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Analysis of UK NHS Absences due to Sickness

UK National Health Service (NHS) Digital

Update Date: July - 2023

Carlos Alegria


Download full report (pdf)   PDF Report



Data:

Country: UK

Period: Monthly until February 2023.

Data Source (NHS): UK National Health Service (NHS) Digital .

Link to the latest data release: NHS Sickness Absence Rates, February 2023.

Information regarding NHS sickness absence statistics:

  • The data in this analysis refers to the sickness absence rates for all causes, for all NHS workers, in England.
  • Rates have been calculated by dividing the “Full Time Equivalent (FTE) Number of Days Sick” by the “FTE Number of Days Available” from the absence dimension on the ESR Data Warehouse. Rates are presented in 4 separate tables showing the National and NHS England (NHSE) region monthly rates, rates by staff group, rates by type of organisation and rates at organisation level.
    Source: Data Excel File.


Monthly absence rates from sickness in NHS workers

We perform the Monthly analysis of changes in sickness absence rates NHS workers in England. We use as a baseline the 2009-2019 average sickeness absence rate in each month of the year, in order to remove seasonality.


Sickness absence rates for NHS workers from 2009 to February of 2023

plot_MonthlyRates_and_Baseline

Summary:

  • We observe a very consistent seasonal pattern of absence rates due to sickness in the NHS from 2009 to 2019.
  • Low absence rates of about 3.9% in the summer months and higher absence rates in winter months of about 4.7%
  • Large peak in abscense rates up to 6.2% in April 2020, due to the Covid-19 pandemic.
  • Large peak in abscense rates up to 5.75% in January 2021, due to the Covid-19 pandemic.
  • From March/April 2021 we observe an abnormal rise in absence rates occurring both in Winter and Summer months. Absence rates peaked in January 2022 at 6.7%


Monthly sickness absence rates - Absolute and relative change from 2009-2019 average

In this section we compute the deviation of sickness absence rate from the 2009-2019 average seasonal baseline. The chart in the left corresponds to the absolute deviation from the baseline (in percentage) while the chart on the right refers to the relative deviation from the baseline (in percentage).

plot_Monthly_DevBaseline_Absolute
plot_Monthly_DevBaseline_Absolute

Summary:

  • In absolute terms, we can observe that the absolute deviation from the baseline was very low for the 2009 to 2019 period. The deviation peaked at 2% in April of 2020, due to the Covid-19 pandemic. From May/June 2021 the deviation from the baseline rose significantly and remained at very high levels until February of 2023.
  • In relative terms, the deviation peaked at about 60% in April of 2020. From May/June 2021 the relative deviation from the baseline sustained very high levels (around 50%) until February of 2023.

Monthly sickness absence rates - Normalized deviation from 2009-2019 average, Z-Score

In this section we compute the Z-score of the deviation of sickness absence rate from the 2009-2019 average seasonal baseline. This measure allows us to access the statistical significance of the deviation from trend that we observe in NHS absence sickness rates since the start of the pandemic. The normalisation factor (noise level) was taken as the standard deviation of deviations from trend during the 2009-2019 time period, prior to the pandemic.


plot_Monthly_DevBaseline_Z

Summary:

  • The normalized (Z-Score) deviation from 2009 to 2019 trend in absence rates ranged between -3 to +3 from 2009 to 2019.
  • In April 2020 the Z-Score peaked at around 16, due to the Covid-19 pandemic. Among other factors, fear of the disease may have played a major role.
  • From May/June of 2021 the Z-Score rose substantially, reaching close to 14 in January 2022, and remaining at very high levels until February of 2023.
  • The rises in absence rates in both April of 2020 and since May 2021 onwards represent extreme increases.



Yearly NHS sickness absence rates.

We perform the yearly analysis of changes in sickness absence rates NHS workers in England. We use as a baseline the 2009-2019 average sickeness absence rate. The yearly analysis allows us to put into context the equivalent analysis we performed for the UK absence and lost worktime rates in the UK and the US.


Yearly NHS sickness absence rates and 2009-2019 average


plot_Yearly_Baseline

Summary:

  • Average sickness absence rates for NHS workers were around 4.2% from 2009 to 2019. From 2020 we see an increased deviation from trend in each consecutive year.
  • In 2020, absence rates were about 4.7%.
  • In 2021, absence rates were about 5.0%.
  • In 2022, absence rates were about 5.6%.

Yearly sickness absence rates - Deviation from 2009-2019 average, relative change

plot_Yearly_DevBaseline_Relative

Summary:

  • The relative deviation from the 2009 to 2019 average in absence rates varied between -5% to +5% from 2009 to 2019. From 2021 we see an increased deviation from the baseline in each consecutive year.
  • In 2020, the relative deviation from the 2009-2019 average was about 11.2%.
  • In 2021, the relative deviation from the 2009-2019 average was about 19.6%.
  • In 2022, the relative deviation from the 2009-2019 average was about 33.8%.

Yearly sickness absence rates - Normalized deviation from 2009-2019 average, Z-Score

plot_Yearly_DevBaseline_Z

Summary:

  • The normalized (Z-Score) deviation from 2009 to 2019 average in absence rates ranged between -2 to +2 from 2009 to 2019.
  • In 2020 the Z-Score was around 4.8
  • In 2021 the Z-Score was around 8.5
  • In 2022 the Z-Score was about 14.7
  • Absence rates have been growing more and more out of line with the previous 2009 to 2019 behavior.


Conclusions

  • Sickness absence rates for NHS workers increased considerably in 2020, 2021 and 2022, when compared to the very stable monthly seasonal pattern from 2009 to 2019.
  • The largest rise in absence rates was in 2022 vs. 2021, highlighting the acceleration of the problems.
  • We observe that the rise in sickness absence rates from 2021 occurs in both winter and summer months, which suggests that the causes at play are not related to seasonal respiratory illnesses such as influenza and Covid-19.
  • The findings are mostly similar to those we found in the UK absence rates analysis (for the whole population) and US absence rates analysis, with very large Z-scores for the deviation from normal in 2021 and 2022.
  • The findings are striking as the rise in absence rates is likely putting substantial pressure on NHS resources.


Observations

  • The rise in sickness absence rates for NHS workers corroborates our previous work on the rise in absence and lost worktime rates in the general UK population. The findings that the rise in absence rates for the NHS workers from early 2021 mirror those of the general UK population and the equivalent analysis for the US, imply that the phenomenon at hand is real and consistent across different samples.

  • The rise in absence rates in NHS workers in 2021 onwards coincides with the mass vaccination rollout, as we have shown with other outcomes for which there is monthly data available, for example US disabilities (here and here).
    We are currently performing an equivalent analysis of the rise in disabilities post-2021 for the UK.

  • Even though we believe that the Covid-19 inoculations play a major role, we must also consider that other factors might be leading to the rise in absence rates, namely, Covid-19, the impact of the pandemic lockdowns, the low unemployment rates in 2021 and 2022 that place extra pressure on currently employed individuals, and other factors.