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My company's HR department utilises the Bradford Factor as a means to determine appropriate disciplinary actions, such as verbal or written warnings, in response to employee absenteeism due to illness.

I get chronic migraines. I've had them since I was 11 and I'm 30 now. I am in the process of being referred to a neurologist. They cause me to be off sick a few days every quarter or so. I've been prescribed a multitude of different medications from the NHS and I've been taking these regularly for a while.

As I have triggered the Bradford factor I've been given a written warning and in the meeting HR asked me to explore the use of holistic medicines.

I personally don't believe in holistic medicine, and I don't want to pay for this out of my own pocket as the NHS won't cover it.

Can they do this, and could I be let go over refusing to try it?

Here's what the written warning says - names have been removed.

I refer to your meeting on 9th March 2023 with {MANAGER}, {HR staff member} and {HR staff member} present the purpose of which was to discuss your attendance record in accordance with the Company’s Absence Management policy. The discussion at the meeting is summarised on {ONLINE PORTAL}. At the meeting you were advised that your attendance record was not satisfactory. As such, you are issued with a First level written warning. The warning will remain on your personnel file for 6 months. As discussed, an improvement in your attendance record is needed. You should be aware that should your attendance levels remain unsatisfactory, it may be necessary to move to the next stage of the procedure which is a Stage Two formal review under the Company’s Absence Management policy. I wish to advise you that under the Company’s policy, a Stage Three review meeting will consider an employee’s ability to undertake their contract of employment in relation to their attendance record. This may mean that your contract could be terminated. Should you wish to discuss this matter further please do not hesitate to contact me.

Here are the relevant minutes from the meeting:

{HR STAFF MEMBER} advised persisting with the GP and asking for a referral to a specialist. He has ticked all the boxes on the roadmap with the GP so that would be the next step.
{HR STAFF MEMBER} encouraged {TFISH} to enquire at the opticians/GPs for protective glasses and if any funding can be offered as {TFISH} said they are too expensive.
Again encouraged {TFISH} to reach out to the GP for private referral for holistic therapies as {TFISH} has advised with the cost of living that’s not something he can fund.

{TFISH} was issued with a first written warning which will remain on file for 6 months. {MANAGER} will hold a follow up welfare meeting with {TFISH} to conduct a further stress risk assessment and check on his progress with referral to a specialist.

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    Comments have been moved to chat; please do not continue the discussion here. Before posting a comment below this one, please review the purposes of comments. Comments that do not request clarification or suggest improvements usually belong as an answer, on The Workplace Meta, or in The Workplace Chat. Comments continuing discussion may be removed.
    – motosubatsu
    Apr 5, 2023 at 14:40
  • "a few days every quarter or so" is 12 days per year. What's the minimum that the UK allows for sick days.
    – RonJohn
    Apr 5, 2023 at 22:13
  • Let us continue this discussion in chat. Apr 6, 2023 at 4:06
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    Request for clarification: UK regulations appear to not require a so-called "fit note" (i.e., a certification from a health care professional that the employee is not fit) for sick leaves of up to 7 days in a row. Therefore I assume that you simply call in sick, which makes the employer suspicious. Would it help to get a fit note every time? The cost appears to be around £50 though which may be prohibitive. Apr 6, 2023 at 11:09
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    I don’t quite understand the relationship between these various medical interventions and the sanctions for absenteeism. Is the point that if you do any/all of these things and still require time off for migraines, you won’t have to worry about further disciplinary actions? Apr 6, 2023 at 23:55

6 Answers 6

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The correct answer here is "talk to your local Citizens Advice" (or a paid employment lawyer if you wish. Citizens Advice will be cheaper in the first instance).

The answer you'll get from this in no way legally trained random person on the Internet is "no fscking way. An employment tribunal would look at this, laugh, and throw the book at your employer for unfair dismissal if they tried this".

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    The OP needs to memorialize what happened during the meeting in an email or something. If they don't, it will be very hard to prove that they recommended this course of action, or that this could be related to their (potential) dismissal. Apr 4, 2023 at 21:55
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    @Tfish Give Citizens Advice a call now - they are chronically underfunded and may have a backlog before they can really talk to you. Apr 5, 2023 at 8:21
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    @JoeStrazzere They shouldn't; HR are in a position of authority here and even "asking" in that situation can be taken as an order - and for all HR know, holistic medicines may in fact be directly contraindicated for the OP's conditions. (And from OP's second addition to the question, HR did more than "ask") Apr 5, 2023 at 19:33
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    @PhilipKendall Exactly so. HR are not medically trained and so should in no way be suggesting ANY course of treatment, and especially not when trying to link it to a formal process like this
    – ThaRobster
    Apr 6, 2023 at 8:13
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    @PhilipKendall I am less convinced than you. If the company does eventually fire Tfish, it will be for unsatisfactory attendance record (because of chronic medical issues), not "failing to accept holistic treatment" - and that will be almost certainly be unchallengeable. However, there is a lot of flexibility about what an "unsatisfactory attendance record" is, and if Tfish were to follow the holistic treatment, the HR employee might well be a lot more supportive. (Yes, this sucks.) Apr 6, 2023 at 10:47
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To engage with the first point: no, your employer cannot require you to try unproven and unorthodox treatments, especially if you have to pay for them. You can refuse and any court will side with you on this matter. May I recommend you simply say "they don't work for me" when asked, because it avoids the contentious "holistic medicine is complete BS" response. You don't have to elaborate.

But the more important point is the Bradford Factor. If I may quote from the Bradford Factor website:

[The Bradford Factor] provides a useful benchmark tool enabling managers to have an assessment score for an individual staff absence record. The Bradford Factor does not take into account any specific factors such as disability, or a short term, but recurring illness causing sporadic absenteeism over a period of weeks, but is useful for the early identification of concerns, or as a tracking tool. Many companies utilise the factor score as a trigger guide to implement more comprehensive support and monitoring procedures for individuals. The Bradford Factor can support an effective staff absence management strategy, but is limited if used as a stand alone tool.

In other words, while the Bradford Factor is useful in identifying employees whose pattern of absence may require "more comprehensive support and monitoring procedures", it is not intended and should not be used as the sole measure of whether an employee is taking time off inappropriately.

From your statement that you have received a written warning, I assume they think you have been faking your illness, or else they are blindly applying an inappropriate tool. You should definitely push back against the use of the Bradford Factor in your case. Tell them clearly that your illness is genuine, and because of its nature the Bradford Factor is not a good measure of the genuineness of your illness. Does the official sick day policy of the company include the Bradford Factor? If not, are you complying with it in all other ways? Ask them to use the Bradford Factor in its intended way, "as a trigger guide to implement more comprehensive support and monitoring procedures for individuals", not as a means of punishment.

Definitely talk to the Citizens Advice Bureau, and you may need a lawyer. See if you can get your doctor to write a letter stating the illness that you have and confirming that the pattern of sick days you have is entirely normal for your condition.

EDIT: In response to the edits in the question, especially the wording of the warning, I am now certain you need legal advice, from the CAB or a real lawyer. I would start by communicating clearly the following facts:

  • That you only take time off on days when you are genuinely unable to work, and you have no control over when this happens
  • That you have documentation from your doctor supporting this (assuming you do)
  • That the Bradford Score is not of itself an indication that an employee is taking time off inappropriately

I will also quote this site to you:

An employee who has been employed for at least two years is protected against unfair dismissal, and can bring a claim in the employment tribunal to enforce such protection if they are fired for being off sick.

Dismissal of an employee with two or more years’ service will deemed unfair, unless the employer can show that:

  • it had a potentially fair reason for the dismissal
  • it acted reasonably in the circumstances
  • it followed a fair procedure in carrying out the dismissal

Note that it's on the employer to show that they acted fairly, not on you to show that they didn't.

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    Too short to propose an edit, but towards the end, if you add a > on the empty lines between the quoted paragraphs as well (so all the lines start with >), then the entire quote will show up as one continuous block, instead of what looks like three separate quotes. Apr 7, 2023 at 0:44
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Two things need to be addressed here.

  • Their suggestion you try alternative medicine.
  • And the written warning.

It is not illegal for your employer to suggest treatment plans for your medical conditions. When offering such a suggestion, the simplest answer is to say: "I will discuss this treatment option with my doctor. Thank you for the suggestion." Nothing more needs to be said.

Regarding the written warning, it is illegal in the UK to discriminate against an employee because they suffer from migraines. If the written warning says you are faking time off, you should request withdrawal of the written warning in writing, and in addition, include a note from your doctor that confirms you medical status.

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    @OldPadawan You provide justification :) And to be honest, they should have asked for justification before giving the written warning. If they were careful, they'd give the employee a chance to justify their absences, rather than run the risk of discriminating. Apr 5, 2023 at 5:27
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    To add to this, I'd suggest actually discussing it with your doctor, in case your employer follows up, so you can honestly say you did actually discuss it with them. To discuss it, I'd probably go with something like "I realise this is complete nonsense pseudoscience, but my employer suggested that I discuss the possibility, so I'm bringing it up just so I can say I did". (There are actually scientifically valid holistic treatments, which basically just means considering the whole body and mind in treatments, but "holistic" has been appropriated by pseudoscience quacks.)
    – NotThatGuy
    Apr 5, 2023 at 10:15
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    I'm surprised at how many responders are reading "holistic" in the question and seeing "alternative". IMHO the two are different things that may at times have overlap.
    – Theodore
    Apr 5, 2023 at 13:42
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    @simonc gov.uk/dismissal/reasons-you-can-be-dismissed You can be dismissed if you have a persistent or long-term illness that makes it impossible for you to do your job., I'm pretty sure a few days a quarter doesn't meet this definition Apr 5, 2023 at 15:32
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    @jwenting The parts of holistic medicine that are not alternative medicine, are just medicine. The stuff you mentioned above is just medicine. Apr 6, 2023 at 12:42
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Additionally to Philip Kendall's answer on contacting Citizens Advice, talk to your local union representative. This serves (at least) two purposes:

  • The union needs to know that this is happening. If it happens to more people than just you, the union can collect such information and consider collective action, which is more powerful than individual action. Best possible outcome? That HR quit misusing the Bradford Factor altogether for penalising employees for suboptimal health.
  • They may have additional advice for you, knowing not only the legal situation, but also the culture at your employer. If you are a member, they might also help you in case of legal action.
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    This is exactly the kind of stuff that unions are much better at handling than any individual employee. Being a union member is a bargain for what safety net it provides.
    – hlovdal
    Apr 7, 2023 at 10:10
  • Wise advice, Can the Equality Act 2010 be used in the original poster's case?
    – gouessej
    Apr 7, 2023 at 18:05
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While I certainly agree with Philip Kendall that Citizens Advice is a great direction, if you like the job, there are a couple of other things you might consider trying.

Managing HR

You're right; holistic medicine is a load of bollocks. As someone with a chronic condition, you are probably also exposed to a lot of people's uninformed suggestions about how to manage your condition, which is very annoying. However, at least one person in HR does likely believe in holistic medicine and you may actually find that can be used to your advantage.

I think there would be significant secondary benefits to consuming some holistic medicine; yes, it can be expensive, but lots of it is literally just sugar, and sugar isn't expensive. It's not going to be any more or less effective if you make it yourself. Cook something up and call it an evening's entertainment. You could technically skip this step, but then you'd have to lie, and I prefer not to lie where possible.

Then, having tried their suggestion, you can go back to HR and thank them, say it seems like a great new thing to try and you feel really positive about it (or some other appropriately vague nonsense). It might not soothe the migraine, but it will soothe the ego of HR. Everyone wants to feel like they are helping, and this might just make you a buddy in HR, or at least, stall things a bit because you are technically complying.

Engaging with Bradford factor

Knowing that they are using the Bradford factor is actually pretty helpful. You likely already know the calculation, but;

Bradford factor = frequency^2 times duration

(This calculation feels rather in keeping with the alternative medicine suggestion...)

So if we run some quick numbers;

  • You are better off taking 8 days in a row off than 3 single days.
  • You are better off taking 49 days in a row off than 5 lots of 2 days.

Given your condition is chronic, you likely cannot avoid multiple absences, but the best play here is to stay off for as long as you think you might potentially be accumulating some benefit from it. The way I would word this idea, if I was talking to my doctor or HR is

"The business had determined that it's best if I can provide output with as much stability as possible. I think that's really smart. This is calculated by the business with the Bradford model. So to optimise this, and ensure that I'm completely recovered before I return to work, it would be best if I extended my absence for a further X days".

Again, you are stroking the ego of HR. If you need a doctor's note, I suspect the doctor will read between the lines. Maybe more days off would be actually helpful?

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    Its actually even more ridiculous than you state. The "duration" variable is the total number of days taken off during the period measured. i.e. your 5 lots of 2 days (10 days total: (5*5) * 10 = 250) you would be better off taking 249 days off consecutively than you would be to take off 5 lots of 2 days. in other words, it would score less on the scale to take off nearly an entire working year, than it would to take off 10 days - in segments of 2 each - throughout the year. Just plain silly!
    – Flats
    Apr 4, 2023 at 21:21
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    So my comment in the question itself was actually way off. I thought four separate days of migraine = 4 x 4 points, 15 days consecutive illness = 15 points. But really 4 days of migraine are (4 x 4) x 4 days = 64 points, which is the same as being off work for three months.
    – gnasher729
    Apr 5, 2023 at 10:09
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    Don't use pseudoscientific treatments just to appease your employer, and don't appease proponents of pseudoscience. Some of it may be "literally just sugar", some of it is literally just water, putting some rocks on yourself or making some noises or playing some sounds. But plenty of other pseudoscience can be quite harmful. 1/2
    – NotThatGuy
    Apr 5, 2023 at 13:49
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    It may require quite a lot of research to figure out what's what, making it yourself could be a lot of work, acquiring certain ingredients can be quite difficult outside of buying expensive products (that are generally unregulated and may contain undocumented and/or dangerous ingredients), if you appease them, you'd be strengthening their belief, which could harm themselves or others, even if you can avoid harm, and you'd potentially open the door of discussing this with them, which may result in you digging yourself into a hole of having to try more and more things to keep them appeased. 2/2
    – NotThatGuy
    Apr 5, 2023 at 13:49
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    Migraines and other chronic illnesses are generally unpredictable. Taking additional days off could thus increase your Bradford factor if the condition doesn't flare up for a while. Also, if you take time off when you're not actually sick, you'd be significantly hurting any legal case you might have, and it's much less likely that someone will stick up for you, as you'd come across as much less reasonable (especially if you've already established some rough pattern of when and how you take time off, and you now change that to take even more time off).
    – NotThatGuy
    Apr 5, 2023 at 14:05
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My gut tells me that you could laugh in their face at the suggestion—and should they try to take any action, the courts would take a very dim view.

The ultimate issue is that an HR representative is not a doctor, or medical practitioner or otherwise a licensed physician.

Could you try something herbal? I mean sure you could; the placebo effect is real.

If you've not tried it, is there any harm in doing so? Possibly not. Would I spend any of my money on something I don't believe is going to work? Absolutely not.

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    Yes, there can be harm in trying "alternative medicine", not only financially, but also otherwise.
    – gerrit
    Apr 5, 2023 at 6:49
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    people die all the time because they go with "alternative medicine" rather than real healthcare. Usually these are people with worse conditions than a chronic headache, but that chronic headache might well be a symptom of something worse that gets ignored if the only thing done is something to suppress the headache
    – jwenting
    Apr 6, 2023 at 8:28
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    I think people are misunderstanding what I'm saying: I mean most over-the-counter 'holistic' medicine are substances which aren't toxic (or at least, aren't toxic in amounts that can be reasonably consumed - like Chocolate). I'm not talking about forgoing medical treatment that could be lifesaving because Bob down the road swears by a herbal remedy. You could try it - if it works - Great! if it doesn't oh well. Apr 6, 2023 at 9:08

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