The number of working-age adults is declining and consequently many people need to carry on working longer. As a result, more people in the workforce are living with a longstanding health problem. Gordon Tranter outlines how those affected by chronic conditions can be helped to function in the workplace.
Chronic diseases are non-communicable illnesses that are prolonged in duration, do not resolve spontaneously and are rarely cured completely. These conditions develop slowly and their onset time ranges from before birth to late in life. Once past certain symptomatic or diagnostic thresholds, chronic conditions are essentially permanent features for the rest of life.
Examples of chronic illnesses include diabetes, heart disease, asthma, chronic obstructive pulmonary disease (COPD), arthritis, musculoskeletal conditions, kidney disease, HIV/AIDS, and multiple sclerosis. Chronic conditions are not just physical. For many mental illnesses, there is not currently a permanent cure. In addition, many people with physical chronic illnesses become depressed. In fact, depression is one of the most common complications of chronic illness.
Chronic diseases at work
According to the 2013 Labour Force Survey, of the 7.2 million people aged 50–64 who are employed, 42% are living with a health condition or disability. As a result, ill health represents a major economic burden for society due to increased healthcare costs, lost productivity and sickness absence. Research suggests that chronic disease has a stronger impact on labour force participation among older workers than increasing age.
Research has shown that if a person has a chronic health condition, it is generally better for them to be working if possible. However, worksite conditions can contribute to the development of chronic diseases, eg through hazardous job exposures, high job demands and inflexible work schedules. Consequently, employers need to be aware of the importance of helping employees with long-term health conditions.
Workers may be affected by their own chronic conditions but they may, alternatively, need to care for family members with chronic conditions and some flexibility in their working conditions could help them better manage the situation.
The Equality Act 2010
Employers have a legal duty to provide support for workers with chronic illnesses. The Equality Act 2010 requires that employers make “reasonable adjustments” in the workplace to prevent employees from being treated less favourably than others for reasons related to their disability or progressive condition. The conditions covered by the Act are physical or mental impairments that have more than a minor or trivial long-term adverse effect on a person’s ability to carry out normal day-to-day activities.
Supporting employees with chronic ill health can also minimise the potential costs of long-term absence and staff turnover and can encourage productivity, job retention and quality of life. Furthermore, it can retain the experience, knowledge and skills of a worker.
Managing chronic illnesses in the workplace
At the conference Working with a Chronic Illness held in Brussels in 2013, the delegates of the European Network for Workplace Health Promotion signed a Declaration on Workplace Health Practices for Employees with Chronic Illness. The Declaration contains 10 recommendations for politicians, employer organisations and unions at EU and national level, as follows.
Focus on the prevention of chronic diseases at the workplace.
Detect chronic diseases at an early stage.
Shift the paradigm from reduced performance to retaining current and future working ability.
Focus on the abilities and resources of the individual and not only on limitations or restrictions.
Address discrimination against people with chronic diseases.
Raise the importance and priority of return-to-work on the policy agenda.
Increase the opportunities for employment of persons with chronic illness.
Ensure that work is rewarding: work must include a positive cost-benefit ratio.
Ensure close and systematic cooperation of all relevant players and stakeholders involved.
Fill the gaps in existing knowledge, extend and maintain evidence and experience-based interventions.
The health and safety policy and strategy
The company’s commitment to supporting workers with chronic conditions should be included in its health and safety policy, together with the arrangements for implementing its integration into the company’s procedures. This should include who is responsible for managing sick leave, reclassification processes, and who the employee can talk to, etc. Where possible, the management of chronic illnesses should involve all relevant stakeholders inside the company (HR managers, health and safety managers, health and safety committees) and outside (occupational medicine services).
This should be a proactive approach to help those with chronic conditions to be able to carry out safe and productive work. A management plan for workers with chronic conditions encourages early intervention and keeps the worker engaged with the workplace.
A key factor that is likely to influence a worker’s capability to continue working is the availability of employment that meets their personal needs and inclinations. This needs early intervention, even if a person’s chronic illness does not fall under the remit of the Equality Act 2010. Proactive work adjustments should be made where practical. Managers should be trained on the issue of chronic diseases and working conditions, and in how to identify work situations that may cause problems for affected employees. Employees should be encouraged to disclose their chronic illnesses.
Discussions about the employee’s condition should be held in private to encourage trust and confidentiality. Employees need to know that personal information will only be shared with those who need to know and the data kept safe. The discussion should promote the benefits of disclosing details of their condition, eg identifying work situations that cause problems for them and the support that can be made available.
Adjustments: flexible hours
Flexible work policies can help many individuals disabled by chronic conditions to function in the workplace. Options such as working from home, working part-time and flexible working hours may have benefits in the self-management of a chronic condition, and may help with the management of chronic pain or fatigue that can often accompany some conditions and have a deleterious effect on quality of life.
At present, only employees who have been in service for at least 26 weeks have the legal right to ask for flexible working. Removing this restriction would help older people with health conditions to enter the workforce and to retain their employment, allowing them to choose the best working habits to fit around the management of their condition.
Adjustments may have to be made for physical work demands, for cognitive work demands and social work demands. These may include:
sharing responsibility for tasks
reducing the mental or physical demands of the work
a slower work pace
allowing a private space for individual to take medication if applicable
modification of equipment to reduce the demands upon the employee.
Steps should be taken to avoid worksite conditions that can contribute to the development or worsening of chronic diseases, eg hazardous job exposures, high job demands and inflexible work schedules.
Medical issues can change over time, so it is important for managers to monitor progress and check that arrangements remain appropriate.
The impact of these adjustments on colleagues should be recognised, particularly if they have to take on extra work. It is important to get them “on board” early to encourage effective teamwork. The employees with the chronic condition should be encouraged to share information with their colleagues about their illness, and what they need to help them cope at work.
Mid-life career review
Mid-life career reviews have benefits for both the workforce and the employer. The review should include discussions about health to enable individuals and employers plan early for the health challenges of working in later life. This can help both those at risk of developing a health condition to start taking appropriate precautions to prevent this and those who may already have a condition to better plan for their future working life. Part of the review should be a consideration of the need for training and reskilling for the changing roles their condition may necessitate.
Some employers are already offering mid-life career review including health-focused measures such as preventative action for common work-related conditions, condition management and occupational health provision.
Access to training and reskilling
It also allows older workers and workers with chronic diseases to learn additional skills and expand their capabilities. This would enable them to change roles or move to other areas of the business more suited to their ability and condition.
Access to appropriate and tailored training is necessary to enable workers to keep up with the changing demands of roles and to be able to compete in the labour market.
The return to work
A key part of managing chronic conditions is the return to work after illness. This requires good people management skills, sensitivity to and understanding of the individual, and effective communication. When a worker returns to work, their general practitioner (GP) should provide them with a Fit Note that can make recommendations on workplace adjustments that might help. However, there is evidence that provision of practical fitness for work advice to patients can be hindered by GPs’ lack of detailed information about job roles and occupational health.
The Government has set up Fit for Work, a web and telephone advice service to which all employers across England and Wales can refer employees who have been off work for four weeks or more. The service is designed to fill the gap in support that currently exists and is particularly useful for those employers with limited in-house occupational health services.
The importance of the return-to-work process is illustrated by the situation in the Netherlands, where more than 2000 reintegration agencies have been established to support people to return to work and find a job that is suited to their altered situation and abilities.
As Stephen Bevan, Director of the Health at Work Policy Unit said, “Chronic illness need not be a barrier to full and fulfilling employment for older workers, especially if they get the treatment and support they need. The real danger is that the knowledge, experience, know-how and skills of many older workers will be lost if we fail to put together joined-up resources and interventions that help them stay at work. This would not only be very harmful for the health, wellbeing and wealth of millions of individuals, it would also be hugely damaging to the economy as a whole.”