What happens when NHS sick pay runs out

The NHS sick pay scale tops out at six months on full pay and six months on half pay, and only after five years’ service. Once the scale is used up, contractual sick pay stops unless your employer extends it or half pay is reinstated. Statutory Sick Pay is paid for up to 28 weeks, and what happens to your job depends on your trust’s absence process.

Where the scale ends

Section 14 of the NHS Terms and Conditions of Service Handbook sets the allowance by length of service. Adding up each row, the most you can have in a rolling period is three months in your first year, four months in your second, eight months in your third, ten months in your fourth and fifth years, and twelve months after five years. The full table is in our guide to NHS sick pay.

The allowance does not reset for each illness. Your employer takes the paid sickness absence from the 12 months before your first day off and deducts it from what you would otherwise have. A long absence, or several shorter ones close together, can use up the scale well before you feel better. Service with other NHS employers normally counts, which is covered in reckonable service for NHS sick pay.

Statutory Sick Pay after the scale

NHS sick pay is meant to supplement SSP, and the handbook says SSP added to half pay must not come to more than full pay. Gov.uk says an employer’s scheme may pay more than SSP but not less, so SSP is the floor once the scale is exhausted, for as long as the 28 weeks last.

According to gov.uk, SSP is paid by your employer for up to 28 weeks, at up to £123.25 a week (or 80 per cent of your normal weekly earnings if that is lower). That is a long way below most NHS salaries, so the drop in income can be steep. The details are in our Statutory Sick Pay guide.

The SSP1 form

If your SSP will stop before your sickness does, your employer must give you form SSP1 on or before the start of the 23rd week of SSP. If it stops unexpectedly while you are still ill, they must send it within 7 days. You can use the form as evidence for a benefit claim, and gov.uk says you may be able to apply for Universal Credit or Employment and Support Allowance when SSP ends.

Benefits to look at

New Style Employment and Support Allowance (ESA) is for people under State Pension age whose health condition or disability limits how much they can work. You can apply up to 3 months before your SSP ends. You need to have paid enough National Insurance contributions, usually in the last 2 to 3 years.

Gov.uk also says you might be able to get Universal Credit at the same time as, or instead of, New Style ESA. If you receive both, Universal Credit is reduced by the amount of ESA. Eligibility for either depends on your circumstances, so the gov.uk pages, Citizens Advice or a union adviser can check yours.

Half pay can come back after 12 months

The handbook protects people whose long absence drags on because of the employer. Under paragraphs 14.10 to 14.12 of the England text, half pay is reinstated in two situations.

If you have more than five years’ reckonable service, it applies when your sick pay runs out before a final review meeting for long-term absence has taken place, after 12 months of continuous sickness absence. If you have less than five years’ service, it applies when your sick pay is used up and no final review has taken place within 12 months of the start of your absence.

Reinstated half pay carries on until the final review meeting is held. It is not backdated for any period of zero pay in the preceding 12 months, and it applies only where the delay is the employer’s. Paragraph numbers differ slightly in the Scotland and Northern Ireland text (14.9 to 14.11), and Wales has its own Section 14.

Extensions at the employer’s discretion

Paragraph 14.13 lets an employer extend sick pay on full or half pay beyond the scale. The handbook gives two examples: where a return to work is expected in the short term and an extension would help recovery, with particular consideration for staff who do not have full sick pay entitlements, and any other circumstance the employer thinks reasonable. You cannot demand an extension, but you can ask for one in writing and say why. A union rep or HR adviser can help you frame the request.

When employment ends

If your employment ends, paragraph 14.3 says entitlement to sick pay stops from your last day. Employers also have the option to end employment before the paid sick period is used up. Under 14.18 that comes only after investigation, consultation and consideration of other alternative posts, where there is no reasonable prospect of you returning, and subject to the trust’s sickness absence policy.

NHS Employers guidance lists options to try before capability action, including a phased return, temporary redeployment and adjustments. Our guide to phased returns in the NHS covers one of them. The employer can also require a medical examination at its own cost. The Acas Code of Practice gives a right to be accompanied by a colleague or union representative at disciplinary meetings that could lead to a warning or other action. The Acas page does not say whether ill-health or capability meetings are covered, so ask your union or HR whether you can bring someone. If you have a disability, reasonable adjustments may apply.

Ill-health retirement

If you cannot return to your NHS job permanently, the NHS Pension Scheme has two tiers of ill-health benefit, set by NHSBSA. Tier 1 applies if you are permanently unable to carry out the responsibilities of your role. Benefits are paid early and what you have built up is not reduced. Tier 2 needs the Tier 1 test plus being permanently incapable of regular employment of similar hours to your NHS job, full or part time. It pays the Tier 1 benefits plus two thirds (1995 and 2008 Sections) or one half (2015 Scheme) of the pension you would have built up to normal pension age.

You need a minimum of 2 years’ pension membership and must be under normal pension age. Ill health must be one of the reasons you are leaving work. Active members apply on form AW33E, and deferred members on form AW240. Our guide to ill-health retirement explains the process across public sector schemes, and the NHSBSA page has the full criteria.

Who can help

Start with HR and occupational health, and ask for the sickness absence policy in writing. A trade union rep (RCN, UNISON, Unite, GMB and others) can come to meetings and challenge delay, for example if no final review has been held. Acas gives free advice on absence and capability procedures. For benefits, use the gov.uk pages or Citizens Advice.