Sickness Absence Toolkit

Guidance for NHS managers to have supportive conversations around sickness absence.

19 January 2024

Chapter 1


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.

Sickness Absence Toolkit: an introduction

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. 

Chapter 2

When staff report they are sick

All you need to know in 30 seconds

The way you respond when staff call in sick can make a difference to how they feel about work. It could even affect the length of this, and future, absences. 

Your role is to be supportive while ensuring you have the information you need to keep things running. 

Listening is key. Put yourself in their shoes and think about how you might feel and what you would want your manager to say and do. 

Always ask your staff the following questions: 

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

Make sure you log the absence and the reason so that you can work with your member to put appropriate support in place for them.

Your response when a colleague calls in sick can make a big difference to how supported they feel, and this can impact how they feel about returning to work.

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.

You may wish to regularly discuss the reporting procedure at a staff briefing so that everyone has the opportunity to understand and contribute to how it works. This will also reinforce the message that absence reporting is about looking after staff health and wellbeing and ensuring the team is supported.

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.

Key points

  • Sickness absence codes are useful for spotting sickness trends and creating benchmarking metrics from the Electronic Staff Record system (ESR) - but only if recorded and used correctly.

  • Follow the agreed process in your organisation.

  • You are responsible for recording the sickness absence of your team so make sure this is done fully with the right ESR code. It's crucial to find the ESR absence code, duration of absence and record it.

  • Sickness absence codes are agreed nationally and are used to identify absence in the NHS.

  • If you are not clear on the codes used, contact your human resources (HR) /occupational health (OH) departments for clarity.

  • Employees may not want to tell you their reason for absence, ask them who they are happy to talk to (such as HR). With the right codes, you can arrange further support your employee might need.

  • Failure to get the codes could impact the employees support needs and entitlements to sick pay, and fail to activate trigger points for interventions.

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.

Chapter 3

Frequent sickness

All you need to know in 30 seconds

Short-term sickness is a period of absence lasting less than 28 days. Frequent short-term sickness absence can be disruptive  to teams and services. It can also indicate a bigger problem with an individual or wider problems within your team.

Spotting problems early will enable you to put the right support in place. To do this you’ll need to:

  • know your organisation’s policies and procedures for sickness
  • review the absence history of your staff regularly and look for any patterns
  • discuss anything you notice with your staff to open up a discussion about their overall health and wellbeing
  • if there are underlying health problems, or this is suspected, refer to occupational health (OH)
  • if there are other issues the staff member is experiencing, at work or at home, work with them to develop a support plan
  • discuss health and wellbeing regularly in one-to-ones and encourage staff to take care of their physical and mental wellbeing
  • if no underlying issue is evident, you should be clear with your staff member that their attendance needs to improve, how this will be measured, and the potential impact if it does not.

As a manager, it is your responsibility to review any absence history and discuss any problems/issues or areas of concern with your staff. Identifying any potential problems early will enable you to put the right support in place to ensure your staff are supported at work and minimise any future absences.

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.

Spotting problems early will enable you to put the right support in place.

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:

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.

Appropriate training can assist you with being able to identify changes in employee behaviour that might result in increased absences and encouraging the employee to discuss these.

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.

Chapter 4

Long term sickness

All you need to know in 30 seconds

Long-term sickness absence is usually defined as a period of absence lasting more than 28 days. Long-term sickness absence can be a difficult time for both the affected staff member and you as their manager. Your role is to support your staff to maintain a connection with the workplace. You also need to make sure their work covered and this doesn't have a detrimental effect on the service, as well as ensuring that your organisation is doing all it can to facilitate a return to work.

For a continuous absence lasting more than 28 days:

  • Make sure you have been given a fit note from the doctor explaining the absence and the length of time your staff member is likely to be ‘not fit for work’, then send this as soon as possible to your payroll department so that the record of absence and pay will be correct. This is important for monitoring sickness and ensuring pay is processed correctly.
  • Keep in touch and agree with your staff member when and how frequent you will be in contact and in what format.
  • Cover the employee’s workload by delegating to existing staff, using bank staff, or recruiting additional staff. Reassure the employee not to worry about their work being covered.
  • Find out your organisation’s policies and procedures for supporting and managing long-term absence.The policy will usually contain a timeline and process for you to follow, and you can seek support from HR with this process.
  • Learn about the condition affecting your staff member and seek advice from OH, charities or support groups as to how best support them.
  • Plan for their return to work, make reasonable adjustments and identify their options if they are unable to return to their original role or work environment.
  • Work with HR and OH at all stages, they are a great source of information and support.
  • Be aware of your organisation’s approach to redeployment, ill-health retirement or, as a last resort, dismissal.  if a return to their role is not possible.

Your role is to support your staff in their absence and enable them to maintain a connection with the workplace.

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.

Read and understand your organisation’s policies and procedures for supporting and managing long-term absence.

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.

The key to actively managing long-term sickness absence is to always know what the next step will be for your employee.

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.

Chapter 5

Reasons for absence

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.

  • There are more than 375,000 cases of cancer diagnosed every year within the working-age population of the UK. Many of these people will continue to work during their treatment and return to work after they recover. However, being diagnosed with cancer is still a life-changing event and can cause many other side effects such as depression and anxiety. People taking care of those with cancer can also develop health problems, due to emotional strain and physical exhaustion.

    Take time to talk to and listen to your employee. Although cancer can be difficult to talk about, and you may be unsure of what to say to support your employee, you don’t need to be an expert in counselling to help. For many people dealing with cancer, just knowing that colleagues are there to support them can be a great help, and what really matters is that you are ready to help your employee when needed, with time to listen and the ability to arrange extra help where required.

    Understand that each case is individual with different and often complex needs - there are no words, actions or situations that work for everyone. Each employee will require tailored and personalised help. Listening carefully will help you to offer the right support to your employee; if you can’t provide certain help or advice, find out who can offer this support in your organisation and arrange for it to happen.

    Always talk through the options with the employee to plan the best way forward. You can put your employee at ease when you talk to them by:

    • Giving them your full attention
    • Having the talk in a calm, quiet and relaxed environment, free from interruptions
    • Letting the employee lead the conversation and encouraging them to talk
    • Not rushing the conversation
    • Trying to keep the conversation as supportive and positive as you can

    Offer your employee services they might need such as: workplace adjustments, time off, or counselling. Contact your human resources and occupational health departments to find out what help they can offer.

    Ensure you familiarise yourself with ill-health retirement and long-term absence policies, and cancer-specific policies in your organisation.

    Macmillan Cancer Support has many useful sources of information and help freely available on their website.

  • Frontline healthcare workers are more likely to contract colds and the influenza virus than the general population, particularly during the winter months when some of their patients will become infected.

    The proven and most effective method to prevent catching the flu is to be vaccinated annually. The Department of Health and Social Care, the General Medical Council and the British Medical Association all recommend that healthcare workers directly involved in patient care are vaccinated annually. Vaccination limits the spread of the virus and protects the frontline staff, their families, and vulnerable patients from contracting the virus.

    As a result of these recommendations, all frontline NHS employees are entitled to a free seasonal flu vaccination. Make sure your team knows this and can access the vaccination if eligible.

    For more information about your organisation's seasonal flu vaccination campaign contact your occupational health department.

  • Employers should ensure their staff are kept informed of the latest COVID-19: information and advice for health and care professionals guidance.

    Although people are no longer legally required to self-isolate, the government are still advising that NHS staff who test positive for COVID-19, who have received one or more doses of COVID-19 vaccine, who have any of the main symptoms of COVID-19, or have received a positive lateral flow device (LFD), should still follow this government guidance. This is because it is still possible to get COVID-19 and spread it to others, even if you are fully vaccinated.

  • Long COVID is a term used to describe the symptoms and effects of COVID-19 that last longer than four weeks beyond the initial diagnosis. 

    The Office for National Statistics (ONS) reported that as of 6 January 2022, an estimated 1.3 million people living in private households in the UK (1.9 per cent of the population) were experiencing self-reported long COVID. The rates of self-reported long COVID were greatest in people aged 35 to 69, females, those living in the most deprived areas, those working in health or social care, and those with a pre-existing activity-limited health condition.

    Symptoms may include persistent fatigue, shortness of breath and brain fog (cognitive challenges). A range of other symptoms which can be found on the NHS website.

    There is still uncertainty around the prognosis of long COVID, as each person can experience a range of different symptoms. In some cases, people have begun to feel better before experiencing a return of fatigue and needing further time off to recover. Therefore, it is important to ensure that you are having regular conversations with your colleagues to ensure they understand what their needs are and to prevent the risk of relapse.

    Access more information on our supporting recovery after long COVID web page.

  • As a line manager, you have a key role to play in improving mental wellbeing in your workplace.

    While it is sometimes seen as a challenging issue to talk about, you don’t need to be an expert in mental health to support your staff. However, you do have a key role to play in improving mental wellbeing in your workplace.

    Having open and regular health and wellbeing conversations with staff about their mental health, providing support and creating a culture of positive mental wellbeing in your team can make a big difference to how staff are able to manage stress and other mental health problems.

    Mental health can fluctuate along a spectrum in the same way that physical health can, and there may be times when it is better than others. Mental health problems should be supported in the same honest and consistent way that physical health problems are. This includes making reasonable adjustments where appropriate.

    You may want to consider completing an early referral for your colleague to your occupational health team and your employee assistance programmes (if your organisation has one) to provide support for your staff.

    Staff with disabilities can face additional mental health challenges in the workplace, find out how you can help support them by accessing our resources. 

    More information about mental health in the workplace and how you can support your staff can be found on NHS Employers website.

  • Musculoskeletal disorders (MSK, sometimes referred to as MSD) are one of the most common reasons for sickness absence in the NHS, and in many cases become long-term absences.

    Early intervention can make a big difference in shortening the employee’s recovery time and preventing a potential long-term absence. Rapid access services can provide prompt support to staff (for example physiotherapy services) in order for them to return to work. These services may be available to staff through referral by you, the occupational health department or through self-referral systems which many organisations now operate. Make sure you are aware of any rapid access services that are available in your organisation.

    To help prevent work-related MSKs and long-term absences: 

    • Encourage your staff and their safety representatives to tell you when MSKs start to develop
    • Review your risk assessments regularly and when necessary
    • Regularly check the accident book and sickness absence records
    • Respond promptly when someone reports an MSK
    • Have information and advice on MSKs on hand
    • Learn about any rapid access services available
    • Use all available information to identify measures that will enable you to reduce the risk to employees and others
    • Arrange modified working, when necessary (rehabilitation and redeployment), to help people stay at work until they are fit to resume their usual job

    When managing employees with MSK-related issues, you may become involved in helping to rehabilitate and redeploy staff. This could include:

    • Helping staff to access rapid access services such as occupational therapy, physiotherapy, and counselling
    • Designing return to work plans including therapeutic return and phased return
    • Making reasonable adjustments for staff
    • Redeploying staff if it is not possible for them to resume their original role

    Getting your employee back to work sooner will benefit both them and the organisation, and in many cases help speed up their recovery.

    You can find more information on our NHS Employers Musculoskeletal health in the workplace webpage.

  • Some people think that sickness and diarrhoea, sometimes referred to as D&V (Diarrhoea and Vomiting) is common in hospitals. However due to hospital hand hygiene procedures D&V is more likely to be picked up outside of a hospital.

    A person with diarrhoea and vomiting should be considered very infectious. If an employee has these symptoms (or they are looking after someone who has them) advise them to:

    • Stay off work until they (or the person they are looking after) have 48 hours symptom free
    • Seek medical advice if they feel very unwell, preferably via phone
    • Avoid visiting hospital or a GP surgery where possible as this could spread infection
    • Avoid preparing food that others will consume until they are 48 hours symptom free
    • Drink plenty of fluids to counteract the dehydration these symptoms cause
    • Follow cleanliness advice for D&V offered by the Health Protection Agency (HPA)
    • Work with your employee to ensure they know to stay away from work until they are free of symptoms for 48 hours
  • Mental health and stress problems accounts for over 20 per cent (as of February 2022) of the total sickness absence in the NHS.

    Although stress itself is not an illness, prolonged exposure to unmanageable stress can lead to long-term illnesses, such as anxiety and depression. Therefore, managing stress is a key part of your role in creating a mentally healthy workplace.

    While stress is sometimes seen as a challenging issue to talk about, you don’t need to be an expert in mental health to support your staff. Having open conversations with staff about their stress can make a big difference to how well they are able to manage it.

    Be clear about the reason you are speaking to the member of staff, as well as emphasising that you are talking to them to support their wellbeing. Reasons why you might want to speak to an employee about stress include poorer performance, lateness or any changes in their behaviour that you or colleagues have noticed.

    It is important for you to be seen as approachable and be available for your staff. Have protected time when staff can speak to you, as well as regular catchups and health and wellbeing conversations. Catch-ups with staff are an opportunity to start a conversation about managing stress and for this to be seen as a normal part of line management.

    You can support your staff to manage stress by:

    • Monitoring the workload of your staff to ensure it is manageable; this will help your staff identify and manage their own causes of stress in the workplace
    • Encouraging staff to have a good work-life balance, including being involved with social events and physical activities, which are shown to boost staff health, teamwork, and mental wellbeing
    • Promoting and teaching staff about relevant organisational policies, such as flexible working
    • Treating all your staff consistently and fairly, and providing positive feedback to them when they do a good job
    • Making staff aware of the internal resources that are available to them such as occupational health or employee assistance programmes (EAPs)
    • Following-up problems on behalf your team as soon as they arise

    More information about stress and its impact in the workplace can be found on NHS Employers website.

  • Five million people in the UK are juggling caring responsibilities with work - that's 1 in 7 of the workforces.

    Often this happens slowly, becoming more demanding over time as illnesses progress. Occasionally people will become carers suddenly.

    Sometimes employees may be afraid to admit to their managers that they are carers outside of work, as they worry it will impact on their career. They may prefer to keep things quiet and carry on with little help. However, caring duties can cause health problems as the carer may become more mentally or physically exhausted over time and receiving help and support can prevent this.

    As a manager, you should be aware that employees who are carers will require more support, such as working flexibly, agreeing special leave, or just talking through their options.

    If you find out your employee is also a carer, start a conversation with them and discuss support options available - they may just need some flexibility in working hours or other arrangements such as emergency planning and time off work.

    You should also consider the mental and physical health of your employees who are carers, as caring can be very demanding. Find out what support your employee needs and refer them to appropriate services, such as local support groups - your human resources and occupational health departments can help you with this.

    Make yourself aware of your organisation’s policies about carers and communicate these to your team. Contact your human resources, health and wellbeing and occupational health departments for information on what support is available.

    In our case study you can learn how Sheffield Teaching Hospitals engaged with and supported carers in the workplace.

Chapter 6

Supporting staff off sick

All you need to know in 30 seconds

  • Maintain positive and regular contact with your employee to make them feel more valued and prevent them from feeling isolated.
  • Contact your employee as soon as possible to discuss the reason for absence and its likely duration.
  • Assure the employee that you will contact them at regular agreed times (usually weekly), setting aside time for them to talk to you about any support they need.
  • Find out if there are organisational policies in place for keeping in contact, use them and communicate them to your team.
  • For a longer period of absence, keep your employee updated about work and consider an active case management approach to keep track of their absence.

Ask your employee:

  • How they are and how their condition is progressing?
  • If they need help accessing appropriate support and treatment?
  • When they might feel ready to return to work?
  • What is preventing them from returning now - could they do minimal or adjusted duties?

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.

Things to consider

  • How are they doing?

  • Are they making progress?

  • Are they receiving appropriate support and treatment?

  • Are they waiting for physiotherapy, counselling, outpatient appointments or inpatient services?

  • What parts of their current job can’t the employee do?

  • When might the employee feel ready to return to work?

  • Can they do minimal or adjusted duties?

  • What can you do for your employee? For example:

    • facilitate easier access to physiotherapy, counselling etc
    • make adjustments to hours or duties
    • explore possibilities of temporary alternative work.

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. 

Setting up a rapid access scheme could contribute substantial savings for your organisation, leading to a more consistent and healthy workforce and reduce pressure on colleagues covering sickness absence.

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.

Contact your occupational health department who can provide you with further support and guidance around how to support your staff and any reasonable adjustments which could be made to allow the employee to remain in the workplace or return to work.

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).

Remember that your employee may not want colleagues to be informed of their illness.

Key points

  • Before you speak to your employee consider what impact their absence is going to have and if there is anything key you might need to ask them about, for example, update on a key piece of work, meetings you may need to cover.

  • How are you planning on covering or re-prioritising their work? Consider whether it would be appropriate to say that so your employee isn’t worrying about their work and can focus on their recovery.

  • Talk to your employee about their illness and ask how they would like you to communicate this to the team and/or organisation.

  • Respect that the employee may want privacy, and if this is the case discuss what you will communicate which may just be, for example: "X will be off this week and is hoping to be back next week, but I will let you know when I have spoken to them."

  • Be clear, positive and supportive with both the employee and the team focussing on the work that needs doing and how this will be managed not the absence and/or reason for absence.

  • Make a plan of action to ensure services are minimally disrupted and your team are not over-stretched when covering workloads, for example does work need re-prioritising?

  • Make yourself aware of support policies and programmes available for your team and communicate this to them. Contact HR and OH for more information.

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:

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.
Chapter 7

Returning to work

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. 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. 

As a manager, you have a duty of care to your team to ensure that policies and procedures are followed.

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.

Where staff have been off with an infectious illness you should encourage them to always contact you before returning to work – especially if the illness was caused by any of the following:

  • diarrhoea/vomiting (should be 48-hours symptom-free before returning)
  • infectious rashes (Chicken Pox/Scabies)
  • undiagnosed persistent coughs with/without a temperature (Tuberculosis)
  • Influenza
  • COVID-19.

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.

  • It is important for all parties to keep the plan under review to ensure that it delivers what is intended and to allow for agreed changes to be made if it is found to be unsuccessful in any way. Lessons learned from implementing return to work plans should be shared with other managers, OH and HR in order to learn from them and improve the process for other employees in the future.

    • welcome the employee back to work and ask how they are
    • clarify the reason for the absence
    • confirm that the employee is fit to return to work and has taken appropriate leave where infectious illnesses have been the cause of an absence
    • consider any changes or adjustments which should be made to accommodate the employee in their return to work
    • consider the appropriateness of a referral to occupational health
    • discuss this episode of sickness in the broader context of other absence, and what the procedure is and when this may be applied
    • consider whether there are any patterns of absence occurring e.g., absences always falling on the same day of the week, prior to a bank holiday etc.
    • engage in a wider conversation about the employee’s health and wellbeing
    • discuss the value of the employee in terms of the team and the impact sickness absence has on the ability to deliver high quality consistent patient care
    • update the employee on any changes that have occurred while they have been away
    • ensure the absence has been recorded and reported accurately
    • ensure the self-certificate or fit note has been provided, if necessary
    • take the opportunity to clarify and/or update reporting procedures and re-circulate these
    • where the absence is related to an infection control issue, consider whether the employee has been away from the workplace for a sufficient period of time to prevent spread of infection? Is further clarification required from occupational health?
    • ensure you have considered the need to undertake any risk assessments prior to the employee resuming full duties
    • if the absence was as a result of a slip/trip or fall, has this been reported through any relevant incident reporting system?
    • if the absence is related to a musculoskeletal issue, make the employee aware of any rapid access to treatment options or recommended that they seek OH advice or support>
    • if the absence is related to mental health issues, consider whether the employee is getting appropriate support, and/or have you discussed a referral to OH?
    • will your employee require a change to their duties upon their return?
    • the expected date of return 
    • details of any steps that need to be taken prior to the employee returning, e.g., risk assessment, ordering equipment, change or transfer of duties etc.
    • details of any therapeutic return plan e.g., agreed times that the employee will pop into work to have a coffee with colleagues, attend a team meeting etc.
    • the agreed detail of any phased return including the duration of this and expectations of what they will be able to do when this has been completed, e.g., return to their substantive role fully recovered
    • the period of time covered by the plan
    • when the plan will be reviewed and by who
    • will the plan have any effect on the terms and conditions of the employee and is there any change to their pay
    • who has been involved in drawing up the plan
    • details of reasonable adjustments and when they should be reviewed.

    All of this can usually be done during and after the return-to-work meetings where you can get a good idea of the absence reason. In all cases you should try to use both ESR codes to drill down to the most appropriate reason. If you are not clear on the code to use or need guidance, you can ask your OH and HR departments to help you.


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.

Five steps on how to undertake a risk assessment

  • Identify the hazards.

  • Decide who might be harmed and how.

  • Evaluate the risks and decide on precaution.

  • Record your findings and implement them.

  • Review your assessment and update if necessary.

Chapter 8

Preventing absence

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.

Chapter 9

Further information and contact

Useful resources


For further information or if you have a question please contact the NHS Employers health and wellbeing team via