Research and analysis

Employee Health, Work, and Sickness Absence: Qualitative Research

Published 20 January 2026

Executive summary

This report outlines the findings from qualitative interviews with 75 employees, who took sickness absences from work and/or had long-term health conditions. The aim of this qualitative research was to understand employees’ experience of sickness absence and their general experience of managing health and wellbeing at work.  

Qualitative participants were recruited from the respondents of the 2024 to 2025 employee and self-employed survey who had agreed to be re-contacted.  

Please note that this research sampled those who were in employment; it does not include those who had dropped out of work or had completely left the labour market (for example, due to health conditions)^{[footnote 1]}.

Key findings include:

• Long and short-term sickness absences occurred due to a variety of reasons which often overlapped, such as mental health conditions, physical health conditions, and personal or family circumstances.  

• Employer contact during long-term sickness absences was typically from line managers, with positive experiences linked to regular, proactive, open and empathetic communications. More negative experiences were often linked to very high or very limited contact.  

• Short-term sickness absences often involved light-touch or no contact, which participants commonly found appropriate due to the short-term nature of their absence.  

• Support provided to those who experienced a long-term sickness absence often did not go beyond the contact they were receiving from their line manager.  

• Existence and application of sickness policies and procedures were varied and those with the most positive experience felt their employer had straightforward policies which managers were able to apply flexibly. Those with less positive experiences reported that policies were unclear or inconsistently applied. 

• The most common reason for returning after a long-term sickness absence was an improvement in health, however, participants commonly reported not feeling fully recovered on their return. Some participants who experienced long-term sicknesses absences were unable to return to work quickly. The most common reason was because they did not have desired adjustments in place. 

• Most who had experienced a long-term sickness absence reported having a conversation about adjustments with their employer. Those who had experienced a short-term sickness absence had a more mixed experience. 

• Many of those who had a long or short-term sickness absence reported some form of adjustment was put in place for their return (although this was less amongst shorter term absences). The most commonly reported adjustments were reduced hours and changes to workloads or tasks. Most of those with adjustments in place reported they would not have been able to return without them. 

• Most of those who had taken long-term sickness absence had returned to the same employer. However, a few respondents reported moving to new employers due to their previous role, sector or occupation not fitting well with their health needs, or due to them feeling their employer had been unsupportive. 

• Most felt they had received the right amount of support at work, to help them manage their long-term health condition or general health and wellbeing. However, those that did not would have valued a more supportive and tailored line management approach and offers of flexible working arrangements.

Glossary of terms

Key term	Explanation
Access to Work	The Access to Work scheme is a publicly funded programme that aims to help employees and the self-employed get, or stay in, work if they have a physical or mental health condition or disability. Support offered through the programme can include a grant to help pay for specialist equipment and assistive software in the workplace, or support with travel costs if public transport cannot be used.
Cognitive health conditions	Refers to long-term health conditions related to cognitive health, including learning difficulties (such as dyslexia and Attention Deficit Hyperactivity Disorder (ADHD)) and autism spectrum disorder.
Child Benefit	Child Benefit is a social security benefit for individuals responsible for bringing up a child who is under 16, or under 20 and in approved education or training. Individuals in receipt of Child Benefit receive an allowance for each child and National Insurance credits which count towards their pension.
Employee Assistance Programme (EAP)	An EAP is an employer-provided benefit offering confidential and professional support for employees facing personal or work-related issues that may impact their wellbeing and job performance. They typically include confidential counselling, wellbeing advice, and practical support.
Employment and Support Allowance (ESA)	ESA is a social security benefit for individuals unable to work due to a health condition or disability. It is based on National Insurance contributions and provides financial assistance and additional support to help individuals meet their basic needs and access necessary services while they are unable to work.
Fit note	Fit notes are used to assess whether someone ‘may be fit for work’ or ‘not fit for work’. Also known as sick notes, fit notes are usually administered by a General Practitioner (GP), although they may also be issued by another type of healthcare professional. If someone is assessed as ‘may be fit for work’, the healthcare professional will detail what adjustments might better help them return to work.
Long-term sickness absence	Long-term sickness absence is a term used to denote all employees that experienced a sickness absence of at least 4 continuous weeks in the last 12 months.
Main health condition	Where employees have multiple long-term health conditions, their main health condition is the one that has the greatest impact on their day-to-day life. Employees were recruited to the relevant health condition quota based on this information.
Mental health conditions	Refers to long-term health conditions related to mental health, including depression, anxiety, and stress.
Musculoskeletal (MSK) conditions	Refers to long-term health conditions related to Musculoskeletal (MSK) conditions, including problems with arms or hands, problems with legs or feet, and problems with neck or back.
Occupational Health (OH) services	OH services provide advisory and support services to employees, employers and the self-employed, such as providing advice on workplace adjustments, developing written return to work plans, conducting risk assessments in the workplace, promoting healthy eating and exercise, providing physiotherapy treatment, or providing counselling sessions to support return to work.
Occupational or Company Sick Pay (OSP)	OSP is a scheme provided by employers to offer enhanced financial support to employees who are unable to work due to illness.
Other physical health conditions	Refers to physical long-term health conditions not related to musculoskeletal (MSK) conditions, including cancer, epilepsy, and chest or breathing problems, for example.
Participant	An individual that took part in the in-depth qualitative interviews, all of whom were employees.
Personal Independence Payment (PIP)	PIP is a social security benefit that provides a financial contribution to help individuals with long-term disabilities and/or health conditions to meet the additional costs related to their condition. PIP is based on the needs arising from a long-term health condition or disability rather than the condition or disability itself. PIP is not means-tested, is tax free and can be paid in addition to most other benefits received. Assessments for PIP involve a thorough evaluation of the individual’s ability to perform various tasks and activities.
Psychologically safe working environment	A psychologically safe working environment means employees feel safe to raise issues and concerns with their line manager/employer without fear of repercussions. This type of working environment contributes to team effectiveness and performance.
Short-term sickness absence	Short-term sickness absence is a term used to denote all employees that had experienced a combined absence of 2 or more weeks (but less than 4 weeks cumulatively) within the last 12 months.
Statutory Sick Pay (SSP)	By law employers must pay SSP to employees if they meet the eligibility criteria. Statutory Sick Pay is £118.75 per week. It can be paid for up to 28 weeks. If an employee is eligible, they are entitled to Statutory Sick Pay for the days they would have worked, except for the first 3.[footnote 2]
Universal Credit (UC)	UC is a welfare benefit that supports individuals and families with their living costs, including those who have health conditions or disabilities. It is designed to replace several existing benefits, making the application and payment process more streamlined. For individuals with health conditions, Universal Credit considers their specific needs, and they may receive additional support or allowances based on their circumstances.

Abbreviations

Key term	Explanation
DHSC	Department of Health and Social Care
DWP	Department of Work and Pensions
ESA	Employment and Support Allowance
GP	General Practitioner
HR	Human Resources
JWHD	Joint Work and Health Directorate
MSK	Musculoskeletal
NHS	National Health Service
OH	Occupational Health
OSP	Occupational Sick Pay
PIP	Personal Independence Payment
SSP	Statutory Sick Pay
UC	Universal Credit

Summary

Introduction

This report outlines the findings from a qualitative study with employees who took sickness absences from work and/or had long-term health conditions. The aim of this qualitative research was to understand employees’ experience of sickness absence and their general experience of managing health and wellbeing at work.

Qualitative participants were recruited from the respondents of the 2024 to 2025 employee and self-employed survey who had agreed to be re-contacted. The qualitative research focussed on employees, rather than self-employed workers, to further explore how employers support individuals to manage their health and wellbeing at work.

In-depth interviews were undertaken with 75 employees, most of whom had experienced a long-term or short-term sickness absence within the last 12 months. Participants were employed in a range of organisations, varying by size and sector. More commonly they worked for large organisations (with 250 or more employees).

Please note that this research sampled those who were in employment; it does not include those who had dropped out of work or had completely left the labour market (for example, due to health conditions).^{[footnote 3]}

General experience at work

Many participants expressed very positive overall feelings about work, describing an empathetic and open-minded workplace culture. For these participants, their line managers provided tailored, trusted, one-on-one support, their wider management encouraged a culture of prioritising employees health and wellbeing, and their colleagues often shared tasks to accommodate different physical abilities. Among the few who had negative perceptions of workplace culture, this was linked to a lack empathy and care from line managers, wider management, or colleagues. Generally, this in turn led to a failure of their employer and workplace to accommodate participants’ general needs, and their health and wellbeing needs, effectively. Occupational Health (OH) was used by some participants for support with both mental and physical conditions. However, participants highlighted that this support was only useful if recommendations were actioned by employers, and noted that this was not always the case.

For those with long-term health conditions, the level of flexibility and autonomy in their roles were key in dictating the ease with which they were able to manage their health conditions or disabilities at work. Most but not all participants disclosed their health condition to employers, usually via their line manager. Disclosures were typically driven by a need to set up a specific support or adaptation at work. Barriers to disclosure, particularly in relation to disclosures of neurodivergence, often included concerns about it negatively impacting their treatment at work (for instance, by peers, line managers and wider management). Despite this, most participants were positive about the idea of having a health and wellbeing adjustment conversation^{[footnote 4]} with their employer once employed. They viewed it as a valuable opportunity for employees to disclose sensitive information that may otherwise get missed during inductions.

Support to manage health and wellbeing at work

Participants who were experiencing impacts related to their long-term health condition had often received some support from their employer, or had adjustments put in place to help manage their general wellbeing or long-term health condition at work. These included flexibilities such as working from home or flexible hours, which allowed participants to better tailor their working patterns around their health conditions, medical appointments, or caring responsibilities. This flexibility was particularly useful for taking breaks when the impact of health conditions or medication became too much to keep working. Participants also mentioned the provision of wellbeing initiatives, including wellbeing emails or newsletters, dedicated members of staff to provide support, wellbeing areas, and Employee Assistance Programmes. The extent to which participants found these wellbeing initiatives useful in managing their general wellbeing or long-term health condition at work varied.

Participants also mentioned support they had received outside of their employment which helped them manage their general wellbeing or long-term health condition. This included support from medical professionals (through the NHS and privately), and more informally from family and peers. Often participants felt that the support they had in place was sufficient, and nothing further from their employer was required. However, specific groups of participants were more likely to feel they required further support from their employer. These groups included those who felt that their management was currently not supportive, and those who had minimal flexibility in terms of working hours or arrangements.

Experience of sickness absence

Participants reported experiencing absences from work for a range of often overlapping reasons. These broadly fell into mental health, physical health, and personal or family circumstances. The length of sickness absences varied considerably between participants and was not necessarily the same across participants with the same condition(s). Where participants experienced a long-term sickness absence, they usually recalled receiving a ‘not fit to work’ note written by their General Practitioner (GP) and signing them off for a specified time.

During a sickness absence, participants who had a short-term sickness absence found light-touch or informal contact from their employer sufficient. Most participants who experienced a long-term absence did receive some contact from their employer, usually from their line manager. When participants had a good relationship with their line manager, this level of contact reassured them that they were valued and that their wellbeing was being prioritised. Regular contact sometimes felt stressful and pressurising to participants when they had a less positive relationship with their line manager. A small number of participants who experienced a long-term sickness absence reported a lack of regular contact from their employer, which led them to feeling neglected and unimportant.

Sick pay was another key factor impacting participants’ experience of sickness absence. Many participants received their full pay during the time that they were off sick, through Occupational Sick pay (OSP). This alleviated financial worries and allowed them to ensure they had fully recovered before returning to work. For those whose OSP was going to be reduced or stopped (due to the length of their sickness absence), or the small number of participants who received only Statutory Sick pay (SSP), the reduction in income led to concerns about financial difficulty. Those receiving SSP often relied heavily on financial support received outside of SSP such as Universal Credit.

Existence and application of sickness policies and procedures were varied. Those with positive experiences recalled straightforward sickness absence policies and procedures which managers were able to apply flexibly. Those with less positive experiences reported that policies were unclear or inconsistently applied.

Returning to work

The most common reason for returning after long-term sickness absence was an improvement in health, but participants frequently reported not feeling fully recovered on their return to work. For many participants who experienced a long-term sickness absence, the decision to return to work was based on additional ‘pull’ factors including work benefiting their mental health or wellbeing, having adjustments agreed (especially a phased return or being able to work from home), or general offers of flexibility and support from employers. Some ‘push’ factors drove decisions to return to work for those with a short-term and long-term sickness absence, including pressure relating to finances, concern about workload or the effect their absence might be having on colleagues or the organisation, and more rarely, fears of negative consequences (for example, impact on progression or employment security).

Most participants who had taken a long-term sickness absence had, at minimum, a conversation with their employer about returning, though these could be informal and did not necessarily result in return to work plans. Many participants who had a long-term sickness absence reported adjustments were put in place for their return to work, with reduced hours or changes to working arrangements (for example workloads or tasks) being the most common. OH recommendations were often a critical factor in participants being able to return to work in a timely way that met their needs. Supportive and flexible management was also key to employees returning to work in a timely way, as they felt comfortable that if adjustments did not work, or their health worsened, they could change the arrangement. This was supported by regular meetings to review arrangements and employee health. Return to work conversations were less common for those who had taken a short-term sickness absence.

Most participants who had taken long-term sickness absences had returned to the same employer. Many thought they would not have been able to return to their previous role or hours, but adjustments meant their role was a good fit for them and they would be reluctant to find alternative employment in case future employers did not agree to such adjustments. A few felt they had returned too soon which led to further sickness absences, more commonly for those whose mental health contributed to their sickness absence.

Conclusions

As mentioned in the introduction, this research sampled those who were in employment; it does not include those who had dropped out of work or had completely left the labour market (for example, due to health conditions).

The findings should be considered with this context in mind:

• Long and short-term sickness absences occurred due to a variety of reasons which often overlapped, such as mental health conditions, physical health conditions, and personal or family circumstances.  

• Employer contact during long-term sickness absences was typically from line managers, with positive experiences linked to regular, proactive, open and empathetic communications. More negative experiences were often linked to very high or very limited contact.  

• Short-term sickness absences often involved light-touch or no contact, which participants commonly found appropriate due to the short-term nature of their absence.  

• Support provided to those who experienced a long-term sickness absence often did not go beyond the contact they were receiving from their line manager.  

• Existence and application of sickness policies and procedures were varied and those with the most positive experience felt their employer had straightforward policies which managers were able to apply flexibly. Those with less positive experiences reported that policies were unclear or inconsistently applied. 

• The most common reason for returning after a long-term sickness absence was an improvement in health, however, participants commonly reported not feeling fully recovered on their return. Some participants who experienced long-term sicknesses absences were not able to return to work quickly. The most common reason was because they did not have desired adjustments in place. 

• Most who had experienced a long-term sickness absence reported having a conversation about adjustments with their employer. Those who had experienced a short-term sickness absence had a more mixed experience. 

• Many of those who had a long or short-term sickness absence reported some form of adjustment was put in place for their return (although this was less amongst shorter term absences). The most commonly reported adjustments were reduced hours and changes to workloads or tasks. Most of those with adjustments in place reported they would not have been able to return without them. 

• Most of those who had taken long-term sickness absence had returned to the same employer. However, a few respondents reported moving to new employers due to their previous role, sector or occupation not fitting well with their health needs, or due to them feeling their employer had been unsupportive. 

• Most felt they had received the right amount of support at work, to help them manage their long-term health condition or general health and wellbeing. However, those that did not would have valued a more supportive and tailored line management approach and offers of flexible working arrangements.

1. Introduction

This report outlines findings from a qualitative study with employees who took sickness absences from work and/or had long-term health conditions. The aim of this qualitative research was to understand employees’ experience of sickness absence and their general experience of managing health and wellbeing at work. This section covers the project background and context, methodology, and reporting conventions.

Project background and context

The Department for Work and Pensions (DWP) and Department for Health and Social Care (DHSC) Joint Work and Health Directorate (JWHD) was set up in recognition of the significant link between work and health and to improve employment opportunities for disabled people and people with health conditions. The goal of the JWHD is to open up opportunities to good work and to support a healthier, more productive and inclusive nation, by helping more disabled people and people with health conditions to: get good work, get on in that work, and to return to work as quickly as possible if they leave it.

The JWHD commissioned IFF Research to carry out qualitative research with employees who took sickness absences from work and/or had long-term health conditions. The aim of this qualitative research was to understand employees’ experience of sickness absence and their general experience of managing health and wellbeing at work. Qualitative participants were recruited from the respondents of the 2024 to 2025 employee and self-employed survey (which was carried out between 28 November 2024 and 16 March 2025) who had agreed to be re-contacted. This qualitative study focussed on employees, rather than self-employed workers, to further explore how employers support individuals to manage their health and wellbeing at work.

In-depth interviews were undertaken with 75 participants, most of whom had experienced a long-term or short-term sickness absence in the last 12 months, between 19 June and 20 August 2025. Participants were employed in a range of organisations, varying by size and sector. More commonly they worked for large organisations (with 250 or more employees).

Please note that this research sampled those who were in employment; it does not include those who had dropped out of work or had completely left the labour market (for example, due to health conditions).^{[footnote 5]}

Methodology

Sampling approach

The qualitative sample was obtained from individuals who agreed to be recontacted upon completion of the quantitative survey. The sample for the quantitative survey was derived from 2 sources:  

• the Royal Mail Postcode Address File (PAF) 

• the DWP Family Resources Survey (FRS)

Quotas were established across key characteristics based on availability in the survey re-contact sample. The primary quotas were based upon length of sickness absence (where relevant), whether they had a long-term health condition(s), type of long-term health condition(s) (where relevant) and number of health conditions (where relevant). The secondary quotas were based on whether the employee had returned to work following a sickness absence and how long this took (where relevant), how long they had had their health condition(s) for (where relevant), whether their health condition(s) fluctuated (where relevant), age, gender, ethnicity, employer size, and employer sector (see Appendix A). 

The priority group for in-depth interviews were employees who had experienced a continuous long-term sickness absence of at least 4 weeks in the last 12 months (a ‘long-term sickness absence’)^{[footnote 6]}. As this group had experienced a longer continuous sickness absence, it was felt that they would be able to provide more insight into their experience of managing a sickness absence at work. However, the survey sample volumes for this group were too limited to achieve 75 interviews, so the sample criteria was extended to include employees who had experienced a combined sickness absence of 2 or more weeks^{[footnote 7]} in the last 12 months, but less than 4 weeks cumulatively (a ‘short-term sickness absence’), and employees with a long-term health condition who had not experienced a sickness absence in the last 12 months. 

Employees who experienced a sickness absence may or may not have had a long-term health condition. Employees who had not experienced a sickness absence in the last 12 months were required to have had at least one long-term health condition so they could talk to their experience of managing this at work.

Fieldwork

The qualitative fieldwork began on 19 June 2025 and ended on 20 August 2025. A total of 75 in-depth telephone interviews were conducted with participants. The interviews were conducted with a range of participants across 3 main employee groups (Table 1.1).

Table 1.1 Completed interviews per employee group

Employee group	Number of completed interviews
Employees who had experienced a continuous long-term sickness absence of at least 4 weeks in the last 12 months (a ‘long-term sickness absence’)	47
Employees who had experienced a combined sickness absence of 2 or more weeks (but less than 4 weeks cumulatively) within the last 12 months (a ‘short-term sickness absence’)	11
Employees with a long-term health condition who had not experienced a sickness absence in the last 12 months (‘Not experienced sickness absence’)	17
Total	75

Topic guide

The interviews adopted a semi-structured approach guided by a topic guide (see Appendix B). For participants who had experienced a long-term or short-term sickness absence, the interviews followed a journey mapping approach where they were asked to discuss their sickness absence experiences in chronological order, from the start of their sickness absence to their journey through it and their return to work. The topic guide also included questions about how participants generally manage their health and wellbeing at work.

Research questions

This qualitative phase of the research aimed to answer the following questions:

• How did participants experience sickness absence from their workplace? What did their sickness absence journey look like? (including engagement with third parties, support received, further support they would have appreciated, type of sick pay received, return to work plans, outcome of sickness absence and policies or systems to manage health at work). 

• For participants who had experienced a sickness absence, what was the nature of the relationship between the participant and their manager or supervisor during their sickness absence journey? (including how this changed over the period of the sickness absence and who the employee was in contact with). 

• How have participants managed (or continued to manage following a sickness absence) their long-term health condition or disability at work? (including how long participants have had their health condition, whether this impacted their health management at work, and any general support that was or could be provided to further support individuals in managing their conditions at work).

Reporting conventions

The term ‘participants’ is used throughout this report to denote all employees that took part in the in-depth interviews. 

The following phrases have been used throughout to highlight different employee groups: 

• ‘Long-term sickness absence’ is used to denote all employees that experienced a sickness absence of at least 4 continuous weeks in the last 12 months. 

• ‘Short-term sickness absence’ is used to denote all employees that had experienced an absence of 2 or more weeks combined (but less than 4 weeks cumulatively) within the last 12 months. 

Quotes are attributed throughout this report with main health condition or length of sickness absence and reason for absence where relevant.

About this report

The findings in this report are based on qualitative research. Qualitative research aims to explore people’s experiences in depth and to understand how and why issues occur and does not seek to be statistically representative of the wider population.

Structure of the report

The report is structured as follows: 

• Chapter 2 describes participants’ general experiences at work, including workplace culture and relationships and managing health and wellbeing

• Chapter 3 presents an overview of the general support participants have experienced to help them manage their health and wellbeing at work

• Chapter 4 explores participants’ experience of sickness absence, for those who had a long-term or short-term sickness absence

• Chapter 5 explores participants’ experiences of returning to work after sickness absence

• Chapter 6 provides concluding comments on the report findings

2. General experience at work

This chapter describes participants’ general experiences at work. It covers overall views on work, experiences of workplace culture and relationships with people at work, how participants manage their health and wellbeing at work, and their thoughts on health and wellbeing conversations.

Overall views on work

Many participants had very positive overall feelings about their work. Participants commonly valued the opportunities their jobs provided for interesting and rewarding work, they felt that their job was a good fit for their skillset, and that they were valued by their employer. Some enjoyed the social aspect of working with their colleagues or appreciated that their work provided a good work-life balance that catered to their family responsibilities or hobbies.

I really enjoy work […] I think one of the things that’s kept me going is being able to work, kind of enabling me to continue. I’ve had periods of time where I’ve been off work, and I get frustrated. I get bored.

Participant with other physical conditions.

Where participants’ overall feelings about work were less positive, they commonly attributed this to stressful working environments, where they were unsupported by managers to meet the demands of their role. Often these participants also cited a lack of flexibility from their employer, in terms of working hours, location, or other adjustments, which meant that they struggled to achieve working situations that suited their health conditions or disabilities. More rarely, there were reports of perceived workplace bullying or discrimination occurring, and these participants consequently had very negative overall feelings about work.

You feel like you’re in the rat race in this job, and everything we do, we have to measure how long it takes us to do each task - so it can be quite stressful.

Participant with mental health conditions.

Not all participants were clearly positive or negative about their work; many acknowledged both positive and negative elements and noted that their feelings about their job often varied day-to-day. This variation was often caused by changeable factors, such as the types of tasks they were undertaking, whether their workload was high or low, who they were working with, and their own fluctuating health conditions.

So I feel like sometimes I do get quite stressed sort of making sure that I’ve done everything I can for that person. So I can have sort of days where I do find it quite tricky. But then again, I can have lovely days where I feel like I’ve done everything I can and I’ve really helped that person, and we have like nice days as a team as well - it sort of varies day to day.

Participant with Musculoskeletal (MSK) conditions.

Workplace culture and relationships

Participants’ perception of their workplace’s culture and the accommodation of their general needs was closely linked to their relationships with their line managers, colleagues, and wider management teams.  

Participants who were most positive about workplace culture generally described consistently positive relationships with all 3 of these groups (line manager, wider manager, and colleagues and peers). A negative relationship with any of the 3 groups was generally enough to negatively influence participants’ overall perception of workplace culture and the accommodation of their general needs.

Line managers

Where participants had a positive relationship with their line manager, they often cited this as the most significant support they had in managing their health and wellbeing at work. Line managers were also often identified as the key contributor to positive workplace culture. 

Participants described how effective line managers created psychologically safe working environments by encouraging feedback and open communication from those they manage, and they provided recognition for hard work. This helped participants to feel heard and valued, and helped to create a positive workplace culture. Some participants also appreciated their line managers monitoring their working hours to ensure they maintained a good work-life balance. Others valued that their line managers facilitated their engagement with Occupational Health (OH) services by making referrals, organising meetings with OH advisers, or signposting them to self-refer.

Generally, participants perceived the onus to be mostly on their line manager to build and maintain a good relationship with them. Participants emphasised that a supportive relationship depended on their line managers making themself available for ad-hoc, one-on-one support when needed. Though they may have had regular scheduled meetings with their line managers, participants rarely acknowledged these as contributing to a positive relationship. Instead, participants focussed on instances where their line managers had supported them with specific issues or queries as soon as they had occurred. As such, relationships were deemed most positive where participants felt their line managers were ‘empathetic’, ‘open’, ‘helpful’ and ‘trustworthy’. These attributes made participants feel comfortable and safe approaching their line managers with professional or personal issues.

We have a really high level of psychological safety in our group. So if I make a mistake, I go to her and I tell her about it and then we fix it together. It’s not a case of I have to hide any mistakes I make. And she’s very open and very, yeah, it’s very, she’s very easy to work for. She’s a great, great manager.

Participant with Musculoskeletal (MSK) conditions.

However, some participants reported that their line managers lacked empathy or failed to regularly meet with them. These key factors negatively impacted their line manager relationship, as well as their feelings about how their health and wellbeing were managed at work.

[My line manager] has not needed to take sick leave for anything so she doesn’t fully understand when people need to take sick leave […] I think other managers might be a little bit more sort of sympathetic but my manager’s got no sympathy when it comes to that at all - it’s like an inconvenience.

Participant who went on short-term sickness absence due to other physical conditions.

Some participants did note that, in order to have a good relationship with their line manager, they also needed to approach the relationship with openness and honesty. For instance, it was considered important by some participants that their line manager had a comprehensive understanding of their health conditions or disabilities, which relied on them sharing personal details. These participants felt that the more knowledge line managers had about their conditions, the more proactively they were able to provide support, and the better the relationship.

I think what’s enabled it (a good relationship with line manager) to remain good is being transparent about what it is that I struggle with and taking more ownership […] because I’ve been able to be more proactive in telling people like I have a condition or at least I think I’m going through the process, I’ve been able to have a better relationship, but it’s not always straightforward and it’s not always easy.

Participant with cognitive conditions.

However, others felt they couldn’t share their personal health information because of a key barrier: a concern their manager couldn’t maintain confidentiality. Several participants mentioned that they were aware of their line manager sharing information about their own, or a colleague’s, health or wellbeing with other staff without their permission. Where this had happened, these participants no longer felt able to trust their line manager with personal information, limiting the usefulness of the relationship.

I do sometimes wish that we had more confidentiality at times […] sometimes, when we’re in meetings and stuff, I would prefer her to not discuss things [information about employees health conditions] the way she does.

Participant with other physical condition.

In some cases, this broken trust limited the information participants were willing to disclose to their line manager. This created a situation where line managers had only a poor understanding of participant’s health conditions, disabilities, or neurodiversity. As a result, several participants reported experiences where their line managers had misunderstood their requests for adaptions or tried to enforce unsuitable or counter-productive adjustments. Regardless of the cause, line managers who failed to understand employees’ health conditions were commonly described as inflexible, and prone to blanket application of company policies regardless of the intricacies of individual participant’s situations. For example, one participant was required to formally request all workplace adaptations from OH, despite their line manager being in a position to make these adjustments independently. They felt this involvement of OH was an unnecessary complication, which demonstrated their line manager’s lack of trust in them, and ultimately delayed them getting the adjustments they requested.

There’s a lack of understanding of neurodiversity from my line manager. I camouflage very well as someone that could be neurotypical but that kind of disguises all the additional work I have to do in the background [to appear neurotypical] and I’d rather keep my camouflaging and masking to enable me to be really good at supporting my families, rather than using it in a work context to pass as ‘normal’ [for the benefit of my colleagues].

Participant with cognitive conditions.

Among participants who felt their relationship with their line manager was poor, several noted that this was exacerbated by a high turnover of managers. This meant they had to repeatedly get to know new managers and were not given adequate time to build good relationships. Most of these participants described these situations as a passive failure to help by their employer, rather than an active attempt to worsen their situation.

Wider management

Some participants reported that their wider management seemed to prioritise the health and wellbeing of their employees, through positive contribution to workplace culture and the accommodation of general needs. Where this was the case, participants believed that wider management genuinely wanted to support and help their employees.

[Health and wellbeing of employees in work] is quite a high priority. I know because I’ve been talking to the HR team about their sickness data and their mental health data and they’re looking at that to try and improve it.

Participant with musculoskeletal (MSK) conditions.

This prioritisation of health and wellbeing created an accommodating workplace culture in a variety of ways, including running internal mental health and neurodivergence support groups, having neurodiversity and disability ‘champions’, promoting mental and physical support services, accommodating time off for family and/or caring responsibilities, designing shift patterns to prioritise work-life balance, and starting internal meetings with a health and wellbeing and/or mindfulness message.

They push a lot of that mindfulness, making sure that you’re taking breaks from your work, they push that, you know, home life is a priority, if you need to go offline to look after your kid, just do, just work up your hours at another time. They push that key messaging that actually you’re more important than the work, look after yourself and then the work will be better. So yeah, they do a lot of sort of educational stuff, they do a lot of training, they have champions for neurodiversity, disabilities, etc, they, yeah, they’re very, very good and it’s all very open and honest conversations around the organisation.

Participant with other physical conditions.

Participants who reported positive wider management often described them providing ergonomic equipment on demand for all employees. In one case, this went as far as company-wide workplace ‘display inspections’ to ensure everyone had the correct setup for optimal working.

They’re very good with checking in, again, particularly since the ADHD diagnosis with what my home set up looks like, if I need any extra IT equipment at home to make the job easier. To make it more fitting to health and safety, we have workplace display inspections and so on. They’ve provided remote keyboards and monitors and all sorts of things to just make my home office environment more conducive to good work and sort of healthy and safe.

Participant with cognitive conditions.

On the other hand, participants who reported more negative wider management often mentioned that they adopted approaches which were unsupportive or disconnected from their employees’ lives. These participants felt that their health and wellbeing was not a priority for wider management, often noting they were not considerate of employees’ lives outside of work when making decisions on working patterns and processes. Another common feature of more negative wider management was large amounts of overtime which was unacknowledged and unpaid. Where this was the case, participants felt they would be able to better manage their health and wellbeing if the overtime was honoured (for example, using the time to attend appointments). This left participants feeling under-valued and unimportant.

I do put it on the system that I’ve done extra hours, but they just never get approved. And if I had those extra hours back, that would then help me go to appointments or I could go to like my daughter’s sports days and things like that when I might need to use that extra time. So, you’ve put days in, which you could then take off further down the line, but they’re not acknowledging that.

Participant with mental health conditions.

There were also rare mentions of bullying from wider management. Examples of this included wider managers socially isolating participants from co-workers or subjecting specific employees to repeated or excessive disciplinary meetings for minor or supposed incidents. Some participants who felt the culture created by wider management was very negative, reported significant reliance on their union’s involvement in order to have accommodations made for them at work.

Peers and colleagues

Compared to the influence of line managers and wider management on workplace culture, participants generally described the role of peers and colleagues as more personal and informal. However, among the participants who described strong relationships with their peers and colleagues, they tended to cite this as their biggest support in managing their health and wellbeing at work. These relationships were also given as a key reason for wanting to come back to work after a period of sickness.  

Where the workplace culture was positive, peers and colleagues had created a culture of helping each other or sharing tasks. Particularly in roles with a physical component, such as waiting tables or working in supermarkets, this attitude from peers and colleagues helped those with physical limitations feel included, valued, and supported.  

Participants who felt positively about the culture created by peers and colleagues often described an open-minded attitude, with an empathetic culture towards neurodivergence and mental health conditions. For some participants, this was exemplified in their company’s voluntary staff networks for neurodivergence or online wellbeing channels where peer support was readily available when needed.

There is an empathetic culture towards it [neurodivergence]. There’s a lot of people who are openly [neurodivergent] in the office, in the company and there’s a lot of awareness of it […] so they would better understand when somebody is experiencing some sort of issues due to their neurodivergence.

Participant with mental health conditions.

It was rare that participants mentioned their peers or colleagues contributing to a negative workplace culture. Where they did, it generally stemmed from workplace adjustments being put in place to manage participant health condition but peers not having similar accommodations in place which created some feelings of ‘favouritism’. Most often, this was permission to work from home on days when their colleague’s attendance in-person was mandated. Several participants suspected that their colleagues did not understand the reason for this allowance and resented that not everyone was expected to meet the same standards they were.

One of our team is based in Poland. I don’t think he likes that I don’t have to travel, because he has 2 young children at home and does have to travel […] I just let things like that just go over my head. He doesn’t know my situation, so I think if he knew it would be different.

Participant with Musculoskeletal (MSK) conditions.

Overall, where good relationships with line managers, wider managers, and colleagues combined to create an accommodating workplace culture, participants reported feeling secure, valued, and cared for. They were able to trust that their employer was ‘on their side’ and would support them if they were to have further issues in the future.

I think if I was maybe struggling with my pay, for example, I wouldn’t have to specifically speak to someone who’s in the pay [department]. I could speak to anyone, and it would be written down and sent to [the right person]. I know it’s going to get sorted no matter who I speak to.

Participant with other physical conditions.

Managing health at work

Participants’ experiences of managing their health and wellbeing at work varied considerably. The level of available flexibility and autonomy were key: this dictated how easily participants managed their health conditions or disabilities.  

Many participants, including those with conditions such as ADHD, or those experiencing chronic pain or muscle spasms, highlighted the importance of being able to take regular breaks during the working day. For some, this included being able to leave meetings when symptoms of their condition became overwhelming. The flexibility to do this when required allowed them to manage their condition without needing to take time off from work. Similarly, participants with Musculoskeletal (MSK) conditions were better able to manage them, even in physical roles, when they had autonomy over the specifics of how they undertook their tasks.

Very easy [to manage health condition at work]. I just assess that at each job that I go into […] if it’s a heavy lifting of this, if it’s a two-man job, I’ll make sure we’re lifting correctly, make sure I’m not lifting on my own. It’s just things like that. Everything, I’m managing it every second of the day, everything I do, I always take into consideration.

Participant with Musculoskeletal (MSK) conditions.

Where this autonomy and flexibility within the role wasn’t possible, managing a MSK condition at work was more difficult. These participants often reported having to tolerate discomfort, or even pain whilst at work, which could make it difficult to focus, or their working day less enjoyable. Despite this, they generally reported that they were still able to manage in the roles they were in and often would prefer that to changing jobs.

If my knees are painful I kind of have to just put it to the back of my head because there is a job to do and there isn’t really anything I can put in place to make it easier because it is such a physical job.

Participant with mental and physical health conditions.

Some participants reported that their health conditions tended to come in waves. When these participants were well enough to work, their condition did not impact them at all, and they were able to work without the need for additional adjustments. However, there were times when their health conditions demanded more flexibility in their role, including taking time off to recover. These participants generally emphasised the importance of understanding the extent to which they could work before triggering a negative episode or experience in relation to their health condition. In this way, some were able to minimise the frequency of needing time off.

Participants with mental health conditions commonly reported that managing their mental health at work required a significant personal effort. They often reported being able to ‘mask’ the impact of their condition whilst working, and some enjoyed the opportunity to switch off from thinking about their mental health condition whilst fully engaged in a day of work. However, this strategy of ‘blocking out’ or ‘masking’ their mental health conditions for the day or shift sometimes negatively impacted their mental health when they returned home.

It’s almost like I’m kind of switching off this part when I’m working because I’m dealing with databases. I need to stay focused all the time so that’s helping, that’s one of the like coping mechanisms I have after work, just focusing on doing something really precise and keeping myself busy.

Participant with mental health conditions.

I try really hard to not impact my mood at work and also I’m a bit sometimes scared of my manager. So I try to put a brave face on it, but then what happens is that feeling spills over into my relationships at home and friendships.

Participant with mental health conditions.

Some participants reported that their mental health conditions affected their sleep, which in turn further impacted their work. Where they were able to, these participants made use of flexible working hours to manage this, for instance by working later into the night and starting later in the morning.

Participants with long-term health conditions or disabilities commonly talked about having to learn to manage their conditions at work. Some emphasised the usefulness of receiving a diagnosis, as it allowed them to understand more about what their limitations were within their job role, and how best to manage them. Those whose conditions were degenerative described how they have adjusted their professional goals based on their understanding of their limitations, and how this has helped them to manage their condition whilst at work.

Getting enough sleep where I can, drinking coffee, I think what else I do. Having boundaries at work as well is something I do to manage myself. I know my patterns of how I work best.

Participant with cognitive conditions.

Some participants also received support from OH to manage their health at work, either as a result of self-referral, or because their managers had referred them. Self-referral was common among participants with mental health conditions who often used OH to access counselling services. Participants reported that consulting with OH was often a key step to getting adjustments made to their working environment. They tended to view OH recommendations positively and valued having a plan to help them navigate adjustments at work.  

However, several participants noted that their employer was not obligated to follow OH recommendations, and some employers had decided not to adopt any of the recommendations. While this was often due to the nature of the role (for example, roles that involved shift work or were patient facing) some participants did not fully understand why OH recommendations were not followed, and attributed it to a general unwillingness of their line manager or wider management to be flexible.  

Those that had the most positive experience of OH support, felt that the support they received addressed both mental and physical aspects of their conditions equally and their employer actioned all recommendations that had been made.

Disclosure of health condition at work

Most participants – though not all – decided to disclose their health condition. Particularly for individuals who required specific support or adaptations at work, this disclosure was a necessary step in getting adjustments put in place. Even where no support was required, some participants noted that they preferred to be honest with their employer from the outset so that if they had an issue related to their condition in the future, the support would be available.  

Most participants reported that they disclosed their health conditions to their employer as soon as conditions occurred, typically via their line manager. Some disclosed their conditions as part of the paperwork of accepting their jobs, and some as part of regular health checks set up by their employer.

A few participants, who felt their condition did not affect their work, did not make their employer aware of their health condition(s). For some, this was partly because they did not enjoy talking about their condition(s), but more commonly this was due to concerns that it would negatively impact their treatment at work. For instance, one participant on a temporary contract was concerned that it would discourage the employer from offering them a permanent position. Other participants were concerned that a disclosure of anxiety or neurodivergence would mean their employers perceived them as less able to do their job, though they often acknowledged that their employer had not given any indication that this would be the case.

I worry that they would think, oh, maybe she’s not up to it. Maybe we shouldn’t extend a contract and make her full time and permanent.

Participant with mental health conditions.

This was particularly common in relation to neurodivergence, with some participants stating that though they disclosed physical or mental conditions immediately, they were more reluctant to share their neurodivergent diagnosis with their employers for fear of negative repercussions.

They’ve known about the depression and anxiety side of things from the COVID times years ago. I only told them about the neurodivergence side in 2023, mostly because I was scared that if I actually told them the extent of what I found difficult at work that they’d put me straight into capability procedures and try and get rid of me, I guess.

Participant with cognitive and mental health conditions.

Overall, good relationships with line managers were highlighted as essential for individuals to feel comfortable disclosing their conditions. For example, one participant, who was not comfortable disclosing their condition to Human Resources (HR), still informed their line manager who was able to make informal adjustments to their role.

Thoughts on health and wellbeing adjustment conversation with employer once employed

Participants were asked how they would feel if employers provided an early conversation, focusing on potential health and wellbeing adjustments. This discussion would take place once the employee was employed rather than at the recruitment stage.

Most participants responded positively to the idea of having a health and wellbeing adjustment conversation with their employer once employed.

Generally, participants that responded positively viewed the conversation as a valuable opportunity for employees to disclose sensitive information that may otherwise get missed during inductions. They felt that having a dedicated time for this conversation would ease the mental load on employees and be useful for building good relationships between the employer and employee.

It may have made things easier. It would have made it easier for me to disclose the information. Because I don’t really feel, I’m not really confident to just come out and say it by myself. Whereas if there was a sort of framework where this is an automatic thing where it was part of your onboarding. Yeah, it would have been easier to disclose.

Participant with mental health conditions.

A small number of participants reacted more negatively to this idea, expressing concerns that it would complicate relationships at work and create additional work. There were also concerns raised about how the information collected during the conversation would be used, and the potential difficulty of convincing employees in these conversations that information shared would not be used against them in future (for instance to block opportunities or progression).

I’d worry that it would be perceived negatively from the person I’m speaking to thinking that I’m trying to weed out stuff which I could potentially use against them - that’s just my cynical side of me is that people wouldn’t be open about it because they’d worry it would go against them at that kind of stage of things, but I can see the benefit from it.

Participant with mental health conditions.

3. Support to manage health and wellbeing at work

This chapter presents an overview of the general support participants have experienced to help them manage their health and wellbeing at work. Nearly all participants had a long-term health condition and so were able to discuss their experiences of general support and adjustments.

Support and adjustments provided by employers

Participants who felt their long-term health condition had an impact on their work had often received some support from their employer or had adjustments put in place to help manage their general wellbeing or long-term health condition at work. These included the ability to work from home, flexible working patterns (that is, when they undertake their work), working environment or workload adjustments and wellbeing initiatives.

Working from home

For participants with a variety of health conditions in office-based roles, the ability to work from home helped them to manage their general wellbeing or long-term health. Most participants who were able to work from home combined this with some office working throughout the week. This ranged from 1 to 3 days in the office, when their health allowed. However, some participants worked exclusively from home, which had typically started during the pandemic. 

Participants reported that the ability to work from home reduced travel time. Travelling to the office was often linked to fatigue, particularly when the office was further away. Therefore, participants felt the reduction in travel time helped them to better manage the impacts of their long-term health condition by reducing fatigue. This enabled participants to continue working during poorer health when they may have otherwise had to take a sickness absence.

he biggest contribution [to managing health and work] has been the ability to work from home, so it just means if I’m having an off day, I can still work, right, because I don’t actually have to physically get up at the crack of dawn and get on a train.

Participant with other physical conditions.

Furthermore, participants were able to make personalised adjustments to their working environment at home. For example, one participant mentioned that the ability to control noise and light helped them to manage migraines. In addition, some participants with mental health conditions found the home working environment less overwhelming. Participants reported that having control over the working environment helped them better manage the impacts of their long-term health condition.

[At home] I have access to all the things that can help me make me feel better. Hot water bottles, painkillers. Sometimes it feels like if you’re in pain, it can be worse if you’re not at home around your comforts. I find it easier to manage my health working from home.

Participant with mental and physical health conditions.

Participants with younger children or other caring responsibilities felt the ability to work from home enabled them to balance work and caring responsibilities. For example, being closer to home enabled them to pick their children up from school. While this was not reported to have a direct impact on the management of a long-term health condition, the flexibility reduced burden on participants and therefore contributed to general health and wellbeing.

I tend to stay at home Mondays and Tuesdays because I need to pick the kids up from school those days but the other days when my wife’s picking them up, I usually work in the office.

Participant with mental health conditions.

Flexible working patterns

Flexible working patterns (for example, the ability to work contracted hours flexibly over the week) also helped participants manage their general wellbeing or long-term health condition in the following ways:

• It allowed participants to attend medical appointments without taking time off work, because they could work missed hours at another time

• It enabled some participants to manage the impact of medication (for example, dizziness) because they could take a break from work until they felt better

• Participants were also able to flex their working patterns during periods of poorer health when they may have otherwise had to take a sickness absence

Flexibility in working patterns was mentioned by participants with a range of long-term physical and mental health conditions. However, it did appear to be more commonly reported by participants in office-based roles.

Participants with younger children or other caring responsibilities felt flexible working patterns enabled them to balance work and caring responsibilities. For example, some participants were able to stop work to pick up their children and then recommence working later in the day. While this was not reported to have a direct impact on the management of long-term health conditions, the flexibility appeared to reduced burden on participants and therefore they felt it contributed to their general health and wellbeing.

I can log off early as needs be if there’s an issue with, you know, getting one child from school. It just means I’ll have to make that time back in the evening, but it’s worked fine for me over the last few years.

Participant with mental health conditions.

Working environment or workload adjustments

Participants reported that adjustments to working environment or workload helped them manage their long-term health condition at work, although this was mentioned less frequently than the ability to work from home or flexible working patterns. For example, one participant reported choosing the right location to deliver in-person training workshops with their employer, to ensure the temperature did not have an adverse effect on their health condition. Another participant working in a global role mentioned that the physical aspects of their role had been adjusted to help them manage their health, including taking meetings online rather than travelling to a different country, which they said reduced stress and worry about how they would manage their health condition at work. Adjustments to working environment or workload was more commonly mentioned by participants with MSK conditions and other physical health conditions.

I will do workshops in front of people and teaching with people. But we pick the locations so they’re not going to be horrendously hot or horrendously cold, which is good for everyone really.

Participant with Musculoskeletal (MSK) conditions.

A few participants with MSK conditions and other physical conditions, who worked in office-based roles, reported the supply and use of ergonomic equipment to help them manage their long-term health condition at work. This included adjustable monitors, stand up desks, footrests, an ergonomic keyboard, and supportive chairs. The provision of ergonomic equipment normally resulted from an Access to Work or an OH assessment. Participants using ergonomic equipment found it helped them to manage the physical impact of their long-term health condition.

Wellbeing initiatives

Some participants mentioned multiple wellbeing initiatives that their employers provided to help them manage their mental health and wellbeing at work, whether they had a long-term mental health condition or not. This included wellbeing emails or newsletters, dedicated members of staff to provide support (for example, mental health first aiders or ‘champions’ for neurodiversity), wellbeing areas for employees to take time out of work and mental health sick days. It also included Employee Assistance Programmes, which were normally provided by an external provider and included counselling services, which provided reassurance to some.

It’s quite reassuring knowing that if I really struggle, [the helpline] is there. Even if I need to offload and I don’t want to talk to a colleague or anything like that, then I know I can pick up the phone […] So that is kind of, it’s mainly a safety net as well as, you know, if I really struggle, I can just use that.

Participant with mental health conditions.

The extent to which participants found these wellbeing initiatives useful varied. For example, one participant with a mental health condition had attempted to access the counselling service through their employers Employee Assistance Programme, but their needs were too severe for it to be of benefit. On the other hand, another participant with a mental health condition stated that they valued having a wellbeing area because it gave them the chance to take a break from work when they experienced a panic attack.

As opposed to thinking I have to stay at this desk until maybe my lunch break or until after work before I can take care of myself, knowing that I have the option to [use the wellbeing room] is very helpful.

Participant with mental health conditions.

Contributors and barriers to engaging with employer support

Barrier: Perceived lack of need

Some participants were aware that their employer offered various forms of general support but did not want to access them because the participants did not think their condition was sufficiently severe or their personal preference was not to engage with such services. The latter was more common amongst older, male participants in this research. These views influenced the extent to which they engaged with the policies and guidelines their employer had around managing health at work, including OH services and Employee Assistance Programmes. Thus, employers could proactively encourage some employees (for example, those with no long-term health conditions or those with less severe conditions) to access support, before their health deteriorates.

Contributor: Supportive management

As discussed in the previous chapter, having a supportive line manager substantially contributed to participants feeling able to manage their health and wellbeing at work. This is because having a line manager that understood their needs heavily contributed to appropriate support and adjustments being put in place. Occasionally, this was because the line manager had lived experience with a similar health condition, so knew the ways in which to manage it. Having understanding management also gave reassurance that implementing adjustments to manage health and wellbeing at work would not affect progression in the organisation.

I can talk to [line manager]. So that psychological safety is key. I think that’s the biggest thing. I don’t need to worry that my job is at risk if I tell her that something with my health is going wrong or something […] I don’t need to worry that my job is at risk because of a medical issue.

Participant with Musculoskeletal (MSK) condition.

Other support received

Participants who felt their long-term health condition had an impact on their work also mentioned other support they had received outside of their employer, including medical support, personal support (for example, exercise and hobbies), and support from family and peers (for example, through social media). Such support helped them manage their general wellbeing or long-term health condition.

Support from medical professionals

Some participants mentioned receiving support for their mental and physical health from medical professionals. This included therapy, counselling, physiotherapy, and medication. However, participants reported that slow referrals and long waiting lists in the NHS meant they did not always receive the support they needed. Some participants reported that their employer provided private medical support, which meant they could access support (for example, from the General Practitioner (GP) or dentist) more quickly. This type of support was sometimes extended to family members.  

Private medical support provided through the employer did not always meet the needs of employees, which caused them to seek alternatives. In one case, a participant had sought mental health support elsewhere because the therapy provided through their employer did not meet their particular needs (for example, they wanted face-face therapy and the employer only offered remote therapy). Where this was not provided by the employer, a couple of participants reported paying for private health support themselves.

Personal support

Participants mentioned steps they had taken themselves which helped them to manage their general health and wellbeing (for example, recording things in writing to aid forgetfulness linked to menopause, or undertaking exercises for mental health). This also included engaging with hobbies and doing physical exercise (for example, being part of a football team). Participants reported this had a positive impact on their physical health, due to staying active, and their mental health, due to being social with peers. This, in turn, had positive effects at work.

I think it really does start with your personal life and how you manage that. If I’m getting enough sleep, I’m eating well, looking after myself […] It will transfer into the workplace.

Participant with cognitive conditions.

Family and friends

Participants also mentioned receiving support from family and friends, which helped them to manage their health and wellbeing generally. This involved support for everyday tasks which their long-term health condition limited their ability to do, including cleaning, cooking, shopping, and assistance getting to medical appointments. Participants tended to find this type of support more flexible, compared to the support provided by third party organisations which was often pre-arranged at specific times. This was particularly helpful when individuals experienced fluctuating health conditions. 

More rarely, participants mentioned the benefits of social media in helping them manage their general health and wellbeing. These participants had found relatable content online, from people with similar long-term health conditions to them, which included advice and guidance on how others manage the impacts of their health.

I get like videos and stuff come up on TikTok of how people are managing their migraines. There’s a guy on [TikTok] called the migraine doctor that’s always [got] weird and wacky way to get rid of migraines.

Participant with other physical conditions.

Further support desired by participants

Most participants felt like they had received the right amount of support at work, to help them manage their long-term health condition or general health and wellbeing. Those who did not feel like they had received the right amount of support at work would have valued supportive management and flexible working arrangements.

Supportive management

As mentioned in the previous section, supportive management was a large contributor to participants feeling that they were able to sufficiently manage their health and wellbeing at work. Some employees felt adjustments were not permitted due to unsupportive management staff (often wider management, not a line manager), and a couple of employees had turned to their trade union in this situation. A few employees did not want to raise health concerns at work due to concerns about repercussions or a desire for privacy. Those that did not have supportive management would find this helpful in the future, at both the line manager and wider level (for example, HR). They felt this would encourage open conversations about necessary support and adjustments to manage health and wellbeing at work.

Having some sort of check in every now and then about general health and wellbeing to make sure that everything’s going well. And there aren’t any, or if there are any adjustments that need to be made […] maybe biannually every 6 months or so.

Participant with mental health conditions.

Flexible working arrangements

Participants who were currently unable to work from home, to work flexibly (for example, the ability to work contracted hours flexibly over the week), or to adjust their working arrangements or workload, often felt these adjustments would help them to manage their health and wellbeing at work. Some also felt this would help them to manage caring responsibilities and work. However, adjustments such as these were sometimes difficult to accommodate due to the nature of the job (for example, roles that involved shift work or were patient facing). Despite this, some participants did not fully understand why flexible working arrangements were not honoured, and attributed it to a general unwillingness of their line manager or wider management to be flexible.

4. Experience of sickness absence

This chapter explores participants’ experiences of sickness absence, including causes of sickness absence, length of absences, employer contact during sickness absence, the use of fit notes, and experiences of receiving sick pay.

Reasons for sickness absence

Participants reported experiencing absences from work for a range of reasons, broadly falling into mental health, physical health, and/or personal or family circumstances. It was also common for multiple different conditions, injuries, or circumstances to interact and overlap, and the cumulative impact of this then caused the sickness absence to take place.

I was definitely on the point of burning out most definitely before I broke my ankle. And then after that, everything seemed to just get worse and worse.

Long-term sickness absence due to Musculoskeletal (MSK) conditions.

Mental health difficulties

Among participants who had a sickness absence for mental health reasons, some experienced mental health crises entirely independently of their working lives. This included participants suffering from Post-Traumatic Stress Disorder, panic attacks, severe anxiety, and depression.  

However, for some participants, the stresses and pressure of their work exacerbated existing mental health conditions, or in some cases created them. In these situations, participants talked about the damaging effect on their mental health of organisational issues such as unresolved workplace difficulties, lack of support, unmanageable workload, and unhealthy and inappropriate leadership styles at their employer.

My head teacher was horrible […] bullying, harassment, verbal aggression, threats […] I wasn’t the first person that was signed off sick.

Participant who went on short-term sickness absence due to mental health conditions.

These participants described how, for them, ‘burnout’ and workload pressures led to anxiety, insomnia, and depression which ultimately meant they could not continue to work.

It was like a classic case of burnout, I was just overloaded with work and because I couldn’t complete everything I needed to complete, I had people chasing which caused a lot of anxiety, I struggled to sleep and these led to depression.

Participant who went on long-term sickness absence due to mental health conditions.

Physical health difficulties

Physical health difficulties which caused participants to have time off work included injuries, illnesses, planned and unplanned surgeries, and chronic conditions. Generally, these physical conditions and injuries were not linked to participants’ work; only rarely did participants feel that their work had influenced their conditions. 

However, there were several participants who were simultaneously struggling with their mental health at the time that they became physically ill or injured. Among these participants, the physical injury seemed to have mandated that they take time off which ideally they would have had regardless for their mental health.

The fall was like the tipping point. I was on the verge of going off due to my mental health, but then when I fell and there was a good few months where I was really, really quite heavily disabled and struggling to do kind of really basic things. And so running all the way through to July, it was still a mixture of back injury and mental health.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions and mental health conditions

Personal or family circumstances

Other participants described situations such as bereavement, domestic abuse, caring responsibilities and family crises that made it impossible to continue working without a break. In some situations, these personal circumstances also exacerbated existing physical or mental health conditions.

I had mountains of court paperwork, solicitor letters to respond to, abuse from my ex […] I wasn’t focusing on work and I had to take some time out.

Participant who went on long-term sickness absence due to mental health conditions.

Length of sickness absence

The length of sickness absences varied considerably between participants, even if the reason for their sickness absence was the same. For instance, among participants who had time off work to have surgery, the length of time off varied from 3 weeks up to 6 months. The length of time off for mental and physical health conditions also had similar variety, with some participants off for just 1 or 2 weeks and others off for more than 6 months. This suggests the way a person responds to a health condition and the resulting sickness absence varies. 

Participants who worked part-time or those who worked shift patterns commonly reported being able to manage short absences from work well. Often their shift patterns created an opportunity for an extended break between shifts, so greater rest was achieved with minimal working days taken for a longer sickness absence.  

On the other hand, most participants who had an extended sickness absence of several weeks or months found this difficult or disruptive. These sickness absences were often linked to significant health challenges, bereavement, surgery or recovery from injury. Participants often reflected on the need for extra time to adjust before returning to work.

I thought surgery would take 6 weeks to heal, but there was more damage than realised. Overall, I ended up having about 3 months off.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

Many participants also reported multiple episodes of sickness absence where conditions recurred, or relapsed. For these participants, multiple sickness absences were spread across months or even years, sometimes the result of premature returns to work encouraged by their own expectations, or in one case an OH recommendation.

July 2024 to September 2024, that was the longest period in the last 12 months, but it was part of a longer absence. Occupational health coaxed me back to work, but it was far too early. I only lasted a month and I had to go back off again.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions and mental health conditions

Fit notes

Fit notes were most common among participants who experienced a long-term sickness absence, and they usually recalled receiving a ‘not fit to work’ note. These were generally written by participants’ GPs and signed them off work for a specified period of time. A few participants who experienced hospital admission during their sickness absence initially got this note from their doctors at the hospital, and the note was then reissued by their GP when they returned home from hospital.

I think I had one from the surgeon themselves for the actual day of the surgery and the preceding days afterwards, and then the rest of it was by the GP. I’m fairly certain it just said post-surgery recovery, that was about it really and just gave a date for when it was due to expire […] I then had a follow-up appointment, and then he basically passed me back to my GP, and the GP then just did an extension for – I think it was another 4 weeks off that.

Participant who went on long-term sickness absence due to other physical conditions.

These ‘not fit to work’ notes generally contained confirmation of the participant’s condition, advice that time off work was required, and the time frame that the note was valid for. The time frame varied considerably between participants; some notes mandated weekly reviews of a participant’s condition, whilst others stated that they should be reviewed only every 4 weeks, or every 8 weeks.

Participants mostly did not mention receiving a ‘may be fit to work’ note for their return to work. For the few participants who did receive a ‘may be fit for work’ note, they included some recommended adjustments to their working patterns, commonly specifying a phased return to work. Sometimes, they went as far as dictating how many hours a participant could work per week, and the rate at which working hours could be increased.

[The GP] was very specific when I went back: they made me go back on reduced hours and things like that, which was really helpful […] so they did it over a few weeks’ time. You’d go back for about 2 or 3 hours and then they’d increase it, but they’d do it gradually.

Participant who went on short-term sickness absence due to other physical conditions.

For a few participants, GPs also included details of activities they should avoid, such as driving, cycling, and lifting. Participants found these notes helped them communicate their requirements to their employers clearly and, for some, provided a reassuring reminder that they were likely to recover within the specified timeframe.

I find that [guidance within the fit note] really useful because I like having a target to aim for. So if someone says you can’t do something, find that almost that, you know, anxiety inducing. Whereas if someone says, even if they say it’s going to be 2 years, if I’ve got a date to work towards, then I find that really reassuring

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) condition.

There was just one participant who remembered their employer specifying that they needed a fit note from their GP in order to return to work.

Participants often reported that the process of obtaining and extending the fit note was straightforward, particularly when they did not have to repeat information, or book an appointment to see their GP again, to extend it. Some participants mentioned they were able to extend their fit note through an online NHS app, which they found helpful. More rarely, participants found the process burdensome. This tended to be participants who had to book a GP appointment to extend their fit note.

All participants who received a ‘may be fit to work’ or ‘not fit to work’ note were clear about the information they included. There were no reports of confusion or difficulty understanding the purpose or content of these notes.

Participants who had experienced a short-term combined absence, rather than a continuous absence, were generally less likely to have needed a fit note due to the short-term nature of their absences^{[footnote 8]}. However, those who were off for more than a week at a time generally did still provide a ‘not fit to work’ note, even if they were not sure whether it was required.

Case study 1: Long-term sickness absence due to Musculoskeletal (MSK) conditions

Joanne is a senior mental health nurse and her role involves clinical care and office-based work. She earns £30,000 to £39,999 per year and normally does 3 12-hour shifts a week. Joanne describes her general health as “pretty good”. However, she experienced an injury as a child which made walking painful. In adulthood, she received private medical treatment which led to the cause of the pain being identified after years of unsuccessful NHS investigations. This resulted in private surgery which required a 3-month absence from work.

Initially, Joanne received a fit note from the hospital advising that she take 6 weeks off work. However, after the initial 6-week period, she did not feel ready to return to work as her recovery was taking longer than expected, so she requested a 4-week extension to her fit note. She did this through her GP using an online NHS app, which she found to be a simple process. She then requested a further 2-week extension to her fit note (again through her GP) because her Occupational Health assessment was delayed due to a change in line management. Joanne delayed her return to work as a result because she wanted to make sure adjustments were in place.

I ended up staying off another 2 weeks because I didn’t want to start work until I had that [Occupational Health] report so that we could obviously plan my return to work.

Joanne’s employer called her at regular points throughout her sickness absence. However, she felt the nature of these calls changed over time, from a genuine check-in about her wellbeing to a focus on her return to work.

They checked in a couple of days later [after surgery] […] it felt that was around my wellbeing. But then, towards the end it changed. It felt like it changed a little bit to “How are you? Okay? So when are you coming back to work?” A little bit more like that rather than how I’m doing.

Joanne was receiving private physiotherapy before the surgery, and she continued using this support throughout her absence. She felt this helped her to return to work more quickly. She stated that, although her employer asked if she needed further support, it was not entirely clear what was available, and she was not clear whether there were formal guidelines or policies in place.

Joanne’s Occupational Health assessment recommended a phased return to work. For the first couple of weeks following the absence, she did 3 6-hour shifts a week, followed by 3 8-hour shifts a week for the next couple of weeks. Joanne also adjusted the type of work she did during the phased return. For instance, she did more desk-based work rather than active patient-facing work. She was also given more time for breaks to complete her strength-based exercises or rest. Joanne reported feeling ready to return to work at full capacity after completing her phased return.

Employer contact during sickness absence

This section is separated into participants who took a continuous long-term sickness absence and other participants who took a combined short-term sickness absence.

Experience of those that took a long-term sickness absence

Most but not all participants who took a sickness absence of longer than 4 weeks received some kind of contact from their employer whilst they were on sick leave. Line managers were generally the main point of contact for this, sometimes joined by wider management such as HR or senior staff members.  

Participants who had a good relationship with their line manager valued having structured, proactive, and highly supportive contact with them during sickness absence. Participants commonly felt well cared for when line managers or senior staff checked in regularly, maintained open communication or even offered practical help. This included weekly phone calls, hospital visits and ensuring participants did not return to work until medically fit. Such support reassured participants that their wellbeing was prioritised and allayed any concerns about a rushed return to work.

My boss and a lady from HR […] we had likely a weekly touch point where we’d have a phone call to see how I was getting on, if there’s anything they could support me with to get me back to work – we came with a bit of an action plan […] that happened throughout the whole 3 to 4 months.

Participant who went on long-term sickness absence due to mental health conditions.

The good relationship that these participants had with their line managers commonly meant that they felt in control of the level of contact. However, where participants’ relationship with their line manager was less positive, a high level of contact sometimes felt stressful and pressurising, with some feeling that contact was due to obligation rather than care. This sometimes also included being sent work while signed off or feeling that concerns about unequal treatment were dismissed. 

In a few cases, participants felt the nature of the conversations shifted towards the end of the absence (for example, from health and wellbeing check-ins to conversations about their return to work). Individuals reported that this added pressure if they did not feel ready to return to work at that time.

I sort of felt a little bit under pressure from taking the call […] I’m guessing she was only taking it because that’s what her role advised her that she has to do -I don’t think this was something she wanted to do.

Participant who went on long-term sickness absence due to mental health conditions.

I felt like there was some sort of pressure really from my manager about constant phone calls. It felt like she wanted to me to go back.

Participant who went on long-term sickness absence due to mental health conditions.

However, some participants reported that contact with their employer whilst they were on sickness absence was limited to brief or administrative messages, with little sense of care or follow-up. For some, this complete or near absence of engagement was disappointing, particularly as they contrasted it with how they would have supported staff that they manage. Others noted that even when additional support was formally recommended, it was not acted upon. This often left participants feeling neglected and unimportant.

They just didn’t bother with me for 7 weeks; I did not receive a phone call […] I’ve been a manager for 5 years, normally if my staff are off, I’d ring them after the first week, but I didn’t receive any of that.

Participant who went on long-term sickness absence due to other physical conditions.

Experience of those that had taken a short-term sickness absence

Where participants were only absent for a short time, they often found a light-touch or informal contact from their employer appropriate. Additionally, some had no contact with their employer, which they equally found appropriate due to the short-term nature of their absence.

Good experiences commonly included occasional check-ins from their line manager, usually by text or phone which allowed participants to respond in their own time. These participants tended to describe this brief, light-touch contact as sufficient and respectful of their boundaries. They commonly noted that they did not require more in-depth contact as they returned to work fairly quickly.

Support during absence

Participants who had experienced a long-term sickness absence often did not mention specific support from their employer beyond the contact they had with their line manager or the support they were already receiving to manage their health and wellbeing at work.

A few participants reported that they had regular check-ins with OH whilst they were off, but more commonly participants had just one or two meetings with OH as they prepared to return to work. Generally, OH was able to advise them on appropriate adjustments for their return to work, such as a phased return or reduced hours.

Where additional support was received, this usually involved support from other organisations, or friends and family:

• healthcare services (private and NHS) – for example, therapy or counselling (to support mental health) or physiotherapy (to support physical health)

• charities – they often provided therapy or counselling services, specific to the health condition experienced (for example, a charity focused on skin cancer)

• family and friends – they often supported individuals with daily tasks, such as cooking and cleaning (more rarely, they provided financial support)

Those who had experienced a short-term sickness absence were generally less likely to have experienced any additional support from their employer or other organisations during their sickness absence. This tended to be due to them not needing any additional support at that time.

Sick pay

Participating employees sometimes indicated confusion around the type of sick pay they received during their absence. Interviewers often needed to provide the definition on the types of sick pay to help clarify what they had received. This definition generally helped to confirm which type of pay the individual had received, but in a handful of instances participants still seemed unsure on which type of pay they had received.

Many participants received Occupational or Company Sick Pay (OSP) which was commonly full pay for the full time that they were on sick leave. This group was split into those who were confident they would receive OSP indefinitely, and those who were aware that they would receive OSP for a specified amount of time before it would be reduced. Among those for whom OSP was indefinitely available, this removed all financial worries about the time they were off and allowed them to ensure they had fully recovered before returning to work. This was also the case for participants who were confident they would recover a long time before their OSP ran out, for instance participants who knew they had up to 6 months of OSP before it reduced.

I think the main thing is that I wouldn’t have stayed off work if I didn’t have it, so I think it just meant that I was able to heal quicker right and invest that time into actually looking after myself. Because my operation was on my foot I needed to keep my foot elevated, so I could have had my laptop on my knee and continued working while I did that but I don’t think I would have healed as quickly.

Participant who went on long-term sickness absence due to other physical conditions.

However, for those whose sickness absence was likely to extend beyond the duration that they would receive OSP, this time limit often created a pressure to return to work before they were ready to avoid the oncoming reduction in pay. In some cases, line managers had the power to extend this period of OSP. In these instances, a good relationship with their line manager allowed participants to feel safer and less pressurised by the deadline, whereas a poor relationship with their line manager formed a barrier to more flexible arrangements.

When I returned to work from my long-term sickness at the start of 2024 it was because I was going down to half pay. I probably could have done with an additional couple of weeks off at full pay to enable me to have been in a better state of mind and healthier returning to work, but my line manager wouldn’t consider that. I was in a position where I had to go back to work because otherwise financially I’d be unable to sustain myself and I’d have had to give up my accommodation and other things if I’d have gone down to half pay

Participant who went on long-term sickness absence due to mental health conditions and other physical conditions.

A small number of participants reported that they received only Statutory Sick Pay (SSP) whilst they were off work. These participants reported significant financial difficulty as a result of their reduced income. They reported falling behind on their bills, reducing their budget for food shopping and depleting their savings in order to cover mortgage payments. They consistently described these struggles as stressful and reported that they all added to a pressure on these participants to return to work before they were ready.

Case study 2: Long-term sickness absence due to Musculoskeletal (MSK) conditions

Emma is an Office Manager at an engineering company and has been in the role for under 2 years. She earns £25,000 to £29,999 per year. She describes her health as “very poor” due to her multiple long-term health conditions, although she rarely takes sickness absences due to her health.

Emma broke her ankle, which led to a 3-month sickness absence from work. She received a 3 month ‘not fit for work’ note from the hospital. Before this, Emma was struggling to manage her health and work because her health conditions caused pain and fatigue, which she feels have worsened since the injury. Emma received Statutory Sick Pay (SSP) during her absence, as her employer did not offer Company Sick Pay. Only receiving SSP had a significant impact on Emma, as she had to rely on the additional financial support she was receiving through her Universal Credit (UC) claim and some personal savings.

[The absence] had a big impact on my personal life, especially financially-wise as well. I’m worried about money now because my employer only pays me statutory sick, so they don’t pay sick pay or anything like that, so I’ve been living off what little Universal Credit I get and what savings I had, so that’s dwindled now. I’ve got very little savings now as well, which is quite frightening.

Before her sickness absence, Emma worked from home 2 days a week, had flexibility for hospital appointments, and used ergonomic equipment (including a mouse and footrest). Though Emma feels her employer is accommodating, she is concerned about taking too many sickness absences due to fears of losing her job. This worry is heightened by the fact she was recently reassessed as part of her UC claim and deemed unfit for work and work-related activities, which Emma is concerned about disclosing to her employer because she would prefer to remain in work.

Emma reported that her employer does not have formal sickness absence policies and guidelines in place, which led to uncertainty around the payment of SSP and provision of an OH assessment. This forced Emma to use government guidelines to justify her requests to her employer, who eventually agreed and backdated payment of SSP. Emma feels this uncertainty results from a lack of qualified HR professionals at the company.

I didn’t really want to stick my head above the parapet, if you know what I mean, especially with my employer. Every time I’d say something, they go, oh, we’ll have to look and see what our policy is, and a lot of the time they didn’t have policies for it, so they’d just go by whatever the government recommendations were, so I’d have to look that up to say, well, look, this is what the government recommendations are.

Emma’s employer did not offer support during her sickness absence or on her return to work, and her line manager contacted her minimally throughout the absence (involving one text a month). Emma did receive a referral to Occupational Health from the hospital following her injury, which led to adjustments being made at home, though she wondered why this was not provided by her employer. Furthermore, Emma has previously received physiotherapy and has been referred to the pain clinic by the hospital, though is awaiting an appointment.

I would have thought by now they [employer] maybe would have offered me an occupational health assessment, which I’ve had anyway, so it makes no odds.

Emma independently requested a phased return to work from her line manager, including reduced hours (4 hours a day, 4 days a week) and flexible working patterns (over mornings and afternoons). Emma initially returned to work 4 hours a day, 4 days a week, across mornings and afternoons. This was an informal agreement, rather than being defined in a return to work plan. Emma was expected to go back to work full-time after a month of phased return, without consideration of her readiness to return. This meant her return to work was not sustainable and she has since been off work due to “burn out”, for around 4 months.

Other financial support

Whilst on sickness absence, a number of participants received financial support outside of SSP. Most commonly, these participants mentioned receiving Universal Credit, Child Benefit, or Personal Independence Payments (PIP). For those receiving only SSP these additional financial supports were essential in helping to cover their monthly bills. There were also a small number of participants who received money from other sources, including: a family member or partner, a care charity grant, their own part-time business, and their own savings.

One participant also remembered that their HR team at work suggested they apply to claim Employment Support Allowance (ESA) at the point where their OSP was coming to an end. This participant reported that they could not face the administrative burden and potentially invasive questions they would have to go through to claim this so they decided not to apply.

I haven’t claimed ESA but when they sent us the letter I just couldn’t face phoning ESA and going through a million questions.

Participant who went on long-term sickness absence due to other physical conditions.

Sickness absence policies and procedures

For some participants, the existence and application of sickness policies and procedures dictated how their sickness absence was managed by their employer.  

Participants were most positive about this when they understood that their employer had straightforward policies which their managers were able to apply flexibly to meet the needs of individual employees. These participants described either simple procedures, like reporting absences with a phone call, or structured but easy-to-follow processes, such as the allowance of 3 days of sickness absence before a case is escalated. Others said policies were applied with discretion and empathy, for example through informal chats with line managers, or managers overlooking absences when they knew that an employee’s recovery was ongoing. These approaches helped participants feel supported and not penalised for their absence

I think it’s something like 3 absences within the year. When I first went back, they said they are not counting that because they realise it’s part of recovery […] they were a little bit flexible.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

For other participants, their employer’s policies were unclear or inconsistently applied, which created confusion and uncertainty. These participants were often unaware of policy details until after absence began, while others had to challenge employers to secure the correct support. There was some inconsistency caused by absences which weren’t formally recorded or where different contracts of different employees within the same workplace had different rules. 

There were also some participants who reported that policies their employer had in place felt too rigid or punitive, with little recognition of individual circumstances. For example, some participants received formal disciplinary warnings whilst off work for surgeries. These policies were often applied strictly and created a pressure to return to work early due to pay restrictions or rigid return to work procedures. Policies dictating that employees on sickness absence should call in to work at specified intervals were also criticised for being unhelpful and unrealistic.

Our process is that you have got to do it in person. You can get disciplined if somebody else phones in for you, which is a bit ridiculous […] then when you are ready to come back you tell your manager and that’s it. There aren’t any other guidelines or policies about being off sick.

Participant who went on short-term sickness absence due to other physical conditions.

Differences by size of employer

Participants’ perception of formal health policies and procedures varied based on lots of factors. There appeared to be distinct patterns among participants working for large employers (organisation with 250 or more members of staff) and participants working for small or medium sized (SME) employers (organisations with fewer than 250 members of staff).^{[footnote 9]}

Among those working for small or medium sized employers, some felt that a formal policy wasn’t required, as managers knew all employees personally so could easily take an individualised approach to managing sickness. In one case, an employer supplemented this with consultation of government guidelines when they were unsure. Where informal policies and procedures were in place, a positive experience was linked to a good relationship between the employee and their line manager, and line managers knowing what support they could provide to employees during a sickness absence. Where small or medium sized employers did have policies in place, they were sometimes aimed at making sure an employee’s absence didn’t impact the rest of the team or reducing absence altogether. This included: checking in with employees on all medical conditions each year, providing wellbeing advice, and providing private health schemes.

We don’t have anything in place (for sickness absence policies), we would try and kind of deal with it ourselves you know - I just ask what the problem is and just talk to people, rather than sending emails and stuff like that, we’ll just talk to people or and ask them if there’s any problem.

Participant with other physical conditions.

Among larger employers, there were more frequent mentions of policies in the context of absence reporting and subsequent disciplinary processes. Unlike at small employers, employees sometimes reported being required to deal with HR or OH teams. There were also several reports where participants had found that their employers were not following their own policies. This included instances of employers not honouring OH recommendations, not honouring policy that allowed adjustments without OH recommendations, or a low awareness and understanding of policies among line managers.

5. Returning to work

This chapter explores participants’ experiences of returning to work after sickness absence. Firstly, it explores participants reasons for returning, their readiness to return and any barriers which prevented them returning more quickly. It then covers return to work conversations and plans and any adjustments and support. Finally, it considers the impact of adjustments and support on participants’ return to work, including their employment outcomes.

Reasons for returning to work

There were multiple factors influencing when participants returned to work. Readiness to return varied, but most often participants reported not feeling fully recovered on their return to work. Some were still receiving treatment or dealing with the impacts of their health condition.  

For many participants the decision was based on several factors including readiness. A mixture of ‘push’ or pressure factors to return were evident as well as ‘pull’ or appeal factors.  For a minority both ‘pull’ and ‘push’ factors were at play.

‘Pull’ or appeal factors driving decisions to return to work

Most often, positive factors influenced participants’ decision to return to work after a sickness absence. These ‘pull’ or appeal factors were more likely to be reasons for those with long-term sickness absences. They were less prevalent amongst those who had taken short-term sickness absences. 

The most common reason for returning was an improvement in their health condition, or agreement from medical staff that they were ready. For some participants being able to undertake a specific physical task, such as sufficient movement to drive, was required for their role. For others it was feeling sufficiently ‘better’.

They [the doctors] said, you know, once 6 weeks is up and you’ve got some movement back […] you’re all right to drive again […] as soon as I was in that position, I was good to go back to work.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

Similarly, for some there had been improvements in family circumstances, for example no longer being needed for caring responsibilities due to a family member’s health.

Wanting to return to work as they enjoyed it, the routine of working, or socialising with others were also common pull factors. Participants often felt their mental health or wellbeing would be improved by returning to work (indeed some reported negative mental health consequences from not being at work). This was more often the reason for those with supportive cultures at work and positive relationships with managers.

Often being at work can be part of the solution for me, rather than part of the problem.

Participant who went on long-term sickness absence due to mental health conditions.

Employers confirming they could put adjustments in place was also a reason some participants returned to work. A phased return with fewer hours or the ability to work from home were key adjustments for some being able to return to work – even if they were not able to fully resume their usual duties.

I was signed off for 8 weeks, but I basically worked from home after about a week and a half […] being the only employee, if I didn’t do bits and bobs, nothing would be done […] I [kept] things ticking over.

Participant who went on long-term sickness absence due to other physical conditions.

Some participants would not agree to return to work until adjustments were in place. In such cases, participants often used fit notes or OH assessment reports to justify these adjustments to their employer. These documents usually included recommendations from an OH assessor or healthcare professional about the type of adjustments employees needed on their return to work, to help them manage their health following a sickness absence. 

Flexibility and communication were important in some participants’ decisions to return to work. The offer of regular check-ins and being able to inform their employer if they were having difficulties made them feel able to try returning even if they were not fully sure they were ready. 

Participants who knew that in the near future they would have further time away from work (for example school holidays), or that they would be retiring were more likely to return sooner, as they knew the length of their return was limited.

What made the difference was knowing that I was going to retire. If I was going back to work thinking I’m still going to have to do this for 5 or 10 years […] I don’t think I could have done it.

Participant who went on long-term sickness absence due to mental health conditions.

‘Push’ or pressure factors driving decisions to return to work

Many participants reported feeling pressure to return to work due to financial or workload concerns, input from employers or worries about repercussions. These ‘push’ factors or pressures were more likely to be reasons for those who did not feel fully recovered or ready to return. 

Financial pressure of feeling unable to continue without their usual wage was the most common push factor, especially as absences grew longer, if OSP was reduced or ceased or if participants were only receiving SSP. Reduced income over a longer period could impact household finances severely – some participants reported not being able to pay their bills or being concerned about losing their home.

I’m going to hit the point where financially, I really need to be trying to get back to work. And that, I suspect, might push me back into the workplace when I’ve got the nagging doubts over whether or not I can really do this.

Participant who went on long-term sickness absence due to mental health conditions.

Some thought they might use up their OSP entitlement and so were worried about how they would manage financially if they needed any more time off within the same year. However, those who were receiving OSP did not typically feel financial pressure to return to work. 

Some felt pressured because of the workload their absence might be placing on others, or because of the impact on the organisation. This generally differed by size of employer – those at larger organisations were more likely to be concerned about the impact of their absence on colleagues’ workload whilst those at smaller organisations were more likely to be concerned about work being able to progress at all. Personal ethics around work and duty, and feelings of guilt also fed into reasons for participants returning.

I’ve got a good work ethic in that respect. I will only be off if I absolutely need to be off.

Participant who went on short-term sickness absence due to other physical conditions.

Fears of negative consequences from taking ‘too much’ time off contributed to decisions to return to work for others. A few reported feeling pressure from their employer. Sometimes, this pressure could be direct, with employers proposing disciplinary hearings or written warnings. Some participants perceived pressure from employers contacting them during their absence or having absence reviews. Participants were often vague about what these negative consequences could be, but ultimately a few were concerned about losing their jobs and others were worried about the impact of absence on their career progression or on how management perceived them.

I don’t want to be having time off because […] if you have so many periods of absence in a certain period of time […] I don’t want to affect my employment […] there are days where I really struggle to be in […] I don’t want to fracture that relationship.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

Barriers preventing an earlier return to work^{[footnote 10]}

The most common reason participants who experienced long-term sickness absences were not able to return to work more quickly was not having desired adjustments in place.

I didn’t want to go off sick in the first place and I felt like if I had adjustments I wouldn’t have needed that long period and probably might not have even developed the way it did.

Participant who went on long-term sickness absence due to mental health conditions.

Participants’ expectations for reasonable adjustments were often set by OH assessments, but the adjustments were not always implemented as recommended due to management conflict. For example, participants thought that adjustments had been agreed with a line manager or OH but then wider management would be unwilling to implement them (or vice versa, thinking that wider management had agreed but their line manager would not put adjustments into practice). These rejected adjustment requests included physical support (for example an ergonomic mouse not being purchased) and changes to working arrangements such as not being able to work from home or not having a phased return.

Employers not implementing suggested adjustments impacted when participants returned to work and for some (who had assumed the OH recommendations or agreements in earlier conversations would be put in place) it also impacted childcare, financial expectations or other arrangements made for an expected return to work.

I was supposed to have started [back at work] 2 months ago […] she [my line manager] was just like, ‘Well, no, you either come into the office or you can’t work at all.’ And I said, ‘Right, fine, I won’t work then because that’s not what was agreed.’.

Participant who went on long-term sickness absence due to mental health conditions.

Participants usually assumed that if adjustments were identified as being helpful in an OH assessment they were entitled to them being in place before returning, and they were used as a negotiation tool to get adjustments put in place, especially if managers were less accommodating. If employers did not implement them, participants felt empowered to delay their return until they were put in place or their health had further improved.

I had the occupational thing and she suggested […] a phased return back because I’d been off for a period of time. And then […] my manager didn’t agree with it. So, it was meant to be like 2 weeks this, 2 weeks that. And […] then [my manager] changed it all and said that I had to take a load of annual leave off and […] that I should break it up more and come back less. So, I wasn’t really being listened to.

Delays to OH appointments could also lead to participants returning later than they might have done. Participants often wanted their OH assessment to be able to negotiate adjustments. 

A stressful working environment, anticipated heavy workloads or staff shortages delayed the return of some participants who had taken a long-term sickness absence. Some of these participants thought a phased return or other working pattern adjustment would not be possible or would not last very long. They felt that returning was ‘all or nothing’ so wanted to delay until they felt more ready.

Return to work plans

The process for returning to work varied considerably. Most participants who had taken a long-term sickness absence had, at minimum, a conversation with their employer about returning, though these were not necessarily formally recorded and not all resulted in formal back to work plans.  

Such conversations were less common for those who had taken short-term sickness absences and were generally only reported by those who had taken continuous absences of at least 2 weeks; only a few of this small group had formal back to work plans. 

Some participants had a plan drawn up prior to their return, whilst others described a plan being put together upon their return. Participants themselves were not always clear whether they had had a formal return to work plan and whether any adjustments put in place were part of this. Indeed, a handful of those who reported they had no return to work plan, or conversation with their employer did report they had adjustments in place, or some form of flexibility offered.  

However, there remained a small group of participants who had taken long-term sickness absences who reported having no plan, conversation, adjustments or flexibility put in place for their return.

Role of Occupational Health assessments and fit notes in return to work

Occupational Health (OH) assessments were common amongst participants who had long-term sickness absences and had occasionally been undertaken by those with shorter absences. Participants described them as assessing their ability to work and supporting them to return. OH assessments were nearly always delivered through the workplace. A few participants had arranged OH assessments themselves, via a local authority, GP or private provision. Meetings were sometimes virtual, sometimes face-to-face although some who had virtual meetings would have preferred a face-to-face meeting. Participants were usually satisfied with their experience with OH, feeling the assessments were suitably tailored to their circumstances and they were understood. A report and any suggested adjustments were often sent directly to managers.

For participants who had OH assessments, the reports and any resulting recommendations were often a critical factor in return to work plans meeting their needs. They felt OH recommendations could be used to objectively justify their requested adjustments, and occasionally OH staff had given them further explanation of their rights to adjustments. A few participants felt that without them, their employer would not have implemented such adjustments.

They agreed to a phased return to work because occupational health told them to.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions and mental health conditions.

A few participants had fit notes which set out their healthcare professional’s advice and recommendations on the conditions needed for a return to work, for example a need for reduced hours or inability to drive for a set time after surgery. As with OH assessments, participants valued having a medical opinion they could present to their employer as reasons for the adjustments they required.

With the doctor understanding [my] condition he can try to say to my boss ‘Well as a result of this he can’t do x, y and z.’.

Participant who went on long-term sickness absence due to other physical conditions.

Case study 3: Long-term sickness absence due to mental health conditions

Claire is a single parent and works as a senior nurse in a hospital, earning £17,500 to £24,999 per year. Her role involves clinical care and office-based work, and she normally works 3 fixed shifts a week. She describes herself as “fairly healthy”. Though Claire would consider her back injury to be her main health condition, she experienced a divorce which led to a period of poor mental health. This resulted in a 3-month absence from work. 

Initially, Claire received a fit note from her GP which recommended that she take 3 weeks off work. Over time, she requested that this was extended through her GP as she did not feel ready to return to work. It was extended to 3 months in total, which she found easy to do through an online NHS app. 

Claire has a good relationship with her line manager, who she feels tries to accommodate her needs. However, she doesn’t feel that her senior managers are very supportive. The senior manager contacted her frequently throughout her absence, asking Claire “intrusive” questions about her wider situation, and offering unhelpful suggestions. The nature of these calls made Clare feel pressured to return to work.

They were ringing me constantly. They’re fully aware of what’s going on, but they wanted to know an update all the time […] it kind of puts a bit of pressure on […] as to you know, you need to be coming back to work.

Claire has been offered an online Employee Assistance Programme through work, though she feels this does not meet her needs as she would prefer to speak to somebody about her experience. Claire is receiving other support through a dedicated charity, which she found through an advertisement at work. She is also receiving support through a chiropractor and private counselling.

I wasn’t being supported at work. They knew I had problems. But it’s a case of ‘don’t bring the problems to work’.

Claire received an Occupational Health assessment before she returned to work. It suggested a phased return to work, which she agreed with her line manager. It included amended hours and flexibility in the days worked. However, the senior manager refused these adjustments before Claire returned to work, which caused her further stress.

That’s caused me a lot of stress, because I’ve managed my life around those arrangements that we’d made. And she changed all my shifts.

Though Claire returned to work, she has found a new job as a nurse in the private sector. The role will allow her to do flexible shift patterns, helping her manage childcare which she feels will reduce burden and contribute to better management of her mental health.

Return to work conversations and development of return to work plans

Those who had experienced a long-term sickness absence

Most participants who had experienced a long-term sickness absence reported having a conversation about adjustments with their employer, shortly before or on their return to work. Some of these resulted in formal back to work plans, but many did not.

I definitely felt like I was getting close to being ready for work. We started to explore it, and we went through the adjustments that could benefit me, and they weren’t set in stone at that point until I told them that I was ready to come back.

Participant who went on long-term sickness absence due to mental health conditions.

Occasionally those who had long-term sickness absences reported they had no return to work plans or discussions about returning, nor did they have any adjustments or flexibilities in place. A few of these participants were unaware they could have had one, which may reflect a lack of awareness of organisational policies by line managers. Indeed, one participant later realised their manager had not correctly followed organisational policy.

This situation was more likely to be reported by participants who only had one long-term health condition which had started in adulthood, and many had been absent at least in part due to a mental health condition. This group returned to their usual working arrangements, with a few remaining absent but planning to return. Those from this group who had returned often reported no review conversations with their employer about how their return was going. More detail about their returns can be found in the section below, ‘Returning with limited or no adjustments’.

There was absolutely nothing done. There was no fit check. There was nothing. I just went back and that was it.

Participant who went on long-term sickness absence due to other physical conditions.

Those who had experienced a short-term sickness absence

Participants that had experienced short-term absences were split roughly evenly between those who did and did not have a return to work conversation. If conversations did happen amongst this group, it was largely for those who had taken continuous absences of 2 to 3 weeks, and they often had serious health conditions including cancer and chronic obstructive pulmonary disease. These conversations tended to take place on their return rather than before their return. Amongst those who did have such a conversation there was a split between those whose discussion resulted in a formal back to work plan and those for whom it remained a more informal, verbal understanding.

Who was involved in return to work conversations?

Return to work conversations and/or adjustments were most commonly between the employee and their line manager. Sometimes discussions were with both the line manager and wider management together. The discussions covered whether the employee was ready to return, and what adjustments needed to be made to support the transition. 

Return to work conversations were commonly informed by OH recommendations for those who had experienced a long-term sickness absence. Less frequently, they were informed by recommendations made by a healthcare professional via a fit note. Levels of employee input varied, though conversations were most commonly driven by the employee or their line manager rather than by wider management. Where it was driven by senior management, this took the form of adjustments being proposed, which in these cases satisfied the participants.

Types and approaches to return to work plans

Return to work plans took various forms. A great deal of overlap with return to work conversations was evident. Plans could be verbal agreements made during a return to work conversation, or a write up of the outcome of these discussions shared in writing with a HR department or wider/senior management and the employee, via email or letter. Some participants described notes being added to their employment record or an online portal. It was often unclear to participants if they had a return to work plan, or if the adjustments agreed in their return to work conversation constituted a formal plan.^{[footnote 11]}

There was some evidence of line managers being unaware of organisational policies, for example, a line manager wrongly categorising their absence so it did not trigger the development of a return to work plan which the employee believed it should have. 

Where participants understood that formal return to work plans were in place, they usually reported they had been agreed between themselves and their line manager in the lead up to the return to work. Sometimes the HR department or wider and/or senior management had to sign off the plan for it to be implemented. This step caused some concern and confusion where participants thought adjustments recommended by OH, or discussed with a line manager had been agreed but then were not implemented.  

The amount of input participants had into their plans varied, but it was often driven by the employee with their line managers support or jointly by both parties. More rarely the contents of plans were driven by senior and/or wider management with little or no input from the employee, though the participants interviewed were happy with the resulting plan as they still felt consulted and that their OH assessments, fit notes and discussions with line managers had been taken into account.

I drove it because I wanted to get back to work. I knew what the potential issues were, so I put suggestions forward [saying], ‘Okay this [adjustment] is going to work for me.’

Participant who went on long-term sickness absence due to mental health conditions.

A few participants did not think they had formal return to work plans but still reported adjustments or some flexibilities being in place or offered. This included both those who had long and short-term sickness absences, and some who were absent at the time of the research but planned to return.

Case study 4: Long-term sickness absence due to other physical conditions

Rachel is currently employed full-time in a sustainability role in the public sector, which is both home and office based. She has been in this position for three months, having previously worked in another role in the same organisation since 2017. When asked about her general health, Rachel described her health as ‘good’. She also mentioned that she was diagnosed with cancer in 2020 and is still feeling ongoing health anxiety and brain fog, but the effect of this varies day to day. Rachel has had multiple sickness absences due to her ongoing health conditions, though her most recent absence was following corrective surgery on her foot which related to her cancer diagnosis. This absence lasted 5 weeks.

Before Rachel’s return to work, a phased return plan was put in place to support her transition back to work. This plan was developed collaboratively between Rachel and her line manager. Rachel also had a referral to OH before returning to work to support the development of the plan.

I did have an occupational health referral as well. They had regular updates with me and discussed when it would be right for me to return to work. So that was really helpful and then they also suggested phased return, things like that when I went back to work, so they suggested how I should return to work.

The return to work plan was developed following a series of weekly conversations between Rachel and her line manager. These discussions, supported by the input from an OH professional, focused on identifying the adjustments Rachel would need and agreeing the structure of her phased return. Once agreed, the plan was documented on a Word document and shared with Rachel and senior leadership. It outlined a phased approach, starting with 4-hour workdays and gradually increasing to full-time hours over 4 weeks. Adjustments were made to her working conditions, including flexibility in office attendance (averaging 1 day per week) and the provision of ergonomic equipment, such as a height-adjustable desk and footrest, to support her recovery.

Rachel highlighted that her line manager was crucial in driving the development of the return to work plan, ensuring it was tailored to her needs and informed by the OH guidance. This supportive approach differed to previous experiences where she felt pressured to return to work prematurely. Rachel noted that the collaborative and empathetic process allowed her to fully recover and return to work feeling ready and capable.

I genuinely felt like I was ready to return, in previous absences I feel like I was returning before I should have. But with this one I think that I’d given myself the time to heal, and with the adjustments in place for me going back with the phased return, and the home working because I couldn’t drive still at the point when I did return to work. And that just really… it just made it feel like I was genuinely ready to go back which is probably one of the first times I’ve actually felt that way when returning from an absence.

After Rachel returned, this supportive and collaborative approach continued. Her manager conducted weekly reviews with her to monitor her progress and ensure the plan remained appropriate.

Adjustments, support and their impact on returning to work

Adjustments were frequently, but not always, written in a formal return to work plan. Some participants reported they were agreed during informal conversations with managers. 

Many of those who had a sickness absence reported some form of adjustment was put in place for their return to work, although as would be expected it was less common amongst those who had shorter absences.

Adjustments for a return to work

Reduced hours were the most common adjustment put in place for those returning to work, especially for those who were returning from long-term sickness absences of at least 4 continuous weeks. This took different forms – some worked fewer but full days, some worked fewer hours each day. For some it was quite short-term, for example they built back up to full time hours by adding an extra day per week. This is a unique adjustment mentioned in relation to a sickness absence and return to work, and was not mentioned as an adjustment to manage health generally at work (in Chapter 3).

Changes to working arrangements including workloads and tasks were similarly common, again especially for those who were returning from long-term sickness absences of at least 4 continuous weeks. These varied and included working from different sites, not lifting heavy objects, undertaking more administrative and fewer physical tasks, not being required to be ‘on call’ or not being required to work night shifts. Adjustments to workloads and tasks were often made to facilitate changes to working hours. Some were also encouraged to take extra breaks during their working hours.

Working from home was not as commonly reported as an adjustment but was possible for some as part of their return to work. Others had mentioned this was already possible, and so was not specifically offered as a return to work adjustment. 

Adjustments to working patterns were implemented for some, but not many participants returning from sickness absence. This was more common for those who had short-term absences. These changes could include, for example, avoiding particularly busy days, allowing for later starting times, or swapping night shifts for day shifts.  

Ergonomic equipment including chairs, keyboards and footstools were provided for a few participants on their return to work. Employers arranged for these to be set up at the participants’ home in a handful of cases. 

Other practical physical adjustments included being able to work near toilets or lifts, or for example a teacher having their own classroom, so they did not need to carry heavy books around.

Case study 5: Long-term sickness absence due to other physical conditions

Susan has worked in an administrative role within the sales team of a manufacturing company for 9 months. She earns £17,500 to £24,999 per year. She has been at the company for 3 years in total. In her previous role, she experienced a longer sickness absence resulting from stress and poor mental health, due to the nature of the work. Susan has multiple health conditions but would describe her main health condition as Crohn’s Disease. She describes her general health as “pretty good”, though it fluctuates.

Susan underwent abdominal surgery which resulted in a 2 month sickness absence from work. Though the surgery took place at the hospital, Susan was provided with a 3 month ‘not fit for work’ note by her GP. Susan received Company Sick Pay during her sickness absence, at full pay, which was unexpected, as she only received Statutory Sick Pay (SSP) in her previous role. 

When Susan notified her employer about the upcoming surgery, she received support from Occupational Health (OH), a third-party contractor. Before the surgery, OH contacted Susan to understand how they could support her at work. Susan did not require extra support, as she was already working from home which allowed her to manage her health and work. They had a further conversation about the return to work following the surgery, which Susan found “really supportive and really helpful”.

Susan described the general relationship with her team leader and colleagues as “good”, due to it being a small “close knit” department. During her sickness absence, Susan was in regular contact with her team leader. They had fortnightly conversations via video call, orientated towards the support the company could provide Susan while she was on sick leave. The notes from these discussions were shared with HR. 

After 2 months off work, Susan’s health had improved, and she felt ready to return to work. Her ability to work from home contributed to her readiness. On notifying her employer, the HR department requested that the 3-month ‘not fit for work’ note was updated to include a phased return to work. Susan asked her GP to amend the note, which they did after some reassurance that she was ready to return.

I had asked the fit note to [include a] phased return after 2 months, but it didn’t. It just said not fit for work for 3 months. So, when I asked if I could have a phased return, HR said ‘if you don’t mind, please can you get a fit note that says that?’ which took some doing, but I did eventually manage to get a fit note off the GP that said phased return is okay.

Susan then phased her return to work, gradually increasing the number of days she worked from home until she was able to work full-time. Following this, she gradually increased the number of days she worked in the office (e.g., 2 days the first week, then 3). The return to work plan was developed collaboratively with her line manager and shared with HR and included the adjustments to working hours and arrangements described above. The office adjustments that Susan had in place before her surgery, such as a standing desk to support with back pain, were reinstated before she returned to the office.

When I asked to return to work, I [did a] phased returned at home. And then once I was full-time and coping, I [did a] phased returned into the office because I’d been working from home for a year and it was quite bonkers.

Susan felt supported by her employer in shaping her phased return to work. Susan was reassured that her workload could be reduced if it became too difficult to manage her health and work, which she said contributed to her returning more quickly because the arrangements were flexible. Susan has been at work at the same company since she returned following the absence.

You’ve got that safety of if you say, actually, I’ve pushed myself and I can probably only do one day in office, they would have been absolutely fine with it […] You knew that if you said, listen, I’m struggling, they would have said, well, you know, let’s reduce it.

Other support for returning to work

Managers offering flexibility, being supportive of the adjustment offer and being personally understanding or sympathetic were the main factors which made participants feel supported when returning to work (other than any adjustments themselves).

Participants felt especially valued knowing their employer was willing to be flexible around their return to work. They often recalled feeling uncertain how long an absence they needed, what level of work they could cope with on their return and how sustainable it would be. Those who were told they could readjust their working patterns, or take more time off if necessary, felt most supported and satisfied with the return process.

I felt the whole way through that if anything felt too much, I could just raise it with my boss and be allowed and afforded the time to take it easy for a bit longer. Luckily, I didn’t need to, but I felt like the option was there.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

This flexibility was often attributed to the employee having a good personal relationship with their line manager or wider management, but could also be due to engagement with OH or the employer’s policies and procedures. Participants with either a long-term or short-term sickness absence all agreed that their employer’s flexibility was important, including some who had returned from long-term absence with no other support or adjustments in place.

For me personally, my line manager listened to me. She empathised with me as well. A lot of understanding. I felt in a very safe place that we could have had those honest discussions.

Participant who went on long-term sickness absence due to mental health conditions.

Similarly, those who were given some autonomy to implement adjustments as suited them felt understood, trusted and supported to return. Regular ‘check-ins’ following the return to work facilitated participants being able to raise the need for changes to any agreements and to discuss their needs.

They also just kept sort of checking in […] if I did start to feel a bit unwell again, the option was always there just to be able to leave early or whatever, so it was again very, very flexible.

Participant who went on long-term sickness absence due to other physical conditions.

Continued engagement with OH was highlighted as providing continued support for a few returning participants. 

A few participants reflected on their employer’s general support for health and wellbeing (for example, access to helplines). They reported that it was reassuring that these were available, though few used these specifically after returning from a sickness absence.  

A couple of participants were also offered support or mentoring from specific members of staff upon their return, though this was not always welcomed due to concerns about privacy and their relationship with the colleague.

Returning with limited or no adjustments^{[footnote 12]}

A sizeable number of participants who had taken long-term sickness absence returned with no adjustments. Amongst those who had shorter absences of two or more weeks when combined, most did not have any adjustments put in place.

Participants who had no return to work conversation or plan at all often had no adjustments or support as these were never discussed or offered. This group typically assumed they had to return to the exact same role, duties and hours. Some returnees were unaware they could have discussed or requested adjustments despite having long-term absences of at least 4 continuous weeks. A couple of these cases were absences due to depression or anxiety, perhaps indicating lower employer awareness of possible adjustments for individuals who were absent due to their mental health.

In hindsight, maybe they could have spoken to me and said, are you happy to go back to full time […] or do you need further phasing hours […] but they didn’t and I didn’t ask because I was worried about losing my job.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

A few who were offered adjustments such as a phased return rejected them as they were concerned about a resulting drop in pay, though they had not all checked that this would be their employer’s policy. This indicates that employers should be clear about their offer.

Some, including many of those who had short-term absences, felt fully recovered and reported no need for any adjustments or support. Those who worked part-time before their absence were less likely to have, or want, reduced hours upon their return.

There was also a small group who did have at least an informal return to work conversation but appear to have been told no adjustments were possible by their employers.

Rarely, but in a few cases, adjustments had been suggested by OH, in a fit note or in discussion with managers, but were not implemented. Participants were not always informed why their requests were not granted. When reasons were given, they included the nature of their role or there being no ‘lighter’ role available, for example their role had to continue mainly involving physical tasks, or being public facing, for example nursing. Some were told the requests did not meet organisational ‘needs’.

I said, ‘Could I return on light duties?’ but they said there was no job roles available. So I couldn’t come back. I either had to stay off or come back on full duty.

Participant who went on long-term sickness absence due to other physical conditions.

Contractual agreements were raised as barriers to adjustments being allowed in some circumstances, for example when the employee had not reached the absence threshold for a phased return to work.

Participants indicated that employer reluctance seemed to be the only factor for some adjustments not being implemented. In a few rare cases participants at large organisations made formal complaints, took it up with trade unions or threatened their employer with ‘court action’ as the adjustments had been recommended by health professionals.

I’m sure that they broke laws and I did have to put in a complaint about what they did.

Participant who went on long-term sickness absence due to mental health conditions.

Workload, and impact on colleagues sometimes led to returning participants feeling pressured to work more hours than agreed with management. Where workloads and responsibilities were not adjusted in conjunction with reduced hours or phased returns participants did not generally find them successful.

Impact of adjustments and support

Participants who returned with adjustments in place in relation to their working hours, workloads or other arrangements reported that the adjustments enabled them to return at their own pace. Many who had adjustments in place reported they would not have been able to return without them, to their usual role or hours.

So I think I was ready to go back. Maybe not to be able to do my full role, but just get back to doing something.

Participant who went on long-term sickness absence due to Musculoskeletal (MSK) conditions.

Other examples of the positive impacts of adjustments on participants included not being required to work from the office which gave them more control over their working hours (for instance, working hours flexibly over the day), not being required to travel to specific sites (for instance, those further away) which reduced travel time, adjusted working patterns which enabled participants to take their medication at home so the side-effects would not affect them at work, reduction in responsibilities meaning a return did not cause stress, and a specialist desk enabling them to avoid pain.

If my knee is starting to twinge sitting down […] I have a rising desk […] I can sometimes work standing up […] it’s good that I’m able to continue working in those situations […] [without it], I doubt my work could be as productive because my mental focus would be [on my pain] rather than on the work.

Participant with Musculoskeletal (MSK) conditions.

Supportive managers, or knowing there was the potential for flexibility in their working arrangements, had very positive impacts on participants experiences of returning, and on their initial willingness to do so. These flexibilities encouraged earlier returns, as employees felt comfortable that if adjustments did not work, or their health worsened they could change the arrangement. Regular meetings to review arrangements and their health reassured participants that employers were willing to listen and support them.

Many who had returned from long-term sickness absence felt their current role was now a good fit for them and their situation. This was often due to the adjustments which had been made (including being able to work from home, reduced hours, flexibilities, and ergonomic equipment). Many would be reluctant to leave their current employer in case future employers did not agree to such adjustments. A few participants thought the adjustments were essential because of their caring responsibilities rather than their health.

The work-life balance of being able to work from between home and the office [makes my role a good fit for my situation]. They’re very understanding and they’ve been very flexible […] very understanding and made allowances so that I can continue working and care for [my autistic son].

Participant who went on long-term sickness absence due to mental health conditions.

Some negative impacts of adjustments were reported, though very rarely. These included:  

• reduced hours resulting in reduced pay (though others with phased returns continued to receive full pay) 

• reduced hours impacting colleagues’ workload so that the employee returning did not feel comfortable working fewer hours  

• having flexi-time or no set hours sometimes meaning no fixed finish time or hours per day  

• ability to work from home created more pressure to return to work sooner than would have been possible if returning to an office or another location

The flexibility sometimes can be a bit difficult as well […] there’s no limit for the amount of time I am working per day. So sometimes I just overwork a lot for a long period of time.

Participant who went on short-term sickness absence due to mental health conditions.

Employment outcomes^{[footnote 13]}

This research was largely undertaken with employees who had taken sickness absence but were back at work. 

Amongst the few participants who were absent from work but had plans to return (which included those who had taken both long-term and short-term sickness absences), all had multiple long-term and fluctuating health conditions. Reasons for their current absence were mixed but none were due purely to mental health conditions.

None of this group who were absent but planned to return had a formal back to work plan, though some reported having back to work conversations or discussions about adjustments with their employer. Some also had adjustments including reduced hours offered or put in place for previous absences, though none had agreement to be able to work from home.

Most of those who had taken long-term sickness absence had returned to the same employer, though many had minor or temporary adjustments to their role in the form of different hours or duties. A small group permanently changed roles with the same employer. These changes included switching to less physical duties, reducing the number of staff they had to manage and roles which did not require travel. Similarly, some reported a permanent change to contractual arrangements to reduce hours, have flexi-time, or work from a different location. Often caring responsibilities also contributed to wanting these permanent changes.

For some of those who did not feel ready, the return to work caused additional worry. This included those who went back to the same job with adjustments, those who went back without adjustments and those who were not back at work yet. Some reported returning too soon as it became unsustainable to continue without further absence (more commonly for those whose mental health contributed to their sickness absence). A couple of participants were considering whether they should leave their employment.

I felt that I was probably returning a little bit too early, especially with the fact that I then came down with shingles a few months down the line […] I didn’t allow myself that time to fully recover.

Participant who went on long-term sickness absence due to other physical conditions.

There was evidence of a few moving to new employers as they felt their previous role, sector or occupation did not fit well with their health needs, or that their employer was unsupportive. This included some who had moved prior to their most recent sickness absence, and some who had only had short-term absences.

Some of these participants who had changed employers did so because their previous employer was not flexible, or the job itself had contributed to their ill health. In a couple of more extreme cases participants reported employers did not believe the impact of their condition.

They couldn’t understand why one day I was spot on and the next day I would slow down. [It was] because the arthritis condition would prevent me from […] picking the orders quick enough […] so consequently, I lost that job down to my health condition.

Participant with Musculoskeletal (MSK) conditions.

A handful of participants decided to take up offers of retirement or redundancy, at least partly because they did not think adjustments would be possible or they had been provided with little or no support during their absence.

6. Conclusions

As mentioned in the introduction, this research sampled those who were in employment; it does not include those who had dropped out of work or had completely left the labour market (for example, due to health conditions).^{[footnote 14]} The findings should be considered with this context in mind.

Amongst participants, long and short-term sickness absences occurred due to a variety of reasons which often overlapped, such as mental health conditions, physical health conditions, and personal or family circumstances. Mental health reasons for an absence were often a mix of conditions which occurred independently from their work, and existing conditions which had been exacerbated by work stressors. Generally, physical health conditions and injuries were not linked to individuals’ working experiences. Only in rare cases did participants feel their work had influenced the need for physical health-related sickness absence.

Lengths of absence varied considerably between weeks and months, with some experiencing multiple episodes due to relapses or premature returns. Where participants experienced a long-term sickness absence, they usually recalled receiving a ‘not fit to work’ note written by their GP. It commonly signed them off for a specified period of time. Where participants recalled receiving a ‘may be fit for work’ note, they often included guidance or recommendations for adjustments. Participants often reported that the process of obtaining and extending a fit note was straightforward. More rarely, participants found the process burdensome.

Many participants received Occupational Sick Pay (OSP) which was commonly full pay for the full time that they were on sick leave. A small number of participants reported that they received only Statutory Sick Pay (SSP). Those on only SSP often turned to benefits, savings, and support from family and friends to keep on top of their bills during this time.

Employer contact during long-term sickness absences was typically from line managers, with positive experiences linked to regular, proactive, open, and empathetic communications. More negative experiences were often linked to very low or very high employer contact. Participants on long-term sickness absence who had very limited contact sometimes felt neglected and forgotten by their employer. On the other hand, those with high levels of contact found this stressful and pressurising while they were managing the impacts of their health condition. These views appeared to predominantly be due to participants not having a ‘good’ relationship with their line manager prior to their sickness absence, which changed the nature of the contact for them. Often this contact did not change over time in terms of nature or regularity. However, in a few instances, participants felt there was a shift in the conversation from wellbeing to return to work, which added pressure for those who did not feel ready to return. Short-term sickness absences often involved light-touch or no contact, which participants commonly found appropriate due to the short-term nature of their absence.

During a long-term sickness absence, the support provided did not often go beyond communications with their line manager, or support that was already in place prior to their absence. However, this did change as their return grew closer. Commonly, participants had one or two meetings with OH as they prepared to return. OH generally advised them on appropriate adjustments for their return to work, such as a phased return or reduced hours. Where additional support was received, this usually involved support from other sources outside of the employer such as healthcare services (private and NHS), charities, and friends and family.

Existence and application of sickness policies and procedures were varied and those with the most positive experience felt their employer had straightforward policies, which managers were able to apply flexibly to meet the needs of individual employees. Those with less positive experiences reported that policies were unclear or inconsistently applied, which created confusion and uncertainty. There were also some who felt policies were too rigid or punitive, with little recognition of individual circumstances.

The most common reason for returning after a long-term sickness absence was an improvement in health, however, participants commonly reported not feeling fully recovered on their return. For many who had experienced a long-term sickness absence, the decision to return was based on additional ‘pull’ or appeal factors such as work benefiting their mental health, having adjustments agreed or general offers of flexibility and support from employers. However, some ‘push’ or pressure factors drove decisions to return to work for those on a short-term and long-term sickness absence. These factors included pressure relating to finances (if OSP was reduced or ceased or if participants were only receiving SSP), concern about workload, or the effect their absence was having on colleagues or the organisation.

The most common reason participants who experienced long-term sickness absences were not able to return to work more quickly was not having desired adjustments in place. Participants’ expectations for reasonable adjustments were often set by OH assessments. However, sometimes participants had agreed an adjustment with their line manager or OH, but then wider management were not willing to implement the adjustment (or by contrast, their line manager was not willing to implement adjustments agreed by wider management or OH).

Most who had experienced a long-term sickness absence reported having a conversation about adjustments with their employer, shortly before or on their return. Some of these resulted in formal back to work plans but many did not. Participants that had experienced short-term sickness absence had a more mixed experience where return to work conversations sometimes did or did not take place. If conversations did take place, it was largely for those who had taken a continuous absence of 2 to 3 weeks. Return to work conversations were most commonly between the employee and their line manager.

Many of those who had a sickness absence reported some form of adjustment was put in place for their return, although unsurprisingly this was less common amongst those who had shorter absences. The most commonly reported adjustments were reduced hours and changes to workloads or tasks. Adjustments that were slightly less common were the ability to work from home, working pattern adjustments, and the provision of ergonomic equipment (however, some had equipment prior to their absence and therefore this may have already been in place). In addition, managers offering flexibility, being supportive of adjustments, and being sympathetic helped participants feel supported when returning to work. However, those that did not have a return to work conversation/plan had no adjustments or support, as these were never discussed or offered. This group typically assumed they had to return to the exact same role, duties, and hours. Some were unaware they could have discussed or requested adjustments.

Participants who returned with adjustments to their working hours, workloads or other arrangements reported that the adjustments enabled them to return at their own pace. Most of those with adjustments in place reported they would not have been able to return without them.

Although most of those who had taken long-term sickness absence had returned to the same employer, some had permanently changed roles with the same employer. There was evidence of a few moving to new employers due to their previous role, sector or occupation not fitting well with their health needs, or due to them feeling their employer had been unsupportive.

Most felt they had received the right amount of support at work, to help them manage their long-term health condition or general health and wellbeing. Many expressed very positive overall feelings about work. Tailored, empathetic and confidential approaches to line management were key to this positivity. For those with long-term health conditions, the level of flexibility and autonomy in their roles was also important in dictating the ease with which they were able to manage their health conditions or disabilities at work.

Those that did not feel they received the right amount of support would have valued a more supportive and tailored line management approach, and offers of flexible working arrangements such as working contracted hours more flexibly, adjusting their workload or duties and working from home (where relevant).

Appendices

Appendix A: Interviews achieved

Table A.1 Breakdown of qualitative interviews achieved

Sickness absence group

Category	Achieved interviews
Continuous sickness absence of 4 or more weeks (‘long-term sickness absence’)	47
Combined sickness absence of 2 or more weeks (‘short-term sickness absence’)	11
Long-term health condition without a sickness absence (‘Not experienced sickness absence’)	17

Current working status (among those who had a sickness absence)

Category	Achieved interviews
Currently working	52
Absent from work with plans to return	6

Length of time taken to return to work (among those who had a sickness absence and are currently working)

Category	Achieved interviews
3 months or less	43
More than 3 months	9

Whether participant has a long-term health condition

Category	Achieved interviews
Yes	65
No	10

Type of main long-term health condition

Category	Achieved interviews
Musculoskeletal (MSK)	15
Other physical	25
Mental health	20
Cognitive	5
No long-term health condition	10

Whether participant has more than one long-term health condition

Category	Achieved interviews
Yes	47
No	18
No long-term health condition	10

Whether daily impact of long-term health condition(s) fluctuates

Category	Achieved interviews
Yes	63
No	2
No long-term health condition	10

How long participants have had health condition(s)

Category	Achieved interviews
Since started working	25
Since childhood	20
Neither or unsure	20
No long-term health condition	10

Gender

Category	Achieved interviews
Male	21
Female	54

Age group

Category	Achieved interviews
18 to 24	4
25 to 34	13
35 to 49	30
50 to 64	26
65 to 75	2

Ethnicity

Category	Achieved interviews
Asian or Asian British	4
Black, Black British, Caribbean or African	3
Mixed or multiple ethnic groups	1
White	67
Any other ethnic group	0

Employer size

Category	Achieved interviews
Small (2 to 49 employees)	12
Medium (50 to 249 employees)	8
Large (250 or more employees)	54
Don’t know	1

Employer sector

Category	Achieved interviews
Administration/Office including Public Sector and Human Resources	8
Agriculture and Land Based Services	0
Arts and Media	0
Automotive Industry, Passenger Transport and Logistics	4
Beauty and Therapy	0
Care/Childcare/Social Care	7
Chemical, Oil and Nuclear Industry	0
Customer Service and Retail	4
Education/Teaching	6
Energy and Utilities Industry	1
Electricians and Building Services	2
Facilities Management	0
Food and Drink	5
Financial Services	2
Health Industry	14
Hospitality Leisure and Tourism	1
Information Technology and Telecoms	0
Manufacturing and Engineering	5
Security and Safety	0
Sports and Recreation	0
Voluntary, Charity and Social Enterprise	2
Other public sector	11
Other private sector	3
Other voluntary sector	0

Appendix B: Topic guide

Researcher introduction – ask all (c. 3 mins)

B1. Interviewer and IFF introduction

Thank you for agreeing to speak with me today, I’m [name] from IFF Research, an independent research agency.

B2. Background to the research

For this study, IFF research have been asked by the Department for Work and Pensions (DWP) and the Department of Health and Social Care (DHSC) to speak to people about their experience of managing their health and wellbeing at work [IF HAVE HAD LONG-TERM SICKNESS ABSENCE: and their experience of time off from work due to longer sickness absence].

Your views will help the government understand more about how people manage their health and wellbeing at work and how they are supported with this, which will help design and refine policies that promote good workplace practices around health and wellbeing.

It is up to you whether to take part

This discussion is voluntary, so it is up to you if you want to take part. If you change your mind at any point during today’s conversation, you can stop talking to me and we will not include anything you have told me in the research.

You can also change your mind about taking part in the research after today’s conversation by letting us know. If you change your mind about participating in this research, please let us know as soon as possible by contacting IFF at employee_selfemployedsurvey@iffresearch.com or 0808 175 6983 and where possible, we will not process this data.

Taking part in this research will not affect your relationships with DWP, DHSC or your employer. Whether you take part or not will not affect your dealings with the DWP and any benefits you may be claiming will not be affected in any way.

B3. How their info will be used

Your views will be looked at together with the views of others taking part in interviews. What you tell me in this discussion today is anonymous and confidential, in line with the Market Research Society’s Code of Conduct which is our professional code. After we have spoken to other people like you, our team here at IFF Research will write up the findings into a report. The report may include some examples of how people like yourself have managed your health at work, and we might include some direct quotes of what you have said, but we will not link these details to you as an individual. The findings will be reported as a whole without identifying any specific individuals.

The only time we will break this confidentiality is if we see or hear something which causes us concern about your physical safety. If this happens, we have a duty to act to make sure you are protected. We would talk to you about what to do and agree actions with you if this happens.

B4. Data use

Additionally, under data protection law (GDPR), you have the right to have a copy of your personal data, to change your personal data, or withdraw from the research at any point. Further information about this can be found on our website in the IFF privacy and GDPR policy. All personal data we hold on you will be deleted within 3 months of the end of the research project, so by the end of January 2026.

B5. Duration

The discussion today will last up to 60 minutes, depending on what you have to say.

B6. Reassurances

No right or wrong answers – we are simply asking for people’s views and opinions.

B7. Thank you for taking part

As a thank you for speaking with us today, you will get a £40 E-voucher.

B8. Reminder about audio (and, if relevant, video) recording

The discussion will be recorded so that we can accurately capture your views, and so researchers can listen back when analysing the data. The recorder is encrypted and only the research team will have access to the recordings. 

Confirm consent to record from participant – if consent not given, please take detailed notes.

B9. Any questions or concerns?

B10. Start recording

Acknowledge consent for being recorded.

C Introduction – ask all (c.3 mins)

C1. To get started, can you tell me a little bit about yourself?

Explore:

• Who they live with 

• How they typically spend their time – work (explore more in next section), caring responsibilities, hobbies

D Employment – ask all (5-10 min)

D1. Thanks for telling me a bit more about yourself. Now I’m going to ask a few questions about your work. What do you do for work?

Explore: 

• How long have you been in the role? 

• What does the role involve? Is it office based or more physical work? 

• How do you find it? Do you enjoy it?  

• How would you describe the environment? Is it quite calm or fast paced?  

• Level of seniority and if supervise others as part of role 

• Working hours – part-time (usually <=30 hours a week) or full-time (usually >30 hours a week) 

• Type of contract – zero hours, casual/ flexible, temporary/ fixed term, permanent, apprenticeship

D2. If not already covered: What type of organisation do you work for?

Explore: 

• Sector – for example, construction, administration, financial services 

• Size of organisation  

• Main activities – for example, private sector, public sector

D3. Have you always done this type of work? (Note for later)

If no, explore what they have done previously (using above probes) and what caused the change

D4. To what extent would you say that your current role is a good fit for you and your situation?

Explore why or why not.

D5. Again, thinking about your current role, what changes or flexibilities, if any, have you experienced to your working arrangements over your time with your employer? For example, to your working hours in terms of what times you work and/or the days you work, or type of contract

If yes, what, if anything, triggered the changes or flexibilities?

D6. How would you describe the relationship you have with your current employer?

Explore: 

• Explore relationship with line manager (as well as company in general) 

• What caused good/bad relationships 

• If held other employment: If relationship with current/recent employer varied from relationship(s) with previous employers – in what ways, what they prefer and why

D7. How much would you say your employer accommodates your general needs?

If feel employer does accommodate needs:

Could you give me an example of how they’ve accommodated your needs? How did this affect you?

If feel employer doesn’t accommodate needs:

How would you like your employer to accommodate your needs in future? How would this affect you?

E Health condition(s) – ask all (5 min)

E1. I’m now going to ask some questions about your health. Please remember, you don’t have to tell me anything you don’t want to. How would you describe your health in general?

Overall good, overall bad, neither good nor bad – why

E2. Would you say that you have any long-term health condition(s)? By long-term we mean anything that is expected to last or will last for 12 months or more

Explore: 

• How many health conditions they have 

• Type of health condition(s) – particularly if Musculoskeletal (MSK) or mental health (MH) 

• How long they’ve had each condition i.e., since childhood or since starting work

E3. How does your health impact your day-to-day life? Can you give me some examples?

Explore: 

• Whether impact of health fluctuates that is, less impact on some days, more impact on other days 

• Whether this impacts the type of work they can do

F Experience of sickness absence – only those from group 1 or 2 who have experienced a long-term sickness absence (25-30 mins)

F1. Now I’d like to explore your experience of sickness absence in the past 12 months. Please can you think about your longest continuous period of sickness absence over this period?

Explore: 

• When it started 

• How long it lasted for

F2. What in particular triggered this sickness absence?

Explore: 

• Deterioration of health condition(s)  

• Diagnosed with new health condition(s) 

• Change in employer/other support

F3. In what ways did your employer support you during your sickness absence?

Note for later and explore: 

• Type of support for example, Employee Assistance Programmes 

• Frequent contact with employer or line manager throughout absence – any signposting or referrals to external support services 

• Any formal guidelines/policies on managing health and wellbeing at work – extent to which these are understood and helpful 

• Adjustments to work or flexibilities around work for example, adjustments to your working hours, adjustments to your workload, change in nature or shape of role, working from home, phased return to work, special aids and equipment etc

F4. Did you provide a fit note to your employer for your sickness absence? What type of fit note was it? Was it a ‘Not fit for work’ fit note or a ‘Maybe fit for work’ fit note?

Explore: 

• Who provided you with the Fit Note? GP or doctor, nurse, Occupational Therapist, Physiotherapists or pharmacist?  

• How clear was it what the fit note said and meant for you? 

• What changes or adjustments were mentioned in the note?  

• Were these changes or adjustments implemented by your employer? If not, explore why. 

• How useful did you find it? What made you feel that way?

F5. How much contact did you have with your employer over the course of your sickness absence?

Explore: 

• If this changed over time 

• Who had contact / type of contact 

• Involvement with line manager v. HR / People teams 

• Feelings about this contact

F6. What type of sick pay, if any, did you receive during your sickness absence?

Explore: 

• Type – Statutory Sick Pay, Occupational or Company Sick Pay, a mix, neither 

• If necessary statutory sick pay: By law employers must pay statutory sick pay (SSP) to employees when they meet the eligibility criteria. Statutory sick pay is £118.75 per week. It can be paid for up to 28 weeks. If an employee is eligible, they are entitled to statutory sick pay for the days they would have worked, except for the first 3. 

• If necessary occupational sick pay: Occupational Sick Pay (OSP) is a scheme provided by employers to offer enhanced financial support to employees who are unable to work due to illness.  

• What, if any, impact did receiving or not receiving sick pay have on you? 

• What, if any, impact did it have on your decision to return to work? 

• Any alternative sources of income – how, if at all, did this help? 

  • What impact did this alternative source of income have on you? 

  • Any impact on your decision to return to work?

F7. What other support, if any, did you receive during your sickness absence? What did this look like?

Note for later and explore: 

• Support from government agencies  

• Support from charities for example, Acas or Citizen’s Advice 

• Support from healthcare professionals for example, NHS, GPs, Occupational Health 

• Support from family and/or friends

F8. If not already covered, what, if anything, could have prevented you from taking this sickness absence?

Explore: 

• More support – explore what would’ve helped and why 

• Improved health

F9. If returned to work, tell me about your return to work following this sickness absence?

Explore: 

• Reasons for returning – better mental and/or physical health, felt ready to return, financial reasons, wider team workload, concerned about progression and my employer’s impression of me 

• If they felt ready to return – if not, what could’ve helped them feel more ready 

• If they returned to the same job – if not, why was this? Were they now unable to do this specific role?

F10. Did you or do you have a Return to Work plan?

[If necessary] A return to work plan is something that outlines how you will return to work and when and what support or adjustments you will need to aid your return. The plan should be specific to you and your job.

If yes had a plan, explore: 

• Development process – who was involved for example line manager, HR, participant (that is, employee) 

• Whether or how documented 

• Nature of content 

• Adjustments made to normal working conditions 

• How long it took to develop 

• Who was driving having a return to work plan 

• Any improvements that would have been helpful in process of developing plan

If not return to work plan, explore:

• if they were aware they could’ve had a return to work plan in place 

• reasons they didn’t have a return to work plan in place

F11. If mentioned receiving employer or other support earlier in the conversation: Earlier you mentioned that [your employer provided support and/or you received support from other organisations] throughout your sickness absence. To what extent did this help you return to work more quickly? 

Explore: 

• In what ways it helped 

• How would you improve this support in the future to help you return to work more quickly? 

F12. If mentioned receiving employer or other support earlier in the conversation: And to what extent did this help you return to work without further absences or long-term absences? 

Explore: 

• In what ways it helped 

• How would you improve this support in the future to help you return to without further absences?

G Managing health at work – all (10-20 mins)

Interview note: for groups 1 and 2 information on managing health at work likely to have spontaneously come out of section F discussion. Section to be kept brief for groups 1 and 2 and yellow highlighted questions to be prioritised.

G1. In this section, I’d like to ask you some questions about how you manage your health and wellbeing at work. I’m interested in how you manage your general health, as well as how you might manage any health condition(s)

G2. In general, how easy or difficult do you find it to manage your health and wellbeing at work?

Explore: 

• Why – examples 

• How this impacts them 

• If easier: What helps them manage their health and wellbeing at work? 

• If difficult: What would need to change for them to be able to better manage their health and wellbeing at work?

G3. If has long-term health condition: Just to touch on the long-term health condition(s) you mentioned earlier. Have you disclosed your health condition(s) to your employer?

If disclosed:

• When did you disclose this? 

• Who did you disclose this to? Line manager, HR 

• What was happening at the time? 

• Was there a particular reason you chose to disclose at that time?

If not disclosed: Can I ask why you haven’t disclosed this to your employer? 

Explore reasons for not disclosing.

G4. If survey info (B7) available: In the survey you mentioned that your health condition(s) impacted the amount, or type, of work you can do in your role. Please could you tell me a little bit more about this?

If survey info (B7) not available: How would you say your general health, or health condition(s), impact the amount, or type, of work your can do in your role?

Explore: 

• How it affects the amount of work they can do – examples  

• How it affects the type of work they can do – examples

G5. How would you describe the general culture around health and wellbeing at your place of work? Could you give me an example?

Explore: 

• Their impression of the following individuals’ feelings towards those with health conditions: 

• Line manager 

• Wider management  

• Peers or colleagues 

• How do the above individuals’ feelings toward those with health conditions impact them

G6. In what ways has your employer supported you to manage your health and wellbeing at work? Can you give me an example?

Explore:  

• Type of support provided for example, Employee Assistance Programmes and meeting with employer or line manager to discuss support needs, signposting to external support services. 

• Any formal guidelines or policies on managing health and wellbeing at work – extent to which these are understood and helpful 

• Adjustments to work or flexibilities around work for example, adjustments to your working hours, adjustments to your workload, change in nature or shape of role, working from home, phased return to work, special aids and equipment etc. 

• To what extent are these types of support actively promoted or encouraged by your employer?

G7. If receiving employer support: How, if at all, has this support helped you at work?

Explore:

• all the ways it has helped is or isn’t helpful 

• How the support has impacted them and/or their life 

• If not helpful: What would need to change for the support to be helpful

G8. If receiving employer support: What challenges, if any, have you experienced when receiving support from your employer?

• Engaging line manager/wider employer/getting adjustments put in place (for example, refusal of adjustments) 

  • If yes: What happened after their employer refused? 

• Personal feelings about adjustments (e.g., fear of disclosure/confidentiality being broken, fear of perception/discrimination from colleagues)

G9. What other support, if any, are you receiving to help you manage your health and wellbeing at work? What does this look like?

Explore:

• Support from the government such as Access to Work 

If necessary: Through Access to Work you can apply for a grant to help pay for practical support with your work for example to help pay for things like specialist equipment, support workers, travel costs, adaptations to your vehicle or physical changes to your workplace. and support with managing your mental health at work. 

• Support from charities for example Acas or Citizen’s Advice 

• Support from healthcare professionals for example, NHS, GPs, Occupational Health. Has your employer been involved in this process at all? How? 

If necessary: Occupational Health services provide advisory and support services to employees, employers and the self-employed, such as providing advice on workplace adjustments, developing written return to work plans, conducting risk assessments in the workplace, promoting healthy eating and exercise, providing physiotherapy treatment, or providing counselling sessions to support return to work. 

• Support from family or friends

G10. If receiving other support: What challenges, if any, have you experienced when receiving support from other organisations?

Explore:

• Engaging with the other support organisations  

• Engaging employer or getting adjustments put in place (for example, refusal of adjustments) 

  • If yes: What happened after their employer refused? 

• Personal feelings about adjustments (for example, fear of disclosure or confidentiality being broken, fear of perception/ discrimination from colleagues)

G11. If receiving other support: How, if at all, has this support helped you at work?

• Explore all the ways it is or isn’t helpful 

• How the support has impacted them and/or their life 

• If not helpful: What would need to change for the support to be helpful

G12. And what, if any, adjustments have you made personally to help manage your health and wellbeing at work? [some examples to prompt on if necessary]: For example, taking breaks and not working beyond your working hours.

G13. What’s been the biggest support to help you manage your health and wellbeing at work so that you can make the best possible contribution?

G14. Do you know if your current employer is part of the Disability Confident Scheme?

• If necessary: The Disability Confident scheme supports employers to create disability inclusive workplaces. The scheme gives free guidance and advice to help employers recruit, retain and develop disabled people in the workplace. 

• How do you feel about them being a part or not being a part of the Disability Confident Scheme?

G15. Only if time for those completing section F: How would you feel about a health and wellbeing adjustments conversation with your employer as soon as you have been employed? By this we mean as soon as you started a new job your employer would have a conversation with you about your health and wellbeing adjustment support needs at work.

• What do you think about this idea? What makes you say that? 

• How helpful, if at all, do you think it would be?

G16. I just want to briefly touch on your previous employment before we move on. Thinking back to your previous employers, how were you supported to manage your health and wellbeing at work? Can you tell me a bit more about that?

G17. Has the approach of previous employers had any impact on how you manage your health and wellbeing at work now? Can you tell me a bit more about that?

H Wrap up – ask all (c.5 mins)

H1. Before we finish, if you could change one thing about how your employer accommodates your health and wellbeing needs, what would it be and why?

H2. And finally, do you have anything else to say about your relationship with your employer, or how they accommodate your needs?

H3. That brings me to the end of my questions. Thanks so much again for taking the time to speak with me. Just before you go can I confirm I have the right information for you, so we can send the thank you for taking part?

H4. Confirm incentive details (£40 E-voucher) and email – list of retailers

Read out: Please be advised that, due to our processing timetable, it may take up to 3 weeks for you to receive your E-voucher payment. Please remember to check your spam folder.

H5. If they need further support, signpost them to:

• For help online: 

• NHS Good Thinking 

• MIND 

• For telephone support: 

• Samaritans: Call 116 123 

• NHS 111: Call 111

1. Participants were either currently working, or absent from work due to ill health with plans to return to work in the next few months. Participants who were not currently working and did not have plans to return to work in the next few months were excluded from the research. ↩

2. It should be noted that this definition of SSP was accurate as of the survey fieldwork dates. In March 2025, changes to SSP were announced that mean up to 1.3 million people on low wages who find themselves ill will receive 80% of their average weekly earnings or the rate of SSP at £118.75 per week – whichever is lowest. The waiting day period will also be removed, so SSP will be paid from the first day of sickness absence rather than the fourth. Further detail on the changes announced in March 2025 can be found here: Changes to sick pay will help people stay in work and grow economy - GOV.UK ↩

3. Participants were either currently working, or absent from work due to ill health with plans to return to work in the next few months. Participants who were not currently working and did not have plans to return to work in the next few months were excluded from the research. ↩

4. A health and wellbeing adjustment conversation is normally a discussion between an employer and employee at the start of a new job, about health and wellbeing adjustment support needs at work. ↩

5. Participants were either currently working, or absent from work due to ill health with plans to return to work in the next few months. Participants who were not currently working and did not have plans to return to work in the next few months were excluded from the research. ↩

6. S11 (in the survey) – Those who said, in the past 12 months, they have been off sick for a continuous period of 4 weeks or more (including weekends). Not modularised (Base: All employees). ↩

7. Derived from C6-C9 (in the survey) – Total days of sickness absence in the past 12 months. Module 2 (Base: Employees with a sickness absence in past 12 months, excluding those who said they had a long-term sickness absence at S11). ↩

8. Fit notes are not issued for the first seven days of a sickness absence, including non-working days (for example, weekends and bank holidays), as employees can self-certify during this period. ↩

9. Fewer than 250 staff and less than or equal to £44m in annual turnover or a balance sheet total of less than or equal to £38m. ↩

10. There is much overlap here with the later section, ‘Returning with limited or no adjustments’ ↩

11. For those who were unsure if they had a return to work plan, the research defined them as ‘Something that outlines how you will return to work and when and what support or adjustments you will need to aid your return. The plan should be specific to you and your job.’ ↩

12. There is much overlap here with the earlier section, ‘Barriers preventing an earlier return to work’. ↩

13. This section explores possible reasons behind different employment outcomes, as based on qualitative research with a defined group it does not present likely outcomes for any group or factor. ↩

14. Participants were either currently working, or absent from work due to ill health with plans to return to work in the next few months. Participants who were not currently working and did not have plans to return to work in the next few months were not interviewed. ↩