Analysis: NHS Sickness Rates In-Depth: The Impact of Covid-19

Provisional statistics on NHS sickness absence rates for England, with data ranging from between the 30th April 2009 to the 31st May 2020 were published last week, Matt White explores the detail. 

The statistics highlight the negative impact that Covid-19 has had on the NHS workforce across ambulance trusts, CCGs, hospital trusts, mental health trusts, NHS trusts, and regions.

The key points from the statistics show that the overall sickness absence for England in May this year was 4.7% – down from 6.2% from the following month of April. 

April this year unsurprisingly saw London reporting the highest sickness absence of 7.2%, where Covid-19 cases were most concentrated. Further, ambulance trusts had the highest sickness absence rate of 7.3% in this month, which fell to 5.3% in the following month of May. 

Most notably, the consistently reported reason for sickness absence was anxiety, stress, depression, and other psychiatric illness; this accounted for 510,281 fulltime equivalent days lost, and 28.3% of all sickness absence in May this year, up from 20.9% from the previous month of April.   

Covid-19 impact

From a total of 1,800,000 lost fulltime equivalent (FTE) days, 340,900 were related to Covid-19 in May 2020; this equates to 18.9% of all recorded absences.

In April, Covid-19 related absence made up 30.6% of all absences, showing a definitive correlation between the peak of the virus in April to subsequent months thereafter, when Covid-19 related absence significantly reduced.

Again, unsurprisingly, the London region reported the highest Covid-19 related sickness absence in April at 40%, and also in the previous month of March at 26%. May saw the highest Covid-19 related absence rate reported in the South East at 25.8%.

When looking into the data, it should be noted that some trusts do not provide comprehensive reasons for sickness absence; in these cases, best figures are used where available. Further, the Chesterfield Royal Hospital NHS Foundation Trust is unavailable on the ESR and does not appear in the statistics. 

That being said, the statistics are comprehensive and provide valuable insight into the effects Covid-19 has had on the NHS, particularly when compared on a month to month basis, and compared with years prior to the pandemic.

Impact in detail

As previously stated, at the peak of the virus in April, the overall sickness absence rate climbed above 6%. To put this into context, April 2016, 2017 and 2018 presented overall sickness rates of under 4%, and April 2019 being at, or just over 4%. 

For additional context, at no point in the last 7 years (as far as this particular dataset dates back to) prior to April 2020, have overall sickness rates climbed above 5%; January 2017 touched 5%, where every other month of this 7-year period has been relatively well under 5%.    

April 2020 saw London have the highest sickness rate by region for the first time when compared to the month of April across this 7-year period. 

Strikingly, pre and post April 2020, the North West has consistently reported the highest sickness absence for any month across this 7-year period, which further reinforces the detrimental impact of the virus on NHS staff in the London region in April 2020.   

However, the North West NHS region is also the country’s biggest employer and one of the largest employers globally, according to the Nuffield Trust.

April 2020 saw the South-Central Ambulance Trust have the highest sickness absence rate of 12.8%, with West Hertfordshire, Hillingdon, and Epsom and St Helier closely behind between 11.2% and 11.4% respectively.

A study conducted prior to the pandemic in 2015 found that out of 3,000 ambulance workers, 91% stated that they were suffering from stress, with 38% of these stating that they’ve had to take time off due to the illness, and 25% admitting they had been close to taking time off.

Factoring in the results of this study creates a logical correlation with the aforementioned ambulance trust staff being the worst affected during the peak of the Covid-19 pandemic in April 2020.

When looking at sickness absence rates specifically by staff group in April 2020, clinical and ambulance staff were highest at 8.6%, however, when looking at the same group month to month from May 2019 to May 2020 (as far as this particular dataset dates back to), ambulance staff have always presented the highest sickness absence rates, consistently over 6%.    

There were no dramatic changes in staff group sickness absence rates in April 2020 compared to previous months in 2020 and 2019; most staff group sickness absence rates rose between 0.5% and 1.8%.

Interestingly, April 2020 saw 20.9% of all staff sickness absence reasons being due to psychological illness (stress, anxiety, depression), although this was not the record rate per month of staff absence prior to April 2020 due to this type of illness; since April 2019, August 2019 presented staff absence from psychological illness standing at 27.7% – much higher than at the peak of Covid-19.

It should be noted however, that in April 2020 there was an exponential rate increase in chest & respiratory, cold, cough and flu, and infectious diseases staff absence reasons, with all three reasons almost reaching 15%, where usually these reasons stay consistently under 10%, mostly towards 5%. This could go some way to explaining why psychological illness reasons were relatively low in this month, where physical illness reasons were prioritised for recording over other illnesses. 

May 2020 saw an exponential rise in psychological illness being the cause of staff absence and set a record high of 28.3%. This could show a delayed impact of the psychological distress the virus caused at its peak, once that peak began to dissipate. 

What the data reveals

From the datasets, it can be viewed that Covid-19 has been a far more psychologically than physically damaging illness, where staff have reported suffering exponentially more from stress than any other illness.

If the NHS is taken as a microcosm to society as a whole, it could be inferred that psychological illnesses have been the most damaging during the pandemic.

Ambulance service staff have been negatively most affected by the virus, although this staff group consistently present as having the most time off work due to illnesses in general, pointing at the difficulty of the job itself potentially compared to other NHS occupations.

It should also be noted, and has been inferred by some NHS CEOs, that there may be individuals who have used the pandemic as an excuse to take time off for insincere reasons; this cannot be inferred directly from the statistics. 

NHS Digital have created an interactive online tool, which presents a multitude of data relating to sickness absence across years, regions, organisations, trusts, and more. 

The tool (source) can be viewed here: NHS Digital Sickness Absence Online Interactive Tool