Ailing Europe declares war on sick leave as lengthy absences soar
Hans van Leeuwen
When Friedrich Merz, the German Chancellor, unveiled a “big bang” of economic reforms last week, it was surprisingly one of the smaller initiatives which generated the biggest response.
Laying out his package of 34 new measures, the Chancellor slipped out that when German workers want paid sick leave, they will need a doctor’s note on the very first day of their illness, and they’ll need to get it in person.
Merz may have wanted to talk about pensions or tax cuts or affordable housing, but the worldwide media frenzy over his sick-note plan eclipsed all else.
The proposal resonated with the country’s economic zeitgeist. Germany has been known as “the sick man of Europe”, on and off, for decades, but it has never been more true than now.
Its industrial base, the linchpin of its economy, faces an existential threat from China. Its population is ageing fast. Its reputation for innovation and efficiency is in peril. And its workers take almost a month of sick leave every year.
Merz, a headmasterly figure with round-rim spectacles and a lofty stature, was telling his fellow citizens to hitch up their boots and get working.
“We can no longer afford the competitive disadvantage caused by prolonged absences from work,” he declared.
His message has echoed across north-western Europe, which increasingly resembles a hospital ward of sick men.
In France, the average worker takes 4.1 weeks of sick leave a year, compared with 3.5 in Germany, according to the Organisation for Economic Cooperation and Development (OECD).
In Belgium, it’s 3.9 weeks; in Finland, 4.8; and Norway, a chart-topping 5.7. Other countries in the premier league include Portugal, Spain, Slovenia and Sweden.
In Britain, the big challenge lies with ill people who have dropped out of the workforce altogether. The UK’s sick leave stats look much healthier: just 4.4 days per worker last year, according to the Office for National Statistics. American workers are similarly robust.
The Europeans are realising that something has to change. Governments across the Continent are scrambling for policy remedies to their chronic sick-leave crisis.
In Norway, where the number is highest, the Government steps in to help employers foot the bill – at an estimated cost of 67 billion kroner ($9.8 billion) a year. In April, Oslo shifted to a new concept of “graded sick leave”.
“We have to ask ourselves whether it has become too easy to go to the GP and ask for a sick leave,” said Jan Christian Vestre, its health minister.
A sick note will no longer automatically sign an employee off work altogether. Instead, the doctor will advise the boss how much the unwell employee can work.
If the doctor advises that the employee can’t work at all, a specific justification has to be provided. And in those cases, the doctor will receive a lower fee. The less time off a doctor prescribes, the higher his or her fee.
Vestre hails from Norway’s Labour party, but his proposal has not gone down well with trade unions.
John Magne Pedersen Tangen, the head of the trade union NTL Ung, said the proposal unfairly blamed workers, rather than addressing “a broken GP service” and the “sloppy arrangements” put in place by employers.
Merz, who is from Germany’s centre-Right Christian Democratic Union party, ran into similar pushback.
Barbel Bas, his own labour minister from his centre-Left coalition partner the Social Democratic Party, disowned the sick-note measure. “That wasn’t my proposal,” she told German media.
Medical industry associations also attacked Merz’s plan, saying it would inundate overstretched GP surgeries with people looking for sick notes, when they’d be better off just spending the day in bed.
The Merz day-one policy already exists in Belgium, where opponents make similar claims that it fills GPs’ schedules with unnecessary appointments.
But the Belgians have pressed on. At the start of this year, the government tightened the list of exemptions to the day-one rule.
They are also targeting workers on long-term sick leave. More than 7 per cent of Belgium’s working-age population, of half a million employees, are on long-term sick leave.
The changes seek to keep absent employees more closely in touch with their employer and the healthcare system. After six months, rather than a previous nine, bosses will be able to claim “medical force majeure” against a worker, and initiate potential termination of their employment.
France has also just stepped up its vigilance on long-term absence, citing the spiralling cost of the system.
From September, it will be much harder to remain off work for months. The initial sick note can last no longer than 31 days, and an extension can be no more than 62 days.
As in Norway, doctors will be required to proffer more detailed justifications. And as in Germany, the medical fraternity is worried at the prospect of more appointments and more paperwork.
The next cab off the rank is Denmark. Workers there take a relatively frugal 2.1 weeks of sick leave a year, but the entitlement is a generous 30 days.
The new coalition government has launched a major review of welfare policy. This includes, as one of its key targets “reducing stress and sickness absence”.
Will any of this succeed? In 2024, Finland made a simple change: the first day of sick leave is now unpaid. The result: in 2023, Finnish workers took an average of 5.2 weeks of sick leave a year; now, that has dropped to 4.8 weeks.
It’s not exactly a miracle cure. But it has helped convert other European governments to the cause.
Merz will be hoping his own reforms deliver a similar dose of economic therapy.
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