How employers should address return to work after an absence

Return to work


The Chartered Institute for Personnel and Development calculates that absence per head costs £522 per employee, with the average absence being 6.6 days per annum. This includes sick pay for absent employees, but there are also hidden costs such as the cost of cover, reduced performance, impact on colleagues,and missed business opportunities. Absence has a significant effect on the bottom line of a business, but companies also want healthy, happy employees who are fully engaged at work. Identifying any potential health issues early and helping the employee to address these is a good sign of a caring employer. Managing absence is therefore one of the most important aspects of a comprehensive HR strategy.

Managing absence involves the three Ms: Measuring, Monitoring, and Managing, and all of these need to be done properly in order to reduce the cost of absence within a business.

Return to work interview

The best way to manage absence is to ensure that employees provide as much information as possible about it. Employers need to know the nature of the absence (measurement), to analyse the information (monitor) and to have targeted strategies at a company and individual level (management).

This information is captured in a return to work (RTW) interview where the manager welcomes the employee back after a period of absence and has a discussion about the the reason for absence. The interview should check to see if they are well enough to return to work and this is the opportunity to discuss any concerns.

Consistency across the company is important and therefore a well written and comprehensive absence management policy is at the heart of a proper approach to managing absence. This policy will cover the process and obligations that the employee and manager should follow, and be clear about the purpose of the RTW interview.

Everyone can get sick and so the meeting should not be designed to worry the employee about taking time off for genuine sickness. No one wants a sick employee coughing in the office and spreading their germs. Fear of taking sick leave can lead to presenteeism, which can lead to further issues either the illness being spread or higher levels of absence as the person becomes worse. A culture of presenteeism also gives the impression that the employer is uncaring which demotivates employees.

So what should the interview cover?

The interview is a non-confrontational meeting to discuss the absence, which should be held on the first day back. This is to ensure that the employee is aware that their absence was noticed, to provide any support to help them return to work and to identify if there is a wider issue which might need closer attention.

Introducing trigger pointsis a helpful way to identify concerns and prompt a specific absence planconversation. The Bradford Factor is a common triggertool, which gives more attention to the number of absences than the length of the absences. However, many companies develop their own trigger points such as three separate periods of absence over three months, or twice being absent on a Friday.

Once an employee hits a trigger point,  the manager can discuss their concerns in the RTW interview. The RTW form should be pre-populated with the absence of the employee to date. HR or the manager can then look to see if there are any trends developing.

So what trends might we see?

Intermittent and random short-term sickness

In these cases, there may be some malingering (unjustified absence), genuine and unconnected illnesses or an underlying condition. If the latter, studies show that identifying these issues early can lead to the most positive outcome for the employee and the company. Often underlying chronic conditions such as stress might show up as regular, but intermittent absence. A medical review can help identify if there is a chronic condition, and give managers the tools to manage it most effectively.

Low back pain is another common reason for absence and any mechanical pain issues such as low back pain or repetitive strain injuries need a robust Health and Safety assessment at work. If the absence is malingering, the formal process of a back to work interview can introduce an element of fear factorwhere the employee realises that the company is measuring and monitoring absence and that there will be consequences for continuing to take unjustified ad hoc days off.

Long-term absence

Long-term absence is generally considered to be over four weeks, and requires specific management.

It could indicate an illness which constitutes a disability under the Equality Act 2010 and needs to managed in a particular way. Under the Equality Act 2010, the definition of a disability is a physical or mental impairment that has a substantial and long-term negative effect on someones ability to do normal daily activities. Substantial is more than minor or trivial. Long-term means 12 months or more.

Long term stress or a formal diagnosis of anxiety or depression needs a thorough review of what treatment the employee has had or what is recommended by their medical practitioner on their return to work. This may include reduced hours or a phased return initially to let them settle back in. These can be formalised with a RTW fit note.

Furthermore, an operation and the subsequent recovery period may require employees to return with altered duties, such as avoiding heavy lifting or walking for too long. Medical input is crucial in identifying if the person has a disability and the employer will be given advice about other reasonable adjustments. Not all long-term absence is related to a disability and once an employee is considered to be fit to work, the interview gives the manager the opportunity to understand the support that the employee may need to return to work.

What questions should be asked?

The company needs to understand the reasons for the absence, and encouraging an open dialogue helps to provide more detail about the illness and fleshes out the data. The more in-depth the information, the easier it is to identify trends and understand if there is anything that the company can do to support the employee on their return.

There may be occasions where the employee is uncomfortable about sharing certain information with their manager (for instance, discussing breast cancer with a male manager) and at this point, its important that they are aware that they can have the meeting with a third party such as HR.

Patients do not have to reveal any details unless they want to. They may require adjustments on their return such as  sitting someone closer to the toilets if they have Crohns disease or allowing employees to snack often if they have diabetes. This often needs to be shared with HR, who are at liberty to request the input of an independent doctor if they wish. 

Managers and HR are not medical experts so having a relationship with an occupational health provider or doctor can assist with understanding the implications of a particular illness. It helps clarify anything that can or should be done to support the employee back into work, the likelihood of future absence and anything that can be done to reduce the risk of future absence. Discussing these options in the BTW interview sends a positive message to the employee that the company values them.

Using the data from the Back to Work interviews

The BTW interviews provide a vast amount of rich information which can be used to help develop specific strategies. If the data is showing an increase in people taking time out for anxiety or stress, the company might choose to implement specific anti-stress policies, such as encouraging people to take a break during the working day or establishing a relationship with a private GP practice or through an Employee Assistance Programme to resolve issues before the person takes time off work. 

Employees do not necessarily go to the doctor due to stress at work, but instead with exhaustion or physical strain, such as neck pain. Clinicians should be in tune with regular absences and address the possibility that it may be an indicator of stress at work, particularly if combined with behavioural changes. Identifying stress and tackling it with the right treatment options help ease an employees transition back to work. All companies should have a wellbeing strategy, which aims to put interventions in place to reduce absence and the data from the RTW interviews can help them to develop targeted interventions.


There will be times where absence is too high for the company to tolerate, either because of pressure on other employees or the cost of the absence or the impact on business operations. In these cases, in conjunction with the absence policy, a capability policy should be clear on the steps that the company will take to manage people whose absence becomes unsatisfactory. The capability policy allows the company to have formal meetings with employees with the objective of encouraging them to reduce their levels of absence. In these instances, it is invaluable to have an occupation health practitioner or a GP to ensure this process is robust and provides the best support for employee and company. Employees should be given a fair amount of time to address their absence if possible, bearing in mind some chronic conditions such as Crohns or kidney disease requiring dialysis are unlikely to improve. If there is no improvement, the outcome could be a fair dismissal.

Measuring, monitoring and managing absence has an impact on the bottom line of the business and on the well-being and motivation of all employees.


Health information is sensitive, and the absence policy should be clear on how data is being held and how it is shared. Generally, any reporting on absence statistics should be generalised and anonymous. The information should only be used on a need to know basis within the company.

*Vicki Field is HR Director and Dr Preethi Daniel is Medical Director of the London Doctors Clinic, a private GP clinic.

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