Annual leave and sick leave in the NHS

Your annual leave keeps building up while you are off sick, however long the absence lasts. If you cannot take it, you may be able to carry some of it into the next leave year. For long-term sick leave, Acas says that is a maximum of 4 weeks’ holiday entitlement, which must be used within 18 months starting from the end of the leave year in which it built up.

Where carry-over comes from

The NHS Terms and Conditions of Service Handbook has no paragraph on carrying over leave lost to sickness, in Section 13 or Section 14 of version 63. The right to carry over comes from the Working Time Regulations, and your trust’s annual leave policy then sets out how it handles requests. Read that policy and ask HR which dates apply to you, as trusts run their leave years differently.

Acas does not define “long-term sick leave” on its carrying-over page, so no particular number of weeks is safe to assume. HR can tell you how your trust treats it, and which date your 18 months run from.

What builds up while you are off

Gov.uk says workers build up holiday entitlement while off work sick, and Acas says they accrue it as normal. Statutory leave is 5.6 weeks a year, capped at 28 days. That is the legal floor, and NHS contracts give more. Our guide to holiday entitlement covers the statutory rules in general.

Part-time staff get leave pro rata, and the handbook says part-timers’ public holidays are pro rata too, rounded up to the nearest half day and added to annual leave (13.6). If you work standard shifts other than 7.5 hours excluding meal breaks, leave is calculated on an hourly basis (13.5).

Section 13 figures

For full-time staff on Agenda for Change, Section 13 gives this basic leave, with general public holidays added on top.

NHS service	Annual leave	General public holidays
On appointment	27 days	8 days
After 5 years	29 days	8 days
After 10 years	33 days	8 days

From the 2021/2022 leave year, NHS Wales staff get one extra day on appointment. Trusts can agree locally to fold some or all public holidays into annual leave (13.2). Your contract shows which applies to you.

Bank holidays and sickness

Acas says paid days off for bank holidays still build up when someone is on sick leave, where bank holidays are part of their holiday entitlement. The handbook is stricter about the day itself: employees will not be entitled to an additional day off if sick on a statutory holiday (14.9 in England, 14.8 in Scotland and Northern Ireland). The entitlement keeps building, yet a bank holiday that falls during sickness does not become a replacement day. See bank holidays and work for how they work generally.

Taking holiday during sick leave

You can ask to use paid annual leave while you are off sick, and gov.uk says leave can be taken during sick leave. Your employer cannot make you. Because employers can have different rules on how they pay for holiday and sick leave, Acas advises agreeing in writing which applies where the two overlap.

Gov.uk says that if you switch holiday to sick leave, you are paid SSP, and the SSP counts towards holiday pay you have already received. If you are on NHS contractual sick pay, ask HR how your sick pay and any holiday pay would be treated, because the handbook does not spell that out. Our guide to NHS sick pay sets out the sick pay scale, and Statutory Sick Pay covers SSP.

Holiday pay itself is based on what you would have received had you been at work. The handbook (13.9) says this includes regularly paid supplements. For regular hours it uses the previous three months at work, or a locally agreed period. For irregular hours staff, since 6 April 2020 it uses the last 52 weeks, looking back no further than 104 weeks from the date the leave begins.

Falling sick on holiday

Report it to your employer at the time if you want the days treated as sick leave. Acas says you can then get SSP if you qualify, and keep those holiday days to use later.

Who can help

If your leave or pay is wrong, start with your manager or HR. A union rep can take it up, and Acas gives free advice on holiday and sick pay disputes.