Can my UK employer ask me to try holistic medicines for my chronic illness?

Question

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.

Answer 1

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".

Answer 2

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.

Answer 3

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.

Answer 4

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.

Answer 5

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?

Answer 6

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.