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Winter sickness absence 2025 – A guide to managing sickness absence

SECTION GUIDE

Why managing sickness absence matters more than ever for SMEs

Sickness absence is rising this winter, and many SMEs are feeling the impact more sharply than larger employers. For smaller teams, even one unexpected absence can create immediate pressure on workloads, client delivery and staff wellbeing.

If this feels familiar, you’re not alone. Across the UK, SMEs are reporting:

  • Higher levels of respiratory illness
  • Longer recovery times due to delays in accessing medical care
  • Increased MSK and anxiety-related long-term absence
  • Managers feeling uncertain about process or support options
  • Teams experiencing fatigue under higher workloads

This supportive guide will help you manage sickness absence confidently and compassionately, with practical steps that protect both your people and your organisation.

 

managing sickness absenceimpact hr ident

Understanding the current picture: Why sickness absence is rising

Before managing sickness absence effectively, it helps to understand the pressures driving higher absence across UK workplaces this winter. Many of these trends are national, but their impact is felt more intensely in small and medium-sized organisations, where resilience and capacity are naturally tighter.

Below are the key factors shaping sickness absence in Winter 2025 — and why they matter.

  • Early and intense winter illness

    Seasonal illness is arriving earlier and circulating for longer. UKHSA surveillance data shows that flu, RSV and COVID-19 activity began increasing several weeks ahead of the usual peak, extending the period in which employers can expect higher absence.

    What’s driving this early spike?

    • Shifts in post-pandemic immunity mean some viruses are spreading faster or out of their usual seasonal pattern.
    • Hybrid working “gathering days” lead to higher transmission when teams come into the office at the same time.
    • Reduced flu vaccination uptake among working-age groups increases vulnerability.
    • Limited access to timely GP appointments results in prolonged symptoms or repeat absences.

    Further information: National flu and COVID-19 surveillance reports: 2025 to 2026 season

    For SMEs, this means more people off at once, longer periods of disruption and greater strain on already-stretched teams.

  • Record levels of long-term sickness

    The UK is experiencing historically high levels of long-term sickness. According to the Office for National Statistics (ONS), more than 2.8 million people are currently out of work due to long-term health conditions — the highest level on record.

    This national picture translates into everyday workforce challenges, including:

    • More employees experiencing long-term conditions while remaining in work
    • Increased likelihood of recurrent absence
    • Greater need for structured support, adjustments and careful case management

    In short: long-term sickness is no longer unusual. It’s something SMEs need to plan for and manage proactively.

  • MSK and mental health issues dominating absence

    Musculoskeletal (MSK) conditions and mental health challenges now represent two of the most common causes of sickness absence across the UK — and often the most complex to manage.

    MSK conditions

    These include back pain, neck pain, joint issues and repetitive strain injuries. Many stem from poor home-working setups, sedentary working habits or physical strain in manual roles.

    Mental health issues

    Stress, anxiety and low mood are increasingly common, often linked to heavier workloads, financial pressures and stretched resources — all factors more acute in SMEs.

    Why these issues dominate:

    • They typically require more time to diagnose, treat and recover from.
    • Symptoms fluctuate, making support needs unpredictable.
    • Employees often delay seeking help, leading to late intervention.
    • NHS backlogs extend waiting times, prolonging absence.

    These conditions require a sensitive, structured and sustained approach — not a one-off conversation.

  • Delayed access to treatment extending absence duration

    One of the biggest contributors to longer sickness absence is the difficulty many employees face in accessing medical support. NHS waiting lists remain high across primary care, mental health services, physiotherapy and diagnostics.

    Delays include:

    • Struggling to get a GP appointment within a reasonable timeframe
    • Waiting months for physiotherapy referrals
    • Long delays for mental health assessments
    • Slow specialist referrals for MSK conditions

    With timely care harder to access, conditions that could have been managed early become more entrenched, costly and disruptive for both the employee and the employer.

    This is why early Occupational Health advice, reasonable adjustments and supportive management conversations are more important than ever.

  • Why this matters for SMEs

    Higher sickness absence does not impact all organisations equally. SMEs face unique challenges:

    Less capacity to absorb absence

    • Missing even one or two people can significantly interrupt operations.

    Increased pressure on remaining staff

    • Teams often shoulder additional responsibilities, increasing stress and fatigue.

    Greater risk of further sickness absence

    • When workloads grow unevenly, burnout becomes more likely.

    Managers juggling multiple roles

    • Managing absence can feel overwhelming when combined with operational duties.

    Customer impact is immediate

    • Delays or reduced responsiveness are more noticeable.

    Understanding this context helps SMEs take a proactive, compassionate and structured approach to managing sickness absence — rather than reacting once problems have already escalated.

  • managing sickness absence

Managing short-term sickness absence

Short-term sickness is a normal part of winter, but for SMEs it can create disproportionate disruption. Smaller teams have less flexibility, workloads are more concentrated, and customer commitments often rely on individuals rather than large departments. A clear, compassionate approach to managing short-term sickness absence helps businesses stay steady while giving employees the support they need to recover quickly and return safely.

Short-term absence typically includes colds, flu, minor respiratory infections, stomach bugs and short-duration flare-ups of existing conditions. While the impact on the individual may be temporary, the impact on small teams can be immediate.

Supportive steps for managing short-term absence

Short-term sickness absence is often easier to manage when expectations are clear, communication is supportive, and processes are consistent. These steps help reduce disruption and create a predictable, compassionate framework.

  • Clarify reporting expectations

    Having a well-understood reporting process helps prevent confusion and ensures managers can respond quickly.

    Employees should know:

    • Who to contact when they are unwell
    • How early they need to report absence (e.g., before their shift starts)
    • What information to provide, such as the nature of the illness and likely duration
    • How they should stay in touch if their condition changes

    Clear expectations reduce uncertainty for employees and ensure managers can plan cover or adjust workloads efficiently.

  • Use return-to-work conversations

    Return-to-work discussions are one of the most effective ways to manage short-term absence sensitively and proactively. Unlike reviews for long-term absence, these conversations can be brief and supportive.

    A good return-to-work conversation will:

    • Welcome the employee back
    • Check whether they feel ready to resume full duties
    • Identify any remaining symptoms that may require short-term adjustments
    • Offer reassurance and support
    • Provide a chance to spot early signs of stress or burnout

    These conversations also promote openness, reduce repeated absences, and show employees that their wellbeing is taken seriously.

  • Record absence consistently

    Consistent documentation helps SMEs identify patterns early and prevents potential issues from being overlooked.

    Recording short-term absence allows you to:

    • Identify frequent repeat absences
    • Spot potential underlying health concerns
    • Understand seasonal or role-specific patterns
    • Ensure fairness and consistency across teams
    • Support constructive conversations if absence becomes problematic

    HR software such as Breathe HR makes this easier and provides useful reports to support future decisions.

  • Promote wellbeing and hygiene practices

    Taking simple preventive steps creates a healthier workplace and reduces the likelihood of widespread short-term illness.

    Helpful actions include:

    • Encouraging regular handwashing
    • Keeping shared equipment clean
    • Improving ventilation where possible
    • Reminding employees not to attend the workplace when unwell
    • Providing tissues, sanitiser and cleaning materials in shared spaces

    These small actions help reduce illness spreading and demonstrate a proactive commitment to employee wellbeing.

Put this guidance into action

Please find further useful guides on managing sickness absence in our impact Hub.

Download Managing Short-Term Sickness Absence Guide

Download Managing Long-Term Sickness Absence Guide

Download Return to Work Interview Form Template 

 

Managing long-term sickness absence

Long-term sickness absence can be one of the most challenging areas for SMEs to navigate. It often requires a careful balance of empathy, legal compliance and operational planning — all while supporting the individual and maintaining fairness for the wider team. Because smaller organisations have fewer people to share the impact, long-term absence can feel especially difficult.

Long-term sickness absence generally refers to any continuous absence lasting four weeks or more, though many SMEs will start reviewing a case earlier if it becomes clear recovery may take time.

Common causes of long-term sickness absence

Long-term absence can arise from a wide range of conditions. While musculoskeletal and mental health issues remain the most common nationally, SMEs frequently encounter long-term absence related to:

  • Musculoskeletal (MSK) conditions

    Such as back pain, sciatica, joint problems, arthritis and repetitive strain injuries. Hybrid working has made poor ergonomics a significant factor.

  • Mental health conditions

    Including anxiety, stress, depression, burnout, trauma response and long-term fatigue. These conditions often fluctuate, making them more complex to manage.

  • Chronic health conditions

    Such as diabetes, asthma, epilepsy, heart disease, ME/CFS or autoimmune conditions. They may require ongoing monitoring and occasional reviews of workplace adjustments.

  • Cancer diagnosis and treatment

    Cancer-related absence often involves treatment cycles, surgery, fatigue, reduced mobility and long-term recovery support.

  • Neurological or cognitive conditions

    Conditions such as long COVID, migraines, seizures, or nerve-related conditions can affect stamina, concentration, or reliability in variable ways.

  • Post-operative recovery

    Employees may require extended time off following surgery or medical procedures, including phased rehabilitation.

  • Pregnancy-related illness

    This may involve conditions such as hyperemesis, perinatal anxiety, pelvic girdle issues, or risks associated with the pregnancy.

While health conditions vary widely, the principles of managing long-term absence remain consistent

A supportive and standard approach to managing long-term sickness absence

Maintain regular communicationReveal

Regular, gentle check-ins help employees feel connected and supported. This does not mean discussing work or pressuring someone to return — it means:

  • Asking how the employee is doing
  • Checking whether anything has changed with their health
  • Offering reassurance and signposting support
  • Keeping the employee informed of next steps

Frequency depends on the situation, but every 1–2 weeks is generally appropriate unless the employee requests otherwise.

Why this matters:

It reduces anxiety, prevents misunderstandings and supports an eventual return-to-work plan.

Request fit notes and maintain documentationReveal

Fit notes provide essential information about:

  • The nature of the condition
  • Expected recovery time
  • Whether the employee may be fit for work with adjustments

SMEs should keep clear records of:

  • dates of absence
  • communications
  • fit notes
  • decisions made
  • adjustments considered

Why this matters:

Good documentation protects both the employee and the business and supports fair, consistent decisions later.

Hold absence review meetingsReveal

Once it becomes clear that absence may continue beyond a few weeks, a formal but compassionate absence review meeting helps establish clarity.

These meetings should cover:

  • How the employee is feeling
  • Current medical advice
  • Any barriers to recovery
  • What support or adjustments might help
  • What the employee hopes for in the coming weeks
  • Whether an OH referral is appropriate

This isn’t about assessing performance — it’s about understanding and supporting the situation.

Refer to Occupational Health earlyReveal

Occupational Health (OH) provides valuable clinical insight.

OH can help SMEs understand:

  • the employee’s condition in more detail
  • likely timescales for recovery
  • what adjustments are recommended
  • whether the condition may meet the definition of a disability
  • how to manage a safe, phased return
  • what the employee can and cannot reasonably do

An early referral helps avoid delays and prevents small issues becoming more complex.

Identify reasonable adjustmentsReveal

Adjustments will depend on the employee’s condition, but may include:

  • Temporary changes to duties
  • Reduced hours or a phased return schedule
  • Home working where possible
  • A quieter space or more regular breaks
  • Adjustments to physical or manual tasks
  • Altered shifts or flexibility around appointments

Why this matters:

Reasonable adjustments are a legal requirement where disability is involved and a best-practice approach in all long-term absence cases.

Develop a phased return-to-work Reveal

A phased return is almost always beneficial after long-term absence. It allows the employee to gradually rebuild confidence, stamina and capability.

A typical phased return plan includes:

  • Step-by-step week-by-week increases in hours or duties
  • Time for medical appointments
  • Regular check-ins with the manager
  • Clear expectations around progress
  • Adjustments that evolve as the employee recovers

Why this matters:

A well-planned phased return reduces the risk of relapse or repeated absence.

Review progress consistentlyReveal

Long-term health conditions rarely improve in a straight line. Regular reviews ensure:

  • Adjustments are still appropriate
  • The employee isn’t returning too quickly
  • Workload remains manageable
  • The business maintains safe expectations

Adjustments should be flexible, realistic and guided by medical advice where possible.

Consider next steps Reveal

If, despite support and adjustments, the employee continues to be unable to return, SMEs may need to consider:

  • Further OH review
  • Additional adjustments
  • Redeployment where feasible
  • Extended sickness monitoring
  • Ill-health capability processes (as a last resort)

These decisions should be made carefully and with HR support, ensuring fairness and legal compliance.

managing sickness absence

Why managing sickness absence is harder for SMEs

While all organisations experience sickness absence, the impact is felt far more sharply in small and medium-sized businesses. SMEs operate with tight teams, close client relationships and limited spare capacity — which means even a single absence can create challenges that become visible very quickly.

Understanding why this happens helps SMEs approach sickness absence with realism, empathy and proactive planning.

Lean team structures with limited cover available

In smaller organisations, roles are often unique or held by one individual. When that person is unexpectedly absent — whether due to short-term illness or a longer-term condition — there may be no immediate colleague who can step in. This leads to:

  • Slower turnaround times
  • Gaps in essential functions
  • Increased workload pressure for others

Because the team is already lean, there is less margin for temporary disruption.

Increased pressure on remaining staff, leading to fatigue or stress

When colleagues take on additional responsibilities, even temporarily, it can quickly lead to:

  • Reduced concentration
  • Longer working hours
  • impact on work–life balance
  • Heightened risk of burnout

This can create a ripple effect where one absence places others at risk of future absence.

Managers stepping into operational tasks

In many SMEs, managers — including owners and directors — wear multiple hats. When someone is off sick, managers often step into day-to-day operational work to keep everything running.

This diverts their time away from:

  • Strategic planning
  • Team leadership
  • Project development
  • Client relationship management

Over time, this increases pressure at senior level and reduces overall business resilience.

Immediate customer service and delivery impact

With fewer layers in the organisation, sickness absence quickly affects client-facing work. SMEs may experience:

  • Delayed responses
  • Reduced availability
  • Rescheduled meetings or appointments
  • Temporary dips in service levels

Because client relationships are often personal and direct, these impacts are felt sooner and more visibly than in larger organisations.

Limited in-house HR expertise or capacity

Many SMEs do not have a dedicated HR function, or HR responsibilities sit with a manager who is already juggling multiple areas. This can lead to:

  • Reactive rather than proactive absence management
  • Uncertainty about process and legal requirements
  • Delayed interventions
  • Lack of documentation or consistent process
  • Difficulty planning adjustments or phased returns

Without HR support, navigating a long-term absence can feel particularly daunting.

Why this matters

Recognising these challenges helps SMEs:

  • Set realistic expectations
  • Put practical, supportive processes in place
  • Strengthen early intervention
  • Protect the wellbeing of the whole team
  • Reduce the risk of repeated or extended absence
  • Build a more resilient approach to people management

A clear understanding of the pressures unique to SMEs is the foundation for a supportive, fair and effective sickness absence management strategy.

Practical steps for managing sickness absence effectively

This section offers simple, achievable actions SMEs can take right now.

  • Use absence data to identify patterns

    What to look for

    • Repeat short-term absences
    • Monday/Friday trends
    • MSK or stress clusters
    • Delays in reporting
    • Absence in specific roles or teams

    Why it helps

    Data supports fair, informed decisions and early intervention.

  • Prioritise early intervention

    What early support looks like

    • Timely check-ins
    • Asking open, supportive questions
    • Offering adjustments quickly
    • Keeping clear notes
    • Escalating concerns early

    Why this works

    It prevents minor issues developing into long-term absence.

  • Strengthen ergonomics and practical adjustments

    Examples of simple and effective adjustments

    • Better workstation equipment
    • Temporary modified duties
    • Reduced hours during recovery
    • More frequent breaks
    • Updated manual handling training

    Why this matters

    Small changes can make a meaningful difference to health and recovery.

  • Use Occupational Health appropriately

    How OH supports absence management

    • Clinical insight
    • Clear return-to-work guidance
    • Recommendations for adjustments
    • Advice on Equality Act considerations
    • Support with complex or sensitive cases

     

  • Equip managers with the confidence and skills they need

    Managers benefit from guidance on:

    • Supportive conversation techniques
    • Documentation and record-keeping
    • Spotting early signs of stress
    • Knowing when to escalate
    • Leading return-to-work discussions

    A confident manager creates a supportive and consistent experience for employees.

  • Review and refresh your sickness absence policy

    Your policy should be clear, accessible and aligned with current legislation.

    Key elements include:

    • Reporting expectations
    • Triggers for review meetings
    • Roles and responsibilities
    • Return-to-work procedure
    • Guidance for adjustments
    • Support for mental health
    • Long-term absence processes

    A good policy builds fairness and confidence across teams.

  • Build psychological safety within your team

    Psychological safety empowers employees to raise concerns early.

    • Ways to strengthen it
    • Open conversations
    • Non-judgemental responses
    • Confidential support route
    • Regular wellbeing check-ins
    • Training managers to listen

    When people feel safe, problems are resolved sooner.

  • Consequences of not managing sickness absence proactively

    If sickness absence isn’t addressed early, SMEs may face:

    • Increased overtime and agency costs
    • Burnout among remaining staff
    • More misunderstandings and grievances
    • Declining customer satisfaction
    • Greater legal risk
    • Leadership distraction from strategic work

    Proactive management protects both wellbeing and performance.

  • What good looks like: A practical framework for managing sickness absence

    A strong and supportive framework includes:

    • Clear policies
    • Supportive conversations
    • Consistent processes
    • Appropriate adjustments
    • OH guidance
    • Data-informed decisions
    • Steady return-to-work planning

    This approach supports employees, reduces risk and maintains service quality.

Where to find out more A collection of hand-picked useful resources for manging sickness absence from impact HR and beyond

Your Questions Answered

Everything you need to know about managing sickness absence

  • Why is managing sickness absence more challenging this winter?Reveal

    Managing sickness absence is harder this winter because seasonal illnesses such as flu, RSV and COVID-19 are circulating earlier than usual, and many employees are also dealing with long-term health conditions. NHS and GP waiting times remain high, which means minor issues can turn into longer absences. This creates more pressure for SMEs with smaller teams and less cover available.

  • What counts as long-term sickness absence in an SME?Reveal

    Long-term sickness absence is generally defined as four weeks or more of continuous absence. However, SMEs may choose to review cases earlier if it’s clear that recovery will take time or if the condition needs workplace adjustments. Managing sickness absence proactively at this stage helps avoid misunderstandings and supports a safe return to work.

  • What is the first step in managing sickness absence effectively?Reveal

    The first step in managing sickness absence is early, supportive communication. Managers should check in regularly, gather information via fit notes, and understand what the employee needs. Early intervention helps prevent issues from escalating and ensures the business can plan appropriately.

  • Do SMEs need to complete a stress risk assessment as part of managing sickness absence?Reveal

    Yes. Stress is now a recognised workplace hazard under HSE guidance, meaning employers must assess and manage work-related stress. A stress risk assessment helps identify the causes of stress, reduce triggers, and prevent long-term sickness absence linked to mental health.

  • How can managers help reduce sickness absence in small teams?Reveal

    Managers play a key role in managing sickness absence. They can reduce absence by:

    • Having supportive wellbeing conversations
    • Spotting early signs of stress or MSK issues
    • Offering temporary adjustments
    • Using clear reporting processes
    • Recording absence consistently

    onfident, well-trained managers create a safer and more supportive environment for employees.

  • How does Occupational Health support managing sickness absence?Reveal

    Occupational Health (OH) provides clinical insight that helps employers make informed decisions. OH can:

    • Clarify medical advice
    • Recommend reasonable adjustments
    • Help plan a phased return

    • Confirm whether a condition may be disability-related

    Using OH early is one of the most effective ways to manage long-term sickness absence.

  • What adjustments can help when managing sickness absence due to long-term conditions?Reveal

    Adjustments may include reduced hours, temporary changes to duties, remote working, altered shifts, additional breaks, or specialist equipment. The goal is to help the employee recover safely while supporting ongoing productivity. Adjustments should be reviewed regularly and updated as the employee’s condition changes.

  • How should SMEs document sickness absence?Reveal

    Good documentation is essential for managing sickness absence. SMEs should record:

    • Dates of absence
    • Fit notes
    • Communication with the employee
    • Return-to-work discussions
    • Adjustments offered

    Accurate records ensure fairness, support legal compliance, and provide clarity during future reviews.

  • When should SMEs consider a phased return-to-work plan?Reveal

    A phased return should be considered for any long-term absence or when an employee is recovering from a condition that affects stamina, mobility, mental health or concentration. A phased return allows the employee to rebuild confidence gradually while ensuring work remains manageable and safe.

  • What should SMEs do if sickness absence continues with little improvement?Reveal

    If sickness absence becomes prolonged, SMEs should:

    • Hold an absence review meeting
    • Seek updated fit notes
    • Request an Occupational Health report
    • Review and adjust workplace support
    • Consider redeployment if appropriate
    • Follow a fair capability process only as a last resort

    A structured, compassionate approach is essential when managing prolonged sickness absence.

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