Sickness absence case management: what can policymakers do to support employees with health conditions to remain in work?

Blog posts

10 Jun 2025

Sally Wilson, Principal Research Fellow

Follow: @sallywilsonIES

The number of working-age people prevented from working for health reasons currently stands at around 2.8 million. The government has proposed significant reforms to employment and health support to tackle this, acknowledging the importance of early intervention and effective case management. This resonates strongly among researchers at IES: there are lessons from previous government efforts and from IES’ own research record on workplace health interventions. In particular, messages from our evaluations of the ‘Fit for Work’ service, a caseworker-led model initiated under the last Labour government, should be considered in shaping any new intervention of this type.

Core standards and service components of case management in the Fit for Work service

The Fit for Work (FFW) service was a UK government initiative designed to support people to stay in or return to work, when dealing with health-related issues. It was aimed primarily at employees on sick leave or at risk of long-term sickness absence. The previous pilots were based on a ‘black box’ model with many aspects of delivery left up to various local providers. But some core features of effective case management in the FFW context can be drawn out from our evaluations.

Early and proactive intervention: Engagement should occur within the first few weeks of absence, with rapid triage and prioritisation of complex or high-risk cases.
 
Individualised Return to Work (RTW) plans: Tailored, actionable plans should be based on the individual's condition, job role, and workplace, with realistic timelines and phased return options, with consideration of alternative employment or job change pathways where necessary.

Employer engagement and workplace liaison: Communication with employers should be regular, with recognition that support for small and medium-sized employers (SMEs) may lack internal HR/occupational health expertise. Workplace adjustments need to fit the employer context.

Integration with other services: Where specialist input is needed, case managers should coordinate with (for example) GPs, mental health services, physiotherapy, and employment support, signposting or referrals.

Monitoring and Follow-Up: Check-ins with employees to review progress and adapt plans should be regular, with follow-up protocols for worsening conditions or failed return-to-work attempts.

Key learning principles

Although the service was successful in improving return-to-work outcomes, it was discontinued in 2018 primarily due to low referral rates. The IES team identified several points applicable to the design of any new case worker support models.

Assure fidelity to the model: Fidelity to the delivery specification was mixed, and often shaped by local capacity, partnerships, and provider experience. This resulted in inconsistent user experience and outcomes, and overall confusion about the offer.

Provide clarity of the service offer: There needs to be transparency and trust around who is providing the service. As mentioned above, the previous services were based on a ‘black box’ model, with the method of delivery left up to the various providers.

Manage expectations around the service: Many employers and employees didn’t fully understand what the Fit For Work pilots would deliver: some employers expected full medical assessments, while some employees confused the service with a Work Capability Assessment for DWP.

Consider a change of job as an outcome: The pilots struggled to address the complex needs of individuals with mental health issues. This complexity made it challenging to provide effective support, especially when a change of job was necessary for recovery, for example, where work environments were ‘toxic’ for the individual.

Ensure adjustments are adequately tailored to the employment context: Employers often struggled to implement recommendations that didn’t account for specific job requirements and operational constraints. For instance, in roles requiring physical presence or specific skill sets, suggested adjustments like remote work or role modifications were not feasible.

What should happen next?

To address acknowledged gaps in occupational health and disability support, an updated case management model should be trialled to test what works in the current employment landscape. This should address:

Use of technology for engagement/service delivery: FFW was launched in a pre-Covid, pre-Teams era, so engagement was face-to-face or over the telephone.

Use of technology in workplace adaptations: Similarly, the potential for adaptations has moved on considerably, for example, support with reading and writing on MS Office is now standard.

Changing nature of commonly disclosed/diagnosed disabilities and health conditions: There is increased prevalence of mental health and neurodiversity diagnoses, particularly in young people. The profile of disabilities has shifted, with a rise in chronic conditions such as long Covid. Also, advances in cancer treatment have enabled more people to remain in work while managing ongoing symptoms and treatment side-effects.

Qualifications of case managers: In the context of FFW, case managers were health professionals, but not necessarily with an occupational health specialism. New models of case management are likely to require different skill sets.

Linking with skills and career provision: This wasn’t a core part of FFW but would need to be considered in any future service to meet current government plans set out in its ‘Get Britain Working’ White Paper.

At the time of writing, a ‘Discovery Report’ has been published as the first step of a review which focuses on how employers and the government can collaborate to reduce health-related economic inactivity and promote inclusive workplaces. There is a strong focus on case management in this report and a call for evidence encourages those who have directly benefited from the process to share their experiences. We hope this call for evidence yields some rich learning and provides a basis for vital research to determine what new approach to case management should include and prioritise.

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Any views expressed are those of the author and not necessarily those of the Institute as a whole.