If you're off sick from your NHS role — whether for a few weeks or several months — you might worry about losing your annual leave entitlement. The good news is that under UK employment law and Agenda for Change terms, your annual leave continues to accrue during sickness absence. But the rules around using that leave, carrying it over, and what happens when you return are more nuanced than many staff realise.
This guide covers everything you need to know about annual leave and sickness absence for NHS workers.
Leave continues to accrue during sickness
This is the fundamental principle: your annual leave entitlement builds up as normal during any period of sickness absence, regardless of how long you're off. This right comes from the Working Time Regulations 1998 (as amended) and has been reinforced by multiple court rulings at UK and European level.
If you have 10+ years of service and are entitled to 33 days of annual leave per year, you accrue 33 days even if you're off sick for the entire year. The same applies to your bank holiday entitlement — those hours continue to build up too.
Why this matters
For short-term absences of a week or two, this rarely causes issues — you return and use your leave as normal. But for long-term sickness lasting months, accrued leave can build up significantly. Understanding your rights ensures you don't lose entitlement you're legally owed.
Can you take annual leave while off sick?
Yes. Under Agenda for Change, you can request to take annual leave during a period of sickness absence. If approved, your leave is paid at your normal rate (rather than any reduced sick pay you might be receiving), and the period counts as annual leave rather than sick leave.
This can be financially beneficial if you're on half pay or nil pay during long-term absence. By switching to annual leave for part of your absence, you receive full pay for those days. However, you should discuss this with your manager and HR team, as some trusts have specific processes for requesting leave during sickness.
Important consideration
Taking annual leave during sickness doesn't extend your sick pay entitlement. If you're approaching the end of your full-pay or half-pay period, using annual leave can bridge the gap — but it uses up leave you might want when you return to work. Think carefully about the trade-off.
Carry-over rights for staff on long-term sick leave
If you're unable to take your annual leave before the end of the leave year because of sickness absence, you have the right to carry it over. Under UK law (derived from the European Court of Justice ruling in Stringer v Revenue and Customs), workers who cannot take leave due to sickness must be allowed to carry over at least their statutory minimum entitlement of 5.6 weeks (28 days for full-time workers).
Many NHS trusts go further than the statutory minimum and allow carry-over of your full Agenda for Change entitlement. Check your trust's local policy or speak with HR to understand exactly how much you can carry forward.
Time limits on carry-over
Carried-over leave doesn't last indefinitely. Under the Working Time Regulations, carried-over statutory leave must generally be taken within 18 months of the end of the leave year in which it accrued. If you return to work, you should plan to use your accrued leave within this window.
Returning to work after long-term sickness
When you return to work after a prolonged absence, you may have a significant leave balance — potentially a full year's entitlement or more if your absence spans a leave year boundary. This creates both an opportunity and a practical challenge.
Managing a large leave balance
Work with your manager to create a phased plan for using accrued leave. Options include:
- Extending your return date — using accrued leave before officially returning to work
- Reduced hours during return — using leave to top up a phased return pattern
- Spreading leave across the year — taking regular days off to gradually reduce your balance
- Carry-over agreement — agreeing with your manager to carry some leave into the next year if it can't all be used immediately
Your employer should make reasonable efforts to allow you to take your accrued leave. They cannot simply cancel it because you were off sick.
Annual leave and occupational sick pay
Under Agenda for Change, NHS staff receive occupational sick pay based on their length of service:
- Under 1 year of service: 1 month full pay, 2 months half pay
- 1–2 years of service: 2 months full pay, 2 months half pay
- 2–3 years of service: 4 months full pay, 4 months half pay
- 3–5 years of service: 5 months full pay, 5 months half pay
- 5+ years of service: 6 months full pay, 6 months half pay
Once your occupational sick pay runs out, you may be entitled to Statutory Sick Pay (SSP) at £116.75 per week for up to 28 weeks. During all of these periods — full pay, half pay, and SSP — your annual leave continues to accrue at the full rate.
What about phased returns?
A phased return to work — where you gradually increase your hours over several weeks — is common after long-term sickness. During a phased return, you may use annual leave to make up the difference between your phased hours and your contracted hours.
For example, if your contract is 37.5 hours but you return on a phased basis working 22.5 hours per week, the remaining 15 hours per week can be covered by annual leave. This means you receive full pay during the transition without relying on sick pay.
Discuss this with your manager and occupational health team. A phased return supported by annual leave is one of the most employee-friendly arrangements available, and most NHS trusts encourage it.
Key points to remember
- Annual leave accrues throughout any period of sickness absence — short or long-term
- You can request to take annual leave during sickness, which may improve your pay
- If you can't take leave due to sickness, you can carry it over (minimum 28 days under law)
- Carried-over leave should be used within 18 months of the leave year it accrued in
- Annual leave can support a phased return to work by covering the gap between reduced and full hours
- Your trust's local policy may be more generous than the statutory minimum — always check
Check your entitlement
Use our free Annual Leave Calculator to work out exactly how many hours or days you've accrued during your absence. Enter your contracted hours, service length, and the number of months you want to calculate. If you're planning a phased return, you can model different scenarios to see how your leave balance would be affected. For a complete picture of your pay during absence and return, try our NHS Pay Calculator.