Please help with confusion around applying for ESA & SSP before surgery, reducing hours, etc

[Myjoyridehasfadedlikeaflower]

Not exactly fun and games but posting here for traffic.

Calling all those good with numbers and/or those who have a clear understanding please 🙏

I currently work & get paid for on basically the NMW (excluding breaks) 32 hours a week.

I need surgery which will force me to take a year off. Date tbc. All healthcare professionals have advised me to take Ill Health Early Retirement due to other chronic illnesses but this isn’t an option.

I also have for 10 years now received the higher elements of both parts of PIP and this is up for renewal in 36 months.

At any time before my surgery I can reduce my hours to a maximum of 16 to claim ESA. If I do this now, I think I have to be signed off by my GP (which she actually is encouraging) for a max of 28 wks I believe - is this correct? But could I go straight to ESA instead while I wait for surgery and then go onto SSP?

Can someone please let me know the timings and what would be more financially beneficial to me regarding timelines?

My head is blurry with what I’m trying to say.

The surgery is a red herring as it’s not imminent! If you’re working 32 hours a week then you’d most likely not qualify for early IHR - this is determined by your pension provider in any case.
If your GP signs you off sick, you get whatever employer sick pay is available. Once that runs out you can apply for SSP. This lasts for 28 weeks. If the absence becomes long term then you can claim ESA. You need more than just a sick note from your GP to get this - you have to complete a form detailing why you think you qualify for it and you’d have an interview to determine if they will continue to pay it.

I think you might have it the wrong way around?

There are a few options:

1. To claim SSP, which pays £123.25 per week, you must be an employee and you must tell your employer that you're too ill for work as soon as possible. SSP lasts for up to 28 weeks. Now that the waiting days have been removed, you could get SSP for the days you don't work if you need to reduce them because of sickness. So you could get £203.36 for the 16 hours, plus £61.63 for 2 days of SSP per week, for 28 weeks. Plus you can claim Universal Credit if your circumstances allow.

You can't get SSP at the same time as ESA.

1. You could claim SSP completely for 28 weeks. That would give you £123.25 per week, plus any UC.

1. You could go straight to ESA. You'll get £95.55 per week while you are assessed, then if placed in the support group, £145.90 after assessment. You can also claim UC, but the ESA will be deducted from the UC amount.

If you claim UC, you can declare your health conditions and be assessed for Capability for Work. If you are deemed to have Limited Capability for Work and Work Related Activity (LCWRA) you'll get an extra £217.76 per month on your UC pre-deduction award. You'd have to submit fit notes and complete a WCA50 form not dissimilar to PIP forms.

Not necessarily a red herring. The surgery is necessary to fix whatever issue @Myjoyridehasfadedlikeaflower has. It sounds like she's trying to keep going when in reality she's too unwell. If she's been encouraged to apply for ill health retirement, she is unlikely to have trouble qualifying for ESA or LCWRA on UC because the medical professionals are telling her not to work, so will be happy to provide evidence that she needs it.

@Myjoyridehasfadedlikeaflower Using and inputting all the details you've provided this is the comprehensive reply which is purely AI generated and could obviously contain mistakes.

It does seem to offer a useful timeline and order though, in which you should apply for SSP and ESA. Offers other benefits to which you may be entitled depending on your living arrangements. Hope you find it useful.

Benefit Timeline & Application Strategy
1. Immediately Post-Surgery (Weeks 1 to 28)

• The Baseline Benefit: If you are employed, you must first claim Statutory Sick Pay (SSP) through your employer, which lasts for up to 28 weeks. You cannot receive New Style Employment and Support Allowance (ESA) while receiving SSP.
• Action Window: Obtain a Fit Note (sick note) from your surgical team or GP starting from the day of your surgery. You can self-certify for the first 7 days, but require a formal fit note thereafter.

2. The Transition to ESA (Month 4 / Week 16 of Sick Leave)

• The Best Time to Apply: You can apply for New Style ESA up to 3 months before your SSP ends.
• Why This Timing Matters: Applying around Week 16 ensures your claim is processed ahead of time. Your ESA payments will then seamlessly begin the exact day after your SSP stops, avoiding any income gap.

Managing ESA and Reducing Hours Pre-Surgery
The term "reduction of ESA" usually refers to the 1-year time limit on payments. If you are placed in the Work-Related Activity Group, New Style ESA is strictly limited to 365 days. However, if your surgery and 1-year recovery leave you completely unable to look for or prepare for work, you need to target the Support Group.
The Support Group has no time limit and a higher payment rate. During your Work Capability Assessment (triggered after you apply), submit comprehensive surgical letters emphasizing that you cannot work or plan for work for at least 12 months.

Information on ESA and How to claim ESA

Reducing Your Hours Pre-Surgery
If you need to reduce your hours before the operation due to worsening health, do so strategically:

• The Risk: SSP and ESA calculations can depend on your average weekly earnings. If you reduce your hours too far in advance, your average earnings could drop below the Lower Earnings Limit, making you ineligible for SSP.
• Best Time to Reduce Hours: If your health permits, keep your full hours until 8 weeks prior to your surgery date. SSP eligibility is calculated using your average earnings over the 8 weeks before your sickness begins.
• What Info is Required by Your Employer: You must formally request a change under the Flexible Working Act or via an occupational health referral. Provide medical letters showing you are waiting for a major operation and require lighter duties or reduced hours.

PIP Renewal: 36 Months Out
Because you have received the higher elements of both PIP components for 10 years, you have a strongly established medical profile.

• The DWP Timeline: Although your award ends in 36 months, the DWP operates a rolling backlog. They will automatically initiate your review 9 to 12 months before your current award expiry date. You do not need to contact them now.
• What to Expect: You will be sent an "Award Review" form. Because your condition has been stable at the highest rate for a decade, ensure your renewal highlights that your functional limitations remain unchanged (or have worsened due to the upcoming surgery). In some cases, long-term stable awards are processed as "paper-based" reviews without requiring a new face-to-face assessment.

Other Benefit Entitlements to Check
Depending on your wider household circumstances, you may also qualify for:

1. Universal Credit (UC): You can claim Universal Credit alongside New Style ESA. While ESA is based on National Insurance contributions, UC is means-tested. If you have less than £16,000 in savings, UC can top up your income and help pay for housing costs (rent).
2. Council Tax Support: Administered by your local authority, an award of ESA or Universal Credit usually makes you eligible for a substantial reduction in your council tax bill.

This is an excellent informative reply.

Just to add that as OP is receiving enhanced PIP for both elements, she would automatically be considered LCWRA (will need to apply for WCA as usual as you mentioned and then declare this).

@Freya1542 I genuinely don't understand why you'd reply with AI which OP presumably could have done herself? No snark, I really don't think there's a place for it on Mumsnet. You have pasted something you admit you don't know is right.

Thankyou for the wonderful support. Just to clarify I certainly didn’t use AI ☺️ Didn’t even occur to me tbh.

When I’m a bit more aware I’ll probably have a few questions. I’m a ruminator.

@Soontobe60 I did say in my OP that Ill Health Early Retirement is not an option. I don’t have enough funds in there to make it worthy. My surgery is imminent and a red herring, it’s a fact, it’s booked and I don’t understand why you would say it isn’t.

@Lougle Thankyou for the numbers but I’m a bit confused. Is receiving (£61.63) SSP while working reduced hours an option?

@Freya1542 Thankyou for the disclaimer. I did google the Lower Earnings Limit and it doesn’t exist now.

I’m a bit confused on what I can claim before surgery in order to reduce my hours (& pain) but I think it may be ESA?

Thankyou to all who have listed info clearly. I can sort of make sense of this. We don’t claim UC and the calculators like EntitledTo tell me we won’t when I’m off sick, DH earns around £38k.

I’m curious as to what surgery requires a year off? Worth knowing that you can’t get a med3 (sicknote) for more than 3 months at a time in the first 6 months, because it’s so unusual to anticipate that people would be off for so long (I’m a GP).

"Thankyou for the numbers but I’m a bit confused. Is receiving (£61.63) SSP while working reduced hours an option?"

@Myjoyridehasfadedlikeaflower I'm happy to be corrected, but yes, if you have complete days off. So if you normally work 4 days, you get a fit note from the GP to say you're only fit to work 2 days, then the other 2 days are sick days. You couldn't get it if you worked 4 hours per day over 4 days because then you aren't unfit on the other days, because if you work even for 1 minute of the day you weren't unfit on that day. It has to be complete days.

It’s back to back surgery. As soon as one procedure is completed and the therapist is content with me moving onto the next round, I’m having the next procedure and next physiotherapy.

To clarify, this can’t be for a long period of 3mths+ though?

Apologies - I misread your post as you’re having surgery in a year, rather than would need a year off following surgery! That’s what I meant by red herring - in that it would only be relevant when you have it. My confusion was compounded by the fact that you said you’re currently working 32 hours a week. I didn’t say that it wasn’t booked though.

So something akin to knee replacement surgery - I’ve been told that I’d have these back to back with a break in between to recover.

Up to 28 weeks, so just over 6 months.

I’m pretty certain this is incorrect! SSP is payable when a person is fully off work. There may be the option of an employer agreeing to pay their own sick pay if you’re returning an a phased basis, but this is not legally enforceable. A GP may well give a fit note advising a phased return after a period of sickness absence, but again this isn’t legally enforceable.
ESA is only payable after 28 week’s SSP has been claimed and therefore SSP has ‘run out’.

https://www.gov.uk/guidance/statutory-sick-pay-manually-calculate-your-employees-payments

Part weeks can be paid as SSP. Periods of sickness can be linked as long as they are less than 8 weeks apart, unless they cumulatively take place over a period that exceeds 3 years in total.

@Myjoyridehasfadedlikeaflower could be sick on Monday and Wednesday, present on Tuesday and Thursday, and have Friday as her normal day off. The GP can provide a fit note that says she can only work 2 days per week, or must work no more than 16 hours, etc.

The only cooperation the employer would need to give is allowing 2 full days of work rather than making the OP spread the hours over 4 days.

You could receive SSP for 28 weeks then ESA could be paid indefinitely if you qualify.

I don’t interpret that document in the way that you do. An important thing to consider is how this would fit in with an employer’s sickness policy. I have never seen a phased return whereby the employee comes back for full days, it’s always been staggered (my experience is in education) with for example 3 mornings a week, increasing to 5 mornings and so on. That being said, where this has happened the employee has always been paid their full salary on a phased return.

"If you’ve been off work for surgery or a long illness, you might want to work fewer hours for a while - for example, working 3 days a week instead of your normal 5 days a week. This is called a ‘phased return’ to work.

Your doctor can write a fit note that recommends you work fewer hours a week, while you recover.

Work out your pay and sick pay while working fewer hours
You should get your normal pay on the days you work and SSP on the days you don’t work.

Your pay might be less while you work fewer hours. You should discuss with your employer what your pay, SSP and CSP will be during your phased return - it’s a good idea to get this in writing."

https://www.citizensadvice.org.uk/work/sick-leave-and-sick-pay/check-if-you-can-get-sick-pay/

I'm not saying it's a classic situation, but if the employer is on board and would rather have some of @Myjoyridehasfadedlikeaflower than none of her, and the GP is willing to write a fit note that allows for a reduced number of days, it is a CVperfectly legal and legitimate use of SSP.

It’s like a minefield isn’t it? The way wording in things like this can be interpreted so differently between individuals is exactly why I posted on here, so thankyou all for your input.

My GP & all appropriate healthcare professionals want me to stop working completely. I am not happy with this at all and my employer would be more than happy to have me on a phased return. That’s their policy.

The procedure I am due to receive in surgery means I will not ever, in any way, return to my current 32 hours in any role 😞