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5. Sick day - no pay? (matter for discussion)

Leeds Branch

That this meeting of RCN Congress discusses the advantages and disadvantages of withholding pay for the first five days of any period of sickness absence.

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Progress report

Council Committee: MRC
Committee decision: No work required
Council member/other member/stakeholder involvement: Tracey Budding, Jane Bovey, Bobbie Chadwick
Staff contact: josie.irwin@rcn.org.uk

The item was a discussion item which did not generate any action. Most of the employers with whom the RCN has a relationship have occupational sick pay schemes that cover sickness absence from the first day of absence.

Debate report

It was clear from the debate around this matter for discussion that sickness absence is a major problem for the NHS and for nurses. Proposer Brian Williamson, RCN Leeds Branch, stated that long-term sickness in the NHS costs the UK £1.7 billion a year. What was less clear was how best to deal with this issue.

Brian suggested withholding pay for the first five days of any period of sick leave as a way of meeting the extra cost of covering for the absent person, as well as discouraging those who are playing the system. Steve Watson of the RCN Management and Leadership Forum highlighted the fact that many private sector workers do not get paid when they are off sick already.

Although Brian stated that his branch are not advocating "presenteeism" – coming into work even if you are unfit – many of those speaking felt that this would be an outcome of this policy. Zeba Arif of the UK Stewards Committee said that it was a pain when members of staff come in who really should have stayed at home. She said: "As well as the 14 patients you have to look after, you have a 15th or a 16th."

Some felt that docking pay would be unfairly penalising those who are genuinely ill. Andrea Spyropoulos, Council Member for the North West, said: "As a trade unionist, I could never support the idea that we stop paying people when they are ill. I treasure the fact that there is a safety net."

Gail Brooks of the UK Safety Representatives Committee spoke of her own absence for work-related stress. She said: "Why should I have had the added pressure of no pay? That would have been added stress on top."

Catriona Forsyth, UK Safety Representatives Committee, felt that it would be better to invest in services that help staff get well, like physiotherapy services for musculoskeletal conditions. 

Mo Nawrung, Norfolk Branch, echoed this, asking: "What do employers do to keep people healthy? How much is invested in terms of staff wellbeing?"


There are two sick pay schemes in place in the UK; state statutory sick pay and occupational sick pay. Statutory sick pay (SSP) is payable to those in permanent or temporary employment earning at least £95 per week, and who are ill for a period of four or more consecutive days including weekends and bank holidays; the first three days, known as ‘waiting days’, are unpaid.

Employers can opt to run an occupational sick pay scheme, which pays more than SSP, as part of the contract of employment. However, employers’ schemes cannot be less generous than SSP. The entitlement depends on rules drawn up by the employer, such as prompt notification of sickness, and may be subject to a probationary period – for example, accessed after three months of employment. Employers’ schemes may also pay for the first three days of sickness.
The NHS Agenda for Change agreement includes provisions for occupational sick pay. An employee who is absent due to sickness, and who has followed local notification procedures, will receive SSP plus occupational sick pay up to an amount which does not exceed normal salary. The period of full sick pay entitlement is dependent on length of service; those with over five years’ service receive six months’ full pay and six months’ half pay while those with a minimum length of service of up to 12 months receive one month’s full pay.

Employers may withhold sick pay, for example in circumstances where agreed procedures for notification have not been followed or failure to produce a valid sick certificate. In withholding sick pay employers have to be mindful to the provisions of the Disability Discrimination Act 1995.

There is a current drive by the Department of Work and Pensions to reduce levels of sickness absence, ill health and incapacity benefits in the working population. A new ‘fit note’ scheme is due to be launched in 2010, replacing the traditional GP sick note certificate which is required after seven days of absence. The fit note will outline the work an employee can do and is intended to support return to work programmes.

Nurses and other health care workers are exposed to a number of occupational hazards which can lead to ill health, injury and subsequent absence. Infection control policies may also require frontline staff to stay away from work when unwell. The Chartered Institute of Personnel’s 2009 annual sickness absence survey reveals average UK sickness absence rate is 7.4 days per employee; public sector rates were 9.7 days compared to 6.4 days in the private sector.
In contrast to high sickness absence rates, the Boorman review (NHS Health and Wellbeing, 2009) into the health of NHS workers in England found high levels of ‘presenteeism’ where staff attend work when unwell; nurses were highlighted as group with high levels of presenteeism.

The Work Foundation has commented that “employers who withhold sick pay (most frequently in manufacturing but also in retailing) often offer bonus schemes which reward good attendance for either individuals or teams (or a combination). However, the practice of paying attendance bonuses has diminished in recent years, now down to 15 per cent of employers.”

References and further reading
Department for Work and Pensions, (2010) Statutory sick pay, London: Directgov.

NHS Health and Wellbeing (2009) Final report of the NHS Health and Wellbeing Review, Leeds: NHS Health and Wellbeing Review (Chairman: S Boorman)

Schmitt, J., Rho, H., Earle, A. and Heymann, J. (2009) Paid sick days don’t cause unemployment, Washington: Center for Economic and Policy Research.

Ziebarth NR and Karlsson M (2009) A natural experiment in sick pay cuts, sickness absence and labor costs, Bonn: Institute for the Study of Labor