Managing Long-Term Sickness Absence

Long-term sickness absence should be managed actively rather than left indefinitely in the hope that the position resolves itself.

The objective is not to push an employee back to work before they are ready. It is to understand the situation properly: what the employee can and cannot currently do, what the medical evidence says, whether adjustments could support a return, how the absence is affecting the business and whether there is a realistic route back to sustainable work.

Good sickness and absence management therefore combines appropriate communication, reliable evidence, regular review and human judgement.

What is long-term sickness absence?

There is no single statutory period after which an employee’s absence automatically becomes “long-term” for employment-law purposes.

Acas commonly describes sick leave lasting more than four weeks as long-term, while government statistical definitions have also used four weeks or more. Four weeks can therefore be a useful practical point at which an employer moves from routine sickness administration towards more structured absence management.

It is not, however, a legal deadline. An absence lasting four weeks does not automatically justify formal action, and an employer does not have to wait a fixed number of months before doing anything.

The appropriate approach depends on the employee’s condition, prognosis, role, length and likely duration of absence, possible disability, operational impact and the steps already taken.

Step 1 — Keep appropriate contact

An employee being signed off work does not normally mean that all communication should stop.

Acas recommends that the employer and employee agree how they will keep in contact, including the method, frequency and person responsible. There is no standard rule requiring weekly, fortnightly or monthly calls.

The right level of contact depends on the circumstances.

Contact might cover:

• how the employee is;
• whether their medical position has changed;
• forthcoming fit notes or medical appointments;
• support available from the employer;
• whether a return to work is becoming possible;
• important workplace developments affecting their role.

The purpose should be to maintain communication and understand the position, not to repeatedly ask when the employee is coming back.

This is particularly important with mental-health absence. Some employees may find frequent telephone calls overwhelming, so email, less frequent contact or communication through an agreed person might be more appropriate.

If the employee is well enough, the employer can also ask them to attend an absence-review meeting. Where attendance is difficult, consider whether the discussion could take place remotely, at another location or in writing.

An employee saying they are too unwell to attend one meeting should not automatically bring the process to a halt indefinitely. Understand why they cannot participate, consider reasonable alternatives and, where necessary, obtain medical advice about their ability to engage in the process.

Step 2 — Understand the medical position

Employers need enough reliable information to make employment decisions. A succession of fit notes saying that somebody is “not fit for work” may confirm the absence, but it does not necessarily answer the questions the business needs answered.

Fit notes

An employee who is sick for more than seven consecutive days will normally need to provide a fit note.

A fit note may say that the employee is not fit for work or that they may be fit for work with changes.

Where changes are suggested, discuss them with the employee rather than treating the fit note as a final decision. If suitable changes cannot be agreed, the employee is treated as not fit for work for the period covered by the note.

A fit note is useful evidence, but it does not decide whether an eventual capability dismissal would be fair.

Occupational health

An occupational-health referral can be particularly useful where the absence is prolonged, the prognosis is uncertain, there may be a disability, adjustments need to be explored or the employer is approaching a significant decision.

Occupational health can translate medical information into practical workplace advice.

Useful questions may include:

• What are the employee’s current functional limitations?
• Is there a likely return-to-work date?
• Is a full return likely within a reasonable period?
• Would a phased return help?
• Are temporary or permanent changes to hours, duties or the workplace likely to help?
• Is the condition likely to meet the Equality Act 2010 definition of disability?
• Is the employee likely to be capable of returning to their substantive role?
• Are there restrictions affecting other suitable work?

Do not simply ask occupational health whether the employee “should be dismissed”. The employment decision belongs to the employer.

GP or specialist reports

An employer can also seek a report from a doctor who is or has been responsible for the employee’s clinical care.

The employee’s permission is required. Where the Access to Medical Reports Act 1988 applies, the employee must also be informed of their rights, including their ability to ask to see the report before it is supplied.

Ask only for information genuinely required to manage the employment position. An employer is not entitled to unrestricted access to an employee’s full medical records.

If the employee refuses consent, record that fact and explain that decisions may ultimately have to be made using the information reasonably available.

What if the evidence is unclear?

Ask follow-up questions.

A report stating that an employee “may return in the future” is of limited assistance if the employer needs to understand whether that means several weeks or an indefinite period.

Different medical opinions should also be assessed rather than simply selecting whichever one supports the employer’s preferred outcome. Consider the expertise of the person giving the opinion, how current the assessment is, their understanding of the employee’s actual role and whether further clarification could resolve the difference.

Step 3 — Hold regular absence reviews

Long-term absence should be reviewed at sensible intervals.

An absence-review meeting should establish where matters currently stand and what happens next. Depending on the stage of the case, this might include discussing:

• current health and treatment;
• updated medical evidence;
• likely timescales;
• possible adjustments;
• return-to-work options;
• the effect of the continuing absence;
• any alternative duties or roles;
• when the position will next be reviewed.

Keep an accurate written record.

The employee should understand if the process is moving from supportive absence management towards a formal ill-health capability process. Avoid allowing a formal capability decision to come as a surprise after months of apparently informal welfare conversations.

For organisations that want somebody experienced to chair or participate directly in difficult absence or capability meetings, Harrington Raine’s HR Consultancy & Meeting Support can provide additional hands-on assistance.

Step 4 — Consider disability and adjustments

Long-term illness and disability are not the same thing.

Under the Equality Act 2010, a person will generally be disabled if they have a physical or mental impairment that has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. “Long-term” generally means that the effect has lasted, or is likely to last, at least 12 months, although special rules apply to recurring, fluctuating and certain progressive conditions.

Cancer, HIV infection and multiple sclerosis receive particular statutory treatment and can amount to disability from diagnosis.

Employers should therefore consider disability before taking decisions about long-term sickness absence rather than waiting for the employee to use the word “disabled”.

Where the employer knows, or could reasonably be expected to know, that somebody is disabled and they are placed at a substantial disadvantage, the duty to make reasonable adjustments may arise.

Possible adjustments could include:

• altered working hours;
• a phased return;
• changes to duties or workload;
• workplace or equipment changes;
• home or hybrid working where appropriate;
• additional breaks;
• changes to absence-management trigger points;
• considering suitable alternative work.

The employee does not have to design the solution themselves. Employers should discuss possible adjustments and consider what could work.

Equally, reasonable adjustment does not mean every proposed adjustment must be accepted. What is reasonable depends on the circumstances, including effectiveness, practicality, cost, resources and the effect on the organisation and others.

If a suggested adjustment cannot reasonably be made, explain why and consider alternatives.

Disability also creates risks beyond the reasonable-adjustment duty. For example, taking unfavourable action because of disability-related absence can potentially amount to discrimination arising from disability unless the treatment can be objectively justified.

The right approach is therefore to understand the disability implications properly — not to conclude either that the employee must be dismissed or that the situation can never be brought to a conclusion.

Step 5 — Plan a return to work

Where a return is becoming realistic, turn the discussion into a practical plan.

That may include:

• the expected return date;
• hours during the initial period;
• temporary changes to work;
• duties the employee should avoid;
• workplace adjustments;
• support from their manager;
• review dates;
• how the arrangement will move towards a sustainable longer-term position.

A phased return does not have to last a fixed number of weeks. Its length should reflect the circumstances and can be reviewed as the employee progresses.

When the employee returns, an informal return-to-work meeting is good practice. It gives both sides an opportunity to check that the proposed arrangements remain appropriate.

A successful return is not simply getting somebody back through the door. The aim should be a return that can realistically be sustained.

What if there is no return date?

A difficult case often reaches the point where the employee remains unfit for work and nobody can give the employer a reliable return date.

There is no rule requiring the employer to wait six months, 12 months or until sick pay expires.

At this stage, assess the overall position.

Consider:

• how long the employee has already been absent;
• the latest prognosis;
• whether further medical evidence would materially help;
• whether a return is likely and, if so, when;
• what adjustments have been considered;
• whether suitable alternative work exists;
• the effect on colleagues, service delivery and costs;
• whether temporary cover can reasonably continue;
• the employee’s own views;
• whether the position should now move into a formal capability process.

The operational effect of an absence is relevant. Businesses are not required to pretend that prolonged uncertainty has no impact.

But operational pressure should form part of a reasoned assessment. It should not replace medical evidence or consultation.

What is ill-health capability?

Capability concerns whether an employee is able to do the work required of them. Under employment law, capability can include capability assessed by reference to health or another physical or mental quality.

An ill-health capability process is therefore different from a disciplinary process for misconduct.

The question is not whether the employee has done something wrong. It is whether they remain capable of fulfilling their role, whether a sustainable return is realistically achievable and whether anything reasonable could enable them to continue working.

A formal process will normally involve updated evidence, consultation with the employee, consideration of adjustments and alternatives, warnings about the possible outcome where appropriate, and a reasoned final decision.

Where the real concern is underperformance rather than prolonged sickness absence, our resource on how to manage poor performance and our performance management support service deal with that issue more directly.

Can an employee be dismissed while off sick?

Yes. Being on sick leave does not itself prevent dismissal.

Long-term ill health may potentially provide a fair capability reason for dismissal. The Employment Rights Act 1996 expressly includes health when defining capability.

What matters is whether the employer has acted reasonably in the circumstances.

Before an ill-health capability dismissal, an employer should normally be able to show that it has properly investigated the position, consulted the employee, obtained appropriate medical evidence, considered the likely duration of the problem, addressed disability and reasonable adjustments, considered suitable alternatives and taken the effect on the business into account.

Dismissal should not be based simply on:

• the employee having used all of their sick pay;
• an arbitrary length of absence;
• frustration that no definite return date has been provided;
• the existence of a disability;
• an assumption that no adjustment would work.

An appeal should normally be offered against a dismissal decision.

Length of service also matters, but it is not a substitute for proper process.

As at 9 September 2026, employees usually require two years’ continuous employment before they can claim ordinary unfair dismissal. For dismissals from 1 January 2027, that qualifying period will reduce to six months.

However, discrimination claims and various automatically unfair dismissal protections do not depend on the ordinary two-year qualifying period. Short service should therefore never be treated as permission to ignore disability, pregnancy or other protected rights.

Where dismissal is becoming a realistic option, obtaining specific dismissal advice for employers before the final decision can materially reduce avoidable risk.

Mental health and work-related stress

Mental-health conditions should be managed with the same seriousness as physical conditions.

They can also amount to a disability under the Equality Act 2010 where the relevant test is satisfied.

Communication may need particular care. Agree a level of contact that keeps the employee connected without making them feel pressured or overwhelmed.

If the employee says that their condition has been caused or aggravated by work, investigate that rather than treating it purely as an individual medical issue.

Employers also have health and safety duties in relation to work-related stress. Where there is an identified risk, the organisation should assess it and take reasonable steps to control it.

This could involve examining workload, working relationships, management behaviour, role clarity, working arrangements or organisational change.

Managing the employee’s absence and addressing the underlying workplace risk are related but separate tasks.

Pregnancy-related sickness

Pregnancy-related sickness requires separate treatment.

Employers should record pregnancy-related sickness separately from ordinary sickness absence and should not count it towards ordinary absence-review or trigger points.

Pregnancy and maternity also carry specific protection against discrimination and unfavourable treatment.

If pregnancy-related sickness occurs during the four weeks before the week the baby is due, statutory maternity leave may start automatically.

Do not mechanically apply an ordinary absence policy to pregnancy-related sickness without checking the specific maternity and discrimination position.

Common long-term absence mistakes

Waiting indefinitely

Doing nothing is not necessarily supportive. Lack of structured review can leave both the employer and employee uncertain about what happens next.

Contacting the employee too much — or not at all

Agree a sensible approach based on the circumstances.

Acting on stale medical evidence

An old report may not provide a reliable basis for a current decision.

Asking the wrong medical questions

Seek practical information about prognosis, functional ability, return-to-work prospects and adjustments rather than requesting unnecessary medical detail.

Treating occupational health as the decision-maker

Occupational health advises. The employer decides.

Ignoring possible disability

Consider Equality Act obligations before formal action.

Assuming every proposed adjustment is required

Adjustments must be considered properly. The legal requirement is to make adjustments that are reasonable in the circumstances.

Assuming adjustments must be permanent

Some changes may be temporary and reviewed as the employee recovers.

Ignoring the business impact

Operational difficulties are relevant. Record them and assess them alongside the medical and employment position.

Dismissing because sick pay has ended

The expiry of sick pay does not end the employment contract and does not by itself justify dismissal.

Deciding the outcome before consultation

A capability process should be genuine. Do not invite the employee to a meeting after the decision has effectively already been made.

Poor records

Keep clear records of contact, meetings, evidence, adjustments considered, decisions and reasons.

Health information is particularly sensitive. Restrict access to those who genuinely require it and manage it in accordance with your data-protection obligations.

Frequently asked questions

Does an employer have to wait a certain number of months before dismissing someone on long-term sick leave?

No. There is no universal minimum absence period. The relevant question is whether dismissal is reasonable in the individual circumstances after proper investigation, consultation and consideration of alternatives.

Does long-term sickness automatically mean the employee is disabled?

No. Disability has a specific legal definition. Some long-term health conditions will satisfy it and others will not. Employers should assess the position rather than assuming either way.

Does every long-term sick employee need an occupational-health referral?

No. Occupational health is not mandatory in every case. It is often useful where the medical or functional position needs clarification, particularly before significant capability decisions.

Can an employee refuse an occupational-health or medical assessment?

An employee can refuse to consent to medical information being obtained. The employer should explain why the information is being requested and what may happen if it cannot be obtained. It may ultimately have to make decisions using the evidence reasonably available.

Does an employee have to suggest their own reasonable adjustments?

No. It is sensible to ask what the employee believes would help, but the employer should also actively consider possible reasonable adjustments once the duty is engaged.

Do employers have to create a completely new job for an employee who cannot return to their old role?

Not necessarily. Employers should consider suitable existing alternatives and whether changes could reasonably enable the employee to work. The reasonable-adjustment duty does not simply require the business to invent any role requested regardless of the circumstances.

Can an employee return before they are completely recovered?

Yes. An employee does not necessarily have to be symptom-free before returning. A phased return or temporary adjustments may allow a safe and sustainable return while recovery continues.

Can an employee be dismissed if their condition is a disability?

Potentially, yes. Disability does not create absolute protection from dismissal. The employer must, however, satisfy its Equality Act obligations, including reasonable adjustments, and ensure that any decision is properly justified and reached fairly.

What if the employee will not engage with absence meetings?

Try to understand why and consider alternatives such as remote meetings, written representations or adjusted arrangements. If the employee still will not engage despite reasonable opportunities, the employer may eventually need to make a decision using the information available.

What if occupational health and the employee’s GP disagree?

Look at why. Their reports may address different questions or be based on different information. Clarification or further evidence may be appropriate before making an important decision.

Should the employer consider another role?

Yes, where there may be suitable work available and particularly where disability is involved. Whether redeployment is reasonable will depend on the circumstances and the roles actually available.

What records should an employer keep?

Keep appropriate records of absence, agreed contact, meetings, medical evidence, adjustments considered, return-to-work plans and formal decisions. Health information is special-category personal data and should only be collected, retained and accessed where there is a proper basis and genuine need.

Long-term absence cases can move from routine HR management into significant legal and commercial decisions surprisingly quickly. Employers who need further guidance can explore our wider HR & Employment Law resources or speak to Harrington Raine about the individual circumstances.