Managing Long-Term Sickness Absence

Long term sickness absence can quickly become challenging for employers, raising both practical and potentially legal issues. This is often the case where employers approach long-term absence reactively, dealing with issues only once they have escalated.

For managers, it can be difficult to know in the circumstances what they should do to ensure they are providing adequate support to the absent worker, while also being mindful of the interests of other staff and the organisation as a whole. Questions are commonly asked about how much contact employers should make with an absent employee, when reasonable adjustments are required to facilitate an employee’s return to work and when dismissal may be appropriate.

In this guide, we explain the legal position on long term sickness absence and share practical advice for HR and managers to help address these issues by balancing the organisation’s needs and interests, and the employee’s wellbeing.

 

What is long term sickness absence?

 

Long term sickness absence is when an employee is absent from work for an extended period of time due to ill health. In many organisations, an employee will be classed as on long term sick leave after a period of around 4 weeks, at which stage an absence review may be undertaken, in conjunction with the employee, to assess the employee’s long term prognosis and what steps can be taken to help support their return to work.

Employers are under a statutory duty to ensure the health and wellbeing of their employees at work, which includes giving them sufficient time within which to make a full recovery and making sure that staff do not come back to work before they are fit to do so.

At the same time, employers will also need to consider the operational needs of their organisation, including whether and when the employee’s return is likely, so that steps can be taken to arrange appropriate cover, or even a permanent replacement, if necessary. However, any decisions must be handled sensitively and in compliance with employment law to avoid legal risks.

 

Managing long term sickness absence

 

Most workplaces have a sick leave policy that outlines the process for managing absence due to illness or injury. A well-defined policy helps set clear expectations for employees, providing reassurance during what can be a difficult and uncertain time.

If a policy is lacking or does not cover long-term sickness absence in detail, the process can generally be divided into two key stages: managing the absence itself and planning for the employee’s return to work.

Stage 1: Managing the Absence
During the early stages of sick leave, it may be unclear whether the absence will become long-term. The employer’s initial focus should be on practical matters, such as ensuring the correct documentation is provided (e.g., fit notes) and administering sick pay, whether statutory or contractual. Employers should also maintain appropriate contact with the employee to offer support while respecting their need for recovery.

Stage 2: Reviewing Absence and Planning for Return
If the absence extends beyond a few weeks, regular reviews should be conducted to assess the employee’s condition, any progress, and the likelihood of a return to work. Seeking input from occupational health professionals may be beneficial to understand any adjustments that could facilitate a successful return. The aim is to balance business needs with appropriate support for the employee.

There is no fixed timeline for these stages, as this will depend on workplace policies and the nature of the employee’s condition, including any treatment plan. Flexibility may be necessary to accommodate medical advice and ensure a fair and legally compliant approach.

 

How many fit notes are needed during long term sickness absence?

 

If an employee is off work sick for more than the self-certification period – 7 consecutive days, including weekends and bank holidays – they will need to provide their employer with a fit note. the fit note should set out the date the individual was clinically assessed, the nature of their condition, when they are likely to recover or whether they will need to be reassessed to determine their fitness for work.

On expiry of any fit note, if the employee continues to be absent on sick leave, they will need to obtain a further fit note, and continue to do so throughout their period of leave.

 

For how long is SSP payable during long term sickness absence?

 

Employees who earn an average of at least £123 per week and have been sick for 4 or more days in a row, including non-working days, will be entitled to statutory sick pay (SSP). This is payable at a weekly rate of £116.75 (SSP rate for the year from 6 April 2024), for up to 28 weeks. An employee may be entitled to an enhanced rate of pay under their contract of employment and any occupational sick pay scheme, but they cannot be paid less than the statutory minimum.

Ensuing that an employee absent from work on long term sickness absence is in receipt of SSP or contractual sick pay forms an important part of the employer’s obligations.

 

Can you contact someone on long term sickness absence?

 

It is important for employers to maintain contact during any period of sick leave, especially in the context of long term sickness absence. Appropriate contact is necessary to deal with absence practicalities, such as updated fit notes and absence reviews, and keeps both parties informed about the next steps in the absence management process. It also allows the employer to offer reassurance and support during the employee’s recuperation; thoughtful engagement helps to meet the employer’s duty of care, ensuring the employee feels valued and supported during their recovery while preserving a positive working relationship for the future.

There are no arbitrary rules governing how often or in what manner an employer should contact an employee during sick leave. However, there is a fine balance between maintaining reasonable contact for welfare and absence management purposes and making excessive or intrusive contact that could hinder recovery.

To avoid misunderstandings, it is advisable to establish clear expectations early on. Employers should outline how and when they will check in, whether through phone calls, emails or meetings, while remaining flexible to accommodate the employee’s needs. It’s important to take a sensitive approach and not to place undue pressure on the employee to return to work prematurely.

 

Should someone on long term sickness absence stay in touch?

 

There is no automatic obligation on an employee to keep in touch during sick leave, not even during long term sickness absence, although it is important for employers to let an employee known in advance what is expected of them if they are signed off sick. Ideally, this should be set out within any workplace policy, including the initial obligation to report their absence from work and the reasons for this, together with the obligation to provide ongoing proof of ill health and to co-operate with any absence review, where needed.

In cases of short term sickness absence, it may be reasonable to ask the employee to call in sick every day to keep their line manager appraised of their return date. In contrast, in cases of long term sickness absence, the employer may instead need to formulate a plan to support the employee during their absence and deal with any practicalities, including the level of contact, communication and co-operation to be expected from both sides.

 

Long term sickness absence & discrimination risks

 

Under the Equality Act 2010, employees with qualifying disabilities are legally protected from discrimination, and employers have a duty to make reasonable adjustments where needed. Failing to handle absences fairly and lawfully can expose employers to discrimination and unfair dismissal claims. Common areas of risk include:

 

Direct discrimination

 

If an employee’s illness meets the legal definition of a disability under the Equality Act 2010 (i.e., a physical or mental impairment that has a substantial and long-term adverse effect on their ability to carry out daily activities), they are protected from unfavourable treatment due to their condition. Employers who dismiss, demote or otherwise disadvantage employees because of their health condition risk facing legal action for direct or indirect disability discrimination.

Employers also have a legal duty to make reasonable adjustments to support disabled employees in remaining in or returning to work. Examples of reasonable adjustments could include:

 

• Adjusting working hours (e.g., part-time hours or flexible start times)
• Modifying duties to remove tasks the employee cannot perform
• Providing assistive equipment or making physical workplace adaptations
• Allowing a phased return to work
• Offering remote or hybrid working arrangements where feasible

 

Failure to make reasonable adjustments, or dismissing an employee without considering them, could amount to unlawful disability discrimination.

 

Indirect Discrimination

 

Policies that apply to all employees but have a disproportionate impact on those with long-term health conditions could be discriminatory unless objectively justified. For example, a policy that automatically triggers disciplinary action after a set number of absences could unfairly penalise employees with disabilities or long-term conditions unless exceptions are made.

 

Pregnancy-Related Absence

 

Pregnancy-related sickness must be treated separately from other sickness absences. Dismissing or penalising an employee for pregnancy-related absence is unlawful discrimination under the Equality Act 2010 and the Maternity and Parental Leave Regulations 1999. Employers should keep pregnancy-related sickness separate from other absence records, avoid using pregnancy-related absence as a reason for dismissal, redundancy, or performance concerns and consider adjustments to help the employee stay in work safely, such as lighter duties or alternative working arrangements

If a pregnant employee is unable to work due to health risks, the employer must undertake a risk assessment and, where necessary, offer suitable alternative work or paid leave.

 

Unfair Dismissal Risks

 

Dismissing an employee due to long-term sickness must follow a fair and thorough process to avoid claims of unfair dismissal. Employers must:

 

• Obtain medical evidence, including a report from occupational health
• Consult with the employee about their condition and prognosis
• Consider all reasonable adjustments before reaching a decision
• Follow a fair capability process, ensuring proper notice and appeal rights

 

Employees with at least two years’ service are protected from unfair dismissal, but dismissal decisions must always be reasonable and proportionate, particularly for disabled employees, where discrimination laws also apply.

 

Harassment and Victimisation

 

Any unwanted conduct related to an employee’s health condition that creates an intimidating, degrading, or offensive environment could be considered harassment. This includes insensitive comments, excessive pressure to return to work, or belittling someone’s condition.

Employees who raise concerns about discrimination (whether for themselves or on behalf of others) are protected from victimisation. Employers must ensure no negative treatment occurs in response to an employee making a complaint, seeking adjustments, or taking legal action.

 

Supporting the return to work after long term sickness absence

 

The employee’s fit note should serve as the starting point when managing a return to work after long-term sickness absence. The most recent statement of fitness for work will indicate whether the employee remains unfit for work or is potentially ready to return, subject to certain recommendations. If a medical professional has deemed the employee fit for work with support, the fit note may specify suggested adjustments, such as a phased return, altered hours, amended duties, or workplace adaptations.

When an employee is deemed fit to return by a qualified medical professional, there is no legal obligation for the employer to follow the advice in the fit note, but it provides a useful guide for both parties. Employers should engage in open discussions with the employee to understand what adjustments they believe would best support their return to work. Ignoring an employee’s input or failing to explore appropriate adjustments could hinder their reintegration and increase the risk of disputes.

For serious or prolonged absences, especially when an employee continues to be signed off as unfit for work, an occupational health referral can provide a more detailed assessment of their fitness to work in relation to their specific role. While a fit note offers broad guidance, occupational health professionals can provide a comprehensive evaluationof the employee’s capabilities, identify potential barriers to returning, and recommend tailored adjustments. Seeking medical advice at this stage helps ensure that decisions about the employee’s future are based on objective evidence rather than assumptions.

Employers must also consider their statutory duty to make reasonable adjustments if the employee’s condition qualifies as a disability under the Equality Act 2010. If the individual’s physical or mental impairment is long-term and substantially affects their ability to carry out daily activities, employers must make reasonable changes to their working conditions. This could involve adjusting working hours, modifying duties, providing assistive equipment, or allowing for flexible work arrangements. Failing to implement reasonable adjustments where required could result in claims of unlawful disability discrimination.

Ultimately, returning to work after a long absence can be challenging for employees, both physically and mentally. Employers should approach the process with flexibility, sensitivity and a commitment to support, ensuring that the transition is manageable for the employee while also meeting operational needs.

 

Long term sickness absence dismissals

 

In theory, it can be possible to fairly dismiss an employee on long term sickness absence, where capability is one of the five fair reasons for dismissal set out under the Employment Rights Act 1996. However, to avoid allegations of unfair dismissal, or claims for unlawful disability discrimination, the employer must follow a fair capability dismissal process.

An absence review meeting should typically be held at the four-week mark, or at any other absence trigger stage as outlined in the employer’s sick leave policy. The purpose of this initial review is to assess the employee’s long-term prognosis and determine the next steps. However, an absence review at four weeks does not automatically justify dismissal; it is simply the starting point for evaluating whether ongoing support, adjustments or further medical assessments are necessary.

Before initiating a formal capability dismissal procedure, employers should usually conduct multiple absence review meetings over a reasonable period, particularly for cases involving serious or fluctuating health conditions. Dismissing an employee too soon without considering all relevant factors could lead to legal risks.

Employers must also obtain and carefully consider medical evidence, ideally from an occupational health specialist or another qualified medical professional, to determine whether the employee is permanently unable to carry out their job role, even with reasonable adjustments. Employers must be able to demonstrate not only that the dismissal procedure was fair but also that the decision to dismiss was reasonable in all the circumstances.

There is no legal maximum period for which an employee can be signed off sick, as this depends on their specific medical condition and prognosis for recovery. Likewise, there is no fixed minimum period before an employer can consider capability dismissal, as this depends on factors such as:

 

• The employee’s likelihood of recovery and estimated timeframe
• Whether the employee’s condition qualifies as a disability under the Equality Act 2010
• The impact of the absence on business operations
• The availability of resources to temporarily cover the employee’s role
• Whether the employer has explored reasonable adjustments to help the employee return

 

In all cases, dismissal should be an absolute last resort. Employers should demonstrate that every reasonable effort has been made to support the employee’s return to work before considering termination. If dismissal is unavoidable, it should be handled sensitively, following proper consultation, medical assessment and legal guidance, ensuring the process is legally compliant and fair.

 

Best practices for employers

 

By understanding how to fairly handle long term sickness absence, the employer should be able to show a system of reasonable responses, not least in the context of any allegations of unfairness if this ultimately results in the employee’s dismissal. Still, having an employee return to work is often the ideal scenario for both parties, where the following best practice tips can be key, not only to demonstrating fairness, but supporting an employee’s recovery:

 

• Have a written policy in place to manage long term sickness absence
• Ensure that any obligation to pay statutory or contractual sick pay is timely met
• Maintain regular contact with the employee and encourage them to keep in touch
• Ensure that the employee knows what to expect and what is expected of them
• Give the employee sufficient time to recover, including completion of any treatment plan
• Secure the opinion of an occupational health expert to assess the employee’s fitness in the context of their job role, with tailored advice on facilitating a return to work
• Seek independent and specialist medical opinion, where needed
• Only dismiss as an option of last resort and where reasonable adjustments cannot help.

 

 

Need assistance?

 

For specialist guidance managing long term sickness absence, including advice on the return to work and dismissals, contact us.

 

Long term sickness absence FAQs

 

How long does an employee have to be off work before it is considered long-term sickness absence?

Long-term sickness absence is generally defined as any period of continuous absence lasting four weeks or more. However, employers should refer to their own sickness absence policies for specific thresholds.

 

Do I have to keep paying an employee on long-term sickness absence?

Statutory Sick Pay (SSP) is payable for up to 28 weeks if the employee meets eligibility criteria. Some employers offer enhanced sick pay through contractual arrangements, so it’s important to check the terms outlined in employment contracts and company policies.

 

Can I dismiss an employee on long-term sick leave?

Dismissing an employee due to long-term illness must be handled carefully to avoid claims of unfair dismissal or discrimination. Employers must follow a fair process, including medical assessments, consultation, and consideration of reasonable adjustments before making any decision.

 

What are reasonable adjustments, and when do they apply?

Under the Equality Act 2010, employers must make reasonable adjustments for employees with a disability to help them stay in or return to work. This could include changes to working hours, role modifications, or providing additional support.

 

Do I need to request medical evidence for long-term sickness absence?

Employers can ask for fit notes (formerly sick notes) from a GP and may also arrange an occupational health assessment to understand the employee’s condition and their ability to return to work.

 

How should I support employees returning from long-term absence?

A structured return to work plan, including phased hours, workload adjustments, and regular check-ins, can help employees reintegrate successfully. Open communication and ongoing support are key to a smooth transition.

 

What happens if an employee refuses to engage in discussions about their absence?

If an employee does not respond to reasonable attempts to discuss their situation, employers should document all efforts made and consider seeking legal advice before taking further action. A fair and transparent approach is essential.

 

Can an employee go on long-term sickness absence during a disciplinary or redundancy process?

While an employee’s illness does not automatically stop a disciplinary or redundancy process, employers must proceed carefully, ensuring decisions are not discriminatory and that adjustments are made where necessary. Legal advice may be beneficial in such cases.

 

How can I reduce long-term sickness absence in my organisation?

Proactive absence management, early intervention, a supportive workplace culture, and access to occupational health or wellbeing services can all help reduce the likelihood of long-term absences.

 

Glossary

 

 

Term	Definition
Long-Term Sickness Absence	A period of continuous absence from work due to illness or injury lasting four weeks or more.
Statutory Sick Pay (SSP)	The minimum level of sick pay employers must provide by law for eligible employees, currently payable for up to 28 weeks.
Fit Note	A medical statement from a GP or healthcare professional confirming an employee’s fitness for work and suggesting any adjustments if needed. Formerly known as a sick note.
Occupational Health	A specialist medical service that assesses an employee’s health in relation to their job role, often advising on fitness to work and reasonable adjustments.
Reasonable Adjustments	Changes made to an employee’s work environment or duties to accommodate a disability or health condition, as required under the Equality Act 2010.
Equality Act 2010	UK legislation that protects individuals from discrimination, including those with disabilities requiring workplace adjustments.
Phased Return to Work	A structured approach where an employee gradually increases their working hours or duties after a period of long-term absence.
Unfair Dismissal	A legal claim an employee can make if they believe they were dismissed without a fair reason or proper process.
Discrimination Claim	A legal complaint made by an employee who believes they have been treated unfairly due to a protected characteristic, such as disability.
Sickness Absence Policy	A company document outlining procedures for reporting, managing, and supporting employees during periods of sick leave.
Occupational Health Referral	A formal request for an independent assessment of an employee’s health to guide absence management decisions.
Return-to-Work Interview	A discussion between employer and employee after an absence to review health status, support needs, and any required adjustments.
Capability Dismissal	A dismissal based on an employee’s inability to perform their role due to health-related reasons, requiring a fair and thorough process.
Medical Evidence	Documentation from a healthcare professional providing insight into an employee’s medical condition and fitness for work.
Early Intervention	Actions taken by an employer to address health concerns promptly, reducing the likelihood of long-term absence.