Managing Health at Work Partnership Information Network (PIN) Guideline

MANAGING HEALTH AT WORK

Guideline 2 Promoting attendance

2.1 Introduction

The greatest resource of NHSScotland is its staff, because it is through them that services are delivered and improved. Staff salaries are the single greatest cost to the NHSScotland budget, and promoting attendance is crucial in the development of an efficient service which has, at its core, the wellbeing of its staff.

This document aims to give all those working in the service (managers or those being managed) clear guidance on the issues relating to promoting a healthy workplace and promoting staff health and attendance.

The PIN guidelines on 'Management of Employee Capability' and 'Management of Employee Conduct' should also be referred to for guidance on the management of health problems.

2.2 Principles and values

NHSScotland is seeking to create and build up a working culture in which regular attendance at work is normal. It will help if we can introduce:

• effective monitoring and management procedures to identify situations where a staff member's attendance is falling below agreed standards; and

• a way of dealing with the circumstances in a sympathetic and fair way, achieving the right balance between managing absence efficiently and providing support and help to a staff member who has health problems or is experiencing personal difficulties.

Attendance levels provide a picture of staff wellbeing, levels of morale and health and safety management performance. Monitoring attendance levels is an important tool in assessing these factors and in deciding where action is needed.

The importance of communication in creating such a working culture cannot be underestimated. Ensuring staff awareness of the importance of attendance is an essential prerequisite to everything that follows in this guideline.

The objectives of this policy will only be achieved if a proactive, consistent and effective approach is adopted throughout NHSScotland. This approach relies on:

• keeping to relevant legislation;

• involving important groups such as the occupational health service (OHS); and

• providing guidance and support to staff, managers and Trade Unions/Professional Organisations.

2.3 The need for this policy

The purpose of a Promoting Attendance policy is to improve and support the health and wellbeing of staff at work and to reduce the level of sickness absence. The policy will also encourage and enable the adoption and implementation of best practice in relation to the promotion of health and wellbeing at work.

The current sickness absence rate for NHSScotland is estimated to be between 4.8% (10.9 working days for each staff member each year) (CIPD, 2001) and 9.9% (Cabinet Office). Both these figures are above the national average for sickness absence, which for 1998 was 3.7% (CBI, 2001).

2.4 The policy aim

The aim of a Promoting Attendance policy is to help NHSScotland organisations make the most of attendance by reducing short- and long-term absence through promoting positive attitudes to work and trying to reduce staff ill health as far as possible. However, it is important to remember that "owing to the very nature of a 'healthcare environment', the issues surrounding sickness absence need to be set in their own particular context" (HEA).

Specifically, a Promoting Attendance policy aims to:

• enable the delivery of consistently high-quality services by achieving the best possible levels of staff attendance at work;

• provide procedures - communicated to and understood by all staff - which make sure that everyone is dealt with fairly and consistently;

• keep to the law, such as the Disability Discrimination Act (to make sure that reasonable adjustments to duties are made, or other suitable employment is offered through redeployment where necessary), and meet legal requirements relating to staff consent to the appropriate handling of sensitive personal data;

• make sure that managers communicate regularly and openly with staff, and where possible, offer appropriate support and help to get them back to work (see the "Carrying out the Return to Work discussion" checklist at Appendix 2.E);

• make resources and support available to staff with health problems through the OHS, staff support services and other specialist agencies;

• use other sources of support, for example, the Employment Service if retraining or redeployment is appropriate;

• make sure that the organisation's employment policies are based on good practice;

• improve staff retention and prevent discrimination;

• encourage staff to adopt a healthy lifestyle;

• help managers to monitor attendance levels effectively by setting up systems which provide relevant and up-to-date information; and

• give all staff the opportunity to be represented at all stages in the proceedings by a staff representative, colleague or friend.

2.5 Putting the policy into practice

The main principles:

• Each part of NHSScotland must examine its own values, in terms of organisational behaviour, culture and ethos.

• If there are obvious health problems of a physical or mental-health nature, the organisation should use an approach which is consistent, fair, sympathetic and caring.

• In order to make the procedures fair and consistent, managers must make sure that they collect enough information on the nature and extent of the health problem in order to make a reasonable decision in each case. This involves setting up an effective communication system with staff and getting professional advice from OHS if necessary.

At all stages in this process:

• there should be confidentiality;

• staff should have the opportunity to discuss the main issues and be able to contribute to possible solutions;

• managers should get advice and support from Human Resources (HR); and

• the staff member should have the opportunity to be accompanied by a colleague or representative from a Trade Union/Professional Organisation.

2.6 Definitions used within the policy

2.6.1 Sickness absence

This occurs when ill health, including disability, makes a person unfit to work. It also occurs when a doctor advises an individual to stay away from work due to illness, convalescence or the possibility of being contagious. (This is also covered in the 'Management of Employee Capability' PIN Guideline.)

2.6.2 Short-term absence

Short-term absence is the period of time covered by a self-certificate (up to and including seven working days). This type of absence does not normally have a set pattern and is usually caused by minor, in most cases unconnected, ailments.

2.6.3 Frequent short-term absence

This is where an employee has a number of short-term absences, which may or may not be related, and may be certified or uncertified.

2.6.4 Long-term absence

Long-term absence is the period of time covered by a doctor's certificate (over seven working days).

The precise definition of long-term absence is best decided locally in discussion with partnership forums.

2.6.5 Unauthorised absence

This occurs when a staff member's absence:

• is not supported by medical evidence;

• has not previously been reported;

• has not been authorised by the appropriate level of management; or

• has not been communicated to the employer using the correct procedure (see Annex 2 of Appendix 2.D).

2.7 Procedures for putting the policy into practice

2.7.1 Promoting the policy

• All existing and new staff members should be made aware of the policy, and all staff must have access to the policy in their place of work. Organisational and departmental induction programmes are an effective way of doing this.

• Line managers must make sure that their staff know about any local reporting procedures.

2.7.2 Recording and monitoring

• NHSScotland organisations have a responsibility to set up proper systems for recording and monitoring attendance. A standard format for recording absences across the organisation is necessary to ensure consistency. The Minimum Dataset provides a framework for doing this.

• Reasons for recording and monitoring attendance include:

  • meeting the requirements of the Statutory Sick Pay provision and Occupational Sickness Allowance;

  • identifying attendance patterns, and frequency and length of absences;

  • helping to detect problems early, so leading to speedier management or medical responses; and

  • helping to decide whether the absence is a 'capability' or 'disciplinary' matter.

• Managers must make sure that a record is made of any meetings that they have with staff members to make clear the conversation that took place and the support that was offered.

2.7.3 'Trigger points'

It is important that managers have clear 'trigger points' in place for reviewing sickness absence. These 'triggers' may include:

• frequent short-term sickness absence;

• absence that is not satisfactorily explained;

• absence linked to certain shift patterns; and

• absence linked to certain days or times.

A suggestion for a 'trigger' would be four episodes, or more than eight days' short-term sickness absence within a 12-month period, which a manager will identify through the local absence recording mechanism. However, this standard is for local determination.

Absence patterns linked to the working environment may highlight a range of problems resulting in high or regular patterns of absence. A major factor in these circumstances is that of work-related stress (see separate guideline).

2.7.4 Reporting absence

On day one	Staff members must tell the appropriate manager or supervisor about their absence as early as possible. This may be varied within departments depending on local agreements.
More than three and up to and including seven working days	The staff member must fill in a sickness absence self-certificate form on their return to work.
More than seven calendar days	A medical certificate from a General Practitioner is required. If a staff member does not return to work when the certificate ends, then further consecutive certificates must be provided. A final medical certificate confirming fitness to resume duties must be sent in before or on the day s/he returns to work.

If a staff member becomes unwell during the working day they must speak to the appropriate manager before leaving work. However, if the person suffers a needlestick injury, s/he must go to the nearest Accident and Emergency Department or OHS as soon as possible.

2.7.5 What if there is no obvious health problem?

If there is no underlying medical reason for the absence, the manager must advise the staff member that the situation is unsatisfactory. Where there is any doubt about a person's fitness for work, help and advice should be sought from OHS. At the same time, s/he should stress the importance of regular attendance at work and reaffirm the organisational and departmental standards of attendance.

In cases where circumstances and investigation indicate a more serious situation, it may be necessary to formally set appropriate standards for attendance which are consistent with the organisational policy. The manager should meet with the staff member to let him or her know that:

• the level of attendance must improve;

• the level of attendance will be closely monitored;

• this monitoring will continue for an appropriate period of time according to individual circumstances; and

• if there has been no improvement in their level of attendance at the end of the monitoring period, the situation may be looked at under the 'Management of Employee Conduct' policy.

2.7.6 What if the absence is caused by a work-related or personal problem?

All staff have a responsibility to tell their manager if their absence is attributable to their work, to allow the organisation to comply with RIDDOR requirements. In these circumstances assistance should be offered to the staff member to help them overcome the problem. Help could include temporarily altering their shift pattern or granting compassionate leave if this is felt necessary. In these circumstances the staff member must continually update their manager, who will monitor and re-assess the support mechanisms as necessary. Throughout such situations, the manager should make the staff member aware of OHS and the staff counselling service, and explain how these services can be accessed.

2.7.7 The importance of maintaining contact

During any periods of extended sickness absence, contact between the manager and the staff member is particularly important. The purpose of the contact is to:

• reflect the genuine concern of a caring employer;

• find out the nature and progress of the illness and recovery;

• make sure the staff member knows they must supply medical certificates; and

• explain and try to provide any support that may improve the staff member's health.

It is important that managers apply a sensitive, consistent approach when reviewing individual circumstances in order to prevent anyone from feeling that particular members of staff are being singled out for special treatment.

The method and frequency of contact will depend on the circumstances surrounding the absence. Contact can be by phone, letter, and (especially important in cases of long-term sickness absence) meetings at the workplace or at the staff member's home.

If a meeting is to be held, the staff member should be asked if they wish to be accompanied. A representative from HR may also attend to give advice to the manager and the staff member. It is important that such meetings are handled sensitively and that the staff member is assured that the meeting does not represent any kind of disciplinary procedure.

2.8 Return to work

After any period of absence a staff member's return to work should be acknowledged. In many cases, this will be no more than a courteous enquiry as to whether the staff member is now well, and this may take place over the phone, or be delegated to another manager or supervisor as appropriate. In other cases, there may need to be an informal meeting, the purpose of which is to:

• discuss the reasons for absence;

• assess the individual's fitness for work;

• decide if the cause of the absence may recur; and

• arrange for a referral to OHS if necessary.

At this meeting the staff member should be given the opportunity to raise any issues they have about their absence and to get help from the organisation.

This discussion may cover some or all of the following, depending on the circumstances of each case (see the 'Carrying out the Return to Work discussion' checklist at Appendix 2.E.).

• Welcome the staff member back to work and provide a work update.

• Ask after their health.

• Make sure that the staff member fills in a self-certificate or provides a medical certificate.

• If attendance levels suggest that there may be an underlying health problem, discuss referring them to OHS.

• If the pattern or frequency of absence is causing concern, you should let the staff member know, explaining what the organisation considers to be a reasonable standard of attendance and what may happen if this is not met.

• Offer support, guidance and advice to help the staff member to attend more regularly, for example, a temporary change in hours or duties, training, etc.

• Set up a regular review process, set attendance standards and offer compassionate or unpaid leave if this is appropriate.

• Any cases involving alcohol, drug or substance misuse should be addressed under the procedure set out in the appropriate policy (see separate guideline).

• Encourage involvement and commitment to solutions.

If a discussion is necessary, this should not be confrontational in any way. It should rather be an investigation into any underlying problems - medical, work-based or domestic - which may be affecting attendance. The staff member has the opportunity to be accompanied by a staff colleague or representative. If the reasons for absence are personal or sensitive, the staff member may prefer to talk to someone outside the immediate situation, such as OHS or the staff counselling service.

These discussions should form part of local training on promoting attendance issues.

2.9 Referring staff to OHS

2.9.1 Self-referral

Staff should be made aware that they can self-refer to the OHS for any health-related matter, particularly if it relates to, or is affecting their work. No communication to any third party should result from a self-referral unless the member of staff concerned requests it.

2.9.2 Management referral

Managers can refer staff to the OHS in order to provide assistance to a staff member on a health-related matter, or to enable the OHS to provide the manager with advice about the staff member's health in relation to their work. Managers may need to use a template management referral form if this is provided by their local OHS.

Such referrals must be done with the informed consent of the staff member, and this must be sought on each occasion a referral is initiated. It is essential that such a referral is not portrayed as a punishment, and that the reasons for it are fully explained to the staff member. The reason for referral should be clearly set out in the referral document along with any specific issues on which the manger wishes to receive advice. In general, the types of issues about which questions might be asked include:

• whether there is an underlying medical problem which could affect performance;

• the prognosis and likely effect on fitness for work;

• restrictions to, or adaptations needed for, work;

• the need for, and nature of, a programme of support;

• recommendations for rehabilitation into work; and

• ill-health retirement issues, if relevant.

2.10 Assessing risk

NHSScotland organisations must fully meet their responsibilities as laid down in health and safety law. This includes, where appropriate, carrying out a risk assessment before a staff member returns to work.

2.11 Phased return to work and adjustments

When a staff member is fit to return to work but cannot carry out their full range of duties (either in the short or longer term), every effort should be made to give them the opportunity for an earlier return to work. This might include reducing or amending their range of duties.

To comply with the Disability Discrimination Act 1995, the Disability Rights Commission recommends that organisations:

"take any steps which it is reasonable for it to have to take, to reduce or remove any substantial disadvantage which a physical feature of the premises or of the organisation's employment arrangements causes a disabled member of staff compared to a non-disabled person". In short, reasonable adjustments to a staff member's job can include:

• changes to duties, shifts or hours;

• changing the place of work; and

• making adjustments to the features of a building or access to it, including its fixtures, fittings and design,

although this list is not definitive. Adjustments should only be made after:

• receiving the advice and recommendations of OHS;

• discussing the matter with the member of staff; and

• carrying out a review of their skills and abilities and the likely needs of the service.

A clear written programme, including timescales and review period, must be agreed with the manager and staff member before any return to work can take place. HR advice should be sought on any agreed variation to contract and pay policy, to make sure that local policy is applied consistently. The use of flexible working arrangements and family friendly policies is encouraged.

Assistance is available from the Disability Employment Advisers based within job centres and other agencies. They can support the staff member and the workplace with respect to carrying out needs assessments, and they can advise on any equipment and modifications that might be required for the working environment.

2.12 Redeployment

If a staff member has been identified as unfit to return to their current post, the organisation must, within reason, offer other suitable employment (Disability Discrimination Act 1995), although a job does not have to be created. The line manager should fully discuss with the staff member and HR all the options for redeployment.

Redeployment may mean changing career direction and must include the assessment and identification of the person's training needs. This may include providing training opportunities from:

• within NHSScotland;

• the Employment Service Work Preparation Scheme;

• disability employment advisers; and

• other appropriate agencies.

2.13 Ending employment and retirement

The option to terminate employment on the grounds of incapacity due to ill health should only be considered when all options for reasonable adjustment or redeployment have been fully investigated and exhausted.

If a member is staff is superannuated, advice should be provided in relation to applying for premature retirement on the grounds of permanent ill health. Information on this is contained in the Scottish Public Pensions Agency "Guide to the Scheme for NHS Employees in Scotland". There are qualifying criteria and appropriate forms to complete, and assistance from HR should be offered to help staff fill in such application forms.

Information should also be given on 'Injury Benefits' payable where an accident (or disease) occurs in the course of work. Advice is available in the same SPPA Guide. These benefits apply even if an individual is not superannuated.

In considering termination of employment on the grounds of ill health, the employer must demonstrate that it has;

• taken account of written advice from OHS recommending this;

• consulted with the staff member and discussed the position with them;

• made a thorough investigation of the medical and other facts;

• balanced the staff member's likely future health against the organisation's needs;

• considered offering the staff member other employment; and

• fully explored other employment options and found these to be unavailable or not practical.

The decision to terminate employment on the grounds of ill health or capability must always be based on medical factors, and is not directly linked to the staff member's pay situation.

If termination of employment is the only available option, the staff member should be invited in writing to attend a meeting to discuss the termination of their employment on grounds of incapacity due to ill health. HR should support this process at the earliest possible opportunity. The staff member must be offered the opportunity to be accompanied by a representative (which can include a colleague or friend not acting in a legal capacity) at this meeting.

The meeting should be handled in a sympathetic and understanding way, making sure that the staff member is given time to discuss their point of view and that they have a clear understanding of the outcome. They should also be offered the opportunity to meet again if they would find it helpful to have some days thinking time to weigh up the options.

In accordance with local arrangements for delegated responsibility for dismissal and related procedures, HR will support the Head of Department to write to the staff member confirming the termination date, taking into account the relevant period of notice. The letter should also set out the staff member's right to appeal against the decision.

2.14 Responsibilities

In putting the Promoting Attendance policy into practice it is vital that all those involved are fully aware of their roles and responsibilities, as defined below.

2.14.1 All staff must:

• attend work regularly;

• keep to their local Absence Reporting procedure ( see Annex 2 of Appendix 2.D) by letting their appropriate manager know as soon as possible about any absences, and to produce medical certificates (as necessary); and

• maintain regular contact with their manager and let them know about their absence, length of time off and return to work date.

Even if they are referred to OHS by their manager, a staff member cannot be forced to attend OHS appointments. However, it is in their best interests to do so. Their manager will act on the information available to him/her, even if this is of a limited nature because the staff member has not kept their OHS appointment.

2.14.2 Line managers must:

• take responsibility for promoting attendance, using information on attendance in a way which will improve attendance levels, reduce absence costs and encourage staff to aim for high attendance levels;

• use the Promoting Attendance policy and its procedures fairly and consistently, taking account of individual circumstances and the staff member's right to confidentiality in relation to their absence;

• make sure that all staff know about the policy and local procedures for reporting absences;

• be available to staff who have problems, whether health, emotional or personal, and be receptive, sympathetic and flexible in dealing with these problems, always letting staff know about the availability of the staff support services;

• maintain open communication with staff, letting them know about the promoting attendance procedures and the implications for their personal situation at all stages;

• manage health and safety in the workplace, carrying out risk assessments of work activities to prevent and reduce health problems as far as possible;

• take part in training related to promoting attendance within the organisation and make sure that staff involved in promoting attendance also receive training;

• make sure all records and documents in relation to managing absence are kept in line with the Data Protection Act 1998; and

• get advice and help from HR, OHS, Health and Safety, the Employment Service and the Disability Employment Advisor when appropriate.

2.14.3 The Trade Unions/Professional Organisations must:

• act, at all times, in line with the role and responsibilities set out in the organisation's Partnership Agreement; and

• take part in training connected to promoting attendance within the organisation.

2.14.4 HR must:

• provide support and guidance to managers, staff members and Trade Unions/Professional Organisations when interpreting the Promoting Attendance policy and procedures;

• train and develop the skills of managers and Trade Unions/Professional Organisations to allow the policy and procedures to be put into practice effectively;

• provide support and expert and independent advice at attendance meetings; and

• make sure that the Promoting Attendance policy and procedures are consistently followed throughout the organisation.

2.14.5 OHS must:

• provide clear advice to line managers and staff on the effect health problems have on the working environment and the effects of work on health;

• help manage the absence process by working with GPs and other agencies to make sure that all relevant and appropriate information is available concerning a staff member's health;

• become involved in the earliest stages of staff absence to reduce the length of absence as far as possible and help the staff member return to work, acknowledging that this may depend on how soon a management- or self-referral is made; and

• encourage and take part in discussions about health problems and their causes, and work with managers to identify and put appropriate solutions into place by:

  • telling managers about any ways in which a staff member's medical condition might limit their ability to perform their normal duties;

  • advising managers on the length of time the staff member's ability to perform their normal duties might be limited once they have returned to work;

  • advising managers on the employment implications of any continuing disability, including recommendations on adjustments to their work, redeployment and legislative obligations; and

  • advising on when and how the Employment Service, and in certain circumstances disability employment advisors, should be involved.