Written evidence from UNISON [EW0020]

Summary

• As the UK’s biggest trade union representing predominantly women workers, UNISON is uniquely well placed to set out how being a woman affects health and well-being at work, including reproductive health.
• In UNISON’s experience, many women find that coping with significant menopause symptoms in an unsympathetic and inflexible work environment is very difficult. Women who are Black and/or disabled can face additional barriers.
• The menopause can also affect transgender and non-binary people.
• UNISON considers that agreeing good workplace policies such as health and safety, sickness absence, flexible working and performance management, that take account of the impact of menopausal symptoms, can go a long way to help ensure discrimination does not take place and prevent the loss of experience from the workforce.
• Training for managers on how the menopause can affect work, the implications for both equality and health and safety, and what adjustments may be necessary to support anyone experiencing the menopause, can also help ensure women are not disadvantaged.
• UNISON considers that more employers should take steps to introduce menopause policies to help prevent discrimination and support those experiencing menopause symptoms. UNISON also considers that the government could do more to ensure a strategic approach to the menopause in the workplace by providing and promoting guidance and best practice for employers

Introduction

1.      UNISON is the UK's largest public service trade union with 1.3 million members, 1 million of them are women. Our members work in the public services, and for private contractors providing public services, including in the essential utilities. They include frontline staff and managers, working full or part time, in local authorities, the NHS, the police service, colleges and schools, the electricity, gas and water industries, transport and the voluntary sector. Many of them are part time and low paid, working in traditionally poorly paid sectors like care, catering, security and cleaning.

2.      UNISON is committed to achieving equality in workplaces, in the union and across society. Equality is a high priority for UNISON in our negotiating and campaigning work.

3.      UNISON also attaches a high priority to health and well-being in the work environment.

4.      As the UK’s biggest trade union representing predominantly women workers, UNISON is uniquely well placed to set out how being a woman affects health and well-being at work, including reproductive health.

5.      Women worker's experiences of health and well-being differ from those of men, due to biological and social factors. Women's health is influenced by the jobs they do, their family responsibilities, and their biology. There are a range of issues relating to the female reproductive system which can impact on women’s health and on their working lives.

6.      UNISON considers that a gender sensitive approach to health and well-being matters is essential to improving women’s health and reducing inequalities. The impact of menopausal symptoms is an occupational health issue and an equality issue. We welcome the opportunity to make this submission.

The menopause and workers

7.      Women make up 51% of the UK workforce[1] . They will experience the menopause at some point in their lives, and not necessarily in their late forties or early fifties. The menopause can affect younger women too through a premature or a medical or surgical menopause. Statistics show that around 1 in every 3 women has either experienced or is currently going through the menopause.

8.      The menopause can also affect transgender and non-binary people.

9.      Around 8 in every 10 women will experience noticeable symptoms and of these, 45% will find their symptoms hard to deal with.[2] Some women may cope well with the physical and emotional changes, but for others, these changes may cause particular difficulties both in work and out of work in a society that does not accommodate women’s changing lives. Without workplace modifications to allow women to flourish, difficulties caused by menopause symptoms at home may spill over into work and can impact on performance at work. These problems can also be made worse because of ignorance and misunderstanding about the menopause, with it often being treated as an embarrassing or taboo subject, or even a topic to make fun of.

10.  In UNISON’s experience, some women find that coping with significant menopause symptoms in an unsympathetic and inflexible work environment is so difficult they have to give up their job. Others may find that managing symptoms means they miss out on promotions and training, reduce their hours, lose confidence in the workplace and see their pay levels drop, all contributing to a widening gender pay gap. Office for National Statistics (ONS) data[3] shows that the gender pay gap is highest for women in the 50+ age group.

11.  The Government Equalities Office published an evidence review in 2017 of the extent to which menopause transition impacts on women’s economic participation in the UK.[4] The evidence paints a consistent picture of women in menopause transition feeling those around them at work are unsympathetic or treat them badly, because of “gendered ageism.”

Black women

12.  The terms ‘minority ethnic’ and ‘ethnic minority’ are in widespread official use today. In UNISON, Black is used to indicate people with a shared history. Black with a capital ‘B’ is used in its broad political and inclusive sense to describe people in Britain that have suffered colonialism and enslavement in the past and continue to experience racism and diminished opportunities in today’s society.

13.  Black women may face additional difficulties dealing with menopausal symptoms, particularly if there is racial discrimination in the workplace, which can mean problems in accessing appropriate support or having their symptoms taken seriously. They may not have access to the same standard of healthcare due to health inequalities and consequently may experience inferior diagnosis and treatment of the menopause. This could lead to prolonged symptoms and more time off to attend additional appointments.

14.  Evidence suggests that there may also be some variations in the average age at which the menopause takes place between women of different ethnic backgrounds. Some studies suggest that symptoms may be more prevalent and more severe for Black women, although research is not yet clear on the reasons for this. Black workers are also more likely to be in insecure work on casual or zero hours contracts, making it even more difficult to cope with significant menopausal symptoms.

Disabled Women

15.  it is also reported by disabled women and those with underlying health conditions, that the menopause can exacerbate their existing impairments and health conditions or even trigger new ones. Medication that is commonly prescribed for the menopause can conflict with other medication or have an adverse effect on other medical conditions. Examples reported include women with diabetes who find it more difficult to keep blood sugar levels stable, or conditions such as multiple sclerosis (MS), mental health problems, skin conditions, chronic fatigue syndrome, fibromyalgia etc. being exacerbated. Menopausal symptoms can in turn also be made worse by the disabled woman’s impairment or health condition. The nature of the impairment may also make it more difficult for the disabled woman to get the medical support they require, or to recognise the symptoms as being related to the menopause.

16.  Recent case law (Davies v Scottish Courts and Tribunals Service (2018)) has found that some women experiencing the menopause may well be disabled persons for the purposes of the Equality Act. In such cases the employer has a duty to provide reasonable adjustments. However, this is not widely known by employers or workers. Many women with menopausal symptoms which would amount to an impairment with substantial long-term affect on their ability to carry out normal day to day activities (the definition of a disabled person under the Act) struggle to get the employer to accept the need for adjustments.   

Transgender and non-binary people

17.  Trans and non-binary people with ovaries who do not take hormones will experience the menopause, as will anyone who has ovaries removed. Trans people who take hormones may experience menopausal symptoms if they stop taking them for any reason, for example, to prepare for a procedure, or if hormone levels are unstable.  Transgender and non-binary people experiencing menopause symptoms may also face difficulties in getting their symptoms taken seriously at work.  Concerns about stigma and prejudice may present barriers for them in raising these difficulties, particularly if they have not disclosed their trans status. It is important for employers to be inclusive of transgender and non-binary people in the support they offer and for this to be explicit in policies.

Women’s experience at work

18.  Research by the University of Nottingham[5] found that many women were little prepared for the onset of the menopause, and even less equipped to manage its symptoms at work. Where time off work was taken to deal with symptoms, only half of the women disclosed the real reason for absence to their line managers. Many worked extremely hard to overcome perceived shortcomings due to menopause.

19.  The Menopause Survey 2018[6] was a joint project conducted by researchers at the Police Federation of England and Wales (PFEW) on behalf of PFEW, UNISON, the Police Superintendents’ Association and the British Transport Police Federation. It examined the experiences and awareness of the menopause amongst police officers and police staff at a national level in England and Wales. Key findings included:

• 76% of respondents who had either gone through or were going through the menopause said that they had found symptoms of the menopause either moderately or extremely problematic at work.

• Overall, 20% of respondents said that they had considered leaving because they found it difficult to deal with the menopause at work; this increased to 44% of respondents who found their symptoms extremely problematic.

• 44% of respondents who had taken sickness absence due to the menopause had not told their manager the real reason for their absence; only 9% who had told their manager the real reason said that their absence had been recorded accurately.

• 35% of respondents had taken annual leave or rest days to take time off because of their symptoms.

• Only 11% of managers said that they had been given training on how to support someone going through the menopause.

• A majority of managers did not know whether their force had a formal policy or guidance on managing the menopause at work; at least two thirds of these managers said that they would find it useful to have a formal policy and guidance.

20.  A 2019 survey compiled by Dr Louise Newson and Dr Rebecca Lewis of the Newson Health and Wellbeing Centre[7] looked at the impact of menopausal and perimenopausal symptoms upon women in the workplace. The findings included:

• Over 90% of respondents felt that their menopausal or perimenopausal symptoms were having a negative impact on their work, with over half of respondents stating that colleagues had noted a deterioration in their work performance.

• As a result of poor performance at work, 9% of women had to undergo a disciplinary procedure.

• Around half of respondents reported having time off work due to menopausal or perimenopausal symptoms with 19% being absent for more than 8 weeks.

• In total, 37% of women had been provided with a sickness certificate from their doctor; of these, 52% listed anxiety/ stress as the cause, with only 7% stating menopause as a reason for sickness leave.

• As a result of their menopausal and perimenopausal symptoms, 31% of women had thought about reducing their working hours and 32% had thought about leaving their job.

• Just over three-quarters of women reported that their workplaces offered no information or support regarding the menopause.

Changing workplace policies and practice

21.  Key to changing workplace policies and practices is providing a genuine opportunity for employees to be heard on the issue. Simply asking the question, ‘what type of support might be helpful for those experiencing the menopause?’ would be a positive start towards changing culture and practice. It would also be inclusive.

22.  Employers could consider gathering data as to the gender,disability and age of those staff in a sickness absence management process. They should be open to possible issues relating to the menopause in musculo skeletal conditions and joint pain. Uniforms, which are not breathable or too tight fitting may also exacerbate problems as may or poor ventilation. Managers should be alert to any sickness issues or performance issues which might have underlying causes due to lack of attention or memory and or lack of sleep, which could relate to the menopause.

23.  Increasingly in workplaces, long-term health conditions are not recorded in the same way as any other sickness absence. UNISON considers that this should also apply to the menopause. Difficult symptoms related to the menopause leading to absence should be recorded as an ongoing issue, rather than as individual absences. As with any long-term health condition or impairment, adjustments should be offered to resolve any barriers that the employee experiencing the menopause encounters including flexible working options. Unfortunately, many employers use sickness absence policies with arbitrary triggers for instigating processes. The Bradford Factor is one example commonly used to evaluate sickness absence, which penalises frequent short-term absences by assigning a negative score to the employee, whilst making allowances for a few periods of long-term absence. Clearly this could disadvantage women facing difficult menopausal symptoms.

24.  UNISON would like to see employers ensure that all line managers and HR staff have been trained to be aware of how the menopause can affect work, the implications for both equality and health and safety, and what adjustments may be necessary to support women who are experiencing the menopause. In addition, all staff would benefit from training to raise awareness and understanding, and to share experiences.

25.  As well as producing national guidance and a model policy on Menopause, many UNISON branches and stewards are developing and implementing policies locally. For example, UNISON’s activists at Velindre University NHS Trust in Wales worked with the Menopause Cafe, Wales TUC and #Pausitivity Know Your Menopause campaign to develop guidance for managers, which is now making a difference across NHS Wales. The Velindre University NHS Trust manager’s guidelines are included with this submission at Appendix 1.

26.  Being aware of issues relating to gender in occupational health and safety ensures that workplaces are safer and healthier for everyone. UNISON would like to see gender specific risk assessments. Where the differences between men and women (such as with the menopause) are acknowledged, there is a greater chance of ensuring that the health, safety and welfare of all workers are protected.

27.  Agreeing good workplace policies such as health and safety, sickness absence, flexible working and performance management, that take account of the impact of menopausal symptoms, can go a long way to help ensure discrimination does not take place and prevent the loss of experienced from the workforce. Training for managers on how the menopause can affect work, the implications for both equality and health and safety, and what adjustments may be necessary to support anyone experiencing the menopause, can also help ensure women are not disadvantaged.

28.  All workplace policies and procedures should be equality-proofed as a matter of course in the workplace, and this exercise should include consideration of workers experiencing the menopause. For example, inflexible performance management may eventually lead to the unfair implementation of capability and disciplinary procedures and even to dismissal. The employer should take into account any impact menopausal symptoms may temporarily have on a woman’s workplace performance with possible memory loss, poor concentration, fatigue, lack of confidence and other symptoms. Capability, disciplinary, redundancy, and recruitment and training are some of the key policies and procedures alongside sickness absence, performance management and health and safety, that should be checked in case they could disadvantage those workers experiencing the menopause.

Working environment

29.  Some factors may not normally be seen as an issue in the workplace but present significant barriers more problematic for someone experiencing the menopause, such as:

• poor ventilation and air quality

• inadequate access to drinking water

• inadequate or non-existent toilet and washing facilities

• lack of control over the temperature or light

• lack of appropriate uniforms or personal protective equipment.

30.  Just as every experience of the menopause is different, so every workplace is different. For instance, in some workplaces it is not possible to open windows to improve ventilation, or women who have to wear a uniform are not able to change the type of clothing they are wearing when they are having flushes or sweating. Risk assessments should consider the specific needs of women and trans people experiencing the menopause and ensure that the working environment will not make their symptoms worse. Issues that should be looked at include temperature and ventilation and the materials used in any uniform or corporate clothing provided to women workers. The assessments should also address welfare issues such as toilet facilities and access to cold water, as well as allowing for more frequent breaks, additional time to carry out a task, homeworking, flexible working and even temporary changes to an employee’s job description or duties.

A standalone policy on menopause

31.  Development of a workplace policy on the menopause could go a long way to help ensure that women are not disadvantaged. Developing a policy provides an opportunity to engage with employees on the issue and shows the workforce it regards the menopause as a serious work-related health issue.

32.  Whatever the approach in the workplace there needs to be a range of adjustments and practices on offer for women and other people experiencing the menopause. Every person experiencing the menopause will have different symptoms for different lengths of time and different levels of severity. A one-size fits all approach won’t work.

33.  UNISON has produced guidance and a model policy on Menopause

34.  The CIPD[8] recommend “a proactive approach to the menopause at work” and suggest employers should consider “adopting a ‘cafeteria approach’, where women can choose from a range of options to help with their specific symptoms.”

35.  Good workplace policies, that take account of the impact of menopausal symptoms, can go a long way to help ensure discrimination does not take place. However, policies are only useful if they are implemented and regularly reviewed.

What the Government could do ensure anyone experiencing the menopause is protected from discrimination and supported in the workplace

36.  Legislation which should protect employees experiencing the menopause is in place. Under the Equality Act 2010, menopause should largely be covered under the three protected characteristics of age, sex and disability discrimination. The Health and Safety at Work Act 1974 provides for safe working, which extends to the working conditions when experiencing menopausal symptoms. However, many workers and employers are unaware of their rights and responsibilities under the Equality Act.  There is also no legal requirement for employers to have a menopause policy or to protect employees experiencing menopause symptoms. There is insufficient legal guidance and support for both employers and employees.

37.  UNISON considers that more employers should take steps to introduce menopause policies to help prevent discrimination and support those experiencing menopause symptoms. ACAS, the CIPD, the TUC and UNISON all provide useful resources to help organisations introduce menopause polices. However, some employers may need encouragement and the confidence to get started, others may need prompting to follow policies and guidance that have been agreed but may not have been widely disseminated or promoted. UNISON considers that the government could do more to ensure a strategic approach to the menopause in the workplace by providing and promoting guidance and best practice examples for employers.

Table of Contents

PURPOSE

The purpose of this guide is to provide guidance for Trust managers to help then to support employees through menopause transition, along with other employees who may be impacted by a partner’s or colleague’s menopause. 

This guidance aims to raise awareness about the menopause amongst managers and provides information to enable them to understand more about the menopause and to provide support where necessary.

Velindre University NHS Trust is actively engaging in the menopause agenda as it wishes to become a menopause aware and supportive organisation.

SCOPE

The guide and risk assessment has been developed to assist managers to support their employees and provide adjustments where reasonable and practical to implement.

This guidance uses gender neutral terms, such as employee, they and their, to reflect that while the majority of employees that are physically and emotionally effected by the menopause are female, menopause can still be relevant to employees who may be or have transitioned gender, as well as male employees supporting a partner, family member or colleague etc.

MENOPAUSE AND THE SYMPTOMS

The Menopause is a normal part of the natural ageing process for females. Menopause symptoms usually begin in a person’s forties (perimenopause) with the average age of entering into menopause is age 51. It should be noted that the menopause can happen much earlier naturally or as a result of a surgical or medical intervention (e.g. hysterectomy or chemotherapy).  Menopause symptoms will normally last for a period of 4 years, but some may experience menopause symptoms for a period in excess of 10 years.

An individual’s menopause experience will vary from person to person.  Some will sail through menopause transition with only mild symptoms, while others, approximately 25% of the menopause population will experience very severe and debilitating symptoms that will impact on their home, working and life in general.

There are 42 recognised symptoms of menopause.  An individual can experience any combination of the symptoms and may encounter difficulties at work as a result. Below are some of the recognised symptoms associated with menopause transition:

* Perimenopause

As a result of the menopause symptoms they may also report feeling less confident, due to what are for many significant and embarrassing symptoms, which impact upon and pose real challenges on their day to day lives.

Under the Management of Health and Safety at Work Regulations (1999) the Trust has a legal obligation to ensure that workplace conditions do not make menopause symptoms worse.  The following workplace conditions can make working life more difficult for those transitioning through the menopause.  This could include but this is not an exhaustive list;

• Failure to undertake a risk assessment;
• Lack of awareness about what the menopause is and the potential impact on all employees and the workplace;
• Failure to providing menopause awareness workshops for employees;
• Lack of training for managers on the menopause;
• Poor temperature / ventilation / air quality control;
• Poor natural light;
• Lack of access to cool or adequate drinking water;
• Inadequate toilet / washing facilities;
• Inflexible working practices / breaks;
• Negative attitudes / behaviour;
• Apathetic line managers / colleagues;

ROLES AND RESPONSIBILITIES

4.1              Managers

Managers should:

• Be aware of what the menopause is and the impact the menopause transition and the associated symptoms can have on employees in the workplace.  Managers should make themselves familiar with the NHS Wales Menopause Policy and Toolkit;
• Use the menopause question contained in the Trust’s Self Certification / Return to Work Form to identify and start a conversation regarding menopause management;
• Be aware of the appropriate information and support available to employees in relation to the menopause and be proactive in signposting employees when they are aware that they may benefit;
• Review working conditions and take account of the difficulties that an employee may experience in the workplace during the period of their menopause transition.  This process should be supported and underpinned by undertaking risk assessments and considering / implementing those reasonable / tailored adjustments identified, where it is practical and cost effective to do so (See Appendix 1).  It should be noted that many menopause related tailored and or reasonable adjustments cost very little to implement.
• Be aware that menopause related symptom may be covered by the Equality Act.  Therefore, it is unlawful to discriminate against an employee on any grounds relating to their menopause.

4.2              Workforce and OD should:

• Increase awareness to ensure that all employees, regardless of gender identity feel supported and comfortable in discussing the menopause in the workplace.
• Ensure menopause related issues are considered when developing workforce policies, procedures and process.

4.3              Useful Reference Documentation

The following are documents which managers and employees may find useful.

PROCEDURE

Introduction

Velindre University NHS Trust recognises that employees may need support during their menopause transition. Until recently, the subject of the menopause had not been fully considered and understood by employers, in relation to the affect that it can have on employees in the workplace.  It is important that all managers have a good understanding of the issues that can affect those going through the menopause, in the workplace.

Some employees will find it difficult to discuss the menopause with their manager.  As a consequence they will not disclose the matter or the impact it may be having on their physical or physiological health, work performance or conduct / behaviour.  It is important that all employees feel able to discuss their menopause with their manager, as some employees may experience:

• Very severe and debilitating symptoms which may require them to take time off work and therefore impact on their sickness absence record;
• Difficulty performing to the expected standards in their role, which could result in the matter being dealt with as a capability matter;
• Relationship difficulties or conduct issues as a result of their symptoms which could result in a disciplinary case / action.

When a manager is aware of an employee’s menopause status they should discuss the matter and consider whether their symptoms are having an impact.  Managers should use their discretion to ensure that employees going through menopause transition do not experience detrimental treatment or are unfairly penalised.

Managers should also be aware that menopause transition can also have an impact on an employee’s partner and colleagues.  It is therefore important that managers are also sympathetic and supportive to all affected, when they are made aware of such situations.

This guidance aims to raise awareness about the menopause amongst managers and provides information to enable them to understand more about the menopause and to provide support where necessary.

Accessing Support

As with all physical and psychological health and wellbeing related issues and conditions, Velindre University NHS Trust is fully aware of the importance of embracing preventative measures, which can be provided via a knowledgeable, sympathetic and supportive management approach.

It is acknowledged that some employees may feel uncomfortable discussing menopause related problems with their manager, especially if they are perceived to be unsympathetic or may be embarrassed by the conversation. Managers and employees should be aware that in such circumstances there are other options available, such as suggesting they;

• Approach a member of the Workforce & OD Department;
• Make a self-referral to the Trust’s Occupational Health or give permission for the manager to make a referral on their behalf;
• Contact the Trust’s Employee Assistance Programme (EAP) provided by Workplace Options or they give permission for the manager to make a referral via the EAP ManagerAssist;
• Speak to their local trade union representative;
• May wish to discuss the matter with another trusted manager or colleague.

5.3     What can managers do to support employees through menopause transition?

• Ensure that they are aware of what the menopause is and how it can impact on the workforce: Use references above for further information;
• Attend a Trust Menopause training session for managers;
• Using the Trust’s Return to Work and Self Certification Form to explore whether their absence / reason for absence is related to menopause and provide guidance and support as appropriate;
• Undertake risk assessments (See Appendix 1 -  Risk Assessment Form and Checklist below), to understand the adjustments which could / should be made, to ensure that the work environment does not make the employee’s menopause symptoms worse;
• Consider flexible working requests and arrangements to support employees to manage their menopause symptoms and remain productive in the workplace: Refer to the Trust’s Flexible Working Policy;
• Ensure that workplace colleagues are aware of the NHS Wales Menopause Policy, the symptom and impact the menopause can have on employees in the workplace. 
• Ensure that employees are not discriminated against, bullied, harassed or victimised in the workplace, (Dignity at Work Procedure) as a result of disclosing health, work, work environment etc. issues, related to or arising from the menopause.
• Be aware of the resources and materials that are available for employees to access via the Trust’s Supporting Employees Through Menopause Intranet page and Hosted Organisations Health and Wellbeing Intranet site pages;
• Refer / signpost employees to ensure they can access appropriate  sources of support e.g. Occupational Health Services, Employee Assistant Programme (Workplace Options) etc.;
• When redesigning offices, changing layouts, making workplace environment improvements etc. consider the needs of menopausal employees to have good light, ventilation / air conditioning, air quality, access to drinking water, good toilet and washing facilities etc.

5.4                   Review

This guidance will be reviewed to ensure that it reflects the contents of the NHS Wales Menopause Policy and Menopause Toolkit, which is due to be released to the service by December 2018.  The guidance will also be reviewed and updated to ensure it reflects best practice in the management of menopause in the workplace.

APPENDIX

MENOPAUSE RISK ASSESSMENT FORM AND CHECKLIST

This document should be retained on the individual’s e-file and reviewed by the individual and manager on a regular basis.

Agreed tailored / reasonable adjustments must be put in place to lower any risks to an acceptable level.

Name:              _________________________               Dept: _________________________                         Date:  ____________________

PLEASE NOTE:

The list above is not exhaustive. There may be other issues that are highlighted which should be considered when agreeing reasonable adjustments.

CONFIRMATION OF COMPLETION OF REASONABLE ADJUSTMENTS IDENTIFIED

September 2021