Rehabilitation

Man and woman talking in an office

This section outlines the elements of good practice in rehabilitation and provides guidance for managing the return-to-work process.

Checklist for employers

This checklist sets out actions that can be considered when managing an employee's return to work after cancer.

Example risk assessments

1. A female employee returning to work after treatment for breast cancer.
2. A male employee continuing to work through cancer treatment for colorectal cancer.

Case studies

Case Study 1 – Non-manual office-based role
Case Study 2 – Material stores worker (manual work)
Case Study 3 – Client manager in a utilities company (office work)
Case Study 4 – Software developer in a medium-sized public organisation
Case Study 5 – House manager in a private medium-sized organisation in the healthcare sector
Case Study 6 – Tax assistant in a private small (micro) organisation in finance (office work)
Case Study 7 – Secretary in a medium-sized organisation in the public sector (office work)
Case Study 8 – Administrative assistant in a large higher education institute (office work)


Rehabilitation aims

At the point of cancer diagnosis

Maintaining contact when away from work

Discussions about returning to work

Planning the return to work

Meetings

Policies

Risk assessment

After return to work

Guidance

Long-term absence isn’t just costly for employees – employers and society pay a high price too. The longer an employee is off work, the less likely they are to return. That's why it's important to begin the process of rehabilitation early, so that employees can:

  • return to work in a suitable role
  • regain confidence and motivation 
  • maintain good relationships with their managers and colleagues 
  • avoid financial hardship, and 
  • avoid having to retire from work because of ill health. 

It's worth stressing that early return to work is not always the right approach in every case. There are times when rest is the best treatment.

The type and severity of an employee's cancer will determine whether they can remain at work while continuing treatment. An employee may not wish to disclose any medical information to their employer. However, relevant information, including the treatment schedule and any restrictions on work or work tasks, could help the employer make any reasonable adjustments needed. If the employee is fit to work it is important that they are not exposed to tasks or substances that are known or thought to be carcinogenic or that could adversely affect their treatment or recovery until a proper risk assessment has been made.

Rehabilitation aims

Rehabilitation has two main aims: to help employees return to work after an illness or disability and to help employees with chronic health conditions stay in work. Good rehabilitation practice involves employers, managers, employees and a range of other professionals working together to find solutions to achieve these aims.

In a large organisation, rehabilitation will be dealt with mainly by line managers, supported by occupational health teams, OSH practitioners and human resources professionals. In a smaller organisation, the employer may look to the OSH practitioner alone to give them advice in this area. Generally, the decision about whether an employee  on long-term sick leave should return to work is made by the employee and their line manager, and they need sound medical advice so they can decide on what the employee is capable of doing. Here, it's worth noting that automatically treating someone who has an impairment or medical condition as a health and safety 'issue' or 'problem' could be regarded as discriminatory.

It is also essential to consult the employee on what work they may be capable of, especially those who are involved in safety-critical work. This does need to be reviewed continually due to the fluctuating nature of symptoms. There may be occasions when an employee's symptoms are so bad that they have to take time off work to recover. If a period of absence has been necessary, it is important for the employer to work with the employee to manage the return to work.

Medical advice should be sought from either the treating specialist, GP or through the occupational health team. Further help may be available from Fit for Work service in Scotland or Fit for work in England and Wales.

Good practice

At the point of cancer diagnosis

When an employee tells you that they have a cancer diagnosis, this is the point to discuss with them the following issues.

  • who needs to know about the diagnosis and what can be disclosed to others
  • what covering arrangements will need to be put in place
  • how best to keep contact between the employee and the workplace
  • providing information on sick pay or other financial matters.

Maintaining contact when away from work

  • hold formal meetings with those who will be involved in the return-to-work process
  • maintain informal contact with line manager and colleagues e.g. telephone calls, emails and visits – if the individual wishes
  • employees should be kept informed about workplace events and changes. 

Discussions about returning to work

  • start in good time before return
  • involve the line manager, HR and occupational health team, OSH practitioner
  • cover physical and psychological issues
  • discuss working patterns, follow-up appointments, workplace and travel accommodations.

Planning the return to work

  • a plan should be put in place – this should be flexible and reviewed on a regular basis
  • a phased return with agreed reduced/flexible hours is likely to be advisable
  • consider travel to work and journey time
  • consider home working 
  • assess work capability 
  • consider impact of treatment and side-effects, especially on complex, safety-critical  or stressful tasks
  • workplace accommodations might include:
    - clear guidance about time off for hospital appointments and treatment
    - reduced physical tasks
    - flexible working – e.g. working at home, later start, earlier finish
    - modified duties e.g. lighter duties and tasks which can be completed quickly and easily 
    - gradual increase in workload but be prepared to reduce if having a bad patch
    - reduced or part-time hours
    - additional breaks
    - redesigning or adjusting workspace e.g. DSE assessment
    - retraining/training
    - assistive devices (further help may be obtained from Access to Work)
    - support from co-workers
    - minimising stress.

Meetings

  • ensure regular meetings are planned, particularly with the line manager, covering review of return to work process
  • establish on-going informal conversations.

Policies

  • a rehabilitation policy covering serious illness including cancer is recommended.

Risk assessment

Risk assessment processes should identify those who are particularly at risk. Although this generally means categories of workers such as young or lone workers, this does include disabled workers. And where this is an individual returning to work after cancer, it may be most effective to carry out a separate risk assessment. Whether carrying out an individualised risk assessment, or reviewing existing risk assessments, the following factors, although not exhaustive, should be considered:

  • use of personal protective equipment
  • ergonomic needs e.g. lymphoedema, reduced range of movement, decreased strength
  • the impact of fatigue on risk
  • the psychological and psychosocial demands of the work
  • risks of infection
  • the journey/access to the workplace
  • driving for work
  • breaks in the working day
  • inclusion of emergency planning if necessary
  • if working at home, ensuring the environment is safe or ergonomically sound
  • assessing new work tasks and ensuring adequate time is given to learn new tasks.

Where the ill health of an individual may compromise their ability to undertake a safety-critical task, thereby posing a significant risk to the safety and health of themselves and others, a suitable risk assessment of the activity should be carried out in order to assess any risk posed by the worker's health or any medical treatment which is likely to cause sudden loss of consciousness, fatigue, impairment of awareness, concentration, balance or coordination or significant limitation of mobility. The requirement for assessment of fitness for safety-critical work should only be applied where it is necessary and not used as a form of medical selection and potential disability discrimination.

The HSE has developed a Return to work questionnaire to help manage return to work. Although it focuses on stress, it is a helpful template for considering any possible problems and a basis for reviewing existing risk assessments.

In Good practice guide to rehabilitating people at work, IOSH provides a useful work adjustment assessment form and guidance.

Other health problems as a result of treatments including changes to vision, fatigue, impact on concentration or lymphoedema may have an impact. Further information is available at Cancer Research UK.

Some side-effects such as lymphoedema can be extremely debilitating and can affect work tasks – e.g. heavy lifting or the constant use of a limb. The Lymphoedema Support Network provides lots of information. This site also has information on Managing lymphoedema in the workplace.

Some problems which might arise initially during the return-to-work process for particular types of jobs, along with suggested recommendations, are illustrated in this table.

After return to work

  • return to work may be a long-term process
  • some problems may persist for months or years after treatment e.g. fatigue 
  • there may be permanent disabilities e.g. lymphoedema
  • continuous assessment of capability to work and any workplace hazards.

Guidance

The HSE has also developed tools and documentation to help with absence management and rehabilitation. These include:

The CIPD, ACAS and HSE together produced a free online toolkit to help managers with absence management.

The content for this toolkit was produced as part of the IOSH-funded research undertaken by the Institute of Occupational Medicine, Loughborough Uional Medicine, Loughborough University and Affinity Health at work.