Serious Illness, Work and Income Support in the UK

Questions about work and money arrive fast after a diagnosis — what leave you're entitled to, what your employer can ask, and what support is available if you can't work. This guide covers your rights and options in plain terms. If you'd rather have a plan built around your situation, answer a few questions and we'll build one around you →

What you have to tell your employer — and what you don't

There is no legal obligation to name your diagnosis to your employer. You are only required to tell them that a health condition is affecting your ability to work, to the extent necessary for them to understand your situation. In most cases, "a medical condition" or "a health issue" is sufficient — you do not have to share the name of your illness, your prognosis, or your treatment details.

If your condition means you need time off or changes to how you work, your employer may ask for more information so they can make appropriate arrangements. It's reasonable to describe your functional limitations — what you can and can't do — without specifying the underlying diagnosis. If you do choose to share more, put any agreements about leave, hours, or adjusted duties in writing so both sides have a clear record.

One exception: if your role involves a statutory licence or professional registration — such as a large goods vehicle (LGV) licence, a commercial pilot's certificate, an SIA door supervisor licence, or registration with a healthcare professional body such as the NMC, GMC, or GPhC — that body may have its own reporting requirements separate from your employment relationship. Check your registration conditions if this applies to you.

Under the Equality Act 2010, cancer, HIV infection, and multiple sclerosis are automatically classified as disabilities from the point of diagnosis, regardless of the effect on daily activities at that time. This means the legal protections below apply immediately — you don't need to demonstrate impact to be protected.

Statutory Sick Pay

Statutory Sick Pay (SSP) is the minimum sick pay your employer must pay you by law. To qualify, you must be an employee (not self-employed), you must earn at least the lower earnings limit (check gov.uk/statutory-sick-pay for the current weekly threshold), and you must have been off sick for at least four consecutive days, including weekends and bank holidays.

The first three days of any sick absence are waiting days — SSP does not cover them. SSP kicks in from the fourth qualifying day. If you've had a period of sickness within the last eight weeks, a linked period of sickness may apply, meaning the waiting days don't reset — check with your employer's HR or payroll team if this is relevant to you.

SSP is paid at a flat weekly rate set by the government — check gov.uk/statutory-sick-pay for the current amount, as it increases each April. Your employer pays it through payroll in the same way as wages; you do not claim it separately. SSP continues for up to 28 weeks. Some employers pay occupational (contractual) sick pay above the SSP minimum — check your employment contract or staff handbook for your specific entitlement.

When SSP ends, your employer must give you an SSP1 form explaining why SSP has stopped. Hold on to this form — you'll need it when claiming Universal Credit or Employment and Support Allowance. You should start looking at those claims before SSP ends, as neither is backdated.

Fit notes — how they work

The document previously called a "sick note" is now formally called a Statement of Fitness for Work, or fit note. For the first seven days of any sick absence, you can self-certify — you don't need a fit note, and your employer cannot require one. After seven days, your employer can request a fit note to support your continued absence.

Fit notes can be issued by a GP, hospital doctor, nurse, pharmacist, or physiotherapist — the rules were broadened in 2022 to include more healthcare professionals. If you're under a consultant or specialist, they can provide a fit note at an inpatient or outpatient appointment.

A fit note uses one of two options:

• "Not fit for work" — straightforward: you are not well enough to work in any capacity during the period specified.
• "May be fit for work" — the clinician believes you might be able to work if certain conditions are met. This is not a statement that you are ready to return; it's an opening for a discussion with your employer. Your clinician can suggest specific options: a phased return to work, altered hours, amended duties, or workplace adaptations.

If your employer cannot accommodate the conditions stated on a "may be fit for work" fit note, you should be treated as not fit for work for SSP purposes — SSP continues if you're still within the 28-week limit. You don't have to accept a return to work that your employer says is "may be fit" if the conditions aren't actually in place.

Reasonable adjustments under the Equality Act 2010

A health condition qualifies as a disability under the Equality Act 2010 if it is a physical or mental impairment that has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities. "Long-term" means it has lasted, or is expected to last, at least 12 months — or for the rest of your life. "Substantial" means more than minor or trivial. As noted above, cancer, HIV, and MS are automatically classified as disabilities from diagnosis.

Once an employer knows (or reasonably should know) that you have a disability, they are under a legal duty to make reasonable adjustments to remove or reduce disadvantages caused by that disability. Failing to do so is a form of disability discrimination.

Reasonable adjustments can include:

• A phased return to work after sick leave — starting on reduced hours and building back up over an agreed period
• Amended or modified duties — removing tasks that your condition makes difficult or impossible
• Adjusted start and finish times, or a compressed working week
• Increased flexibility about working from home
• Additional rest breaks during the working day
• Provision of specialist equipment, software, or physical adaptations to your workspace
• Moving your workstation or office location to reduce travel within a building

Whether an adjustment is "reasonable" depends on the employer's size and resources, the nature and cost of the change, and any disruption it would cause. A large employer is expected to do more than a small one. You can request adjustments in writing and describe the difficulty you're experiencing — you don't need to use the word "disability" or provide a specific diagnosis if you'd rather not.

For guidance on discrimination or if you feel your employer is not meeting their obligations, the Equality and Human Rights Commission (EHRC) provides advice at equalityhumanrights.com or on 0808 800 0082. Acas can also advise on next steps before formal legal action is considered.

Unfair dismissal — your protections

Employees with at least two years' continuous service have the statutory right not to be unfairly dismissed. Dismissing someone because of illness — or principally because of absences caused by illness — may be an unfair dismissal, depending on the process the employer followed.

For a dismissal on capability grounds (which is how long-term illness dismissals are framed) to be fair, an employer must at minimum: obtain up-to-date medical evidence about your prognosis and likely return date; consult with you properly and give you an opportunity to respond; genuinely consider whether reasonable adjustments or alternative roles are possible; and follow a fair and reasonable process throughout. An employer who jumps straight to dismissal without going through these steps faces a real risk of an Employment Tribunal ruling.

Separately, if your illness qualifies as a disability, any dismissal related to your disability — including dismissal for sickness absence caused by the disability — may also amount to disability discrimination under the Equality Act 2010. Disability discrimination claims carry no qualifying period: they apply from day one of employment. This means even employees with less than two years' service may have a claim.

If you are dismissed and believe it was unfair or discriminatory:

• You must contact Acas for Early Conciliation before lodging an Employment Tribunal claim — this is a mandatory step. Acas will attempt to resolve the dispute; if that fails, they issue a certificate allowing you to proceed to the Tribunal.
• The time limit to bring an Employment Tribunal claim is three months minus one day from the effective date of your dismissal. Don't delay.
• There are no fees for bringing an Employment Tribunal claim.

Citizens Advice and Acas can both provide guidance on the process. If your case is complex, consider seeking legal advice from a solicitor specialising in employment law — many offer a free initial consultation.

Long-term absence and redundancy

Extended sick leave does not automatically end your employment, but if it is prolonged, an employer may eventually go through a process to dismiss you on capability grounds — see above. What an employer cannot do is use long-term sickness absence as a cover for redundancy. A genuine redundancy situation is one where the job itself ceases to exist, is reduced in scope, or where the business closes or relocates — not simply where a person has been absent.

If your role genuinely becomes redundant while you are on sick leave, you are entitled to the same redundancy process and pay as any other employee. Employees with at least two years' continuous service are entitled to statutory redundancy pay, calculated using your age, length of service, and weekly pay (subject to a statutory cap — check gov.uk/redundancy-payments-service for the current weekly pay cap and multipliers). Your employer must follow a proper consultation process.

Being selected for redundancy because of your disability, or because of sickness absence related to your disability, is unlawful discrimination — the selection criteria must be genuinely objective and applied consistently. If you have concerns about the fairness of the selection process, raise them in writing with your employer and seek advice from Citizens Advice or a solicitor.

If you're self-employed

Self-employed people have no entitlement to Statutory Sick Pay and no statutory sick leave. There is no employer to pay you during illness, and the protections under the Equality Act apply to employment relationships — not to self-employment contracts in the same way.

The main private protection for self-employed people is income protection insurance, if you hold it. Check your policy for the waiting period (how long before payments start), the benefit period (how long payments continue), and how the policy defines "unable to work" — some policies require total inability to work in any occupation; others cover inability to work in your own occupation.

On the state side, self-employed people may be able to claim:

• New Style ESA — if you have made sufficient National Insurance contributions in recent tax years, you may qualify regardless of your level of self-employment income, as this is a contribution-based benefit.
• Universal Credit — available to self-employed people, but the DWP applies a Minimum Income Floor (MIF): for UC purposes, you are assumed to be earning at least the National Living Wage for your expected hours, even if your actual earnings are lower. If you are too ill to work, report your health condition to DWP — the MIF can be suspended during periods of sickness when you are not gainfully self-employed. The rules are detailed; seek advice from Citizens Advice before applying.

If your business has to pause or wind down, keep records of your income drop — self-assessment tax returns, bank statements, and client correspondence — as these may be relevant to any benefit claim or insurance application.

Universal Credit and New Style ESA

Claim as soon as you need to — neither Universal Credit nor New Style ESA is backdated to before your claim date.

New Style Employment and Support Allowance

New Style ESA is a contribution-based benefit for people whose ability to work is limited by a health condition or disability, and who have paid sufficient National Insurance (NI) contributions — generally in the last two to three full tax years. It is not means-tested: your partner's income, savings, or other household income do not affect it. It can be claimed alongside Universal Credit.

When you claim, there is an assessment phase (usually the first 13 weeks) during which you receive a lower assessment rate. During this time you'll be asked to complete a capability for work questionnaire and may be invited to a Work Capability Assessment (WCA) with a healthcare professional. The WCA determines whether you are placed in the Work-Related Activity Group (WRAG) — where you're expected to take steps towards future employment — or the Support Group, for people with the most significant health limitations, where no work-related activity is required. After the assessment phase, your payment rate increases according to which group you're placed in. Apply online at gov.uk/employment-support-allowance or call the DWP on 0800 055 6688.

Universal Credit

Universal Credit is the main means-tested benefit for people of working age who are out of work or on a low income. It takes into account your household income and savings — there is a savings threshold above which it reduces. Apply online at gov.uk/universal-credit. If you can't apply online, call the Universal Credit helpline on 0800 328 5644.

When you apply, tell the DWP about your health condition. You'll be referred for a Work Capability Assessment (the same process as for ESA). If the WCA finds you have Limited Capability for Work-Related Activity (LCWRA) — the more significant finding — a monthly addition is made to your Universal Credit award and no work-related requirements apply. If the finding is Limited Capability for Work (LCW), a smaller addition may apply. Check gov.uk/universal-credit/what-youll-get for current rates, as these change each April.

If you're already receiving another benefit such as Employment and Support Allowance and your circumstances change, report that change to DWP — do not simply stop claiming one benefit and start another without checking the implications first.

Carer's Allowance — for those providing care

If someone close to you — a partner, family member, or friend — has had to reduce or stop paid work to care for you, they may be entitled to Carer's Allowance. This is a payment for the carer, not for the person with the diagnosis, and is worth noting so that the person caring for you is aware of it.

To qualify, the carer must provide at least 35 hours of care per week and must not be earning more than a weekly net earnings threshold (check gov.uk/carers-allowance for the current threshold, as it changes each April). The person they care for must be receiving a qualifying disability benefit — such as the Personal Independence Payment (PIP) daily living component at either rate, Disability Living Allowance at the middle or highest care rate, or Attendance Allowance.

Receiving Carer's Allowance can affect entitlement to other benefits the carer may hold. Your carer should check with Citizens Advice before applying to understand the full picture.

Keep a simple record

As you navigate sick leave, benefit claims, and employer requests, maintain a basic written record. You don't need a formal system — a notebook, a folder of emails, or a notes app is enough — but having a record matters if anything is disputed later.

• Keep copies of all fit notes before handing them to your employer — once submitted, you may not get them back easily.
• Save payslips showing SSP payments and any changes to your pay.
• Keep copies of all written requests for reasonable adjustments, and your employer's responses.
• Note dates and a brief summary of important verbal conversations — with your manager, HR, or DWP — and email yourself immediately afterwards so the timestamp is clear.
• Hold on to any reference numbers, correspondence, and decision letters from DWP and keep them in one place.