Employee absence is a significant cost for many organisations, yet research suggests that only a minority of employers monitor that cost. Employees may need time off for a variety of reasons, from short-term sickness to longer-term health issues. An effective absence management framework should support the health needs of employees while providing clear and consistent guidance to avoid unauthorised absence or inappropriate use of sick pay schemes.

This factsheet takes a closer look at sickness absence, the reasons for it, and its implications for organisations. It offers guidance on how businesses can measure absence, what organisations should include in their absence policies, and practical advice on how to manage short- and long-term absence. Finally, it outlines the legal position when addressing unacceptable absence. 

Explore our viewpoint on employee health and wellbeing in more detail, along with actions for government and recommendations for employers. 

Read our recommendations for an effective sick pay system.

Effective absence management is about supporting employees with health issues to stay in or return to work. Developing effective return-to-work programmes and offering flexible working where possible form part of an effective attendance management strategy. Employers should remember that most absence is genuine and that employees often need support in their recovery from illness.

Employee absence is a significant cost to businesses. Our Health and wellbeing at work survey report has data on UK sickness absence causes and management. It also looks at current practices in managing absence and attendance.

Effective attendance management involves finding a balance between providing support to help employees with health conditions stay in and return to work, and taking consistent and firm action in the minority of cases where employees could try to take advantage of their organisation’s occupational sick pay scheme.

A focus on employee wellbeing and health promotion is good for people and their employers. It can help avoid non-genuine absence problems developing, and support people to balance work in a way that minimises the impact of their symptoms, where possible.

Types of absence

There are many reasons why people take time off work:

  • Short- or long-term sickness. 
  • Other authorised absences, including annual leave; maternity, paternity, adoption, or parental leave; time off for public or trade union duties, or to care for dependents; compassionate leave; educational leave.
  • Unauthorised absence or persistent lateness.

This factsheet focuses on sickness absence issues. For more information on authorised forms of absence, see our working hours and time off work factsheet.

In our 2021 Health and wellbeing at work survey, the main causes of short-term sickness absence were identified as:

  • Minor illness (includes colds/flu, stomach upsets, headaches and migraines).
  • Musculoskeletal injuries, including back pain.
  • COVID-19 (including confirmed cases, self-isolation, quarantine and shielding).
  • Stress.
  • Mental ill health (for example depression and anxiety).

The COVID-19 pandemic has had significant implications for people’s health and wellbeing, and how employers effectively manage sickness absence and pay. These are dealt with under separate headings below:

Managing Covid-19 absences

The UK government has issued a living with COVID-19 plan and from 1 April 2022 onwards all remaining COVID-19 restrictions are lifted. However, employers cannot behave as though the virus does not exist; it remains a life-threatening disease especially for the clinically vulnerable and unvaccinated. 

Many employers have already decided to maintain their existing COVID-19 practices in the medium term by advising against entry into the office where an employee has tested positive. Other measures include encouraging the use of mask wearing, ventilation, hand sanitisers and advising employees to take lateral flow tests. Employers will vary in how they manage risks with some taking a stricter approach than is envisaged under the government’s plan. It is worth bearing in mind that after 1 April 2022:

  • People with COVID-19 symptoms are no longer expressly advised to remain at home and can decide themselves whether to visit work and other places despite their symptoms, Employers do therefore need to plan whether they wish to prevent staff with symptoms attending the workplace.
  • In addition, free lateral flow testing will only be available after 1 April, including the over-75s and over-12s with weakened immune systems, social care workers and NHS staff. Other people will have to buy a test from pharmacists or other retailers.
  • Employers no longer must undertake COVID-19 separate risk assessments when assessing how to keep employees safe but should at least include this as a separate risk as part of their normal workplace risk assessments for the foreseeable future. 

Overall, the indications are that employers must take responsibility for implementing mitigations that are appropriate for their circumstances and find their own strategies for managing the risk of COVID-19 in workplaces. The government will replace the ‘Working Safely’ guidance with further public health guidance after consultation with businesses.  The government Plan so far states that employers must consider the needs of employees at greater risk from COVID-19, for example those whose immune systems trigger higher risk of serious illness. 

Employers should consider this guidance and their own wider health and safety duties to manage COVID-19 within their workforce. Relevant pre-existing duties include statutory, common law and contractual duties to take reasonable care for employees’ safety and provide a reasonably suitable working environment. As further variants remain possible employers should be flexible and be prepared to adapt quickly

Sick Pay

The government brought in a number of temporary changes to Statutory Sick Pay (SSP) during the pandemic which have now ended: 

The self-certification rules reverted to the usual 7-day timescale on 26 January 2022 (previously during coronavirus restrictions employees were not required to provide a fit note or medical evidence for the first 28 days of absence). 

  • SSP is no longer payable from the first day of COVID-19 related sickness absence, and has reverted back to being payable from day four. 
  • From 24 March employees are no longer eligible for SSP for self-isolation, unless they are unwell and off sick
  • The Statutory Sick Pay Rebate Scheme, which had been supporting employers with COVID-19 related absences, closed on 17 March 2022; employers could submit or amend claims by 24 March. 

The disruption caused by the pandemic to businesses in terms of working time has been incalculable in many ways. This impact, coupled with differences between organisations in which aspects of COVID-19-related absence, if any, they include in their absence rate (such as suspected or confirmed cases, self-isolation, quarantine, shielding), mean we were unable to provide a valid average sickness absence rate in our 2021 Health and wellbeing at work survey report. Nevertheless, it’s clear that COVID-19 has significantly contributed to absence levels in the majority of organisations. Just one in ten organisations report they haven’t suffered any absence due to COVID-19-related illness, quarantine, self-isolation or shielding. 

Find out more in our Responding to the coronavirus hub.

Accurate measurement and monitoring, identifying trends and exploring the underlying causes are key elements in effective absence management.

There are different ways of measuring time lost:

‘Lost time’ rate

This measure expresses the percentage of total time available which has been lost due to absence. It can be calculated separately for different departments to identify areas of concern.

Total absence (hours or days) in the period x 100
Possible total (hours or days) in the period

Frequency rate

This measure shows the average number of absences per employee expressed as a percentage. It gives no indication of the length of each absence period or any indication of employees who take more than one spell of absence.

No of spells of absence in the period x 100
No of employees

The calculation gives an individual frequency rate by counting the number of employees who take at least one spell of absence in the period, rather than the total number of spells of absence.

Bradford Factor

By measuring the number of spells of absence, the Bradford Factor identifies persistent short-term absence for individuals and is therefore a useful measure of the disruption caused by this type of absence. It's calculated using the formula:

S x S x D

where S = number of spells of absence in 52 weeks taken by an individual
and D = number of days of absence in 52 weeks taken by that individual.

For example:

10 one-day absences: 10 x 10 x 10 = 1,000
1 ten-day absence: 1 x 1 x 10 = 10

5 two-day absences: 5 x 5 x 10 = 250
2 five-day absences: 2 x 2 x 10 = 40

It should be noted that the use of Bradford Factor scoring can be controversial and care should be taken when using this as a guide to identify issues with an employee’s absence record. The Bradford Factor can unfairly penalise employees who fall ill and then come back to work as quickly as possible. The reasons for an employee taking frequent periods of absence should be discussed with the employee before any disciplinary action is taken. The Equality Act 2010 ensures that processes and procedures related to absence are adjusted for employees with a disability. A person’s disability may predispose them to regular short-term absences, and this could potentially lead to tribunal action if the employee was unfairly disciplined as a result of receiving a high Bradford Factor score.

Organisations should have a clear policy that supports their business objectives and culture, and explains the rights and obligations of employees when absent due to sickness. The law requires employers to provide staff with information on any terms and conditions relating to incapacity for work due to sickness or injury, including any provision for sick pay.

The policy should:

  • Provide details of contractual sick pay terms and their relationship with statutory sick pay.
  • Explain when and who employees should notify if they are not able to attend work.
  • Include when (after how many days) employees need to fill in a self-certificate form.
  • Contain details of when employees need to provide a fit note from their doctor.
  • Explain how any review or trigger point system used by the employer operates.
  • Say that the organisation reserves the right to require employees to attend an examination by a company doctor or occupational health professional and (with the individual's consent) to request a report from the employee’s doctor.
  • Include provisions for return-to-work interviews.
  • Explain that adjustments may be appropriate to assist the employee in returning to work as soon as is practicable.
  • Give guidance on absence during major or adverse events (for example, snow, pandemics or popular sporting events such as the Olympic Games or World Cup).

Fit notes

The Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) Regulations 2022 came into force on 6 April 2022, removing the requirement for fit notes to be signed in ink, enabling them to be issued digitally. 

When completing a fit note a doctor has the choice between two options:

  • Not fit for work.
  • May be fit for work.

If the doctor selects ‘may be fit for work’, one of the following four options should also be selected:

  • Phased return to work.
  • Amended duties.
  • Altered hours.
  • Workplace adaptations.

The doctor then has the option to make any additional comments.

Employers should arrange to meet with an employee who is assessed as ‘may be fit for work’ to discuss appropriate ways to manage the return-to-work process and support the employee by making adjustments.

Absence interventions

Effective interventions in managing short-term absence include:

  • Return-to-work interviews.
  • Providing leave for family circumstances.
  • Using of trigger mechanisms to review attendance.
  • Disciplinary procedures for unacceptable absence levels.
  • Changes to working patterns or environment, such as flexible working.
  • Employee assistance programme.
  • Training line managers in absence management.
  • Involving occupational health professionals.

Return-to-work interviews can help identify short-term absence problems at an early stage. They also provide managers with an opportunity to start a dialogue about any underlying issues which might be causing the absence.

Disciplinary procedures for unacceptable absence should make it clear to staff that unjustified absence will not be tolerated and that absence policies will be enforced. It’s important that any underlying health conditions are taken into account as part of this process.

Promoting a positive attendance culture, while emphasising that genuine sickness absence will be supported, can help to ensure illegitimate absence is not tolerated and attendance-focused initiatives are supported.

The role of line managers

Line managers have an important role to play, and our research shows more organisations now look to line managers to take primary responsibility for managing both short- and long-term absence. However, this expectation isn’t matched by a corresponding increase in the proportion training managers in absence-handling and/or providing them with tailored support. Managers need good communication skills and the ability to create a trusting culture where employees feel able to flag issues at an early stage. If line managers can spot the early warning signs of potential problems, employees can be given appropriate support before matters escalate.

Line managers need to be trained in:

  • The organisation’s sickness absence policies and procedures.
  • Their role in the attendance management process.
  • The way fit notes operate and how to act upon any advice given by the doctor.
  • The legal and disciplinary aspects of absence, including potential disability discrimination issues.
  • Maintaining absence record-keeping and understanding facts and figures on absence.
  • How the trigger points system operates (where applicable).
  • The role of occupational health services and proactive measures to support staff health and wellbeing.
  • Managing complex cases with the support of occupational health professionals and HR.
  • Developing return-to-work interview skills.
  • The skills needed to raise and discuss potential issues, including those related to more complex or sensitive problems.

Long-term absence is usually defined as lasting at least four weeks and can be challenging to manage as the longer someone is off sick, the harder it can be for them to return. Consequently, organisations need to keep in touch with absent employees in a sensitive way and have a formal return-to-work strategy for those returning after prolonged absence. Awareness of potential disability discrimination issues is also crucial, and organisations should have a disability leave policy that treats absence linked to someone’s disability as distinct from sickness absence.

The role of the line manager is vital in managing long-term absence, but other interventions are also important. These include:

  • Return-to-work interviews that are supportive and discuss ongoing adjustments where needed.
  • The role of occupational health services and proactive measures to support staff health and wellbeing.
  • A supportive case management approach, for example involving HR, occupational health services and the individual’s line manager.
  • Risk assessment to help return to work after long-term absence.
  • Changes to work patterns or environment, including flexible working.
  • Return-to-work interviews.

There are five typical elements in the recovery and return-to-work process:

  • Keeping in contact with unwell employees, in a sensitive manner, to help prevent them feeling isolated.
  • Planning and implementing workplace adjustments where necessary, in collaboration with the individual.
  • Accessing professional advice and treatment.
  • Planning and co-ordinating a return-to-work plan.
  • Regular evaluation with the employee about how they are adjusting to being back at work.

Our Manager support for return to work following long-term sickness absence guidance and checklist looks at the key behaviours managers need to support successful and lasting returns to work after long-term absence.

Used properly, the Acas Code of practice on disciplinary and grievance procedures, together with the employer’s own procedures, provide the main tools for addressing unacceptable absence. See more in our discipline and grievances at work factsheet.

Disability discrimination

Employers may need to make ‘reasonable adjustments’ to support employees who have a disability or health condition, as outlined in the disability discrimination provisions of the Equality Act 2010. Employers should be aware that physical and mental health conditions might be covered under this legislation. For more on how to address the issues, see our factsheets on disability, stress and mental health in the workplace.

Other legislation affecting absence management

If an employer requests a medical report from a health professional, it's essential to follow the Access to Medical Records Act 1988.

Employers must be careful not to breach the Data Protection Act 2018 (DPA) when they collect, use and store information about their employees’ absence. Details of an employee’s health, either physical or mental, are categorised as ‘sensitive personal data’ under the DPA. Read our data protection factsheet.

CIPD members can find out more on legal aspects from our Absence management law Q&As and our Data protection law Q&As.


Acas - Absence from work

Health and Safety Executive

GOV.UK - Statutory Sick Pay (SSP) - employer guide

Fit for Work

Workplace wellbeing tool

Books and reports

ASHBY, K. and MAHDON, M. (2010) Why do employees come to work when ill? : an investigation into sickness presence in the workplace. London: Work Foundation.

COOLE, C., HAMMOND, A. and WATSON, P. (2015) Getting the best from the fit note: investigating the use of the statement of fitness for work. Wigston: Institution of Occupational Safety and Health.

Journal articles

BURT, E. (2018) Britain’s presenteeism crisis. People Management (online). 24 May.

DORRINGTON, S. et al. (2018) Systematic review of fit note use for workers in the UK. Occupational and Environment Medicine. Vol 75, No 7, pp530-539. Reviewed in In a Nutshell, issue 91.

HOWLETT, E. (2021) Should HR be worried about long Covid? People Management (online). 28 January.

RYLEY, M. (2017) Managing ‘tricky’ absences from work. People Management (online). 4 December.

WHITEHOUSE, E. (2018) How to cure the long-term sickness headache. People Management (online). 13 December.

CIPD members can use our online journals to find articles from over 300 journal titles relevant to HR.

Members and People Management subscribers can see articles on the People Management website.

This factsheet was last updated by Rachel Suff: Senior Employee Relations Adviser, CIPD

Rachel informs CIPD policy thinking on health and wellbeing as well as employment relations. She has over 20 years’ experience in the employment and HR arena.

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