How frustrating is it when staff are regularly off sick for small bouts of really trivial things? The disruption it causes to the service, the impact on other staff, the ability to arrange cover… all of these are major headaches for practice managers everywhere.
Robyn Clark (aka JacksonR) and Susi O’Brien (HR Help advisor) hosted our lunchtime HR Clinic which focused on managing persistent short-term absence.
Here is a summary of the questions we received, and the answers given.
Let’s go over some basic principles first before we jump into the questions!
Firstly, we have to remember that all staff members are likely to go off sick at some point in their careers with us. And as employers, we always have to assume that the sickness is genuine (unless we are given pretty good evidence to suggest it isn’t!).
There is, within each organisation, what is deemed to be an acceptable level of absence. This is because we appreciate that not everyone stays well 100% of the time – especially these days with Covid flying about everywhere! So, all of our policies and targets do have an allowance for a certain level of absence. It’s down to you as individual employers to determine what is an acceptable level of absence for your practice.
Your strongest tool in tackling persistent short-term absence is active management – which means return-to-work interviews after every episode, having a policy that sets out clear expectations and manages staff who breach targets, proactive support for staff with health conditions, engagement with Occupational Health to address any barriers to coming to work, and a clear reporting policy for staff when they call in sick. These are all important elements of a good sickness management process.
What tools do you recommend using to manage regular incidents of absence?
There are a few systems you can use which I’m sure most of us are familiar with by now. You can start simple and just set targets based around the number of episodes of sickness or the number of days lost. This tends to work well for smaller practices as large numbers of episodes can have a major impact on service provision, so keeping it simple can be helpful. However, the simpler the method the easier it is to manipulate, which is something I expect most of you can relate to. It’s easy enough for a few chancers to think, “Okay, so I can have two episodes in six months and not trigger anything, and after those six months, I can have another one and still be okay.” This is where the other methods come in.
Most common to us in the NHS is the Bradford Factor system. This system basically calculates a score based on the number of absences and the total time lost to sickness. Your trigger points are then based on whatever score your organisation deems an acceptable level of absence to be. If you’re super savvy, your trigger points won’t rely on the Bradford Factor alone but will also have other factors considered in there. So, for example, you’d trigger on three absences in six months and/or a Bradford Factor score of 180. This is good as it makes the system harder to play.
The other one I would recommend, and my personal favourite, is percentage attendance. You can calculate an employee’s percentage attendance simply by checking the amount of time spent off sick against the amount of time being scheduled to work. Organisations usually deem anything between 94 and 96% attendance to be an acceptable level. If you have someone who is persistently off, and has managed to play the Bradford Factor and the episodes system (and these people do exist, trust me!), percentage attendance is always a good one to use, as they often don’t understand how it works. So, I like to use it alongside the Bradford Factor and the number of episodes. You’ll often discover some useful figures that can really demonstrate how much time is spent off sick – for example, if you’ve got someone who has, say, three absences in six months, but each absence lasts for about three weeks, their percentage attendance is going to plummet. What time period you reference is up to you, but it needs to be clearly outlined in your sickness policy. If you’re at the point where you’re considering dismissal for poor attendance, percentage attendance calculations are great for demonstrating an overall picture, and whether a picture is improving or getting worse. So, if you calculate it, say, over a three-year period, and then break it down into individual years, it can highlight a trend.
Can you explain how the Bradford Factor score works and how it should be applied? Is sickness counted within the leave year or should it be a rolling year?
So, it’s essentially multiplying the number of episodes squared by the number of days or hours lost (depending on how you want to work it). You then get a score, and if the score is higher than your trigger point, then they hit the next stage of your policy. Always do it within a rolling 12 months – otherwise people have a strange tendency to always go off sick in January…
How can I implement the Bradford Factor and my sickness policy in unison? Many staff are on six months’ full pay and in recent months, sick leave has become an issue.
Provided your sickness management policy isn’t contractual then you can amend it at any time you like. If you only monitor the number of episodes, for example, then just amend it to include the Bradford Factor as well. Pay is a different issue – so, if you want to amend pay entitlement, then you’ll need a consultation with staff and I’m fairly certain we have more questions on this later on, so I won’t go into too much detail just yet!
Employee has numerous short absences and under two years’ service.
Regardless of how long the employee has worked for you, unless they’re in their probationary period and your probation policy says otherwise, you should manage this as you would for any other employee. You need to be certain that there’s no underlying health condition here that could be linked to a disability, as the length of service won’t protect you from a discrimination claim.
Once again, proactive management is the key here. Are they on an improvement plan for their attendance? Have you been having return-to-work interviews after each episode of sickness? Do they need any additional support?
Is there the ability to alter T&Cs relating to sick pay – for example, only paying sick pay from the fourth day?
To alter anyone’s contractual terms and conditions will require a formal consultation. If the change affects more than 20 people, you must follow the statutory consultation process with set periods of notice before any change is implemented.
However, I would urge caution. Why are you looking to reduce entitlement? If it’s because the practice can’t afford it, then that’s a different kettle of fish, but if it’s to discourage people from going off sick then, in my view, this isn’t the way to go about it. What may result is staff who don’t regularly have time off sick feeling penalised for the actions of others – or what they might perceive as management’s inability to deal with the problem. This can lead to staff leaving to find better terms elsewhere, which wouldn’t be good news for you.
If this is the reason then, again, active management of the sickness is what’s needed. If you have people taking so much time off that it’s costing you more money than you can accommodate, then they need to be being escalated up the policy. You might look to tighten up the parameters of your sickness policy instead of reviewing pay entitlement, making it easier for people to trigger the next stage. Or you might seek to include another measure of attendance, as mentioned previously, to make it harder for staff to play the system.
I’m never a fan of changing a whole system to pick up issues caused by a minority; it doesn’t feel fair to me and it wouldn’t feel fair to the staff who are playing their part. However, if the problem is widespread then it would be a practice decision as to whether to move ahead, but formal consultation would still be required.
If we offer sick pay in the contract, such as two months’ full, one month’s half for long-term sickness, can we limit the number of ad hoc sickness episodes (1-2 days’ duration, for example) to a certain number of days in the year, e.g., max 5 ad hoc sick leave will be paid; anymore, and it can be taken as annual leave or unpaid?
Again, this would require a consultation and contractual change but there’s nothing to stop you from doing it in terms of the level of entitlement and the circumstances.
The only thing I would say is not to offer staff the opportunity to use annual leave to cover sick leave – annual leave is for respite. The risk of allowing this means they have less annual leave to take; they then get tired and overwhelmed and go off sick even more. You may also find staff abusing this as there’s no request process for sick leave, so if they want a particular day off and you say no, and they then go off sick and request to have it paid as annual leave, then they’ve essentially won!
If you’re sick, you’re sick – so, it’s whatever sick pay provisions you have in place that would apply.
How do you manage staff morale when they’ve been covering for a colleague off sick and the colleague is posting on Facebook what a great time they’re having when they’re off. The employee is signed off with low mood.
This is a question we get asked a lot.
First of all, you need to dispel the myth with your staff that when you’re off sick, you’re meant to be housebound, completely isolated and not doing anything remotely enjoyable. This isn’t true and it definitely wouldn’t be recommended by a doctor to help make the employee get better. I would say to my team, especially if they knew why the employee was signed off, that hopefully the employee is feeling better and will be able to come back to work soon.
I’d then follow it up with a conversation with the employee, because we still do need to address this, and we wouldn’t want there to be growing resentment in the team. I would explain that it’s good to see them looking better but I would ask them to be mindful of what they post online, as their colleagues who are at work are able to see it and it may not come across in the way it was intended.
I’d also then ask how things are going, and if they have any idea of when they’ll be back at work. Any opportunity to manage the absence should be taken!
Obviously, sometimes the things we see posted on social media are not in keeping with the reason for the employee being off sick.
We have a number of young single parents who are staff, and our biggest issue is when the child is ill – as this can be very regular.
Well, technically, this isn’t about short-term sickness because this only applies when it’s the employee who is sick. When the child is sick, this becomes an issue of time off for dependants. You should never allow an employee to take time off sick if they’re not ill themselves. Time off to care for a sick child falls under other policies, and depending on what those policies say, can either be paid, unpaid, or staff can be given the option to use annual leave or make the time up. It should never be recorded as sickness.
If you then find staff claiming they’re the ones who are ill, they run the risk of escalating themselves up your sickness policy.
I’d also make it clear to staff that they have to be honest about the reasons for their absence. I once took an employee to a hearing for persistent absences – all unrelated, self-limiting illnesses and there was no underlying health condition – and at the hearing, she claimed to the panel that actually the time off had been to look after her son and she hadn’t in fact been ill herself. I think she thought this would save her, but instead it actually reinforced the panel’s decision to dismiss. They highlighted to her that either way, her level of absence was unacceptable, and that she’d also effectively admitted to being in receipt of sick pay that she wouldn’t otherwise have been entitled to!
How can we manage the risks of the employee getting what they want, i.e., going into a long-term absence? Could we be more proactive in the management of the situation?
Absolutely! As I’ve mentioned before, when talking about long-term absence, early intervention is key. Regular contact at an agreed rate, early referral to Occupational Health if it looks like it could go long-term… these are all key in trying to reduce the amount of time that could be spent off sick.
I think we also need to remember not to make assumptions; not everyone wants to be off long-term. If that’s the impression you’re given, I’d be looking into why that is. Are staff taking their annual leave effectively so they get regular breaks from work? Is the workload really high and is there anything that can be done to mitigate that? Do staff feel supported when at work, and if not, how can you address that? The majority of staff are honest, hard-working people, and the real chancers are few and far between. How you manage them is key in tackling that sort of behaviour.
How do you manage someone who is off a lot but always for little things, like stomach bugs or viruses? I don’t feel there is much I can do to support them to improve their attendance.
If we bear in mind that, on average, we can expect staff to have around three or four short-term absences per year for conditions like this (especially now Covid is in the mix as well), we shouldn’t be overly concerned if absences are at this level.
However, if the level is much higher, and we’re talking about every month or every other month, then you do still have options. At your return-to-work meeting, I’d highlight the number of absences and the reasons for the absences to the employee, and ask them if there’s any link they can think of or any underlying health condition they might be aware of that could make them more susceptible to picking up bugs. Sometimes this can lead to a disclosure you weren’t aware of, or it might make the employee consider getting checked out. Sometimes it can highlight someone suffering from stress, which can make them more run down and therefore more susceptible to picking things up. Then you can consider referring them to Occupational Health for a medical opinion too.
This can help in one of two ways. If they’re taking the mick a bit, the fact that you’re willing to go to bat for them, have shown that you’re concerned and that you care, may make them pull their socks up and be a bit less likely to take time off sick in the future. The other option is that it might highlight a health problem they didn’t know they had, or they may open up to you about something they’re struggling with, in which case you can then provide support.
If you’ve done this and the episodes keep happening and there’s nothing to suggest there’s anything else going on, then you follow your usual process up to dismissal if necessary.
Do I have to make adjustments to sickness targets for disabled staff?
If they’re suffering from a disability that’s likely to cause them to have more absence than someone without a disability, then yes you should. This is one of the simplest reasonable adjustments you can make. However, it doesn’t mean that there should be no target for disabled staff, as that wouldn’t be reasonable. That would be like assuming you could run your service without that person ever being there, in which case why do you have the role in the first place?
So, an adjustment is just that – an extra allowance before the disabled employee would trigger any action. This should be set following discussion with the staff member, and ideally following an Occupational Health referral. You can just ask Occupational Health what they’d recommend and then discuss it with the employee to see if their recommendation can be accommodated. If it can’t, explain why, but try to come to some sort of compromise.
You can also make adjustments in the form of discounting episodes of absence related to their disability. I would advise caution, however, as this could lead to your not counting any absence at all, in which case the reasonable aspect may have been removed. Each case should be looked at individually, taking into account the condition and the employee’s previous sickness record as well as what the service can reasonably accommodate.
We have a staff member who is off a lot and we suspect they might have some kind of alcohol problem. Do you have any particular advice for dealing with this?
This is a tricky one. What I would advise every time is a supportive chat with the employee. You may have to highlight what makes you think there might be a problem, or use probing questions to see if they divulge anything themselves. I’ve had this before myself with an employee whose episodes always started on a Monday, and gossip from the staff implied that they were always out drinking on a Sunday. So, when it was time to have a meeting under our sickness policy, I highlighted the pattern of absence and asked if they had any understanding of why that was. I was able to probe a bit more and asked them if there was anything they were doing over the weekend that might impact on their ability to attend work. Now, this person wasn’t an alcoholic, just a binge-drinker, so the scenario was a bit different, but the end result was still a disclosure of what was going on.
Your next step is then to offer support. Alcoholism is a disease, and we manage staff in the same way as any other health problem; we see what we can do to help. And we encourage staff to help themselves. However, you also have to reiterate your policy on alcohol at work, to ensure the staff member is clear that they cannot come to work if they’re under the influence, and that to do so may lead to disciplinary action. Occupational Health can still help, and you may want to support them in finding a local service where they can get help.
Just a final point on this, alcoholism as a single condition is excluded from the definition of disability under the Equality Act. Therefore, the usual rules about making reasonable adjustments don’t apply. However, a condition that’s related to someone’s alcoholism such as depression or liver disease may still be considered a disability, so manage these situations carefully.
There’s a staff member who I’d like to discipline for sickness, but I’m worried we can’t do this because we’ve not done any previous return-to-work meetings (just too busy!). Am I best to leave it?
Well, first of all, what does your policy say? Does it say that return-to-work interviews have to happen after every episode? If not, then you could be okay, provided you’re confident the employee is aware of the policy and the potential repercussions for persistent absence.
However, if your policy indicates that these should have happened, then I would use caution. And it’s never too late to start, so make sure you hold them going forward! Within seven days of their return to work is best practice.
I’m a bloke but I manage a mostly female staff team who are sometimes off for reasons like periods or menopause. That makes return-to-work meetings really awkward. Would I be better asking a female partner to do these?
I did have to chuckle at this one! Who’s feeling awkward here? If the employee is willing and happy to have these discussions with you, then it shouldn’t be an issue. If it makes you feel awkward, then you may be in the wrong line of work! Whatever happens, just try not to muddy the waters or have the management process messed up by getting a partner involved! Regardless of the reason for sickness, your approach will always be the same in terms of listening, acknowledging, supporting and reinforcing your policy. You might find you benefit from some additional training in supporting staff with these issues, and I’d highly recommend having a menopause policy for your workplace given your largely female team.
I have a clinician who cancels sessions in the morning for menopausal issues. How do we tackle this? It’s been going on for quite a few years!
The same as any other health condition – an Occupational Health referral for advice (and make it a good referral; ask the right questions!). Then meet the staff member to discuss the report and the impact of their condition on their attendance. You can still manage their attendance in the same way as any other staff member and implement your policy. Just be mindful that you may need to adjust targets if the menopause has lasted long enough to potentially be classed as a disability.
I know it’s my job to manage absence, but I find it incredibly hard in cases where I know the absences are genuine and the member of staff doesn’t deserve to get sanctioned. One person who I used to get on well with took it badly, for example, and it changed our relationship. And that’s not the kind of manager I want to be. How do others do it?
I totally get where you’re coming from, but it is a necessary evil. So, here are a few points to remember.
Every absence is genuine in our eyes, remember? So, it shouldn’t matter whether you think someone is taking the mick or if they’re definitely really poorly – they’re all genuine.
Your role is to support the employee and safeguard the business. You can’t run a service on absent staff – and when staff are off, it’s the patients and their colleagues who suffer. Is it fair for that to happen as opposed to having to manage the absence?
I’m really opposed to “disciplining” people for sickness, or “sanctioning” them. I don’t use this sort of wording in my policy or in my practice. If you trigger a stage of my sickness policy, you’re not given a warning; you’re given an improvement plan. Changing the language around it, I find, has helped a lot to maintain relationships with staff after these meetings. They’re made to understand that there has to be a process in place because we can’t sustain a lot of absence, but that my aim is to support them to be able to attend work. I reinforce that it’s not personal, and I don’t doubt for a second that the absence is genuine, but the policy is in place because we can’t run a service if we have high levels of absence.
The potential consequences are still the same; if you fail to meet the targets of your improvement plan, you move to the next stage and eventually you may be dismissed. But it’s rare for people to trigger that final stage – most actually do manage to meet the improvement plan.
One of my staff has a final written warning for lateness and they’ve now triggered our absence procedure as well. Can I dismiss?
In short, no! These are two separate policies and if you attended our last HR clinic on disciplinary, you’ll know that you can’t mix and match! So, if they’ve triggered the absence procedure, then you have the meeting as normal and follow that policy separately.
How do I manage someone who has persistent absence and then when the policy kicks in, improves for a while? Very frustrating!
I think we’ve covered this one already to an extent. Make your policy harder to play games with. You also have the option of adding an element of “exceptional circumstances” to it – so, for example, “Should an employee’s absence become a significant cause for concern, the practice reserves the right to take a view on escalation to a higher stage of the policy or to set amended targets”.
This would allow you to meet the employee and highlight the pattern of absence you’ve noted, and then set an amended target or put them back on a higher stage of your policy. But you must ensure it’s recorded!
A Bradford Factor question: what do I do when an absence covers the start of the 12 months? For example, off 3rd Feb 2021 to 27th Feb 2021, then off again 15th Feb 2022 for 2 days. And do I use the start or end of the absence?
I always include any absence – in its entirety – that falls within 12 months prior to the START of this latest absence. So, in your example, I would include the whole of the Feb 2021 absence in my calculation. There isn’t an onus on us to work it all out to the smallest detail. If it was an episode – and part of the calculation relates specifically to episodes – then I’m including all the days lost in it.
What if staff are always off around the same time each year, e.g., Christmas, summer holidays, etc?
This is what we’d call a pattern of absence, and the first thing I’d do is call it out for that. At the return-to-work interview, highlight the pattern and ask them if there’s anything contributing to this. Quite often, once you’ve shown that you’re keeping an eye on it, the pattern will stop. If not, highlight that you expect to see an improvement and that you may consider escalation in your policy if it continues.
How long do they need to be off for it to be classed as long-term sickness and to trigger an Occupational Health referral?
Four weeks/a month is what we would normally class as a long-term episode. You can send a referral off, though, as soon as you become aware that it’s likely to become longer term – for example, if an employee has been signed off for two weeks and after the second week presents you with a new sick note for a further two weeks. Obviously, for things like operations or broken bones, where there’s a set recovery time, this may not be necessary.
Are you able to share a watertight sickness policy?
There’s a template available on Practice Index Plus if you’re a member: Sickness absence management policy [PLUS]. But you can adapt this however you like, depending on what tools or mechanisms you want to implement to manage absence, so feel free to amend it! If you’re a Plus member, you can also access the HR Advice Line if you’re unsure of anything.
Do you have a policy for managing staff with disabilities?
No, and I’ll tell you why! Disabilities are far too individual for one policy to cover everything you’d want it to consider. What you should do instead is review your existing policies and have a paragraph highlighting what you’d do in the event of having a staff member with a disability. This should form part of the equality impact assessment that you carry out on your policies. So, for example, in my sickness policy, I just have a paragraph stating that reasonable adjustments will be considered for staff with disabilities – either in the form of adjusted sickness targets, or in relation to the role/working environment where this would support a disabled employee’s attendance at work.
Links to useful documents
Sickness absence management policy [PLUS]
Sickness absence policy (reporting procedure and rules) [PLUS]
Managing sickness absence templates [PLUS]
Notification to maintain contact during sickness absence [PLUS]
Menopause in the workplace policy [PLUS]
Time off for dependants policy [PLUS]
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