Last reviewed 5 December 2016

With work now acknowledged as a “health outcome”, the Government is keen to help employers get people back to work as soon as they are fit. Nigel Bryson highlights some of the main approaches to help employees back into work after sickness absence.

Extensive analysis by the Office for National Statistics revealed that, in 2013, 131 million days were lost through sickness absence. To give this figure some sense of proportion, during the same year 443,600 working days were lost in the UK through industrial action by workers, ie working days through strikes represented 0.3% of those days lost to sickness absence.

The main causes of sickness absence in 2013 were:

  • musculoskeletal disorders (MSDs) — 31 million days lost

  • coughs and colds/flu — 27 million days lost

  • stress, anxiety or depression — 15 million days lost.

This annual toll on business performance also adds costs to the NHS. For example, the cost of sickness absence in the NHS itself was estimated at £1.4 billion in 2013/14. The annual cost of sickness absence to employers has been estimated at about £11 billion for 2015.

Considering that “good work” actually aids rehabilitation, and considering the costs associated with sickness absence, the Government has been keen to support employers in getting people back to work as soon as they are “fit for work”. So where can organisations turn for advice and assistance?

Government support

Fit notes were introduced in 2010, to allow GPs to provide patients and employers with information about how the individual’s health problem could affect the work he or she could do. Employees must give their employer a doctor’s fit note if they are off sick for more than seven days in a row (unless the employer provides its own form for self-certification of sickness). The fit note will say the employee is either “not fit for work” or “may be fit for work”. It was hoped that the latter would encourage discussion of the options for returning to work, eg a “lite” version of his or her present job, or an alternative role temporarily. The idea was that this would encourage the employer to be flexible in terms of adjusting the work to the current capability of the worker.

Then, in September 2015, the Government announced that its Fit for Work programme was fully operational and available to all employers in England, Wales and Scotland. This has drawn together all aspects of the Government’s approach to assist people on longer-term sickness absence back to work.

After four weeks or more of sickness absence (or the expectation that the employee will be absent for at least four weeks), GPs or employers can refer individuals for an assessment by an occupational physician under the Government’s Fit for Work scheme. This allows the individual in question to discuss what he or she may be able to do at work.

Following the assessment, experts assist the employee in drawing up a return to work plan, which provides guidance on that individual’s capacity to work and may include a suggested return to work date, any modifications or adjustments (physical or in terms of working time) that may help, and how the return to work will be monitored and reviewed. With the employee’s permission, the return to work plan can be shared with his or her employer and GP. This can replace the need for a fit note.

What can employers do?

Larger companies may have in-house occupational health services and procedures but for most small and medium-sized enterprises, the Government’s Fit for Work scheme is a useful starting point where employees have been absent due to long-term ill health.

The Health and Safety Executive (HSE) also offers guidance on getting people back to work, in addition to information on preventing occupational injuries and ill health. Organisations are advised to develop sickness absence policies and return to work procedures. The following are identified as appropriate measures.

  • Employees and their health and safety representatives (where appropriate) should be consulted in developing policies and procedures.

  • Line managers need to be trained and supported in managing sickness absence and return to work.

  • Sickness absence should be recorded, monitored and measured, and the data is effectively used at an organisational level.

  • Managers should keep in contact with absent employees and plan with them for their return to work.

  • Professional or other advice and treatment should be accessed where possible to help employees.

  • Any risks to employees from work activities should be controlled, especially for those with continuing poor health.

  • Reasonable adjustments to enable disabled workers to continue to work must be put in place.

Ensuring that the employee returns to work he or she is capable of doing after a sickness absence benefits both worker and employer.

Note that legislation requires employers to make “reasonable adjustments” to ensure that employees categorised as disabled are helped back to work. This is particularly important where the individual has suffered some incapacity directly from his or her work: contracting occupational asthma, or other work-related condition, or when he or she has suffered an industrial injury, for example.

More resources

The Government recently released a Green Paper, entitled Improving Lives: Work, Health and Disability, in which it asks for public comment.

“This Green Paper marks the start of that action and a far-reaching national debate, asking: ‘What will it take to transform the employment prospects of disabled people and people with long-term health conditions?’”

While reviewing the employment of disabled people, the paper also has implications for employers both in relation to employing disabled people but also where their employees have been disabled by the work environment.

In the Green Paper, the Government identifies employers as a key group in its new proposed approach:

“How big a role can we expect employers to play in ensuring access to opportunities for disabled people, and how can the ‘business case’ for inclusive practices be strengthened? What is the best way to influence employers to support health and wellbeing in the workplace, both to ensure the effectiveness of their workforce and avoid employment practices which can negatively impact health? How can we prevent sickness absence resulting in detachment from the labour market?”

This means that the whole issue of people being able have work suitable for their physical and mental capabilities is going to be scrutinised over the next few years.

The public consultation on the Green Paper finishes on Friday, 17 February 2017. For further information, see

Is it working?

A survey published by HRreview on 10 November 2016 indicates that most of the 1000 employers surveyed recognise the line manager as a key figure in implementing an effective sickness absence policy. Unfortunately, the survey also revealed that “most employers are not giving [line managers] the tools they need to manage absence effectively”.

Only 25% of the employers surveyed offered “tailored” support for long-term absence. Clearly, one survey is not a reason to castigate a whole system. However, the HSE stresses that training line managers is a key feature of an effective sickness absence and return to work policy.

The survey also reveals that many employers do not have effective sickness absence procedures and return to work policies.

Where now?

Given that the current approach of the Government was launched in 2015, it is too early yet to fully evaluate the impact of the system. Sickness absence causes a huge loss to UK employers overall. Clearly for many organisations individually, it may not be a major issue. However, with the launch of the new service in 2015 and the launch of the Green Paper in October 2016, the issue of getting people back to work will be under great scrutiny in the next few years.

Employers will be well advised to review the issue in their own organisations and address it. While many will have effective measures in place, the indications are that many do not.

Managers need to ensure that they have the training and support to help their colleagues return to work as soon as is appropriate. There is plenty of advice and assistance available. It is worthless if it is not used and put into action.