Developing effective return-to-work programmes, helpful workplace adjustments and offering flexible working form part of an effective attendance management strategy. Employers should remember that most absence is genuine and that employees often need recovery support even after their return to work from illness.

Our Health and wellbeing at work survey report has data on sickness absence causes and management. It also looks at current practices in managing absence and attendance.

A focus on employee wellbeing and health promotion benefits people and their employers. It can help prevent ill health, and support people to balance work whilst minimising the impact of any ill health symptoms, where possible.

This factsheet focuses on sickness absence. For information on other forms of absence, see our working hours and time off work factsheet.

Sickness absence is defined by Acas as any period of time when an employee is unable to work due to illness, injury, or other medical reason. Accurate measurement and monitoring, identifying trends and exploring the underlying causes are key in effective absence management. The different measurement methods include:

‘Lost time’ rate - expresses the percentage of total time lost due to absence. Separate calculations for different departments can identify areas of concern.

Total absence (hours or days) in the period x 100
Possible total (hours or days) in the period

Frequency rate - shows the average number of absences per employee expressed as a percentage. It doesn’t indicate the length of each absence or employees who take more than one spell of absence.

No of spells of absence in the period x 100
No of employees

Bradford Factor - measures the number of spells of absence and identifies persistent short-term absence. This is therefore a useful measure of the disruption caused by this type of absence. It's calculated using the formula:

S x S x D

where S = number of spells of absence in 52 weeks;

and D = number of days of absence in 52 weeks (taken by that individual).

For example:

10 one-day absences: 10 x 10 x 10 = 1,000

1 ten-day absence: 1 x 1 x 10 = 10

5 two-day absences: 5 x 5 x 10 = 250

2 five-day absences: 2 x 2 x 10 = 40

However, the Bradford Factor can unfairly penalise employees who have a disability or health condition. The Equality Act 2010 means that processes and procedures related to absence should be adjusted for employees with a disability, as a person’s disability or long-term health condition may predispose them to regular short-term absences. However, organisations should be supportive for genuine health and wellbeing issues that aren’t necessarily covered by legislation such as long COVID, menopause transition, pregnancy or baby loss and infertility issues. 

Policies should clearly explain the rights and obligations of employees when absent due to sickness. Employers must inform staff of terms and conditions relating to sickness or injury, including sick pay. For example, policies should:

• Provide details of contractual sick pay terms and their relationship with statutory sick pay.
• Explain when and who employees should notify if they are not able to attend work.
• Include provisions for return-to-work interviews.

Fit notes

When completing a fit note a doctor (or health care professional) can choose:

• Not fit for work.
• May be fit for work.

Employers should arrange to meet with an employee who is assessed as ‘may be fit for work’ to discuss appropriate management of the return-to-work process and support the employee by making adjustments.

Amending regulations came into force on 6 April 2022 enabling fit notes to be issued digitally as well as in ink, as was previously standard. From July 2022, fit notes can be issued by nurses, occupational therapists, pharmacists and physiotherapists as well as doctors.

Absence interventions

Return-to-work interviews can help early identification of short-term absence. They also enable managers to start dialogue about any underlying issues causing the absence.

Promoting a positive attendance culture, while emphasising that genuine sickness absence will be supported, can help to ensure non-genuine absence is not tolerated.

The role of line managers

Line managers play a key role in managing absence, but they need training and guidance in absence-handling and good communication skills. A trusting culture enables employees to flag issues at an early stage. If line managers can spot early warning signs, employees can be given appropriate support before matters escalate.

Long-term absence is usually defined as lasting four weeks or more and can be challenging to manage; the longer someone is off sick, the harder it can be for them to return. Organisations need to sensitively keep in touch with absent employees and have formal return-to-work strategies for those returning after prolonged absence. Awareness of potential disability discrimination is crucial, and as well as a sickness absence policy, organisations should have a disability leave policy that treats absence linked to disability as distinct from sickness absence.

Line managers are key to managing long-term absence, ideally as part of a case management approach with HR and occupational health, but other important interventions include:

• Keeping sensitively in contact with unwell employees, to help prevent them feeling isolated.
• Reasonable adjustments (where agreed) including flexible working and return to work plans.

Our ‘Manager support for return to work following long-term sickness absence’ guidance and checklist looks at the key behaviours managers need to support successful and lasting returns to work after long-term absence.

Contacts

Acas - Holiday, sickness and leave

Health and Safety Executive

GOV.UK - Statutory Sick Pay (SSP) - employer guide

GOV.UK - Support with employee health and disability

GOV.UK - Fit note

Workplace wellbeing tool

Books and reports

Ashby, K. and Mahdon, M. (2010) Why do employees come to work when ill?: an investigation into sickness presence in the workplace. London: Work Foundation.

Cooper, C.L. and Lu, L. (eds.) (2018) The Cambridge companion to presenteeism at work. Cambridge: The University Press. 

Journal articles

Aarstad, J. and Kvitastein, O.A. (2023) Effect of long-term absenteeism on the operating revenues, productivity, and employment of enterprises. Administrative Sciences. Vol  13, No 6, June. 10pp. 

Dorrington, S. et al. (2018) Systematic review of fit note use for workers in the UK. Occupational and Environment Medicine. Vol 75, No 7, pp530-539. Reviewed in Bitesize research.

Jackson, I. (2024) Jobs including work from home have lower sickness absence, research finds. People Management (online). 8 January.

Klasen, S.H., Van Amelsvoort, L.G.P.M. and Houkes, I. (2021) Exploring expected and perceived facilitators and barriers of an indicated prevention strategy to prevent future long-term sickness absence; a qualitative study among employers and employees. BMC Public Health. Vol 21, No 1, pp1-15. 

Lancman, S. and Barroso, B.I.L. (2021) Mental health: professional rehabilitation and the return to work – a systematic review. Work. Vol 69, No 2, pp439-448.

Mathisen, J., Nguyen, T.L. and Jensen, J.H. (2022) Impact of hypothetical improvements in the psychosocial work environment on sickness absence rates: a simulation study. European Journal of Public Health. Vol 32, No 5, October, pp716-722.

Ryley, M. (2017) Managing ‘tricky’ absences from work. People Management (online). 4 December.

Stynen, D., Houkes, I. and Van Amelsvoort, L. (2023) Opportunities, barriers and facilitators of an indicated prevention strategy to prevent future long-term sickness absence in SMEs: a qualitative study. Work. Vol 74, No 3, pp871-889.

Thonon, F., Godon-Rensonnet, A.S. and Perozziello, A. (2023) Return on investment of workplace-based prevention interventions: a systematic review. European Journal of Public Health. Vol 33, No 4, August, pp612-618.

Varela-Mato, V., Blake, H. and Yarker, J. (2023) Using intervention mapping to develop evidence-based toolkits that support workers on long-term sick leave and their managers. BMC Health Services Research. Vol 23, No 1, pp1-10.

Whitehouse, E. (2018) How to cure the long-term sickness headache. People Management (online). 13 December.

CIPD members can use our online journals to find articles from over 300 journal titles relevant to HR.

Members and People Management subscribers can see articles on the People Management website.