Absence management processes can help people return to work after long-term sickness absence, but many do not go back. Among claimants of Employment and Support Allowance who had worked in the 12 months before their claim, 45% took a period of sickness absence before they left work.

Between 2010 and 2013 there were around 960,000 long-term sickness absences a year in Britain. Stress and acute conditions are responsible for many long-term absences, followed by mental ill health, musculoskeletal injuries and back pain. Employers spend around £9 billion a year on sick pay and associated costs.

Since the NICE guideline on managing workplace sickness absence was published in 2009, there have been several changes to policy and practice designed to help people return to work and reduce the social and economic burden of long-term sickness absence from the workplace. For example, the government consultation Health is everyone's business: proposals to reduce ill health-related job loss, encourages early action by employers to support employees with a disability or long-term condition to remain in work. Since 2009, there have also been changes to legislation, including the replacement of the Disability Discrimination Act (1995) by the Equality Act 2010. In light of these, and new evidence, it was decided to update this guideline.

The 'fit note'

In 2008, Working for a healthier tomorrow - work and health in Britain (Department for Work and Pensions) challenged the perception that it is inappropriate to be in work unless 100% fit. It shifted the emphasis from what a person cannot do to what they can do and led to a move from the 'sick' to the 'fit' note. A review in the government policy paper Improving lives: the future of work, health and disability suggests that there are too many fit notes stating 'not fit for work', when people 'may be fit for work' as long as appropriate workplace adjustments are made.

Occupational health support

The 2016 Occupational medical workforce crisis report by the All Parliamentary Group on Occupational Safety and Health noted that the recruitment of occupational health physicians has been declining since 2003. In 2011, only 38% of employees had access to occupational health services and this is less likely among smaller organisations. However, in 2019 over 99% of private sector organisations had fewer than 50 employees.

Support for mental ill health

In England, 19% of long-term sickness absence is attributed to mental ill health. In 2009, the Department for Work and Pensions added employment advisers to some Improving Access to Psychological Therapies (IAPT) services. In 2019 the NHS Long Term Plan identified stable employment as a major factor in maintaining good mental health and set out plans for investing in further employment support in IAPT.

Employee assistance programmes, many of which provide counselling, are increasingly being offered as an employee benefit. In 2017 the government's Thriving at work: a review of mental health and employers proposed core mental health standards that can be implemented by organisations of all sizes, and enhanced standards for larger organisations or those that are able to do more.

Who is covered

Everyone aged over 16 in full-time or part-time employment (paid or unpaid), who has had a long-term sickness absence (4 or more weeks) or recurring short-term sickness absences (less than 4 weeks each) and so may be at risk of moving from short- to long-term sickness absence. Everyone aged over 16 who is unemployed and gets benefits because of a long-term condition or disability that prevents them from working.