Pressure to work through periods of short term sicknessBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3446 (Published 09 June 2011) Cite this as: BMJ 2011;342:d3446
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Readers will know that a unilateral change to contract at Central Manchester Foundation Trust was imposed on all staff in November 2011. The medical staff were advised by the BMA to seek a declaration at the High Court against this and this is listed but still to be heard.
The non medical staff union UNISON who have a different contract however followed a different route via the Employment Tribunal and made different allegations. Their case was that the changes introduced by the Trust were unlawful deductions of pay. The employment tribunal is the correct forum for such a claim which can be seen to be different to the doctors’ claim.
Mrs J Bent v CMFT was heard in January 2012. Of the 86 claims lodged, six were heard as test cases and the judgement was to be binding on the remainder. The judgement was last week. “It was the unanimous judgement of the Tribunal that the claimants’ claims of unlawful deduction from pay pursuant to the provisions of Part ll Employment Rights Act 1996 are well founded.
“The claimants have been subject to a variation of the terms and conditions of their employment to which they have not consented and through the imposition of which they have been subject to a series of unlawful deductions from their pay.”
The Hearing was only to decide liability, clearly here the Trust lost and the employees won and the tribunal has set a separate date for remedy.
In Employment tribunal cases, each side bears their own costs. The Medical Director has previously commented that he pays himself £200 000 per year. It is not known how much this case cost the Hospital and therefore almost directly the tax payer.
COI Oliver Dearlove is not a doctor.
Competing interests: Oliver Dearlove is not a doctor
We were very pleased to see the important, but often neglected issue
of the health of health professionals and the effect that this may have on
their work discussed in a recent editorial (1). However, we were
surprised that Professor Dew took such a uni-dimensional view of
presenteeism, describing it in such a way as to imply that it is always
wrong for an individual to be at work while they have symptoms which may
impact their occupational performance. Presenteeism is difficult to
define and is more complex than this would suggest. He cites a study
where the researchers measured presenteeism by asking healthcare workers
to retrospectively self-report if they had been present at work when they
perceived that they should have taken sick leave. This is a highly
subjective assessment. Not only do attitudes to health and illness vary
between individuals and workplaces, but it is part of the self-image of
some workers, for example doctors, that they have to be very ill to avoid
Whilst few would disagree that individuals who are too ill to work
should not be pressurised to do so, there is overwhelming evidence that
individuals with medical problems that prevent them from working at full
capacity can benefit from adapted duties (2). It is well recognised that
the longer an individual is absent from work due to illness, the greater
the likelihood of them developing psychological barriers to return to work
(3). This in turn leads to an increased risk of long-term disability and
loss of employment.
In England, the Government has recognised the importance of
maintaining individuals with medical disorders in the workplace by
replacing the 'sick note' with the ' fit note'. The aim of the fit note
is to shift the focus of advice from what people with medical problems
can't do to what they can do, thereby facilitating their retention in the
workplace (4). Employers generally would prefer to pay for an employee to
be at work, albeit at reduced capacity, for a few weeks than to pay them
full pay to be at home. In addition many employers recognise that making
temporary adaptations to job requirements to facilitate the retention of
an employee with a medical condition, often results in the employee
returning to their full productivity at an earlier stage than if they had
stayed off work on sick leave.
Individuals whose illness may pose a health or safety risk to others
in the workplace, including members of the public, should clearly remain
away from the workplace until safe to return. Additionally, individuals
who consistently under-perform at work due to a medical condition should
be referred for occupational health advice. But presenteeism is complex;
it has many positive aspects and is not just a negative phenomenon as
implied by Professor Dew.
1) Dew K. Pressure to work through periods of short term sickness.
BMJ 2011; 341:d3446
2) Waddell G, Burton K and Kendall N, Vocational Rehabilitation: what
works, for whom and when? The Stationary Office, 2008
3) Waddell G, Aylward Mansel. Models of sickness and disability
applied to common health problems. : The Royal Society of Medicine; 2010
4) Verbeek J, Madan I. From sick notes to fit notes. BMJ 2009;
Competing interests: No competing interests
I enjoyed Professor Dew's article on the problems caused by
presenteeism . However, I feel that compared to absenteeism the
problems caused by presenteeism are the lesser of two evils. The article
states that in a four week period a third of NHS staff have symptoms that
should cause them to be off sick, and if they then attend work they will
only be functioning at 50% capacity. But I feel that is better to have
some staff working at half capacity than many at home ill, or for the NHS
to have to cover the cost of hiring expensive cover staff for all those
taking time off.
I am interested to know what constitutes "medical conditions that
should prevent [staff] from attending" . Surely hardiness for different
symptoms varies between individuals, and when some people consider they
are too ill to work, others would view the same condition as only a minor
Also, we must consider the problems in a doctors training that are caused
by too many sick-days. Their absence will mean that they learn less than
their peers, and therefore may not progress through their training as
quickly. In addition, whilst working in a team-environment, a day off for
one person means more work for everyone else. The GMC also requires that
doctors ensure there is sufficient cover for their patients when they are
not present, and that they should work the period specified in their
contract . If you are very ill then obviously you cannot fulfil your
duties, but if you feel you can work through it than you should do to
ensure your patients are receiving adequate care.
I agree that NHS staff should not be working when they have active
infections that could spread to other staff and cause them to be ill, and
to patients especially if they are immune-compromised. But I do feel that
there must be ways of modifying activity in the workplace for other
ailments: for example, if a junior doctor has injured his/her leg, then
they could ask their colleague to go on the ward round for them whilst
they complete all the paperwork. In this way, loss of productive work will
be minimised, the doctor is still at work and gaining experience, they
have not let their team down, and the NHS has not had to pay for the cost
of a locum.
1. Dew K. Pressure to work through sickness. Student BMJ 2011;19: 9.
2. The General Medical Council. Good Medical Practice. http://www.gmc
-uk.org/guidance/good_medical_practice.asp (accessed 27th August 2011).
Competing interests: No competing interests
Presenteeism present in Manchester - you bet your BIPPY!
Readers of the BMJ and of the dumb-cluck things our employers do
nowadays will be unsurprised to learn that presenteeism is part of the
employment policy of Central Manchester Foundation trust
Yes readers, pressure to turn up to work in Hospital when you're ill!
In 2010, the trust as employer informed the work force medical and
ancillary that they were inserting new terms into our contracts and that
would be The Behavioural Incremental Pay Policy. The new terms would mean
anyone who had eighteen days off in a rolling year or four periods of
illness would not receive their contracted pay increment. This was done
without agreement as the Trust said agreement was not necessary. Other
trusts are excitedly watching this introduction and how well it works, we
Those that turn up to work ill and obviously
unable to function - perhaps because they are pyrexial or obviously
infected in other ways are encouraged to self-certify they are unable to
work (rather than be sent home by their employer). Given that the worker
has self-certified himself, their line manager can then enter their names
into the list of those to be paid less. They do this in a very very
concerned way. We are certain the list is enlarged with great regret, but
bonuses, we all know, depend on circumstances such as these.
Administration was unable to say how much money these manoeuvres had
saved the trust to date although the low morale and demotivation that this
causes can and has been measured.
Oliver R Dearlove M.A., M.B., BChir., F.R.C.A.
Late Chairman of Royal Manchester Children's Hospital medical staff
Conflict of Interest; These views DO reflect his employers views
although obviously not of any sane person. No other declaration of
conflict other than treated ca rectum.
Competing interests: as script
Dew highlights presenteeism.1 This is an important phenomenon but it
must be kept in perspective.
All workers face health issues at times during their careers. It is
important that employers invest in the health of their workforce to
enhance performance and productivity. The solution to presenteeism should
first be to encourage action that enables employees to continue their
activities when health issues arise, by making adjustments and providing
effective occupational health support.
Dew references reports studies that indicate a high prevalence
suggesting, for example, that during a period of four weeks a third of
doctors and nurses have worked when they should have taken sick leave.2
This is a bold claim and will not match the experience of many. It is
based on a study of only 32 doctors in Finland.
In contrast the 2010 NHS staff in United Kingdom only 1% of all
respondents indicated they had not been able to do their daily work for
either a physical or psychological reason the past four weeks. More than
150 000 NHS staff responded to this survey.3
Dew also suggests that women may attend work more when ill. The
higher rates of sickness absence amongst female workers are well known.4
The suggestion that work related factors have a bigger effect on
presenteeism than personal circumstances is based on a single study of 32
doctors and 137 nurses.2 There is very limited evidence that presenteeism
leads to significant morbidity (especially when health issues at work are
Workers have health issues. Employers need to take action and provide
suitable occupational health support. Healthcare workers have particular
needs and NHS occupational health services should be suitably commissioned
and configured to meet them.5
1. Dew K. Pressure to work through periods of short term sickness.
2. Rantanen I, Tuominen R. Relative magnitude of presenteeism and
absenteeism and work-related factors affecting them among health care
professionals. Int Arch Occup Environ Health 2011;84:225-30.
3. Care Quality Commission data.
accessed 17 June 2011
4. Office for National statistics data.
http://www.statistics.gov.uk/cci/nugget.asp?id=1577 accessed 17 June 2011
5. Boorman S. NHS Health and Well-being Review: Final Report. London:
Competing interests: No competing interests