How do you deliver an effective health service with a workforce severely depleted by swine flu? Rachael Heenan looks at ways of coping

The NHS Confederation estimates that some organisations may face up to 25 per cent staff absence during a pandemic. Inevitably some staff will contract swine flu but others will take leave for a variety of reasons - they might need to care for others who are sick or have fears for their own health or that of their families.

Of course, any staff who display symptoms of H1N1 virus should be sent home, informed not to work until fully recovered and be paid in accordance with the organisation’s normal sick pay procedures.

Pregnant workers can be suspended, with pay, on health and safety grounds

But what if it’s suspected that an employee is not genuinely ill? Unauthorised absence can be dealt with under an organisation’s disciplinary procedure. But how practical is this?

It is unlikely to be feasible to carry out investigations and disciplinary hearings at the peak of the pandemic and even if the matter is deferred to a later date it may well be difficult to obtain convincing evidence one way or the other.

Fear of catching swine flu is not, in itself, a sufficient reason for absence. Dealing with health risks is nothing new for health workers: every day patients receive care despite the fact that their conditions pose the most serious health risks to others. By carrying out risk assessments and taking steps to manage the situation, risks are reduced to a reasonable level.

The question will be has an organisation done enough to manage the swine flu risk?

Pregnant women are particularly vulnerable to swine flu and employers should take particular care in dealing with health and safety issues for pregnant workers, such us drawing up a tailored health and safety assessment and considering moving workers to environments with lower risks.

If risks cannot be adequately managed then, ultimately, pregnant workers can be suspended, with pay, on health and safety grounds.

The Department of Health estimates that 50 per cent of children may be affected by swine flu. So staff may be fit but still need to take time off work to care for others who are sick or because schools have closed.

Employees have a legal right to take reasonable time off work to help dependants in certain circumstances, including assisting someone who is ill or dealing with unexpected incidents involving a dependant child in school hours.

Dependants include a spouse, civil partner, child, parent, or a person who lives in the same household as the employee. It can also include those who rely on an employee for the provision of care such as an elderly neighbour.

The right to take leave is not opened ended, however, and there is no legal right to be paid for taking leave to look after a dependant. Some employers have allowed paid leave but unless managers apply a consistent policy, an organisation could find itself defending claims of unfair treatment and even discrimination.

A second wave of swine flu is expected this autumn and organisations should have put in place staff plans (see box). Some are likely to be contentious. HSJ has already reported the calls from the Royal College of Surgeons and Doctors’ pressure groups to suspend the working time directive and so allow more than an average of 48 hours to be worked in a week.

But, as the Department of Health has pointed out, this is not necessary: the WTD already allows working during rest times in certain emergency situations. Rest times cannot be ignored, however. If rest times have had to be worked, then compensatory rest must be allowed in all but the most exceptional circumstances and even then the workers’ health and safety must be safeguarded.

Health organisations can encourage frontline staff to get vaccinated (when vaccines are available) against seasonal flu and swine flu. Preventative anti-virals can be issued but only, national guidance provides, in specific circumstances.

No one solution can provide the complete answer to meeting the staffing challenges posed by swine flu. Adopting several solutions will help organisations to meet the challenges but ultimately it will be the staff’s commitment to ensuring that patients receive the healthcare they need that enables the system to cope.


  • Redeploy staff with appropriate skills to depleted services
  • Utilise reserve or bank staff
  • Re-employ recently retired staff on short terms
  • Extend working hours
  • Refuse requests for annual leave in the winter
  • Allow flexible working
  • Allow home working
  • Ask part-time staff to consider working full-time hours
  • Offer vaccinations to frontline NHS staff


Department of Health

The Health Protection Agency