Although estimates of the costs of sickness absence to the UK economy vary, as do the methods used to quantify these figures,1,2 it is clear that these costs exceed the total NHS budget. Annual costs of sickness absence and worklessness associated with ill health are estimated to exceed £100 billion per year.2 The costs to UK business of mental ill health alone are estimated at £26 billion each year.3 Despite these huge costs, this remains an under-researched area,4 and most of the research that has been done has been conducted in Scandinavia where the welfare and certification systems differ significantly from those in the UK and elsewhere.5
There are clear links between deprivation and worklessness and ill health. About 7% of the workforce are in receipt of long-term illness-related benefit. An alarmingly low proportion of them ever return to paid employment, locking themselves and their dependents into long-term deprivation and social exclusion,2 particularly in areas of low employment with up to a tenfold variation between UK regions.6 The arguments for enhanced family income for those on long-term sickness benefits are less robust since the welfare reforms and minimum wage have been introduced since 1997. Furthermore, recent modifications to disability legislation require employers to make reasonable workplace adjustments that can facilitate access to paid work for disabled adults and also accommodate the consequences of illness within the workplace.
However, critics of the government's aim to reverse the drift towards increasing proportions of the workforce on long-term sickness welfare benefits, suggest that many of those targeted as potentially fit to return to the workforce are those least likely to be offered work, particularly in times of recession, and represent hidden unemployment.6
While the Department for Work and Pensions (DWP) can track trends in long-term sickness and the associated certification, less is known about the causes and progress of sickness absence of less than 6 months. Research using duplicate sicknotes and employer surveys suggests that mild to moderate mental health illness represents the largest diagnostic group in the UK, above musculoskeletal problems, which still predominate in Scandinavia. Research suggests that in addition to the cause of illness, increasing age, being male, and deprivation also increase the risk of sustained absence.2,7