Factsheet – Multiple sclerosis (MS)

This resource is part of our Disability Essentials range. You can find the other free resources that are included in this range by clicking here.

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What is multiple sclerosis?

Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord. It causes a wide variety of symptoms throughout the body depending on the location and severity of the damage.

The symptoms of MS are caused by the body’s immune system attacking the myelin sheath which covers and protects the nerves. Eventually, the damage and scarring will mean that the nerves are less efficient, causing the signals sent through the nerves to be slower or disrupted. It is similar to an electrical flex cover (myelin sheath) getting damaged or worn away. The exposed wires will also get damaged and not work as efficiently.

The MS Trust estimates that approximately 130,000 people in the UK have MS, and about 100 people per week are diagnosed with the disease. MS is two to three times more common in women than men.

There is currently no cure, but effective therapies can slow the disease’s progression in people with ‘relapsing-remitting MS’ and those with ‘secondary progressive MS’ with relapses.

Like many medical conditions, the causes of MS are unknown. Genetics and environmental factors such as access to vitamin D are thought to be involved. Viral infections, especially those of the Epstein-Barr family which cause glandular fever, are also suspected.

Types of MS

Relapse remitting MS

This is the most common type of MS diagnosed, affecting eight out of ten people with MS. It is characterised by episodes of new symptoms or worsening of existing ones (relapses). They can develop over a few days, and recovery can take from just a few days to several weeks or months.

The episodes may resolve entirely, or there may be some permanent residual damage. The more episodes of symptoms a person has, the increased likelihood of permanent damage to the nervous system and symptoms do not fully resolve.

This pattern of episodes and remission can continue indefinitely, but most people will progress to ‘secondary progressive MS’ after several years. Secondary progressive MS is when the symptoms gradually progress with no obvious episodes of symptoms or remission.

Periods between attacks are known as periods of remission, and they can last for years in some cases.

After many years (usually decades), most people with relapsing-remitting MS go on to develop secondary progressive MS.

Primary progressive MS

This type of MS affects just over one in ten people with MS. It starts with a gradual worsening of symptoms which continues over several years with no periods of remission. The areas of the body affected will also increase. Some people will experience times when their condition seems to stabilise or plateau, but not all.

How does MS affect an individual?

MS is a lifelong condition that can be challenging to live with. However, new treatments can slow the progression of the disease for many people. Many can live full and active lives for many years with little or no visible sign of the disease.

The symptoms of MS vary widely from person to person and will depend on where the damage is and its extent in the brain and spinal cord. The most common symptoms include:

• physical and mental fatigue – this is much more than normal tiredness
• difficulty walking
• vision problems, such as blurred vision
• bladder problems including infections, increased frequency, and urgency
• bowel problems, including a sense of urgency
• numbness or tingling in different parts of the body
• muscle stiffness, spasms, pain and weakness
• difficulty with speech and swallowing, which can increase the risk of choking
• problems with balance and co-ordination
• problems with thinking, learning and planning
• anxiety and depression.

Potential impact on work

The potential impact on work will depend on the type of MS and how far the disease has progressed. Some people will have permanent symptoms, whereas others may have mild symptoms with very long periods of remission.

MS can develop at any age, but it is most commonly diagnosed in people in their 20s and 30s. People typically have mild symptoms for an extended time before they are diagnosed, which may have already affected their performance at work.

Some work-related tasks may be affected by a diagnosis of MS. These may include working at heights, physically demanding roles, driving, diving or piloting a plane. For more advice on this, Occupational Health should be able to advise you.

Other additional health and safety issues may need to be considered, such as lab work, access and emergency egress. Again, Occupational Health should be able to advise you on a case-by-case basis.

Legal duties

The Equality Act 2010

In the UK, employers have duties to:

• prevent discrimination, and
• provide reasonable adjustments

for their disabled employees. This means that it is unlawful for employers to treat applicants, job candidates and employees unfavourably because of their disability.

The Equality Act also requires employers to make ‘reasonable adjustments’ for their disabled employees.

Suggested adjustments

MS is unique to each individual who has it. A person’s needs will fluctuate depending on the type of MS they have and if they are having a relapse or in remission.

Accessing, using, and leaving buildings can be difficult for many people with mobility challenges. Building regulations, and health and safety legislation try to mitigate these where possible, but some will remain.

Some adjustments commonly provided for employees with MS include:

• Provide accessible parking spaces near the entrance to the building. It is also good to have a policy that allows for someone with temporary symptoms to park in an accessible space. This may apply to people with MS who are newly diagnosed and have not received their ‘blue badge’ or who usually are well but experiencing a relapse.
• Doors can be very heavy and ideally should have an accessible opening system, such as a push-button activations system. The position of swipe card opening systems should enable wheelchair users to access them easily.
• Once inside the building, accessible lifts may be required. These should be easily accessible for people who use walking aids and wheelchair users. Some electric wheelchairs are large, especially if there are extra bags and equipment attached. Handrails may also be beneficial in some key areas.
• Accessible toilets and other facilities should be provided. It is vital that everyone can access these. MS can affect a person’s bowels and bladder, and if so, their desk should be situated somewhere where they have easy and quick access to accessible facilities.
• Emergency egress must be considered for all staff and visitors. If a person with MS is experiencing mobility challenges, whether temporary or permanent, a Personal Emergency Evacuation Plan (PEEP) should be put in place. This may be as simple as having a ‘buddy’ to help them safely leave the building or having a refuge area with a planned exit procedure in place.
• A workstation ergonomics assessment should be carried out as required by the regulations. This includes a reassessment every time there are significant changes to a person’s health, workplace or role. It should involve assessing access to their desk and everything they need to do their job. The assessment should also consider the need to buy specialist software or hardware, including dictation software, larger screens and magnifiers, lighting, keyboards and mice. If the person is travelling for work, the weight of laptops and related equipment may need to be considered. For example, a trolley bag may be easier than a backpack. Access to Work may be able to carry out specialist workplace assessments and provide financial assistance with some adjustments.
• Providing equipment to help the employee with symptoms that may affect motor co-ordination and grip. For example, a hands-free telephone and voice recognition software.
• Temperature control can be challenging for many people with MS, and so adjustments to allow for this should be implemented. This may mean moving their workstation away from beside a radiator and providing a fan.
• Regular breaks can help a person manage mental and physical fatigue, which is one of the most common symptoms of MS. Flexibility around working hours and possibly working from home regularly or as required can also be a benefit.
• There may come a time when the disease progresses to the extent that the person can no longer carry out their role. Most people have a degree of warning about this, and so training and planning for a future role that still uses their skills and experience should be considered as soon as this becomes apparent. Redeployment can be a reasonable adjustment under the Equality Act, and therefore a legal requirement.
• Allow time off to attend appointments for assessment, treatment or rehabilitation.
• 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 less favourably for a reason relating to their disability.
• Business travel can be tiring and bring additional challenges for someone with MS, especially as the condition progresses. Adjustments may include allowing extra daytime travel to and from sites, especially for long-distance and overseas travel. All overseas travel should include a travel risk assessment and should be completed early for anyone with MS to enable any adjustments to be included. This might be arranging travel to a hotel or booking an accessible room, or airport or train assistance. The app, Access Able can help with this.

Because the symptoms of MS are unique to each individual, there is no one-size-fits-all approach to adjustments for MS. Adjustments provided should be specific to the barriers that the person faces. They should be fully discussed and agreed with the employee before they are implemented.

Refer to our resource, ‘Making workplace adjustments’ for more information.

Further information

Business Disability Forum

Knowledge Hub

For more information on suggested adjustments, specific barriers for MS and information about the law, please see our other resources in the Knowledge Hub.

Advice Service

For tailored information and advice about a specific situation, contact the Advice Service:

• Tel: +44-20-7403-3020
• Textphone: +44-20-7403-0040
• Email: advice@businessdisabilityforum.org.uk

MS Trust

Spirella Building, Bridge Rd, Letchworth Garden City, Hertfordshire, SG6 4ET

• Web: mstrust.org.uk
• Tel: 0800 032 38 29
• Email: hello@mstrust.org.uk

MS Society

• Web: mssociety.org.uk
• Tel: 0808 800 8000
• Email: helpline@mssociety.org.uk