Getting what you deserve : navigating work and welfare after a cancer diagnosis

Abstract

Across Europe there are increasing numbers of older working age people experiencing long term health conditions, including cancer. Symptomatic of an ageing population and consequent ageing workforces, it represents a significant and ongoing challenge to labour markets at both a local and national level. Older workers with long term health conditions such as cancer often recourse to state welfare during their illness, with many navigating a return to their specific workplace, or the labour market more widely. It is this navigation, between work and welfare in the context of long term ill health, that is the focus of this paper. It draws on qualitative interview data from multiple perspectives; older workers (aged 50 years and over), employers (including line managers, occupational health staff and human resources staff), healthcare professionals and staff from a cancer support charity. Participants were sampled via their connection to a cancer-specific employment support service in the UK. Analysis was informed by constructivist grounded theory. A key finding from this study was the observation of how both the UK state welfare apparatus, and workplace policies and procedures functioned to compel employees back into the workforce. It was apparent in participant narratives that both institutions employed an acute and short-term model of illness, that did not accommodate the material circumstances of older workers with cancer. Judicious use of ‘deservingness’ as a decision-making tool with regard to the support (financial or otherwise) offered to older workers with cancer featured in the data of both work and welfare post diagnosis. It was used in an administrative sense in terms of individuals’ entitlement to out of work sickness benefits. When acutely ill, older workers with cancer were able to access state welfare with (relative) ease. However, as their cancer transitioned into a collection of longer term and fluctuating symptoms they found the conditions attached to entitlement increasingly challenging, and were forced back into the labour force, ready or not. Employers utilised deservingness with more nuance, but with similarly material implications. Effectively, they categorised their employees with cancer as deserving or underserving over time. This categorisation related to the delivery of sick pay, redundancy pay, and in particular, reasonable adjustments in the workplace – a legal entitlement for UK workers with cancer, as it is defined as a disability under the Equalities Act (2010). These adjustments were framed explicitly by employers as a reward for employees who they perceived to have met subjective and individually held expectations of how they should behave. Specifically, they rewarded older workers who evidenced a desire to return to work as soon as possible. This paper highlights the arbitrary and subjective decision making in relation to the support offered to older workers diagnosed with cancer. It argues that policy makers and employing organisations should forgo the rhetoric of deservingness, and instead respond to the material realities of older workers experiencing long term ill health.