Benefits, work and cancer: Easing back into work

Part Two of a three-part series looks at how employers can adapt and benefits help, when you are ready to ease back into work We look at reasonable adjustments to make it practical to work and how health related and "in work" benefits can help when earnings may be lower as you ease slowly back to into past hours or look to work part-time

Welcome to Part two of a series of blogs around Benefits Work and Cancer.

In Part 1 , I introduced the different benefits that can apply if you need to take a time out from work for a while going through surgeries and treatments after a cancer diagnosis. I took one not uncommon journey through this as a way to illustrate how and when the different benefits kick in and how they fit together with any ongoing sick pay from work. But of course, that may not be the experience you have: perhaps after coming to terms with the initial shock, you may be on a watch and wait regime, perhaps feeling well enough to work as normal, or perhaps with some minor adjustments. Or you may hope to work through treatments, but do explore the potential for this with this your medical team. Or it may be that for you it feels like a big choice to be made to leave work behind and consider early retirement.

So while, here in Part 2, I move on to how the benefits from last time can help when easing back into work during recovery, the financial support they can offer when gently building up hours can also apply if you are looking at carrying on doing perhaps more limited hours at an earlier stage.

Am I ready for work?

Taking time out from work can feel very hard emotionally, quite apart from the financial implications. You may be feeling the loss of an important sense of purpose and identity, miss the social aspect of work and interaction with colleagues or feel that somehow you are letting yourself, work and family down by “giving into” the limitations imposed by your cancer and its treatments.

It may feel important to get back to normal as quickly as possible or to try to hang on to some normality early on. Overwhelmingly the desire for independence and the work ethic is strong with most people and you may feel keen not to “take advantage” . Or just be plain bored.

However, it may very well be that employers, colleagues and family want you to take the time out your health needs, all the sooner to return in fine fettle. It is then important to recognise and work through those feelings but not necessarily to stagger into work too soon, but rather to plan and prepare for a successful return to work

Working during treatment

Do discuss that possibility with your clinical team. What may be realistic will depend on the sort of treatments planned for you, how you respond in practise and the sort of work you do. It may be possible to perhaps work from home on a less time critical project, where you might do something on better days but not feel bound to work on bad days. There may be barriers of insurance, the law and the practicality and risk of working to consider.

There is an added factor in these strange Covid times around risks if your immune system is going to be impaired, as the risks may be that bit greater.

It is something that can be doable, but if your treatment is likely to be hard hitting or your work not doable or flexible enough when your capacity may be rather limited , it may not be something that can work for you. If it might seem doable do think creatively with your line manager, colleagues and family about what feels like a realistic plan. But also be guided by what you actually find are the side-effects for you when you actually get into treatment.

Your employer may have the resources to pay you full time, while reducing expectations of what you may do, especially if they might be paying you full sick pay without any work being done. In the case of other jobs, it might be a financial choice between just Statutory Sick Pay and payment for hours worked. Financial pressures can be eased by talking to a Money Advisor to help re-negotiate bills, mortgages and so financial commitments. And other benefits may help when in paid work with perhaps temporarily reduced earnings.

Work then could be doable during treatment or it may be just not safe or reliably possible. But do recognise that it’s a big ask of yourself and be ready to adapt your plans to do so. It may be a time when financial pressures are not so great – e.g. should you have access to full sick pay in the early period of sickness absence. Benefits may help fill gaps and it may be possible to reduce financial commitments. It may perhaps feel a bit easier in this more limited period of quite intense activity to remember that your health has to come first.

Easing back into work in recovery

There can be similar issues about adjustments to work and cunning plans and creative thinking as and when you feel ready to plan a return to work. The difference may be that financial pressures may be biting harder – but do get advice – and you may be pressuring yourself more, as you may have been hoping for a quicker return to work and normal after some initial recovery from the side-effects of treatment.

But these can take longer to clear than you had hoped for. Direct side effects from receiving treatment will slowly, perhaps imperceptibly at first start to ease, but you may experience some ongoing late effects from e.g. chronic fatigue, particular limitations/adaptions from your surgery and the emotional/psychological impacts of all you have been through.

An employer may have been sympathetic through the rigours of treatment but starting to ask about return, under their long term absence policies. The DWP may start taking an interest in re-assessing your sickness benefits, although they usually allow quite a time after treatments before doing this and may need an update on ongoing medications or new treatment plans.

Once again, do try and be gentle on yourself. Work is not always the great solution, even if getting back to it feels like a yearned for return to some sort of normality. It’s a balancing act – some pushing at the limits of chronic fatigue can help it ease away and if yours is a positive working environment a successful easing back into work can help with depression. But pushing either of those issues too far , too early can mean your attempt to return to work may not be a successful one and put you back in a worse place and delay that return.

Many employers have a policy of “phased returns” to work, where you enter into go back on your usual pay but build up your hours gently over that first month. This is great if you just need to gently get back into the swing of it, but are still mostly fit and ready. But you might need to think about other adjustments too (see below).

If you need to ease back in over a longer period, working reduced hours with lower earnings, benefits can help with the financial gap.

Your rights at work

Now you may not want to begin a conversation with “I know my rights!” nor want to be quoting the law, but it can feel useful to be aware that you have some legal rights in this situation:

Firstly, you will have all the normal rights against unfair dismissal (depending on how long you will have worked for them), fair selection and compensation in any redundancy situation and so on.
Secondly you will have additional rights under the Equalities Act not to be discriminated against at work because of disability. For these purposes, cancer counts as a disability. So just refusing to engage sensibly in reasonable adjustments because of your health issues, passing you over for promotion or other opportunities, unfairly selecting you for redundancy because of disability, could al count as unlawful discrimination.

You may want to take a look at a couple of useful publications from Macmillan:

But there is also more useful general information for the perspectives of an employee, an employer and someone who is self employed on the Macmillan website. - please see the links at the bottom of this blog. So, for example both you and an employer may not have come across this situation before, so you may not know what changes to ask about and an employer may not know what to suggest, so the links may be useful for both of you.

Reasonable adjustments:

One of your rights is to be able to request reasonable adjustments at work. An employer doesn’t have to agree to these requests, but needs to show why they can't reasonably allow for that adjustment., to avoid the risk of committing unlawful disability discrimination.

But it can be hard to know what you might ask for and a meeting with an employer might be a bit of a well meaning "erm… " session as each one of you may seek to be guided by the other.

Some examples of adjustments might be:

varying hours and days in a variety of ways (working long days to allow for some extra days off in between or shorter working days if a full day is too much or going part time for an agreed period) ,
physical adaptions to workspace and special equipment,
more frequent breaks for e.g. toileting issues, break out space,
changes in role, if certain tasks are very difficult for you, but others may work better or redeployment to another role altogether.

Again see the Work and Cancer pages at Macmillan for more ideas.

How benefits can help

We met a range of benefits in Part 1. You may remember that some of these are non-means tested and can be helpful to all during a return to work . Others – including those more generally linked to support when in work are means tested. These may not apply to everyone, but can be very useful if there isn’t a lot of other money coming into your home. I will start then with the main non-means tested ones:

The non-means tested benefits

These are the benefits that are not usually affected by other income and savings and certainly not by those of any partner. of the the two benefits below, PIP is not affected in any way by any other income, whereas ESA is affected by an earnings limit, because it is a benefit designed to offer a rather basic replacement income for earnings.

Contributory ESA

Contributory Employment and Support Allowance (C-ESA) is the main non-means tested benefit for sickness, to give a rather basic replacement for earnings. I am assuming from last time that any entitlement to Statutory Sick Pay (SSP) has now passed. So you will have either claimed Contributory ESA from the day after SSP ran out or from the beginning of time off unwell if you were not entitled to SSP:

ESA has a a rather double edged approach to work:

on the one hand the full Work Capability Assessment (WCA) it uses can make you feel you really have to prove that you are “unfit for work”, leaving you with a sense that doing anything might be held against you.
But on the other hand, the test is actually about “limited” rather than “no” capability for work, and ESA does offer real incentives and other support to encourage you to try - or prepare for – work as and when health allows.

Many people with cancer may not have had to endure the full WCA process, as you bypass most of it while “awaiting, receiving or recovering from cancer treatments”. Others though, may have experienced the full works of the WCA perhaps while on “watch and wait” regimes or if you have needed to been re-assessed in recovery. While some will be back in work before ESA wants to review their entitlement because you are no longer seen "recovering from treatment" , others may still need to continue with ESA as they get to grips with longer physical and psychological "late effects" from the whole cancer experience. So, if you have been through a full WCA, you may feel rather nervous at taking steps towards work for fear of losing your ESA.

However, ESA encourages you to do try dipping your toes in the water of work by:

allowing you to try "Permitted Work" within a limit of doing no more than 16 hours a week and/or earning no more than £140.
not triggering a new WCA because of you doing "permitted work" , although both success in managing that work easily or difficulties and support needed with it, might both be relevant when your next WCA comes up.
offering some other resources, training and support to help a return to work.

When you are ready to go beyond these limits, financial support will be more from the changing means tested benefits – see more on these below

Personal Independence Payment (PIP)

As we saw last time PIP – and its predecessor Disability Living Allowance (DLA) that some people still get - is not directly related to your fitness for work. Rather it is an concerned with extra payment for difficulties with day to day living and/or getting around out of doors. Those needs may be caused by a health issue that really limits any work that you can do, and you may well have started a PIP claim during say chemo.

But it may also be that , with the right support, flexibility and reasonable adjustments , that you would be fine to work, whether part time or full time. But you may still have ongoing difficulties with PIP activities from life changing surgeries or “late effects” . Indeed your potential needs may increase as you meet the needs of a workplace, rather than potter about at home.

So you going back into work is not an issue for any PIP award, unless that return to work is linked to a falling away of difficulties. It may be it is in spite of those difficulties or actually lead to an increase in those difficulties

So, you can continue to receive your PIP as long as you have a sufficient level of difficulties to qualify. So PIP may be a helpful support that rolls off as recovery continues or be a permanent part of the financial support that helps make work pay when wrestling with more long term difficulties.

Means tested benefits

As we saw in Part 1 these are a-changing and while both old and new systems do it in different ways, both aim to help you move into work as health allows. They can help whether your work has tended to be in lower paid roles in the past or whether in easing back into work, there may be limits on the hours you can do or the level of responsibilities you can take on at first.

These then provide help on a rolling basis according to your income in work. tasks that you can take on to make work pay. Which system of help you come under depends:

If you are new to benefits you will be claiming under Universal Credit (UC), which seeks to cover all groups within the one means tested benefit e.g. those with limited capability doing a bit of work and those stepping up into more hours or even working full time.
The old "legacy benefits" system only applies to those who still receive support this way, which includes the majority of people with health issues. Here the means tested journey into work involved a switch from the old Income-related ESA over to Working Tax Credit.

Claiming under the old system

Most people cannot start an entirely new claim under the old system. The main exception is if you are getting an amount called a “severe disability premium” within any current “legacy benefit” that you receive. Doing so currently stops you from claiming Universal Credit and instead you can still make new claims under the old “legacy benefit system” if you need to switch from eg. Income-related ESA to Working Tax credit.

You can also do this if :

you are still getting WTC from before you became ill. WTC carries on for up to 28 weeks, so moving from a temporarily sick worker for WTC back into work is possible within that time
if you still received Child Tax Credit (CTC) perhaps before and since becoming unwell. CTC help with the costs of children applies whether you are in work or not and most people receiving tax credits also have families. If you are receiving CTC, then you can have WTC added to it when you become eligible, as it is part of the same tax credits claim.

The old “legacy benefits” system has a two-stage approach:

when you first start easing into work you might be getting Income-related ESA – as a top up to or instead of Contributory ESA. You can do Permitted work as described above within the same 16 hours / £140 a week limits
If you already to go beyond 16 hours, if you can, you switch over to Working Tax Credit. However, if you are not able to start receiving Working Tax Credit this is the point when you would switch over to the new Universal Credit system instead.

If you have been getting help with rent from Housing Benefit HB) , while off work this can continue as you move into work and switch from Income-related ESA to Working Tax credit as help with your other living costs

Working Tax Credit

It uses very similar rules as income tax and takes your income on the same annual basis. That can really reduce the paperwork, as HMRC already know your income figures. And this makes WTC particularly easier for the self employed.

It adds up the maximum WTC you could receive adding up several elements that apply in your case. WTC then looks at your gross income; below a threshold of £ - or £ a week - there is no effect on your maximum WTC . But above that your WTC tapers off at 41p in the £.

Any PIP you get is ignored in these sums, but the PIP can also help to increase your entitlement to Working Tax Credit. This is because either receiving PIP now - or having been on sickness benefits for over 6 months before claiming WTC – entitles you to be counted as a “disabled worker” . And that means two things:

you only need to normally do 16 hours a week to receive WTC
you are entitled to an extra “disabled workers element” worth £ a year – equivalent to £ a week - in the WTC sums.

Tax credits have had their share of problems too, often not related to the basic idea but cuts and complications. But some of the advantages it has are:

It all links into the tax system, so it doesn’t need to ask you for so much detail when you claim it. HMRC already know about you
It is set up to look at your income in the same way as Income tax so you don’t need to keep separate records or report income differently as you do under UC , which can make a big difference for the self employed.
It has a clear idea of a "worker with disabilities" – i.e. who does not need a separate health assessment about limited capability, but who is at a disadvantage finding work. WTC offers extra support for disabled workers without some of Universal Credit’s confusions.

Housing Benefit

This helps with any rent you have to pay whether you are in paid work or not.

If you are on Income-related ESA you still get the maximum help that HB can allow, even if you start doing permitted work . If you had to go through the HB sums, you would have earnings from permitted work ignored.
As you move onto Working Tax Credit , then you will have to go through an HB assessment, but will be helped by having a small amount of earnings ignored, but also extra premiums in HB related to any PIP that you get.

The Universal Credit (UC) system

The big advantage of UC is that it it is one benefit that will eventually take over from Income-related ESA, tax credits and Housing Benefit (along with a couple of others). So that means as you make that journey from not feeling up to any work, doing a few hours or getting more into the swing of things, you can stay with UC with no switching of benefits and a simple readjustment of your UC award each month.

UC then mainly doesn’t distinguish between phases and likes to say it has no hours rules or odd effects when e.g Income-related ESA gives way to WTC. It does though, currently have a real confusion in the way it deals with workers with health difficulties.

In general UC can be more flexible and generous for people who are well moving from say being unemployed and looking for work and into work. It can offer more help and incentives in that more straightforward journey into work. But it seems less thought through for people easing back into work with health problems.

The basic support from UC involves:

a "Work Allowance" – if you pass the same Work Capability Assessment as used by ESA or have children. You do not get a double allowance if both apply. The allowance means that the first £292 a month of any earnings - rising to £512 if UC does not help you with housing costs - is ignored
After that, you lose 63p of UC for each £ of net earnings above your work allowance.

Compared to the "legacy benefits" system:

there is no distinct category of "permitted work", so you may not feel as safe starting work as you might under ESA. It is a judgement call for your work coach as to whether changes suggest a new WCA is required.
the UC Work Allowance is a similar idea to the permitted work earnings limits, but is rather less generous; put in monthly terms, ESA would ignore £606.20 of earnings
there is no equivalent of WTC's concept of a "disabled worker". WTC understands that while you may certainly be "fit for work" – and maybe can work full time – you still need extra support because of ongoing health issues putting you at a disadvantage in work.

As a result, UC is currently rather strange in dealing with workers who would have been “disabled workers” for WTC, because UC doesn't deal with "disability" separately. So, UC will allow you to continue to treat you as it might a worker who is not fit for work, but taking initial steps to try work. The only extra help availble is linked to sickness from work on passing the WCA and the work allowance that those with limited capability for work can gain from. UC does not have separate amounts for "disability" so as you move into work over 16 hours -and even full time work - the equivalent help to Working Tax credit still depends on you passing a WCA.

Indeed, a special exception is made in the UC regulations to allow a worker doing over 16 hours to undergo a WCA as normally you would be ineligible to do so. But that concession is to allow you to undergo an entirely wrong and inappropriate assessment for "limited capability" when you might be working full time; UC may allow you to undergo the WCA but without any change to the rules, it's a test that you really have no business passing.

Now to get the special concession to undergo the WCA you need to be getting PIP. UC could sort this mess out in one of two ways:

the one with the least change is to allow people receiving PIP to automatically pass the WCA, as they already do with those over pension age dragged into UC by a younger partner
or for a more complete solution get a grown from legacy benefits to explain why "sickness" (limited ability to work) and "disability" (extra difficulties with day to day living and getting around that might not prevent you working) are two very different things that are better dealt with separately.

You may then need to get advice to get through the bizarre approach of UC to not making work pay for workers with health problems. This may involve your MP or at some point taking UC to court yet again.

And so:

Easing back into work requires some imagination and thinking outside the box by both you and any employer. It should not be a simple case of are you or are you not fit enough to jump straight back into what you were doing before

It may be that agreeing a gentle phased return is the only thing you need. But it may be that there are other reasonable adjustments that could enable your return to work succeed.: different duties, flexible working hours, changes to your role or duties, specific equipment, awareness raising with colleagues.

All things that a good employer may be willing to consider as a way of keeping your valuable experience and skills in the workplace, supporting you back into work and avoiding unlawful disability discrimination. It may be that both you and and your employer could do with learning about approaches that have worked well, as you may not know what to ask for and they may not know what to offer.

You may have only first come across benefits during time off work when unwell, but they don’t just stop immediately as you return to work.

Non-means tested benefits can continue to help regardless of most income and earnings:

Contributory ESA is usually not affected by savings and most other income, except earnings. However, you can continue to receive C-ESA , while working, as long as earnings are below £140 a week and you are doing under 16 hours
Personal Independence Payment (PIP) may have been picked up in sickness, but can stay with you as you ease into work or even in the longer term if you still face those restrictions,. It can carry on regardless of any income or savings and can help you with extra support from means tested benefits.

Means tested benefits are changing:

Some people are still covered by- and a few can still start a claim through- the legacy benefits system. This is based on a switch at 16 hours a week from "permitted work" under Income-related ESA over to Working Tax Credit (with its disability element) . Throughout, any help with rent will come from Housing Benefit (HB)
Most new claims will be under the new Universal credit system with its seamless segue from no work to part time to full time work. UC has its version of Income-related ESA permitted work, if a little less generous. But until, things are changed, UC gets into a muddle with support for those working over 16 hours, but still affected by long term health limitations. Do get advice if you you get stuck.

But regardless of UC’s foibles, valuable financial support is there to help you ease back into work from all of these benefits, both means tested and non-means tested. They can help if you need a bit of "in work" financial support if you need to slowly ease into work in recovery or if you are looking at working a little through treatments.

Best wishes,

Tom

Useful links and further reading:

Work and Cancer

DWP: Permitted Work- official information
DWP: UC Work Allowances
DWP: UC: Health conditions and disability guide
HMRC: The disability elements of tax credits
Revenue and benefits : Understanding disability and tax credits

Other blogs in this series:

Part 1: Stepping back from work when unwell
Part 3: Working while being a carer - (link to come when posted)

Other useful Benefits Blogs

Getting further help and advice:

Visit your local Maggie's Centre and talk with one of our benefits advisors. Find your nearest centre here
See if there is a Macmillan advice service near you here
Find your local Citizens Advice office: in England & Wales - here. In Scotland - here