Karen was off work with back pain and minor illnesses for more than six weeks last year. She has had the odd day off in 2009 as well. "I'm beginning to feel panic-stricken and sick inside," says the secondary school teacher. "I feel worried for myself and concerned for the pupils who are having cover lessons."
Trouble is, Karen's increasing anxiety is likely to lead to even more time off. It is also the kind of vicious cycle that could explain the sheer scale of teacher absence in the UK. Teachers in England took nearly 3 million days off sick in 2007, compared with 2.5 million in 1999. According to an analysis of the official figures by the Conservatives last month, this equates to almost 15,000 teachers being absent every day.
The Tories' claims caused predictable dismay. Ill health was seen to be crippling England's army of 466,000 teachers. In Wales, 244,700 days were lost to absence in 2007 - an increase of 17,200 days on the previous year.
Michael Gove, the shadow schools secretary, said it could cost schools millions of pounds a year in terms of cover, although many schools take out insurance to pay for longer term supply teachers. But compared with other professions, teacher absence looks less astounding. The average public sector worker takes 9.8 days off a year, according to the 2008 annual survey from the Chartered Institute for Personnel and Development. Those working in education sit below that average, taking just 7.8 days off a year. Instead, it is health employees and central and local government workers who are the most likely absentees.
"Teachers actually compare favourably with other public sector jobs," says Patrick Nash, chief executive of the Teacher Support Network (TSN). "They drag themselves in because they are committed to the young people they teach. Then they hang on until the weekend or half-term before they allow themselves to get properly ill."
But despite the Department for Children, Schools and Families' assurance that figures are low, stable and "well within industry norms", the profession is far from receiving a clean bill of health. Even taking the Conservative figure of 5.4 days off per teacher, it is considerably higher than absence rates in the private sector.
The causes of absence are varied, but common problems include overwork, common colds and flu, back pain and stress. The weight of bureaucracy shouldn't be underestimated either. Teachers received more than 6,000 pages of government paperwork in 2008, on top of considerable pressure to get results and climb the league tables. The TSN has also reported an increase in the number of teachers concerned about the credit crunch. "It's normal that people get stressed from time to time," argues Patrick.
"Schools shouldn't perceive it as a failure. They must expect teachers to feel really down at some point in their careers, so they need to know what to do about it."
June, a teacher from a secondary school in the North-west, could not have returned to school without her head's reassurance. "I had been at the end of my tether when aspects of work and personal life had become simply unbearable," she says. Her headteacher told her to take as much time off as she needed.
"He told me that things got too much for everyone sometimes," she says. "He made me feel valued and reassured me that my job would be kept safe." With the help of counselling, June finally conducted a phased return back to school after about three months off. Having ditched some of her extra responsibilities, she now feels ready to apply for more senior positions again.
Like every frontline caring profession, teachers' absence will always be keenly felt, says Richard Preece from the Society of Occupational Medicine. "If teachers do have health issues, they can look forward to periodic long breaks, so it's not unremitting. But on the other hand, they can't schedule in quiet non-contact days like office workers can."
Laura (not her real name) has missed her children's prize givings, sports days and nativity plays because she was unable to take time off during term. She was also unable to accompany her father, who has Alzheimer's, to see a specialist.
"People in other jobs would be able to take a day off," she says. "I know teachers get long holidays but we spend half of them working and it's often too expensive to go abroad. To me, it's nothing short of a miracle that the sickness rate is as low as it is."
The uniqueness of the school environment certainly rules out some flexibilities enjoyed by other employees. Guilt may prevent staff from taking time off around revision times, for example. And classroom teachers do not have the luxury of a few days sitting silently behind a computer if they feel rough. But within these confines, schools can foster a healthy, supportive culture.
Ferryhill Business and Enterprise College in County Durham hosts a health and wellbeing week in the middle of its longer autumn and summer terms - typically when exhaustion starts to set in. During this week there are healthy prize draws, ranging from spa day vouchers to pedometers, plants or food and drink, in every staff briefing. It costs about pound;50 each week they hold it, but reaps dividends in terms of morale and attendance.
In addition, there are no extra meetings or training sessions scheduled during the healthy week, and staff are encouraged to leave promptly at the end of the official school day.
Small, seemingly innocuous changes such as this can make all the difference. St Swithun's Lower School in Bedfordshire lost 271 days to staff absence in the 2003-04 school year. Through identifying its weaknesses and regularly reassessing priorities, it slashed that figure by 77 per cent within three years. Despite rising staff numbers (28 at present), it expects about 63 sick days this year.
It used the national wellbeing programme from Worklife Support, a company that offers teacher wellbeing advice, to tackle low teacher morale. The programme involves all staff completing a self-review, which highlights areas for development and forms the basis for a school-wide action plan.
St Swithun's started with its physical environment. It got rid of its so- called "kitchen" (consisting of a sink in an alcove), decked out the staffroom with a fridge and dishwasher and installed another staff toilet to cater for the breaktime rush.
Barbara Eames, head of nursery, was appointed wellbeing facilitator. She introduced a noticeboard to inform, amuse and recognise achievements and a "sunshine fund" to provide treats, such as flowers and birthday presents. The most recent Worklife Support self-review revealed a lack of continued professional development for support staff, so the head duly introduced more high-quality training to meet their needs.
"It's helped all our staff feel connected and part of a team," says Barbara. "Staff appreciate being listened to. If they need to look after sick children or parents, they can, and the noticeboard keeps other staff in the loop about what's going on."
College Heath Middle School in Suffolk also adopted the wellbeing programme as it was coming out of special measures seven years ago. Five of its 45 teachers had left in quick succession and a large proportion of the remainder were on temporary contracts. Two members of staff were on long-term sick leave and shorter-term absence rates were also high.
Today, the school has no long-term vacancies and no supply staff covering long-term absences, thanks in part to tackling three main areas identified in its wellbeing self evaluation: workload, communication and physical environment. If a pupil flouts two behaviour warnings in class, teachers can now use the "pupil support line" (a card delivered to reception by a responsible pupil) to summon immediate staff back-up. Teachers appreciate the service and feel less isolated and stressed when dealing with persistent disruption.
In addition, the school has introduced daily briefings and regular staff socials, and created a new spacious staffroom. The next stop is to limit the workload of the senior management team. "We're going to start having a masseur coming into school for the staff," says Rachael Smith, a modern foreign languages teacher and chair of the schools wellbeing board. She heads a wellbeing meeting once a term to review and act on any small grievances or suggestions.
"The important thing about the meetings is that we have representatives from all areas of the school," she says. "That way every faction of the school community, from the admin staff to the caterers, has their view heard."
Other industries, keenly aware that absence costs money, are already prioritising wellbeing. Royal Mail, one of the UK's largest employers (it boasts a workforce of 190,000 - 0.6 per cent of the UK's working population), proves that you don't have to be small to provide effective, personalised solutions. It slashed absence rates by 25 per cent between 2004-07, saving pound;227 million in the process.
"It was quite clear we were struggling to deliver the services expected of us," says Dr Steve Boorman, chief medical advisor of the Royal Mail Group. "A lot of that was down to low morale and poor attendance. The cost of temporary cover was enormous, and those temporary staff were not usually as committed to the business or the quality of service."
So Royal Mail embarked on a deliberately broad range of measures that shifted the company mindset from a negative view of absence into a positive approach to attendance. Unbroken attendance records were rewarded in competitions that saw 37 employees win a car and 74 enjoy pound;2,000-worth of holiday vouchers. All 90,000 who qualified for the draw got a pound;150 holiday voucher.
It also introduced health screenings, health clinics, on-site fitness centres and more absence-related training for managers. When consulted, employees wanted better work environments, including TVs in the restrooms and a re-vamp of the toilets. They also wanted to minimise workplace bullying, so local employee groups were established to discuss possible solutions.
The London School of Economics found that the Royal Mail experience could become a valuable blueprint for other sectors. "Workers like to feel valued, supported and cared for," says Dr Boorman. "They need earlier intervention when things go wrong, and if they do have to take time off, they want to keep in contact with work. They need to know about self-help support programmes for them and their families and have their voices heard at the decision-making level."
But even collectively, schools would struggle to match the pound;46 million Royal Mail invested over three years into the health of its employees. Dr Boorman argues that having a creative approach to workload is more important than major investment. So a teacher who is taking time off due to relentless bad behaviour in a class could be offered more non-contact time, during which they complete a useful scheme of work.
"There are lots of initiatives out there that are low cost and effective," says Dr Boorman. "Local charities or primary care trusts will welcome the opportunity to work with schools and share their resources and expertise. Simply by signposting teachers towards helplines or advice points would make a difference. Healthy, appreciated employees are more likely to go the extra mile at work, and it will improve their quality of life at home as well."
John Lewis, the department store, takes a similarly innovative and proactive approach to managing absence. Its registry department is designed to provide workers (known as partners) with support and democratic involvement across the business. Partners can raise any problems with the registry, including medical issues, stress, harassment or bullying. The registry will then provide advice and, if need be, refer partners to specialist advisers such as debt counsellors.
In addition, there are in-house occupational health advisers, a doctor, plus opportunities for annual health checks. Line managers remain in regular contact with staff on longer-term sick leave to prevent them from becoming too depressed and help them feel more positive about the prospect of returning to work.
This last initiative would work especially well in schools, says Patrick Nash, who believes that losing touch often compounds health problems, especially among staff who are worried about colleagues' or pupils' reactions. "Most teachers want to get back after a week's absence but they don't know what to expect," he says. "They get stressed thinking about how much work they've got to catch up on or people's attitude towards them."
The Government has also rubber-stamped a more proactive approach to wellbeing at work. Last March, Dame Carol Black's health and work review recommended the introduction of "fit notes" - which state what absent workers can do, rather than what they can't - plus early intervention to prevent sickness drifting into incapacity.
However, teacher absence may not always be down to something physical. Early stress signs include anything out of the ordinary, according to Rick Hughes, lead advisor for workplace counselling at the British Association for Counselling and Psychotherapy. This could be individuals who are eating more or less than normal, who are particularly irritable or smoking or drinking more.
"Managers need to create the kind of environment where problems are less likely to arise. If they do, they need to be proactive and have enough training and understanding to offer support as soon as possible," Rick says.
"Managers may not be able to solve the problem but it's important they show genuine care and have an arsenal of tools at their disposal."
If people are genuinely unfit to come in to work, they should not be forced to, Rick adds. It is a seemingly uncontroversial message. But when a cough medicine recently suggested that those who felt unwell stay in bed and take a "Benylin day", it caused uproar.
Critics said the ads encouraged workers to take sickies. But teachers do not take the decision to stay at home lightly. In fact, their dedication can work against their ability to cope. This is when line managers need to step in and reassure them that they can and should give themselves time to recover.
"It may mean finding cover for a couple of months but schools will reap the benefits in the long run," says Rick. "It's a much better option than an empty staffroom."