• Crohn’s Disease and Ulcerative Colitis – the two main forms of Inflammatory Bowel Disease (IBD)– are lifelong diseases of the gut. Crohn’s and Colitis can be diagnosed at any age. Some people with Crohn’s or Colitis feel well most of the time, other people take longer to find a treatment that’s right for them.
• Providing a safe, inclusive and supportive environment can help employees feel that they can talk to you about their condition.
• Each person with Crohn’s or Colitis is unique and their needs are very different. The best way to find out what the employee needs to help them at work is by asking them. It is best to continue checking in and reviewing your employee’s needs regularly, as their needs may change over time.
• If an employee is considered disabled under the Equality Act, you have a duty to make reasonable adjustments. Where adjustments are more costly, such as installing separate toilet facilities, Access to Work may help with financial and practical support.
• It is best practice to have organisational policies on sickness absence, disability leave and medical appointments. This can help you and the employee clearly understand their rights and entitlements.

Crohn’s and Colitis don’t just affect the gut. They can affect almost every aspect of life: from digestion to energy levels and mental health.

Crohn’s and Colitis affect everyone differently. Some people with Crohn's or Colitis feel well most of the time. Other people take longer to find a treatment that's right for them.

Crohn's and Colitis can cause:

• Diarrhoea (sometimes with blood)
• Urgent or frequent need to go to the toilet
• Abdominal pain
• Extreme tiredness
• Nausea
• Lack of appetite and weight loss

Some people with Crohn’s or Colitis may also suffer from painful joints, eye problems, mouth ulcers, and skin rashes.

Some symptoms can be obvious to others, and other symptoms are invisible. Most people living with Crohn’s or Colitis will have times when symptoms are largely under control, known as remission, and flare-ups where symptoms are more active.

Crohn's and Colitis misconceptions

• Crohn's and Colitis are not the same as irritable bowel syndrome (IBS). IBS is a different condition that requires different treatment.
• Crohn's and Colitis are not infectious.

Crohn’s and Colitis happen when the body’s immune system doesn’t work properly. Usually, the immune system protects the body. In Crohn’s and Colitis, the immune system starts attacking the body.

We do not know why the immune system attacks the body. Most researchers believe Crohn’s and Colitis are caused by a mix of genes and the environment (like germs, diet, smoking and stress). Right now, there is no known cure for Crohn’s or Colitis.

Crohn's and Colitis generally require lifelong treatment. Many people with the conditions take medication that may have unpleasant side effects. Treatment is designed to control Crohn's or Colitis symptoms when they are active. Effective treatment can reduce the chance of relapses and maintain good health.

One type of medicine used to treat Crohn’s or Colitis is corticosteroids (steroids). Steroids reduce inflammation in the gut. Unwanted side effects of steroids can be:

• Significant weight gain
• Roundness of the face
• Acne
• Mood swings, from euphoria to depression.

Steroids can also have the effect of making someone taking them look healthy when they are actually having a flare-up of their illness.

Other medicines used to treat Crohn's and Colitis include immunosuppressant medicines, which affect how the body's immune system works. A person taking these medicines may be at higher risk of catching infections and risk of getting colds and flu. Some people get side effects from taking immunosuppressants. Side effects can include headaches and nausea.

Biologic medicines are used to treat Crohn's and Colitis and can also help people in remission keep their symptoms controlled. These medicines are given by a drip into the arm (infusion) in a hospital or given at home by injection.

Sometimes Crohn's flare-ups can be treated with a liquid diet called enteral or parenteral nutrition, where nothing other than the diet and water are allowed for weeks or months. The high concentration of nutrients in the feed sometimes causes nausea, headaches, and a feeling of light-headedness.

Sometimes surgery is needed to treat Crohn's and Colitis.

The first step is to provide a supportive environment where someone with Crohn’s or Colitis feels able to tell you about their condition.

Supportive and flexible management will enable most people with Crohn's or Colitis to continue working productively, and most are highly motivated to do so. However, employers should be aware that legal considerations may apply to people living with Crohn's or Colitis, as with any other long-term health condition.

Under the Equality Act, a person has a disability if they have a physical or mental impairment that has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.

Not everyone with Crohn's or Colitis may consider themselves to have a disability. But in practice, whether or not they perceive themselves to be 'disabled', people with Crohn’s or Colitis may still qualify for protection against discrimination.

The employee's rights will not be affected because their Crohn's or Colitis symptoms fluctuate (change over time). For example, they may have periods when they have few or no symptoms and times when their symptoms are active (such as during a flare-up). The Equality Act covers fluctuating conditions; the main point is that the overall effect is long-term.

In most cases, treatment for a health condition is not considered when deciding if someone is disabled under the law. This means that employees may still benefit from the protection of the Equality Act even if symptoms are controlled by medication.

With your employee's permission, you might find it helpful to obtain a report from their doctor, either their specialist or GP. The report will inform you about their condition and whether it is likely to affect them at work.

The Equality Act is in place to protect people against discrimination at work, even people who may consider themselves not covered by the Act, such as people who are:

• Working on a casual basis
• On zero-hours contracts
• Trainees
• In some situations, self-employed

Discrimination can occur in many aspects of work such as recruitment, pay, training, promotion, dismissal and redundancy.

Discrimination can happen in different forms. It is discrimination when:

• An employee is treated less favourably than a person who is not disabled for a reason related to their disability.
• Reasonable adjustments are not made.
• A person is subjected to harassment for a reason related to their disability.
• A person is treated unfairly because they’ve complained about discrimination or harassment.

If an employee is considered disabled under the Equality Act, you have a duty to make reasonable adjustments. Reasonable adjustments could involve making physical changes to the workplace, changing working arrangements, or providing equipment. Reasonable adjustments must be made to reduce a substantial disadvantage the disabled employee faces, compared to a non-disabled person, when doing their job. 

Even if you are unsure whether the employee's condition is considered a disability, it is still a good idea to make reasonable adjustments to support productivity.

Different employees will require different adjustments. Ask the employee about what adjustments might help them, as they will be best placed to make suggestions.

The sort of adjustments considered reasonable will depend on the individual situation. When deciding whether an adjustment is reasonable, an employer should consider:

• How effective the change will be in avoiding the disadvantage that the employee would otherwise experience
• Practicality
• Cost
• The organisation's resources and size
• The availability of financial support

More information on the duty to make reasonable adjustments can be found at Acas or the Equality and Human Rights Commission website.

Many adjustments needed by people with Crohn's or Colitis have little or no cost and cause minimal disruption.

They might include:

• Allowing time off for medical appointments or treatment.
• Offering shorter, different or flexible working hours.
• Unlimited toilet breaks.
• Moving the workstation close to a toilet.
• Providing a car parking space close to the entrance to work.
• Allocating some duties to another member of staff.
• Offering another place of work or the option of working from home.
• Adjusting performance targets to consider the effect of sick leave or fatigue.

Where adjustments are more costly, such as installing separate toilet facilities, Access to Work may help you with financial and practical support.

Access to Work is a publicly funded employment support programme. Disabled people can apply for help to overcome practical difficulties that may stop them from working. The amount of help that may be given will depend on the length of time the person has been employed by you and what support they need. For people who are unemployed and starting a job with you, the grant is up to 100% of the approved costs, subject to a cap.

An example of help that Access to Work may be able to provide is covering the costs of travelling to work in a taxi if the employee is unable to use public transport.

Access to Work is available for individuals on permanent or on temporary contracts. It is available for people who are working part or full time.

You can contact Access to Work to apply. There is the option to apply for an Access to Work grant online.

There may be times when the employee will have to take time off work. This absence could be unplanned due to a severe flare-up or fatigue. Or the absence could be planned, such as a hospital appointment to receive treatment. It is best practice to have organisational policies on sickness absence, disability leave and medical appointments. This can help you and the employee clearly understand their rights and entitlements.

It may be helpful to set up an agreed plan about how you and your employee could keep in contact when they are absent. At times, it may be appropriate to appoint a family member as a point of contact. The employee may prefer contact from a co-worker, close colleague, union representative or an occupational health worker. This might make them feel more supported rather than being contacted by their line manager, making them feel they were being checked up on. It is also a good idea to establish what type of contact they would prefer, whether by telephone, email, letter or in person. It is important not to pressure an employee into returning to work too soon before they are well.

If the employee is absent from work because of a disability-related sickness, this should be recorded separately from other sickness absences, such as having a cold. This is to make sure that the employee is not discriminated against if decisions about promotion or bonuses, for instance, take sickness absence into account.

If the employee is absent for more than a week, they will need to obtain a 'fit note' ('statement of fitness for work') from their doctor. The doctor can suggest any additional support or adjustments the employee would benefit from, such as a phased return to work.

If possible, involve the employee in planning their return to work. This allows them to voice any concerns they may have or to request adjustments. They may need a phased return if they have been off work for a considerable period and do not feel able to work a full day at first. For example, they may wish to start by working fewer hours and gradually building up to their usual working pattern. To begin with, having a reduced workload might also be helpful.

If the employee has to remain away from work until reasonable adjustments are in place to enable them to return to work (for example, moving their workstation closer to a toilet), this should not be recorded as 'sick leave', and they should receive full pay.

Ongoing support and regular reviews

It is helpful to have regular reviews with your employee. Their situation may change, and they may wish to vary any adjustments to make it easier to continue working.

Employees may feel that they have been discriminated against if they have received an unfavourable appraisal or performance review. An example is if they have not met targets due to sick leave or tiredness caused by Crohn's or Colitis. They might also feel unhappy if there has been a disagreement about 'reasonable' adjustments to their work. Being bullied can also be an issue for people with Crohn's or Colitis.

Most employees would prefer not to take formal action. Often, talking things through resolves any issues. You should, however, make sure your employees are aware of your grievance procedures. Ideally, they will discuss any problems with their line manager, HR team or union representative (if available). Alternatively, there might be another person who can mediate in the event of disagreements. It is good practice to keep detailed records of meetings in all cases.

If the issue is not solved informally, the employee may raise a formal grievance or make a claim to an employment tribunal. Acas can provide help relating to preventing or resolving disputes.

There may be rare occasions when you have made reasonable adjustments, but the employee feels that their condition makes it difficult to continue their job or an alternative job. In these circumstances, you may feel that you have no alternative but to consider ending their employment. Dismissal should be a last resort after you’ve tried other ways to support the employee and help them get back to work. Certain procedures have to be followed before taking this step. You must ensure you have made all reasonable adjustments with the employee. For example, you will need to consult with the employee, obtain medical evidence and consider whether alternative employment or training has been offered.

Acas can provide advice about ending employment.