There are more than 200 types of cancer, according to the charity Cancer Research UK, which makes it difficult for employers to understand how best to support employees affected by the disease.
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- Employees often remain in work after their cancer diagnosis.
- Employers may be required to make reasonable adjustments to support an employee’s return to work.
- Line managers require training about how to communicate with staff affected by cancer.
A common mistake some employers make when selecting employee benefits to help them tackle this sensitive issue is to offer staff an all-singing, all-dancing private medical insurance (PMI) policy that covers cancer from diagnosis through to treatment.
But determining the scope of healthcare providers’ cancer cover and the potential costs involved can be a minefield for employers. For example, will a provider cover reconstruction, and perhaps augmentation, surgery for an employee who has had breast cancer, as well as the treatment required to remove the cancer?
Ken Steed, a cancer specialist who is part of the managed care team at healthcare provider WPA, advises employers to be wary of providers that claim to cover every aspect of the treatment required by employees or their relatives. “What does fully-funded cancer care really mean?” he asks.
Employers that already offer cancer care may also face a challenge if they want to remove, or limit, the cover they offer employees. This is despite the fact that the vast majority of private cancer care now takes place in an NHS setting, as well as the fact that a comprehensive PMI plan may not be appropriate for, or even of interest to, their workforce.
PMI may also not be the most cost-effective support an employer can offer its staff. For example, it may be more appropriate, and valuable, for an employer with a limited healthcare budget to offer health screening for all or most of its employees, instead of comprehensive PMI for a select number of senior staff.
Chris Evans, a senior consultant at employee benefits consultancy Buck Consultants, says: “The costs and cost implications for employers can be quite devastating.”
For example, one employer is currently dealing with a £700,000 claim by just one employee, so organisations need to be realistic about the range of cover they can realistically afford.
Supporting affected employees within the means of employers’ healthcare budgets is a tough challenge, particularly given the sensitive nature of cancer and many organisations’ continued desire to be seen as paternalistic towards their workforce.
However, there are many cost-effective forms of workplace cancer support that may prove valuable to staff, such as health screening.
According to Cancer Research, even for cancers with a poor overall survival rate, the chances of survival improve the earlier the disease is diagnosed.
Hewlett-Packard (HP)’s workplace cancer scheme, Fighting cancer at HP, illustrates the value of health screening.
The scheme, which won the technology provider the ‘Best healthcare and wellbeing benefits’ award at the Employee Benefits Awards 2013 in June, was designed to increase employee awareness of some of the most common cancers in the UK through education-based campaigns and screening initiatives. The initiative resulted in several cancers being diagnosed in employees that would otherwise have gone undetected.
The scheme also has potential business benefits for HP, including reduced employee absence costs and lower PMI and income protection costs, plus savings on life assurance and early retirement due to ill-health.
Health screening is available from a range of healthcare providers, as well as specialist providers, as HP proved by using HealthScreenUK, and is a great way for employers to invest a relatively small amount of their benefits budget and achieve significant results both for them and their workforce.
EAPs can play a key role in helping employees cope with the psychological impact of cancer, such as the potential stress of treatment plans and the impact of drugs they are prescribed, as well as dealing with their finances.
Line manager training
But perhaps the best support an employer can offer staff is well-trained line managers who are equipped to recognise and address their needs appropriately.
A growing trend that line managers should be aware of is the desire by many employees affected by cancer to continue working. This may require managers to make reasonable adjustments to workstations and the surrounding workplace to accommodate the needs of employees undergoing treatment, as well as formulating rehabilitation strategies for staff returning to work after a long period of absence following treatment.
Workplace adjustments may include relocating an employee to a workstation near a bathroom because of the effects of, for example, chemotherapy, which can include nausea and diarrhoea.
Changes may also include a different job role for an employee who usually works outside, because of cancer sufferers’ sensitivity to sunlight during chemotherapy.
Dietary requirements are another consideration for affected employees at all stages of their illness. This may involve employers ensuring that their workplace canteens and vending machines offer a wider range of healthy options, or installing more water machines around their premises, to help boost affected employees’ immune systems as they undergo treatment.
Flexible working may also be needed as employees travel to and from hospital for treatment.
Laura Dillingham, working through cancer project manager for UK charity Macmillan Cancer Support, says employers should be sensitive to employees’ individual needs, because every cancer sufferer has a different experience. What is suitable for one person may not suit another, so employers must listen to their employees and try to understand what they need, and be flexible.
“[An employee] may think they’ve got their chemotherapy dates planned out, but they may not be able to have that treatment on that particular day because they’re under the weather,” she says. “It’s about [employers] understanding that cancer is a long-term condition, and not to think that once an employee is back at work, they’re cured. The side-effects [of the treatment] can last a long time.”
Duty of care
An employer’s duty of care can also be long-term. The Equality Act considers cancer as a disability for life, from the point of diagnosis, but this does not necessitate a standalone workplace cancer care policy.
Dillingham adds: “A long-term conditions policy, or a sickness absence policy, is really the bare minimum employees should expect on their employer’s intranet site. The key thing is for [employees] to know what is available to them: it will avoid them going off sick unnecessarily.”
Health and wellbeing awareness days, at which healthcare providers and occupational health teams, where available, can showcase the support they offer staff, are one way employers can spread the message.
But, ultimately, employees affected by cancer need to take responsibility for addressing their own needs, which starts with deciding whether to inform their employer about their illness, which they are not legally obliged to do.
Of course, divulging such information requires trust between employee and employer.
Joy Reymond, head of rehabilitation services at Unum, says: “There are certain taboos in the workplace and illness, particularly cancer, is a big one, and there isn’t an awareness about how to have the conversation from the employee or the employer, [despite] a willingness.
“Most of the time, when things go wrong it’s because [employers and employees] are not talking about stuff because they’re afraid to have the conversation.
“The fear is also of getting it wrong and the dire consequences that may flow from that. The more options there are, the more likely it will be to find a successful conclusion between the two parties.”
Viewpoint: Rachel Dineley: Employers must be mindful of their legal duties
Any employer of any significant size is bound, from time to time, to have to deal with the consequences of an employee’s cancer diagnosis and treatment, not least because research indicates that one in three of us will develop some form of cancer in the course of our lives, according to Macmillan Cancer Support.
At all times, employers should avoid making any assumptions with respect either to a particular type of cancer or to how any particular employee will cope with it.
Without invading an employee’s privacy, it is usually both practical and appropriate for an employer to discuss in confidence how a [recruitment] candidate or an employee would wish to deal with the situation, to the extent that their condition impacts on their ability to fulfil their role .
Disability is a protected characteristic under the Equality Act, and under Schedule 1, cancer is to be treated as a disability even where it may not, at any particular stage, have a substantial, long-term, adverse effect on an individual ’s ability to undertake normal day-to-day activities.
Together with other protected characteristics, such as gender and race, it is unlawful for an employer to discriminate, either directly or indirectly, because of an employee or candidate’s disability.
Nor may they treat the individual unfavourably because of something arising from the disability, without objective justification.
Employers have a duty to make various reasonable adjustments to reduce or avoid substantial disadvantage, attributable to the disability of the affected employee or candidate, under sections 20- 22 of the Act.
It is a common misconception that an employee who is caring for a cancer patient has the same right to have reasonable adjustments made to their working arrangements. They do not. However, if the employee is a carer of a child or adult with cancer, and falls within the Flexible Working Regulations of 2002, they can request a change in their working pattern to accommodate their caring responsibilities.
Rachel Dineley is an employment partner at law firm DAC Beachcroft
Case study: Serco tweaks GIP policy to support staff with cancer
Serco entered negotiations with its long-term group income protection (GIP) provider, Unum, last year about the possibility of offering proportionate benefit to employees with cancer.
The global outsourcing organisation offers GIP to all employees after two years’ service, up to 60% of salary.
Ashleigh Witcher, senior benefits and pensions administrator, says: “We’ve had GIP for years, but we’ve used it for [employees] who are well or injured and off work. We started to realise that cancer is one of the diseases that is now probably the third most important category, and that 70% of people that get cancer are curable and do return to work, or they don’t go off at all, but obviously they can’t do five days a week.
“Together, we [Serco and Unum] have worked out that we can use proportionate benefits and keep an employee in work and keep their skills retained.”
For example, in the case of a project manager who was redeployed to a more suitable, but less well-paid, role on return to work after cancer, Unum funded the shortfall in salary.
Witcher says project managers have to be very motivated, and a long-term illness can change an employee’s personality and the way they are driven. Serco’s approach is to support an employee even after they have recovered from cancer, she says.
The employer’s line managers have faced perhaps the toughest challenge in Serco’s cancer care strategy, in communicating with affected staff about their illness.
“Line managers say [they struggle with] never really knowing how much to get involved,” says Witcher. “Obviously, it’s a very hard situation and these are very hard conversations to have. We are still struggling with the difference between HR dealing with it and managers dealing with it.”
But Witcher is confident that the employee assistance programme Unum also provides as part of Serco’s GIP cover can help managers to support staff affected by cancer.
She says Serco’s cancer care policy is based on feedback from employees about how they would like to be supported in the workplace.
Of its 40,000-strong workforce across the UK and Ireland, 25 of Serco’s employees are currently living with a cancer diagnosis.
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