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Stroke and

employment

Building disability-smart organisations

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STROKE AND EMPLOYMENT

Table of Contents

The purpose of this guide ..................................................................................................3

What is a stroke? ................................................................................................................4

Types of stroke ...................................................................................................................4

The effects of stroke ...........................................................................................................4

Considering the impact on home and personal life ............................................................5

Treatment and rehabilitation ..............................................................................................5

Stroke and employment .....................................................................................................6

When you find out an employee has had a stroke .............................................................6

When an employee tells you they have had a stroke ........................................................7

Adjustments and working arrangements to retain employees who have had a stroke .8

Physical adjustments ........................................................................................................8

‘Soft’ adjustments..............................................................................................................8

Driving ..............................................................................................................................9

Access to Work programme ..............................................................................................9

Emotional support and well-being .....................................................................................9

Redeployment as a reasonable adjustment .................................................................... 10

Appropriate training and awareness-building for staff ...................................................... 10

Disability leave and managing absences ........................................................................ 10

If someone has a stroke in the workplace ...................................................................... 11

Recruitment and selection ............................................................................................... 11

Pre-employment ............................................................................................................. 12

Adjustments at the interview ........................................................................................... 12

If a candidate tells you they have had a stroke ................................................................ 12

Further information........................................................................................................... 13


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The purpose of this guide

This is a guide for line managers and Human Resources (HR) professionals who may be managing employees who have had a stroke. Many myths around who can have a stroke and what someone can and cannot do after a stroke still prevail within our society. This guide is an introduction to stroke and employment and will help you to understand the following:

What a stroke is and how someone may be affected by a stroke;

Some of the language and its meaning that you may hear from an employee who has had a stroke or in medical or occupational health contexts about stroke – including types of stroke and the structure of rehabilitation;

How to manage an employee who has had a stroke – including from when they first tell you they have had a stroke to managing their return to work;

Common adjustments for people who have had a stroke – both during recruitment and employment;

What to do if someone has a stroke at work;

Sources of further information and support.

This guide is intended to be an introduction to managing stroke in the workplace. It must, however, be remembered that each person is different. This means that each individual’s stroke and their experience of stroke is different and people will be affected and cope in very different ways to one another. It is therefore important to establish and maintain good, personalised communication between line managers (or HR) and the employee so that the needs and adjustments of each person are listened to and support is provided according to individual needs and experience.


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What is a stroke?

A stroke occurs when the blood supply to the brain is blocked or interrupted. This prevents essentials such as oxygen getting through to the brain. This blockage can injure the brain, having immediate neurological implications such as slurred speech, facial weakness, or paralysis in the arms – all of which can be short-term symptoms or may lead to a long-term impairment. Most these symptoms may be alleviated or managed through rehabilitation therapies and on-going self-management. A stroke can be life-threatening but, for some 75 per cent of people who have a stroke, this is not the case.

The quality of stroke rehabilitation in the UK is currently very good and is continuing to improve rapidly. The importance of early intervention after a stroke cannot be emphasised enough; the earlier a stroke is caught, the fuller the ‘recovery’ and the more effective rehabilitation can be. However, someone who has had a stroke may still experience symptoms or acquire a ‘secondary’ condition (epilepsy, for example, is common after a stroke) even post-rehabilitation, which can be managed in a variety of ways.

Stroke can happen to anyone and at any time. Depictions of stroke in the media may often lead us to believe that a stroke is something that happens exclusively to older people. In reality, over 25 per cent of people who have a stroke are under the age of 65 – meaning that they are of working age and can therefore just as easily be employees in your organisation.

Around 152,000 strokes happen in the UK each year. Although a stroke is a serious medical emergency, many people are able to return to full and independent lives post-rehabilitation.

Types of stroke

There are two main types of stroke. An ischemic stroke is where an artery which carries blood to the brain becomes blocked, and a haemorrhagic stroke occurs when blood leaks into the brain.

A Transient Ischemic Attack (or TIA) is where the symptoms are similar to that of a stroke, but they last temporarily (commonly up to 24 hours). A TIA is sometimes referred to as a ‘mini stroke’.

The effects of stroke

Each stroke is different and it is important to consider how someone is individually affected. The following are potential symptoms of a stroke and some people may experience all or some of the following, depending on the type of stroke they have had and how long ago it happened:

Dexterity – there may be changes or enhanced difficult with carrying out tasks which involve gripping or picking up items, and the speed in which such tasks are done can often be slower;


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Vision – restricted field range, blurred, or double vision;

Communication – speech can be slower and more slurred than before. Some words may become harder for some people to say and become more unclear for the listener to immediately understand;

Mood – depression or low mood, anxiety, increased frustration, and irritability are common after a stroke;

Muscular or central nervous system – muscle spasms, tremor, and difficulty with balance are common after a stroke. Pain, discomfort or stiffness can also be experienced in affected limbs, particularly if a stroke has caused some paralysis.

Considering the impact on home and personal life

A stroke can be a huge life-changing event, impacting on a person’s identity as an individual. Those around them (such as friends and relatives) can also be impacted by someone having a stroke. Additional care, activities or tasks (for example) which need to be done differently can impact people around the person who has had a stroke as everyone gets used to new routines, different ways of communicating with one another, or different ways of doing things together. It may therefore be helpful for managers to be mindful (whilst not making assumptions) that, following a stroke, the employee may be working through changes to how they work whilst navigating big changes – and challenges – in their personal lives as well.

Treatment and rehabilitation

The treatment and rehabilitation of people who have had a stroke varies greatly depending on the type of stroke and its severity. Rehabilitation is often intense soon after as stroke, as early intervention is crucial to someone regaining as many skills as possible. The amount of rehabilitation someone receives is very much dependent on the type and severity of the stroke and how much someone can manage. When someone has had a stroke, they will often be treated at hospital in a specialist stroke unit. It is common for rehabilitation therapies to take place between three and five days per week during this time.

Much stroke rehabilitation is through a multidisciplinary team which can include the following:

Speech and language therapy. After stroke, speech can become slurred and swallowing can be difficult. A speech and language therapist helps an individual to restore these skills as much as possible.

Physiotherapy. Decreased movement or paralysis – often in the upper limbs on one side – can occur. Through individually tailored exercises, a physiotherapist works with someone to help regain movement and strength.

Dietitian. Since swallowing can be affected, the consistency of food may need to be altered for someone after a stroke. The role of the appropriate foods at key stages of rehabilitation is therefore important. A dietitian also helps to ensure that someone is getting the correct nutrients as well as ensuring healthy


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weight management after what may have been a significant period of time of being in hospital or decreased activity.

Occupational therapy. This is key to enabling someone to regain the confidence to return to as much independence as they had pre-stroke as possible. An occupational therapist may assist with equipping the individual to regain skills that allow them to independently carry out daily activities such as washing, dressing, making a meal – all of which can be affected by altered vision, dexterity, and movement. The occupational therapist may also suggest additional daily living aids to make daily tasks easier and more comfortable (such as perching stalls, walking sticks, or gripping aids) – some of which may need to be transferred in the workplace.

Psychologist or counsellor. A stroke can be life-changing for an individual and also for those around them. Feelings of stress, anxiety, low mood, depression, frustration and anger are commonly reported by those who have had a stroke. This team looks after the emotional resilience and well-being of the individual after a stroke.

Social worker. A social worker is not always involved. Again, this depends on the severity of the stroke and the social and personal circumstances of the person. A social worker may be involved if home care is needed following a person’s discharge from hospital. This type of care may be long-term, short- term, or not needed at all.

Appointments with any of the above health and care professionals can fluctuate depending on a person’s recovery or rehabilitation. It can be the case that someone is ready to return to work but they may still need a morning (for example) a week to see a therapist for a period of time after returning to work. These appointments will usually be known about in advance, allowing managers to be able to plan ahead for them. Best practice – and where reasonable – would allow for employees to attend these appointments as disability leave or special leave. For different types of disability-related absence, contact Business Disability Forum’s Advice Service (contact details below on page 15).

In addition to the above types of therapies, people who have had a stroke may have started to take different or new medications, which can bring side-effects of their own. These can take time to get used to. Medication reviews and general GP appointments may therefore be needed.

Stroke and employment

Someone who has had a stroke might be protected within the definition of ‘disability’ in Equality Act 2010. This means that you, as employers, play a critical role in helping someone who has had a stroke work through or return to work after having had a stroke.

When you find out an employee has had a stroke

For people who are already employees in your organisation at the time of their stroke, the information that they have had a stroke may not come directly from them. A stroke


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can happen at any time and it is a medical emergency. It may therefore be the case that someone such as a next of kin notifies the organisation what has happened. At this stage, the employee may be in hospital and not currently able to communicate with your directly.

In this case, establish with the following with the person who has notified you that the employee has had a stroke:

If they are the person that you should keep in touch with – and how they would like you to do this;

Explain why it is important for you as the employer to keep the line of communication open between you;

Show that you are supportive – both in terms of retaining the employee and showing your understanding of how difficult a time is potentially is for the person you are speaking to. Some organisations also have employee assistance or health benefits that relatives can use as well;

Where possible, give them a named person – whether that is the line manager, someone in HR, or a case manager – and direct contact details so that they can contact you with any new information or progress. Establishing two-way communication will help build up trust with someone you potentially haven’t spoken to before.

When the employee is well enough to be in touch with you themselves, contact should then be with them wherever possible. You can then follow the advice below on ‘When an employee tells you they have had a stroke’. Note that the employee may still not be ready to return to work at this stage, but it is still important to open up this communication with them.

When an employee tells you they have had a stroke

If an employee tells you that they have had a stroke, encourage them to have a confidential and supportive discussion with their line manager (if that isn’t you) or HR (whoever is appropriate for your organisation). Although this discussion should be documented, communication and note-taking should be handled sensitively.

Try not to make assumptions about their experience of the effect that their stroke has had on them. Remember that, as above, stroke rehabilitation can be very effective and having a stroke does not automatically mean that someone has to stop working. Let them take the lead by telling you what has happened.

During this discussion, ask the employee:

How they are feeling, emotionally and physically;

Whether they wish colleagues to be informed and what information they would like you to share;

What sort of time off they might need for medical appointments and during treatment. It may be case that the employee does not know these details at this stage – this is common;

You could also offer any services your organisation to help them – for example, details of your Employee Assistance Programme or any counselling services,


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relevant employee networks or forums, or any return to work or long-term condition management programmes that you offer;

Close the meeting by assuring the employee that they and their work are valued and that you are committed to providing support at if they need any support. Agree how you will keep the lines of communication open, and set a date for the next meeting;

You can also record any adjustments that are agreed using Business Disability Forum’s Tailored Adjustment Agreement form which is available by contacting the Advice Service.

Adjustments and working arrangements to retain

employees who have had a stroke

Some people will be able to manage their own condition and may require few (if any) adjustments. If someone had a stroke some time ago, they may have developed useful techniques and ‘coping’ mechanisms for managing any remaining symptoms.

However, others may need adjustments in order to support their return to work. The adjustments listed below are examples of the type of adjustments a person with who has had a stroke might need.

This list is not exhaustive. In order to identify the most appropriate and effective adjustments, it is important to speak to an employee about their own individual challenges, as every person will have a different experience of having had a stroke.

Physical adjustments

These can include:

Ergonomic equipment such as a different computer mouse and/or keyboard. A different chair may also be helpful to some;

Bigger screens or screen magnifiers;

Assistive software. This can help if speech has become impaired or if the use of upper limbs has become restricted by converting speech to text or text to speech, (for example);

Grab or reaching aids to help pick up items;

Moving a workstation – for example, if ease of access to facilities such as toilets or the kitchen area now more difficult;

Providing somewhere private for rests or taking medication.

‘Soft’ adjustments

Employees who have had a stroke may also require changes to their working pattern or job role. The adjustments that might be needed include:


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Adjusting performance targets to take into account the effect of – for example – sickness absence or disability leave;

Assistance with a phased return to work, whereby hours are gradually increased over a period of time;

Modifying a job description to take away minor parts of the job that cause particular difficulty;

Allowing extra breaks to aid concentration, move around, or take medication;

Allowing an employee to work from home.

Driving

Driving may be part of someone’s job. A stroke can impair someone’s ability to drive. This can be short-term or long-term and can be due to changes in strength, vision, concentration, tiredness or decreased speed when decision-making. People are usually not allowed to drive for one month after having had a stroke. After this time, a doctor will decide whether or not someone can start driving again.

If, after a month, someone is still having difficulties related to their stroke, they should notify the Driver and Vehicle Licensing Agency (DVLA). Further details about driving and stroke can be found on the Government’s website at https://www.gov.uk/stroke-and-driving

When someone becomes able to drive safely, they may need to do this in a different way. Adaptations to cars – such as steering balls or adjusted seating – can enable people who have had a stroke to drive again, where appropriate and safe to do so.

If the main purpose of someone’s job is to drive, you may need to take medical and/or occupational advice on the prospect of the employee returning to driving, and within what potential timeframe. It could – for example – be that they be ready to drive within a timeframe which means they could be able to do different duties at work before they are allowed to drive again. If the timeframe is unreasonable length for you to wait in order for you to meet the needs of your business, or if the employee’s medical team advises that they should not drive again, you may need to consider redeployment opportunities. If redeployment is not an option, you may be looking at dismissal on the grounds of ill-health. You should always get advice before you do this, from your internal legal team. You can also discuss your situation with the Advice Service (contact details on page 15).

Access to Work programme

Access to Work is a Government run programme that offers employers financial support with providing adjustments for employees in the workplace, such as adaptations to premises or purchase of equipment.

For more information on Access to Work, contact Business Disability Forum’s Advice Service and ask for our Member Resource on this, or visit www.gov.uk/access-to-work

Emotional support and well-being

It is natural for someone to experience a change in mood after a stroke. This can include stress, anxiety, low mood or depression, irritability, anger, or increased

https://www.gov.uk/stroke-and-driving

https://www.gov.uk/stroke-and-driving

http://www.gov.uk/access-to-work


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frustration. These emotions may be new to them and you as a manager or employer may notice a difference as well. Sometimes these emotions subside through time and with the support of rehabilitation. You will need to support the employee as they are going through this, and you may also have to manage other employees’ responses to this as well.

This support might include ensuring the employee has access to your Employee Assistance Programme, counselling services, relevant employee networks or forums, or any return to work or long-term condition management programmes that you offer.

Redeployment as a reasonable adjustment

When all possible reasonable adjustments have been considered, if an employee is unable to perform the core duties of their existing role because of a disability, you have a duty to consider redeployment. ‘Transferring the disabled person to fill an existing vacancy’ should be the final reasonable adjustment you consider.

For further information, refer to our briefing on ‘Redeployment as a reasonable adjustment’. You can get a copy of this from the Advice Service (contact details on page 15).

Appropriate training and awareness-building for staff

Ultimately, employers should ensure that all staff receive disability-related training appropriate to their role. For managers, this will mean ensuring they have the necessary skills to have potentially sensitive conversations and handle difficult situations in the workplace. It is also key that managers know how to make adjustments for employees and know what the process is for doing this in your organisation.

Additionally, when an employee in a team has acquired an impairment or condition and it would help the team to have an increased awareness of what this means, how they should help and respond, and adjusting to the team perhaps needing to work in a different way, some organisations have found it helpful to ask a relevant impairment-specific organisation to come in and speak or do a workshop with the team. This can help the team adapt to changes in working and also help to break down any nervousness or awkwardness which colleagues may naturally feel by knowing that a colleague of theirs has gone through a life-changing experience.

Disability leave and managing absences

People who have had a stroke should not be unjustifiably discriminated against for a reason arising from their disability in the attendance management process.

Whilst some employees may need time off for appointments, you should not assume that every employee who has had a stroke will have a high level of sickness absence. They may need some clinic appointments, but these will mostly be planned in advance. This type of absence might be categorised as ‘disability leave’ and could be considered as a reasonable adjustment. If reasonable, disability leave should be paid. Although ‘disability leave’ is not a legal term, it can be a useful way of helping to categorising absence.

You may need to:

Allow time off to attend appointments for assessment, treatment or rehabilitation;


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Ensure that you have a scheme in place that distinguishes between sickness absence taken for a reason relating to a disability and general sickness absence;

Ensure that adjustments are made in processes to manage attendance and sickness absence so that disabled employees are not treated unfavourably for a reason arising out of their disability; It might be a reasonable adjustment in some cases to discount some or all disability-related sickness absence;

Allow the employee to work flexible hours to overcome fatigue from treatment;

Be understanding. The employee will be much more likely to try come into work if s/he knows that s/he can take a break or go home if necessary.

For further information on managing absence, refer to our briefings on absence management or contact the Advice Service (contact details below on page 15).

If someone has a stroke in the workplace

A stroke can happen to anyone at any time, and it is a potentially life-threatening situation. Ensure your first aiders know how to identify if someone is having a stroke and what to do if someone is displaying the symptoms of a stroke. There are signs to look for which can help to identify if someone is having a stroke. They may be experiencing facial weakness, they may not be able to move one of their arms, and their speech may be affected. Identifying these symptoms is called the FAST test:

FACIAL weakness: Can the person smile? Has their mouth or eye drooped?

ARM weakness: Can the person raise both arms?

SPEECH problems: Can the person speak clearly and understand what you say?

TIME to call 999.

The Stroke Association produces ‘at a glance’ posters and wallet-sized cards about the FAST test. (See contact details below on page 15).

Recruitment and selection

You need to make sure that you do not discriminate against an employee who has had a stroke. You also have to make reasonable adjustments during the recruitment process. However, some people who have had a stroke may not require any adjustments at all.

It is important not to make assumptions about what an applicant can or cannot do. Instead ask applicants if they need any adjustments as part of the recruitment process. If you use external recruitment agencies, ask for evidence they make reasonable adjustments for disabled applicants and work to the standards that underpin this guidance.


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It is important to be specific about what skills are needed and what the job involves when drawing up job descriptions and person specifications. This will give a person a clear understanding of what is required from them should they be successful in their application.

Pre-employment

The Equality Act makes it unlawful to ask applicants general questions about their health or a disability prior to making a job offer. This provision is designed to prevent employers making assumptions about an applicant's capability because of their medical history.

You can ask applicants if they need reasonable adjustments for the interview and you can also ask applicants questions about their ability to carry out intrinsic elements of the job. For example, a construction company who is recruiting scaffolders can ask about health or disability on the application form or at interview if the questions relate specifically to an applicant's ability to climb ladders and scaffolding to a significant height. The ability to climb ladders and scaffolding is intrinsic or fundamental to the job.

In practice, even if a function is intrinsic to the job, you should ask a question about a disabled person's ability to do the job with reasonable adjustments in place. There will therefore be very few situations where a question about a person's health or disability needs to be asked.

Adjustments at the interview

Before inviting a candidate to interview, make sure you ask about if they need any adjustments. The key to ensuring candidates tell you about the appropriate adjustments that will be effective for them during their interview is to give us much detailed information about the interview process – i.e. the format of the interview and what they will be asked to do – beforehand as possible. For example, tell candidates how long the interview will be and the format of the interview (for example, a face-to-face discussion with a panel, a timed computerised assessment, or group work). If you do this, candidates are more likely to understand the type of adjustments that they should ask you for. If, for example, they know they will need to do a 45 minute exercise on the computer, they will know if they need to ask you about using different ergonomic equipment, assistive technology, or if they need to discuss any concerns about the timed nature of the assessment with you.

For further information, refer to our briefing on ‘Managing Recruitment’ or contact the Advice Service (contact details below on page 15).

If a candidate tells you they have had a stroke

Candidates who have had a stroke may have a gap in the employment history due to being unwell or going through a period of rehabilitation. It is sometimes the case that a candidate tells you that they have had a stroke. Except in very limited circumstances or for very restricted purposes, you are not allowed to ask any job applicant about their health or any disability until the person has been:

Offered a job either outright or with conditions, or


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Included in a pool of successful candidates to be offered a job when a position becomes available (for example, if an employer is opening a new workplace or expects to have multiple vacancies for the same role but doesn't want to recruit separately for each one).

This includes asking such a question as part of the application process or during an interview. Questions relating to previous sickness absence count as questions that relate to health or disability. No-one else can ask these questions on your behalf either. This means that you cannot refer an applicant to an occupational health practitioner or ask an applicant to fill in a questionnaire provided by an occupational health practitioner before the offer of a job is made (or before inclusion in a pool of successful applicants) except in very limited circumstances.

The point of preventing employers asking questions about health or disability is to make sure that all job applicants are considered on the basis of whether they can do the job in question, and not ruled out just because of past issues related to or arising from their health or disability which is not necessarily likely to tell you much about whether or not they can do the job now.

You can ask questions about health and disability once you have made a job offer or included someone in a group of successful candidates. At that stage, you can make sure that someone’s health or disability will not prevent them from doing the job. You must, however, consider if there are any reasonable adjustments that would enable them to do the job.

Further information

Advice Service (Business Disability Forum)

Telephone: 020-7403-3020

Textphone: 020-7403-0040

Email: [email protected]

Website: www.businessdisabilityforum.org.uk

Stroke Association

Helpline: 0303-3033-100

Textphone: 18001-0303-3033-100


Website: www.stroke.org.uk

Access to Work

Telephone: 0345 268 8489

Textphone: 0345 608 8753


mailto:[email protected]

http://www.businessdisabilityforum.org.uk/


http://www.stroke.org.uk/



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Website: www.gov.uk/access-to-work

NHS FAST campaign for organisations

Website: www.nhs.uk/actfast/Pages/stroke.aspx

Campaign resource material site: http://campaigns.dh.gov.uk/category/act-fast/

This publication and the information contained therein are subject to copyright and

remain the property of Business Disability Forum. They are for reference only and

must not be reproduced, copied or distributed as a whole or in part without prior

permission, apart from internal distribution within the original recipient’s organisation.

The information provided in this publication is for guidance only and Business

Disability Forum accepts no liability for any actions, or consequences of actions,

arising from this information.

Business Disability Forum is committed to ensuring that all its products and services

are as accessible as possible to everyone, including disabled people. If you wish to

discuss anything with regard to accessibility, please contact us on the details above.

http://www.gov.uk/access-to-work

http://www.nhs.uk/actfast/Pages/stroke.aspx

http://campaigns.dh.gov.uk/category/act-fast/


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