Long-term absence is usually defined as four weeks or more of continuous absence.  

The CIPD’s 2023 Health and Wellbeing at Work report emphasises the benefits of taking a preventative approach to absence by focussing on health and wellbeing. While absence levels have increased across all sectors, the causes remain the same. The most prevalent conditions responsible for long-term absence are:  

• mental ill health (such as clinical depression and anxiety)
• musculoskeletal conditions (such as neck strain and repetitive strain injury, including back pain)
• acute medical conditions (such as stroke, heart attack or cancer)
• stress.  

Having clear absence management policies and effectively managing a return to work will give the returning employee the best chance of getting back to work safely, confidently and in a timely way.

• Absence is a persistent problem for organisations and presents a major public health and economic concern. 
• In the UK in 2022, 185.6 million working days were lost due to sickness or injury, which is a new record high following a relatively stable decade prior to the pandemic. This follows a general worldwide trend of absence levels remaining high following the pandemic, rather than returning to pre-pandemic levels.   
• The cost of absence to businesses is significant and is estimated at over £100bn per year in the UK and more than double that figure in the US.  
• The sickness absence rate for those with long-term health conditions has increased to its highest rate since 2008. The number of working days lost to those with long-term sickness absence in the UK in 2022 was 104.9 million days.  
• In the UK, around 16,000 workers permanently withdraw from the labour market each year as a result of a workplace injury or work-related ill health. As at July 2023, those who were economically inactive due to sickness was also at a record high. Many of these workers may have stayed in work with better support. This is a significant loss of talent, skills, knowledge and training investment to organisations.

• Absence can often cause distress, increased costs and an increased workload for all parties involved. Support from HR can help to ensure a fair and organised return to work and decrease the likelihood of returning workers claiming unfair dismissal or discrimination.  
• Typically, the longer someone is off sick, the harder it can be for them to return. Having supportive and proactive absence management policies in place can help to retain valued employees. 
• Long-term absence of one team member can have a knock-on impact to other team members, affecting their workload, motivation, engagement and wellbeing. As HR is responsible for populating and resourcing jobs and roles throughout the organisation, support from HR can help mitigate these impacts.  

• Good work is good for health and can reduce health and economic inequalities.
• Returning to work represents a return to a sense of normality and restores an individual’s identity, which can lead to an increase in self-respect, self-esteem, mental wellbeing and social inclusion. 
• A poorly managed return to work can contribute to relapse, further absence and in some cases an exit from work.  
• A timely, well-supported and well-managed return-to-work process can make the difference between someone staying in and thriving at work and exiting work. 
• The impact extends beyond the individual to their colleagues, who may be taking on additional duties, and family and friends, who may be taking on additional home responsibilities or sharing the financial burden of sickness absence. 

The effective management of long-term sickness absence has benefits for everyone. This is why there should be shared responsibility for supporting returning employees. 

When we are unwell, we need other people to help us recover and return to work. No one can do it on their own. Although much of the direct responsibility for managing the return to work falls on managers, the IGLOO framework for sustainable return to work, developed by the University of Sheffield and Affinity Health at Work, emphasises that all parties involved have responsibilities. The framework outlines resources at the individual level, the group level, the manager level and the organisational level that can support a sustainable return to work.

• It is important that returning employees prioritise self-care and take appropriate responsibility to manage their condition. This includes developing an understanding of their own condition and how best to manage the symptoms of their condition. 
• Returning employees may need support to develop their ability to manage their condition effectively, for example in areas of self-management strategies, resilience and confidence in their ability to manage their work and health.

• Colleagues, as well as friends and family, play a vital role in supporting absent and returning employees. They help them to stay connected, retain their identity and feel valued when they offer non-judgemental support and understanding.
• Returning employees are best able to stay in and thrive at work when their colleagues support them through providing feedback on tasks, helping when completing challenging tasks and treating them as the person they were before their absence, while supporting any adjustments that may need to be made.
• Agree with the employee what information about their absence and condition they would like to be shared with colleagues and others, how their return-to-work plan will be communicated and how they would like the team to support them. This helps to avoid misunderstandings and uncertainty for the returning employee and their colleagues.

Evidence shows that managers have a significant impact on successful return to work; what they do and how they behave can affect whether the returner is able to return to and stay in work. This is because managers are:

• often the employee’s first contact point
• responsible for the day-to-day management of the employee on their return
• key to providing access to work adjustments and the implementation of job modifications on return and in the long term
• can influence employees’ exposure to workplace psychosocial hazards (for example work demands, control, and so on) and these are likely to be felt more keenly by those returning following a period away from the workplace
• can cause employee stress (or prevent additional stress) or anxiety, particularly in those who are vulnerable returning after a period of sickness absence.

The CIPD's guide for managers on supporting employees to return to work after long-term absence contains detailed guidance on the recommended process for managers to follow when facilitating an employee's return to work.

Organisational policies can help or hinder a return to work in the way that they are designed and implemented. Further information about absence measurement and management practices, including the main components of an absence management policy, can be found in our factsheet. 

Work-focused counselling has been found to improve an employee’s ability to return to and stay in work following absence. While counselling is typically seen as relevant for people with mental ill health, it can be useful for people with other conditions. Mental health can often deteriorate as a result of the symptoms or impact of illness, for instance when there are changes in capacity and a sense of identity, or when they are faced with the uncertainty of living with a new or fluctuating illness.

Advice and guidance from HR professionals can help make sure that processes and procedures are fair and are designed to prevent discrimination.

Organisations may also provide access to services from other specialist professionals: occupational health, medical professionals who specialise in health and work, can generate an individualised recovery and rehabilitation plan and can ensure relevant medical investigations have been performed. Other professionals such as vocational rehabilitation practitioners and occupational therapists can provide specialist support depending on the condition and employee’s needs.

• Ensuring individuals returning to work are able to prioritise self-care and have the skills and resources to self-manage their work and health.
• Supporting groups working with the returning employee to know what they can do to support and feel confident in doing so.
• Supporting managers to have the knowledge, skills and confidence to implement the policies and practices and behave in a way that will support returning employees effectively.
• Checking organisational policies and practices are designed and implemented in a way that fully supports returning employees and are flexible to accommodate the needs of those with fluctuating conditions.

Return to work is often managed as if it is a one-off event, but in reality, it is a (sometimes long and unpredictable) journey. How employees felt about their work before their absence, how they are communicated with and whether they feel valued during their absence, all play a role in their return. How employees are managed during their initial return to work, as well as support provided on an ongoing basis, has a direct impact on their ability to stay in work. Below we discuss the guiding principles to follow when navigating the key steps to managing an effective return to work:

1. Maintain communication during absence. 
2. Prepare for the return to work. 
3. Support the employee and manager during the immediate return. 
4. Support the employee and manager on an ongoing basis after the return.

Every situation is different, but maintaining contact can help the employee feel valued and help managers and employers plan ahead. 

• Early in the absence (at the time the fit note is issued is best) agree with the employee how and when you will keep in touch. For example, “We would like to keep in touch while you are absent from work. Please let us know who you would like to be your point of contact (HR, manager, trusted colleague), how often (bi-weekly, monthly) and what mode you prefer (phone, email, text, letter).” 
• Agree with the employee what information about their absence should be shared with others to avoid misunderstandings. Ensure confidentiality is respected. 
• Remind the employee of any support available from the organisation, such as employee assistance provider or occupational health service. 
• Focus on them as an individual, not the work that they may have left unfinished. For example, ‘”How are you? We are thinking of you,” rather than “We wondered where you had put X” or “This project has really been left in the lurch. We are struggling without you. When are you coming back?” 
• Ensure it is understood that they need to rest and recover. Guilt is a common experience in these situations and it can prevent people from focusing on their recovery. Make sure your employee knows they can do what they need to do to get better – this may be a walk in the park, lunch with a friend, a swim. 
• Ensure that the employee is aware of your absence policy and terms, including the pay they will receive and support they are entitled to, such as employee assistance provision. However, refer to the steps above first and don’t make this the main focus of contact. 

Taking time to prepare for the return to work can help to anticipate challenges and ensure the process is clear and fair. 

HR professionals should: 

• Support employees and managers in their planning of a phased and flexible return. 
• Consider whether the individual requires medical clearance before returning to work, for example where work involves high exertion or stress or is a safety-critical role. 
• Lack of line manager skills and confidence to support wellbeing was the top challenge identified by the CIPD Health and wellbeing at work survey report 2023. Check in with the manager and reflect on whether their management style will provide a supportive environment for the returning employee. If this is an area of concern, encourage managers to identify skills gaps themselves with self-assessment tools (such as the guide for managers) and provide them with guidance and training.
• Connect the employee (and manager where appropriate) to occupational health services or other allied health professionals to gain advice on appropriate work adjustments and job modifications. 
• Ensure that a return-to-work conversation is scheduled and that the manager and returning employee are aware of how best to prepare for the conversation and what to expect during the conversation. Offer support and guidance where needed. 

Managers should be encouraged to: 

• Put themselves in the employee’s shoes: encourage managers to think how they would feel if they had been seriously unwell and absent from the daily routines of work.  
• Consider the possible adjustments and job modifications that could be accommodated: what would these mean for the team/organisation? 
• Consider the impact on the team: how has the employee’s absence impacted the team and the team’s workload? How can the requirements of the returning employee and the needs of the team be balanced? 
• Reflect on their behaviour as a manager to ensure they manage in a way that will support the returning employee.  
• Seek help, guidance and training if they do not feel confident in managing the return-to-work process. 
• Most importantly, managers should aim to nurture trust-based relationships with employees because this will enable genuine and supportive conversations with the employee about health and return to work.  

Returning employees should be encouraged to: 

• Reflect on how their health might impact their ability to do their job, including a consideration of the commute and breaks. Encourage them to think through their typical working day to identify any concerns that need further discussion or clarification. 
• Write down what they feel able to do now, and what tasks or roles they may need to build confidence in (for example, a teacher may feel ready to teach a class and mark work but may not feel ready to lead an assembly or manage playground duties). 
• Consider adjustments or job modifications that they feel might be helpful in the initial return. 
• Think about whether they would benefit from developing or refreshing any skills to equip them to do their job having been away from work. 

Considering work adjustments, accommodations and job modifications 

While there are some things we cannot change about work, there are some things that can be easily adjusted, at least in the short term, to support employees. Most adjustments cost little or nothing to implement; they just require some time to make a change in a process or task. For example, an employee commuting to a city centre may find starting late morning to avoid the rush hour helpful, while a teacher may benefit from a recalibration of work with higher marking or administrative load and fewer student-facing activities. 

• Every individual and every situation is unique. Think creatively about what could work and be prepared to try different things until the best fit is found. Ensure the returning employee is able to contribute to these considerations.  
• Work adjustments can include changes to an employee’s work schedule, roles and responsibilities, work environment, policy changes, additional support or assistance, or redeployment. 
• Rethink and Acas have useful information and case studies on reasonable adjustments. Information on long-term absence and managing a return to work for people with a disability is also available in the CIPD’s joint manager guide with the DWP. What is considered reasonable depends on the circumstances. However, if, for example, costs are considered unreasonable for one adjustment, alternative more affordable and reasonable adjustments should be considered.  
• Access to Work is a UK Government organisation that provides free advice and support regarding work adjustments (including the provision of technology and equipment) to keep employees in work. 

Arrange a return-to-work conversation and agree a return-to-work plan 

• A return-to-work conversation provides the opportunity for employees and managers (or employers) to explore together how the return to work can best be managed. 
• Employees and managers will have more productive conversations when they are prepared and have a clear framework for the return-to-work conversation, so they know what to cover and what to expect. Managers may find the information on holding a return-to-work conversation on the Mental Health at Work website useful.  
• Ensure that expert advice has been sought where necessary before the return-to-work conversation (such as from an occupational health professional). 
• There is no set time for the conversation to happen. However, it may be best to agree the return-to-work plan with the employee prior to the plan’s implementation. The conversation may differ from a return-to-work interview which normally happens after the employee has returned to work. 
• During the conversation it is important to agree a return-to-work plan. The plan should include any changes to the employee’s roles and responsibilities, key work priorities, work adjustments, timeframes for the phased return, how it will be monitored, when it will be reviewed, and what action should be taken if any questions or concerns need to be discussed. The plan may be confirmed in writing to ensure all parties are clear regarding the plan. 
• However, remember plans may need to change as employees returning from long-term absence learn to manage their work and health, particularly those with fluctuating conditions. It is important that all involved are encouraged to keep an open mind, and to remain flexible and patient. 

• Welcome the employee back to work and ensure someone is there to greet them on their first day. 
• Ensure the quantity and complexity of the work is gradually increased over time. Giving an employee too much work too soon can lead to relapse. 
• Monitor and review how the returner is managing their health as well as their work. Consider if further adjustments are required. 
• Monitor and review the impact of any work adjustments or modifications on the manager and the team. 
• Remember the IGLOO framework for a sustainable return to work. The individual, their group (that is, colleagues), their line manager and the organisation’s professionals all have a role to play in helping employees to return to and stay in work. 

• Discussions to review how the returner is managing their work and health may become less frequent over time, but it is important to check in on an ongoing basis. This will allow the employee, manager and organisation to take early action to prevent work impacting on the employee’s health; or the employee’s health impacting on their own work or that of the team. 
  
  Some people return to full health and are able to return to full capacity at work. Some may have a fluctuating condition that means there are ongoing periods where their health and ability to work is compromised. There is increasing evidence that this is the case with long COVID, so employees and managers should be prepared to adjust plans accordingly. 

• Some people may never fully recover from long-term absence and their condition may be classified as a disability. Open communication and regular check-ins will help to prevent further absence, ensure that appropriate support is provided and, where necessary, address capability and work ability issues early. Health passports and/or a wellness action plan can be a helpful and empowering way for the employee to manage an ongoing condition or their mental wellbeing. 
• Remain flexible and seek expert advice from an occupational health or allied health professional where needed. 

While these four steps seem quite simple, they are often overlooked. Too often absent employees report that there is no communication from anyone in the organisation, except for the policy and sick pay terms, and many return to their full workload only to struggle and relapse. Following these steps will give returning employees the best chance of returning to work safely and confidently and will ensure that managers are equipped to support them through this process. 

Research shows that a compassionate absence management policy, access to work adjustments and a supportive manager can make the difference between a successful return and someone struggling and likely relapsing soon after return or even exiting the workplace. It helps to have a strong focus on communication and flexibility 

Ask yourself: do your absence management policies, processes and practices… 

Use compassionate language and convey support and care through your absence management processes? 

• For example, do your communications include genuine concern for the employee’s health and recovery, alongside information on the procedural aspects of absence and return policies and processes? This can include sharing information about the support available through the organisation or local resources (such as local charities, services). 
• Sometimes this can include providing an explanation for why formal procedures are being activated. For example, “Please could you provide us with a letter from your doctor or allied health professional as we need this in order to process your Sick Pay,” rather than “Please provide your doctor’s note within the next seven days.” 

Allow for an individualised approach to be effectively implemented? 

• For example, empower managers to make decisions and take action where it is in the best interests of the employee, the team, and the organisation, without seeking additional sign-off from senior management or HR. 
• Encourage job-crafting where possible so employees can work to their strengths. 

Make clear that work adjustments are available and explain how employees are supported to identify and access appropriate adjustments? 

• Many employees will benefit from early and supportive work adjustment (and in the UK it’s a legal requirement under the Equality Act 2010). Organisations should offer supportive adjustments for any employee with a health condition where possible. 

Accommodate fluctuating conditions? 

• For example, be clear about the terms of sick leave and pay. 
• Encourage an ongoing conversation between the line manager and the employee to assess how they are coping and any continuing impact of their condition on their ability to carry out their role. 
• Allow a slow, gradual return to work if required (for example, employees with long COVID may require a slow return over many months rather than weeks to prevent relapse). 
• Remove or adapt absence triggers and caps for workers with known long-term or chronic conditions. 
• Embed flexible working practices and time off for treatment and follow-up appointments where needed. 
• Allow a flexible process that supports the manager and employee in monitoring, reviewing and adapting as needed. For example, many employees with fluctuating health conditions find that what works one month may not work the next. 

Tell people what needs to be done AND how to do it? 

• Knowing what needs to be done is very different from knowing how to make it happen and feeling confident in doing it. 
• For example, many policies will state that there is a need to ‘have a return-to-work interview’, but limited information about how this can be done to achieve the best outcome. Guidance on when, where, how to prepare, and what to ask would help managers and employees hold better return-to-work conversations. More information on conducting return-to-work interviews is included in the manager guide on returning to work after long-term absence.  

Equip managers with the knowledge, skills, abilities and confidence to manage absence and returns? 

• A BITC survey found that only 8% of managers reported that they had received training to support return to work or implement work adjustments, and many are not confident that they are doing or saying the right thing. 
• According to the CIPD’s 2023 Health and Wellbeing at Work report only 30% of organisations provide guidance/training for line managers on how to support people to stay at work when managing health conditions.  

Build a culture of psychological safety, where good-quality work, good work conditions and open conversations are prioritised and psychological health and physical health are given equal standing? 

• There is increasing evidence that the employee’s work environment and work relationships prior to absence influence the employee’s experience of absence and return to work. 
• The Thriving at Work report outlines the economic and social benefits of taking action to protect psychological health and outlines the key actions organisations can take to create healthy workplaces. 
• Updating your organisation’s policies and practices to incorporate these considerations will give returning employees the best chance of returning to work. 
• More information on building trust and psychological safety is available in our evidence review.

NICE guidance on workplace health: long-term sickness absence and capability to work 
Acas guide on managing staff absence 
Access to Work 
IGLOo guide to sustainable return to work 
Fit note guidance

Gov.uk Support with employee health and disability

CIPD guide

Mind 
Samaritans 
Mental Health at Work 
Good Thinking 
Every Mind Matters 
HSE guidance for work stress 
Rethink 
CIPD and Mind: People manager’s guide to mental health 

Asthma UK 
British Lung Foundation 

Arthritis and Musculoskeletal Alliance 
Versus Arthritis 
BackCare 

Macmillan Cancer Support 
Cancer Research UK 

NICE COVID-19 rapid guideline: managing the effects of COVID-19

NIHR Living with COVID-19: A dynamic review of the evidence around ongoing COVID19 symptoms 

NHS Your COVID Recovery 

CIPD guidance on supporting employees working with long COVID

Acas (Advisory, Conciliation and Arbitration Service) 
BACP (British Association of Counselling and Psychotherapy)
BPS (British Psychological Society) 
CIPD (Chartered Institute of Personnel and Development) 
DRC (Disability Rights Commission) 
HSE (Health and Safety Executive) 
IOSH (Institution of Occupational Safety and Health) 
RCOT (Royal College of Occupational Therapists) 
SOM (Society of Occupational Medicine) 
TUC (Trades Union Congress) 
VRA (Vocational Rehabilitation Association)

HR teams are crucial in supporting an effective return to work after long-term absence, helping both the individual and the manager. Approximately 16,400 workers leave the UK workplace each year as a result of injury or illness, many of whom may have stayed in work with better support. For businesses, this is a huge loss of talent, as this employee will already have the skills, knowledge and training for that role and organisation.

Investing in and protecting employees is a significant responsibility for all businesses, and HR teams play an essential role.

While a manager should hold the closest relationship to the employee, from dealing with them on a day-to-day basis and keeping in contact with them while they are out of the business, the role of the HR team is to help the individual and their manager prepare an employee for their return to work, giving them all the information they need and ensuring a smooth and fair transition back to work.

The most common reasons why employees take a long-term leave of absence include mental ill health, musculoskeletal conditions and stress. Data from our Anytime HealthLine has shown a phenomenal rise in calls; at the start of the pandemic we saw a 250% increase in calls with people experiencing anxiety, stress and depression. These have remained steady throughout the pandemic, with people citing mental health as a key thing they were struggling with. Another trend is people being unable to access or worried about accessing primary care through their usual means. This means a lot of conditions have gone untreated, resulting in more employees needing time off to manage symptoms and later intervention.

For those working from home, the impact of not having a designated workspace has meant that more people are experiencing aches and pains. Our research1 shows that only one in three (33%) people have a dedicated workspace in their home, and as a result, homeworkers are using their sofas, kitchen chairs or even beds as makeshift workstations. This was mirrored by data from our Physioline, which saw a spike in calls between June and October with posture-related problems.

As we continue to deal with the aftermath of the COVID-19 pandemic and other factors such as the cost-of-living crisis, it’s important that HR teams are able to support employees where they may be struggling. 

From bereavement to long COVID, there are a range of factors that will affect long-term absence and extra considerations need to be taken to reflect this. Working with occupational health professionals to provide support is also hugely beneficial. Their role is to make sure that employees are healthy and safe while in work and manage any risks in the workplace that are likely to give rise to work-related ill health. As we move out of the pandemic, this support will be hugely valuable to HR teams.

There is no ‘one size fits all’ approach to returning to work after long-term absence and it’s key that the right support is in place to help with the transition.

Bupa Global & UK is one of the UK’s leading healthcare specialists, providing health insurance and operating dental practices, care homes, health clinics and London’s Cromwell Hospital.

Bupa Health Clinics has 45 centres across the UK offering customers health assessments, GP appointments and women’s health services. They also offer a wide range of remote appointments.

They also support companies to keep their employees well and in work, offering services such as employee assistance programmes, mental health onsite support and most recently, introducing COVID-19 support services.