Your web browser is outdated and may be insecure

The RCN recommends using an updated browser such as Microsoft Edge or Google Chrome

Supporting staff who are living with long COVID

Guidance for managers


Illustration of woman alone surrounded by COVID

One of the long-lasting, but unanticipated, impacts of the COVID pandemic has been the emergence of long COVID. There are significant numbers of people experiencing varied, ongoing, and debilitating symptoms that can last weeks, months or years following their COVID-19 infection. 

This guide is specifically for you, as a manager, to help, understand and support any staff members who are living with the condition.

Understanding what long COVID is

Long COVID special issue clinical article on the latest research

You don’t have to be an expert on long COVID to effectively support staff members who are living with long COVID, but it is important that you and your team have an understanding of what long COVID is.

Symptoms vary greatly from person to person, so use your understanding of long COVID to enhance, but not replace, conversations with the individuals in your team needing support due to long COVID.

Long COVID is the umbrella term used for ‘Ongoing Symptoms’, and ‘Post COVID’ Syndrome. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.

Ongoing symptomatic COVID-19 refers to signs and symptoms of COVID-19 up to 4-12 weeks from infection. Post COVID Syndrome refers to signs and symptoms of COVID-19 that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.

Long COVID can have a significant impact on general health, and is more likely to affect women, people of working age, disabled people and those working in the health and social care sector. See the graph below. For additional information about what long COVID is, please watch Long COVID physio's video.

Emerging evidence suggests long COVID has a greater effect on people’s quality of life than some cancers (BMJ 2023).

An international study by Davis et al reported that 45.2% of patients with long COVID had to reduce their work schedule compared to the period before the illness and that 22.3% were not working (at the time of the study), for reasons such as sick leave, dismissal, or resignation (SOM 22).

Difficulties in returning to work are often due to the unpredictability and management of symptoms, job demands, and unhelpful attitudes and expectations (Lunt et al. 2022). Similar findings were reported in a survey by the TUC and Long COVID Support (TUC 2023) and the British Medical Association (BMA 2023).

The health effects of long COVID are varied and can affect people in different ways. The most common symptoms are:  

  • fatigue
  • breathing and chest problems 
  • fever
  • pain
  • brain fog, cognitive and headaches 
  • stomach problems
  • muscle and bone problems
  • mental health and mood disorders
  • ear, nose, and throat
  • skin rashes.

However, this list is not exhaustive and over 200 symptoms have been reported. A series of videos by Long COVID physio (LCP) can provide more information about the most common symptoms of long COVID.

Fatigue is the most common symptom, with figures from the Office for National Statistics showing 69% of people living with long COVID are affected. The next common symptom, affecting 45% is difficulty in concentrating, followed by shortness of breath (42%) and muscle ache (40%).

When considering an employee’s long COVID symptoms, it is important to remember that they may be episodic – for instance, relapsing and remitting.



Fatigue is more than feeling tired, it is exhaustion, and it affects every aspect of daily life.

When having a ‘good day’ it’s easy to for individuals living with long COVID to do too much, only for it to affect their energy levels over the following days. This is known as the ‘boom and bust’ pattern of long COVID - where the person's fatigue levels will fluctuate.

Recognising triggers of fatigue

Individual triggers will differ; however, they may include:

  • a lack of routine
  • change in routine
  • too much or too little activity
  • overstimulation
  • stress factors (work related or personal)
  • having a low mood, feeling anxious or worried
  • diet
  • medication
  • physical illness.

The exact cause is not yet fully understood, and triggers can vary from person to person. Often triggers are associated with physical or cognitive (thinking) exertion but can also include sensory overload from noises or light (NHS July 2023). Research is available around fatigue in myalgic encephalomyelitis (ME) and commonalities with long COVID.

It is important to note that physical activity is different to exercise. Physical activity is any muscle movement that requires the production of energy (ME Association 2022).

Strategies to manage fatigue

Whilst there is no magic wand to immediately take away fatigue, there are strategies and methods that people living with long COVID can use to help manage it

To help staff overcome this cycle, encourage, and support them to prioritise, plan and pace their workload - known as the 3 Ps.

For example:


  • Decide together what needs to be done and when. 
  • Plan each day in advance. 
  • Delegate certain tasks to others.
  • Build in rest periods, allowing and encouraging the staff member to take regular breaks and not to push themselves.


  • Focus on what is necessary.


  • Consider what is involved in a work-related task and break it down into smaller ‘chunks’ where possible.
  • Encourage the staff member to use an activity diary to help establish a personal baseline to help recognise own their personal triggers.
  • Gradually build up work activities.
  • Encourage openness so colleagues can understand and support.

Fatigue and activity needs to be carefully managed to prevent post exertional malaise (PEM) also known as post exertional symptom exacerbation (PESE), and a relapse of symptoms.

It is common for people with long COVID to have feelings of guilt and to push themselves to do things that could be done at a different time.

PEM, also known as post exertional symptom exacerbation (PESE), is a disabling form of exhaustion sometimes referred to as a ‘crash’.  The activity that triggered the worsening of symptoms may have been something that caused no issues previously. Symptoms typically develop 12 to 48 hours after the activity and can last hours, days, or week. PEM is worsened by the ‘boom and bust’ cycle. 

Often, individuals with PEM and long COVID can enter a cycle of ‘push and crash’. For example, when having a good day, pushing themselves to do as much as they can, but the over exertion in completing these tasks then leads to an increase in symptoms. (COVID Aid 2023).

To avoid PEM, follow the advice on fatigue management and encourage the staff member to stop, rest and pace (JOSPT 2021).


Cognitive dysfunction (often called brain fog) can make concentration and remembering things difficult, and ‘thinking’ may be slower than usual. Cognitive dysfunction is common among people with long COVID. The Society of Occupational Medicine (SOM) say the extent of someone's cognitive dysfunction often doesn’t become apparent until they return to work.

As a manager it is important to be aware that very few people living with long COVID have been able to access neuro-psychological testing to ascertain the impact of their cognitive impairment.

Strategies to help support staff to manage brain fog

Encourage and support the staff member to:

  • Take notes to help remember things. 
  • Take regular breaks away from distractions. 
  • Make a clear plan before approaching any new or complicated tasks, for example breaking it down into steps and keep checking as the plan is followed.
  • Gradually build up activity.
  • Eat healthily, for example a Mediterranean diet including olive oil, fruits and vegetables, nuts and beans, and whole grains has been proven to improve thinking, memory, and brain health. 
  • Don’t drink too much alcohol. 
  • Good sleep hygiene by avoiding energising foods, activities, and sensory stimulus.
  • Do things known to stimulate the brain and improve mental health, such as social activities, learning something new or practising mindfulness. It is worth noting however, that some people with cognitive dysfunction may struggle with mindfulness due to the concentration required.

In a work setting this can mean that the individual has:

  • Difficulty coping with noise 
  • Issues with short term memory
  • Lack of concentration
  • Can’t comprehend long emails/documents
  • Only able to concentrate on one thing at a time
  • Don’t always hear what people are saying
  • Poor decision-making
  • Inability to deal with complex situations

Cognitive dysfunction needs to be given proper consideration before a member of staff returns to work.

Some people living with long COVID find that they regularly get breathless, and this can happen when doing simple tasks, such as walking, going up and down stairs or when carrying things. It can make people feel panicky, hot, and overwhelmed. The chest can feel tight, and the individual might take short shallow breaths instead of breathing normally.

Many people with long COVID have not been assessed by a respiratory consultant or a physiotherapist and so may not be aware of the cause of their breathlessness.

Strategies for managing breathlessness.

You may want to encourage your staff member to practice breathing control and breathing techniques. For example:

Rectangular Breathing Technique:

  • Sit on a comfortable chair, or if no chair available, lean into or against a wall.
  • Look for something that is rectangular in shape (for example a book, screen, or picture).
  • Relax your shoulder muscles.
  • With your eyes, follow the sides of the rectangle.
  • The short side of the rectangle is the in breath and the long side is the out breath.
  • This should gradually slow down breathing rate and improve breathlessness.

Blow as you go – walking up stairs:

  • Deep breath in before taking a step up.
  • As you step up, breathe out.
  • Go a few steps at a time.
  • If it helps lean into a wall or the banister as you recover your breathing.
  • Then start stepping again.


Is long COVID a disability?

Illustration shows woman walking with empty battery symbol above her head symbolising fatigue

This depends how the individual staff member is personally affected by long COVID, as the effects will vary from person to person.

Therefore, it is important that you, as a line manager, consider each member of staff individually, to determine if they can be deemed to have a disability for employment purposes.

The definition of an individual deemed to have a disability for the purposes of employment under the Equality Act 2010 and the Disability Discrimination Act 1995 Northern Ireland is: 

"A physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities”.

Daily activities are everyday things, such as walking, dressing, going up and down stairs etc.

The Definition of long term is:

“At least 12 months or likely to last at least 12 months or the remainder of the person's life if less than 12 months”.

There are special rules about recurring or fluctuating conditions. If an individual meets the definition, they are deemed to have a disability for employment purposes.

In Burke v Turning Point Scotland (June 2022) and Anrude v The Advisory, Consolidation and Arbitration Service (April 2023) the Employment Tribunals ruled in a preliminary hearing that the claimant’s long COVID did, in this instance, amount to a disability under the Equality Act.

Remember, although long COVID isn’t an officially recognised disability, this does not mean that the Equality Act or the Disability Discrimination Act (Northern Ireland) does not cover those individuals with the condition.

If an employer knows or could reasonably have been expected to know an employee has a disability following a long COVID diagnosis, any reasonable adjustments must first be made before dismissing that individual. This is to remove any disadvantage suffered by the disabled employee in doing their job when compared to non-disabled people including, for example, different working arrangements or workplace adaptations.

The Employment Act 2010 is a baseline for good practice. As a line manager, you should consider any reasonable adjustments and weigh that against the benefits of retaining your staff member in work.  Remember, most reasonable adjustments don’t cost much money to implement. Taking time to understand the strengths and limitations of your staff member living with long COVID through an ongoing professional relationship facilitates the retention and loyalty of experienced staff.

Until case law becomes more established, the RCN advises that you consider whether the definition of a disability applies to the individual and if so ensure that all necessary legal obligations are met.

In any event, the staff member with long COVID will be entitled to take sick leave, regardless of whether their symptoms should be treated as a disability, in the same way as they would in relation to any other condition that affects their ability to work. This includes the right to either statutory sick pay or, where applicable, enhanced contractual sick pay, provided the employee satisfies the eligibility criteria for paid leave (David Morris 2023).

Long COVID as an occupational disease

The RCN has been pressing for long COVID to be classed as an occupational disease to make it easier for health and social care workers to claim Industrial Injuries Disablement Benefit and therefore receive compensation.

Belgium, Denmark, France, Germany, and Spain have already formally recognised long COVID as an occupational disease.

The RCN has been pressing for long COVID to be classed as an occupational disease to make it easier for health and social care workers to claim Industrial Injuries Disablement Benefit and therefore receive compensation.

Belgium, Denmark, France, Germany, and Spain have already formally recognised long COVID as an occupational disease.

Supporting staff who are off work

Long COVID special issue how to support a colleague

Work is generally good for our overall health, providing purpose and enabling financial independence.

Evidence shows line managers have a significant impact on a successful return to work. You do not need to be an expert in long COVID, but it is important you are there to support your staff member, listen to their concerns and act where you can.

Long COVID affects people in different ways, and everyone will require various levels of support dependent on their role, symptoms, work environment and personal situation.

Make time to actively listen to your staff members needs and concerns and work together to find solutions that work both for the staff member and your team.

People living with long COVID have reported that the most successful measures for returning to work have been:

  • early advice on how to self-manage activity pacing
  • an initial meeting, preferably online, with tailored follow up meetings
  • getting the right tests at the right time” and early treatment of symptoms
  • the importance of peer support groups
  • “Nothing about us, without us” i.e., being fully involved in the decision-making process.

Peer support groups are helpful for general support and/or specific topics such as management of specific symptoms, sharing of ideas and problem-solving. The RCN has a long COVID peer support group for RCN members living with long COVID.

If your member of staff is off work because of their long COVID symptoms, it is important to keep in touch with them and let them know you are thinking of them. Initially, this could be by phone or video call. You should also familiarise yourself with your organisations polices in relation to sickness and return to work.

  • Before you call, make sure you won’t be disturbed and have allowed sufficient time to actively listen to your staff member. 
  • If appropriate, you may want to explore whether the staff member would benefit from any health services/assistance provided by your organisation, such as:
    • occupational health/employee assistance programme
    • physiotherapy
    • psychological support.
  • Agree what to tell others, such as colleagues, but be mindful of confidentiality.
  • Remember, many people feel guilty being off work; let them know you are there to help and support rather than asking when they think they will be returning to work.
  • It may be useful to arrange a time for the next meeting but be mindful that early morning or late afternoon calls may not be appropriate, nor are overly long calls.
  • Suggest forwarding any relevant information via email to aid understanding and capture the salient points of the meeting.

In a supportive manner, follow-up meetings should begin to touch on a return to work, with an emphasis on exploring with your staff member what their obstacles are in returning to work and how these obstacles may be overcome.

Some individuals will require medical clearance before returning to work, especially in safety critical roles, or if pre-existing health conditions have worsened.

Suggest the staff member living with long COVID starts to think about the following:

  • What is your normal pattern of working?
  • Where is your work base? For example, a fixed site, community or home based?
  • How do you get to work?
  • Do you need to travel once you get to work?
  • Do you stay in one place during the day or move around?
  • What is your work environment like? 
  • What are your main duties?
  • What control do you have over your workload? E.g., Do you work to deadlines?
  • Do you manage other staff?
  • Where do you normally go for support at work? E.g., another work colleague
  • Do you have a union rep?

As a manager you may wish to seek independent, professional advice from your occupational health provider. Occupational health can assist in assessing medical fitness to return to a given job role and can provide advice on workplace adjustments. 

For individuals returning to work with long COVID there will often be the need to involve several parties, such as the employee, employer, line manager, union representative and occupational health (OH) professionals. The priority should be for a gradual, adaptive, and appropriate return to work (SOM 22) acknowledging that a return to work with long COVID is unlikely to be a linear process. 

Provided appropriate support is put in place, some people living with long COVID can return to and thrive at work, however some individuals will require substantial additional support and workplace adjustments to be able to successfully return to work.

Often, there is a significant gap in the confidence and capability of organisations to provide the necessary support, such as developing line manager knowledge and confidence when most organisations rely online managers to take primary responsibility for managing long-term absence (SOM 22). 

When the individual is ready to return to work, arrange a return-to-work conversation to agree a return-to-work plan.  Remember that coming back into the workplace can be overwhelming in itself, and the first face to face meeting should factor in re-orientation, including a chance to catch up with colleagues.

  • Consider the type of work carried out and start to think about possible workplace adjustments; ask the staff member to do the same.
  • Request the staff member comes to the meeting prepared to talk about how living with long COVID might impact on their work.
  • Encourage the staff member to identify the tasks they feel able to do now and, what adjustments would help them do their job, or part of their job. 
  •  Encourage the individual to seek advice from their doctor or from the organisation’s occupational health provider about anything they should or should not do.
  • It can be helpful to involve human resources and union representatives at this stage.
  • Make sure you have set aside uninterrupted time where you will not be disturbed.
  • Put the person at ease.
  • Ask how they are and if there is anything they are worried about and explore solutions. 
  • Talk about workplace adjustments, work priorities, and together start to draw up a return to work plan that you and the individual are comfortable with.
  • Mention ‘Access to Work’ a non-means tested government funded programme with the aim of providing help to people with a physical or mental health condition or disability to stay in work (see section on ‘Access to Work’).
  • Explain that you will monitor and review the return-to-work plan to see how things are progressing and to amend the plan accordingly. 
  • As a manager, be pragmatic and think in the long term.

Return to work plan

Long COVID special issue support and rights at work

A successful return to work will need careful planning. The plan must be realistic, doable and one which you are both comfortable with, aiming for sustained work ability.

The plan should set out who needs to do what and when and should be flexible as getting back to work with long COVID is often not a linear process. Key aspects of the plan should include:

  • What can be done and what can’t?
  • Identification of the obstacles to the persons return to work.
  • Working out the actions to overcome those obstacles.
  • An agreed return to work date and a timeline for actions (including transitioning back to usual job or moving to a different job).
  • Plan for PESE/PEM (flares) for example, use of sick leave or annual leave.
  • An agreed review schedule (to allow for the plan to be revised).

It is also important to think about post-exertional symptom exacerbation (PESE) and how this can be minimised during the return to work process. It may also be beneficial to include equipment to support symptom management.

Some individuals might experience fluctuating symptoms and it might take time to be able to work at the same level as before. Be prepared to be flexible and for things to change over time. It is important to remember that any agreed plan will need to be reviewed and may need to be adapted (SOM 2021).

The RCN recommends the following:

  • An individual risk assessment is undertaken, and measures put in place to prevent reinfection (see section 5).
  • The phased return is planned over a realistic time scale to gradually build up duties and hours, starting with non-consecutive days. 
  • Implementing a phased return over at least a 12-week period, rather than the standard 4-6 weeks. The key to success is being flexible and realising that the process won’t be linear.
  • The plan is agreed in partnership (employee, union rep, manager, HR).
  • Advice is sought from occupational health.
  • Reasonable adjustments are considered, such as:
    • reduced or amended duties
    • redeployment
    • provision of equipment
    • working from home
    • flexible hours (long or short term).
  • Regular welfare meetings and self-referral options.
  • Relapses are taken into consideration (sick leave/annual leave).
  • Complete a health ability passport.

For further information on supporting staff and colleagues back to work you can read Long COVID and Return to Work – What Works? (SOM August 22).

A health ability passport is a document completed by an employee, who requires reasonable adjustments, and their line manager that details the reasonable adjustments a staff member with health or disability issues needs at work. It provides a framework within which to discuss the employee’s health and what changes can be made at work to assist them.

It can also be known as 'disability passport', 'health passport', 'adjustments passport' or 'workplace adjustments passport'. 

Where health ability passports are adopted by an employer and form part of policy, they are most successful. This is because the passport is recognised across an organisation. Once adaptations have been agreed the document is signed by both parties to indicate that the adjustments will be made and upheld. 

This means that if the employee’s line manager changes, they do not have to explain their requirements again and that the current arrangements will not be withdrawn.

The completed document should be considered binding so that employees can see that their input and honesty is valued. It should also build in review dates so that both parties can propose alterations when their needs change. 

For further information go to our health ability passport webpage.

The RCN believes it is important to get organisational agreement that long COVID is disregarded from sickness absence records that contribute to trigger points within the sickness absence policy.

If your organisation insists on operating sickness absence triggers, you should ensure that:

  • Any related meetings (including ‘virtual’ meetings) explore causes, at least in the first instance, so that employees can be supported to return to work or improve their attendance. 
  • Remember that changes to trigger levels for disabled staff can constitute a reasonable adjustment.
  • The Advisory, Conciliation and Arbitration Service (ACAS) advises that where a worker who has long COVID, has been off sick but is hoping to return to work, the employer should talk with the employee about any support they may need. This could include: 
    • getting an occupational health assessment
    • making changes to the workplace or to how the employee works such as different working hours.
    • a phased return to work
    • what they want to tell others at work about their illness.
  • Other changes could be allowing the employee to work from home, paid leave for medical appointments, support with workload or temporary redeployment to a more suitable role.

ACAS states that employers should “make sure they have done everything they can before considering a capability procedure”. 

It is important you familiarise yourself with your organisational policies and procedures for managing sickness absence and determine if there is a specific long COVID policy.

The purpose of a sickness absence policy is to provide a clear framework for managing, reporting, and recording sickness absence in a fair and consistent way. The policy should clarify what is expected from you as a manger and from the employee. As a minimum, the policy should include the following sections:

  • Statement of policy: an explanation of the policy’s purpose and scope.
  • Reporting procedures: how to report absences, who the employee should contact and when.
  • Fit notes: when the employee needs proof of ill health, and how and when to self-certify.
  • Sick pay: how much the employee will be paid and for how long.
  • Keeping in touch: how and when the employer and employee should keep in touch.
  • Support services: what support will be provided by the employer, including any occupational health scheme or employee assistance programme.
  • Return-to-work interviews: when and with whom return to work discussions will be held.

As a line manager, we recommend that you familiarise yourself with capability/disabled staff policies that exist locally or nationally which detail the responsibilities of employee and manager in terms of supporting individuals during their employment.


A reasonable adjustment is a change to the work environment or to a workplace policy, criteria or practice that aims to remove or minimise disadvantages experienced by disabled employees and job applicants. In some individual circumstances, these adjustments may be permanent.

In all cases of long-term sickness absence, employers should follow the ACAS advice to talk with the employee about any support they may need to return to work including making changes to the workplace or to how the employee works.

As long COVID is a relatively new disease, ACAS also advise it would be better for employers to focus on what adjustments they can make for the employee, rather than trying to work out whether or not the member is a disabled person within the meaning of the Equality Act 2010 (and the Disability Discrimination Act 1995 in Northern Ireland).

The Equality Act 2010 (and the Disability Discrimination Act 1995 in Northern Ireland) gives disabled workers the right to reasonable adjustments where they experience substantial disadvantage. 
Employers have a legal duty to provide reasonable adjustments where they know or should have known the employee was disabled.

Examples of reasonable adjustments that might apply to a member with long COVID could include, but are not limited to:

  • alteration in number of days or hours worked
  • shorter days, more breaks, later starts or earlier finishes
  • change of hours to avoid travelling at peak times
  • paid time off work to attend medical appointments
  • access to rest area
  • home working (for all or part of the working week)
  • phased return to work, gradually increasing the days/ hours worked over a period of several weeks
  • temporary transfer from night or shift working to regular daytime hours (if applicable)
  • noise cancelling headphones to reduce overstimulation.

As a line manager:
  • find out what support is available within your organisation for people living with long COVID
  • maintain regular contact to support and keep in touch with your staff member 
  • signpost your staff members to:
    • musculoskeletal and rehabilitation services
    • wellbeing services
    • peer groups
    • staff networks 
    • financial advice
    • guidance on working from home.
    • chronic Fatigue Service
    • occupational Health provision
    • local NHS resources for post COVID-19 syndrome
    • encourage individual to seek advice from return-to-work occupational therapy services (if the workplace does not offer this, it might be via GP referral) or staff physio for advice, for example on reasonable adjustments such as specialist chairs etc.
  • does your organisation have a long COVID policy? 
  • find out if there is any precedence in your organisation for supporting staff to return to work whilst living with long COVID.  Your staff disability network or HR department may be able to help.
  • are there ways your workplace supports people living with ME that can be used for staff members living with long COVID (we know there are some commonalities). Remember many policies allow for flexibility by using the words ‘usually’ or ‘normally’, allowing you to use your autonomy where this is not the case.

The statutory right

An employee who has been continuously employed for at least 26 weeks can make one request every 12 months to change their terms and conditions of employment relating to:

  • the hours they are required to work,
  • the times they are required to work, 
  • the place they are required to work.

The flexible working request must be made in writing, be dated and state:

  • the request is made under the statutory right to request flexible working,
  • the change(s) applied for and the date on which the changes(s) would start,
  • what effect(s) the proposed change(s) would have on the employer and how the effect(s) can be dealt with, and
  • whether a previous application has been made to the employer and, if so, when.

The employer must deal with requests reasonably and decide within 3 months. The employer can refuse the request.

Job carving

It may be worth considering temporarily created roles to suit the staff member, including pay protection if they work in a lower grade/pay band.

A contractual right (e.g. Section 33 of the NHS Terms and Conditions of Service Handbook)

A member employed on Agenda for Change terms and conditions has the right to request flexible working from day one of employment:

  • to make more than one flexible working request a year
  • to request flexible working for any reason.

Flexible working policies and procedures should be developed agreed locally in partnership but must include the statutory requirement, as well as:

  • an initial exploratory stage between the member and their manager to look at all the options for reaching a mutually agreeable outcome
  • an escalation stage for requests not agreed, to see if there are any options beyond the immediate team that could be agreed
  • a decision stage that either confirms and documents the agreed request or provides objectively justified and specific written reasons for requests not agreed.
  • an appeals stage that should include consideration of whether the local process has been appropriately followed and whether all appropriate options had been fully explored.

NHS staff on Agenda for Change Contracts

The terms and conditions of service set out in the Agenda for Change handbook (AfC) apply in full to all staff directly employed by NHS organisations, except very senior managers and staff within the remit of the Doctors’ and Dentists’ Review Body. NHS organisations include health and social care organisations in Northern Ireland.  The handbook is published on the NHS Employers website. It is amended whenever new agreements are reached in the NHS Staff Council. 

Section 14 of the AfC handbook provides information regarding arrangements for sickness absence, with separate sections for England, Wales, Scotland, and Northern Ireland and is supplemented by annex 26 (which sets out the key employer and employee responsibilities).

Paragraph 14.13 states that during the rehabilitation period employers should allow employees to return to work on reduced hours or, where possible, encourage employees to work from home without loss of pay. It is worth noting that no time limit for the phased return to work is specified.

NHS sick pay

It should also be noted that paragraph 14.6 of the Agenda for Change handbook states that absence caused by injuries, diseases, or other health conditions that are wholly or mainly attributable to the employee’s NHS employment and which have been sustained or contracted in the discharge of the employee's duties of employment, should be disregarded for the purposes of calculating sickness absence allowances.

Staff may also be able to claim NHS injury allowance as defined in section 22 of the handbook.

Sick pay for nursing staff outside of NHS Agenda for Change Contracts

For nursing staff working outside the NHS, employers have discretion to grant additional paid leave and the RCN advises members to request that long COVID absences are discounted.

NHS Injury Allowance

If your member of staff has evidence that they caught COVID-19 in the course of their work, they may be able to claim NHS Injury Allowance. The allowance provides support for staff who sustain an injury, disease or other health condition which is wholly or mainly attributable to their employment.

The allowance can be paid for up to 12 months. Nursing staff may be able to claim if they meet all of the following requirements:

  • Employed within the NHS, under NHS terms and conditions 
  • Contracted COVID-19 wholly or mainly attributable to NHS employment 
  • Staff member is on authorised sickness absence or phased return to work 
  • Earnings have been reduced to less than 85% of pay because of your ill health.

Access to Work  is a non-means tested government funded programme with the aim of providing help to people with a physical or mental health condition or disability to stay in work.  The support available will depend on individual need and could include:

  • a grant to help pay for practical support with the individual’s work
  • support with managing mental health at work
  • taxi fares if the person cannot use public transport
  • a support worker or job coach. 

To be eligible, the individual must:

  • have a physical or mental health condition or disability that means the individual needs support to do their job or to get to and from work
    be 16 or over
  • be in paid work (or be about to start or return to paid work in the next 12 weeks)
  • live and work (or be about to start or return to work) in England, Scotland or Wales - there’s a different system in Northern Ireland.

Access to work will not pay for reasonable adjustments as these are changes that employers are legally required to provide. You cannot get access to work if you live in the Channel Islands or the Isle of Man.

It is advisable for individuals to apply as soon as possible to avoid delay. As a manager, make sure you are aware of whose details need to be included from management to sign off the application, for example, it may be the immediate line manager and the head of service.  Your HR/Support services should be able to advise, the information may also be found in your organisations capability/disabled staff support policies.

Employee is unable to return to work

Long COVID special issue wellbeing psychological impact

An employer is legally entitled to dismiss a member of staff living with long COVID due to ill health, where their capability constitutes a potentially fair reason for dismissal. For example, an individual who has been on long-term sick leave with no reasonable prospect of resuming their job role.

However, this should be a last resort, where the employer must be able to objectively justify any dismissal, including why any reasonable adjustments could not be made to support the employee’s return to work.

If the employer knows or could reasonably have been expected to know an employee has a disability following a long COVID diagnosis, any reasonable adjustments must first be made before dismissing that individual. This is to remove any disadvantage suffered by the disabled employee in doing their job when compared to non-disabled people (David Morris 2023).

In the first instance, advise the staff member to contact their pension provider to find out what their rules are in relation to ill health retirement (IHR). 

To successfully claim IHR the staff member will need to establish that they are permanently incapable of continuing to do their job due to a physical or mental condition. To demonstrate the permanency of their condition, a medical professional (occupational health or a specialist consultant) will need to provide a report which states that there are no further treatments or medications available that could facilitate their return to work.

NHS ill health retirement

The RCN cannot make a recommendation about whether an individual will qualify for ill health retirement (IHR), nor which tier may be awarded. Eligibility is dependent on several factors, including:

  • being a current member of the NHS pension scheme and have been for at least two years
  • an application prior to the scheme retirement age
  • having a long-term health condition that has a substantial impact on current or future employment
  • there is robust medical evidence to support the application
  • the application is made whilst still employed.

Any awarded pension is based on contributions made and is not reduced because of retiring early, as in voluntary early retirement.

Further information can be found on our ill health retirement advice guide.

Risk of reinfection

Long COVID special issue cover image

For people with long COVID evidence suggests a reinfection usually causes a relapse at best and additional ongoing symptoms at worse. It is therefore important that re-infection is avoided.

Evidence shows there is also a risk of developing long COVID when re-infected with the COVID-19 virus. For example, the Office for National Statistics (ONS) in their February 2023 report, states there remains some risk of new-onset long COVID after a second COVID-19 infection. In addition, a research paper by Bowie et al 2022, concluded reinfection contributes to additional health risks beyond those incurred in the first infection.

As a manager you have a responsibility under health and safety legislation to ensure you protect your staff from workplace hazards. This applies to COVID-19 infections. We now have overwhelming evidence that COVID-19 is airborne and the need for appropriate respiratory protective equipment (RPE) in controlling this risk, where identified (Ferris et al. 2021; Lawton et al 2021). Please refer to our COVID-19 risk assessment toolkit for further information.

A systematic review found that FFP3 masks were the most effective in providing protection against coronavirus infections. Given this, the RCN believes all health care organisations should be providing staff with FFP3 masks where a risk assessment has identified their use as a control measure against infection. 

Sufficient evidence now exists regarding the effectiveness of non-pharmacological methods in the preventing COVID-19 (re)infections, including:

  • indoor air quality and ventilation
  • the use of fitted FFP3 masks.

As many health care settings do not have adequate ventilation it is imperative that well fitted FFP3 masks are worn where the need has been identified (through risk assessment).

The World Health Organization (WHO) also states that the effectiveness of using HEPA filters to reduce COVID-19 infections in staff and patients has been explored and demonstrated they effectively removed COVID-19 particles from the air.



If a member of your staff has tested positive for COVID-19 (coronavirus) or has COVID symptoms, they should tell you as soon as possible.

Whilst 'Self-isolating' (staying at home) is no longer a legal requirement, the government advices that the staff member refrains from coming into the workplace until at least 5 days after a positive test or 5 days after symptoms began. However, the RCN advises that staff do not return to work until they are no longer COVID positive.

If a team has a known member of staff with long COVID then consideration and adaptations should be made to ensure their safety if another member of staff returns to work before testing negative.

Resting during the acute phase of COVID-19 can reduce the chances of the individual developing long COVID.


Checklist for managers

This checklist is a summary of the actions to be taken as a line manager to support staff members who are living with long COVID.

Please ensure you have read the main content of the managers guide before completing.

Download the checklist.