A long-term health condition is defined by the UK’s NHS as ‘a health condition that cannot at present be cured but can be controlled by medication and therapies’.

Long-term health conditions require management over many years and can lead to permanent or temporary impairment or disability. The most prevalent long-term health conditions in the UK include: 

• Common mental health problems (for example, anxiety or depression) 
• Musculoskeletal conditions (for example, arthritis, backpain)
• Cardiovascular conditions (for example, heart disease) 
• Respiratory conditions (for example, asthma) 
• Neurological conditions (for example, multiple sclerosis)
• Cancer
• Menopause
• Other conditions include diabetes, hearing and sight loss, among many others. 

Everyone’s experience of a long-term health condition is individual to them. Symptoms can vary from mild to severe and some require no changes to the way they work, while others require changes to their job or working pattern. Often, someone’s symptoms can be hidden to others. 

The most common problems reported by people in the UK with long-term health conditions of working age relate to mental health (42%), mobility (41%), or stamina/breathing/fatigue (32%). Many also experience difficulties with impaired dexterity, memory, hearing, vision, learning or social activity. 

Defining and identifying long-term health conditions is often made difficult as many people have more than one condition. The relationship between mental health, physical health and neurological conditions is complex but, for example, an individual may develop mental health problems (such as depression or anxiety) due to their diagnosis. 

The pathway to diagnosis and identifying a successful plan for someone to manage their health condition is often not straightforward:

• The onset of the condition may be acute and rapid or may build up over a long period of time, being ignored or passed over as temporary, until an employee seeks advice and help from their doctor. 
• For many conditions, there’s no single test to detect the condition. To get a diagnosis an employee may need to attend multiple specialist appointments and undergo a series of tests and referrals, the majority of which are offered in working hours. 
• Once a diagnosis is obtained, there’s a new journey to identify the most appropriate treatment to manage the symptoms and develop new strategies to learn to live with the condition. 
• Over time, an employee’s condition may fluctuate; some symptoms can vary over the course of a month, day or even hour, making life unpredictable. 
• Over time, treatments may become less effective and need review, or new treatments may become available, so there is a need for ongoing review. 
• For many, this occurs against a backdrop of uncertainty about what their condition, its symptoms and the impact of treatment means for their ability to live in the way they had done before – both at home and at work. Understandably, for many people this can lead to a re-evaluation of their identity and a loss of confidence. 
• The stigma and lack of openness that exists in society about ill health, in particular some conditions such as mental ill health, can add another layer of complexity. This can make it challenging for individuals to talk about a health condition at work and seek the support and adjustments they need. 

Having good management practices, being prepared to work with the employee through their journey of diagnosis, and to develop a management plan, will give the employee the best chance of staying in work. Should an employee need to take sickness absence, it will also give them the best chance of returning to work in a sustainable way. See our guidance for HR and people managers on managing a return to work after long-term sickness absence. 

While there are many different long-term health conditions, this guide offers organisations a starting point when providing effective support for any condition. There are also links to more in-depth resources on specific conditions.

• Long-term health conditions can have an impact on an individual’s productivity at work, and their ability to stay in work. However, this impact can be lessened when work is designed and managed in a supportive and flexible way. 
• For many people, small, practical changes can often make a significant difference on their ability to work and to manage their health condition successfully. 
• Employer support can help employees to stay in productive work and maintain financial security and independence; employers can also realise benefits through better attendance, work engagement and reduced staff turnover. 

Unfortunately, CIPD research in the UK shows that only 32% of HR professionals report that their organisation has a well-communicated workplace adjustment process, suggesting that too many people are not accessing the help and support available to them. In addition, half of HR professionals (50%) think that people managers lack the knowledge and confidence to manage people with long-term health conditions.

• Support from HR professionals can help to ensure employees with long-term health conditions are managed fairly and are supported, decreasing the likelihood of them claiming unfair dismissal or discrimination. 
• Employees exiting the workforce can significantly add to HR professionals’ workload recruiting and training for roles. 
• Poor management or the long-term absence of one team member can have a significant knock-on effect for other team members, for example affecting their workload and motivation.

• Good work is good for health and can reduce health and economic inequalities. 
• Work often forms an important part of an individual’s identity, which can lead to an increase in self-respect, self-esteem, mental wellbeing and social inclusion. 
• A poorly managed work environment can make it difficult for employees to manage their health condition, contributing to flare-ups, absence and in some cases an exit from work. 

• Many people with long-term health conditions are also considered to be clinically vulnerable and were required to take additional precautions, and many still need to do so.
• Many people with long-term health conditions have experienced significant delays in accessing healthcare services during the pandemic. For example, surgery, tests and check-ups have been delayed or cancelled. It is likely that many people are living with deteriorating health conditions and yet-to-be diagnosed conditions that could otherwise have been managed. 

The growing understanding of chronic conditions, coupled with an ageing workforce (in whom chronic conditions and co-morbidities are increasingly prevalent) creates an environment in which supporting employees to manage long-term health conditions well has benefits for everyone.

Everyone has a role to play in supporting employees with long-term health conditions at work. While many employees with long-term health conditions report long periods of time where their condition does not impact their everyday health or ability to work, they may experience times when they feel unwell or are in pain. At these times they need other people to help them recover and offer support at work. 

The IGLOo framework for thriving at work, developed by the University of Sheffield and Affinity Health at Work, outlines the different resources at the individual level, the group level, the leader/line manager level and the organisational level that can help an employee when managing a long-term health condition.

IGLOo framework for sustainable return to work

• Wherever possible, it’s important for employees with long-term health conditions to prioritise self-care and take appropriate responsibility to manage their condition. This includes developing an understanding of their condition and being able to identify early warning signs of symptoms. 
• Employees may need support to develop their ability to manage their condition effectively, for example in areas of self-management strategies, resilience and confidence in their ability to manage their work and health. 

• Friends, family and colleagues play a vital role in supporting people with long-term health conditions. They can help them to identify early signs of onset and help them to feel valued through non-judgemental support and understanding. 
• Employees are best able to stay in and thrive at work when their colleagues support them through constructive feedback on tasks, helping when completing challenging tasks and treating them as the person they were before having their long-term health condition. This also means that the manager needs to ensure that there is understanding and flexibility in the team to adjust workloads to accommodate any impact of the individual’s health condition on performance. 
• It’s very important to agree with the employee what information about their long-term health condition they would like to be shared with others, how this will be communicated and how they would like the team to support them

Evidence shows that people managers have a significant impact on employee health at work. What they do and how they behave can affect whether the employee feels able to take steps to manage their condition in work, to take early action to mitigate deterioration and, ultimately, to stay in work. This is because people managers

• are responsible for the day-to-day management of the employee and the tasks required of them 
• are key to providing access to work adjustments and job modifications 
• can influence employees’ exposure to workplace psychosocial hazards (for example work demands), which are likely to be felt more keenly by those managing a health condition 
• can cause employee stress (or prevent additional stress), or anxiety, particularly in those who are feeling less confident in their abilities due to the impact of their health condition.

Organisational policies can help or hinder an employee’s ability to work effectively in the way that they are designed and implemented. Further information, including the main components of an absence management policy, can be found in our absence measurement and management factsheet. Providing flexibility, including flexible working arrangements, should form a cornerstone of the organisation’s support for people to help manage their health condition with the demands of their role. See the CIPD’s guidance and practical resources on flexible working. 

People’s physical and mental health are closely linked, and someone’s mental health can deteriorate as a result of the symptoms or impact of a physical illness and vice versa (as this report shows). Mental health impacts can result from changes in capacity or a sense of identity, or when someone faces the uncertainty of living with a new or fluctuating illness. Work-focused counselling has been found to improve an employee’s ability to stay in work following absence related to mental ill health and is likely to bring benefits for employees managing long-term health conditions. While counselling is typically seen as relevant for people with mental ill health, it can be useful for people with other conditions as well.

Advice and guidance from HR professionals within the organisation can help make sure that processes and procedures are fair and designed to prevent discrimination.

Organisations may also provide access to services from other specialist professionals: occupational health professionals can generate an individualised stay-at-work plan and can ensure relevant medical investigations have been performed. Other professionals, such as vocational rehabilitation practitioners and occupational therapists, can provide specialist support depending on the condition and employee’s needs.

HR professionals can play a central role in implementing the IGLOo model through ensuring that:

• Employees managing long-term health conditions can prioritise self-care and have the skills and resources to self-manage their work and health. 
• Groups working with the employee know what they can do to support employees managing long-term health conditions and feel confident in doing so. 
• Line managers have the knowledge, skills and confidence to implement policies and practices and behave in a way that will support employees to manage their health and work effectively. 
• Organisational policies and practices are designed and implemented in a way that fully supports employees with long-term health conditions and are flexible to accommodate the needs of those with fluctuating conditions or conditions that need regular ongoing monitoring or support (for example through paid time off for appointments). As well as effective support for people to stay in work and thrive, this should also include access to advice about ill-health-related retirement to support people to retire ‘well’, if they decide that’s the right approach for them. 

The IGLOo resources play a role in helping people to balance their health and work and should be kept in mind at all times, alongside the guiding principles described in the next section.

There is a vast body of research that has examined the experiences of employees working with long-term health conditions. This research has informed the following guiding principles.

Employees working in supportive environments are more likely to discuss a health condition, to ask for help when needed and to return to work following sickness absence. Build a culture of psychological safety, where good working conditions and open conversations are prioritised and mental health and physical health are given equal standing. 

Organisations that have good people management practices are best placed to enable employees to thrive when managing a long-term health condition. Good practices include inclusive recruitment and assessment processes; training and support for people managers to protect and promote health and work; access to information and support through multiple channels.

When managers manage well and build trust-based relationships with their team, they help to create an environment that is open, respectful and kind, in which people feel ‘psychologically safe’. This means individuals feel able to speak up about a health or work issue without fear of criticism and in the knowledge they will be listened to and receive support and understanding. This doesn’t mean that a people manager should become a counsellor, best friend or confidant. Their role is to help them with the work aspects of the situation and make helpful adjustments where needed.

Many employees find telling others about their long-term health condition challenging. Whether they are experiencing menopausal symptoms, chronic back pain or another condition, many people are unsure of what to say and afraid that others will see them differently. 

Generally, it is unlawful for an employer to ask any job applicant or employee about their health or disability and an individual doesn’t have to disclose a health condition. There are some exceptions, such as where an employer needs to properly assess an individual’s suitability for the role (for example, if the nature of the role requires a certain level of physical fitness). 

Many people find that talking to others about their condition and its impact on their work can bring a number of benefits, including access to support and helpful work adjustments, improved working relationships and peer support, and feeling they can bring their real self to work. Conversely, research shows that disclosure can lead to negative effects such as stigma and discrimination if it is not managed well or if the organisational culture is not supportive. The organisation needs to make it very clear that any individual who shares information about a health condition will be treated fairly and with compassion, and their career opportunities not jeopardised. This should include reassurance for anyone on an atypical arrangement, such as a zero-hours contract.

The CIPD people managers’ guide to mental health has useful tips and a conversation checklist that can be followed when opening a conversation about someone’s health and its impact on their work.

Follow the links at the end of this guide for condition-specific guidance and stories from people working with different health conditions.

It is important to ensure that employees with long-term health conditions can easily access information that could help them stay in work and work productively. This includes all relevant company policies and support, such as their rights under the Equality Act, absence management and return to work, flexible working and work adjustments, an employee assistance programme, health insurance benefits, occupational health services, and counselling services.

Absence and return to work are often managed as a one-off event, but many employees with long-term health conditions will need to take multiple absences as their condition fluctuates over time. The most common approaches to managing short- and long-term absence in organisations include return-to-work interviews, trigger mechanisms to review attendance and disciplinary or capability procedures for unacceptable absence. These approaches are often experienced as an additional stressor by employees with long-term health conditions. Taking a flexible and individualised approach to absence management can help prevent unhealthy presenteeism and avoid unfairly penalising employees with ongoing health conditions. An understanding of the condition and its likely impacts on a person’s capacity to be in work and to perform in work by their manager should be the foundation of a more individualised and sensitive approach to managing absence. 

The CIPD guide on Managing a return to work after long-term absence sets out the guiding principles to follow when navigating the key steps to managing an effective return to work: 

1. Maintaining communication while absent. 
2. Preparing for a return to work. 
3. Supporting the employee and manager during the immediate return. 
4. Supporting the employee and manager on an ongoing basis on return.

Employers have a duty of care to identify and manage risks to physical and mental health at work. Risk assessments are often carried out as part of the return-to-work process, but for employees with long-term health conditions that could impact on, or be affected by, work activities, this is a vital step in the process.

Some employees may require adjustments to their job role, work environment or work schedule to manage their health and work. The nature of the adjustment will differ depending on many factors, including the nature of the job, the organisation and the employee’s unique needs. Providing that the employee’s agreement has been given, it may also be helpful to contact their GP or consultant for advice about the employee’s medical condition and the most appropriate work adjustments that need to be made to enable them to remain in work.

Often employees will need to make a series of adjustments to treatment regimens or
lifestyle to manage their symptoms and keep well. These self-management strategies
play a vital role in enhancing work and health outcomes. Self-management support in the workplace can help employees to develop skills to manage the impact of the symptoms and treatment. Examples may include adhering to treatment regimes, attending therapy, following specific dietary requirements, completing cognitive fitness exercises, using technology to remind people of appointments. 

To understand how the organisation’s policies and practices are working, it’s necessary to implement a system of reporting and review. With an increasingly ageing workforce, and the growing prevalence of health conditions experienced by employees, there is a need to understand the composition of your workforce, and how employees with long-term health conditions are experiencing work, to ensure that workforce needs are being met. 

While these guiding principles will support employees with long-term health conditions to thrive at work, they will also benefit all employees.

Employees with long-term health conditions may find the following interventions useful. 

Wellness action plans are a simple but empowering tool to look after their wellbeing while working, and to help employers know how best to support them. Anyone can complete one and they set out how an individual feels and behaves when they are well, what they need to do to maintain their wellness, any signs or triggers known to impact health, and the preferred action or response if these signs are noticed by others. Mind has downloadable wellness action plans that can be readily adapted for any condition. 

These are agreed between the employee and their manager and can include a combination of approaches. Taking a flexible test-and-learn approach will help the employee identify which work adjustments could be beneficial. These could include:

• Changes to an employees’ work schedule (for example, short breaks, leave for appointments, flexible hours). 
• Role and responsibilities (for example, workload or temporary change in duties).
• Work environment (for example, working from home, relocation of desk to a quiet space or close to toilet facilities). 
• Policy changes (for example, extended leave). 
• Additional support or assistance (for example, buddy, supervision or skills training). 
• Redeployment. 
• Additional physical resources (for example, dictator, screen reader). 

Health passports or a written adjustment agreement approach can empower individuals to manage their health condition with the organisation’s support. In the UK, only 9% of organisations reported using them, but where they are in place they are broadly seen as effective.

Health cash plans allow employees to claim back some of the costs of healthcare expenses, while health insurance covers treatments, usually with a limit, for conditions developed after the start of the plan. Around a quarter of UK organisations report having cash plans or private insurance. This suggests that the majority of employees in the UK are reliant on individual plans or NHS provision. 

Support from occupational health or vocational rehabilitation professionals can help employees stay well in work. Early engagement with specialists can help employees supplement advice and treatment from their healthcare practitioner with guidance specifically related to their work. 

Our research in the UK found that only a third (35%) of organisations provide financial education and support to employees.

While many employees are able to continue working with little impact on their ability to do their job, some find their working life will be greatly changed by their condition. People with long-term conditions could have reduced income or additional expenses, which can affect their wellbeing. They may need to change roles, reduce working hours or even leave the labour market. Many employees with long-term health conditions would benefit from provision equipping them with the knowledge and skills to better understand the financial implications of their condition on their work

Some people with long-term conditions benefit from seeking support from condition-specific organisations, local groups or peer support. It could help for the employer to signpost to or be aware of available support. 

Receiving a terminal diagnosis can obviously be a devastating experiencing for someone and extremely difficult to come to terms with. Many of us find it very uncomfortable to talk about end-of-life illness and death, and there can be considerable stigma and silence around these issues in society and at work. While respecting confidentiality and people’s individual wishes, it’s vital that organisations are ready to provide compassionate, flexible and practical support for an employee who is facing a terminal diagnosis. Some key points include the need to:

• Recognise the differences in experiences – some people will want, or need, to carry on working, while others may not want to. 
• Recognise the unpredictability of a terminal illness – it’s likely that the individual won’t know how long they might live for and therefore might not know what they want to do about work. 
• Appreciate that employees may not know their rights in terms of protection from discrimination – they might be worried that they will be made redundant or forced to retire if they disclose that their illness is terminal. 
• Provide information about the organisation’s ill-health retirement policy and accessing their occupational pension. Where possible, provide employees access to advice about drawing their pension early as it could affect any life cover through work (which could be more valuable than their pension) and personal affairs such as writing a will and making a lasting power of attorney. 
• Signpost people to external sources of advice as they could need a range of different sources of help and information. For example, Marie Curie is a leading end-of-life charity. They provide front-line nursing and hospice care, a free support line and a wealth of information and support on all aspects of dying, death and bereavement. 
• Agree with the employee what information they would like to be shared with colleagues and clients, and when. Remember, it is their decision whether to tell others or not, but many people find that because of the effects of treatment, or being absent from work, telling colleagues can help them understand the reasons behind any changes to the employee’s role or working pattern.

If an employee sadly dies during employment, there could be a significant impact on their close colleagues, and the organisation should be prepared to provide compassionate bereavement support for those affected and grieving. See the CIPD’s guidance for compassionate bereavement support.

Consider the following about your policies and practices 

• Are they written in a way that can be understood by everyone, using plain language and a tone that’s compassionate and demonstrates care? All too often policies use formal, legalistic language that employees don’t understand or makes them feel like a number in a system. The organisation also needs to proactively communicate the range of policies and support available for employees who experience health issues, as well as how to access them.  
• Do they need to be adjusted to provide appropriate and flexible support? For example, the use of trigger systems and disciplinary processes can place additional pressures on employees with fluctuating health conditions. Removing or adapting absence triggers for employees with known long-term or chronic conditions can help them to better self-manage their condition and their work with their manager’s support. 
• Are they consistent across the organisation? Recruitment, inclusion and leadership practices increasingly reflect the benefits of flexible, individualised approaches and compassion. It’s important that these practices are reflected in everyday management practices. 
• Do they allow for an individualised approach to be effectively implemented? For example, are managers empowered to make decisions and take action where it is in the best interests of the employee, the team and the organisation, without seeking additional sign-off from senior management or HR? Are employees encouraged to be involved in designing their jobs so that they can work to their strengths? 
• Do they make clear that work adjustments are available and how they can be accessed? Organisations are legally required to make reasonable adjustments, and many employees will benefit from early and supportive work adjustments. However, many employees don’t know how to access work adjustments and many managers are unsure how to implement them. It’s in both the individual’s and organisation’s interest to help an employee manage the impact of their symptoms at work so they can thrive at work. 
• Do they put flexibility front and centre? Allowing a flexible process that supports the manager and employee in monitoring, reviewing and adapting work patterns as needed can be particularly beneficial to employees with long-term health conditions. 
• Do they tell people what needs to be done and how to do it? Many policies will outline what needs to be done in practice, but few provide information about how this can be done to achieve the best outcome. Guidance on when, where, how to prepare and what to ask would help managers and employees hold better return-to-work conversations. 
• Do they equip managers with the knowledge, skills, abilities and confidence to manage employees with long-term health conditions?  

Updating your organisations’ policies and practices to incorporate these considerations will give employees with long-term health conditions the best possible chance of staying in and thriving at work. 

The CIPD is grateful to the organisations and experts who gave their time and expertise to provide feedback to help inform this guide. These include:

• Andrew Berrie, Mental Health at Work – national lead, and Jessica D’Cruz, senior information officer, Mind 
• Georgina Carr, chief executive, Neurological Alliance 
• Macmillan Cancer Support 
• Amy Matthews, information and support content manager, and Caroline Beard, strategic project lead, Marie Curie 
• David Yeandle OBE, MS ambassador and patient advocate, Merck Group, and director and trustee of Eastleigh Citizens Advice Bureau

It also draws on research and perspectives of workers with long-term health conditions, colleagues, line managers, occupational health and rehabilitation professionals as well as people professionals.