Supporting employees during long-term sickness

The scale of workplace absence is hard to ignore. Absence levels have risen significantly in recent years, and with new statutory sick pay reforms now in force from April 2026, pressure on employers has increased. Businesses without a structured approach to managing long-term sickness face a growing set of risks, such as productivity loss and difficulty maintaining quality standards.

What the evidence shows, however, is that early, genuine support doesn’t just improve the chances of a successful return to work, it builds trust with employees. 

Summary

• Over 2.8 million working-age people in the UK are economically inactive due to long-term sickness [1], with mental health now the leading driver of absences lasting four weeks or more [2]. 
• Average sickness absence has risen to 9.4 days per employee per year - up from 5.8 days before the pandemic [2]. 
• Since 6 April 2026, statutory sick pay has been payable from day one of sickness, the three-day waiting period has been removed, and the lower earnings limit no longer applies for SSP qualifying purposes, extending eligibility to an estimated 1.3 million additional workers [4]. 
• Employers have a legal duty under the Equality Act 2010 to make reasonable adjustments where a long-term health condition qualifies as a disability. No formal diagnosis is required [5]. 
• The government's Keep Britain Working Review (November 2025) calls for a shared-responsibility model between employers, employees, and health services, with early intervention at the centre of its philosophy [6]. 
• Practical steps - regular contact, occupational health referrals, phased returns, flexible working, and clear documentation - cost relatively little but significantly improve outcomes.

The scale of the problem

Office for National Statistics data shows that 2.81 million people of working age were economically inactive due to long-term sickness in the August to October 2025 period [1] - nearly three quarters of a million more than the equivalent period before the pandemic. Long-term sickness has been the single largest reason for economic inactivity since late 2021, overtaking caring responsibilities and early retirement. 

Within the workplace itself, the picture is equally stark. The CIPD's Health and Wellbeing at Work report (2025) found that employees took an average of 9.4 sick days per year in 2024, up from 7.8 in 2023 and 5.8 pre-pandemic [2]. Mental health was cited as the leading cause of long-term absence by 41% of employers surveyed, followed by musculoskeletal conditions (31%) and other long-term health conditions (30%). Across the NHS workforce in England, anxiety, stress, and depression alone accounted for around 31% of all sickness absence and over 708,000 full-time equivalent days lost in a single month [3]. Heavy workloads were identified as the top driver of stress-related absence, with 64% of organisations reporting some stress-related sickness in the previous year. Mentor's own advisers see this reflected in call volumes: around one in five enquiries from clients relate to managing employee absence due to illness, with mental health conditions featuring prominently. 

For small businesses, even a single long-term absence can create significant operational strain. Covering the absent employee's workload - whether through temporary staff, overtime, or redistribution - adds cost whilst the business continues to pay statutory or occupational sick pay. Employee replacement costs range from 50% to 200% of annual salary, making staff retention through effective absence management far more cost-effective than allowing skilled employees to leave the workforce. 

Statutory sick pay changes from April 2026

The Employment Rights Act 2025 introduces the most substantial reforms to statutory sick pay (SSP) since 1983, with changes taking effect from 6 April 2026 [4]. Three changes are particularly significant for employers managing long-term sickness. 

First, the three-day waiting period is abolished. SSP is payable from the first qualifying day of sickness absence, increasing cost exposure on short absences and removing the previous buffer that filtered out brief illnesses [4]. 

Second, the lower earnings limit has been removed entirely for purposes of SSP. Employees no longer need to earn a minimum weekly amount to qualify, extending SSP eligibility to an estimated 1.3 million additional workers - predominantly part-time, lower-paid, and variable-hours staff [4]. 

Third, the SSP calculation method changes. Rather than a flat weekly rate alone, SSP is paid at the lower of £123.25 per week (2026 SSP rate) or 80% of the employee's average weekly earnings, calculated over the eight-week reference period before the absence began [7]. For employees already receiving SSP before 6 April 2026, transitional protections apply: they continue receiving the uprated flat rate for the duration of their continuous absence [4]. 

SSP at a glance: before and after April 2026

These reforms have immediate practical implications. Payroll systems need updating, sickness absence policies require revision to remove references to waiting days and earnings thresholds, and any occupational sick pay schemes that mirror SSP rules should be reviewed for alignment. 

Important to note: an employee's statutory sick pay running out does not end the employment relationship, nor does it give the employer an automatic right to dismiss. The contract of employment continues, and the employer's duty of care - including the obligation to consider reasonable adjustments - remains in force regardless of whether SSP is still being paid. 

The Keep Britain Working Review

In November 2025, the government published the Keep Britain Working Review, led by Sir Charlie Mayfield [6]. The review estimates the cost of health-related economic inactivity to the state at £212 billion per year and identifies three persistent problems: a culture of fear around discussing health at work, a lack of effective support systems at the interface between work and health, and structural barriers faced by disabled people. 

At its centre is the concept of a "Healthy Working Lifecycle" - a framework covering prevention, early intervention, stay-in-work support, return-to-work planning, and long-term retention. The review recommends that employers adopt a Workplace Health Provision service: an external, non-clinical case management model designed to guide managers and employees through structured absence and return-to-work plans [6]. 

The review also highlights that fit notes, as currently designed, often serve to take the employer out of the loop rather than encouraging collaboration. Reform of the fit note system forms part of the longer-term recommendations, though systemic changes are expected to take several years to implement. 

For employers, the immediate takeaway is clear: early, consistent engagement with absent employees - rather than waiting for a fit note or SSP expiry - produces better outcomes for both parties. 

Practical steps for managing long-term sickness

Maintain regular contact

One of the most common mistakes employers make during long-term absence is losing contact with the employee. Uncertainty about what to say, concern about intruding, or assumptions that the employee will "come back when they're ready" often lead to prolonged silence that damages the employment relationship and delays return. 

Agree a communication plan early. Regular welfare contact with the absent employee is part of the employer's duty of care as well as effective absence management. This ensures the business has up-to-date information about the absence and allows both parties to discuss next steps. The employer should set a reasonable frequency and format for contact with the employee, typically through scheduled welfare calls or meetings. Employee preferences should be considered, though they should not override the employer's need for regular, meaningful communication. Only where an employee is too unwell to engage directly should written alternatives be considered, and even then the arrangement should be kept under review.

Seek occupational health input early

Where an absence extends beyond a few weeks or involves a condition likely to be long-term, referring the employee for an occupational health assessment can provide expert, objective guidance. An occupational health professional can advise on likely recovery timescales, recommend reasonable adjustments, and assess whether the employee is fit for modified duties. 

Access to Work grants, funded by the UK government, may cover the cost of workplace assessments, specialist equipment, support workers, and coaching for employees with disabilities or long-term health conditions. Grants of up to £69,260 per year may be available and do not require repayment [8]. 

Plan phased returns and reasonable adjustments

A phased return - where the employee gradually increases their hours or responsibilities over a defined period - is one of the most effective tools for supporting return to work after a long period of absence. It reduces the psychological burden of returning to full capacity immediately and allows both employer and employee to assess how the phased return is progressing. 

Reasonable adjustments might include flexible working hours, modified duties, changes to the physical workspace, additional breaks, or temporary reallocation of certain tasks. Many effective adjustments cost nothing: written instructions rather than verbal briefings, predictable scheduling, regular one-to-one check-ins, or a quieter workstation. 

Where the employee's condition constitutes a disability under the Equality Act 2010, the duty to make reasonable adjustments is a legal requirement, not an optional gesture of goodwill [5]. 

Document everything

Thorough documentation protects both parties. Record all welfare meetings, agreed actions, medical advice received, adjustments made, and communications. If the situation eventually progresses to a capability dismissal, an employment tribunal will assess whether the employer followed a fair process - and gaps in documentation are difficult to defend. 

Keep notes factual. Where formal meetings take place, provide the employee with a written summary and an opportunity to comment or correct the record. 

Long-term absence management: a step-by-step checklist

• Week 1: Make initial welfare contact. Confirm the employee understands their sick pay entitlement and absence reporting requirements. Record the expected return date if known. 
• Weeks 2-4: Maintain regular contact at the agreed frequency. If the absence is likely to extend beyond four weeks, consider an occupational health referral. Review whether any immediate adjustments could facilitate an earlier return. 
• Month 2: Obtain occupational health advice on the employee’s condition, recommended adjustments, and fitness for modified duties. Hold a formal welfare meeting to discuss findings and agree next steps. Begin exploring phased return options. 
• Month 3+: Review progress against the return-to-work plan. If no return is foreseeable, consider whether alternative roles exist within the organisation. Seek legal or specialist HR advice before starting any formal capability process. 
• Throughout: Document every meeting, decision, and communication. Ensure the employee has access to any employee assistance programme or mental health support available.

The legal framework

Equality Act 2010

A person has a disability under the Equality Act 2010 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 [5]. "Long-term" means lasting, or likely to last, at least 12 months. Crucially, no formal diagnosis is required - tribunals assess impact on daily activities if no treatment was given and recurring conditions may qualify if the effects are substantial when active. 

Once an employer knows, or ought reasonably to know, that an employee may have a disability, the duty to make reasonable adjustments applies [9]. Failure to comply can result in significant financial penalties. The average disability discrimination award in 2023/24 was £44,483 [10], with a maximum recorded penalty of £4.6 million in a 2024 case involving ADHD and PTSD [11]. 

Dismissal as a last resort

If, after exhausting reasonable adjustments, alternative work and return-to-work options, the employee remains unable to perform their role, dismissal on grounds of capability may be lawful - provided the employer can demonstrate a fair and thorough process and can demonstrate the reason why dismissal is reasonable in the circumstances. This includes obtaining up-to-date medical evidence, considering alternative roles within the organisation, consulting with the employee at every stage, and following the ACAS Code of Practice on disciplinary and grievance procedures. Tribunals can increase compensation awards by up to 25% where employers unreasonably fail to follow the Code [12]. 

Every situation is different. An employee with cancer, for example, is automatically considered disabled from the point of diagnosis under the Equality Act 2010, regardless of the severity of symptoms. Seeking specialist HR or legal advice before initiating any dismissal process is essential. 

Building a proactive absence culture

The most effective approach to long-term sickness is one that begins well before the absence does. Organisations that invest in employee wellbeing initiatives, train managers to have early and supportive conversations about health, and build flexibility into working patterns tend to experience shorter absences and higher return rates. The CIPD's 2025 data supports this: 39% of organisations that invest in wellbeing initiatives report reduced sickness absence, alongside improvements in engagement and performance. Where employers trained managers to support staff with mental ill health, 73% reported that managers felt confident having sensitive conversations and signposting to support, compared with 57% where no training was provided. [2]

Small, consistent actions - a welfare call in the first week of absence, a written return-to-work plan with clear milestones - signal to employees that they are valued and that the organisation is invested in their recovery. These measures also build the kind of documented, supportive process that withstands legal scrutiny if the situation deteriorates. 

Long-term sickness will remain a feature of working life. The employers who manage it well are not those who avoid it, but those who respond to it with structure, empathy, and a genuine commitment to keeping people in work. 

This article is intended for informational purposes only and does not constitute legal advice. The information is accurate at the time of writing but may be subject to change. For advice specific to your situation, please consult a qualified professional. 

[1] ONS, Economic inactivity by reason (seasonally adjusted), August-October 2025. 

[2] CIPD/Simplyhealth, Health and Wellbeing at Work Report, September 2025. 

[3] NHS England Digital, NHS Sickness Absence Rates, 2025. 

[4] ACAS, Statutory Sick Pay, updated for Employment Rights Act 2025 changes (effective 6 April 2026). 

[5] ACAS, What disability means by law. 

[6] GOV.UK, Keep Britain Working Review: Final Report, November 2025. 

[7] GOV.UK, Rates and Thresholds for Employers 2026 to 2027. 

[8] GOV.UK, Access to Work Factsheet for Customers. 

[9] ACAS, Reasonable Adjustments: Disability at Work. 

[10] GOV.UK, Tribunals Statistics Quarterly: April to June 2024.

[11] BBC, Hammersmith and Fulham Council boss speaks out over £4.6m pay-out, March 2024.

[12] MFMAC, 25% ACAS Code Uplifts Endorsed - Employment Tribunal Guidance, 2024.