Support for employers

This section will help you to find out more from Maggie’s about supporting people with cancer as an employer. 

Talking about cancer

When an employee receives a diagnosis of cancer it can feel really difficult to know what to say or do that can be helpful.

You may feel out of your depth and be worried about upsetting them or intruding as a colleague or an employer.

There is, however, a strong business case for supporting employees with cancer, as well as a natural human urge to do so.

Cancer is often considered a taboo subject. Personal experiences and a number of myths and fears can get in the way of communicating and working out ways to offer effective support.

There are many different types of cancer and treatment. Increasing numbers of people return to work during or after cancer treatment but each person's situation and their ability to work or stay in touch with work colleagues will be unique to them. 

Things can change in the weeks and months after diagnosis. The person with cancer is facing a period of huge uncertainty until treatment options emerge, finding out what these mean in practice and taking faltering steps into recovery.

Feelings, choices and decisions about work may change over time, along with the support needs.

Many people of working age are living with cancer.

Others employees may be acting as carers and supporting someone with cancer. 

An increasing majority of people survive their cancer and may remain on the workforce. They'll return as effective and loyal workers. Therefore, management and support is essential throughout

There is no single right way to support someone through a cancer journey. Rather, it may be a case of one step at a time. There may be periods of time out for appointments, sickness, and absence. 

Some employees may be able to stay in work during treatment, if flexibility and reasonable adjustments are made. Others may feel unable to work, from point of diagnosis, during treatment or when treatment has finished.

Different cancers may have specific limiting effects requiring specific disability adjustments e.g. special chairs, text to speech equipment, short and more frequent breaks for food or toilet needs.

Other symptoms can be more generalised, whether from the cancer itself or from major treatments. Some symptoms will be a direct side-effect of treatments. They'll start to ease off slowly as these are completed. Others may continue as late effects into recovery.

Late effects might include adapting to surgical changes, chronic fatigue and the emotional impact of living with cancer..

Employers or colleagues may have  their own ideas about side effects of cancer and its treatments. They may expect employees to look unwell when, in fact, some side effects are less visible or obvious. 

Employers may be unaware of the specific effects on work abilities. For example, mistaking the impact of cancer and treatment on concentration, for poor attitude. This lack of cancer awareness can lead to misunderstandings or even unlawful discrimination. 

A diagnosis of cancer does not mean the managed end of someone’s working life. Whilst some may need a total break, others may choose to carry on working. Many people find keeping contact with work, if unwell, can be a very important objective following a cancer diagnosis. 

Feelings an employee may having about work can include: 

• worries about supporting  themselves and dependants financially
• a loss independence, normality and  purpose that can be tied up in work 
• frustration and anger at not being able to work
• worry about what employers, customers and colleagues may think
• concern at extra workloads on colleagues or not meeting responsibilities
• feeling out of touch with what’s happening and changes in the field of work
• loss of confidence and self esteem

The challenges that may get in the way of work can vary considerably during someone’s cancer experience.

There may be various stages in a cancer journey - with different implications for their life as an employee: 

An initial period of turmoil and tests 

Someone may not be physically unwell, but  struggling emotionally as they attend appointments.

For some carrying on in work might offer a welcome sense of normality. Support may be around offering understanding, flexibility and time off to attend clinic appointments.

For others the cancer diagnosis news may be overwhelming. They may need to be a short period of sickness absence to take it all in. 

During and after treatment

This can be where limiting effects may be more specific.

There may be periods when work is out of the question.  Other employees may benefit from the flexibility of working from home, and on less intense projects for a while.

Surgery may be relatively minor, although some people may need life changing major operations. There may be lengthy recovery times and some long term or permanent changes to get used to. 

Radiotherapy may be given over several weeks and require daily appointments. The side effects build up, and most people experience increasing tiredness as the treatment progresses

Chemotherapy is usually given as a combination of drugs in cycles of several weeks. The duration of the cycle will depend on the drugs used. The side-effects can be more wide ranging, and build up over time. However, with added flexibility, people can successfully do some work during a programme of chemo cycles.

Recovery

This may be a time of a phased return. The person with cancer may wish to build up gradually to the usual working week. They may need longer term reasonable adjustments. 

Early recovery may be a gradual easing of the immediate side-effects of treatment or healing from surgery.

There may be less aggressive long term follow up treatments which have their own side effects.

Later into recovery, it may be learning to adapt and manage “late effects”. It can be now that the emotional /psychological impacts and processing kicks in. 

After the treatment is finished, changes from surgery and long term effects of treatment may need to be managed and support given. 

Looking ahead

Many may not need further treatment and in time be able to put their cancer experience behind them. Others may get a recurrence and/or spread, requiring further treatment, or develop long term effects with changing needs for workplace support.

This might lead to a rethink regarding work and a need for early ill health retirements. 

Carrying on in work, however, is often both possible and important, even for some with advanced cancers.  

Supporting an employee to remain in work has benefits to the workplace too, including:

• Retaining the value of an employee’s knowledge, skills, contacts and experience.
• Saving recruitment costs - rushing to replace someone, comes with recruitment and training costs as well as a period of time for the new recruit to get up to speed
• Easing pressures - providing options to remain in work during treatments, or return to work gradually means less of a staffing shortage..
• Encouraging staff loyalty - a supportive response will be rewarded with greater loyalty and goodwill, not just from the employee concerned, but also from their colleagues.
• Business reputation - partner organisations, potential applicants  and customers may appreciate working with an organisation known for good business ethics and values. 
• Meeting your legal obligations - cancer counts as a “disability” within the Equalities Act. Meeting those obligations is not only good practise, but is also the law. It avoids compensation, legal costs, management time and reputational damage that you may otherwise incur. 

As a manager or employer, you may need to talk about work issues. Some suggestions to help meetings with your employee go well include:

• Allow privacy, space and time for conversations and  let the employee know they can bring a friend or staff rep with them, while stressing this is is an informal initial discussion
• Your employee may already be feeling overwhelmed. Take your lead from them, how much they wish to go into detail and how much they have taken in at that point
• Avoid approaching the meeting with a set agenda. It can be hard to set a clear plan in an uncertain and changing situation. A willingness to be open and flexible around work adjustments and to be supportive may be very welcome.
• Avoid scheduling an appointment when you know you need to rush off. Be as open ended as possible, but also be willing to break off for a further session. It may be that an initial discussion is a scene setting one, where you can offer both information about policies around absence for medical appointments and sick leave if needed. 
• Have an open and flexible approach to being supportive for whatever lies ahead. You might also signpost to other people in the organisation to talk to including HR, occupational health and any workplace support and counselling provisions.
• Neither you nor your employee should be feeling that the only option is to give up work. You may both need further time to think through reasonable adjustments to make work potentially possible.
• If the conversation is soon after diagnosis, be aware that your employee may still be processing the life changing news or deciding between treatments. There may need to be further tests ahead to know where they stand and for treatment plans to emerge. This is not the time to focus on managing absence.
• When treatment plans emerge then there may be discussions around the short to medium term. There may be scope to work through treatments but how might that be facilitated? Any plans need to be flexible as the impacts of that treatment can be variable and may be unknowable until they start.
• It may be that time off sick for a while is inevitable and planning will be around keeping the option of a return to work in recovery open.
• At that point long term impacts and “late effects” may be known and it can then be easier to plan around reasonable adjustments.
• It may be that as things develop, priorities may change or the cancer proves much more difficult to treat. The focus may be looking at ill health retirement, special provisions in pension schemes or a desire to carry on working for as long as possible.

Legal obligations and rights 

In employment law, cancer counts as a “disability”. This means that: 

• it is unlawful to discriminate against your employee in terms of redundancy, promotion, opportunities for career development etc 
• they have a right to request reasonable adaptations around hours, workloads, roles, additional equipment etc, which should not be refused unless it would be unreasonable or impractical to make them

In practice, conversations may be far more informal, helpful and supportive and the law never need raise its head.  

An employee may be concerned that a cancer diagnosis means that work is over. They may also be worried that they may be forced to work whilst they are unwell. It is important to show that this need not be the case. 

Reasonable adjustments at work

As an employer you don't have to agree to every request for a reasonable adjustment. You do need to consider them positively and come up with a good reason for declining that request. 

However, part of the difficulty with the limitations that cancer imposes is that they can be generalised and variable in nature. 

It may be only simple adjustments are needed. Changes to work stations, regular toilet breaks and meal breaks, or assistive software/equipment after loss of voice. 

Some ideas that people have found helpful include: 

• greater flexibility in hours - shorter days, different start /finish times, allowing staff  to clock out for breaks within a day, looking at part-time working.
• working from home - perhaps on some specific and /or less time sensitive projects - where it may be easier to adapt and manage the workload between good and bad times.
• temporarily changing the role to remove some aspects that are difficult, while perhaps taking on others that might fit better instead.
• Understanding and support round issues such as concentration, or a need to take time out.
• Being sensitive and aware of how physical changes may affect a person’s self esteem. Some people may feel self conscious about these changes, and need support to integrate back into the work setting.  

Your employee is not seeking special treatments or advantages over colleagues. It may be that the routine has been fixed hours, and full time posts. With creative thinking, it may not have to be that way in the future.

With some added flexibility, perhaps some special equipment (for which grants are available), you can help your employee. They can work normally and effectively as possible for the team.

While there may be some limitations to be overcome, there may also be something new and different to the mix. This can be used to contribute to positive change and increased productivity.  

Access to Work Grants

This is a scheme run by JobCentre Plus, part of the Department for Work and Pensions.

It can help pay for any specific equipment that you may need as an adaption to enable you to work, additional costs of travel to work (e.g.if you need to avoid public transport because of infection risk)  or a support worker. Sometimes it can help with indirect costs too. For more details please visit gov.uk.

Occupational Health and counselling support

Advice on work adjustments and when to stay in work may be available from your organisation or company , along with access to counselling around major changes and work stress. Both could be bought in if self employed. 

Practical and emotional support

More cancer specific emotional and psychological support may be via your clinical team or cancer charities. Help and support is a key part of what is available at Maggie's.

Financial support from employers 

At the start of a cancer journey, employees are covered by sick pay from work. Depending on contractual provision, they may be free from financial worries in the short term. For example - if on full pay for a period or if able to carry on in work.

There may still be additional costs that employees may face, even on full pay. They may also face reduced income at some point - the benefits system can help. Some benefits are “non-means tested” and so are unaffected by ongoing pay from work or other income.

Others are “means tested” or income-related but may become relevant as contractual sick pay tapers off or during periods of part time working or easing back into work

For an overview of the most likely benefits of assistance to your employees, see the page Work and Cancer and links to further information from there.

Of particular note are:

• Personal Independence Payment (PIP) - entirely non-means tested extra help for additional costs of daily living or getting around, whether working or not
• Contributory ESA - that can start the day after Statutory Sick Pay (SSP) stops whether or not any contractual sick pay continues after that date
• Benefits for low income - whether unable to work or when cutting back hours in work or easing back into work.

There are a variety of people who can support employees whilst they explore, and make decisions, about working through cancer or easing back into work in recovery. (See our useful links below)

Emotionally, the employee has a lot to think about too. Work is often a huge part of someone's life and role. Maggie's Centres can offer psychological support for anyone with cancer finding the changes around work affecting their feelings and emotions

Our benefit advisors specialise in helping those with cancer, and those close to them, to claim all the benefits they are entitled to

They can explore how the benefits system and can help employees both when unable to work and when carrying on in or returning to work. Both ’drop-in’ and appointments for benefits advice are available. Or you can simply drop into your nearest centre to find out more about benefits and other support available.