Case Study - Return 2 Health

University Hospital Southampton NHS Foundation Trust

Dr Julia Smedley, Consultant

This innovative programme won the 2011 HPMA Award for excellence in improving employee health and wellbeing.

What we did

The team used a highly integrated case management approach to significantly reduce sickness absence and improve employee health and wellbeing.


Prior to developing and implementing this programme, Southampton University Hospital Trust had low levels of sickness absence. The previous OH service had comprised traditional fitness for work assessments, fast track physiotherapy treatment, counselling and passive reports to managers about return to work plans.

The occupational health team, led by Dr Julia Smedley at University Hospital Southhampton NHS Foundation Trust developed a more proactive approach to sickness absence management and employee health and well being. They undertook a scientifically robust evaluation of the programme.

The aim was to have a positive impact on employee experience and well-being and to reduce sickness absence to 3.5%

The Approach

Return 2 Health focussed on reducing sickness absence longer than 4 weeks.

The new approach was radically different from the previous service. The fundamental change was a very active, integrated and intensive case management approach. It aimed to enable employees to access specific treatment, advice and support for their condition and identify their own return to work barriers. The programme provided high intensity follow-up to encourage and support employees to set their own personal goals. As a result, staff were empowered to overcome hurdles to achieve earlier rehabilitation.

A key aspect was the early recognition of psychological distress, and the use of positive techniques, such as cognitive behavioural therapy to minimise impairment of mental well-being. Occupational Health Physicians were involved early in the management of complex cases and in case reviews with the multidisciplinary team. The interaction with managers was also active, with practical input into planning adjustments to work especially where managers were reluctant to consider any.


A scientifically robust evaluation was a vital aspect of the work. Similar interventions have previously been assessed as successful, but these have not been evaluated gainst a comparison (no-intervention) group. The project evaluated the new service against a control Trust that had a broadly similar occupational health service that had not built in a Return 2 Health intervention.

The principle analysis used sickness absence data from the Electronic Staff Record.

The Outcomes

The key measurable achievement for this project is the change in the proportion of 4-week absences that progress to cross the 8-week absence threshold. This fell by over 10%.

The overall sickness absence rate fell from 4.14% (an already low level) to 3.3%.

During the Return 2 Health intervention there has been a year on year improvement in the indices of staff satisfaction in the staff survey results.

A cost benefit analysis is currently being undertaken.


Return 2 Health had four key components:

  • Focus on reducing sickness absence longer than 4 weeks 
  • A high intensity case management approach
  • Provision and signposting of multidisciplinary treatment, advice and support, including on-line Cognitive Behavioural Therapy (cCBT), exercise and activity management and physiotherapy 
  • Close liaison with HR and line managers

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