I am not sure how a referral to Occupational Health (OH) can help improve attendance, can you clarify this?
Managing sickness absence is the responsibility of the manager. It starts from the time a worker goes off sick or their health impaired work. There are so many health issues, and people’s reactions to health issues so varied, that a Manager cannot be expected to understand all the needs of their staff. Professional health staff understand health and the workplace, the manager understands the job. Working together we can make sure that the person receives the right advice and direction.
Both OH and HR can be asked for advice and support along the way. Most companies will have an informal or formal system for managing absence – in larger companies this is usually written into a procedure called something like ‘The Attendance Management’ policy, which sets out what managers should do in particular circumstances.
Workers may be uneasy about telling their manager about a health condition fearing prejudice or that others may find out. Health professionals work under a strict code of confidentiality plus the worker will not be seeing the OH professional for issues such as disciplinary, grievances, management and pay rise issues; they are independent of that.. It’s better to keep these things totally separate in the workplace.
OH can be asked for an opinion that will help you manage this process by giving advice about a health condition, how it is likely to affect a worker’s performance and what adjustments you might consider to help that employee continue in their role, particularly if they may have a health condition included under the Equality Act 2010.
OH will also advise the employee about measures they may take to help themselves such as counselling, physiotherapy, improved diet, following medical advice, exercise etc. OH may also advise if redeployment is indicated.
How do I maintain contact with a member of staff who is off sick without being accused of harassing them?
Getting the balance right is difficult particularly if work related stress is the cause of absence. The terms and conditions of employment usually sets out reporting and contact regimes expected when a person is off sick. This generally involves notification processes and what is expected on both sides for paying of statutory sick pay or company sick pay schemes.
For the first phase (first 2-3 weeks) Managers need to focus on supporting employees, ask how they are, and not immediately asking when they are coming back to work. You can ask how long they are off work, is there anything you can do to help them and agree when you will call them again or they will call you.
Send them a card or invite them in to team meetings or for social visits; it helps them to still feel part of the team. In some cases another manager or HR can be the main contact.
How do I manage the employee who has repeated episodes of sickness?
Repeated absence or long-term absence due to ill-health needs managing fairly and this is usually set out in a company Attendance Policy. Employees are paid to come to work and whether absence is due to one particular health issue or several reasons, whether it is short or long-term, considered genuine or not, the person needs to know their attendance is being counted. Many employees believe that if they have a genuine illness their employment cannot be terminated. This needs explaining if they hold that belief. Monitoring attendance is the first step in controlling absence and should be for the team not just those you suspect are malingering or skiving.
Attendance goals and targets can be set with review dates to see if they have been met. The process needs to start informally and if no improvement noted then it should move into a formal process leading to redeployment to another role or, in some cases, dismissal due to capability and ill-health retirement, HR are there to advise and help you.
What is the single most important thing I can do to get the best out of a referral to occupational health?
Communication is key to a meaningful and helpful referral process – this means both with the employee who is off sick and with OH. If necessary contact OH to discuss any concerns or to ask for guidance add link bout the referral. The OH service professionals should always be available to advise and support you prior to and after a referral. The employee should also be fully aware of why they have been referred and have a copy of the referral.
The process should be as transparent as possible. Both Managers and employees need to trust each other and the OH service to act fairly.
Occupational Health called me and said I did not include enough information on the referral what else do they want?
It helps OH to have as much information as possible about the background to the absence, focusing on facts not opinions, as the employee can disagree and have a negative effect on the manager/employee relationship.
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 may have about their functionality i.e. their physical or mental ability to undertake the role.
What is a case conference and could that help?
A case conference meeting is an opportunity for the employee, manager, HR and OH to all get together and check the current situation for the employee, normally when a case is complex or been ongoing.
It is an opportunity for everyone to discuss queries raised by either the employee or manager. Take brief notes of actions which can be referred to later if necessary. Often OH will advise a case meeting following a referral when it is useful to discuss return to work plans, which parts of the role can be done or avoided for an agreed time. Case conference useful as part of a review process when an employee has work related issues that need exploring or when an employee is under formal capability processes. Case conferences cuts down time and misunderstandings especially when there are different people involved in the decision-making process.
Case conference meetings are not routinely held for all referrals as they take up a lot of resources; the outcome report written by OH forms the basis for the start of the discussion.
I had a difficult conversation with a staff member about being referred to OH, have you any advice about what is the best approach to take?
Employees appreciate feeling cared about, so when referring to OH, explain you want to do as much as possible to help them get back to work and to give all the support you can to help them to do this.
Explain that OH can help you manage the situation 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 this advice you will do all you can to accommodate the suggestions but that you also have the rest of team to consider and needs of the business, so not everything is possible.
If the employee is off sick you may feel it better to go and see them to talk the referral through or do it on the phone, either way you need to send them a copy of the form. Ideally you would take it to them to discuss and sign.
Employees who have not had the reason explained or seen a copy of the referral are often suspicious and reserved about the process, it also wastes time for the OH advisor having to explain it during their appointment and reassure them.
See also: An Employee’s Guide to OH
What if the employee refuse 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.
However, if they insist on not going to OH you will need to explain that you will be making decisions based on the information you now have and without the benefit of independent medical advice.
How do I use the recommendations from OH to help manage my employee?
The outcome report from OH should be set out as follows;
- The reason for the referral
- 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;
- Answering specific questions you have asked eg is this person likely to covered by the provisions of the Equality Act
- Review date if required
As you continue with the management process, guided by the Attendance Policy, the information from OH should help to clarify your direction. It may suggest you consider making some changes or allowances to accommodate a person’s health problem.
As the manager, you need to consider whether you can follow the advice, if not you can discuss alternative solutions with OH and the employee or you need to explain why this is not possible. Refer these cases to HR if possible.
What else will OH do to help me manage employees who are off sick?
During referrals, OH may advise the employee about likely consequences of their absence, for instance if they have had lots of time off sick for minor health issues they may be advised that their manager will set some goals and time scales for an improvement in attendance rate.
OH staff will also point out the possible outcomes from the process which could include dismissal. Often this may be the first time that the employee has had to face this situation.
One of my staff is refusing to attend an OH appointment, stating they deal directly with their own GP. What can I do?
You need to continue the management process, but without the advice and information provided by OH, you will have to take the best course of action with the information you have, whilst also trying to safeguard your business, health and safety of others, the employee and the rest of your team.
You can explain this to the employee and advise them that their GP looks after their health and treatment but OH is specifically there to advise about how their health condition may affect or be affected by their job. OH will also act as a link between the employee, manager and GP to recommend any adjustments, restrictions, plans for a return to work or redeployment.
The GP is not familiar with the workplace details or can be able to do this sufficiently to support the employee in the best way. You can tell them they may be disadvantaged by not attending an OH appointment as you, the manager, may have to make a difficult decision about their job based on very 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.
The Government has recently launched a fit for work service where employees who have been off sick or likely to be off sick for more than 4 weeks can be referred to an independent medical adviser.
For more information go to Government Guidance here
Phased return to work is often suggested by OH or GP’s. What does this mean?
Following long-term sickness or a serious illness, returning to work on full hours straight away is very tiring, overwhelming and lead to further absence quite quickly. Research shows that coming back by gradually building up hours over several weeks is more successful in the long-term; helps build confidence and avoids excessive fatigue. The GP will usually issue a Fit Note stating ‘phased return’ and/or ‘adjusted duties’.
Most OH services follow a standard rehabilitation programme of four week period of increasing work hour to build up strength and stamina. This may be 2 days in week one and 3 or 4 days in week two. Alternatively it could be 4 or 5 half days in the first week and increasing these hours in the second week then returning to full-time in week 3 or 4 depending on the illness the motivation of the worker and the type of job..
After serious illness or longer time off sick, the rehabilitation period could be extended.
It is important to discuss payment of working reduced hours during this time to prevent misunderstanding especially if a person has had extensive sick leave and used up any company sick pay. One option is to use accrued leave.
Remember to discuss payment and hours of work at a case conference meeting and if the recommended hours are practical for the manager and team, it is often a useful way of getting back into the routine of work. 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 the hassle of an Occupational Health referral – can’t I just tell the person to come back to work or get another job?
The attendance policy, HR and OH teams are there to support you and help prevent complications arising when dealing with attendance management. If you do not follow the policy or advice, you risk treating people differently and unfairly which they may feel aggrieved about. You may make decisions about their job without seeking adequate advice. There is always a risk of potential litigation if things go wrong.
By following the guidance, your staff sickness absence problems can be dealt with fairly and in a timely fashion.
One of my staff is off sick regularly for odd days due to many different reasons. Should I refer them to OH?
Not necessarily, you can ask them if they have a particular health issue causing their absence or they are concerned about and need support with. You can offer to refer them, but if there is no underlying medical condition, then OH is not likely to offer any further useful information to help you manage the situation. In fact, you will be wasting everyone’s time if you send an employee to OH who has no real underlying health problem.
You need to follow the company policy on repeated absence and manage their attendance by applying the relevant rules.
One word of warning, make sure you treat everyone the same. Do not make the assumption that some illnesses are ‘genuine’ and others not unless you have evidence to back this up. What affects one person badly may have little effect on another, such as, working with a cold or chest infection.
A worker has a planned operation and will be off for 6 weeks after which they will be back to work as normal, do I need to refer them to OH?
Referral is probably unnecessary as long as everything goes to plan and they have an uneventful recovery. Sometimes infections occur or recovery is slow. Ask the worker to ring you if anything untoward happens and there is doubt about the planned date of return.
If this happens then you would be able to refer to OH then if required.
Also available on this site (if you register) are referral forms and templates for GP and Specialist report, consent forms etc.