Learn how to measure sickness absence, the main components of an absence policy, and how to address short- and long-term absence in an organisation.
No one piece of legislation deals exclusively with absence management. However, numerous pieces of legislation have an impact on this area. For more information see our Absence procedures Q&As. Some absence is inevitable, but motivation and job satisfaction is crucial to minimising short term absences. Information on Absence Management relating to COVID-19, including FAQs, is available from our COVID-19 hub.
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Q: How should we handle any cases of monkey pox with regards to self-isolation and pay?
Currently only a small number of employers will need to manage employees who have contracted monkey pox. However, both employers and employees are now far more vigilant about taking measures to prevent infections from spreading. Organisations that do encounter cases can use similar precautionary measures to those developed during COVID-19.
It’s important to note that the disease is dramatically less contagious than COVID-19 and is a pre-existing virus with available treatments. The overall risk to the public is low and the disease is usually mild only causing severe illness in some cases.
If employers do encounter monkey pox cases in the workforce, they should follow UK Health Security Agency advice which is for the infected person to self-isolate for 21 days, and to avoid the workplace. People who have had high risk contact with a case (that means direct unprotected contact) are also advised to self-isolate for 21 days. Examples of high-risk contacts include household contacts and sexual contacts. Medium risk contacts include passengers seated directly next to a monkey pox case on a flight or those who shared a car or taxi. Low risk are those with no physical contact, and unlikely droplet exposure such as a community contact within 1 to 3 metres of a symptomatic case.
The UK Government guidance for contact tracing states that contacts should particularly avoid immunosuppressed people, pregnant women, and children aged under 12 where possible.
Symptoms of monkey pox include a blister like rash. Individuals should avoid close contact with others and seek medical advice if they develop this rash as they are infectious from the first symptoms until all the scabs fall off. During this time close contact with others must be avoided. Other symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. The virus also spreads from touching clothing, bedding or towels used by someone with the monkeypox rash, and through coughs and sneezes.
Employees or workers are entitled to Statutory Sick Pay (SSP) if they are unwell with monkey pox. If they are in self-isolation as a high risk contact, but are not unwell, they should work from home if possible. If they can’t work from home, staff who are well but are isolating are not entitled to SSP. However, an employer can update their sickness policy to pay voluntary sick pay at the same rate as SSP or a higher rate during isolation periods if they so choose.
Employers should take care not to discriminate; obviously any practice or policy adopted in the workplace should be applied equally to all staff.
Employers should keep up to date with UK Government guidance on the symptoms, diagnosis and management of monkeypox virus infections and on contact tracing.
It is important to fully understand the extent of a sickness absence problem in order to manage it. Employers need to distinguish between lateness, short-term absences and long-term absences.
Where the absence consists of lateness or short but persistent and apparently unconnected absences then, after suitable investigation, disciplinary action may be appropriate in some cases. For information on disciplinary and grievance procedures see our Q&As on Discipline and grievance procedures.
The key steps in pro-actively managing short-term absence are:
- Investigate the level, causes and reasons for absence.
- Carefully monitor trends in the workplace. Keep records with accurate information and statistics to fully understand the pattern and reasons for absences.
- If employees are needed at specific times of the year, ensure their contracts of employment provide for this and the required working period is communicated clearly to all those involved in advance.
- Take a sensible view of minor unauthorised absences.
- Discuss any recurring absence problems with the employees concerned. Consider the use of return-to-work interviews and completion of self-certification forms even for one day of absence.
- Consider praise and financial rewards for employees with the best attendance rates.
- Authorise reasonable absences to cover medical appointments. All pregnant employees, regardless of service, are entitled to reasonable, paid time-off for ante-natal care (prospective fathers or the mother's partner can also have time off to accompany the mother on to up to two ante-natal appointments).
- Allow for authorised absence whenever appropriate to cover specific religious observances.
- Consider requesting a medical report to establish if there is any underlying medical condition behind the level of absence; an employee may have a hidden condition which risks the possibility of disability discrimination.
- Work with employees in connection with their GPs' advice to help the employee get back to work where appropriate.
- If there are grounds to suspect that the employee’s reasons for the absence are not genuine, investigate carefully, discuss the issue with the employee, pursue formal disciplinary action where appropriate, including written warnings and compliance with the organisation’s own procedure and the Acas Code of practice on disciplinary and grievance procedures.
- Disciplinary action in accordance with the organisation’s procedure, the Acas Code and in compliance with any provisions relating to disciplinary issues in the employee's employment contract, may be appropriate, but always treat each case on its merits. For example, if the absences were due to domestic problems now resolved, it is unlikely that the level of absence will continue, so is it appropriate to discipline?
- Consider what can be done to assist employees with personal or family problems - would counselling help?
- If there are medical reasons for the absence, consider any links to the disability discrimination provisions of the Equality Act 2010. For example, does the absence relate to hospital appointments or treatment required? If this is the case, the Act requires an employer to make reasonable adjustments which includes allowing time off for treatment.
- If the employee has a recognised illness or medical condition that is not a disability but their absence rate is unacceptably high, it may be possible to dismiss fairly for some other substantial reason after following due process. The employee's length of service and the availability of suitable alternative employment are relevant factors to consider before reaching a decision.
Employers should allow reasonable absences to cover medical appointments, including ante-natal care. All pregnant employees, regardless of service, are entitled to reasonable, paid time-off for ante-natal care (prospective fathers or the mother's partner can also have time off to accompany the mother on to up to two ante-natal appointments).
Employers should also Allow allow for authorised absence whenever appropriate to cover specific religious observances of minority groups.
If this occurs, employers should consider requesting a medical report to establish if there is any underlying medical condition to support the level of absence; there may be a hidden condition which may not be immediately apparent and this risks disability discrimination.
Employers should work with employees, in conjunction with GPs' advice, to help them get back to work where appropriate. If there are no good medical reasons for the absences, the employee should be counselled, told what improvement is expected, and warned what the consequences will be if none is seen.
If there are grounds to suspect that the employee’s reasons for the absence are not genuine, employers should investigate carefully, discuss the issue with the employee, and pursue formal disciplinary action where appropriate, including written warnings and compliance with the organisation’s own procedure and the Acas Code of practice on disciplinary and grievance procedures .
Disciplinary action, in accordance with the organisation’s procedures, the Acas Code and in compliance with any provisions relating to disciplinary issues in the employee's employment contract, may be appropriate, but always treat each case on its merits. For example, if absences were due to domestic problems now resolved, it is unlikely that the level of absence will continue, so consider whether it is appropriate to discipline the individual.
There may also be a need to assist employees with personal or family problems, for example, by providing access to counselling.
If there are medical reasons for the absences, employers should consider any links to the disability discrimination provisions of the Equality Act 2010. For example, does the absence relate to hospital appointments or treatment required? If this is the case, the Act requires an employer to make reasonable adjustments which includes allowing time off for treatment.
If the employee has a recognised illness or medical condition that is not a disability, but their absence rate is unacceptably high, it may be possible to dismiss them fairly for ‘some other substantial reason’ after following due process. The employee's length of service and the availability of suitable alternative employment are relevant factors to consider before reaching a decision.
Long-term sickness absence
Managing long-term sickness absence is a difficult process and has the potential to result in claims for unfair dismissal, disability discrimination, stress related personal injury, breach of contract or a payment to settle such claims.
Long-term absence is nearly always the result of physical or mental ill health. High absenteeism or large staff turnover, frequent interpersonal conflicts or complaints by workers are signs that may also indicate a problem of work-related stress. Large organisations may be able to address these problems through more flexible working policies. Employers should carefully monitor trends in the workplace. As with all types of absence, it is important to keep records with accurate information and statistics to fully understand the pattern and reasons for absences.
In smaller organisations there may be a real need to replace the employee but this must be handled cautiously and by following both the company's own capability, disciplinary and dismissal procedures and the Acas Code of practice on disciplinary and grievance procedures. The issues to be considered during the process and in meetings with the employee include:
- Just how much damage is being caused by this absence?
- How long will the absence continue?
- What was the employee’s GP's initial advice on the fit note and what is the GP's, or the organisation's doctor's, prognosis now?
- Will there be a full recovery or will a return to the same work be imprudent?
- Is alternative work available, with re-training if necessary?
- How long has the employee been working for the organisation?
- Have all possibilities been discussed with the employee and their representative?
Employers often wonder if it is appropriate to contact employees when they are off sick. If reasonable contact is kept with an absent employee this may facilitate a return to work as soon as the employee has recovered. Evidence suggests that early intervention and support is likely to assist in a return to work at an appropriate time as part of the recovery process. However, an employee may feel harassed or bullied by their employer if contact is made too often. In order to maintain contact as part of a pro-active absence management procedure the following points should be borne in mind:
- The sickness absence procedure should govern how often the employer contacts an employee on sick leave.
- Medical advice should be obtained in appropriate cases and the organisation’s policy should explain this.
- Employers should be appropriately pro-active in keeping in touch with employees throughout their absence.
- The sickness absence procedure should specify that employees must maintain reasonable contact with the company during absences. If employees know what to expect, they will not think that the company is harassing them by maintaining regular contact.
- Employers need to be tactful, sensitive and use common sense. Some employees may resent the intrusion (or be genuinely too ill to come to the telephone); others may feel abandoned if the employer never gets in touch at all.
- Line managers should be the main point of continuity and contact for an employee telephoning in sick.
- In some cases, home visits may be appropriate.
- Matters to discuss with the employee include referrals for medical reports and if any temporary adjustments would help the employee return to work.
- Employers should be up to date with the disability discrimination legislation and make reasonable adjustments where appropriate.
Self-certification forms and SSP
Statutory Sick Pay (SSP): The statutory sick pay (SSP) system envisages that employees will complete self-certification forms for the first seven days of absence and that employers should not normally ask for medical evidence for this initial period (but see COVID-19 note above for temporary changes). Weekends and bank holidays (when the employee may not normally work) are included when counting the seven days.
As explained below, statutory sick pay only applies for absences of four days or more, so only part of the first seven days absence are paid, unless the employer adopts a more generous policy.
Self-certification forms usually include details such as:
- information about the sickness or illness
- the date the sickness started and ended.
(see the government's Employee's statement of sickness form to claim SSP)
Contractual sick pay
If an employer pays contractual sick pay, or if an employee is frequently sick, some employers request medical evidence during those first seven days of sickness absence. An employer’s policy on sick leave should specify how many days' sick leave applies before proof of illness, or a fit note, is required.
If employers request a fit note for absences of seven days or fewer, the GP’s practice may charge to provide a fit note and it is usually the employer’s responsibility to pay for this.
For more than seven days' absence, employers will usually ask for evidence, or proof of the illness, by suggesting employees obtain a fit note from their GP.
If an employee is under the care of a hospital, the fit note may be issued by the hospital, rather than a GP.
There should not be a charge from an NHS doctor for providing a fit note if an employee is off work sick for more than seven days.
SSP is payable for any sickness absence of four days or more provided the employee meets the qualifying conditions. Difficulties may arise where a GP has advised that an employee may be fit for work, but the employee remains off work because the employer cannot provide the necessary support. In such cases, employers should treat the note as a ‘not fit for work’ note and pay SSP in the same way.
The government emphasises in its guidance for employers that SSP is only a minimum provision and that if an employer is considering a return to work which involves reduced hours due to sickness, it may be cost effective for that employer to consider paying voluntary sick pay for the hours not worked due to illness or injury, even when SSP does not apply.
Fit notes (or fitness for work statements) are intended to encourage employees back to work more quickly and ultimately reduce the numbers receiving incapacity benefit. Their aim is to give employers and employees greater flexibility in managing sickness absence.
Fit notes focus on the work employees can do, rather than what they cannot do.
GPs can advise that the employee is either:
- not fit for work, or
- may be fit for work taking account of the GP's 'advice on how this should be managed'.
Fit for work
An employee may have some health problems, but this does not necessarily prevent them from working. If the GP opts for the 'may be fit for work' option, this means that in the GP’s view the employee’s condition does not necessarily prevent them working. The GP should try to suggest ways of helping an employee get back to work, outlining on the note the work that patients can do in spite of their illness. The GP should give advice about the effects of the employee's health condition and some suggestions about the types of adjustment the employer could consider.
The employer can then discuss with the employee appropriate adjustments such as:
- a phased, gradual return to work
- altered hours (for example, varied start and finish time)
- flexible hours
- time off for treatment
- amended duties
- workplace or equipment adaptations
- relocating place of work.
Obviously if any of these variations amounts to a variation in the employee's contract then their agreement must be obtained to the change.
Employers are not bound to follow the GP’s advice and if it is not possible for an employer to provide support for the employee to return to work the employer can use the statement for sick pay purposes as if the GP had advised ‘not fit for work’.
The fit note does not include the option for GPs to advise an employee that they are fully fit for work. The government emphasises that it is a myth that an employee needs to be fully fit for work; employees do not need to be ‘signed back’ to work by a GP. If an employer does want a medical opinion stating that an employee is fit for work, this is a matter for a private arrangement with a GP or occupational health specialist.
On the fit note, the GP should have stated how long their advice will last for. The employer should then agree a 'return to work plan' with any appropriate adjustments in place for a temporary period. If the employee cannot then return to their normal duties, long term changes may be necessary taking into account the provisions of the disability discrimination legislation. In the first six months of any health condition, the maximum period a GP can issue a fit note for is three months.
Problems with fit notes have included:
- GPs having difficulties making judgments between 'unfit for work' and 'may be fit for some work' as they may not know enough about the nature of the work
- disagreements between employees and employers concerning the nature of adjustments which are appropriate
- employees refusing to return to work once adjustments have been made, leaving the employer to decide whether to invoke disciplinary or capability processes, or stop paying statutory sick pay
- other employees may feel disadvantaged if another employee achieves a variation to their working schedule on what the other employees see as spurious health grounds
- disability discrimination claims may be generated as a result of refusals to carry out adjustments in appropriate cases
- possible increased risk of personal injury claims from members of staff who injure themselves while back at work following a fit note saying they may be fit to return.
To try and minimise the risk of the problems highlighted above occurring, employers should have reviewed their absence, return to work and flexible working policies to ensure they are compatible with the fit note system. There should be an appropriate emphasis on returning to work as soon as is practicable. Other documentation which may need checking or amending include standard contract clauses on sickness absence reporting, self-certification forms, letters inviting an employee to attend a meeting following a period of sickness absence and structures for return-to-work interviews.
Line managers should be trained in dealing with fit notes, particularly on how to manage the need for appropriate adjustments and the length of time those should last, and managing other employees' expectations or concerns over such arrangements.
For more information, see the government's Fit note: guidance for patients and employees.
It is important to emphasise that employers should also be aware of their duties to pay statutory sick pay and make reasonable adjustments under the disability discrimination provisions of the Equality Act 2010. Employers should be wary of contravening these provisions if the employee’s health problems qualify as a disability.
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