Returning to work in the Netherlands: a different approach

Anna Kelsey-Sugg

Dutch occupational physician Frederieke Schaafsma describes a new Netherlands system of return to work that has seen the number of employees on long-term sick leave dramatically reduced.

There are over 2000 occupational physicians in the Netherlands, a country of 16 million people. This is a good indication of how familiar occupational health care is to the Dutch, and how well they understand the importance of employees being looked after, as well as being taught to look after themselves.

Under recently introduced Dutch laws, if an employee calls in sick at work, before anything else it is a matter between the employee and their employer, the person who is responsible for the return to work procedure. “As soon as they think it is more than say the flu, managers have to get some sort of advice,” said Dutch occupational physician Dr Frederieke Schaafsma. 

“If an employee calls in sick and has back pain then the advice for the manager is just to be supportive and ask the employee, ‘Can I do anything for you?, When do you think you’ll be able to get back to?, Do you need medical advice?’ And suppose the employee says, ‘No, that’s fine, I’ve been to the GP and I’ll be back on Tuesday’, then nothing would happen,” Dr Schaafsma said.

If the employee said to their manager, ‘I’m in terrible pain and I don’t know when I can come back’, then, under the new Dutch system, the following would take place:

  • The manager would say, ‘Maybe it’s good if you seek some medical advice about possible interventions and what we can do to help you go back to your work
  • The employer or employee would make a medical appointment with the occupational physician
  • The manager could call the physician and say, ‘This person who’s been working for me needs to have an appointment with you, this is the case, this is the type of work they do, and please advise’ 
  • The employee will go to the physician and they will discuss the severity of the problem, possible intervention, and consequences for the work situation. The physician will probably call the manager again and say, for example, ‘This is my advice and I’ll put it in writing, but I think the person should stay active and do a half day of work and gradually prolong the hours, and then be back fully within four weeks. This report focuses on what the employee can do, rather than what they can’t do.

“For preventive occupational health and safety, companies do not have the obligation to work with an occupational health service and can decide to do it on their own. But it is an obligation for all companies in the Netherlands to work together with an occupational health physician when an employee is on sickness absence,” said Dr Schaafsma.

It’s also the responsibility of the employee to seek the best medical help possible. And if an employee doesn’t want to give medical information or doesn’t want the occupational physician to receive the information, the occupational physician can now say, ‘I cannot give advice because I don’t have all the information’. “That’s a big benefit now because it encourages employees and also employers to take the advice of the occupational physicians seriously,” Dr Schaafsma said.

“If the medical advice is that the employer needs not to work for a period of time, the physician may prescribe that as well, but it must be put in general words and there has to be an estimation of when the physician thinks everything will be back to normal.”

Dr Schaafsma is pleased with the new laws – and their results. “There have been huge positive effects; the number of people on sick leave has decreased enormously, and especially the number of people that have long-term claims,” she said. “The previous regulations made it very easy for employees to stay at home and it wasn’t very expensive for employers to just let people be sick, because if you were sick long-term, after one year a public insurance company would take over the claim and pay all the income. With the new law it’s the wallet of the employer that suffers, so now there’s a lot of motivation for the employer to make sure that the employee does everything possible to get back to work.”

It’s good to know that “the law also states very clearly that managers have a responsibility to do everything possible and to let people be sick too”. Dr Schaafsmar describes the best part of the new system, in particular the immediate meeting between employer and employee in the case of illness or injury, as a “de-medicalisation” of the issues. Sometimes problems are greater than that which a medical provider can resolve. “Also, it’s not such a taboo topic anymore; the employee’s health is something they can actually talk about.”

“The employer is involved and has a responsibility to help the employee to return to work. This makes it really clear if there’s another issue – it might be that it’s a medical problem, but it might be that the employee is unhappy at work, that they don’t really like their colleagues or that they feel they’re not taken seriously by management. It really helps to clarify that and take it away from the whole separate medical issue – those things you can’t solve when you visit an occupational or a general physician.”

Communication is key in the Dutch system. In her workplace in the Netherlands it would not be uncommon for Dr Schaafsmar to be one of three people sitting down together to discuss how to better deal with an employee’s return to work; there would be the employee, employer and herself, and sometimes someone from human resources too. “For everybody who was sick for a half year or longer, then every half year all three or four of us would have a talk” – a practice she described as commonplace in companies the Netherlands.

While in Australia management involvement is often incidental in the process of rehabilitation and return to work, the Dutch system is geared towards better communication between the employee and the workplace, and earlier intervention. Employees have access to occupational physicians even before problems arise, and while both employee and employer communicate first with each other, they both also have the resource of the occupational health professional to guide, advise and support them through the process of return to work.

The process in a nutshell: 

  • If an employee feels sick they call their employer and both discuss whether the illness or injury is likely to prevent a return to work within a limited number of days; if this is the case, an appointment must be made with the occupational health physician
  • If after six weeks the employee is still unwell or partly unwell, the occupational physician makes a report of the situation, at least part of which goes to the employer. The employer is then obliged to write a plan to help the employee return to work. This must be agreed upon by the employee.
  • If it looks like problems are going to be long-term, after 12 weeks or so the report also goes to a public insurance company for ill or injured workers. The report is a sign for the insurance company that this person might need financial help after two years.
  • Then every six weeks the plan or report needs to be updated by all parties. If after 22 months employee still cannot fully return to work fully, a claim will be made to the institute to take over the financial responsibility as, after two years, the employer no longer needs to pay.

Published 09 March, 2009 | Updated 10 March, 2009