NHS sickness absence policy: triggers, reviews and formal stages

No national rule says how many days off sick will start a formal review in the NHS. The NHS Terms and Conditions of Service Handbook says contractual sick pay works “in accordance with local sickness absence procedures”, so the triggers, the meetings and the stages are written by your own trust or board. What is national is the way absence is described, the expectation of a conversation after every absence, and a handbook protection for people whose long-term absence is not reviewed in time.

Where the triggers come from

NHS Employers does not give a numerical trigger point. It says organisations may set more specific thresholds that show when a manager should start a formal review, offer counselling, make an occupational health referral or consider capability action. The measures it lists are total days absent in a set period, the number of absence episodes, a mix of days and spells, and patterns.

Managers are also told to look for patterns, such as absences that fall on a particular day, around bank holidays or near meetings and events. Acas takes the same line for employers generally: a trigger point should prompt a review and should not lead automatically to disciplinary action, and the employer should set it out clearly in an absence policy. Ask HR for your trust’s policy. The NHS sick pay guide covers the pay side.

Return to work conversations

NHS Employers calls return to work meetings one of the most effective ways to reduce short-term sickness absence and says they should follow every absence, even a single day. The manager welcomes you back, confirms the reason for the absence, and checks whether you are fit and what support you need.

Acas notes that a return to work chat is not a legal requirement and is often an informal talk between you and your manager. In the NHS it is normal practice, so expect one. If you are disabled, it is the point where reasonable adjustments should be looked at, and where a fit note or an occupational health referral may come up.

Short-term and long-term absence

The toolkit defines short-term sickness as an absence of less than 28 calendar days and long-term sickness absence as a continuous absence of more than 28 days. Another NHS Employers page cites NICE, which defines long-term absence as four or more weeks, so you may see slightly different wording in different documents. You need a fit note from the GP once you are off for more than seven consecutive days. Many trusts ask for self-certification from the first day and medical certification from the eighth.

For longer absences the toolkit says the line manager should arrange a meeting to review the situation, and that it should be made clear the meeting is not part of any disciplinary process. NHS Employers also says employers should consider early support at the latest within one month of someone going off sick. Employers may require you to attend an examination by a medical practitioner at any time, and you do not need to be off sick to be referred for one. The handbook says the employer meets the cost.

Formal stages

The toolkit does not define formal stages, so the steps in your trust’s policy are the ones that count. NHS Employers describes capability action as one stage employers may reach under their local thresholds, and lists phased return, temporary redeployment and adjustments as options to consider before dismissal.

The handbook allows an employer to end employment before the contractual sick pay period runs out. That is 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 own policies and procedures.

If you are invited to a formal meeting, ask what stage it is, who will attend and whether you can bring someone. Acas says a statutory right to be accompanied covers disciplinary meetings that could lead to a warning or other action. Its page does not say whether sickness or capability meetings are covered, so check your trust policy. A union rep or a colleague can often support you, and the union can tell you what your trust’s policy allows. The disciplinary procedures guide explains the Acas Code.

The 12-month final review and sick pay

The handbook links long-term absence to your sick pay. Where you have used up your sick pay allowance and your employer has not held a final review meeting for long-term absence, half pay can be reinstated.

With more than five years’ reckonable service, half pay is reinstated after 12 months of continuous sickness absence if your entitlement ran out before the final review took place. With less than five years, it is reinstated if the final review does not happen within 12 months of the start of your absence. Reinstatement runs until the final review meeting. It does not go back over any period of zero pay in the preceding 12 months, and it applies only where the delay is down to the employer. What happens when allowances end is covered in what happens when NHS sick pay runs out.

Absence linked to disability

Acas says an employer can decide that absence related to disability or pregnancy will not count towards review points, and that it should be flexible and sensitive to individual circumstances. It lists not counting some or all disability-related sickness absence towards trigger points as an example of a reasonable adjustment, along with raising the number of absences that trigger a review. NHS Employers says trigger indicators must comply with the Equality Act 2010 and that absence from a workplace injury or work-caused ill health should be left out of capability triggers. Our guide to reasonable adjustments at work explains how to ask.

Work-related injury can also affect pay. See NHS injury allowance.

Confidentiality and Scotland

NHS Employers describes sickness absence information as confidential. It should not go to the wider team unless you have clearly agreed.

NHS Scotland has its own Attendance Policy under Once for Scotland, which applies to all employees and workers, including bank, agency and sessional staff. The overview page lists the policy, a flowchart, guides for managers, employees and occupational health referrals, and a page on the right to be represented. Its triggers and stages were not set out on that page, so read the policy itself if you work for an NHS Scotland board.