SSP and Chronic Conditions: Managing Recurring Sickness

Employees with chronic health conditions like diabetes, Crohn's disease, arthritis, or mental health conditions need ongoing support. Managing SSP fairly while addressing attendance issues requires understanding both the law and compassionate management.

Common Chronic Conditions

What Are Chronic Conditions?

Chronic conditions are long-term health issues that may cause:

• Regular short absences (flare-ups)
• Occasional longer absences (relapses)
• Ongoing symptoms affecting work
• Need for regular medical appointments

Examples

Physical conditions:

• Diabetes
• Asthma
• Arthritis
• Crohn's disease
• Multiple sclerosis
• Chronic pain
• Epilepsy
• Fibromyalgia

Mental health conditions:

• Depression
• Anxiety disorders
• Bipolar disorder
• PTSD

Disability Status

Many chronic conditions are disabilities under the Equality Act 2010 if they have a substantial long-term effect on the person's ability to carry out day-to-day activities.

Long-term means: 12 months or more (or likely to last 12 months).

SSP for Recurring Absences

The Linking Rule

Absences due to chronic conditions often link together if there's less than 8 weeks between periods of sickness.

Impact: The employee uses up their 28-week SSP entitlement faster.

Example Pattern

Employee with Crohn's disease:

• January: Off sick 5 days (flare-up)
• March: Off sick 4 days (flare-up)
• May: Off sick 6 days (flare-up)
• July: Off sick 5 days (flare-up)

All absences less than 8 weeks apart = linked.

SSP used: 20 days total (approximately 4 weeks of SSP entitlement used).

Tracking Is Essential

For employees with chronic conditions:

• Track each absence carefully
• Calculate gaps between absences
• Monitor cumulative SSP used
• Alert when approaching 28-week limit

Communicating the Limit

If an employee is approaching their 28-week SSP limit:

• Have an early, compassionate conversation
• Explain what will happen when SSP ends
• Discuss options (adjustments, occupational health, redeployment)
• Prepare form SSP1 if limit is reached

When SSP Runs Out

The 28-Week Maximum

Once 28 weeks of SSP have been paid in a linked period, no more SSP is due.

What happens next:

1. Give employee form SSP1
2. Employee can claim Employment and Support Allowance (ESA) or Universal Credit
3. Employment continues (unless terminated for capability)
4. Occupational sick pay may continue (if scheme allows)

Resetting the Clock

If the employee is well for more than 8 weeks, their SSP entitlement resets.

New 28-week period starts if they're off sick again.

Practicalities

Scenario: Employee has used 28 weeks SSP due to chronic condition.

Options:

1. Employee returns to work: Support with adjustments to prevent relapse
2. Employee remains off sick: ESA replaces SSP, consider capability process
3. Medical retirement: If condition means they can't work, explore ill-health retirement (if pension scheme allows)

Reasonable Adjustments

Legal Duty

If the chronic condition is a disability (usually is), you must make reasonable adjustments to remove disadvantages.

Common Adjustments for Chronic Conditions

Flexible working:

• Later start times (for medication side effects)
• Working from home to manage symptoms
• Reduced hours
• Compressed hours (fewer days, longer days)

Physical adjustments:

• Ergonomic equipment
• Adapted workstation
• Parking close to building
• Rest breaks

Role adjustments:

• Reduce physical demands
• Remove certain tasks that trigger symptoms
• Job redesign

Time off adjustments:

• Time off for medical appointments (don't count as sickness)
• Phased return after absences
• Regular review meetings to monitor wellbeing

What's Reasonable?

Factors to consider:

• Cost of adjustment
• Size and resources of business
• Impact on business operations
• Effectiveness of adjustment

Small adjustments (flexible hours, home working) are usually reasonable.

Expensive adjustments (major building works, specialized equipment) may not be reasonable for small employers.

Occupational Health Referrals

When to Refer

For employees with chronic conditions:

• After repeated short absences (e.g., 3+ in 6 months)
• When absences are impacting work
• To understand prognosis and adjustments needed
• Before considering capability proceedings

What Occupational Health Can Tell You

• Is the condition a disability?
• Prognosis (will it improve, remain stable, worsen?)
• What adjustments would help?
• Is the employee fit to continue in their role?
• Are there roles they could do?

With Employee Consent

You need employee consent to refer to occupational health and to receive the report.

If they refuse, explain:

• The referral is to support them
• Without it, you can't identify adjustments
• Refusal may impact your ability to keep them employed

Disability Discrimination Risks

Direct Discrimination

Treating someone less favourably because of their disability.

Example: Not promoting someone because they have epilepsy.

This is unlawful.

Discrimination Arising from Disability

Treating someone unfavorably because of something arising from their disability.

Example: Dismissing someone for absences caused by their chronic condition without exploring adjustments.

This is unlawful unless you can show it's a proportionate means of achieving a legitimate aim.

Failure to Make Reasonable Adjustments

Not making reasonable adjustments that would remove a disadvantage.

Example: Refusing to allow an employee with arthritis to start 30 minutes later to manage morning stiffness.

This is unlawful if the adjustment is reasonable.

Harassment

Unwanted conduct related to disability that creates a hostile environment.

Example: Making jokes about someone's absences or symptoms.

This is unlawful.

Absence Management for Chronic Conditions

Standard Absence Triggers May Not Work

Many employers use Bradford Factor or absence triggers (e.g., "3 absences in 6 months").

Issue: Employees with chronic conditions will often hit these triggers through no fault of their own.

Adjusted Approach

Disability-related absences:

• Discount from absence triggers (but still monitor)
• Focus on reasonable adjustments to reduce absences
• Regular reviews rather than punitive approach

Non-disability absences:

• Manage normally under absence policy

Keep separate records to distinguish disability-related and unrelated absences.

Example Policy Wording

"Absences directly related to a known disability will not automatically trigger the attendance management process. However, we will proactively work with the employee to identify reasonable adjustments to support attendance and wellbeing. Persistent absence, even if disability-related, may ultimately lead to capability proceedings if adjustments have been exhausted and the business cannot sustain the absence levels."

Capability Dismissal

When Is It Fair?

Dismissal for capability (ill-health) may be fair if:

1. Genuine belief employee cannot perform their role
2. Reasonable investigation (OH reports, medical evidence)
3. Consultation with employee about situation and alternatives
4. Adjustments considered and implemented (or ruled out as unreasonable)
5. Redeployment explored (to less demanding role)
6. Fair procedure followed

High Bar for Disability Dismissals

Dismissing someone with a disability requires:

• Evidence adjustments have been tried
• Evidence no suitable alternative roles
• Clear business need (role must be done, cannot remain unfilled)
• Proportionate decision

Failure to meet these = discrimination claim likely to succeed.

Process for Chronic Condition Dismissals

1. Occupational health referral
2. Discuss OH report with employee
3. Implement recommended adjustments (trial period)
4. Review effectiveness
5. If attendance doesn't improve: Further OH referral
6. Consider redeployment (to roles with fewer demands)
7. If no options: Formal capability hearing
8. Dismissal with notice (if no alternative)

Notice and Pay

If dismissed on capability grounds:

• Full contractual notice
• Accrued holiday paid
• Any remaining SSP (if within 28 weeks)

Phased Returns

What Is a Phased Return?

Gradually increasing hours/workload after absence to ease back into work.

Example:

• Week 1: 2 days, half days
• Week 2: 3 days, full days
• Week 3: 4 days
• Week 4: Full time

Benefits for Chronic Conditions

Reduces risk of relapse by avoiding sudden return to full demands.

Pay During Phased Return

No legal requirement to pay full salary for reduced hours.

Common approaches:

1. Pay for hours worked (most common)
2. Full pay for a set period (e.g., 2 weeks)
3. Use accrued annual leave to top up pay to full salary
4. Combination (e.g., half pay for hours worked, half normal pay)

Disability discrimination: If you offer phased returns to some but not to employees with disabilities, this could be discriminatory.

Medical Appointments

Time Off for Appointments

Employees with chronic conditions may have frequent medical appointments.

Legal position:

• No statutory right to paid time off for medical appointments (except pregnancy-related)
• Reasonable adjustment: May require allowing time off (paid or unpaid) as an adjustment

Common Approaches

1. Paid time off for regular appointments (generous, supports wellbeing)
2. Unpaid time off (minimum compliance)
3. Make up the time (work longer on other days)
4. Use annual leave (but this reduces employee's holiday)

Best practice: Paid time off as a reasonable adjustment for disability-related appointments.

Workplace Adjustments Examples

Diabetes

Adjustments:

• Regular breaks to check blood sugar and eat
• Access to fridge for insulin storage
• Flexible start times if hypoglycemic in morning
• Understanding if they need to suddenly leave (medical emergency)

Crohn's Disease / IBS

Adjustments:

• Proximity to bathroom facilities
• Flexibility to leave meetings quickly
• Working from home during flare-ups
• Reduced travel requirements

Arthritis / Chronic Pain

Adjustments:

• Ergonomic chair and desk setup
• Voice recognition software
• Breaks to move and stretch
• Flexible hours (start later when stiffness eases)

Mental Health Conditions

Adjustments:

• Quiet working space
• Reduced exposure to stressful tasks
• Regular one-to-ones for support
• Flexible hours for therapy appointments
• Phased return after absence

Asthma

Adjustments:

• Smoke-free environment (usually standard)
• Control of triggers (dust, cleaning products)
• Understanding if inhaler needed during work

Communication and Support

Regular Check-Ins

For employees with chronic conditions:

• Monthly one-to-ones to discuss how they're managing
• Open-door policy for concerns
• Early intervention if struggling

Supportive Culture

• Manager training on disability awareness
• Encouragement to declare conditions (without pressure)
• Normalize discussions about health
• Zero tolerance for disability-related jokes or comments

Employee Assistance Programs (EAP)

Offer access to:

• Counseling
• Health information
• Financial advice (if worried about SSP running out)

Balancing Support and Business Needs

The Reality

Supporting employees with chronic conditions is the right thing to do and legally required if the condition is a disability.

But: Businesses need reliable attendance to operate.

Finding the Balance

1. Make all reasonable adjustments - genuinely try to support attendance
2. Monitor and review - are adjustments working? Could anything else help?
3. Be transparent - explain business needs and limits
4. Document everything - shows you've acted fairly
5. Seek advice - OH, HR professionals, legal advice if needed

When Support Isn't Enough

If, despite all adjustments:

• Attendance remains unacceptably low
• Business cannot sustain the absence pattern
• No alternative roles available

Fair dismissal may be possible, but only after exhausting all options.

Key Takeaways

• SSP links if gaps are less than 8 weeks - chronic condition absences often link
• 28-week maximum - monitor carefully, plan ahead
• Reasonable adjustments required if condition is a disability
• Occupational health referrals essential for understanding and supporting
• Adjusted absence management - don't apply standard triggers rigidly
• High bar for dismissal - must exhaust adjustments and alternatives
• Communication and compassion - supportive approach benefits everyone

Managing chronic conditions requires balancing empathy, legal compliance, and business practicality. Get it right and you retain valuable employees and avoid costly discrimination claims.