How does a referral to Occupational Health (OH) improve attendance?

Managing sickness absence is the responsibility of the manager. It starts from the time a worker goes off sick or their health impaired.  There are so many health issues and responses; a Manager cannot understand all of them.  Occupational health (OH) staff, understand the workplace, health and job and can give advice and support along the way.

Most companies will have an informal or formal system for managing absence.  This is usually written into a policy, called something like ‘Attendance Management’. It sets out what everyone should do in particular circumstances.

Workers may not like talking to Managers about their health.  This may be because of a Manager’s possible reaction to the problem, or because others might find out. Yet, OH work under a strict code of confidentiality, and have no say in disciplinary and pay issues. They are independent of that.

You can ask OH for an opinion on how to manage the worker’s health condition, and receive advice about:

  • A health condition,
  • How it is likely to affect  a worker’s performance,
  • What adjustments to consider, particularly if there is a health condition covered by the Equality Act 2010.

OH also helps employees, by suggesting counselling, physiotherapy, improved diet, exercise and so on. OH may also advise on suitable redeployment sometimes.

How do I stay in contact with a member of staff off sick without harassing them?

Getting the balance right is difficult particularly if work related stress is involved. To avoid this, include reporting and contact regimes in any company policy.  Also, include how statutory sick pay and company sick pay is calculated and paid.

For the first two/three weeks absence, Managers need to focus on supporting employees. Ask how they are, and not keep asking when they are coming back. Ask also if there is anything you can do to help them and agree when to call them again or they call you.

Send the absent employee a card or invite to team meetings or a social visit. It helps them to feel part of the team still.

In cases of personal conflict, another manager or HR can be the main contact.

How do I manage employees with repeated sickness?

Repeated absence or long-term absence due to ill-health needs managing fairly. The process is usually set out in a company Attendance Policy.

Absence can be due to many reasons; short or long-term, genuine or not so genuine. Whatever the type and length of absence, it all needs counting.

One fallacy, that many believe, is that if you have a serious illness you cannot be sacked.  This is not true. You need to explain that to workers. But, if you are going to dismiss someone, track everyone’s attendance, so you act fairly.

If a worker has poor attendance, Managers need to make it clear that it is not acceptable. Set attendance goals and targets and explain what you are doing and why. You will also need to check the plan regularly.

The process usually starts on an informal basis.  If there is no improvement, then everything becomes more serious. Workers can also be moved to a new role, or, in some cases, dismissed due to capability. For serious health issues maybe ill-health retirement is necessary (depending on any company pension plan).

What is the most important thing I do to get the best out of an occupational health referral? 

The process of referral should be as transparent as possible.

Managers and employees need to trust each other. So clear communication is the key to success.

OH should always be available for advice and support before and after a referral. If necessary contact OH to discuss any concerns or ask for guidance about the referral.

The employee should also be aware of why they have are being referred and have a copy of the referral letter.

Occupational Health said I did not include enough information on the referral. What do they want?

It helps OH to have as much information as possible about the background to any absence. Focus on facts, not opinions. Remember, the employee can disagree with opinions but not facts.

Include in your referral:

  • Dates of absences
  • Any background history if relevant
  • A job description especially if aspects of the role are of concern
  • Individual risk assessments are particularly helpful.
  • Say what you have done so far to support the employee
  • Plans you have to support them in the future.
  • Include specific questions you want answering, i.e. their physical or mental ability to do a task.

See also: Referring to Occupational Health a Managers Guide

What is a case conference and could that help?

A case conference is when key people, such as, the employee, manager, HR and OH meet and check what’s happening. Are there any problems?  It is an opportunity for everyone to discuss queries raised by either the employee or manager.  They are useful when exploring work-related issues or when an employee’s capability is in doubt.  They cut down time and misunderstandings.

Case conferences happen rarely; usually for complex cases only.  Use the meeting to discuss any return to work plans, which tasks role can be done or avoided for an agreed time.

Remember to take notes of actions for reference later.

What is the best approach to take with an employee going to OH?

Explain you want to do as much as possible to help them get back to work, or adapt work to suit them. Give some examples of how it has helped workers in the past. The message is that you are trying to help, nothing more.

Explain that OH can help them and you by giving advice about:

  • When they are likely to return
  • What tasks would be easiest at first and those more difficult
  • Whether a phased return might help
  • What adjustments might help

Explain that when you get advice, you will do all you can to accommodate the suggestions. Sometimes things are not possible but you will try your best to make the adjustments.

If the employee is off sick you may feel it better to go and see them at their home or talk on the phone.  Whether it face to face or telephone, you need to send them a copy of the referral form. Ideally, you would ask them to sign the form.

If you don’t explain the reasons for the referral or an employee not seen a copy of the referral, they could be suspicious and refuse to go. Explanation saves time and misunderstanding when the employee gets to OH.

See also: An Employee’s Guide to OH

What if the employee refuses to go to OH?

Employees have the right to refuse to attend OH. Do not take it personally or think that the employee is being obstructive.

In this case, explain that you will make decisions based on the information you have already, and without any medical advice.

How do I use the recommendations from OH?

The report you get back from OH should include:

  • The reason for the referral
  • Background
  • Overview of medical aspects
  • Work related aspects
  • Opinion and recommendations including capacity for work; recommended adjustments and restrictions including rehabilitation;
  • Prognosis including further suggested treatments and referrals;
  • Answers to your questions you have asked in the referral letter
  • Review date if required

The information from OH should help to clarify what you need to do to manage the person. Suggestions such as making some changes or allowances to accommodate a person’s health problem.

As the manager, you need to consider whether you can do what OH suggests. If not, you need to discuss alternative solutions with OH. Remember the employee is aware of the recommendations. Suggest tweaks to the plan and explain why some things are not possible.

What else will OH do to help me manage employees who are off sick?

For short-term absence, that is, odd days off, OH will explain the consequences of absence with the employee. For instance, how you may set goals and timescales for an improvement in attendance rate. Or maybe even disciplinary actions. They will explain that this is for their line manager to decide, not OH.

OH staff will also talk about possible dismissal if the absence continues.  And this may be the first time that the employee has heard that.  It can be a shock.

A staff member is refusing to go to OH, stating they deal only with their own GP.  What can I do?

Workers can refuse to attend. You can’t force them.  But you need to continue the management process without advice from your own OH service.

In this case, take the best course of action with the information you have. Explain your role that is, keeping a business going, health and safety, and what the rest of the team need.  Explain this to the employee. Tell them OH is there to tell you about how their health condition may affect or be affected by their job. Explain that OH will be a link between the employee, manager and GP. And how you can all work together on adjustments and plans for a return to work.

Tell them that by not going to OH, you, the manager, may have to make a difficult decision. You have limited information, and they could be unhappy with the outcome. You could also ask them why they have a problem attending OH to see if there is an underlying reason or belief.

Another option is to consider the Fit for Work service. Employees who have been off sick for more than four weeks can see an independent medical adviser.

For more information go to Government Guidance here

What does phased return to work mean?  

Returning to work full-time after an illness is tiring, and if not handled well, could lead to further absence. Some jobs need high levels of stamina and fitness. Research shows that coming back gradually, that is, building up hours over several weeks, is more successful. It also builds confidence and avoids excessive fatigue.

The GP will usually issue a Fit Note stating ‘phased return’ and ‘adjusted duties’.

Most rehabilitation programmes run over a four week period. The idea is to increase working hours gradually. The great benefit being that workers can return far earlier too.

Typical programmes are two days in week one and 3 or 4 days in week two. Or, 4 or 5 half days in the first week, increasing these hours in week 2 and full-time in week 3 or 4. The progress depends on the illness, motivation of the worker and the type of job.

The rehabilitation period can be extended after a serious illness or longer time off sick.

It is important to discuss pay in rehabilitation programmes, especially if a person has had extended sick leave and used up any company sick pay.  One option many businesses adopt is to use accrued leave for the non-work time.  Remember to discuss payment and hours of work at case conference meetings. It’s important to explain clearly any reduction of pay.  Beware though of workers returning to work too early, just because their sick pay has expired.  In this case, it would be wise to refer to OH for a full investigation.

Why bother with Occupational Health referral – can’t I just sack them?

The attendance policy, HR and OH teams, are there to support you and make sure you act reasonably.  Employment law makes some actions illegal.  You need to act within the law.

If you do not follow the policy or advice, you risk going to an Employment Tribunal where badly or unlawfully treated workers can claim compensation or even their jobs back!

There is always a risk of potential litigation if things go wrong.

One of my staff is off sick for odd days due to many reasons. Should I refer them to OH?

Always ask at the return to work interview if they have a health problem causing their absence from work. If so they may want to discuss it with you. Or you can offer to refer the worker to your OH.

But if they are skiving or there are no medical reasons for absence, OH is unlikely to help. So you need to drill down into the real cause of absence yourself. I have come across child care issues and domestic violence in the past.

You also need to follow your company policy. Does it specify you have to send workers to OH? If so, then you need to follow procedures or, think about changing the system.

One word of warning, make sure you treat everyone the same.  Do not make judgements on illnesses or workers. Believing that some are ‘genuine’ and others not. You need evidence to back this up.  Remember, what affects one person’s health severely may have little effect on another.

A worker has a planned operation and will be off for six weeks,  do I need to refer them to OH?

Referral is probably unnecessary as long as everything goes to plan. Sometimes, infections occur, or recovery is slow. Ask the worker to ring you if anything untoward happens, and there is doubt about the expected date of return.

If this happens, then you would be able to refer to OH then if required.

Also available on this site are referral forms and templates for GP and Specialist report, consent forms, etc.