Coping with chronic illness

One in six workers in the European Union has a long-term illness or disability that affects their ability to work, according to The Work Foundation. Closer to home, the CBI says that although only five per cent of sickness absence is long-term, it accounts for 40% of all time lost, at a cost of £5.3bn a year to the UK economy.

That’s a sobering thought for managers, especially in the current financial climate. Here’s some more facts to get you thinking: the Institute of Occupational Medicine states that after six months there is only a 50% chance that a sick employee will return to work at all; the number of young people with chronic conditions is rising; and medical advances in cancer treatment mean more patients live for longer, but have long-term health issues or periods of relapse.

But the outlook needn’t be all negative. Improved management and treatment of chronic illnesses means more people can carry on working – so long as they are well supported by their employers. Research published in the Journal of Occupational Rehabilitation in 2009 found managers' support to be the single most important factor in how well employees manage their condition.

“Before my last operation I had a lot of pressure to ‘get on top of things’,” recalls Rebecca, a public sector worker with a congenital heart condition. “But I was sick and very tired. I felt stressed and found it hard to concentrate. My manager was new in the post and I had little support on how to deal with my situation.”

Although Rebecca had a phased return to work over five weeks after her operation, the support was short-lived. “Before long I had a bigger workload than ever. I felt under pressure from both my manager and HR. I look healthy, but I’m not. You don’t have to be in a wheelchair to have a disability.”

The situation has since been resolved after Rebecca asked her union to intervene. She admits that, initially, she did not disclose details of her condition to her employer: “I didn’t want it to affect my future career prospects as there are so many unknowns with my condition.”
Encouraging disclosure is crucial to successfully managing an employee with a chronic illness, according to Jo Yarker, occupational psychologist and director of Affinity Health at Work, an organisation that promotes healthy workplaces. “If the relationship is not good to start with, engaging the employee during periods of ill health is much harder,” she says.

Although periods of sick leave are sometimes inevitable, taking a proactive approach to attendance management is vital. “Even when employees are unwell, in many cases it’s possible to keep them working in some capacity,” says Jane Williams, occupational health adviser at food manufacturer Samworth Brothers.

Equal opportunities

Employees with chronic conditions are protected under the Disability Discrimination Act 2005, which requires employers to make reasonable adjustments to ensure these employees are not treated less favourably than other staff members. This can involve arranging shorter working days or simply providing somewhere quiet for them to rest or take medication. With a busy workload and other team members to consider, it’s also vital that managers seek support.

Occupational health (OH) departments can support staff to manage their condition and managers need to be aware of OH policies and refer any employee off sick for longer than two weeks. With health and safety advisers, they can also assess whether additional equipment or changes to the work environment are required in line with health and safety law.

HR departments become involved when long-term sickness absence, or a continuing inability to carry out an existing job description, enters the equation, and can offer guidance on adjusting the employee’s existing role or duties. External resources, such as charities and trade unions, can also offer advice.

The emotional effects

But addressing physical and practical factors is only half the story. The emotional impact of chronic illness can be devastating, as Graham, a finance worker at a county council, discovered when he was diagnosed with prostate cancer. “It shocked me to my roots and completely threw me off balance. It was difficult to concentrate on my job and I got quite depressed.” Graham was referred for six sessions of counselling, paid for by his employer. “It helped me get my balance back. My manager said he was happy for me to return when I could, doing the hours and days of my choice, and just see how I found it. He let me be the judge, and I planned to start back on three days a week. However, by the end of the first week I was up to five days, but going home if I felt tired.”

A flexible, phased return is the best approach, says Yarker, but admits that it can be a challenge. “You think the individual is well and plan accordingly, then three weeks later they have to go off sick again. It is best to underestimate what they can do and plan six to 12 months to get them back up to speed.”

Graham’s manager insists his approach was instinctive. “It was the first time I’d encountered this kind of situation. My main concern was Graham’s wellbeing. We prioritised his workload before his operation, but I put contingency plans in place that involved reallocation of his work among team members if he had not returned by a certain date.”

A few weeks after his return, Graham had to be readmitted to hospital for a week but, apart from regular medical check-ups, he has not been off work due to sickness since. “I feel more loyal to the organisation and to my manager because of how they supported me,” he says.

If employees require sick leave, maintaining regular contact is vital. “Managers don’t want to be seen to be pressurising employees, but staff members who aren’t contacted feel let down, cut off and ignored,” says Yarker. “It’s about how the contact is framed: ask them how they’re doing rather than asking about work.”

Once they are ready to return, let the employee say what they can handle rather than being too directive, and review the situation regularly. If the employee has been off for a few months, treat their return as a re-induction, with an initial catch-up in an informal setting and a negotiated, phased return over a number of weeks. “You may find their priorities have changed, so allow time for them to settle down,” advises Yarker. “As they regain their confidence, their career aspirations will return.”

Fit to work

But what should a manager do if the employee is unhappy with the negotiations for their return to work or repeatedly fails to show up without informing anyone?

“In cases of resistant ‘illness behaviour’, anyone trying to get that employee back to ‘work normality’ will be perceived as a bully,” says Williams. “Some employees won’t take responsibility for their health or comply with medical advice.”

Hannah, an account manager for a London-based US design firm, experienced difficulties with an employee who had asthma. “She smoked and was blatantly dishonest about the seriousness of her condition. On one occasion she had a serious attack after painting her bedroom without ventilation. She didn't see it as her duty to try and stay fit for work.”

If such situations continue, it is crucial to involve HR and follow the correct disciplinary procedures. Under the Employment Rights Act 1996, employers must offer an alternative role where available, but if ‘parting company’ becomes the only option, you must adopt fair procedures and the statutory minimum dismissal, disciplinary and grievance procedures.

But most of the time, employees want to stay working, as Andy Clarke, local competence centre manager at printing firm Agfa Graphics, found after a valued engineer had a heart attack. “Rob was hounding me to get back to work, but it took a lot of time and energy to build up his confidence again and make sure he was safe. It would have been easy to let him slip through the net or see him sidelined. Instead, he is back in the same role so all the effort was definitely worth it, for him and for the company.”

With planning and good communication, Yarker stresses that a chronic illness does not have to result in compromise for either side, and can even bring benefits. “People see getting back to work as a marker of their normality and the manager is key in helping them get that normality back. Handled well, it can actually increase employee loyalty and productivity.”