Workplace support strategies
There are many simple actions you can take to minimise the impact on daily operations and support your employee.
Some people with cancer will be able to continue to work, while others will need time off during treatment. This section looks at both unplanned and planned time off.
During the first seven calendar days of sickness, an employee can self-certify that they are unable to work. After this time, a doctor may issue a ‘fit note’ (this replaces the old ‘sick note’). A fit note allows doctors to advise whether someone ‘may be fit for work’ or is ‘not fit for work’. In either case, the GP will include evidence for the advice they have given.
If the note states that someone “may be fit for work”, the GP will include information about the functional effects of the person’s condition. They will also give advice about what may be done to help the person be able to work. The information is intended to encourage a discussion where the employer and employee consider and agree any changes that would help the person return to work.
If the note states that someone is unable to work, then the organisation’s sick leave policy will come into use – see below.
Time off for appointments
Agreeing some time off work will be one of your employee’s most pressing needs. They should try to give you advance notice so you can arrange cover if necessary, but this may not always be possible.
People living with and after cancer will need to attend medical appointments. Some may need to stay in hospital for treatment. They may also benefit from receiving complementary therapies and may need time off for these appointments too.
Sick leave and Statutory Sick Pay
Your organisation should have clear policies about sick leave – this forms an essential part of an employment contract. Your sick leave policy should include information on how time off for medical appointments is dealt with. However, you may need to exercise your discretion occasionally, depending on the number and frequency of appointments your employee needs to attend.
Employers are obliged to pay Statutory Sick Pay (SSP) to qualifying employees who are off sick for four or more days in a row, including weekends and holidays. It is not payable for the first three days in any period of entitlement but after that, it is payable for up to 28 weeks at a weekly rate.
When SSP is due to end, your employee should check their entitlement to Employment and Support Allowance (ESA). This benefit provides financial help to people who are unable to work because of illness or disability. It also provides personalised support to those who are able to work.
For more information about SSP and ESA, call 0800 055 6688 if you live in England, Scotland or Wales (0800 012 1888 for Welsh language), or 0800 220 674 if you live in Northern Ireland. You can also visit gov.uk, or nidirect.gov.uk if you live in Northern Ireland.
Occupational or company sick pay
Your employee may be entitled to occupational or company sick pay on top of SSP under their employment contract.
Where organisations are in a position to do so, we encourage them to look at the possibility of reasonably adjusting their occupational sick pay to cover extended periods over and above the standard statutory or contractual obligations.
Time off for carers
If your employee is a carer, they may be legally entitled to take reasonable time off to deal with an emergency affecting the person they care for. Whether this is paid or not will depend on your organisation’s policy.
Other options you can explore with your employee include:
parental leave (if their child has cancer)
flexible working (carers have the right to request this)
working from home
reduced or condensed hours
taking time off in lieu, if appropriate.
The above options aim to allow your employee to look after their own health or the person they care for, keep your organisation running smoothly, and protect the employee as much as possible from financial hardship.
Cover for an absent employee
You may need to arrange cover, for example, if your employee is unable to work for a long period, or if they choose to reduce their hours. You should try to:
discuss this honestly with your employee
be clear about your reasons for hiring temporary cover
be sensitive to their views and concerns – they may feel you don’t have confidence in their treatment programme
let them know that the extra resource is temporary
follow your organisation’s standard procedures for employing temporary workers.
We have more information about sick leave and financial issues.
For more information about managing absence and other employment issues, you can refer to the Chartered Institute of Personnel and Development (CIPD).
Carers UK offers advice on employment issues and rights for carers, including time off.
Employers and employees can contact the Advisory, Conciliation and Arbitration Service (ACAS) for help on any employment issue, including absence management. The website also has useful information about this and other relevant topics.
In Northern Ireland, you can contact the Labour Relations Agency.
People living with cancer often feel ‘out of touch’ with work during their absence. It’s important to maintain appropriate contact with your employee during periods of sick leave. This contact can be maintained through their line manager or a nominated ‘buddy’. Handle communication carefully so that your employee still feels valued but doesn’t feel you are pressuring them to return too soon.
If possible, discuss arrangements for keeping in touch with your employee before their absence. Ask them:
Do they want to receive newsletters and key emails?
Do they want to hear from colleagues? If they do, how (by phone, email), and how often?
Is there is a good time to get in contact?
Cancer treatment may make it difficult for your employee to be in contact at certain times, and this may only become apparent after treatment has started. If you have agreed to call at a certain time on a certain day, keep that arrangement as your employee may have made the effort to be able to take the call.
Sometimes an employee may not want any contact. Explore their reasons and reassure them you just want to be supportive. It may simply be because of how they are feeling at that point in time. You can ask them about it again later, when they may find the idea of contact from work less daunting.
The role of occupational health
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Your employee and your organisation may benefit from the help of an occupational health adviser. This is a health professional, such as a nurse or doctor, who specialises in workplace health issues. Occupational health advisers draw on their clinical knowledge and an awareness of the specific duties and demands of the employee’s role. You may consider consulting an occupational health adviser at an early stage, before going ahead with important changes or decisions affecting policies or individuals.
Most occupational health advisers serve in an advisory role for managers and employees. They can help you understand your responsibilities under employment and health and safety law. They can also inform business decisions about:
reasonable workplace adjustments
release of company benefits such as pensions.
Occupational health advisers can also help managers carry out appropriate risk assessments for employees with cancer or other chronic health problems. This is to ensure that, from a health and safety perspective, the work the employee returns to is appropriate.
When someone has cancer, occupational health advisers are most often used when:
considering a job applicant’s fitness for employment
considering someone’s fitness for returning to work after sickness absence
there is management concern about the health and safety or performance of an employee who has been sick.
Occupational health services are not provided free under the NHS or health service and are offered at the discretion of employers. Some large organisations have occupational health expertise in-house. Medium-sized and smaller organisations often access this expertise through external contracts, although some won’t have any occupational health arrangements.
Many commercial companies offer occupational health consultancy to businesses. Or, you can use NHS Health at Work, an occupational health service (that charges fees) for small and medium-sized businesses.
Free occupational health advice is available to employees and their employers over the phone if they work in a small business. Call 0800 077 8844 in England, 0800 019 2211 in Scotland or 0800 107 0900 in Wales.
In Northern Ireland, you can contact the Workplace Health Advisors at Health and Safety Executive Northern Ireland (HSENI). They provide guidance on workplace health and well-being promotion and their services are available to businesses for a fee.
Macmillan has an e-learning module for occupational health advisers. Working with cancer: the occupational impact of cancer is a two-hour module about the occupational impact of a cancer diagnosis on working-age adults.
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If your employee has been away from work having treatment, it can be difficult to know when they are ready to return.
When Macmillan surveyed employees about their experiences of work and cancer, most said they received little or no worthwhile medical advice about returning to work at the right time.
Many people are left to make this decision alone, based on when they feel it’s the right time to return.
Finding out your employee’s needs
While many employees choose to share their cancer diagnosis with their employer, as a manager, you have no legal right to know the diagnosis or the clinical details of an employee’s condition. In fact, employees have a right of confidentiality under the Human Rights Act 1998. However, law and medical ethics recognise that employers may legitimately seek information relating directly to operational matters (although this still does not oblige an employee to disclose their medical information). For example, with the employee’s permission, you could ask an occupational health provider for advice about the person’s health in relation to their ability to perform their role. This conversation may cover:
the likely duration of absence
the likely effect health issues may have on their return to work
the likely duration of any health issues that may affect the individual’s ability to carry out their role
whether there are any adjustments needed in the workplace to help overcome any disadvantage the individual may suffer as a result of health issues
the likely duration of any adjustments
the potential impact of health issues on performance
the potential impact of health issues on health and safety
if the individual will be unable to carry out their role for some time, whether the individual could carry out alternative roles within your organisation (see below).
If you seek occupational health advice about an employee’s condition (with their permission), you should frame your requests for information around questions that are relevant to running your organisation.
Joint return-to-work planning
This is where both you and your employee discuss and agree the best way forward. Cancer can be unpredictable so plans should be flexible, allowing for regular reviews and changes along the way.
The possibility of flexible working and a gradual, phased return to work are potentially helpful ways of easing someone back into the workplace. It’s important to fully involve the employee in these conversations to ensure it’s a shared decision-making process.
In addition to agreeing a return-to-work plan, it’s a good idea to schedule a meeting with your employee a week or two before they start their first day back at work.
Having a meeting before their return to work gives them a chance to visit the workplace, hear important updates and raise any concerns. It also allows you to find out how they are feeling and sort out any potential problems before they occur. In addition, you can check how much they want the team or the rest of the organisation to know, and how comfortable they will be with people asking them how they are.
As a line manager, you will need to be flexible with your employee’s return-to-work scheme. Their recovery from cancer may be difficult to predict, so the plan may have to change over time.
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Under the Equality Act 2010 (England, Scotland and Wales) and the Disability Discrimination Act 1995 (Northern Ireland), employers have a duty to make reasonable adjustments if the location, working arrangements or a lack of extra support (auxiliary aids) puts a disabled person at a substantial disadvantage compared with others. People with cancer are considered disabled for the purpose of this legislation and are therefore protected from the point of diagnosis.
As part of your joint return-to-work plan, you will need to discuss and finalise any reasonable adjustments needed in the workplace or the employee’s working day.
What are reasonable adjustments?
There is no fixed definition of ‘reasonable’. What is reasonable will depend on the circumstances, including practicality, cost, the extent to which the adjustment will be effective, and the extent to which business may be disrupted.
An employer will not be obliged to make reasonable adjustments unless they know or ought to reasonably know that the individual is disabled.
Any planned adjustments should be discussed with the employee.
Reasonable adjustments for someone with cancer may include the following:
Allowing a phased return to work – see below.
Letting them take time off to attend medical appointments – this may already be covered by your existing policies.
Modifying a job description to remove tasks that cause particular difficulty – either on a temporary or permanent basis.
Being flexible about working hours. This can help enormously if fatigue is a problem, because it allows your employee to work when they feel strongest and have the most energy. Flexible hours also means your employee can avoid the strain of travelling at peak times.
Offering the option to work from home. Home working for one or more days a week has many of the same benefits as flexible hours. It allows your employee to conserve their energy. Make sure their home has a suitable work environment and that they have the required facilities and equipment to do the job.
It’s also important to make sure they stay in touch with colleagues and don’t become isolated.
Allowing extra breaks to help them cope with fatigue. A short rest in a quiet place can be helpful.
Adjusting performance targets to take into account the effect of things like sick leave or fatigue, or giving them a role with more suitable duties.
Making sure there is easy access to the workplace for someone using a wheelchair or crutches.
Providing disabled toilet facilities.
Changing the date or time of a job interview if it coincides with a medical appointment.
Just one or two small changes could be all it takes to help an employee stay in work.
Our short film Making work adjustments for an employee affected by cancer may be helpful. You can watch this on our Cancer in the workplace DVD or online at macmillan.org.uk/workvideos
Respondents to a Macmillan Cancer Support/YouGov online survey reported being denied time off for medical appointments, passed over for promotion, or feeling abused by their employer or colleagues (for example by being given unfair workloads).
Phased return to work
Allowing a gradual, phased return to work is one example of a reasonable adjustment you can make.
Agreeing a lighter workload or using holiday entitlement accrued during time off to shorten the working week could be one way of doing this.
Research commissioned by Macmillan has shown that a phased return to work (as well as line manager support) is an important predictor of a successful adjustment back to work.
Changes to the work environment
Reasonable adjustments can involve making changes to the work environment. For example:
Is mobility is a problem? If so, having a car parking space closer to the entrance is helpful.
Are there any issues with accessibility that should be considered and, if so, what changes would it be reasonable to make?
Does your employee need different equipment or a change in the location of their workstation? For example, you may need to move a workstation to avoid stairs. A professional assessment can help with this – seek advice from an occupational health adviser (see above).
The Access to Work scheme can help if a person’s long-term health condition affects the way they do their job. It gives employees and employers advice and support to meet the additional costs that may arise because of the employee’s health condition.
The scheme may pay for special aids and equipment needed in the workplace as a direct result of the employee’s condition, travel to work if the employee can’t use public transport, or a support worker.
The Employers’ guide to Access to Work is available to download.
To find out more about Access to Work in Northern Ireland, contact an Employment Service Adviser in your local Jobs and Benefits Office or JobCentre, or visit nidirect.gov.uk
In a Macmillan Cancer Support/YouGov survey, 46% of people said their employer did not discuss sick pay, flexible working and making reasonable adjustments with them.
Other ways you can help
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You can also try these specific and practical steps, to help your employee settle back into work:
Be there on their first day or, failing that, make sure you phone them. Make sure the rest of the team are expecting them, adding to the welcome.
Meet at the start of the day to discuss their work plan and handover arrangements. This is another opportunity to check for concerns they may have.
Help them feel part of the team again. Treat all your employees equally to ensure everyone knows arrangements are fair.
Agree a regular review process with your employee. This way, you can monitor their progress, make sure their workload is manageable and make any necessary adjustments to help them succeed.
Make sure they are taking breaks and that they are not overworking. Overtime should be discouraged, so check your employee is leaving work on time.
Consider a health and safety assessment, especially if there has been a change in duties or working arrangements. If they are working from home, you should assess this environment too.
Signpost them to sources of further support. There are useful organisations here to help you and you can search for them on our website. Suggest they talk to an occupational health or HR professional if this is possible in your organisation. If there is a confidential counselling service at work, you can let them know about this.
Plan for occasional future absences. These may be due to medical appointments or because your employee, or the person they care for, is not feeling well. Fatigue can persist long after cancer treatment has been completed.
These tips can ensure a smooth handover of work:
Make sure your employee doesn’t return to an unmanageable amount of work and emails. Spread the work out so everything isn’t given to them at once.
Try to break tasks down into smaller steps to make the job more manageable and encourage a sense of achievement.
Prioritise duties so your employee knows what the most important tasks are. They’ll have a greater sense of control and achievement. This will also ensure the needs of the job are met.
Reallocate or change work duties. Manage this sensitively, so colleagues don’t feel overburdened, and reassure the person with cancer that this is temporary and not designed to undermine them or their work.
Adjust performance targets temporarily so they remain realistic for your employee.
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Suitable alternative employment may be an option if, despite best efforts, your employee is unable to fulfil their role. If the situation is likely to change in the future, this can be offered on a temporary basis with an agreed date for review.
Remember, changes to your employee’s working conditions can be temporary or permanent and may have an impact on their terms of employment.
Before any substantial changes are agreed, make sure the employee is completely clear on what the changes mean.
Review your organisation’s policies to find out what support can be offered. Any substantial and/or permanent changes should be confirmed in writing, and your employee should sign this document to indicate their agreement to the change.
These measures don’t have to be expensive or disruptive. Many of these ideas are just common sense. Sometimes, small changes can make a big difference for your employee.
Most of the points above can also apply to carers. However, carers may have additional difficulties re-entering the workforce, particularly if they have been bereaved. Their confidence and skills may have been affected by absence from work, and they may also have emotional and practical issues to deal with following the death of a loved one. A carer may require professional help in overcoming these issues, although some people may want to work through problems themselves.
You may find our short film about Supporting carers helpful. You can watch this on our Cancer in the workplace DVD.
If your employee wants to resign, it’s important to understand their reasons. However, sometimes the person’s emotional state can lead them to make this big decision. Additional support and an explanation of all the options may lead to a different decision – and help you retain a valued member of staff. Of course, for some people, leaving work is the best choice. If this is their decision, make sure you follow your organisation’s leaving procedures.
Stopping work because of cancer can have serious financial implications. Resigning or retiring early can change a person’s entitlement to state benefits, pensions and insurance. It’s a complex area and every person’s situation is unique. Because so much is at stake, encourage your employee to seek expert advice and establish what their position is, before any formal action is taken on either side. We have more information about personal finances.
Although many people survive cancer treatment, your employee or the person they are caring for may die from their illness.
If your employee is terminally ill
Many people live for months or years after a diagnosis of incurable cancer. By law, an individual should be allowed to work for as long as they want, subject to medical advice and any health and safety concerns.
Many people with cancer choose to remain at work for as long as possible. In this case, the employer should make adjustments and do their best, within reason, to allow the person to keep working.
If the employee is gradually getting weaker, this can be difficult to manage. An occupational health adviser should be able to help.
Colleagues may also find this time upsetting. Let employees know about any counselling or employee assistance programme (EAP) that’s available. You can also suggest they call the Macmillan Support Line for support.
The person who is ill may also need advice about things like their pension or writing a will. Macmillan’s financial guidance service on the support line can also help with this.
If your employee dies
If the person with cancer dies, as an employer you will be responsible for carrying out these practical steps:
Informing colleagues within the organisation.
Telling clients, customers and suppliers. This can prevent embarrassment and upset if they attempt to contact your colleague without knowing what has happened.
Assisting the family. There should be just one point of contact between the employer and the family. Normally this would be the line manager or someone in the HR department. Prompt action should be taken to settle financial matters such as remaining pay, pensions and insurance, and ensuring as far as possible that correspondence is not addressed to the person who has died.
Letting colleagues know about funeral arrangements. The family’s wishes must be respected in every way. Ask what kind of contact and involvement they want from people at work.
Returning belongings to the family. This should be done as soon as possible and with sensitivity.
Arranging the return of any employer property, such as computers or a company car. Be sensitive about when you do this.
Even if the team has known that a colleague is terminally ill, it can be extremely difficult to come to terms with their death. People will react differently and some team members will need your support, personally as well as professionally. This could be an exhausting time for you. Remember to look after your own needs and be aware of where you can get support from too.
You may want to think about ways to remember the person, perhaps by setting up a memorial, such as a garden or plaque.
If anyone at work needs someone to talk to, whether or not there is an in-house counselling service, they can contact us for emotional support. They can also contact Cruse Bereavement Care.
We have a series of videos on work and cancer. Our short film Managing bereavement and end of life offers advice on how to cope with these issues and includes stories about how they have affected real lives in the workplace.
An employee that is caring for someone who is dying may start to need more time off. You may need to be flexible about this.
When the person they care for dies, they will need time off work to grieve and be with their family. This is sometimes known as compassionate leave.
If there are children who were close to the person who died, your employee will need to give them extra emotional support.
It may not always be easy to predict when they will be needed at home.
They may also need time off work to sort out practicalities, such as arranging the funeral and dealing with financial or legal matters.
This is obviously an emotional time. Some people won’t want to talk about their feelings at work, but it will help if you can provide an appropriate opportunity. We have more advice on talking about cancer. If your company provides counselling or an employee assistance programme (EAP), you should bring this to their attention.