NHS Sick Pay Running Out: Long-Term Sickness, Half Pay and What Next

Long-term sickness is stressful enough without not knowing when the pay will stop. This guide follows the money from the sick pay scale through to the 12-month point and beyond, including the half pay reinstatement rule that is not in most summaries of NHS sick pay, and explains the options around it. It is based on Section 14 (England text, amendment 63) and GOV.UK. Scotland, Wales and Northern Ireland have their own versions of Section 14 with the same reinstatement rule but different paragraph numbers. This is general information, not legal or HR advice.

The sick pay scale in one table

Para 14.2 sets how much occupational sick pay you can have, based on your reckonable service. Para 14.7 says the amount available at any time is the entitlement on the first day of sickness less the paid sickness absence in the 12 months immediately before that day. The table also shows how many months of the first year you will be unpaid if you are off continuously, before para 14.10 can apply at the 12-month point:

The scale assumes you have not used any of the entitlement in the previous 12 months. Absence caused by a work-related injury or condition covered by para 22.3, and certain absences linked to crimes of violence, is disregarded when counting what you have used (para 14.7). Use the NHS Sick Pay Calculator for your own dates and the rolling 12-month rule.

Half pay plus SSP

Two paragraphs cap what you can receive. Para 14.6 says full pay needs to be inclusive of any statutory benefits so as not to make sick pay greater than normal working pay, and that Statutory Sick Pay added to half pay must not exceed full pay. Para 14.8 says sick pay when added to statutory sickness, injuries or compensation benefits, including dependants' allowances, must not exceed full pay.

In practice, in the half pay period you can receive half pay with SSP added up to the cap. Statutory Sick Pay is £123.25 a week or 80% of your normal weekly earnings, whichever is lower, for up to 28 weeks, paid like wages, per GOV.UK. We have not verified how each trust counts SSP weeks against the 28-week limit while occupational pay is being paid. If your absence is long, ask payroll for your SSP end date in writing, because it decides when ESA or Universal Credit needs to start.

The 12-month rule: half pay reinstated (para 14.10)

Three more paragraphs set the limits of the rule:

• ✓ Duration (para 14.11): reinstatement continues until the final review meeting has taken place.
• ✓ Not backdated (para 14.11): it is not retrospective for any period of zero pay in the preceding 12 months of continuous absence.
• ✓ Employer delay only (para 14.12): these arrangements follow local sickness absence procedures established in accordance with Annex 26, and only apply where the failure to hold the final review meeting is due to delay by the employer. They do not apply where a review is delayed for reasons other than those caused by the employer.

Worked example: a Band 5 nurse

This illustration uses the 2026/27 Band 5 starting salary of £32,073 (basic pay only), which is £616.79 a week. It assumes more than five years' reckonable service, continuous absence from week one, and no prior sickness in the last 12 months. Figures are gross and illustrative, and do not model SSP on top of half pay.

For a nurse with 2 years' service, the same absence would pay 2 months of full pay and 2 months of half pay, then nothing for months 5 to 12 (aside from any SSP and benefits), and half pay could be reinstated after 12 months only if a final review has not taken place within 12 months of the start of the absence, and not backdated to the unpaid months (paras 14.10 and 14.11).

Extensions and the employer's discretion

Para 14.13 gives employers discretion to extend full or half pay beyond the scale where there is an expectation of return to work in the short term and an extension would materially support a return or assist recovery, with particular consideration for staff without full sick pay entitlements, or in any other circumstance the employer deems reasonable. Para 14.14 says that during rehabilitation employers should allow reduced hours or, where possible, working from home without loss of pay, consistent with statutory sick pay rules. If you are close to the end of your entitlement, make the request early, in writing, with an occupational health report and a return plan if there is one.

When SSP ends: ESA and Universal Credit

Per GOV.UK:

• ✓ SSP stops when you have received the maximum of 28 weeks, and your employer must give you form SSP1, within 7 days of SSP ending unexpectedly, or by the 23rd week if the end is anticipated.
• ✓ You may be able to apply for Universal Credit or new style Employment and Support Allowance (ESA). You can apply for ESA up to 3 months before SSP ends, and you start getting it as soon as SSP ends.
• ✓ New style ESA requires enough National Insurance contributions, usually in the last 2 to 3 years, with NI credits also counting, and a health condition or disability that affects how much you can work.
• ✓ ESA is affected if you receive more than £85 a week from a private pension. Check how any other income, including occupational sick pay or an NHS pension, is treated before you rely on a figure.

Check the current ESA and Universal Credit rates on GOV.UK. Our income protection gap calculator shows how a drop in pay compares with your outgoings.

Ill health retirement

If you are unlikely to be able to return to your role, or to similar work, ill health retirement may be considered. It is a separate application assessed by NHS Pensions on medical evidence, often raised through occupational health in long-term absence. The Handbook says the sickness absence framework in Annex 26 is intended to manage the risk of premature and unnecessary ill health retirements (para 14.1). Read our ill health retirement guide for the tiers and process, and NHS Pension and long-term sickness for how absence affects accrual.

Can the NHS dismiss you while you are sick?

The Handbook contemplates it in limited circumstances. Para 14.18 says that after investigation, consultation and consideration of other alternative posts, and where there is no reasonable prospect of the employee returning to work, employers will have the option to terminate employment before the end of the contractual paid sick absence period, subject to their agreed sickness absence policies and procedures. Para 14.3 says sick pay ceases from the last day of employment. So a fair capability process is the route, and the steps in it matter:

Per GOV.UK, a condition is a disability under the Equality Act 2010 if it has a substantial and long-term negative effect on normal daily activities, long-term meaning 12 months or more. A long absence for a long-term condition can therefore raise disability issues, so take advice from your union or a solicitor before any final meeting.

If you have a sickness absence meeting coming up, our sickness absence meeting pack helps you prepare.

Work-related illness: injury allowance

If your illness or injury is wholly or mainly attributable to your NHS job, Section 22 of the Handbook can top your income up to 85% of pay for up to 12 months per episode, and para 14.7 says such absence is disregarded when counting sick pay used. See NHS injury allowance explained.

What to do now: a checklist

• ✓ Ask payroll for your sick pay entitlement, the dates full pay and half pay end, and your SSP end date, in writing.
• ✓ Ask HR whether a final review meeting has been scheduled, and keep a log of any delays and who caused them (para 14.12).
• ✓ Diarise the 12-month point of continuous absence and ask in writing whether para 14.10 is being applied.
• ✓ Ask for a discretionary extension under para 14.13 if a return is realistic, with an occupational health report.
• ✓ Apply for ESA up to 3 months before SSP ends, and ask your employer for form SSP1.
• ✓ Ask occupational health whether ill health retirement should be considered.
• ✓ Check whether your condition might be work-related and claim injury allowance if so.
• ✓ If you are a union member, tell your representative now, not at the final meeting.
• ✓ Check income protection or insurance cover that may pay out, and your mortgage and bills.

Related guides

This page is general information about Section 14 of the NHS Terms and Conditions of Service Handbook, GOV.UK guidance on Statutory Sick Pay, Employment and Support Allowance and the Equality Act, and is correct to the best of our knowledge as of October 2026. Trust procedures vary and Annex 26 was not reviewed. It is not legal, HR or financial advice. FrontlinePay is independent and is not affiliated with the NHS, NHS Employers or NHS Pensions.