Supporting Attendance Policy

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1 Supporting Attendance Policy Reference Number: 117 Author & Title: Gayle Williams Deputy HR Business Partner Responsible Director: Director of HR Review Date: 05 November 2018 Ratified by: Director of HR and Strategic Workforce Committee Date Ratified: 05 November 2015 Version: 8.1 Related Policies and Guidelines Appraisal Policy Employee Code of Expectations Managing Conduct Policy Managing Performance Policy Maternity Leave Policy Smoke Free Policy Substance Misuse Policy Managing Stress Policy Redeployment Policy Author: Gayle Williams Deputy HR Business Partner Page 1 of 32

2 Index: 1. Policy Summary 4 2. Policy Statements 4 3. Definition of Terms Used 5 4. Duties and Responsibilities Employee responsibilities Behaviours whilst absent Annual leave whilst on sick leave Sickness during annual leave Managers responsibilities Role of Human Resources Role of the Representative Role of Occupational Health Failure to attend an Occupational Health appointment Case Conferences Payroll Department Procedure for Dealing with Frequent Sickness Absence Procedure A Manager s discretion and patterns of absence Stage 1: First formal sickness meeting Stage 2: Second formal sickness meeting Stage 3: Formal sickness hearing Final written warning Dismissal Procedure for Managing Long Term Sickness or an on-going Medical Condition Procedure B Planned sickness absence If an employee is too unwell to attend meetings Early interventions Return to work after long-term absence Employee unable to return to work Suspension on Medical Grounds Time off for Appointments/Treatments Routine Dental/GP/Hospital appointments Time off for other appointments/treatments 23 Author: Gayle Williams Deputy HR Business Partner Page 2 of 32

3 9. Notifiable and Other Infectious Diseases D&V reporting Accidents at work Monitoring Compliance Review Training References 26 Appendix 1: Frequent Absence Flow Chart 27 Appendix 2: Long Term Absence Flow Chart 28 Appendix 3: Return to Work Interview Form 29 Document Control Information 30 Ratification Assurance Statement 30 Consultation Schedule 31 Equality Impact: (A) Assessment Screening 32 Amendment History Issue Status Date Reason for Change Authorised 4.0 Approved January Planned Review TCNC Policy Sub Group Approved 18 th March 2013 Planned Review, Formatted Lynn Vaughan, Director of HR 6.0 Approved 6 th June 2013 Accidents at Work revised Lynn Vaughan, Director of HR 7.0 Approved 8 th May 2014 Planned Review TCNC Policy Sub Group & Strategic Workforce 8.0 Approved 30 th April Approved 05 November 2015 Planned 6 month policy review trigger and targets revised Minor update to include a revision around accidents at work committee TCNC Policy Sub Group Strategic Workforce Committee and Director of HR Author: Gayle Williams Deputy HR Business Partner Page 3 of 32

4 1. Policy Summary Throughout this policy the Royal United Hospitals, Bath NHS Foundation Trust is referred to as the Trust. This policy covers the management of health and sickness issues in all Trust employees, including junior doctors and those with honorary contracts. The Trust is committed to providing and delivering the highest quality health care for patients as assessed by patient safety and clinical outcomes and evidenced by patient surveys. We have a stable and highly committed workforce, which we seek to support and develop. We recognise that staff are our most valuable asset and by offering attractive and fair conditions of employment, flexible working opportunities, a healthy environment and, above all encouragement to all members of staff to own their organisation, we hope they will play active roles in its future. The key to our success lies in the motivation, competence and capability of the people we employ. High attendance rates are essential for delivery of service. The management of attendance is an integral part of performance management. A positive and proactive approach to the management of absence is required in order to optimise attendance rates and enable the Trust to move forward to achieve its goals. This Policy and Procedure supersedes all previous policies and procedures in relation to managing health and sickness in the Trust. 2. Policy Statements The policy of the Trust is to encourage positive action to be taken in the event of sickness absence. The purpose of this policy is to:- Clarify expectations for both management and all members of staff. Harmonise the Trust's approach to the management of attendance. Enable a consistent standard to be applied to all members of staff within the Trust. Optimise attendance and minimise absence through standard setting, monitoring and where required intervention. Support, protect and promote the interests of those who are genuinely incapacitated. Support employees to return to work with reasonable adjustments if required. Author: Gayle Williams Deputy HR Business Partner Page 4 of 32

5 3. Definition of Terms Used Within this policy, a distinction will be drawn between sickness absence without an underlying health cause and sickness absence with an underlying health cause. Sickness absence without an underlying health cause - This is a period of sickness for which Occupational Health advise that 'there is no underlying health condition causing the individual's sickness absence'. This will normally present itself as short term sickness which may be described as relatively minor, self-limiting illness or injury that requires little or no medical intervention. A medical fit note is often not required. Sickness with an underlying health cause this can be either an isolated period of absence or on-going absences for which Occupational Health advise there is an underlying health condition Long term Sickness - This is an episode of sickness absence that lasts for 4 weeks or more. Phased Return - A phased return is a return to work on reduced hours and/or days for a specified period of time, usually no longer than four weeks, this may be extended with Occupational Health advice. Advice will be sought from Occupational Health prior to the start of a phased return. Adjustments to the Workplace - The Line Manager should consider whether the recommended adjustments can be accommodated and may seek further advice from Occupational Health. Altered Hours or Duties and Temporary Placements - The employee should not be disadvantaged through being at work on a fit note when compared to being signed off as sick. Therefore when a fit note recommends restricted duties or hours the employee will be paid as if they were at work i.e. at the same grade and the same hours as their substantive contract. Working weeks this will refer to an employee s normal working week. For instance a staff member who works 22.5 hours over 3 days will have a working week of 3 days. A member of staff who works the same hours over 4 days will have a working week of 4 days. Author: Gayle Williams Deputy HR Business Partner Page 5 of 32

6 4. Duties and Responsibilities A member of staff who is absent from work due to illness should rightly feel that the organisation is concerned for his/her well-being and will provide appropriate support prior to and following a return to work. In the majority of cases absence will be manageable because it is short in duration and/or non-recurring. Occasionally however, individual cases arise where attendance falls outside normal expectations. Managers expect and plan for normal levels of attendance based on the general health of the majority of staff. Where attendance falls outside such expectations, pressure is placed on the service and team to continue to perform to the level of output planned and contracted for. In some cases it may not be immediately clear whether some issues, for example, poor performance or persistent short-term sickness absence, fall into the scope of the Managing Performance Policy, the Conduct Policy, or the Supporting Attendance Policy. Line Managers should take advice from HR and decide which is the more appropriate after weighing up all the circumstances. However, it may be necessary to move from one policy to another as circumstances dictate. The Line Manager will explain the reasons for their decision to the member of staff. The member of staff will be told which Trust procedure is being followed. Staff should be aware of the policies and procedures regarding sickness and governing attendance. Procedures must be followed to ensure consistency and fairness. The management of attendance is the responsibility of Line Managers. The role of Human Resources and Occupational Health Services is advisory and supportive Employee responsibilities Every member of staff is expected to attend work when fit to do so, and is required to fulfil their contractual working hours, as agreed with their Line Manager. The Trust does not expect members of staff to work when they are unfit to work. Staff may be unfit for their normal role but fit to attend work in another capacity for a temporary period if suitable work can be found. In these circumstances staff will be expected to return to work on their normal pay, or on rehabilitation under the terms described in Section 6. Unjustified refusal to return to work may be dealt with under the Trust s Conduct Policy. Members of staff, who require time off for routine/on-going medical/dental appointments off site, should give their Line Manager reasonable notice for time off. Author: Gayle Williams Deputy HR Business Partner Page 6 of 32

7 It is recognised by the Trust that there are occasions when a member of staff is unable to attend work due to sickness absence. In such instances, the member of staff's responsibility is to:- Report their absence in accordance with the agreed local procedure. Members of staff are expected to make reasonable efforts to contact their Manager directly and not to notify their absence through messages with colleagues, text message, voice mail or answer phones unless this is the procedure agreed for that particular department, in which case the Line Manager will contact the member of staff on receipt of the message. Provide a self-certificate or medical certificate (fit note) as soon as possible to their Manager following a period of sickness or during sickness absence if prolonged in order for sick pay to be paid correctly. Late certification of sickness absence can result in incorrect sick pay being paid to staff, particularly those near to a half or no pay situation. Provide a reason for the absence (although this may not necessarily include a medical diagnosis). Estimate the anticipated length of absence and agree with the Manager when he/she will contact the Manager next if the absence is expected to last more than a day. If contact with the immediate Line Manager is not possible the member of staff will be expected to contact the Deputising Manager of the department Behaviours whilst absent In all cases of sickness or injury that necessitate taking time off work, it is expected that the employee will do their utmost to facilitate a speedy return to fitness and to work. In this regard, employees are expected to act sensibly and honestly, for example - not to undertake heavy manual work i.e. DIY/gardening with a back injury. - not to undertake any other employment whether paid or unpaid. The Trust expects employees to do everything to aid a speedy recovery, and working whilst absent on sick leave may be classed as an act of gross misconduct, may be investigated by Counter Fraud and may lead to dismissal under the Managing Conduct Policy Annual leave whilst on sick leave Employees are not normally expected to go away on holiday during a period of sickness absence. However, when a member of staff wishes to honour a prebooked holiday they should inform their Line Manager in advance. The Line Manager may request information from Occupational Health Department about the fitness of the employee. Author: Gayle Williams Deputy HR Business Partner Page 7 of 32

8 4.4. Sickness during annual leave If an employee is sick during a period of annual leave, they can request sick leave to be granted instead of annual leave, so long as they contact their Manager in line with normal reporting arrangements for sickness absence. Staff will be required to inform their Manager on the first day of absence and provide either a self-certificate or medical certificate as appropriate verifying the sickness. Staff returning from annual leave and requesting retrospective sick leave will not generally have their request granted if the accepted reporting arrangements for sickness have not been followed Managers responsibilities As part of a member of staff's induction, Managers are to ensure that the Trust's policy on sickness absence and the local reporting guidelines relating to absence from the workplace are discussed and that the member of staff is clear about the local reporting arrangements. This is to ensure that members of staff are aware of the Trust's standards of attendance and the requirements of this policy. The member of staff should be provided with a copy of the local reporting guidelines. At this time both parties should come to an agreement about how the member of staff may be contacted at home by the Manager if there is an unexpected failure to attend work. Managers should forward any sickness certification (self-certificated or medically certified) as soon as possible to payroll for processing. Late receipt of sick notes can result in staff receiving the incorrect sick pay and being over/underpaid. Managers are also responsible for keeping accurate documentation relating to absence, and monitoring levels of attendance. Records should be reviewed regularly and appropriate management action taken for those members of staff who have been identified with a poor attendance record. Members of staff should be informed that such records are being kept and given a copy of any such record on request. Regardless of whether sickness is self-certified, or medically certified, Managers should undertake a review of a member of staff's attendance record. Managers should seek advice from HR whenever an individual's attendance record gives rise for concern. Communication with members of staff is vital to the successful management of absence. The Manager will establish contact with the member of staff, and agree a method and frequency of communication, until the member of staff returns to work. The Manager should ensure that unnecessary contact with the member of staff (by Manager or colleagues), outside of this agreement, does not occur. Return to Work interviews are to take place following every period of absence. If a staff member has been absent due to stress (personal or work related) a specific return to work form can be completed to help the Manager and staff member identify stress triggers. This is available under the Supporting Attendance policy pages on the Intranet. Author: Gayle Williams Deputy HR Business Partner Page 8 of 32

9 If a Line Manager identifies that a member of staff's sickness is reaching the trigger points, (see Procedures for dealing with frequent sickness absence Section 6), a sickness management meeting with the member of staff should be arranged, to encourage discussion at an early stage, of any problems that may have arisen and to provide support or advice before matters escalate. The Line Manager will also outline their reasons if they exercise the option to refer members of staff to Occupational Health. Any medical diagnosis if offered to the Line Manager should be kept in confidence. Managers will distinguish between reported sickness absence and unauthorised absence where the absence is not reported in line with the procedure and acceptable explanation is given. Unauthorised absence will be managed through the conduct policy Role of Human Resources The role of the HR Department is to provide specialist advice, to support Managers at all stages of the Supporting Attendance Policy, and to attend meetings at informal/formal stages as required. HR will also support Managers in identifying sickness absence trends through the monthly sickness absence reports and provide training in the management of attendance Role of the Representative At all formal stages of the procedure, members of staff have the right to be represented by their Trade Union representative or work colleague. The Trust encourages the involvement of representatives, as they will be able to advise the member of staff and where appropriate encourage them to seek further medical or other advice. The representative will also seek to ensure that the member of staff fully understands the options that are available to them and also the consequences of further sickness absence or inconsistent attendance at work Role of Occupational Health Occupational Health offers a range of confidential services, which promote the health, and well-being of staff through:- Pre-employment assessment of fitness to work Provision of a workplace immunisation programme Sickness/absence referral Counselling service Physiotherapy service Health education/promotion/well being Case conferences Provision of advice on health related workplace issues and work problems Author: Gayle Williams Deputy HR Business Partner Page 9 of 32

10 When a member of staff's level of absence becomes a concern or has reached the trigger points set out in section 6 the Manager in discussion with the member of staff may decide to make a referral to Occupational Health. It is essential that the member of staff and the Occupational Health Advisor and/or Physician are informed and understand the reason(s) for the referral. All referrals must be in writing and signed by the referring Line Manager. These referrals must be timely and received in Occupational Health prior to the appointment date. The Occupational Health referral should contain all information to prevent any delay and Managers should ensure that the information is accurate. The employee will be contacted by Occupational health and informed of their appointment. If telephone contact has not been possible a letter will be sent to the employee. Other than short notice appointments the Manager can expect to receive a copy of the appointment letter. Management Referrals The Manager will discuss and agree the referral with the member of staff and will make arrangements for attendance. The member of staff should be advised that a report relating to an assessment of their capacity to undertake their full range of duties would be forwarded to the Manager, the member of staff and the relevant HR Advisor if appropriate. Managers are required to provide Occupational Health with full details of attendance record and any relevant background information. This may include details of the work environment to aid the Occupational Health Physician in assessing what adjustments may be needed. Following the referral, Occupational Health will be able to provide a medical opinion on the member of staff's fitness to work, and in long term sickness cases, the expected timescale for a return to work. The Occupational Health Advisor or Physician will be able to advise Line Managers on whether any restrictions on activities in the workplace need to be made to facilitate the member of staff's return to work. The assessment will indicate the length of the rehabilitation period, if any. Line Managers working closely with Occupational Health Department will seek effective and successful resolutions to any sickness absence cases. Occupational Health gives advice to both members of staff and Line Managers alike, often assisting the member of staff to understand an illness and minimise its impact on his/her life, and providing Line Managers with general information, which may help them to plan and manage their team effectively during a member of staff's illness. The member of staff has a right to patient confidentiality and this right will be adhered to at all times. In the event of frequent sickness absence, the Occupational Health Physician may advise that a member of staff is fit to undertake their work and that there is no underlying medical condition. In such instances, it is the responsibility of the Line Author: Gayle Williams Deputy HR Business Partner Page 10 of 32

11 Manager concerned to take further appropriate action, following advice from their HR Advisor. If a Line Manager receives a statement of fitness to work that advises that the member of staff may be fit to return to work subject to temporary workplace adjustments a referral should be made to occupational health prior to an agreed return date. The member of staff may be required to attend an occupational health appointment or partake in a telephone appointment. All advice from occupational health will be followed up in writing/by to the Manager It is inappropriate for advice on employment or medical condition to be sought from or provided by the member of staff's GP or Medical Specialist direct to the Line Manager. Information on the clinical management of a member of staff's illness may, however, be sought with written consent of the member of staff from their doctor(s) by the Occupational Health Department to enable a full assessment to take place, and relevant advice to be given to Line Managers. Line Managers may at any time require a member of staff who is absent from work due to illness to attend an appointment with Occupational Health. Furthermore, staff do not need to be off sick to be referred to the Occupational Health Department or for a further medical assessment. The Manager will meet the cost of any medical examination resulting from such a referral from their departmental or directorate budget. - Self-Referrals Self-referral to the Occupational Health Doctor for further advice is a service offered to staff. No report will be forwarded to management unless there are extenuating circumstances. If a report is required this will be discussed first with the member of staff to obtain his/her consent. Staff can self-refer for work related conditions. For other issues that are not work related staff should make an appointment with their GP Failure to attend an Occupational Health appointment Attendance at an Occupational Health appointment is a reasonable management request, and the member of staff is obliged to attend. Failure to attend may therefore be grounds for action under the Trust s Conduct Policy. The Trust will make all reasonable efforts to facilitate an employee s attendance at Occupational Health. Occupational Health will inform the Manager if an employee has failed to attend an appointment. The Line Manager may contact the employee to discuss the reasons for non-attendance. In the event of an employee s continued avoidance of attending Occupational Health, a management decision will be taken on how to proceed on the basis of the information available. Author: Gayle Williams Deputy HR Business Partner Page 11 of 32

12 4.10. Case Conferences There may be occasions when it will be necessary to hold a case conference to discuss a member of staff's condition, its impact and possible limitations on their ability to discharge their duties, in more detail. Case conferences are arranged with a view to looking at a constructive way forward for both the service and member of staff. The aim of the conference will be to identify ways to support the staff member to return to work from long-term sickness, or increase their level of attendance if they have frequent sickness absence. Case conferences can take place at any stage of the procedure, either with or without the member of staff being present. The member of staff will receive a written invitation to the case conference and be reminded that they are entitled to bring along a representative or work colleague Payroll Department The Payroll Department are expected to: Accurately enter sickness absence dates and causes of absences in to ESR; Ensure the HR department, the Line Manager and the employee are notified in a timely manner when the employee s pay status is due to change; Ensure that employee s sick pay is correctly and accurately administered; Withhold payment if absence has not been certificated. 5. Procedure for Dealing with Frequent Sickness Absence Procedure A Frequent intermittent absence is defined as sickness absence that results in a staff member being unable to attend work for any of the following: 3 or more episodes in a 6 month period, 5 episodes of sickness in a 12 month period. Have sickness absence equating to a total of 4 or more of their working weeks in a 6 month period. A pattern of absence that is a cause for concern or that falls below 95% A level of absence that is unsustainable for the service For a single episode of sickness absence that lasts for 4 or more weeks refer to procedure B. However, a long term episode of sickness will still count as an episode of sickness for the purposes of managing staff with frequent sickness absence. This means an episode of long term sickness could cause a member of staff to trigger the frequent absence procedure. Author: Gayle Williams Deputy HR Business Partner Page 12 of 32

13 Likewise if an attendance target has been set and an episode of long term sickness occurs during the target period, this should be counted. Where there are frequent episodes of short and long term absence then one attendance target will be set for both forms of absence. Where an employee has triggered formal sickness absence management, Managers are required to consider the pattern of the sickness to date. If the sickness absence days are intermittent or are a cause for concern owing to their frequency, Managers will be required to manage the employee under the formal procedure Manager s discretion and patterns of absence Where the Manager recognises that the sickness absence is for a specific reason e.g. a broken wrist and the employee will be absent for a clearly defined period of time before returning to work or there is no history of intermittent sickness, or discernible pattern in sickness Managers are advised to take a pragmatic approach to the application of the trigger. Where a pattern of sickness is identified that is of cause for concern the Manager will arrange to meet with the employee under the first formal stage of the sickness absence procedure. Some examples of unusual patterns of absence are listed below. This is not an exhaustive list and it is important to note that one off occurrences are unlikely to constitute a pattern. For instance taking sick leave immediately prior to or following annual leave on one occasion would not usually require formal management of attendance, unless it contributed to other episodes of sickness. However if there was a repeated incidence of this, the Manager may want to consider formal absence management. Additional guidance on the use of discretion is available by contacting the operational HR team. Examples of patterns could be: Recurrent days of absence that fall on the same day or same shift (i.e. always on a Monday or when the staff member is due to work a night shift) Taking sick days immediately prior or after annual leave Taking sick leave routinely but not enough to trigger formal management. Taking sick leave immediately following/at the end of a period of formal management Once the employee has hit a trigger as part of the return to work interview, a Frequent Absence and Referral to Occupational Health form should be completed with the employee to ascertain whether a referral to Occupational Health is necessary. Author: Gayle Williams Deputy HR Business Partner Page 13 of 32

14 If a referral to Occupational Health is necessary, they will be able to offer advice on the impact an underlying health condition is likely to have on the employee s attendance. Pregnancy related sickness should not be considered as part of any sickness absence management process Stage 1: First formal sickness meeting The Manager should arrange a formal sickness meeting with the employee as soon as reasonably possible. The purpose of the meeting is to inform the employee of the results of the Occupational Health assessment if a referral has been made and to discuss how the employee can achieve an acceptable level of attendance. The employee may be accompanied by a colleague or union representative at this meeting and should be invited to do so in the invite letter. If Occupational Health advice has been sought and has confirmed that the recurrent absences are due to an underlying health condition, the Line Manager should seek further advice on what level of sickness absence they can reasonably expect. They should then consider what reasonable adjustments can be made to facilitate the employee s attendance target. This could include: Change in working patterns Reduction in hours Alteration of duties The attendance target will run for 6 months. During this time the employee will be set a target of: No more than two episodes of sickness absence or combined absences that exceed 4 or more working weeks. And, no more than 5% absence in 6 months. This should be confirmed to the employee in writing following the meeting. Guidance on how to conduct this meeting can be found on the HR intranet site. If the employee makes the required improvement, after six months the formal process will stop. The employee s attendance will continue to be monitored as with all other employees. However if there is a repeated breach of the short term absence management targets within 12 months of achieving the target set at the first formal meeting in stage 1, the formal procedure will recommence at stage 2, the second formal advisory meeting level, following further Occupational Health advice if appropriate: The employee should be advised of the above in a formal review meeting at the end of the six month review period. Guidance for how to conduct the formal review meeting can be found on the HR intranet site. Author: Gayle Williams Deputy HR Business Partner Page 14 of 32

15 Setting adjusted targets In exceptional circumstances the Line Manager may consider adjusting the expected attendance target in light of an underlying health condition in question, (i.e. decrease the level of attendance the employee is expected to achieve). In the case of a member of staff with an underlying condition an attendance target based on a percentage may be more appropriate. A calculator for working out a percentage attendance is available on the Intranet. The percentage target should also be set over a 6 month period from the date of the sickness meeting. In deciding what an acceptable level of attendance would be, advice from HR and Occupational Health should be sought to ensure a consistent and equitable approach is being taken across the Trust Stage 2: Second formal sickness meeting Should the target set in the Stage 1 meeting be breached, a second formal sickness meeting should be set up as soon as possible after this breach. In advance of the meeting the employee will be offered a referral to Occupational Health. The purpose of the meeting is to advise the employee that they have breached their attendance targets, to inform them of the results of the Occupational Health assessment, (if one has been carried out) and to discuss how the employee can achieve an acceptable level of attendance. If an Occupational Health referral reveals there is an underlying health condition causing the short term recurrent absences, adjustments should be considered and discussed, including setting a target based on percentage attendance At the meeting a further attendance target will be set. Again this target will be no more than two episodes of sickness absence, or combined absences that last 4 working weeks or more over the course of six months from the date of the meeting and no more than 5% absence. The employee will be given a formal written warning that if they fail to achieve this attendance target during the second review period there will be a further meeting at which their employment may be terminated. This warning will remain current on their file for 24 months. The issuing of the warning and the contents of the meeting should be confirmed to the employee in writing following the meeting. Guidance on how to conduct this meeting and a template letter can be found on the HR intranet site. If the employee makes the required improvement after six months, a formal review meeting should be arranged in which the employee is advised that the formal process will now stop. The employee s attendance will continue to be monitored as with all other employees. Author: Gayle Williams Deputy HR Business Partner Page 15 of 32

16 If there is a repeated breach of the attendance targets while the formal written warning remains live, the formal procedure will recommence at stage 3, following further Occupational Health advice if appropriate. The contents of the meeting should be confirmed to the employee in writing following the meeting. Guidance on how to conduct the meeting and a template letter can be found on the HR intranet site Stage 3: Formal sickness hearing Should the target set in the Stage 2 meeting not be met, or the staff member trigger the absence triggers whilst a formal written warning is live the Line Manager should refer the matter to the Head of Nursing, or Deputy/Divisional Manager for the employee concerned, who will seek support from the HR Department. A Stage 3 Formal Hearing should be set up by the Senior Manager as soon as possible after the target breach, to which the affected employee and Line Manager should be invited. The Senior Manager will chair the meeting, with support from a HR representative and an independent Manager as a third panel member. The Line Manager, also supported by a representative from HR, will present a management case detailing: The sickness absence history of the employee The meetings held with the employee Advice received from Occupational Health The employee will be encouraged to be represented in the meeting by a work colleague or an accredited trade union or professional association representative. It is the employee s responsibility to arrange representation. If the Occupational Health advice reveals there is an underlying health condition causing the short term recurrent absences, adjustments should be considered and discussed. In considering whether to issue a final written warning or dismiss the employee the panel should consider the following: Whether it is reasonable to conclude that the level of absence will not improve in the foreseeable future. Whether the level of absence had a serious adverse effect(s) on service provision. Whether all reasonable steps to reduce the level of absence have been exhausted. Whether other alternatives such as redeployment, and those described in the Equalities Act are appropriate or available. Whether the employee has taken any steps to improve their attendance/overall health and well-being? Author: Gayle Williams Deputy HR Business Partner Page 16 of 32

17 5.5. Final written warning If the Senior Manager concludes that there are exceptional circumstances which mean that sufficient reasonable opportunity has not been given to the employee, a final attendance target of no more than 2 episodes of sickness/4 working weeks absence and 5% or less absence in a 6 month period will be set. The employee will be given a final written warning that if they fail to meet this target during this third review period the Stage 3 Formal Hearing will be reconvened at which their employment may be terminated. This final written warning will remain live and current on the employees file for 24 months after the date of the hearing. The contents of the meeting should be confirmed to the employee in writing following the meeting. Guidance on how to conduct this meeting and a template letter can be found on the HR intranet site. If the employee makes the required improvement, a formal review meeting should be arranged between Line Manager and employee and the employee advised that the formal process will now stop. The employee s attendance will continue to be monitored as with all other employees. However if there is a repeated breach of the attendance targets stipulated while the final written warning remains live, the formal procedure will recommence at stage 3, following further Occupational Health advice if appropriate. If there is a repeated breach of the attendance targets stipulated after the expiry of the final written warning, the formal procedure will recommence at stage Dismissal If the Senior Manager concludes that the employee and the process have been managed fairly, they will confirm that the employee s employment has been terminated with the appropriate notice for failure to meet an acceptable level of attendance. The main details discussed during the meeting and its outcome will be confirmed in writing to the employee and if applicable their representative. There is a right of appeal if the employee is dismissed and this will be in with the Trust s Appeal s Policy. Author: Gayle Williams Deputy HR Business Partner Page 17 of 32

18 6. Procedure for Managing Long Term Sickness or an on-going Medical Condition Procedure B If an employee has been absent, or is due to be absent for more than 4 weeks then procedure B should be followed. Long term sickness absence is defined as a period of continuous absence of 4 weeks or more. As soon as it is apparent that sickness absence will be for four weeks or more, the Line Manager should seek advice from Occupational Health Planned sickness absence If it is known in advance that an employee is going to be taking sick leave, for instance due to planned surgery, then the Manager will make arrangements with the employee, prior to their absence, to make future contact with them on an agreed date. The purpose of the Manager making contact at this time is to determine how the employee is and when the likely return to work will be. The Manager should consider making a referral to Occupational Health (OH) for a health assessment prior to a return to work following surgery. This will involve discussing any suitable work adjustments and their implementation If an employee is too unwell to attend meetings If, due to their illness, an employee is unable to attend meetings held under this policy, then a letter from the GP or consultant or Occupational Health will be required to confirm this. The Line Manager should consider how meetings may proceed in such circumstances such as organising transport for the employee, making a home visit or holding the conversation by telephone. If the employee is seriously ill, the Line Manager may have to have these discussions through the next-of-kin, representative or proceed in the employee s absence Early interventions If a member of staff has been absent from work, or is currently at work but struggling due to: A Musculoskeletal reason (i.e. back pain) the Line Manager should refer the individual to Occupational Health immediately for early intervention via the Trust s Physiotherapist; or A Stress (home or work), Anxiety or Depression reason, the Line Manager should discuss with the member of staff if they need extra support and if appropriate offer a Author: Gayle Williams Deputy HR Business Partner Page 18 of 32

19 referral to Occupational Health. In addition they should notify the member of staff of the support they can access from the Trust s counselling services, the Employee Assistance Programme (EAP). Any contact with the Trust s EAP service is confidential and will not be passed back to the Line Manager. The service is there to provide staff with psychological support and intervention where appropriate. The Trust s Stress Management Policy should also be consulted when a member of staff is absent due to work related stress Following receipt of a report from Occupational Health, the employee should be invited to meet with the Manager. The employee should be advised in writing that this is a formal meeting and of their rights to representation by a work colleague or trade union representative as recognised by the Trust. The purpose of the meeting will be to discuss: how long the employee is likely to be off work/what support can be given to enable them to remain in work. whether there are any steps that can be taken to support to sustain attendance at work or a return to work if they are absent(e.g. adjustment of hours or duties) advice from Occupational Health, the GP, specialist consultant. Other options to be considered in the event that the employee is unable to return to work are outlined later in the policy. Managers should note that many cases of long term sickness absence may well relate to disabilities as defined by the Equality Act In any case, the Trust will meet the standards of the Act, in order that the situation is managed consistently and fairly Return to work after long-term absence Following a return to work after a long absence, management will need to ensure appropriate reviews to check on an employee s progress. The number of reviews and the timescales will depend on the employee s needs and the reason for and length of the absence. Alternative Options for the employee to return to work During discussions with the employee and in consideration of Occupational Health and GP advice (from the medical certificate), it may become apparent that the employee is not able to undertake the duties of their substantive role in the same way as they had done previously. In such circumstances the following options could be considered: Returning on reduced days, hours or restricted duties Occupational Health, or the medical certificate, may advise a phased return to work on reduced days or hours or restricted duties. Managers are best placed to plan the details of the phased return to work and discussion will need to take place between the Manager Author: Gayle Williams Deputy HR Business Partner Page 19 of 32

20 and the employee regarding what would be suitable/reasonable hours and duties in line with service requirements. Occupational Health will be able to advise on the suggested length of time of the adjustment and the maximum number of hours to be worked. The arrangement should be put in writing. A phased return is usually supported for a period of four weeks or less and the Trust will grant full pay for a rehabilitation programme for this period. Regular reviews by the Manager should take place during rehabilitation period to ensure that the arrangement continues to work for the employee and the service. Occupational Health can advise if a medical review of the employee is required, including advice and support from the rehabilitation nurse. If the programme extends beyond four weeks, other options such as a temporary reduction in contractual hours or use of accrued annual leave should be explored. Reasonable adjustments (temporary or permanent) - If there is an underlying medical condition contributing to sickness absence, management will need to consider whether there are adjustments that could be made to the job. These could be to change the physical environment, the employee s attendance target, to adjust job content and/or to reduce hours. Adjustments may also be recommended by Occupational Health or by the GP on the medical certificate, and management will need to consider if these adjustments are reasonable and practical in terms of the needs of the department, the cost, the impact on colleagues, and whether the adjustments can be made permanently or for a limited period only. Where adjustments are made, management will inform all necessary parties, e.g. supervisors/colleagues to ensure the department continues to support the employee with their return to work. Management will need to ensure when informing colleagues of the reasonable adjustments, that they do not breach confidentiality (e.g. disclosing the reason for absence or underlying condition). Managers should discuss and agree with returning members of staff what will be shared with their team members upon their return to work Employee unable to return to work When all other options have been explored and exhausted, and if the long term sickness absence continues, management will need to consider the overall absence in its entirety. If there is no indication that the employee is able to return to work within a reasonable timeframe, having due consideration to the needs of the service, a recommendation for dismissal on grounds of capability will be made. Ill health retirement may also be a consideration at this stage. If it is unclear whether or when an employee will be able to return to work, management, (rather than Occupational Health) is responsible for determining whether the service can continue to support the employee and when to proceed to a hearing. Author: Gayle Williams Deputy HR Business Partner Page 20 of 32

21 Ill-health retirement If the employee, in agreement with Occupational Health, decides they wish to apply for ill health retirement on the basis they are not fit to carry out their role then they will be dismissed under the grounds of ill health / capability. Employees who have been contributing to the NHS Pension Scheme for at least two years may put forward their application for ill health retirement. To begin the process the employee needs to discuss his/her intention to apply for ill health retirement with his/her Manager, in conjunction with the occupational health advice received. The Manager will then contact payroll to obtain the AW33(E) form. Completing the form requires the support of a doctor, usually from Occupational Health, alternatively the employee s GP could complete the relevant part. The completed form needs to be sent back to Human Resources in the first instance and will then be forwarded to the Trust s Pension Officer, and subsequently the NHS Pensions Agency. The decision to grant ill health retirement is external to the Trust. For information on Ill Health Retirement conditions visit NHS Pension website. Further information regarding the ill health retirement process will be provided by the member of the Workforce Relations Team supporting the Manager Terminal illnesses There are special provisions in the Pension Scheme for terminal illnesses, which are designed to make a person s circumstances as comfortable as possible in such difficult times. Staff may be able to opt to convert their pension benefits (annual pension and lump sum) into a larger one off lump sum, known as commutation. Therefore early advice should be sought from the Pensions Department and information is available from: Termination of Contract by mutual agreement: There may be some instances where the nature of the employee s illness is such that they do not wish to proceed with a formal meeting or hearing, or are too unwell to do so. In such a circumstance the Manager may agree with the employee the most appropriate way to manage the employee leaving the Trust. For example a discussion might take place with the employee and Manager, ideally in person, but if not then over the telephone and the decision confirmed in writing rather than holding a full hearing. The employee will still have the right to appeal the decision. Formal Meeting: Should the employee not wish to mutually agree their dismissal, a formal meeting will be arranged with the employee who has the right to be represented by a work colleague or trade union representative as recognised by the Trust. The employee will be given 7 calendar days notice of this meeting. The meeting will be chaired by a Senior Manager who has the authority to dismiss. Author: Gayle Williams Deputy HR Business Partner Page 21 of 32

22 7. Suspension on Medical Grounds Suspension on medical grounds is intended to help ensure safety of staff and patients. It seeks to make sure staff do not work when it is not safe for them to do so. Under certain circumstances listed below the Line Manager is authorised to suspend the member of staff on medical grounds. Clearly this is not in any way connected with disciplinary action and this should be made clear to the member of staff. This form of absence will be paid at full pay for an initial period of up to 2 weeks, and subsequently reviewed weekly by the Line Manager to ensure that it is appropriate to maintain the suspension. Suspension on medical grounds should only be chosen in order to seek initial or further medical opinion including advice from the Occupational Health Service. Suspension on medical grounds will be for short periods only and should, in case of any doubt, be decided on after discussion with the HR Manager. Circumstances when suspension on medical grounds can be used include:- o If any member of staff returns to work after sickness absence and the Line Manager has doubts about their ability to perform the full range of their duties in a safe way and prior to an Occupational Health Assessment. o If the member of staff is unwell or has a condition which causes the Line Manager concern and might present a risk to him/her or to others. In cases involving medical and dental staff, the advice of the Medical Director must be sought at the earliest opportunity. 8. Time off for Appointments/Treatments 8.1. Routine Dental/GP/Hospital appointments Staff should arrange to attend routine GP, dental and hospital appointments that are off site in their own time e.g. day off, at beginning or end of the working day/shift to minimise disruption to the service. Staff should provide reasonable notice to their Line Manager when making a request to attend an appointment off site and agree how they will make up the time owed. Where this is not possible, either annual leave, unpaid leave, time off in lieu, or a combination of these, will need to be negotiated, prior to taking the leave, which will be subject to the needs of the service. (NB all antenatal appointments are covered under the Trust's Maternity Leave Policy). In the event that a member of staff is required to attend an emergency appointment during paid working hours, the member of staff is to notify their Line Manager as soon as reasonably practical of the appointment in accordance with local reporting procedures. Author: Gayle Williams Deputy HR Business Partner Page 22 of 32

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