Sickness Absence Toolkit

About this toolkit

Welcome to our toolkit about supportively managing sickness absence. 

This guidance is designed to support line managers to have both confidence and consistency every step of the way when it comes to supporting colleagues with conversations about sickness absence.

How to use this toolkit

Use the +chapters navigation menu at the bottom of your window or click on a chapter on the right-hand side of the page to explore the different elements of sickness absence. 

All you need to know in 30 seconds

Communicate your reporting practices

A clear, well-communicated reporting procedure for when a member of staff calls in sick will help to ensure you get the information you need to keep the service running, tackle any future problems and effectively support that person during their absence. Making your staff aware of the reporting procedure and clearly signposting to where that is, will help to avoid any misunderstandings and help your staff get the information they need in a timely manner. 

As a manager, you will need to know and understand the reporting procedure including who is responsible for reporting. You should also make sure you know where to find the contact information and referral procedures for your occupational health service, counselling and/or employee assistance programme (EAP) or your rapid access services.

Consistently gather key information

When your member of staff calls in sick, always ask your staff the following questions:

1. What’s the reason for the absence?
2. How long do you think you’re likely to be off?
3. Is there any work you’ve been doing that needs to be picked up while you’re off?

Your organisation’s sickness absence policy may have suggested questions that you should ask.

Depending on the reason they give, you may also want to find out:

• Are there any adjustments that you could make that would enable them to come to work?
• If the illness is infectious, is there a specific period of time that they need to remain off work once they are symptom free?
• If the reason for absence is musculoskeletal (MSK), could you refer them to a rapid access service either within your organisation or as part of your integrated care system (ICS), if you have this available? 
• If the reason for absence is related to a mental health issue, could you refer them to a counselling service or a mental health hub (if you have this available)?
• If they are fit to work but physically unable to come in, is there another area they can work in or could they work from home?
• If they are likely to be off for longer than a few days, when will they next get in contact to give you an update and is there any further steps, they will be taking in the meantime that would be helpful for you to know and/or support with

As a line manager it is your responsibility to ensure records of sickness absences are maintained, including conversations with staff while they are off sick and any meetings you have following those absences.

Over time, accurate records will enable you to spot any patterns of absence or themes within the reasons for absence which will help you effectively support your member of staff. This will also allow you to have a balanced and supportive, fact-based conversation with them about any worrying trends. It may even help you to facilitate early intervention to prevent bigger health problems, for example, early access to physiotherapy for a bad back which may prevent regular MSK related absences.

Listen and support

Active listening at this stage of the conversation is key. This may seem obvious but when you are busy, with competing demands and priorities, the importance of listening can sometimes be forgotten and/or overlooked while juggling priorities and thinking about overall staffing. If this were you ringing in sick, how would you feel, how would you want to be supported and what would you want your manager to say?

It may be that all you need to do is to listen, wish them well and agree either when they will be back or when you/they will next be in touch. Listening carefully, reserving judgement, referring them to further support, if necessary, at this stage and allowing staff the time to discuss things further if needed will ensure they feel fully supported.

Sickness absence coding

Sickness absence codes are a useful tool you can use to spot sickness trends in your team. Making sure these are used and recorded properly can help identify problem areas to target with interventions, such as infection prevention and teams under a lot of stress or other mental health issues. If correct codes are used, you can use them to create metrics and compare them to national sickness absence rates to see how your organisation is doing.

As a line manager you are responsible for recording accurately any sickness absence for the staff you manage, which could help you spot trends in absenteeism and address any potential issues within your team. This means that you must use the agreed process within your organisation and know what you need to do to follow this. You must also ensure that any sickness absence report is accurate in terms of length of time off and use the right ESR code for the absence. Failure to do this could impact on your employee's sick pay entitlements and mean they do not receive the help or support they might need.

The ESR sickness codes are nationally agreed and should be used to identify the absence reasons for employee sickness.

Sometimes employees may not wish to disclose the nature of their absence, making it hard to give them support. In this case, you should ask them if there is another person, they feel more comfortable discussing this with i.e., HR, OH, a manager of the same sex etc. If they still do not want to discuss the issue, perhaps show them the codes, and ask them to select the most appropriate code without them having to go into the detail. It’s important you get the code right and can arrange for further help, and that trigger points are activated appropriately for any HR intervention needed.

Keep in contact

If your employee is going to be off for more than a day, you will need to discuss how often you will keep in touch and who will contact who. Knowing when you’ll next be in touch will reassure them and enable you to:

• review whether you can do anything within the organisation to support them 
• plan how to cover their workload and keep the service running
• discuss dates and options for your staff member’s return to work.

Consider reasonable adjustments

Usually, staff will be able to return to their role and work environment. However, you may need to ask if any adjustments could be made to allow them to return to work and/or prevent further absences. The sooner you have this conversation, the more time you will have to arrange for the support, equipment or adjustments needed. Making adjustments could also mean your staff member could return to work sooner.

Our making reasonable adjustments to support disabled staff in their roles has information to support you.

All you need to know in 30 seconds

Know what you’re looking for

Short-term sickness is defined as an absence that lasts less than 28 calendar days (or what you have agreed as part of your sickness absence management policy). Everyone may have short-term sickness absence during their working lives, often because of common illnesses such as colds and flu. However, frequent, ad hoc absence may indicate an underlying issue with a staff member or team.

When reviewing absence history, look for patterns to the absence, for example:

• Is it always on a specific day or week in the month?
• Is it a collection of Fridays or Mondays?
• Days after a bank holiday?

You should also look for themes in the reasons given for absence and review any fit notes provided for recurring information.

Discuss what you notice

Where a pattern is identified, speak to the individual privately about it to see if there is any underlying reason for the absences. Often, just having a conversation is enough to alert staff to the need to address any underlying causes or behaviour. 

You could revisit the health and wellbeing conversations that you have had previously with your staff and check in on how they feel things are, any actions around referrals /undertaking  any initiatives to support their wellbeing could be beneficial to see or if any circumstances have changed which may be impacting on their wellbeing. 

Further signposting to initiatives/support your organisation provides for health and wellbeing could include:

• flexible working policy/guidance
• carers networks
• staff counselling
• financial wellbeing
• menopause awareness groups
• weight management
• physical activity 
• staff discounts. 

There are also the national NHS health and wellbeing offers that may support your staff. 

By having this important conversation, in some cases, you may have uncovered an underlying health or mental health problem, issues outside of work, difficulties within the team or a problem with the working environment. Putting the right support in place early, for example referrals to occupational health or physiotherapy, can help to minimise any potential future absence.

If no underlying issue(s) are evident or been identified, it is important that you should be clear with your staff member that their attendance needs to improve, how this will be measured, and the consequences for them if it does not. 

It is important that this conversation and what was discussed is captured and reflected/sent back to the member of staff to ensure clarity and understanding. You may need to refer to your organisation’s sickness absence policy for more information.

Monitor the situation

Keep track of whether a sickness absence pattern is improving, maintaining, or getting worse and look out for any unusual patterns of absence, for example if a staff member is experiencing more absences, or more frequent absences than usual. Your observations could enable further discussions and identify emerging issues.

Be sensitive and supportive

Having regular health and wellbeing conversations with your team allows you to understand and get to know your staff and their health and wellbeing needs. As we have previously mentioned, it is important to note health and wellbeing conversation should not focus/replace the sickness absence conversation. 

When you have noticed a sickness absence situation, having a supportive conversation, adapting your approach to the conversation depending on what you find, and your staff member’s reaction, should enable you to be sensitive where necessary and provide the appropriate support. You need to approach these conversations and situations as a supportive line manager and not a clinician. 

It is important to know and understand there may be personal or sensitive circumstances affecting their absence.

It is also important to be mindful of the cost and the effects of frequent sickness absence on the workload and the wider team. 

If you notice someone is becoming withdrawn and quiet, create a suitable confidential environment to tell them what you have noticed, ask them if they are OK and offer them the opportunity to discuss things.

Know where to go for help

As a line manager, it is important to know that you will not be the expert on every eventuality your colleague may bring to you. However, is important that you become an expert in listening and signposting. Your organisation will have policies on things like special leave and/or flexible working, should your staff require a period of time away from the workplace or adjustments to their usual working pattern/hours for personal reasons. Your occupational health (OH) provider and/or health and wellbeing lead/team can also help with signposting to specialist services available to your staff, for example for drug or alcohol dependency, gambling awareness, domestic violence or stress, anxiety, and depression.

The Advisory, Conciliation and Arbitration Service (ACAS) advisory handbook is a useful starting point for handling short-term absence. You could consider making reasonable adjustments to support your staff to stay well in the workplace.

Usually, staff will be able to return to their role and work environment. However, you may need to ask if any adjustments could be made to allow them to return to work and/or prevent further absences. The sooner you have this conversation, the more time you will have to arrange for the support, equipment or adjustments needed. Making adjustments could also mean your staff member could return to work sooner and be supported in their role.

All you need to know in 30 seconds

Defining long-term sickness

Long-term sickness absence is defined as a continuous period of absence lasting more than 28 days.

In June 2022, the government laid down new legislation in relation to guidance and the signing of fit notes. This new legislation provides the opportunity for registered nurses, occupational therapists, pharmacists, and physiotherapists to sign a fit note and be responsible for that episode of care. Previously to this legislation, only doctors were allowed to sign a fit note. 

The employee must give you a ‘fit note’ (formerly a ‘sick note’) if they’re absent for more than seven days (this includes non-working days, such as weekends and bank holidays). A fee may be charged if a fit note is requested before seven days. The fit note will say the employee is either ‘not fit for work’ or ‘may be fit for work.’

If the fit note says the employee ‘may be fit for work,’ you should discuss any changes with the employee that might help them return to work, such as flexible working, different hours, or tasks. You can get support from your OH provider if you need help and advice on making reasonable adjustments.

Keep in contact

It is important to maintain regular contact with your colleague particularly when their absence becomes long term. This will provide an important connection for your staff member back to their workplace, enable them to feel supported and will allow you to keep up to date with their progress.

Together you should agree from the start how and when you will contact each other/catch up and how they will keep you informed of any developments in their treatment and recovery. Having this regular agreed connection in place will allow you to effectively support them with their absence and recovery, and help you plan in the time to have the conversation to support them back into the workplace.

As their manager, you should be aware of what the next step is for the employee, such as a GP review or hospital appointment. Your aim should be to facilitate their safe return to work, and your staff member should be aware of this and understand this aim.

Manage their workload

Depending on the length of absence you will need to decide whether your team can cover their colleague’s workload or whether you need to recruit additional staff.

To help you decide, consider:

• how long the absence is expected to be (if known)
• the duties that need to be delegated
• whether these duties could be sustainably covered in the team.
• read your organisation’s policies and procedures for supporting and managing long-term absence. This will usually involve discussions with HR and a referral to OH.

Holding regular wellbeing conversations with your colleagues allows you to have discussions with them about their health.  

Actively manage the absence

The key to actively managing long-term sickness absence is to always know what the next step will be for your employee, even if it is that they have an appointment booked which they are waiting for. This allows you to support your employee as much as possible throughout the absence and helps you to avoid allowing the absence to drift, and the employee to feel forgotten about. 

Organisations are increasingly adopting an active case management approach to sickness absence cases, where HR, OH, the line manager, the employee and - where appropriate - the GP, other medical professionals and/or staff side representatives work together to support the employee and manage the absence.

Agree early on who the case manager will be so they can ensure the process is streamlined, and there are minimal unnecessary delays, such as with sharing information between each party or getting appointments.

If absence continues

If the absence continues for more than 28 days, you need to meet with them to review their absence and discuss possible options. The purpose of the absence review meeting is to offer you and the staff member the opportunity to discuss the nature of their absence, and next steps for returning to work or continued absence, in a positive and supportive way.

Make sure that your staff understand that this meeting does not constitute part of the disciplinary process. This is a chance to have an open and supportive conversation. Encourage your colleague to bring forward any concerns that might be affecting their attendance. Also ask them for any ideas about what would help them return to work.

If a return to work is not possible, you will need to discuss the options with HR and OH, consulting relevant policies. Encourage your colleague to seek support from staff side representatives where appropriate.

Some of the most common reasons for sickness in the NHS

In this section we look at some of the reasons that might be given for sickness absence in the NHS. 

Click the + to expand the items and find out more.

All you need to know in 30 seconds

Maintain contact

Positive and regular contact with your employee is crucial, and can help them feel supported and valued, and prevent them from feeling isolated.

Talk to your employee about the nature of their illness, its impact on their work and likely duration as soon as they report their absence from work. If you don’t take their first call, contact the employee at the earliest opportunity to have this discussion.

Weekly contact with employees is recommended for illnesses lasting several weeks, as well as for illnesses that will result in a longer period of absence. However, each case will be slightly different due to the nature of the employee’s illness, so the frequency of contact should be discussed and agreed with the employee.

As well as agreeing to the frequency of contact, make sure you also set aside time to fully discuss their absence and any support they may need. Always remind your employee that you will be keeping in contact with them during their absence and that you are there to help facilitate their return to work.

To find out more about providing any help your employee needs, see sections on rapid access to treatment, phased return, making reasonable adjustments and redeployment. 

For longer absences, update the employee about any work changes that have happened during their absence, to prevent them from feeling isolated. Keep your employee in the loop by including them in emails about work, so they can keep an eye on things while they are absent or catch up when they return. This will help them alleviate any worries about their work, and who is covering for them.

Find out if there are organisational policies in place for keeping in contact and use them. Ensure your team are familiar with reporting procedures so they know what to do and expect when they are absent. If a reporting procedure needs development, get your staff involved as this helps employees feel supported and less worried if they do need to follow the procedure.

Case management approach

For longer absences, consider taking an active case management approach to manage the absence. This approach is when the line manager, human resources, occupational health, your employee and (where appropriate) the GP or other medical professional work together to actively manage the absence.

This approach should take place from very early on in the sickness absence episode. One individual should be in charge of the case and should work to ensure that the process is streamlined and that there are minimal unnecessary delays – for example in sharing information between each party and in getting appointments.

Rapid access to treatment

Rapid access, or fast tracking as it is also known in some NHS organisations, is a system which provides rehabilitation and treatment for NHS staff but not to the detriment of the health needs of other patients. This enables staff to remain in the workplace or enables a return to work which is, fast, practical, and reasonable. Each circumstance should consider the needs of the individual, organisation and where the support required is complex, be able to demonstrate value for money. Our guidance is intended for organisation boards making decisions about how to manage rapid access services for staff in their organisation. 

Early intervention such as occupational therapy, physiotherapy or counselling is important for preventing acute conditions becoming chronic and securing successful rehabilitation. Evidence also suggests that earlier interventions in a period of sickness absence are more effective than waiting for an indicator to trigger action.

For example, in cases where appropriate, referral to physiotherapy in the first week of sickness can have your team member rehabilitated back into work by the time they would normally have been having the first review of their case – triggered by an indicator. This benefits the organisation, your team member, and your patients.

Our updated rapid access to treatment and rehabilitation for NHS staff guidance supports NHS organisations to manage rapid-access services for staff in their organisation.

Learn how Cambridgeshire and Peterborough NHS Foundation Trust created a rapid-access mental health service for their staff in our case study. 

Fit note and sick note

On 10 June 2022, the government laid down new legislation in relation to guidance and the signing of fit notes with an implementation date 1 July 2022 across England, Wales, and Scotland with the aim to free up GP time. 

From July 2022, fit notes can be certified and issued by nurses, occupational therapists, pharmacists, and physiotherapists in addition to doctors.

Guidance for employers and professionals will be available in the near future, along with an e-learning package which all professionals who will take on this responsibility will need to complete.

For more information, visit the GOV.UK website

The advice in the fit note is about your employee’s fitness for work in general, and not specifically about their current job. This gives you maximum flexibility to discuss possible changes to help them return to work (which may include changing their duties for a while). The fit note also tells you whether your employee is likely to need a new fit note when their current one expires.

You should receive a copy of the fit note as soon as possible once your employee has received it, so that you know what the reason for their absence is, if there is anything you can do to support them to return to work and set up a return-to-work plan. Your finance department will usually need this for payment purposes so you should familiarise yourself with your local procedure for this.

If your employee does not provide a copy that details, they are unfit for work, then they would be classed as being on unauthorised absence and you would need to speak to your local HR department for further support. It is in the employee's best interest to be open and honest about this, so you can provide or arrange for the support they need.

Where the fit note marks your employee as 'may be fit for work', it means that returning to work may aid in their recovery and should also provide details on how to get the employee back into work. It's important that you work with your OH service to ensure everything is covered. Often the fit note may detail alternative duties for the employee until they feel fit to undertake all their usual duties and this should be agreed by all parties.

GPs, nurses, occupational therapists, pharmacists, and physiotherapists are often not familiar with their patients work or work environment so it may be possible for your local OH department to suggest alternatives to support staff to return to work. Where you feel this may be an option you should seek further advice from your OH department who would be responsible for contacting your employee to get the required consent and consulting with the GP.

Using your occupational health service

Occupational Health (OH) services are all about making sure your staff are fit for the work they do, and how their work affects their health. OH can provide support and guidance on how to support your staff and on making reasonable adjustments to allow the employee to remain in the workplace or return to work.

Your focus as a line manager should be on the impact the employee’s health is having on their ability to undertake their role, as opposed to the detailed nature of the health complaint and any treatment they may be receiving. 

Make sure you discuss with the employee the reasons for referring them to OH, so that they understand and are fully aware of the reasons for referral. The employee should also be given a copy of the referral letter.

You need to be aware that confidentiality principles place constraints on OH professionals in regard to the release of the personal medical information of staff. These apply in all cases. You may wish to speak to your HR team for more information about referring a colleague for your occupational health service locally.

NHS England’s Growing occupational health and wellbeing (OHWB) together is a five-year strategy to improve the health and wellbeing services for our NHS people, to keep them safe and healthy, and empowered to pass good care onto our patients.

For more information on occupational health please see the NHS Employers website.

Impact on the team

It's important to talk to your employee about their illness, and consider:

• the length of sickness
• cover options
• what they want others to know
• how regularly they'd like to keep in contact.

It is important to work with your team to manage the impact of the absent employee. One way to do this is to make sure other team members know how to perform each other's duties. Discussing and implementing contingency plans in the event of an absence with your team will not only maintain continuity of workflow but will also empower your team in being actively involved in the solution to the problem. The contingencies will be especially useful in the event of a longer-term absence such as a serious or terminal illness, or if the employee decides on early or ill-health retirement.

Make sure you have an open-door policy to discuss the impact of the employee's absence. Be clear, positive, and supportive when discussing matters with both the person who is off sick and the rest of the team. This will help your team to remain positive and supportive of the person who is away sick and reduce any gossip.

It is possible that the rise in workload among the team could give rise to feelings of resentment or anger. Lead by example and be supportive, positive, and clear with your team (and, if appropriate, the wider organisation), keep them informed as much as possible and openly acknowledge their efforts in maintaining the workflow during the team member's absence.

Your employee may not want colleagues to be informed of their illness. You should respect their need for privacy and be sensitive where possible and within reason, whilst making sure that the service provided is minimally disrupted. Be careful not to burden them with the repercussions of them being off sick as this could give rise to feelings of guilt which could impede their recovery. If the illness could impact upon the team and service you provide, discuss what details should be shared with your HR department.

Be aware that once a person’s condition becomes known, they can be overwhelmed with well-wishes, and they might find this uncomfortable – talk to your employee and make a plan you can both agree on to manage this.

Make yourself aware of support policies and programmes available for your team and communicate this to them. Contact human resources and occupational health for further information about these, as well as information about having difficult conversations and support available for all involved, such as counselling and Employee Assistance Programmes (EAPs).

Ill-health retirement

Sometimes one of your employees may become very ill and permanently incapable of doing their current job. In these situations, you should always look at options for redeployment or alternative duties in the first instance. However, if these options are not possible, your employee may apply for ill health retirement.

Ill health retirement is only available to members who are under the retirement age for the NHS Pension Scheme. If an employee is over the retirement age, they do not need to apply for ill health retirement can apply for their NHS pension as normal. The only exception is when an ill member has a life expectancy of less than 12 months.

The NHS Business Services Authority has information online to help you guide your staff through the ill health retirement online application, including in-depth information on who is eligible to apply.

Tailored information is available for:

• employees via the knowledge base and member hub
• employers via the employer hub.

You should make yourself familiar with the process, so you can help your employee navigate their way through it as easily as possible. Contact your human resources (HR) or occupational health (OH) departments for information and support.

Your employee should fill out form AW33E if they still work in the NHS, or form AW240 if they no longer work in the NHS but have had two years membership of the pension scheme. All forms can be found on the NHS Pensions website.

Applications will be assessed by a medical adviser, and if successful the employee will receive their pension. The pension will be based on their accumulated entitlement, but without any reduction for early repayment.

Should the employee recover and return to NHS employment, the pension will be reduced - this is called abatement.

If your employee is diagnosed with a serious condition and is expected to live no longer than a year, they can apply for a one-off, tax-free lump sum payment.

In this case, they will need to have some HMRC personal lifetime allowance (LTA) and fill in form AW341, which can be found on the NHS Pensions website.

To apply for ill-health retirement the member of staff:

• must work for the NHS, or have recently worked for the NHS
• have at least two-years membership in the NHS pension scheme
• should be younger than normal state retirement age (65).

Three copies of any application must been completed. These are:

• one for the employee
• one for their line manager
• one for the OH department to add the medical details of the employee’s condition.

Making reasonable adjustments

Sometimes reasonable adjustments can be made to enable your employee to remain at work, or, if they are off sick, to return to work. Where this is the case, it is important that you and the employee work together to ensure that any adjustments are practicable. Where needed this may also involve HR, OH or other support available, for example Access to Work. 

It is important that you discuss any adjustments fully with the employee to see if the adjustment is suitable and would enable them to do the duties, they have agreed to without exacerbating their health complaint. The sooner you have this conversation, the more time you will have to arrange for the support, equipment or adjustments needed. Making adjustments could also mean your staff member could return to work sooner.

Reasonable adjustments are an area that often causes concern for line managers due to the requirements of the Equality Act. However, if you approach all employees in the same way and discuss reasonable adjustments openly, seeking advice where necessary from OH or other experts then this should help you manage the process with confidence. You are not expected to know what adjustments should be made but you must consider them and work with the employee and professionals to identify and apply them when required.

Where ill health, injury or other impairment meet the relevant criteria under The Equality Act 2010, discrimination is prohibited and ‘reasonable adjustments’ to working arrangements must be considered. However, considering adjustments where relevant and applying this approach consistently to all employees is the recommended approach.

It is important that advice is sought from OH and HR when determining whether any reasonable adjustments or modifications can be made to the existing workplace and/or duties. A risk assessment should be carried out as appropriate. 

In this Understanding workplace adjustments infographic you can find out about the different types of workplace adjustments that can help support disabled staff in their roles.

Health and safety

Health and safety is all about minimising illness or injury in the workplace. It covers many related aspects such as policies, accident reporting, potential hazards and risk assessments, manual handling, violence towards staff from patients, infection control, needle stick injuries and many more. It is the responsibility of all staff to safeguard the health and safety of the workplace and the team.

As a manager, you have a duty of care to your team to ensure that policies and procedures are followed. You should make yourself aware of your local health and safety policy, as different business areas will have different guidance in place to safeguard health and safety - for example, there will be separate advice for staff working in freight and logistics to those working in an office-based environment. You should be aware of where you need to go to gain further support, such as your OH or HR departments.

As part of the role of manager, you will need to carry out workplace risk assessments for your work areas and setup preventative measures for any hazards identified. Your OH or HR department can help with any training needed for yourself and your staff to make sure your work area is as safe as possible.

Make links with the team in your organisation responsible for health and safety and find out what you need to do as a manager to keep your team, colleagues, and patients safe. The Health and Safety Executive (HSE) also has a number of tools on their website (such as the line manager competency indicator tool) to help you assess your own skill levels as a manager in dealing with health and safety issues. These are very useful in identifying where you may need further training, support, and information.

The NHS Staff Council’s Health, Safety and Wellbeing Group (HSWG) Workplace health and safety standards aim to help organisations comply with health and safety law by pulling together legal requirements and good practice. The document provides practical pointers and signposts for meeting appropriate standards in key areas of workplace health and safety. The HSWG has also published other useful guidance, research and advice on topics such as, lone workers, sickness absence and the Musculoskeletal health in the workplace,, which outlines measures to reduce the incidence of work related back and musculoskeletal disorders.  

Health and safety in the NHS in England is regulated by the Health and Safety Executive (HSE), and the Care Quality Commission (CQC). They have a liaison agreement that allows them to co-ordinate actives and share information relating to health and safety within the NHS. They have a wealth of information on their website, including safety alerts for employers. The HSE also works with other trade regulators such as the General Medical Council (GMC) and have agreements with them on health and safety issues for their members. 

Infection prevention

Employees are responsible for managing their own health and deciding whether they are fit enough to be at work or not. However, there are times as a manager when you may need to reinforce to staff whether someone can be at work in line with infection prevention, so that this does not pose any risk to patients, colleagues, or the public. 

As a manager, when an employee is off work, you should always ask what the nature of the absence is. This allows you to provide support and also to take any steps necessary to ensure prevent or contain the spread of infection. 

Should a member of staff call in, you can seek advice from HR/OH if you are unsure what to do. Ultimately if the employee poses any health risk to other people, they should not attend work until they are well.

Make sure you consult the organisation policy on hand hygiene and make sure your employees are aware of this and practice the guidelines - this reduces the risk of spreading infections.

Phased return

Phased return to work allows the member of staff to gradually return back to the workplace over an agreed period of time, and research suggests that it also aids recovery. Not everyone who has been off on long-term absence will need or require a phased return. Normally the employee will be able to return to work with zero or minimal reasonable adjustments. However, a phased return may be required particularly where the employee needs to build up their stamina. Taking annual leave and slowly building up time the employee spends at work is the usual way of doing this.

Times allowed for rehabilitation vary from organisation to organisation and does of course depend upon the original cause of the absence and will need to be decided on a case-by-case basis. You should consult occupational health (OH) and your local policy to ensure that you are working within the appropriate guidelines.

You should discuss with OH professionals the best course of action with the employee, considering:

• the nature of the condition the employee is suffering from
• what level of work they can or cannot do
• how many hours they are reasonably capable of doing
• over what period of time they should work towards achieving a full-time return to work
• any modifications that would help them return to work faster, including special equipment or re-training
• time needed to continue any ongoing medical treatment such as physiotherapy, counselling, hospital, and GP visits
• regular reviews of the situation
• compliance with the Equality Act.

Therapeutic return

This allows members of staff to start to make links with the workplace prior to a full return to work. This may include steps like, coming into the workplace for a meeting with you and/or colleagues to have an informal catch up, attending team meetings and/or time outs. Where a member of staff has been off for a longer period of time this can help the employee to settle back into work more quickly and remove some of the fear around return.

Return to work meeting and plan

When carried out effectively, return to work meetings are proven to be the single most effective measure for reducing short-term sickness absence. They indicate to employees that their absence was noticed and that they were missed, and that the employer wants to take the time to find out how they are. They also serve to indicate that managing sickness absence is a priority for the employer. Below we highlight some key aspects to consider when conducting a return-to-work meeting.

The return-to-work meeting is an opportunity to confirm the reason for an employee's absence and gives you the opportunity to discuss with your employee how they are, and if there is anything you can do to support them in the workplace. Reassure the employee that they were missed, and that you and the team are glad they have returned.

A return-to-work meeting should be carried out after every instance of sickness absence – even one day. Shorter frequent absences could mask a health concern which may go unnoticed if return to work meetings are not conducted.

To be effective, return to work meetings should be carried out in a fair and consistent way, and approached in a supportive way. They will usually be informal and brief.

You should follow your organisation’s policy around conducting the return-to-work meeting but see below for some general principles you can follow.

Organisations usually provide managers with a template to use for the return-to-work meeting as a guide and to promote consistency, including questions to ask and as a template to record the discussion and any agreed actions. Contact your HR department for this.

Please refer to your local procedures when completing your return-to-work meeting.

Redeployment

Many organisations using rehabilitation as part of their sickness absence management policies have found that it is not always possible to rehabilitate staff back into their original post in the short term. This may be due to or to the nature of their illness or the requirements of their role. For instance, musculoskeletal problems may need time to heal without the risk of further damage.

In these circumstances, a widely used alternative is redeployment.

Redeployment is seen as an important mechanism that can assist in the retention of experienced and skilled staff in the NHS. An effective redeployment policy can help minimise the need for redundancies, not only as a result of organisational change, but to help retain staff unable to do their own job through ill health or injury.

This can be used in the short term, while an employee is recovering from a period of ill health before returning to their usual job full time, or permanently for staff who have no likelihood of returning to their original role.

In our impact of redeployment on nurse wellbeing and retention resource you will hear about the findings of the nurse redeployment study as well as key recommendations to support future improvements.

See your local redeployment procedure for more detailed information on this topic.

Risk assessments

The purpose of a risk assessment is to identify and prioritise risks arising from workplace duties and to put practical measures in place to eliminate or reduce identified risks. Undertaking a risk assessment is the employer’s responsibility and it is important for you to regularly review and update risk assessments in collaboration with your team and their representatives.

Operational managers are usually responsible for ensuring risk assessments are carried out in their own work areas. Competent advice and assistance should be sought where necessary (for example by a health and safety advisor) and input from employees can provide a valuable perspective in addressing any new or job specific issues that may arise.

You may find it useful to visit the Health and Safety Executive’s website which contains a range of resources on risk management. This includes a risk assessment and policy template along with frequently asked questions.

You can find further information on risk assessments on our webpage.

Health and wellbeing conversations

The NHS People Plan asks that all NHS staff have a health and wellbeing conversation and are supported to develop a personalised wellbeing plan. In most cases, a health and wellbeing conversation may be held by a line manager or supervisor, but in some cases, staff might want to have this confidential discussion with someone else.

You can hear how an innovative health and wellbeing passport is helping staff at The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust feel more confident in bringing their whole selves to work in our recent case study.

Our health and wellbeing conversation web page has more ideas for ensuring that quality health and wellbeing conversations and plans that best meet the needs of our diverse workforce are embedded within your teams and organisation.

Supporting the basic needs of your staff

Lack of access to basic wellbeing needs such as hydration and sleep have been identified as a major concern for NHS staff wellbeing and patient safety. In the 2021 NHS Staff Survey respondents continued to indicate that they often or always felt that every working hour is tiring from the. It is therefore vital we address basic staff needs, such as sufficient breaks, as priority. 

As we know, there is no one size fits all approach when it comes to supporting the wellbeing of your staff and NHS organisations may be at different points of their health and wellbeing journey. We also appreciate there are often a number of barriers to fulfilling your staff needs, this guidance highlights some ways to overcome them.

As well as the organisation, individuals have a personal responsibility towards looking after their own wellbeing. Collectively, organisations should work closely with their people to ensure the workplace environment fulfils all needs.

Our guidance has information to support NHS health and wellbeing leads and managers to prioritise and fulfil their staff wellbeing needs.

Useful resources

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