Supporting employees with cancer at work

Some people with cancer will be able to continue to work and others will need time off during treatment. If an employee is off sick for more than seven calendar days, they will need to show a fit note. These are issued by a GP. If the fit note says that the employee cannot work, they should be allowed sick leave according to the company’s policy. Your organisation should have clear information about sick leave entitlements.

After four days of sick leave, employees should be paid Statutory Sick Pay (SSP) from the fourth day onwards. SSP can be paid for up to 28 weeks. If your company offers occupational sick pay, this can be given on top of SSP.

If your employee is away for a long time, you may need to arrange for cover. You should discuss this openly with them and explain that it is temporary. You can also signpost them to schemes like Access to Work for extra support.

You can keep in touch with your employee during their absence, to make sure they are still happy with the arrangement.

Knowing what your employee needs

Many employees choose to share their cancer diagnosis with their employer or manager. Knowing this can allow you to make reasonable adjustments. But you have no legal right to know the diagnosis or the clinical details of an employee’s condition. Employees have a right of confidentiality under the Human Rights Act 1998.

With the employee’s permission, you could ask an occupational health provider for advice about how the person’s health may affect their ability to do their job. This conversation may cover:

  • the likely length of time off
  • the likely effect of their health issues on their return to work
  • the likely length of time any health issues may affect the individual’s ability to do their job
  • whether there are any adjustments needed in the workplace to help overcome any disadvantage the individual may have because of their health issues
  • the likely length of time any adjustments are needed for
  • the potential impact of health issues on their performance or attendance
  • the potential impact of health issues on health and safety
  • whether the individual could do other roles in your organisation.

If you need occupational health advice about an employee’s condition (with their permission), you should make sure your questions are relevant to how your organisation is run.


Options for time off

Some people with cancer will be able to continue to work and others will need time off during treatment. On this page, there is information about both planned and unplanned time off.

Sick leave

Your organisation should have clear policies about sick leave. This is an essential part of an employment contract and should include information about time off for appointments.

Your employee may be entitled to company sick pay under their employment contract. This is also known as occupational or contractual sick pay. It may be more generous than the legal minimum, which is Statutory Sick Pay (SSP). It can’t be less.

If your organisation is in a position to do so, you could think about reasonably adjusting your company sick pay policy. This could be to cover extended periods over and above the standard statutory or contractual obligations.

SSP is paid after four days of sickness and lasts for up to 28 weeks of illness. If SSP is due to end soon, your organisation should provide the employee with a form called SSP1. This will give them information about when the last payment will be, and about applying for a benefit called 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.

Fit note

During the first seven 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 used to be called a sick note. A fit note allows doctors to advise whether someone may be fit for work or not fit for work, and will say why. Someone completely fit for work will not be given a fit note.

If the note says that someone may be fit for work, the GP should include information about how the person’s illness affects them.

They may also give advice about what could be done to help the person be able to work. The information should encourage the employer and employee to discuss and agree any changes that would help them go back to work.

Time off for appointments

Your employee will want to agree some time off. They should try to let you know in advance, so you can arrange cover if needed. But this may not always be possible.

People with cancer will need to go to medical appointments. Some may need to stay in hospital for treatment. They may also need time off if they are having complementary therapies.

Your sick leave policy should include information on how time off for medical appointments is dealt with. But you may need to be flexible sometimes. This will depend on how many appointments they have and how often they are. Allowing time off work for appointments is a reasonable adjustment.


Hiring temporary cover

You may need to arrange temporary cover. This could be because your employee is unable to work for a long period of time, or if they want to reduce their hours. You should:

  • 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
  • let them know that the extra help is temporary
  • follow your organisation’s standard procedure for employing temporary workers.

For more information about managing absence and other employment issues, you can visit the Chartered Institute of Personnel and Development (CIPD) website.

Employers and employees in England, Wales and Scotland can contact the Advisory, Conciliation and Arbitration Service (ACAS) for help on any employment issue, including absence management. In Northern Ireland, you can contact the Labour Relations Agency.

Remember to ask your employee about their preferences for keeping in touch while they are absent.


Making reasonable adjustments

Employers have a legal duty to make reasonable adjustments to the workplace and working practices for an employee who has cancer. This duty applies when the workplace or working practices mean the person with cancer is at a ‘substantial disadvantage’ because they have cancer. This disadvantage has to be ‘more than minor or trivial’. This is the law under the Equality Act 2010 (England, Scotland and Wales) and the Disability Discrimination Act 1995 (Northern Ireland).

There is no fixed description of what a reasonable adjustment is. It will depend on things like:

  • the cost of making the adjustment
  • how much the adjustment will benefit the employee
  • how practical it is to make the adjustment
  • how much the adjustment will disrupt the organisation.

Employers do not have to make a reasonable adjustment unless they know (or should know) that an employee has cancer.

Your employee should be fully consulted and involved in the adjustment process at every stage. It is usually in both your interests to work together to make the adjustments, as they will allow the person to continue working.

Examples of reasonable adjustments

Just one or two small changes could be all it takes to help an employee stay in work. Remember that what counts as a reasonable adjustment will always depend on the situation.

Here are some examples of changes you could make:

  • Giving your employee time off to go to medical appointments or for rehabilitation. This may already be covered by your existing policies.
  • Changing their job description to remove tasks that they would find hard to do because they have cancer, or temporarily allocating some of their work to a colleague.
  • Allowing them to work more flexible hours. This can help if your employee has fatigue, because it allows them to work when they feel strongest and have the most energy. Flexible hours also mean your employee can avoid travelling at busy times.
  • Giving them extra breaks if they feel very tired. A short rest in a quiet place can be helpful.
  • Changing their performance targets to take into account time off or any treatment side effects, such as fatigue.
  • Moving them to a role with more suitable duties – with their agreement.
  • Making sure they can access the building if they use mobility equipment, such as a wheelchair or crutches. A car parking space closer to the entrance may be helpful. Or you could change where they work, for example by moving them to a ground floor office if they find it difficult to climb stairs. A professional assessment can help with this – get advice from an occupational health adviser (see below).
  • Giving them computer equipment that might help, such as voice-activated software if they can’t type.
  • Providing an accessible toilet.
  • Changing the date or time of a job interview if it was planned at the same time as a medical appointment.
  • 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 save their energy. Make sure their home has a suitable work environment and that they have the right equipment to do the job. It’s also important to make sure they stay in touch with colleagues and don’t become isolated.
  • Allowing a phased return to work.

You may find it helpful to watch our video about making work adjustments for an employee affected by cancer.

Making work adjustments for an employee affected by cancer

Showing how one employer made temporary changes to an employee’s work duties to help them remain in work during treatment for cancer.

About our cancer information videos

Making work adjustments for an employee affected by cancer

Showing how one employer made temporary changes to an employee’s work duties to help them remain in work during treatment for cancer.

About our cancer information videos


Occupational health advice

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 offer advice based on their clinical knowledge and an awareness of the 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.

How they can help

Occupational health advisers can help you understand your responsibilities under employment and health and safety law. They can also help with business decisions about:

  • reasonable workplace adjustments
  • recruitment
  • return-to-work plans
  • ongoing employment
  • release of company benefits, such as pensions.

They can also help managers do 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 you might need workplace occupational health advice

When someone has cancer, occupational health advisers are most often used when:

  • considering whether a job applicant is fit for employment
  • supporting an employee after their diagnosis
  • there is a management concern about the health and safety or performance of an employee who has been sick.
  • considering whether someone is fit enough to return to work after being off sick.

If you don’t have a workplace occupational health service

There is a government-sponsored service providing occupational health advice to working people, called Fit for Work. It was introduced in 2015 in England, Wales and Scotland. It is free and confidential.

Fit for Work provides the services of occupational health professionals to working people if they:

  • have been off work for four weeks or more
  • are likely to be off work for four weeks or more.

The service is available to everyone. It is particularly suitable for people whose employers don’t have their own occupational health services. You can refer your employee directly to the service.

In England and Wales, call 0800 032 6235 or visit fitforwork.org/employer

In Scotland, call 0800 019 2211 or visit fitforworkscotland.scot/employers

The Fit for Work service is not available in Northern Ireland. If you live in Northern Ireland, you should contact your workplace occupational health service, if you have one. 

Many commercial companies offer occupational health consultancy to businesses. Or you can use NHS Health at Work. This is an occupational health service for small and medium-sized businesses. It charges fees. Visit nhshealthatwork.co.uk for more information.

Some employees and employers can get free occupational health advice over the phone if they work in a small business. This is only available in some areas of the UK. Call 0800 077 8844 in England, 0800 019 2211 in Scotland or 0800 107 0900 in Wales.

Macmillan has e-learning 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.


Access to Work

Access to Work is a government programme for people living in England, Scotland and Wales. It can help you or your employer if you have a long-term health condition that affects the way you do your job. It gives advice and practical support to meet extra costs that may arise because of your health.

The scheme may pay for:

  • special aids and equipment needed in the workplace as a direct result of your condition
  • travel to and from work if you can’t use public transport
  • a support worker to help you in the workplace.

There is a different system in Northern Ireland.

The challenge for me was getting the balance right in terms of work. I was aware she wanted to return but didn’t want her doing too much too soon.

Judy

Back to If you are an employer

Introduction for employers

Managers play an important role in supporting employees living with cancer, or caring for someone with cancer.

How cancer affects people

Understanding how cancer treatment may affect your employee’s ability to work can help you give them the right support them.

Talking about cancer at work

It may be difficult for your employee to talk about their diagnosis, but open communication may make it easier for you to support them.

Helping your employee back into work

Making small changes to your employee’s working arrangements can make a big difference. It can help them settle back into work successfully.

Legal rights about work and cancer

In the UK, there are laws that protect employees with cancer from being treated unfairly in the workplace. This includes discrimination, harassment and victimisation.

Supporting carers at work

Carers are legally entitled to take reasonable time off work. They can also request flexible working.