Each year 2.7 million teaching days are lost through sickness. Last year 2,500 teachers took early retirement on grounds of ill health. A large secondary school with an average number of absences could face annual supply costs of up to pound;100,000. Nationally, the bill is around pound;300 million. Classes are disrupted, work programmes interrupted and remaining staff overburdened. So what can be done to boost attendance? And how do you sort the ill from the ill-intentioned?
Are teachers in a worse state than other workers?
No. A 2002 survey by the Chartered Institute of Personnel and Development ranked education ninth in its league table of sickness, with teachers having fewer days off sick than policemen, health workers or civil servants. A teacher in the maintained sector has an average of 5.5 to 6.5 days off work each year because of illness, while those in independent schools take about five days. But the headline statistics don't tell the whole story. For example, DfES figures for 2002 show that 43 per cent of teachers didn't take a single day off due to illness, which means the average absence rate of the remaining 57 per cent was close to 10 days a year. And while comparisons with other public sector workers look good, teachers work a shorter year than most, so the proportion of days lost is higher. Nor do the statistics for time off reflect that as part of a "caring profession", many teachers struggle into school when unwell, while others habitually suffer ill health when term finishes.
Long-term despair, short-term disruption
An alarming number of teachers are on long-term sick leave. Defined as an absence of more than 20 consecutive days, this accounts for 43 per cent of all teaching days lost to sickness and reflects the increasing number of teachers suffering serious ill-health. It's also directly linked to the numbers who take early retirement on medical grounds. But Dr Tony Bowers of Cambridge University warns that while staff attendance rates can easily be affected by long-term sickness, it is the recurring bouts of tummy upsets and the sniffles that cause real problems. "The figures don't tell you anything. A school's staff attendance rate can easily be skewed by a couple of long-term absences yet, from a professional perspective, having lots of one or two-day absences causes far more disruption."
Why do teachers take time off work?
Teachers catch the same bugs as everyone else. Dr Bowers's research at Cambridge reveals that the most common causes of absence in teaching are colds, flu and respiratory problems - as in most professions. Working with large numbers of children in small spaces doesn't help. The second most common cause is stomach trouble, the one category in which teaching outstrips other professions. On a happier note, teachers suffer fewer back problems than most workers.
What about stress?
Stress-related absence comes fourth down the list, behind migraines and headaches. But of all the statistics, this is the most misleading. In a survey of 350 headteachers, a majority said "more than 50 per cent" of all their staff absences had stress as the root cause. Yet estimating the true impact of stress on health and wellbeing is impossible. There are well-established links, for example, between stress and stomach complaints or headaches - but even coughs and colds may be the result of an immune system being weakened by stress. "Teachers report very real physical symptoms, yet time and again when we look into it more deeply, stress is the real problem," says Anne Donovan-Hill, occupational health adviser for the London borough of Hammersmith and Fulham's education department.
The bug stops here
Stress-related illness can be a particular problem for headteachers, even if they seem to take few days off work. A 2000 study of 300 Warwickshire members of the National Association of Headteachers found that one in three was on regular medication for stress, and one in four reported serious health problems including high blood pressure, chronic insomnia and eating disorders. Although their attendance and performance at school may have been as reliable as ever, the pressures were showing in other ways. More than half claimed their family lives had suffered, and one in six said they were alcoholics.
Can schools prevent staff getting sick?
When it comes to controlling the spread of viruses and bacteria, there isn't a lot they can do other than promote good basic hygiene. Washing your hands often is recognised as the best way of limiting the spread of bacteria, so making sure staff have easy access to basins makes sense. Some schools strongly discourage staff and pupils who are unwell from attending school, so they don't infect others. Believe it or not, tackling stress is easier than tackling germs. "Don't be frightened of stress cases," says Nigel Murphy, attendance management consultant at HR Wigwam, a company that specialises in boosting employee attendance. "Remember, stress is a set of symptoms - and these can be tackled."
A report compiled in late 2001 for the Teachers Benevolent Fund concluded that workplace counselling could help cut staff sickness by reducing stress and highlighting problems before they escalate. Addressing the workload issue is another good starting point. At Stretford high school in Manchester - where, since September last year, staff have had Friday afternoons free from teaching - headteacher Karen Cooper claims sickness levels have "reduced substantially".
Other ways to promote general well-being include making sure there's water available in the staffroom, as well as coffee, and dedicating times when any sports facilities can be devoted to staff use. Some schools even start the day with staff t'ai chi or yoga. In the United States, however, a material approach is, literally, paying dividends. Staff absences have fallen drastically in Arlington, Texas, since the education authority gave schools a set budget for hiring supply staff, with any unspent cash handed back to staff at the end of the year. The best attenders receive the most money.
Iron fist or helping hand?
There will always be teachers who find the lure of daytime TV an attractive alternative to Year 11 and Lord of the Flies. Nigel Murphy argues that the first step to tackling absenteeism is to root out malingerers - and there's little room for sentiment. He says some heads may just not get tough soon enough. "Sometimes the only reason for high absence is lack of interest, and this is not a sickness issue but a conduct matter. Review procedures, take advice, get legal help, but tackle it. Good attenders will always support you if you clamp down."
Employing an outside company can help by making awkward situations less personal. But while some teachers aren't at work when they should be, others struggle on when they should take time off. "Sometimes teachers need to listen to their bodies, rather than working until they break down," says John Bangs, head of education at the National Union of Teachers. "It's easy to feel that if you take time off the children will suffer, or you'll fall behind with the curriculum. But if you're in teaching for the long haul, you need to pace things and look after yourself." A quiet word from concerned colleagues may help, though some heads report being forced to order staff home to bed.
Insuring your workforce
Private health insurance as a staff perk is probably beyond the means of most schools, but there are alternatives. Some mutual health organisations offer special deals to public service workers. For example, Benenden Healthcare operates a "healthcare back-up scheme" for those working in the public sector. Schools can join for around pound;1 per teacher per week, giving staff access to free consultations with specialists and covering the cost of a wide range of treatments and surgery. "When a school invests in the scheme it's an obvious boost to morale," says Benenden's Jackie Stubbington. "It also cuts absence rates because staff get access to treatment more quickly than through the NHS. A diagnostic consultation can often be arranged in a matter of days rather than weeks, and we have an eight-week target for surgical procedures."
Getting staff back to work
Personnel specialists say "back-to-work" interviews are a key strategy in cutting absenteeism. Logging the exact details can also help schools trace a pattern; avoiding certain classes perhaps, or a particular building causing throat or chest problems. If the interview is presented as a means of gathering data, rather than a personal interrogation, it's less likely to be perceived as threatening. "A back-to-work interview that becomes an ordeal may put staff off the idea of returning to work at all," says Maureen Cooper, author of The Well Teacher. "It's important that they're seen as routine and give staff a chance to voice concerns about the working environment."
Getting those who have been off sick for a long time back to work can help boost morale and improve figures, although it may take several discussion sessions, with an emphasis on flexibility and encouragement. Explore ways in which long-term absentees can be eased back gently, perhaps by returning in an unofficial capacity to help as a classroom assistant, or working part-time for a specified period. Unions will also give advice on renegotiating job descriptions to accommodate changes in health.
How can the LEA help?
Most have occupational health nurses, but often they come into play only when a teacher has been off sick for some time. "It's a seriously under-developed resource," says Ms Cooper. "It should be called 'occupational ill-health', as schools usually send staff only when they want to get rid of them."
Sue Jennings of Oxfordshire County Council - which has England's lowest proportion of teachers taking time off work (just over 20 per cent) - believes the county's low rate is partly down to a policy of encouraging staff to visit occupational health specialists at an early stage. But not all teachers have this option. In several authorities, schools have to buy into the scheme from their own budget, and many choose not to do so.
On the other hand, some LEAs are taking positive steps. A handful have appointed "wellbeing co-ordinators" as part of a scheme designed by Worklife Support, an offshoot of the TBF. Their job is to carry out confidential questionnaires, asking staff about all aspects of school life, to build up a picture of the "wellbeing" of staff in the school and recommend changes. "Seemingly trivial matters, such as a nicer staffroom or better toilets, can affect wellbeing. And that in turn can cut sickness absence," says Clare Robertson, co-ordinator in the Cambridge area. "We also offer advice to individuals. Many teachers express an interest in alternative therapies such as massage or aromatherapy, and we put them in touch with the right person." Almost two-thirds of schools involved in the scheme report staff attendance as being "much improved".
Coping with absences
The trick is making sure they put as little extra strain as possible on those still in school. Using existing staff to cover may save on supply, but it could be a false economy if it causes other teachers to become ill or resentful. Obviously, it's important to review supply arrangements regularly to ensure maximum efficiency (see the Issue, Friday magazine, November 1, 2002). Staff should know who to inform about their illness and what their responsibilities are for setting work during their absence. One way to encourage teamwork and responsibility is to pair staff up, usually with someone in the same department or building, so that if one of the pair is absent, the other can take responsibility for work set. Departmental schemes of work can also stop non-specialist supply teachers floundering.
In the case of longer absences, tweaking the timetable can ensure that the most important classes - probably the exam year groups - don't suffer too much.
Dr Tony Bowers's research has established that teachers over 45 have substantially more time off work than younger staff. "Teachers are like cars," he says. "The more miles on the clock, the more likely they are to break down." The most reliable model, it seems, is the male teacher under 30, though from then on it's females who prove more roadworthy. And while there's a sharp drop in reliability after 45, there's actually an upturn when teachers reach their late fifties. "We call it 'the survivor effect'," says Dr Bowers. "If teachers are still in the profession at that point, the chances are that they've found good strategies for avoiding illness, or that they're just naturally healthy people. If we want to find ways of reducing absence, perhaps these are the people we should be talking to."
Main text: Steven Hastings. Photographs: Neil Turner, Alamy. Additional research: Sarah Jenkins
Next week: work experience