers have a great deal to lose from the proposal to shift responsibility for signing sick notes to employers. We know exactly what would happen because the Dutch government went down the same route in 1997. Sickness absence dropped very slightly over a few years, but relationships between GPs and employers' occupational health services declined dramatically.

The most positive outcome has been a recognition that in many cases there might be common ground between both sides about what was best for the patient's recovery.

The legal change brought about a disastrous change in the work carried out by occupational health services in the Netherlands. The Dutch government was already in dispute with the European Court for its interpretation of the Framework Directive, preferring to see the rise of large occupational health monopolies operating from outside the workplace, to the internal prevention services intended by European law.

The changes lead to a collapse in the prevention work done by occupational physicians (OPs) - though some prevention work is done by other professional groups.

"In some OHSs sickness absence consultation even takes almost 100 per cent of the occupational physician's working time. In comparison with a few years ago OPs spend less time on periodic health examinations, workplace surveys and recommendations regarding work organisation and working conditions."

Weel ANH, van der Beek AJ, Kroon PJ, Verbeek JHAM, van Dijk FJH. Recent changes in occupational medicine in the Netherlands. Int Arch Occup Environ Health (1999) 72:285-291.
Commission of the European Communities (2003). Case C-441/01 Opinion of the Advocate General in the Case C-441/01 CEC v Kingdom of the Netherlands.

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Sickness absence figures suggest 20 per cent is the result of poor working conditions. The CBI reported that during 2002 approximately 166 million working days were lost due to sickness absence.

The latest Health and Safety Executive (HSE) survey(4) covering almost a similar period found that 32.9 million days were taken off work because or work-related ill-health. It says 40 per cent of these were due to new problems.

These statistics are likely to underestimate time off from work-related causes because of the way work-related ill-health is defined in the Labour Force Survey. It is known that those most at risk from stress-related illness fail to report work-related stress in the survey.

This could be a very significant omission. An October 2003 survey by Personnel Today and the HSE concluded 11 per cent of the UK's total sickness absence is due to stress.

Most sickness absence is for short periods. Older workers tend to take longer periods off-work - and this is particularly true for work-related health problems. Research has shown a strong relationship between measures of organisational stress and sickness absence levels and the CBI survey finds a relationship with "poor workplace morale."

The European Court made the point in its judgment on the Dutch OHSs, that internal services allow much greater participation by employees in prevention work, than use of external providers does, and that this was the purpose of the Framework Directive.

The point is sharpened by recent proposals from the Information Commissioner, that make it clear that managers should not have access to workers' confidential medical information (see www.hazards.org/testingtimes). If employers wish to take on sick note certification duties and to have effective prevention services they will have to employ specialist staff operating at arms-length from management.

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