Rewriting the return-to-work rules: what needs to change?

The number of people on long-term sick leave shows no signs of changing. Where are we going wrong?

Frank Vandenbroucke: “Over the past 25 years, sickness and disability benefits are the one branch of our social security system that has remained untouched. With that in mind, we started taking steps in 2021 to adapt the system for the modern age.

I strongly believe that responsibility is something that needs to be shared: you can’t have true solidarity without doing so. But to get there, everyone needs to sing from the same hymn sheet: health insurance funds, employers, the doctors treating the long-term sick, mediation services and so on. We also need to be able to work on the assumption that it is clear to everyone which role they play. At the same time, we all need to work toward the same goal. Polarisation won’t get us anywhere: we all need to pull in the same direction.”

Hanne Sanders: “Sure, we need a more detailed picture of who does what. Right now, that’s not always sufficiently clear. At the same time, we need to put even more effort into dialogue between all parties.

Another area that needs a lot of work is collecting relevant and clear data. The data we have right now remains too vague. The press only reports the big numbers: ‘more than 500,000 people are on long-term sick leave or incapable of work’ and the like. If we want to target our efforts more precisely and share responsibility, we need more granular analysis. Which sectors are hardest hit? What are the reasons or clinical conditions that keep people out of work?”

Wim Adriaens: “The social potential we are not utilising is too great. There’s not enough of a ‘there’s still something I can do’ mentality among people struggling with illness or disability. In Denmark, for example, it’s perfectly normal to visit a job centre after three weeks off work to discuss your situation. Psychological safety plays a major role in this.

Our system continues to place too much focus on compliance and too little on what people can still do. It also takes too long for people to get to the stage where they’re in contact with VDAB, and by that point, their self-confidence has often taken a battering. And that self-confidence is exactly what they need to take control of their own destiny.”

Is the coalition agreement sufficiently committed to preventing long-term sick leave?

Frank Vandenbroucke: “Our efforts are still lacking in terms of prevention. The working-age population is getting older, and the world of work is changing rapidly. Prevention should focus on the fundamentals of how jobs are organised today. The key question here is how to create jobs that are challenging and in which people can manage their own workload.

In fact, that’s a question I’d like to put to the prevention services: how do you think organisations can focus on prevention in a more efficient and agile way? What do they need to do so?”

Is the legislation around returning to work too complex?

Hanne Sanders: “Absolutely. The pathways by which people return to work are tough and legally set in stone. The role of occupational physicians is also highly regulated. As an industry, we are engaged in a major thought exercise to see how we could operate more flexibly. Employees should not face any barriers when they reach out to us. In political terms, the calls from our sector have already been heard, and changes to welfare legislation are in the pipeline.”

The coalition agreement has also picked up on the ‘fit note’ concept. Is that a good thing?

Bart Teuwen: “A fit note is essentially a modified version of a sick note, using the things that an employee on sick leave can still do as its starting point. Can the patient in question still work, perhaps in a different or adapted role?

I am absolutely in favour of that measure, provided we interpret it smartly. There are lessons we can learn from the introduction of something similar in the UK, where the process went too quickly. As a result, most doctors simply stopped specifying whether a sick employee still has any capacity to work. We need to avoid repeating that mistake with a proper implementation strategy and clear agreements.”