Category: Health Conditions

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Disability Employment Law Employment Rights Act 1996 Health Conditions Mental Health Reasonable Adjustments Return to Work Sick Pay

Changes and guidance on fit notes for employers and line managers

View of the City of London at sunset

The government has just published changes to its fit note guidance for employers and line managers. It even included a handy checklist so that employers can avoid painfully drudging through the lengthy (4,462-word) document. The checklist includes the necessary steps and information that employers should have at their disposal when an employee has been issued a fit note.

Firstly though, what is a fit note? It’s a note from a certified healthcare professional who has determined after consultation with an employee, whether or not they ‘may be fit for work’ or are ‘not fit for work’. A fit note allows employers to discuss with their employees any health conditions that may prevent them from undertaking their work as usual. It also gives employers the chance to have an interactive discussion with their employees to establish tailored measures suited to both parties going forward.

The changes to this guidance as of 2022 state that where these fit notes had previously been required to have a signature of ink, they are now moving forward (as we all are) to accepting just the name and profession of the issuer. This enables the fit notes to be received and sent digitally. The DWP also expanded their accepted list of healthcare professionals who can certify the notes to include nurses, occupational therapists, pharmacists, and physiotherapists. It should be noted that although digital notes are embedded in primary care settings (GP), they are not yet in secondary care settings (hospitals), and so a pre-printed note may still be used by employees recently discharged from hospital.

There are a number of general rules that surround fit notes, so I’ll just outline the important ones to familiarise yourself.

In the first 7 days of sickness, employees can self-certify. If your organisation requires medical evidence within this time, any costs incurred by the employee for accessing a healthcare professional will be yours to cover eg:- where there has been a pattern of absence say on a Monday and Friday and you tell the employee that any further absence on these days will require a fit note.

The length of a fit note can cover a maximum of 3 months at a time during the first 6 months of sickness. Any specific time decided will be determined by the clinical judgement of the healthcare professional.

Private (non-NHS) healthcare professionals can produce reports like a fit note which can be considered. Private medical certificates or the Allied Healthcare Professionals Work Report can be accepted with no further need to obtain a further note.

Fit notes can come in a variety of ways, whether that be computer-generated and printed out, or sent digitally to your employee. Digital fit notes will include a barcode so that they can be scanned by employers and added to sickness records.

Now onto the fitness for work assessment and what that means for employers. The healthcare professional will state whether the employee is fit for work or not, and the length of time that any adaptions are required/the amount of time the employee is unable to work for. If they ‘may be fit to work’, the healthcare professional will give general recommendations on adjustments to be made for the employee to work safely or return to work entirely. These recommendations are not binding and if the recommendations cannot be implemented given the nature of work, the fit note can then be used as evidence for sick procedures.

General adaptions you may choose to explore as an employer include:

  • Phased return to work

  • Altered hours

  • Amended duties

  • Workplace adaptions

While at first glance these fit notes may appear to be potentially obstructive, by supporting your employee to stay or return to work you may actually avoid absence costs and minimise disruption for your organisation. Having an open discussion with your employee about adjustments will serve to create a more trusting work relationship that can only benefit both parties!

Martha Regan
Refreshing Law

 

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Duty of Care Employment Law Health Conditions HR Stress

Guest Blog | How HR can take a trauma-informed approach to support employees

Platfform Wellbeing's HR support services

All businesses have a duty of care to their employees and safeguarding their mental health is a fundamental part of this. April is National Stress Awareness Month and a time to reflect on the negative impact of stress in the workplace.

We all know that stress is one of the most common causes of long-term work absence in the UK but how much do HR professionals understand about the impact that trauma can have as a contributory factor to stress and work burnout?

It’s important to understand what psychological trauma is and how it can have a significant impact on an individual’s mental and physical health. Trauma-informed care is an approach that recognises the impact of trauma on individuals and seeks to create a safe and supportive environment for healing.

So how can HR take a trauma-informed approach to supporting employees through work stress and burnout?

Create a safe and supportive environment

Creating a safe and supportive environment is an essential part of a trauma-informed approach. This includes:

  • Establishing trust: Building trust with employees is essential. This can be achieved through open communication, active listening, and a non-judgmental approach.

  • Fostering a sense of safety: Employees need to feel physically and emotionally safe in the workplace. HR can ensure that the workplace is free from harassment, discrimination, and other forms of violence.

  • Providing choice and control: Employees need to feel that they have choices and control over their work environment. HR can provide employees with opportunities to give feedback, participate in decision-making, and have a sense of autonomy.

  • Empowering employees: Empowering employees to take control of their work environment and manage their stress can help them feel more confident and reduce the risk of burnout.

Offer resources and support

HR can offer resources and support to help employees manage their work stress and prevent burnout. This may include:


  • Counselling services: Counselling services can help employees manage their stress and cope with trauma.

  • Training and education: Providing employees with training and education on stress management and mental health can help them understand the impact of stress and develop coping strategies.

  • Flexible work arrangements: Offering flexible work arrangements such as hybrid or flexible hours can help employees manage their workload and reduce stress.

  • Peer support: Providing employees with peer support networks can help them feel connected and supported in the workplace.

In summary, taking a trauma-informed approach to supporting employees through work stress and burnout is essential for promoting employee wellbeing and preventing burnout.

HR can create a safe and supportive environment, offer resources and support, and empower employees to take control of their work environment. By doing so, HR can help employees manage stress and prevent burnout, leading to a more productive and healthier workforce.

If you would like to learn more about becoming a trauma-informed organisation, you can find further information on the Platfform Wellbeing website.

Platfform Wellbeing
Platfform Wellbeing is a commercial training, workplace wellbeing and counselling service aimed at organisations across the private, public and third sector. It offers kind, compassionate responses at times of distress and supporting organisations with creating cultures and teams than enable people to thrive. We are part of Platfform, a mental health and social change charity.

 

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Anna Denton-Jones Disability Employment Law Employment Rights Act 1996 Equality Act 2010 Health Conditions Mental Health Return to Work Sick Pay

Revised — Fit notes

View of the City of London at sunset

You may be aware that the categories of people who are able to sign a Fit Note for the purposes of Statutory Sick Pay and other Social Security claims has been broadened with effect from 1 July 2022, so that pharmacists, physiotherapists, registered nurses and occupational therapists are now all able to sign Statements of Fitness for Work.

The old rules that such paperwork needed to be ‘wet’ signed by the GP have also been removed so it is now possible for the electronic generation of this paperwork in order to improve the way in which medical professionals are able to issue such documents. The Fit Note is still required to be signed and include the name of the healthcare professional who authorised it to be legally valid so a version that is blank isn’t genuine.

The Department for Work and Pensions has issued guidance for healthcare professionals which is called “Getting the most out of your Fit Note”.

It is interesting reading, in particular the instructions to medics to focus on fitness for work in general rather than fitness to attend a particular occupation, which suggests that it ought to be harder for somebody to achieve a state where they are unable to work at all, compared to being unable to perform aspects of their job.

The case studies are interesting as well. Particularly the fifth one called “relationship issues at work”. It gives the example of a patient complaining that she doesn’t get on with her manager, is feeling very stressed and wants to be signed off work. The medic determines in the consultation that although the situation is upsetting for the individual, they do not have a mental health condition and that they are fit for work. The medic then explains to the individual that they can see that she is being affected by work but is not in a situation where she should be issued with a Fit Note. The patient reacts badly and tells the medic that their manager has been really horrible to her and that she is finding it difficult to cope. The medic is directed to say that they appreciate that that may well be the case but to explain that the situation is not making the patient ill. If they were ill then they would be issued with a Fit Note and the medic would be acting with their health interests in mind. Instead, the medic is encouraged to explain that this is not a medical problem but a management issue and that going off on the sick will not resolve the problem or help her to find another job if that is what she decides to do. If that conversation happened, I think all employers would be relieved.

The medic is then encouraged to discuss with the individual whether they can talk to somebody at work to help resolve their problems such as speaking to HR, a Trade Union representative or speaking to ACAS. In the case study, the patient decides to approach another colleague for advice, to check the internet and to look at ACAS materials on managing conflicts at work.

Using that example, the situations we come across in HR where this is some kind of conflict or dispute in work, should not by this analysis result in somebody being signed off from work. It will be really interesting to see to what extent the medics toughen up their approach, as we all know that the stereotype is that Drs will provide a Fit Note “on demand”.

In the question and answer section of the document, it’s interesting to see that there is a question relating to “what if my patient fears job loss, stigma or discrimination if I reveal a health condition (or its effect on their work functioning) on their Fit Note?”. The answer is as follows: “if you feel that revealing a particular diagnosis or a limitation would harm your patient’s wellbeing, compromise their position with their employer, you can enter a less precise diagnosis on the Fit Note”. We have all come across examples where a Fit Note has said something like “unwell” or “stress” rather than an actual medical condition – this is why it is always worth referring somebody to occupational health to get the full picture. It reminds us that this scenario may be behind what a medic has written and that all may not be what it seems from the face of the paperwork: further exploration is necessary.

It is interesting to note that medics are encouraged to only issue bereavement related Fit Notes if somebody is genuinely so distressed by what happened to them that they are unfit for work – where they are not actually medically unwell then they should be having compassionate leave with their employer not time off sick. Again it will be interesting to see how many medics follow this guidance.

There is also further guidance for employers and line managers: Fit note: guidance for employers and line managers. Amongst other things, this repeats the position that has been the case for some while now but which I find employers are often confused by, in relation to return to work before the end of a Fit Note. The employee can come back to work at any time, even if this is before their Fit Note expires and they do not need to go back to their healthcare professional first. If somebody is coming back and you believe it is too soon or harmful in some way, then you would need to refer to occupational health for an assessment and further guidance. Where a healthcare professional assesses somebody is fit for work, they will not be issued with a Fit Note (there are some very narrow occupations where certification has to be given).

Something else that strike me about this new guidance is the emphasis that people do not need to be 100% fit to return to work because they may well be returning to work with adjustments and need to do alternative duties. That would probably surprise employees.

Anna Denton-Jones
Refreshing Law

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Anna Denton-Jones COVID-19 Disability Duty of Care Employment Law Employment Rights Act 1996 Equality Act 2010 Health and Safety Health Conditions Sick Pay

Long COVID was a disability

Royal Courts of Justice, London

The first Employment Tribunal case to determine that an employee with long COVID was disabled within the meaning of Section 6 of the Equality Act 2010 has taken place. The employee was a caretaker and he tested positive for COVID-19 in November 2020. Initially, he was experiencing mild symptoms. After isolating, he developed severe headaches and fatigue that were so severe that after simple acts like having a shower or getting dressed, he had to lie down and recover. He struggled to stand for long periods. He couldn’t undertake household activities like cooking, ironing or shopping. He experienced joint pain, loss of appetite, a reduced ability to concentrate and difficulty sleeping. This all led to him feeling unable to socialise. His symptoms were unpredictable: he would experience an improvement, only to suffer from fatigue and exhaustion again.

In January 2022, so after a few months, his health began to improve but the sleep disruption and fatigue continued to affect his day to day activities. His notes referred to long COVID Post Viral Fatigue Syndrome. The employer obtained occupational health reports which both indicated that he was fit to return to work with a view that the disability provisions of the Equality Act were unlikely to apply. However, due to his fatigue levels and the fact that he didn’t return to work, in August 2021 because of ill-health, his employer dismissed him when he had been absent from work for 9 months.

The Tribunal has had to determine the preliminary issue of whether he was disabled at the relevant time. It has concluded that he was and that he wasn’t exaggerating his symptoms and had a physical impairment (The Post-Viral Fatigue Syndrome caused by COVID-19). The Judge found it relevant that there was no incentive for him to remain off work when he had exhausted his sick pay. They found that his symptoms were consistent with the June 2021 TUC Report into long COVID and in particular, the fluctuating nature of those symptoms. The physical impairment had an adverse effect on his ability to carry out normal day to day activities and they found that the effect was more than minor or trivial and that it was long term because it could well last for a period of 12 months when viewed from the dismissal date. In particular, they noted that the employer themselves was of the view that there was no date in sight where a return to work seemed likely.

Clearly this case does not mean that the employee will be successful in his claims of disability discrimination – at this stage he has just got over the first hurdle of proving that he had a disability. The Tribunal will have to go onto consider whether or not the dismissal was justified in all the circumstances. In doing that, they are particularly likely to take into account to what extent reasonable adjustments were explored and the process that was followed around the dismissal. This might include considering alternative employment.

Indeed, in another case, the Employment Appeal Tribunal has considered Section 15 of the Equality Act which you will recall is ‘discrimination arising from a disability’ in connection with dismissal following a period of absence. When Section 15 is raised, the Tribunal is going to be considering whether dismissal was a ‘proportionate means of achieving a legitimate aim’ of the employer. That case reminds us not to act prematurely in dismissing a disabled employee – the employer had grudgingly adopted a trial in an alternative location but failed to implement the trial reasonably or properly evaluate its success before their decision to dismiss. Where there was such an opportunity of work from a different location, a Judge is likely to find that that alternative was a less discriminatory alternative to dismissal that the employer should have taken. Clearly that wouldn’t have helped the employee with long COVID as he wasn’t able to work at all at the stage he was dismissed.

Anna Denton-Jones
Refreshing Law

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Absence Anna Denton-Jones Disability Employment Law Health Conditions Return to Work Sick Pay

Extension of who can provide an employee with a Fit Note

View of the City of London at sunset

You will all be familiar with GPs providing employees with certification that they are insufficiently well to attend work on day 8 of their absence, enabling the employer to then process, for example, statutory sick pay.

Some new regulations, snappily titled “The Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) (No. 2) Regulations 2022″ amend the position to expand the category of people who can sign Fit Notes for the purposes of Statutory Sick Pay and making Social Security claims.  From 1 July 2022, registered nurses, occupational therapists, pharmacists and physiotherapists will also be able to sign the Statements.  The idea behind this is to reduce workload on GPs and as you can envisage the GP practice may pass some routine work to the practice nurse, for example.

However, employees are still going to primarily be thinking of their GP when they are thinking about evidence for their employer of them not being fit to attend work.

You will need to update managers on this development so that they appreciate that any paperwork they see with the four new categories of signature are genuine and acceptable.

Anna Denton-Jones
Refreshing Law

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Anna Denton-Jones Duty of Care Employment Law Employment Rights Act 1996 Equality Act 2010 Gender Inclusivity Health Conditions Menopause Sick Pay

Developments in the law relating to menopause

Royal Courts of Justice, London

The Employment Appeal Tribunal has only ever heard two cases in this space. Most recently they dealt with the second case that’s come before them where essentially they told the lower Tribunal off for failing to recognise the employee’s disability and potential sex discrimination claims. The case involved Leicester City Council and a social worker who was claiming constructive unfair dismissal, disability discrimination and sex discrimination. Her claim centred around the Council’s treatment of her in relation to her menopausal symptoms.

In her claim she described suffering from physical, mental and psychological effects of the menopause for a 2 year period. This included insomnia – causing fatigue and tiredness, light-headedness, confusion, stress, depression, anxiety, palpitations, memory loss, migraines and hot flushes. These had a negative impact on her life to the extent that she struggled physically and mentally to cope, had been to her GP who prescribed hormone replacement therapy and was under the care of a consultant at a specialist menopause clinic.

The employer had referred her to Occupational Health but were unable to meet the request that she be reviewed by a female doctor. The employee felt embarrassed and uncomfortable discussing her symptoms and the difficulties she was experiencing in their presence and in particular she had had a work related warning for her absence levels and at appeal, four men were present to make the decision. She described how when she had advised a male manager that she was suffering from hot flushes in the office, he had said he also got hot in the office, dismissing this as a menopause symptom.

The legal issues in the claim were more about the Tribunal having not applied the right level of detail to the explanation of their findings. The case still illustrates a number of key points:

  • That the menopause and menopause related symptoms can meet the definition of disability under the Equality Act as regards a physical or mental impairment which has a substantial and long term adverse effect on somebody’s ability to carry out normal day to day activities.
  • The need for employers have their antenna looking to spot in performance cases or cases where they are managing absence levels, whether there may be an underlying issue such as the menopause and the need, where there is, to use normal processes, and ensure further advice is obtained rather than ploughing on regardless, dismissing the issue as ‘just sickness absence’.
  • When referring somebody to Occupational Health, it would be respectful, to abide with an employee’s wishes to enable them to see a female Dr if they want. A rule that they had to see whoever was available may be indirectly discriminatory and you would need to think carefully about whether you could justify such a requirement or whether it’s actually going to be seen as a separate act of harassment or victimisation if you fail to be flexible on this.
  • It’s important to train managers so that they are aware of the menopause and don’t belittle it or think it can’t affect some people. We have a one-hour training session that we are able to provide on this subject area, if you are interested.

Interestingly, the Institution of Occupational Safety and Health has, as part of its response to the Parliamentary Enquiry that is currently going on into the issue of menopause in the workplace, made a number of recommendations including that employers need to take a more holistic view and put the spotlight on effective management practices and practical support. The Parliamentary Enquiry which launched in July of this year will consider, for example, whether it would be necessary to elevate menopause as a stand-alone disability like cancer under the Equality Act so that it gets the recognition it lacks at the moment.

Anna Denton-Jones
Refreshing Law

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Anna Denton-Jones Communication Duty of Care Employment Law Health and Safety Health Conditions Mental Health Risk Assessment Stress

What to do when you’re worried about someone — Suicide awareness

View of the City of London at sunset

Friday, 10th September was Suicide Awareness Day. By coincidence I ended up having the same conversation twice with two different organisations. In both cases, the employer had an employee who was on long term sick and where a pattern of contact with the employer had been established but they felt that something had changed. The lack of contact they were now experiencing was out character from the employee. In one case the employee had shared that they were having negative thoughts and in the other the employer was just concerned.

In such a case where efforts to speak with the employee are not fruitful, if you have any concerns then I recommend you act on them rather than ignore them. Our intuition is there for a reason.

The first port of call might be the next of kin that the individual has left with you. You don’t need to get into discussing any details about the employee or their absence, their health or anything like that: you can just remind the next of kin that they have been appointed by the employee as the next of kin and that you are worried about the employee because there has been a change in behaviour — are they okay? This is likely to prompt the next of kin to say that they will check.

The second port of call might be the GP. If you have the employee’s GP details which you are likely to do from the fit notes that they will have been submitting, you could contact the practice explaining that you have concerns and this is likely to trigger the practice then checking up on the individual. The GP will not be able to discuss anything about the individual with you but they will note if you are saying there is out of character behaviour and the fact that you have bothered to take the time to call.

Clearly you might be barking up the wrong tree entirely but for the sake of a phone call or two, if you are in any doubt, it is better than regretting not having raised a concern if there is something to worry about.

Anna Denton-Jones
Refreshing Law

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Absence Anna Denton-Jones Burnout Disability Duty of Care Employment Law Health Conditions HR Mental Health Remote Working Return to Work Risk Assessment Video Working from Home

Video | Working from home and ill health

YouTube video playing on a phone

Our latest video is available to view on the Refreshing Law YouTube channel — please click here to watch Anna discussing ‘working from home and ill health’ and the potential impact on individuals and businesses.

Anna Denton-Jones
Refreshing Law

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Anna Denton-Jones COVID-19 Disability Duty of Care Employment Law Equality Act 2010 Health Conditions Maternity Pregnancy Reasonable Adjustments Remote Working Return to Work Working from Home

Déjà vu — Shielding

View of the City of London at sunset

If this feels familiar, we have been here before…

In Wales
The clinically extremely vulnerable have been advised to shield in Wales since the 22 December 2020. Shielding for the clinically extremely vulnerable will be paused on 31 March 2021. The fact that the word “pause” is being used indicates that this position may change again in the future so be prepared to be flexible.

Working from home should still be the position wherever that is possible. Where that is not possible, employers will have to take measures to make the workplace COVID secure which may involve changing the person’s duties etc.

In England
The clinically extremely vulnerable have been shielding since 5 January 2021. As of 1 April 2021, they will no longer be advised to do so and will not be eligible for statutory sick pay on the basis of being advised to shield.

The advice is still that they should continue to work from home wherever that is possible, so employers ought to be attempting to facilitate that. Where they cannot work from home, then they are advised to attend their workplace and employers will be under a duty to take measures which will reduce the risk of exposure to COVID-19 in the workplace. That may involve changing the person’s duties etc.

Both
Furlough is an option where the employer decides working from home isn’t possible. The employer would need to consider the discrimination risks associated with, for example, singling out a worker for furlough, when their category of colleague was not also being furloughed.

Anna Denton-Jones
Refreshing Law

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Anna Denton-Jones Compensation Constructive Dismissal Disability Diversity Duty of Care Employment Law Employment Rights Act 1996 Equality Act 2010 Health Conditions Protected Characteristics

We can learn from a recent disability discrimination case

Royal Courts of Justice, London

Last year, a university law lecturer at BPP University named Elizabeth Aylott was constructively unfairly dismissed and unfavourably treated because of something arising from her disability, despite the fact that other disability related claims were dismissed. She suffered from autistic spectrum disorder, anxiety and depression, which were her disabilities.

A member of the management team talked about her with a colleague and referred to her as a good worker but “mad as a box of frogs”. This comment then got back to her.

She found herself working very long hours including weekends and evenings.

A complaint resulted in a breakdown in the relationship with her employer, in particular, the employer did not allow her to see the complaint or defend herself.

Those three acts were found to be unfavourable treatment, as was the failure to refer her to occupational health.

Other concerns involved a crass and insensitive remark made about how she should have been able to handle her workload – this was inappropriate in the context of what was clearly a poor mental state.

Her employer was found to have failed to reduce her workload or provide extra support or heed any of the indications that she was not coping. Given the numbers of people who are experiencing challenges through the pandemic, you can see how easily an employer can fall into this trap and be found to be guilty of failing to do the right things.

Whenever anybody is complaining of their workload, the hours that they are working or exhibiting other signs that they are suffering from stress and not coping, which could be falling productivity, unusual disengagement or irritability and being more sensitive than normal in relation to normal day to day work related matters, an employer should be considering what they can do to support the employee.

One of the interesting things in this case, is that the employee found a job fairly quickly, so within a 3 month period of her having resigned. However, the Employment Tribunal still awarded her £71,000 worth of compensation for future losses (presumably her new job did not pay as much), £32,000 for past financial losses – so bridging the gap between the jobs, and £20,000 for injury to feelings. The Judge noted that the discriminatory conduct had been integral as to why she chose to resign and that although she had commenced working elsewhere, she remained unwell throughout the period up to the Hearing, when she was able to talk about how the treatment she had received had affected her. This shouldn’t be underestimated.

Managers need to be aware that during a Section 15 of the Equality Act claim that somebody has suffered from discrimination arising from a disability, they need to do the following:

  • Show that their disability causes “something”. That something might be fatigue or more stressed when under pressure or to lose their concentration or not perform as well under pressure.
  • If as a result of that “something” they then receive unfavourable treatment, so that might be performance management, sickness absence management or they aren’t promoted, put forward for training or allocated work, those actions can then be connected back to the disability. The employer has to then show that they are pursuing a legitimate aim and have done so in a proportionate manner when carrying out those actions.
  • For example, it may be that managing absence or attendance at work is a legitimate aim but if the employer has not obtained occupational health advice and has not made real efforts as regards reasonable adjustments, the employer is unlikely to be able to show that their actions were a proportionate means of achieving a legitimate aim.

Anna Denton-Jones
Refreshing Law