To Be or Not to Be Self-Employed? Helping People Find Sustainable Work After Illness or Injury

When illness or injury changes someone's relationship with work, the answer isn't always as simple as returning to their previous job or starting again somewhere new.

For some people, a significant illness or injury can fundamentally change how they think about work.

A job that once felt manageable may no longer fit their health, priorities or values. Someone may begin to wonder whether self-employment would give them greater flexibility and control.

For someone who has previously been self-employed, the opposite may happen. Running a business can suddenly feel overwhelming, and returning to employment may appear to offer the security and support they need.

For vocational rehabilitation professionals, these conversations can present a particular challenge.

How do we help someone explore their options without inadvertently steering them towards a decision that may not be sustainable?

This was the focus of a recent VRA webinar presented by Heather McLellan, physiotherapist and vocational rehabilitation professional, drawing on more than 30 years of experience across occupational health and vocational rehabilitation, alongside her own experience of managing a serious long-term health condition while self-employed.

The discussion highlighted an important principle:

The goal should not simply be getting someone back to work. It should be helping them create work that works for them.

In this article

• Why self-employment can look attractive after illness or injury
• The risks of making major work decisions during recovery
• Employment and self-employment: different opportunities, different risks
• The importance of a financial runway
• Exploring the middle ground
• What VR practitioners can do differently
• Moving from a pressured decision to an informed choice
• Key takeaways

Key takeaways

• Self-employment can provide flexibility and autonomy, but it does not automatically mean less pressure or fewer demands.
• Employment can provide greater financial and organisational security, but may involve structures that do not easily accommodate someone's changing health needs.
• Major decisions about work may be made when someone is physically, cognitively and emotionally depleted.
• Practitioners should explore why someone wants to change their working situation, not simply respond to the proposed solution.
• A phased approach to decision-making may be just as important as a phased return to work.
• Sustainable work needs to be considered across health, financial, personal and social circumstances.
• Sometimes the best immediate option is to remain in an existing role while creating space to consider longer-term alternatives.

Why self-employment can seem like the answer

When someone has experienced illness or injury, their priorities can change.

They may no longer want the long hours, commute, workplace culture or level of pressure associated with their previous role. They may want greater control over when and how they work.

Self-employment can therefore appear particularly attractive.

It can offer:

• greater autonomy
• flexibility around working hours
• control over workload
• choice about clients or customers
• creative freedom
• the opportunity to build work around changed circumstances
• greater control over workplace adjustments

For someone who has found their previous employment environment difficult to manage following illness or injury, this can feel like an obvious solution.

But flexibility is not the same as sustainability.

As the webinar discussion highlighted, self-employed people can also experience significant pressure to accept work, particularly when they are uncertain about where their next income will come from.

The ability to say "I'll work when I want" can easily become "I need to say yes because I don't know when the next piece of work will arrive."

The risks of self-employment are not always obvious

Self-employment involves much more than delivering the service or product that generates income.

There may be:

• business start-up costs
• equipment and technology
• insurance
• accounting and administrative responsibilities
• marketing and business development
• unpaid work
• fluctuating income
• responsibility for finding future work
• limited access to sick pay
• limited organisational support when health deteriorates

There is also the challenge of managing the business and managing a health condition.

For someone recovering from illness or injury, that combination needs careful consideration.

A person may have the skills to perform the work but not have the physical, cognitive or emotional capacity to manage all the additional demands of running a business.

That distinction is important.

Being capable of doing the job is not necessarily the same as being capable of sustaining the business around it.

Employment isn't necessarily the "safe" alternative

The opposite transition can present equally important challenges.

Someone who has been self-employed may look at employment and see:

• predictable income
• structured hours
• clearer boundaries
• sick pay
• occupational health support
• income protection
• pension provision
• an established organisational structure

These can be significant advantages.

However, returning to employment can also mean giving up some of the autonomy and flexibility that helped someone manage their health.

There may be recruitment processes to navigate, including CVs, applications and interviews. Someone may need to consider how and when to disclose their health condition and negotiate adjustments with a new employer.

And the job itself needs to be examined carefully.

A job advertised as a particular number of hours may operate within a workplace culture where overtime, additional responsibilities or working beyond contracted hours are expected.

For someone managing a long-term health condition, the actual demands of the job matter just as much as the job title or contracted hours.

The timing of the decision matters

One of the most important themes from the webinar was when these decisions are being made.

People may be asked to make significant decisions about their employment while they are still:

• physically depleted
• cognitively exhausted
• emotionally affected by what has happened
• uncertain about their recovery
• adapting to a new health condition
• dealing with financial or benefits pressures

In these circumstances, a decision can feel less like a carefully considered career choice and more like an escape route.

Someone may say:

"I just don't want to do this anymore. I'll work for myself."

But what they may actually be saying is:

"I can't see how I can return to the way things were before."

Those are two very different starting points.

Equally, someone who is self-employed may feel overwhelmed by the prospect of rebuilding their business and conclude that employment is the only viable alternative.

The role of the practitioner is therefore not necessarily to accept the proposed solution immediately, but to explore what is driving the decision.

Is this a considered preference?

Or is it a response to a situation that currently feels impossible?

Sometimes the decision needs to be phased too

Vocational rehabilitation practitioners are familiar with the concept of a phased return to work.

The webinar raises an interesting parallel: perhaps some people also need a phased decision-making process.

Someone may not yet be in the best position to decide what they want their working life to look like for the next ten years.

They may, however, be able to decide what will work for the next three months.

That could mean returning to an existing role with appropriate support, stabilising their health and finances, and then reviewing their longer-term options.

This can create valuable breathing space.

As Heather reflected from her own experience, returning initially to what was possible did not necessarily mean that this was the long-term answer. Her own decisions about changing direction developed over several years as she understood more about what was sustainable for her health.

That is an important distinction:

A decision that works for now does not have to become a decision for ever.

Don't overlook the possibility of changing the existing job

One of the most valuable points raised during the discussion was the danger of treating the choice as simply:

employment OR self-employment.

There may be a third option:

What would need to change for the existing work to become sustainable?

That might involve reconsidering:

• working hours
• workload
• boundaries
• rest breaks
• annual leave
• flexibility
• working location
• expectations around availability
• responsibilities
• the way the person approaches their own work

Sometimes a person returns to work with a completely different perspective.

They may decide that they will no longer routinely work beyond their hours, skip lunch, accept every request or sacrifice their own health to meet workplace expectations.

Those behavioural changes can sometimes transform the experience of returning to a role that previously felt unsustainable.

This is where the expertise of a VR practitioner can be particularly valuable.

Rather than accepting "I can't go back to that job" at face value, we can explore:

"What would need to be different for you to be able to do this work sustainably?"

There is also a middle ground

The choice does not necessarily have to be all or nothing.

For some people, a combination of part-time employment and self-employment may provide a useful transition.

This could provide:

• some financial security
• access to an established workplace
• continued autonomy
• an opportunity to test self-employment
• gradual rebuilding of confidence
• flexibility while health stabilises

But this option also needs careful assessment.

Multiple roles can create additional cognitive demands, competing diaries, different systems, changing priorities and the need to constantly switch between different working environments.

So again, the question is not simply whether an option is possible.

It is whether it is sustainable for this particular person.

A risk assessment approach to vocational decision-making

Heather proposed approaching these conversations through a broader risk assessment lens.

This means looking beyond the headline question of "employment or self-employment?" and considering the whole context.

Current work situation

• What is the person's current employment status?
• Are they employed, self-employed, a business owner or currently off sick?
• What work were they doing before their illness or injury?

Health and functional capacity

• Where are they in their recovery?
• What is their current physical capacity?
• What is their cognitive capacity?
• What is their emotional and psychological capacity?
• Is further treatment or rehabilitation anticipated?
• What might their longer-term health needs look like?

Financial position

• What income do they currently have?
• Is there an income gap?
• How much financial runway do they have?
• What would happen if the new work does not generate income quickly?
• Are there additional business or employment-related costs?

Personal and social circumstances

• What support do they have at home?
• What responsibilities do they have outside work?
• What practical resources are available?
• What would the proposed change mean for their wider life?

Decision readiness

Perhaps most importantly:

Is this person currently in a position to make a major decision?

If they are still overwhelmed by the immediate consequences of their illness or injury, the most appropriate intervention may be to create stability first and revisit the bigger decision later.

Plan A needs a Plan B

Whatever direction someone chooses, sustainable vocational rehabilitation should include consideration of what happens if things don't go according to plan.

For someone moving into self-employment:

What happens if the business takes longer than expected to generate sufficient income?

What happens if their health deteriorates?

What happens if they cannot work for several weeks or months?

For someone moving into employment:

What happens if the role isn't suitable?

What happens if the adjustments aren't sufficient?

What happens if the person's health needs change?

Planning for these possibilities does not mean expecting failure.

It means recognising uncertainty and helping someone build resilience into their work plan.

The role of the VR practitioner

Perhaps the most important message for practitioners is that our role is not to decide whether someone should be employed or self-employed.

It is to help them explore the options with sufficient information to make an informed decision.

That requires curiosity.

It requires us to challenge assumptions—including our own.

And it requires awareness of the potential influence we have.

As was acknowledged during the webinar discussion, practitioners who have their own experience of employment or self-employment may carry their own biases about which option is preferable.

The aim should therefore be to keep those experiences in perspective and remain focused on the individual in front of us.

Their skills.

Their health.

Their finances.

Their values.

Their circumstances.

Their ambitions.

And, crucially, what they can sustain.

Sustainable work is the real goal

The question "Should I be employed or self-employed?" can sound like a binary choice.

In reality, there are many possible answers.

Someone might:

• return to their existing role
• change their working pattern
• negotiate different responsibilities
• move to a new employer
• retrain
• start a business
• return to self-employment gradually
• combine employment and self-employment
• take time to explore options before making a decision

The right answer may also change over time.

That is why vocational rehabilitation should not be focused solely on getting someone back into work.

The bigger question is:

What kind of work can this person sustain alongside their health, financial and personal circumstances?

That is a much more useful question—and one that places the individual's long-term wellbeing at the centre of the vocational rehabilitation process.

Final thought

Illness or injury can change much more than someone's physical capacity.

It can change their priorities, confidence, identity, values and understanding of what they want from working life.

For some, that may lead towards self-employment.

For others, it may lead back towards employment.

For many, the answer will sit somewhere between the two.

Our role as vocational rehabilitation professionals is not to make that choice for them, but to create the space, challenge the assumptions, assess the risks and help them understand their options.

Because ultimately, successful vocational rehabilitation is not simply about returning someone to work. It is about helping them find work that works for them.

About the webinar speaker

Heather McLellan is a physiotherapist by background who has worked across occupational health and vocational rehabilitation for more than 30 years. She has also experienced self-employment alongside managing a serious long-term health condition, informing her work supporting people navigating their own return-to-work journeys. Through her work as the Return to Work Mentor, Heather focuses particularly on supporting people who may have limited access to traditional occupational health or vocational rehabilitation support.

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