Abstract
Long term sickness absence in the United Kingdom labour market has become a major health issue in recent years. In contrast to short term sickness absence, where rates have been falling in recent years, rates for long term sickness absence (LTSA) have been on the increase. This thesis is concerned with identifying barriers and enablers to returning to work (RTW) from LTSA from the perspective of the long term sick and the processes involved in work disability and RTW, in a policing population. The epistemological position of this thesis is one of methodological eclecticism: both quantitative and qualitative methods have been utilised to elicit distinct kinds of data. This thesis proposes that through the lens of the long term sick the work disability experience can be conceptualised systemically, as three identifiable co existing domains; individual, organisational and societal, each populated with factors perceived by the long term sick to be associated with work disability and their effects, manifested in absence duration and RTW outcome; thereby supporting the need for a wholistic and integrated approach to RTW interventions. This thesis aimed to establish regularities and patterns in LTSA among the occupationally diverse Anon Force using a large administrative database. In doing so, it substantiated the presence of objectively determined individual domain barriers to RTW and predictors of RTW outcome and established the absence phase specificity of a number of risk factors of prolonged work disability. These comparative quantifications were detailed by the stories from the qualitative subset of interviews which elaborated and identified additional barriers and enablers from the perspective of the long term sick. The results of this thesis confirmed that from this perspective the experience of LTSA can be conceptualised systemically, as three identifiable, co existing domains; societal, organisational and individual. They also provide insight into the factors that populate each of the three identified domains, the interplay between domain factors and the emergence of secondary barriers. The results also provide knowledge about key RTW processes, explaining how respondents perceived and responded to events as they progressed along the disability timeline, finding or not finding a way back to work. In particular, communicating relationships, occupational bonding, motivation to RTW and cognitive appraisal were all identified as processes that are significantly involved in work disability and RTW. The evidence from this thesis suggests there is a limited window of opportunity in which to target remedial resources if they are to deliver maximum benefits and minimise the likelihood of the onset of chronic disability symptoms. This thesis offers new insights into the variations in RTW behaviours through the detailed examination of the LTSA experiences of the work disabled and allows for better targeting of RTW interventions.