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Long COVID

A guide about Long COVID

Introduction

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Coronavirus (COVID-19) can cause symptoms that last weeks or months after the infection has gone. This is sometimes called post-COVID syndrome or "long COVID". 

The symptoms of long COVID are many and are varied in severity with some individuals experiencing a debilitating illness. Studies remain ongoing across the world to fully understand what causes long COVID and how to treat it.

This guide provides advice and resources for nursing staff with long COVID. It is relevant to wherever you work with any NHS specific guidance highlighted.

Please note that diagnosis of long COVID is not dependent on having had a positive test for COVID-19.

Sickness absence

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Check your contract and employer’s sickness policy for more information including absence targets and meetings.

Contact us for advice before you attend any sickness meetings.

Our Sickness advice guide provides information on how to prepare for meetings and what the process may involve. 

If you are off work sick for more than 4 weeks this is likely to be considered as long term sickness absence. Both you and your employer should continue to follow the sickness absence policy.

The RCN expects all health and social care employers to give support to any staff who are absent due to long COVID;  this should include financial and employment support.  However, if after taking medical advice, it appears unlikely that a staff member will be able to return to work in the future, it is not automatically unfair for their employer to seek to terminate their contract. This can be complex area so you should seek support from the RCN. 

 

Your fitness to work is a matter between you and your GP and is described in your fit note. Legally, this is only “advice” to an employer, and they may wish to take further medical advice, for example from an occupational health specialist.

UK Government advice to employers states the following: 

“You can choose to give this other evidence precedence over the advice in the fit note. Your employee may disagree with you, and you may need to demonstrate to an employment tribunal why the alternative source of evidence was more acceptable to you than the fit note.”

This should be discussed in any absence management meeting and you may wish to take someone with you as support. Speak to your RCN representative or contact us for further advice. 

If you work for the NHS in England, see the NHS Employers guidance supporting recovery after long COVID.

Pay and your finances

Statutory sick pay (SSP) is paid by your employer for a maximum of 28 weeks. If you are eligible, you will get SSP from the fourth day you are off sick. Full details, including eligibility, are on the government website. 

If your SSP runs out or you are not entitled to SSP, then our information about income and benefits in this section may be helpful and you can also use our financial wellbeing checker.

If you work under an NHS Agenda for Change (AfC) contract, your entitlements to sick pay are in section 14 of the NHS Terms and Conditions of Service handbook. Section 14 contains information under separate headings for England, Wales, Scotland and Northern Ireland. It is also recommended that you check your employer's policy for more information on sick pay as it should include any additional guidance relating to your individual workplace. Your employer has the option to extend sick pay on a discretionary basis. You can make this request of your manager and/or ask your local RCN rep for support. Also see our section on additional sick pay. 

You can see our guide on NHS terms and conditions which includes advice on sick leave and our Sickness guidance.

If you believe that your absence is attributable to your employment, section 14.7 of the NHS Terms and Conditions of Service 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.

If you work outside of the NHS, your sick pay entitlements will be detailed in your contract of employment. If you do not have a copy of your contract, speak to your manager and request a signed copy.

Even if you are working outside the NHS, employers have discretion to grant additional paid leave and members are advised to request that long COVID absences are discounted.  RCN representatives are available to provide support and negotiate an agreement with local management. 

See our Sickness advice guide for more information. 

How to access additional sick pay (this applies to wherever you are working)

Ask for a meeting with your line manager to review sickness absence arrangements. You can contact us prior to the meeting for advice and support.  

  • Conduct research and review your employer’s policies on sick pay before the meeting. Your Human Resources (HR) department and/or your manager can assist you to locate the relevant policies.
  • At the meeting, establish when your contractual entitlement to sickness absence runs out.  
  • Be clear about your current state of health, capabilities and your pro-active efforts to manage your condition. 
  • If you reasonably believe the condition was contracted at work, say so and be specific about how and when. 
  • You can make the following formal requests, ensuring that they are captured in the meeting notes:
    • that your absence to date is not being considered as part of any absence management process
    • that future absence (if required) will be on a paid basis for example, the employer agrees to extend paid leave beyond your existing entitlement 
    • that the employer recognises Long COVID as a disability for the purposes of the Equality Act 2010 
  • If your employer cannot make a decision in the meeting, ask for the decision to be sent to you in writing within a reasonable period, for example 14 days.

What to do if the request(s) are denied 

There is no automatic right to additional paid leave in the case of extended absence related to long COVID. If your employer refuses to grant additional paid leave: 

  • Ask for the decision in writing with clear reasoning as to why the request(s) have been refused.  
  • Consider raising a formal grievance in response but contact us prior to this as we may be able to advise and support you throughout the formal parts of the process.
  • Any grievance will be heard by a different or more senior manager and if this process is unsuccessful, the RCN may be able to assess your case to establish the prospects of any legal claims. In some circumstances it may be that a refusal to grant additional paid leave could amount to unlawful discrimination. However, cases are assessed on their individual merits and legal support is contingent on there being reasonable prospects for success in your case.  

The RCN expects that all employers will look favourably on applications to use discretionary options to extend sickness absence. Long COVID has the potential to amount to a disability as defined by the Equality Act 2010 and as such, employers are likely to be under a legal duty to make reasonable adjustments to remove the disadvantage created by the condition. This includes but is not limited to consideration of extended paid leave arrangements in the event of long COVID related absence.

If you are involved in a formal sickness process, or require further advice and support, please contact us.

You can also access our Financial wellbeing resources and support.

NHS injury allowance can be paid when you are on authorised sickness absence, or a phased return with either reduced pay or no pay. You may be able to claim if you meet all of the following:

  • you are employed within the NHS under the NHS terms and conditions of service handbook or where the injury allowance is provided for in your employment contract
  • you have had an accident or contracted an illness/disease that is ‘wholly or mainly attributable’ to your NHS employment
  • you are on authorised sickness absence or a phased return to work
  • you have had your earnings reduced to less than 85% of your pay because of your ill health.

If successful, you can receive up to 85% of your pay for up to 12 months per episode. Payment is not dependent on length of service, so all staff are covered from their first day of employment.

For further information see the RCN’s NHS injury allowance guidance and the NHS Employers guidance. The NHS Terms and Conditions of Service Handbook contains provisions of the NHS injury allowance scheme at section 22 which applies across the UK. This should be read in conjunction with section 14, detailing the sick pay provisions for England, Wales, Scotland and Northern Ireland, and annex 26. 

You should request your employer's policy for the processes that you will need to follow as this may vary between employers and where in the UK you live. The NHS guidance for staff details the information that your employer may require including medical evidence, witness statements and any accident/incident forms that may have been completed.

Information about PPE and measures your employer should take to keep you safe, can be found in our COVID-19 PPE guidance and Respiratory risk assessment toolkit.

If you disagree with your employer’s decision or require support, it is important to contact us for further advice and support.

If you are struggling financially because of your illness there are a number of options that may be available to you: 

The industrial injury disablement benefit (IIDB) scheme provides no-fault, tax-free benefit for any employee who suffers a personal injury caused by an accident arising out of and in the course of work, or who contracts a prescribed industrial disease or prescribed injury while working.

Current advice from the Department for Work and Pensions (DWP) for those who believe they have contracted long COVID as a result of exposure in the workplace, is to make a claim for IIDB as an industrial accident using form BI100A. 

Our Industrial injury disablement benefit guide explains the processes around IIDB and how to contact our Welfare Service. The RCN has successfully supported a member who has long COVID with an IIDB claim and our magazine article explains how we helped.

Our Welfare Service has more information about financial support in their sick leave guidance.

If you believe your employer was in some way negligent, perhaps because you weren’t supplied with adequate PPE, you may be able to make a legal claim for personal injury compensation.

This is not easy and requires a high level of evidence. Speak to your RCN rep or contact us about making a claim.

The limitation for issuing a claim for personal injury (be it for long Covid, stress or fatality) arising after contracting COVID-19, is 3 years from the date you first contracted the virus.

You can see our personal injury page for information about the service and contact us for an onwards referral to one of our specialist teams across the UK.

 

Returning to work

As with any long-term illness/absence, your employer should discuss in advance the best way for you to return to work.

They may wish to seek advice from an occupational health adviser or your GP via advice on your fit note.

It can be helpful for you to go into any discussions with suggestions which can be implemented to enable you return to work successfully.

Our section on reasonable adjustments outlines a number of options of support that your employer should consider providing. You may benefit from protection from discrimination under the Equality Act 2010 - for more information see our section within this guide.

Your employer has a legal duty of care to ensure they provide a safe and healthy workplace so far as is reasonably practicable. Our Respiratory risk assessment toolkit provides guidance on managing risks associated with transmission of respiratory infections, specifically COVID-19. 

If you have a problem at work and feel you have been treated unfairly, you can also see our problems at work checklist for advice on what to do next.

If you are employed in the NHS, most employers will have an absence management policy that outlines their process.

This includes as a minimum, the guidance outlined in Annex 26 of the NHS Terms and Conditions of Service handbook which describes the need for early intervention and consideration of rehabilitation and redeployment. This also includes a requirement for a phased return on full pay for an agreed length of time before staff are expected to utilise their annual leave, if their hours are still reduced.

In England see the NHS Long COVID plan 2021/22 and the Society of Occupational Medicine guidance on Returning to work following Long COVID.

NHS Employers have further guidance:

Our Health ability passport guidance details the reasonable adjustments a staff member with health or disability may need at work. You can also see the NHS Supporting NHS staff with long COVID blog for more information about support on returning to work.

It outlines the types of reasonable adjustments, the role of occupational health and what to do if there are problems implementing any adjustments.

You may also be able to get practical or other types of support through the government run Access to Work.

Our additional resources section below links to information on adjustments that are specific to long COVID.

If there are issues with your return, discuss them with your manager/HR and contact us.

Julie shares her long COVID journey, the challenges she has faced and her experience of supporting health care professionals with long COVID back to work. 

Julie's story

Here are a range of resources to help you consider your options when returning to work.

Many of the issues discussed in Alison's video can be found within this guide, such as ill health retirement.

Problems returning to work

If there are issues with your return, discuss them with your manager/HR and contact us if you need support.

The RCN expects all health and social care employers to give maximum support to any staff who are absent due to COVID-19; this should include financial as well as employment support.

If you are employed by an independent health and social care provider

Your employer may seek to terminate your employment on grounds of ill health when you are unable to continue in employment because of a health condition (such as long COVID) and all alternative options have been considered/exhausted. Termination on grounds of ill health may also be applicable where an application for ill health retirement (IHR) has been unsuccessful.
 
An application for ill health retirement and the HR process for termination on grounds of ill health can run concurrently. Once you have submitted an application ill health retirement you are informing that you are permanently unfit for work and as such, they can commence the termination process. The RCN will always request that your employer does not make a termination decision until an ill health retirement decision has been reached. Also see our information in this section on IHR if you work for an independent health and social care provider.
 
It may be reasonable for your employer to dismiss you if you have been absent from work for a long time or won’t be able to return to work at all due to ill health. However, this should be a last resort and employers should firstly support the employee and help them to return to work. This could include making reasonable adjustments if the employee has a disability or long-term health condition.
 
Termination on the grounds of ill health usually occurs at the end of capability process and employers must undertake a full investigation and have a valid reason for termination. If a fair process has not been followed by the employer, you may have a legal claim. It is very important to involve the RCN at the earliest possible point, we can provide advice and representation and if your case has reasonable prospects for success, the will RCN will support a legal claim against your employer.   

If you are employed by the NHS 

Your employer can seek to terminate your employment on ill health grounds. This can occur prior to any application or decision about ill health retirement. 
 
It may be reasonable for your employer to dismiss you if you have been absent from work for a long time or won’t be able to return to work at all due to ill health. However, this should be a last resort and employers should firstly support you to return to work. This could include making reasonable adjustments if you have a disability or long-term health condition due to long COVID.
 
Any dismissal should follow a fair procedure. You should obtain your employer’s policy (likely to be in the sickness or capability policy) for the procedure your employer should follow. You can see the information in this section on Ill health retirement in the NHS and our IHR advice guide. 

NHS Employers have guidance for how employees should be supported with long-term health conditions including long COVID.

This can be complex area so you should seek support from your RCN rep or by contacting us.

Our sickness advice guide provides detailed information on dismissal following long term sickness absence.

In the first instance, you should contact your pension provider to find out what their rules are in relation to ill health retirement (IHR). You should also request a pension forecast, as this will provide you with an estimate of your pension pot value and/or retirement income. As a member of the RCN, you are able to contact Quilter Financial Advisers for a complimentary financial review. 

In order to successfully claim IHR you will need to establish that you are permanently incapable of continuing to do your job due to a physical or mental condition. In order to demonstrate the permanency of your 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 your return to work.
 
If you decide that IHR is the right option for you, you should contact us so that we can support you to engage with your employer and their HR team.

There are a number of criteria that need to be satisfied to make a successful application for NHS ill health retirement. Please see our Ill health retirement advice guide.

One of the criteria is that you must show you have a long-term health condition that has a substantial impact on your current or future employment. Due to the evolving nature of COVID-19, there is currently no definitive answer to whether long COVID would satisfy the criteria, and you will require robust medical evidence to support your application. 

If you are on long term sick leave it is important to contact us for additional support.

Some employees feel pressured to resign but you should not resign without first taking advice. Resigning may remove your entitlement to notice pay and compromise your ill health retirement benefits.

If you find yourself at a career crossroads due to a change in your health, you're not alone. RCN Careers speak to many members who successfully redesign their career around ill health or disability.

Their guidance on Managing your career with ill health and disability talks about the different options you may have and includes a list of jobs that may be more suitable for members with impairments.

If you have any concerns about your employer failing to put in place appropriate adjustments or supporting your to return to work please contact us.

Employers have legal duties and responsibilities to ensure they provide a safe and healthy workplace so far as is reasonably practicable.

The RCN has produced a COVID-19 workplace risk assessment toolkit. This helps support health care professionals consider and manage risks associated with the transmission of respiratory infections, specifically COVID-19, and aid local decision making about personal protective equipment (PPE) at work.

Specific roles and responsibilities for applying health and safety legislation will be different depending on the roles and positions within your own organisation. Health and Safety legislation and regulations apply to all workplaces. This includes health and care settings wherever care is provided such as people’s own homes, prisons and ambulances.

The NMC have a range of revalidation resources. This includes information on how they may be able to support anyone having difficulties in revalidating and the confirmation guidance includes a list of appropriate confirmers.

Reasonable adjustments can be offered to people using the NMC's services.

The NMC also have produced guidance on Health and Character information which may be helpful if you are worried about being able to practise. If you have any concerns about your revalidation or aspect of your health declaration, contact us.

The RCN revalidation guidance includes lots of helpful hints and tips and a section on reasonable adjustments with relevant links to the NMC.

Long COVID and disability

The National Institute for Health and Care Excellence (NICE) in their guidance (updated January 2024) COVID-19 rapid guideline: managing the long term effects of COVID-19, has defined long COVID or “Post-COVID-19 syndrome” as:

“Signs and symptoms 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. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body”.

Section 6 of the Equality Act 2010 outlines that a person has a 'disability' if they have:

(i) a physical or mental impairment and,

(ii) which has a 'substantial' and 'long-term' adverse effect on their ability to carry out normal day-to-day activities.

Our guidance on discrimination and the Equality Act 2010 details what is likely to be considered a disability. Some conditions are automatically considered a disability immediately on diagnosis, for example cancer. In other cases it will depend on the diagnosis, the seriousness of the impairment and that it has a long term adverse effect on someone's ability to carry out day to day activities.

Due to the evolving nature of COVID-19, there is currently no definitive answer to whether long COVID satisfies the above statutory definition.

An employee suffering with long COVID symptoms could likely demonstrate a physical or mental impairment that impacts their ability to carry out 'normal day-to-day activities'.

For example, an employee suffering with breathlessness, extreme fatigue and cognitive impairment may struggle to complete day-to-day activities such as concentrating or walking as easily as they could before.

Our guidance on discrimination and the Equality Act 2010 gives more information about what is likely to be considered a disability. The Equality Act places a proactive duty on employers to make reasonable adjustments and protects people against discrimination.

An Employment Tribunal ruling has now accepted that long COVID may meet this definition of a disability but each case will be decided on its own facts. 

How the RCN can help you

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Your employer has a duty of care to ensure your health and safety at work.

It may be that other workplace issues have arisen, or you are facing difficulties as a result of experiencing long COVID.

Visit our Get Help pages for information on a range of issues such as bullying and harassment, time off work and health and safety.

We also have our Member Support Services including those below. If you require any help and workplace support, please contact us.

Our Peer Support Service is a network for members with lived experience of disability. We share experiences and knowledge, give and receive non-professional support, contribute to guidance and promote the benefits of a diverse health care workforce. 

We have a long COVID network where members can join our closed Facebook group to speak to others with long COVID. We use this group's experiences to inform our ongoing work on long COVID. 

If you are struggling with money or debt, don't suffer alone. The RCN Welfare team can support members with a wide range of welfare related issues and are here to offer confidential, non-judgmental advice to try to help you get back on track.

We have teamed up with MoneyHelper to bring you a range of tools and calculators to help you budget, save and analyse your spending.

As an RCN member you can access our Counselling service to get free, confidential support and assistance to help you deal with challenging, emotional issues whether work related or personal.

We have supported members experiencing difficulties because of their long COVID in a number of ways:

Additional resources

This includes resources to help you return to work and provide general advice concerning long COVID. Some resources may only be available to RCN members and RCN programme participants.

We have a range of clinical resources on COVID-19 in our Clinical Guidance for managing COVID-19; please log in to access this information.

There are other resources relating specifically to long COVID which are below:

We want to grow and develop this resource and would welcome feedback.

Email your comments and any suggestions to HSWTeam@rcn.org.uk.

COVID-19

Find answers to your questions about COVID-19 (coronavirus) and work.

Financial Wellbeing

Advice, support, and resources to help you feel more in control of your finances

Sick leave and sick pay

Learn about your sick pay entitlements, prepare for review meetings and find ways to deal with work-related stress.

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Page last updated - 12/06/2024

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