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You are here: Home i In Focus i In focus 2010 i Theme: Nordic region tightens sick leave rules i Sick leave in Finland: municipalities on the right track
Sick leave in Finland: municipalities on the right track
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Sick leave in Finland: municipalities on the right track

| Text: Carl-Gustav Lindén Photo: Cata Portin

Many Finish municipalities have managed to turn the trend of ever increasing levels of sick leave. As the country's largest municipal employer, the City of Helsinki is developing ways of helping people on long-term sick leave to get back to work.

"The most important thing is to keep people in work for the sake of their own well-being. It is not a relief to be awarded sickness benefit, it is a trap," says Leena Haakana.

When people have a job to go to, it is a good thing both socially and economically. Haakana is an occupational health worker at the City of Helsinki. She is the co-author of a report detailing three years of innovative public health work. A five-person workgroup within the city's occupational health service have worked on an activity model, using 270 people on long-term sick leave with serious problems as their research base.

Promising 

The result is promising. On average the patients had been away from work for 1.5 years - some as long as seven years. More than half of them could return to work after going through the entire chain of available support - doctors, health workers, rehabilitation planners, psychologists, physiotherapists - and the rest found a new career.

The overriding idea was that everybody possesses some kind of resource and skill to be able to function in a work place. The solution has been to adapt the work to fit the individual's capacity, in a human and reasonable way. For many people on long-term sick leave, returning to work can be a daunting prospect. Have they lost their competence? Will colleagues look at them with distrust? Will they manage? But Swedish research shows that giving support to employees considerably lowers the threshold for them to return to work.

The greatest worry is the large number of people taking early retirement because of psychological problems.

"Statistically there aren't more depressed people now than before, but working life is now so hectic that those who are depressed manage less well."

It used to be skeletomuscular illnesses that put people out of work.

Improved numbers

Figures from the City of Helsinki show a decline over the past few years in the number of people on long-term sick leave (between two to four weeks). Other municipalities are interested in learning which models work when it comes to preventing long-term sick leave.   

Haakana

Many from all over the country want to hear from Leena Haakana how the City of Helsinki has managed to cut their sick leave figures. 

"There is a demand for our expertise," says Leena Haakana.

Workplace managers have been given a more active role in recent years. They have received training in how to enter a dialogue at an early stage with employees who are starting their long-term sick leave or who are frequently absent due to illness. There is also an improved mapping of health risks among employees. The City of Helsinki stand to save considerable amounts of money by undertaking this work. People who took early retirement in 2008 cost the City €12.5m.

It is also important to try to get people to work for longer, to allow employers to prepare for the oncoming labour shortage. The average age of employees at the City of Helsinki is 46.5 year. 

"The average age increases year on year. When people grow older, the risk of them falling ill and going on long-term sick leave increases too."

Positive focus

Tiina Pohjonen is the occupational health director at the City of Helsinki. She says the project's main objective has been to change people's perspective. Rather than focusing on the negative - risks and problems - the main focus now is on what capability workers who are ill actually have, and what tasks they would be able to perform. The tools which have been made available allows management to take action at an earlier stage, which means the measures needed to get people back into work needn't be so extensive.

"Managers have learnt to be leaders in workplace well-being."

It has also become clear that in order to get people to work longer, they have to feel that their work is meaningful. If not, neither laws nor rules will help.

"I don't believe in normative control, that you can force people to work. Work must make sense."

Economic downturn changes the picture

Research shows the level of sick leave among Finland's municipal workers rose until 2005, but it has fallen ever since. All eyes are now on the release of last year's figures from the Finnish Institute of Occupational Health.

Many municipalities made people redundant last year, and people who have retired have not been replaced because of the financial crisis. Meanwhile a large municipal reform programme has seen the merging of many municipalities, and this has created uncertainty among workers even though they have been given a five year employment guarantee. All this will inevitably start to show somewhere.
Bjarne Andersson at the Association of Finnish Local and Regional Authorities has been sceptical for some time.

"We wondered why the general picture seemed to be so very positive while the economic downturn had hit also us. But it was said that the crisis needn't necessarily impact on employees' view of their own role in the labour market."

Andersson says the capital Helsinki is a good example of how to handle sick leave. Yet smaller municipalities with fewer resources might find it harder to adapt, facing a reality where occupational health care functions mainly on a GP level. A lot can still be improved, says Andersson.

Occupational health care awaits reform

By the end of January, two working groups should be presenting their plans for how the Finnish can be helped to stay longer in working life. There is an aim to increase the retirement age by three years by 2025. Despite the current retirement age of 63, most people retire before they are 60.

The two working groups comprise representatives from trade unions, employers and the state. One group looks at ways of increasing the retirement age, the other will examine ways to make people work for longer. The working groups have so far failed to agree, and if they can't the government will eventually take the reins. 

The hardest task is to increase the retirement age. Prime Minister Matti Vanhanen ran into opposition earlier when his government tried to force through a bill increasing it to 65 years. 

Occupational health care will take on a more preventative role and co-ordinate its work to better fit in with the pension system and state health insurance. There might also be measures aimed at shortening university course times, and to help young people who fall outside the labour market soon after finishing secondary school finding their place in society.


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