The number of sick days taken by NHS staff varies dramatically across England with the north faring worst, according to a new report from the Audit Commission today.
The watchdog says that there was a "significant variation" in sickness absence rates between different types of trusts and between different departments within those trusts.
Although the report also found that NHS staff living in areas of high deprivation were more likely to take sick leave, as were junior staff, the commission says "these factors alone cannot explain all the variation" and some deemed more likely to suffer had "bucked the trend".
It said that other factors, including the way organisations manage, motivate and support staff, also went some way in accounting for the differences.
"There are some very good reasons why sickness absence rates in the NHS differ between organisations, and even between departments," says Andy McKeon, managing director of health at the Audit Commission.
"Managers need to be realistic about what they can achieve and accept that some staff, such as frontline workers who deal with sickly patients all day, are likely to have more days off sick than, for example, those without direct patient care responsibilities."
Through figures collected from all local NHS organisations by the NHS Information Centre for Health and Social Care between July 2009 and June 2010, the watchdog found that while the north-east had the highest average sickness absences, London had the lowest.
The jobs most likely to suffer absences were nursing, midwifery and health visitors; ambulance crew; and health assistants.
Nationally the NHS rate varied from 1.6 days to 6.8 days and between NHS, foundation, and primary care trusts.
In 2009 the Boorman review found the direct cost of staff absences on the NHS was £1.7bn.
The Audit Commission report says the figures do not go as far as explaining why long-term sickness levels are a particular problem in the NHS.
"These kind of factors do not explain all the variation, nor, for example, the level of long-term sickness in the NHS," says McKeon. "Health trusts can make big savings and improve the wellbeing of staff by identifying where they have unexplained high levels of sickness, and targeting efforts at reducing them. Our briefing provides a good starting point for this."
A key part of tackling the issue and reducing sickness levels would be to understand factors better. Among the recommendations for managers included in the report were reviewing and comparing absence rates; identifying staff groups prone to illness; better monitoring of department costs and considering ways to reduce absence.
If the NHS focuses on the causes that local management can most influence it could increase staff productivity and morale and generate millions in savings, the report says.
Setting out her hopes for the findings, Dame Carol Black, national director for health and work, says the "discerning analysis of sickness absence across the discrete organisations of the NHS confirms the high costs of impaired health and wellbeing.
"Unexplained variations between trusts highlight the importance of good management practice in minimising the causes of sickness absence of staff at every level. The findings of the report will prompt reflection in every trust, and review with remedial action in many."
According to the last annual absence management report by the Chartered Institute of Personnel and Development (CIPD), public sector staff took an average of 9.7 sick days last year, compared to just 6.4 in the private sector, but with variation between sectors such as local government.
Ben Willmott, author of the CIPD report, agreed that more influence through local management could have an impact, especially when it comes to stress-related issues.
"Line managers are best placed to identify employees that are struggling to cope," he says. "One starting point is to ensure people in line management roles receive training in people management. It's line managers who implement absence management policies. If they aren't conducting return-to-work interviews or properly reporting, you end up with people not being managed consistently."
The report also considers the hidden costs of so-called presenteeism, where there is a productivity loss caused by staff turning up to work while ill. It said the cost of this could be as high as one and a half times that of sickness absence.