Manager support and engagement with the return-to-work process has consistently been found to be the most effective way of reducing both long- and short-term sickness absence. Studies over recent years have consistently demonstrated this.

For long-term sickness absence, managers have a crucial role to play in maintaining regular contact with the employee concerned, and to initiate any intervention and support options that would expedite the employee’s return to work. As a manager knows and works closely with the employee, they are in a unique position to provide support.

An employee’s relationship with their manager is probably the most important relationship in the workplace. A supportive relationship between employees and their manager fosters better health and wellbeing outcomes following periods of long-term absence.

It is key that a manager is able to show empathy, understanding, concern and consideration for all employees in their team and maintain these relationships while the employee is out of the business with long-term absence. Once the employee returns to work, it’s vitally important that the manager is able to support their needs and help the employee adjust to being back at work.

The most common reasons why employees take a long-term leave of absence include mental ill health, musculoskeletal conditions and stress. Line managers have a role to play in supporting a return to work from any type of absence, but must be mindful of the considerations required for these specific types of absence.

The role of managers in employees’ mental health support is being recognised by more and more employers. According to employee wellbeing research carried out by REBA in 2020, 61% of employers offered mental health training for managers in 2020, compared with 48% in 2019. People managers are employers’ main support base, and equipping them with tools and knowledge to assist with mental health forms a first line of defence to foster early intervention.

This support, however, needs to go beyond mental health. The other main causes for long-term absences need to be tackled in the same way. For employees who have long-term absence due to musculoskeletal conditions, manager support is essential, making sure the employee has the right equipment and making the necessary adjustments to help them feel comfortable returning to work.

Stress has a huge impact on the workplace; in particular, over the last year we’ve seen levels of stress rise. It’s the manager’s role, as the employee returns from long-term absence, to support with their workload and reduce pressures.

People managers are employers’ main support base, and equipping them with tools and knowledge to assist with mental health forms a first line of defence to foster early intervention.

As we move out of the COVID-19 pandemic and understand the impact it has had on our workforce, it is important that managers are able to identify and support employees where they may be struggling. The role of the manager is crucial in supporting an effective return to work, benefitting the employee, their team and the organisation.

Alaana Woods, Bupa Health Clinics

Managing sickness absence is an inevitable part of a manager’s role. Most of the absences you encounter are likely to be short term; however, you may also have to manage long-term absences in your team. Research shows that employees are more likely to return to work safely and productively following long-term sickness absence if they are well supported during their absence and on their return, so how you manage these situations will make a difference to whether the individual returns effectively and sustainably to work.

Long-term absence is typically defined  as four weeks or more of continuous absence. According to the CIPD’s 2023 Health and Wellbeing at Work report, the most prevalent conditions responsible for long-term absence are:

• mental ill health (such as clinical depression and anxiety) 
• musculoskeletal conditions (such as neck strain and repetitive strain injury, including back pain)
• acute medical conditions (such as stroke, heart attack or cancer)
• stress

Although long COVID is not one of the most prevalent causes of long-term absence, it is a condition which may be more difficult to manage because the symptoms fluctuate over time and research is still ongoing. It is estimated that 10% of worldwide COVID-19 infections develop into long COVID. The CIPD has published a report on Working with long COVID, which includes recommendations on returning to and staying in work, as well as providing support.

This guide is designed to support you, as a manager, to manage instances of long-term absence in your team, drawing on the manager behaviours identified by CIPD research as important to support team health, wellbeing and engagement. In particular, the key behavioural areas which will assist you in managing this issue are:

Building and sustaining relationships, including showing empathy, concern and consideration for all employees, taking an interest in them as individuals and offering opportunities for people to speak to you one-to-one. Having good relationships with all your team members prior to any absence, maintaining that during an absence and continuing it when someone returns is important for managing absence in a way that is constructive for the absent/returning person and the rest of the team.

Providing knowledge, clarity and guidance, including giving advice and guidance if an absent/returning employee needs it. This may include discussing the phased return-to-work process and adjustments that can be made to the employee's work and then following through on any action you agree to take. This behavioural area also includes providing clarity about your own and the returning employee’s roles and your expectations of them on their return (refer to the section on How do I support a returning employee?).

Being open, fair and consistent, which will help you bring respect and openness, consistency, kindness and fairness to managing both the person who is absent and the rest of the team, even when you are under pressure yourself. This also includes being positive and appreciative of team members.

Exercise 1, Exercise 2, Exercise 4 and Exercise 5 offer advice on how to develop these behaviours.

Absence is a persistent problem for organisations and presents a major public health and economic concern. 

The following statistics illustrate the problem at a national level in the UK:

• In 2022, 185.6 million working days were lost due to sickness or injury in the UK, which is a new record high following a relatively stable decade prior to the pandemic. This follows a general worldwide trend of absence levels remaining high following the pandemic, rather than returning to pre-pandemic levels.
• The cost of absence to businesses is significant and is estimated at over £100bn per year in the UK and more than double that figure in the US.  
• In the UK, around 16,000 workers permanently withdraw from the labour market each year as a result of a workplace injury or work-related ill health, many of whom may have stayed in work with better support. This is a significant loss of talent, skills, knowledge and training investment to organisations. 

Within your team, long-term absence of one team member can have a knock-on impact on other team members, affecting their workload, motivation, engagement and wellbeing. As the line manager, you can help an employee have a fair and supported return to work and ensure that they are able to sustain their return. 

Work is good for health and can help individuals have a sense of meaning and purpose as well as meeting their financial needs. For someone who has been off sick for a long period, returning to work represents a return to a sense of normality and restores an individual’s identity, which can lead to an increase in self-respect, self-esteem, mental wellbeing and social inclusion.

A poorly managed return to work can contribute to relapse, further absence and, in some cases, that person stopping work altogether. Thus, a timely, well-supported and well-managed return to work process can make the difference between someone staying in and thriving at work, and exiting work. The impact extends beyond the individual to their colleagues, family and friends. 

A well-managed return to work also decreases the likelihood of the returning team member claiming unfair dismissal or discrimination, which often causes distress, cost and an increased workload for all involved. 

Everyone has a role to play in managing long-term absence. When we are unwell, we need other people to help us recover and return to work. No one can do it on their own. Although much of the direct responsibility for managing the return to work falls on managers, the IGLOO framework for sustainable return to work, developed by the University of Sheffield and Affinity Health at Work, emphasises that all parties have responsibilities. The framework outlines the different resources that can support a return to work at individual, group, line manager and organisation levels to support a sustainable return to work. As a line manager, you can play a role in ensuring that resources at all these levels are mobilised to support a member of your team who is returning to work.

• It is important that a returning employee prioritises self-care and takes appropriate responsibility to manage their condition. This includes developing an understanding of their own condition and how best to manage the symptoms. 
• Returning employees may need support to develop their ability to manage their condition effectively, for example in areas of self-management strategies, resilience and confidence in their ability to manage their work and health.

Related manager behaviour

As their manager, you may be in a position to help a team member develop these abilities. This relates to the behaviour area Supporting development, though the focus in this case is likely to be on individual capacity development, rather than career development. Look at Exercise 6 for advice on how to develop this area.

• Colleagues, as well as friends and family, play a vital role in supporting absent and returning employees. They help them to stay connected, retain their identity and feel valued by offering non-judgmental support and understanding. 
• Returning employees are best able to stay in and thrive at work when their colleagues support them by providing feedback on tasks, helping when completing challenging tasks and treating them as the person they were before their absence, while suporting any adjustments that may need to be made.
• As the returning employee’s line manager, you will need to agree with them what information about their absence and condition they would like to be shared, how their return to work plan will be communicated to colleagues and others and how they would like the team to support them. This helps to avoid unnecessary misunderstandings and uncertainty for the returning employee and their colleagues.

Related manager behaviour 

As a manager, you have a role in enabling this group-level support, wherever possible, to be provided in the workplace. This relates to the behaviour area Providing knowledge, clarity and guidance. Look at Exercise 4 for advice on how to develop this area

• Evidence shows that managers have a significant impact on successful return to work as well as employee retention: what you do and how you behave can affect whether the returner is able to return to and stay in work. 
• As a manager, you are:
  • often the employee’s first contact point 
  • responsible for the day-to-day management of the employee on their return 
  • key to providing access to work adjustments and the implementation of job modifications on return and in the long term.
• In addition, as a manager, your behaviour will have an important impact on the working environment to which your team member returns; for example, you can:
  • influence employees’ exposure to factors in the workplace that can increase or decrease the pressure on team members (for example work demands, control, and so on) and these are likely to be felt more keenly by those returning following a period away from the workplace
  • (often unintentionally) behave in ways that cause the employee stress or anxiety, particularly those who are vulnerable due to returning after a long period of sickness absence.

It is important to recognise that you do not necessarily need to be knowledgeable about the person’s health condition. It is more important to show good people management skills, including sensitivity, empathy and understanding for the individual. 

Related manager behaviour

All the manager behaviours identified by the CIPD research mentioned above will help you manage return to work and prevent and reduce stress for returning team members. The behavioural areas that are particularly important in this context are:

Building and sustaining relationships: see Exercise 5.

Being open, fair and consistent: see Exercise 1 and Exercise 2.

Providing knowledge, clarity and guidance: see Exercise 4.

• Organisational policies can help or hinder a return to work depending on how they are designed and implemented. Advice and guidance from HR professionals within your organisation can help make sure that processes and procedures are fair and are designed to prevent discrimination and that they are implemented correctly through providing training and support to managers.
• Work-focused counselling has been found to improve employees’ ability to return to and stay in work following absence. While counselling is typically seen as relevant for people with mental ill health, it can be useful for people with other conditions. Mental health can often deteriorate as a result of the symptoms or impact of illness; for instance, when there are changes in someone’s capacity and sense of identity, or when they are faced with the uncertainty of living with a new or fluctuating illness. If your organisation provides counselling, make sure you are aware of how to signpost employees in a sensitive manner. 
• Organisations may also provide access to services from other specialist professionals such as occupational health (medical professionals who specialise in health and work), who can generate an individualised recovery and rehabilitation plan and ensure relevant medical investigations have been performed. Other professionals such as vocational rehabilitation practitioners and occupational therapists can provide specialist support depending on the condition and employee’s needs. Again, you should be aware of how to signpost employees to these services where relevant. 

As a line manager, it is important that you understand your organisation’s policies and processes so that you can navigate them and help your team members do so too. Make sure that you understand the approach your organisation takes to long-term sickness absence and keep up-to-date with any changes to related policies and procedures. 

Related manager behaviour

You also need to ensure that you and your team members access the relevant organisational support. This relates closely to the element of seeking support for yourself and your team within the behaviour area Handling conflict and people management issues. Look at Exercise 3 for advice.

Return to work is often managed as if it is a one-off event, but in reality it is a (sometimes long and unpredictable) journey. How employees felt about their work before their absence, and how they are communicated with and whether they feel valued during their absence, all play a role in their return. How employees are managed during their initial return to work, as well as support provided on an ongoing basis, has a direct impact on their ability to stay in work. The following sections are the key steps to managing an effective return to work.

Every situation is different, but maintaining contact can help the absent employee feel valued and help you plan ahead. Furthermore, contact at this stage may help relieve the employee’s anxiety about returning to work, thereby addressing one of the barriers to return. 

• Agree how and when you will keep in touch. For example, ‘We would like to keep in touch while you are absent from work. Please let us know who you would like to be your point of contact (HR, manager, trusted colleague), how often (bi-weekly, monthly) and what mode (phone, email, text, letter) you prefer.’
• Remind the employee of any support available from the organisation (for example, employee assistance provider or occupational health service).
• Focus on them as an individual, not the work that they may have left unfinished. For example, ‘How are you? We are thinking of you,’ rather than, ‘We wondered where you had put X?’ or ‘This project has really been left in the lurch. We are struggling without you.’
• Ensure it is understood that they need to rest and recover. Guilt is a common experience in these situations and it can prevent people from focusing on their recovery. Make sure your employee knows they can do what they need to do to get better – this may be a walk in the park, lunch with a friend, a swim.
• Keep them in the loop about work issues if/when appropriate and address any related concerns they may have.

Taking time to prepare for the return to work can help to anticipate challenges and avoid unnecessary struggle. 

• Put yourself in the employee’s shoes: how would you feel if you had been seriously unwell and absent from the daily routines of work? Don't make assumptions about what will be best for your employee.
• Consider possible adjustments and job modifications that could be accommodated to help them. While there are some things we cannot change about work, there are some things that can be easily adjusted, at least in the short term, to support employees. Most adjustments cost little or nothing to implement; they just require some time to make a change in a process or task. Think creatively/outside the box and, involve the employee.
• Don't expect your team member to return to doing the entirety of the job from day one of their return. Explore how to provide them with a phased return to work. Think about how both the hours and the content of their job could be reduced on their initial return and then gradually increased over time as they adjust to being back in work. 
• Consider the impact on the team: how has the employee’s absence impacted the team and their workload? How can the requirements of the returning employee and the needs of the team be balanced? 
• Reflect on your management style and how you can best provide a supportive environment for the returning employee. 
• Seek help, guidance and training for yourself if you do not feel confident in managing the return-to-work process. 
• Support your team member in their planning of a phased and flexible return. Help them to:
  • Reflect on how their health might impact their ability to do their job, including considering the commute and breaks. Encourage them to think through their typical working day in their mind to identify any concerns that need further discussion or clarification. 
  • Write down what they feel able to do now, and what tasks or roles they may need to build confidence in (for example, a teacher may feel ready to teach a class and mark work, but may not feel ready to lead an assembly or manage playground duties). 
  • Let you know of any adjustments or job modifications that they feel might be helpful in their initial return. 
  • Think about whether they would benefit from developing or refreshing any skills to equip them to do their job after having been away from work. 
• Consider whether the individual requires medical clearance before returning to work, for example where work involves high exertion or stress or is a safety-critical role. Connect them to occupational health services or other allied health professionals to gain advice on appropriate work adjustments and job modifications.

When the employee is almost ready to return, you will need to arrange a return-to-work conversation and work together to agree a return-to-work plan:

• A return-to-work conversation provides the opportunity for you and the employee to explore together how the return to work can best be managed. Information on holding a return-to-work conversation is available on the Mental Health at Work website. Another approach, known as WARM, is detailed below. 
• Prepare in advance for this conversation and support the absent employee to do so too. You will have more productive conversations when you and your team member are prepared and have a clear framework for the discussion, so you both know what to cover and what to expect. 
• Ensure that expert advice has been sought where necessary before the return-to-work conversation (such as from an occupational health professional). 
• There is no set time for the conversation to happen. However, it may be best to agree the return-to-work plan with the employee prior to the plan's implementation. The conversation may differ from a return-to-work interview which normally happens after the employee has returned to work (see below). 
• During the conversation it is important to agree a return-to-work plan, including roles, responsibilities and timeframes for a phased return and a process for monitoring and review. This may be confirmed in writing, depending on your organisation’s procedure, to ensure all parties are clear regarding the plan, bearing in mind the need for flexibility. 
• Remember, for employees returning from long-term absence, particularly those with fluctuating conditions, plans may need to change. It is important all involved are encouraged to keep an open mind, and to remain flexible and patient. Refer to the CIPD’s Guidance for people professionals to support employees with long-term health conditions.

Return-to-work interviews are an important part of managing absence. Employees returning from long-term absence are likely to be nervous about returning to work and any potential change that may have taken place that may affect them or their role. A return-to-work interview is an opportunity to discuss any further treatment or adaptations to their work, working environment or working time. It is important that you keep the purpose of the interview focused on support to help the employee back to work. To help you focus on the tone of the return-to-work interview, the acronym ‘WARM’ is a good reminder of the approach to take, and it also helps you to follow a structured interview approach, enabling you to make notes as the interview progresses. 

• WELCOME the employee back to work. 
• ACQUIRE information about their health and how they’re feeling about their return. If an employee does not want to share details of their illness, reiterate that the interview is to establish the employee's current needs and if any adjustments made are suitable. However, you should respect their right to privacy, should they insist, while confirming your duty of care for their health and safety and that of others. Ask if they visited a doctor and check if they are taking medication which might affect their work (such as making them feel drowsy). 
• RESPONSIBILITY: remind the employee it is their responsibility to attend work regularly and to discuss how they’re feeling. Go through their sickness record if it is causing concern, but be careful not to turn the interview into a performance or disciplinary meeting. Keep your tone and pitch WARM but firm. 
• MOVE the conversation on to catching up with what the employee missed out on and refocusing them on their work. The return-to-work interview should end in a positive and affirmative manner. Remember to keep the notes of the return-to-work interview, as you will also need these for your records. Check with HR whether there is a form or document you need to complete regarding the return-to-work interview. 

• Welcome the employee back to work and ensure you or someone else are there to greet them on their first day. 
• Gradually increase the quantity and complexity of the work over time. Giving an employee too much work too soon can lead to relapse. 
• Monitor and review how the returner is managing their health as well as their work. Consider if further adjustments are required. 
• Monitor and review the impact of any work adjustments or modifications on the employee and the team.

• There can be a tendency to return to business as usual following an employee’s return, but continuing to provide support and care is important. Someone returning from long-term sickness absence may need ongoing support for some months following their return. 
• Discussions to review how the returner is managing their work and health may become less frequent over time, but it is important for you to check in on an ongoing basis. This will allow you to take early action to prevent work impacting on the employee’s health; or the employee’s health impacting on their own work or that of the team. 
• Some people return to full health and are able to return to full capacity at work. Some may have a fluctuating condition that means there are ongoing periods where their health and ability to work is compromised. There is increasing evidence that this is the case with long COVID, so you should be prepared to adjust plans accordingly. 
• Other people may never fully recover from long-term absence and their condition may be classified as a disability. Open communication and regular check-ins will help to prevent further absence, ensure that appropriate support is provided and, where necessary, address capability and work ability issues early. 
• Remain flexible and seek expert advice from HR, occupational health or other allied health professionals where needed. They can potentially provide useful information about organisational processes, health conditions, work adjustments, and sources of support; they can also help you discuss any concerns you may have. 

While these four steps seem quite simple, they are often overlooked. Too often absent employees report that there is no communication from anyone in the organisation, except for the policy and sick pay terms; and many return to their full workload only to struggle and relapse. Following these steps will give returning employees the best chance of returning to work safely and confidently.

Related manager behaviour 

To help you with all of these steps, you can draw on the behaviour areas Being open, fair and consistent, Providing knowledge, clarity and guidance, Building and sustaining relationships, and the element of seeking support for yourself and your team within the behaviour area Handling conflict and people management issues. Look at Exercises 1, 2, 3, 4 and 5 for advice on how to develop these areas.

Employers have a legal obligation to absent and returning employees. Responsibility for fulfilling this obligation will often fall on you as a line manager. An awareness of relevant legislation is important to avoid discrimination and ensure fair treatment of absent/returning employees. In particular, you need to be aware of: 

• The Equality Act 2010, which covers a number of different types of discrimination and applies to protected characteristics, such as disability. This includes not treating someone less favourably because of something connected to their disability and the responsibility to make reasonable adjustments to accommodate the needs of a person with disability. 
• The Health at Safety at Work Act 1974, which places a duty on employers to ensure, as far as is reasonably practicable, the health, safety and welfare of employees. 
• The Employment Rights Act 1996, which covers areas related to the employee’s contract and includes areas such as unfair dismissal and the termination of employment on ill-health grounds. 
• Fit notes and proof of absence: employees are required to give employers a fit note (this replaced the sick note) if they are off for more than seven days in a row (including non-working days). Fit notes are provided by a GP or, where employers agree, an allied health professional (such as a physiotherapist or occupational therapist).

You should seek advice from HR if you have any questions about what you’re expected to do with regards to these obligations

Sickness absence management and return to work 
NICE guidance on workplace health: long-term sickness absence and capability to work 
Acas guide on managing staff absence 
Access to Work  
IGLOo guide to sustainable return to work 
CIPD resources  

Gov.uk Support with employee health and disability

Fit note guidance 
www.gov.uk  

Menopause 
CIPD guide  

Work adjustments and job modifications 
For useful information and case studies on work adjustments: Rethink and Acas. Access to Work is a government organisation that provides free advice and support regarding work adjustments (including the provision of technology and equipment) to keep employees in work. 

Mental health conditions 
Mind
Samaritans
Mental Health at Work  
Good Thinking  
Every Mind Matters  
HSE guidance for work stress  
Rethink  
CIPD and Mind: People manager’s guide to mental health  

Respiratory conditions 
Asthma UK  
British Lung Foundation  

Musculoskeletal conditions (muscle and joint pain) 
Arthritis and Musculoskeletal Alliance  
Versus Arthritis  
BackCare  

Cancer 
Macmillan Cancer Support  
Cancer Research UK  

COVID-19 resources 
Society of Occupational Medicine COVID-19 return-to-work guide for recovering workers  
Society of Occupational Medicine COVID-19 return to work in the roadmap out of lockdown guide for workers, employers and health practitioners  
NICE COVID-19 rapid guideline: managing the effects of COVID-19  
NIHR Living with COVID19: A dynamic review of the evidence around ongoing COVID19 symptoms
NHS Your COVID Recovery  
CIPD COVID-19 Hub