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With the UK economy currently facing a sustained period of pressure, thanks to slower than expected growth, central to this problem is the issue of poor productivity, which continues to plague British businesses. The UK government has said that a “culture of presenteeism” among workers has damaged UK productivity and, according to the Chartered Institute of Personnel and Development (CIPD) 2023 health and wellbeing survey, presenteeism is widespread in the UK workforce.
Presenteeism can be a problem in any organisation as workers in the UK are among the least likely to take sick days, especially when compared to other Organisation for Economic Co-operation and Development (OECD) member countries and European countries. However, they are more likely to persevere at work through sickness, which can have a productivity cost. This extra hidden cost to businesses is estimated to be £25 billion from lower productivity among people working through sickness. This is often referred to as presenteeism.
But what exactly is presenteeism? In this article we will explain what presenteeism is. We will also consider the consequences of presenteeism on organisations, workers, and on the wider UK economy, examine some of the reasons that lead to presenteeism, highlighting some examples of presenteeism, and offer some strategies and tips that can help to reduce presenteeism in the workplace.
Presenteeism explained
Presenteeism, as defined by researchers refers to productivity loss resulting from workers being present at work but, because of illness or other medical or emotional conditions, or through disengagement, they are not fully functioning.
Employees engaging in presenteeism may be physically present at their workplace, but they are not working to their full capacity. For many the term presenteeism denotes people continuing to work despite being unwell. We have probably all done this at some time, feeling unwell but not sure if we are ill enough, or well enough to be present in work, so we show up and do what we can.
Providing that an illness is not infectious or that it is not overly incapacitating, presenteeism can have its benefits for the employee. Working whilst not fully recovered from an illness or an injury can be therapeutic, as a managed approach to returning to work can enable employees to gradually return to their duties after sick absence. Work provides people with structure and meaning, building their confidence and their self-esteem, and offers them opportunities for social engagement and support. However, presenteeism can be a health and safety risk that should be carefully managed. Organisations should take advice from occupational health professionals to manage returns to work following sick absence.
However, presenteeism can also refer to employees who continue to work well beyond their working hours and optimal productivity levels, or to those employees who, although present at their workplace, they are disengaged from their work, and they participate in non-work activities such as surfing the internet rather than doing their job. When employees come to work and are not fully engaged, or perform at lower levels as a result of ill health, their productivity can be reduced and they can also risk harming their overall wellbeing. Let’s look at each of these in more detail.
According to new research conducted by Canada Life, over the last two years, more than two-thirds (68%) of UK workers, equating to 21.7 million people have continued to work while feeling unwell. There are many reasons why employees feel the need to engage in presenteeism when they are feeling ill, the Canada Life research found that:
- 25% said their workload is or has been too heavy
- 23% feel like too many people rely on them to warrant taking time off
- 22% do not want to give their colleagues more work to do
- 18% have worked through illness because of the financial consequences of taking time off
- 17% stated that they can work from home, so they still feel they need to, or can, work when unwell
- 13% are made to feel guilty by other colleagues / senior members of staff for taking time off work
- 10% are not taking time off because they are worried about not getting paid.
- 9% do not feel secure enough in their job to take time off work
- 8% of those workers who did call in sick, have had their illness or inability to work questioned by their manager
Most people take their jobs seriously, and want to give a good impression at work, so not being present or visible when others are working can feel like a threat to this. Being present at work, even if they are unwell, can seem like the safer thing to do.
People also worry that being off work may mean putting tasks on hold, or adding to another person’s workload, that it may affect their chances of a promotion, or they may feel more at risk of losing their job because of their sick absence record. Financial pressures are also a key influence on the practice of presenteeism, particularly in roles where sick pay is limited or not paid at all, or for those in roles where bonuses are linked to attendance.
There are particular professions where presenteeism is more prevalent than in others. Health and social care, and education, for example, are professions where there is an increased attendance pressure due to staff shortages, lack of cover for sick absence, and increasing and demanding workloads, so greater flexibility is required of staff in all disciplines, and presenteeism becomes normalised. In addition, people who are self-employment, particularly those who work in the “gig economy” where work may be scarce and low-paid, and where there is no right to sick leave or healthcare benefits often engage in presenteeism as many cannot afford to take sick absence.
Although figures from the Office for National Statistics (ONS) indicate that in the past 25 years, sickness absence has steadily decreased with slight increases during COVID 19, the pressure to turn up at work at all costs has significantly increased presenteeism over this time period. Before the COVID 19 pandemic, data from one UK survey showed that 80% of workers said presenteeism existed in their workplace, with a quarter of the respondents saying it had got worse since the prior year.
A major factor behind the increase in presenteeism is the rise in the number of employees reporting suffering from mental health conditions such as depression and anxiety. Often, because of the stigma associated with these conditions, employees are reluctant to reveal a mental health illness to their employer, so they attend work when it would be more beneficial to their health to take time off sick.
Since the pandemic, the rise of flexible working and the ability of working from home, has seen the rise of what is being referred to as digital presenteeism, that is remaining in work online in order to be seen to be working, or due to a feeling that working long hours is an expectation. People are working longer than ever, responding to emails and messages at all hours of the day to show how engaged they are, and are often working beyond normal mental or physical ability. When people work too many hours, or when they are working when they are unwell, they are unlikely to be their usual, productive selves.
Presenteeism can also refer to workers who are undertaking tasks such as responding to emails outside of their usual working hours and even when they are supposed to be on paid leave. This kind of behaviour is often caused by having too much work to do, being afraid of falling behind, or not having a clear line between work and personal life, especially with the rise of remote working. It can cause burn-out, declining productivity and mental health problems in the workforce.
A more insidious form of presenteeism happens when for example an employee gives the appearance of being present in the workplace, but may actually be somewhere else. For example, an employee logs on in the morning, or an employee who places a jacket on the back of their workstation chair, both to appear to be present in the workplace, but then they disappear often to carry out non work related activities.
Presenteeism vs Absenteeism
Presenteeism appears to be a much costlier problem to businesses and to the UK economy than its productivity-reducing counterpart, absenteeism. Absenteeism is when employees take unplanned time off due to illness or for other reasons such as a bereavement. The Institute for Public Policy Research (IPPR) estimate that employees now lose the equivalent of 44 days’ productivity on average due to working through sickness. Whereas the average rate of employee sick absence now stands at 7.8 days per employee per year. They concluded that presenteeism costs UK businesses £25billion a year in lost productivity, this compares to £5billion lost because of sickness absence.
Absenteeism to some degree can be expected in any workplace, as employees may need to take time off for a variety of reasons, ranging from an employee simply needing a few days off work to recover from a virus, to more complex matters such as persistent absenteeism, or long term sick absence.
However, with absenteeism employers are usually able to make contingency plans to cover for the absence, whereas with presenteeism it is generally a hidden problem, when an employee is present at work but working under par, it may not be immediately obvious that productivity is suffering. Some employers have seemed to just accept presenteeism as they view that it is better to have someone in work doing something, rather than them being off sick.
Consequences of Presenteeism
When employees engage in presenteeism and are not taking time off when they are sick, this can slow their recovery time, increase the risk of further sickness later which can result in them taking increased sick days, and has the risk of spreading any infectious illnesses to others, meaning more staff taking sick absence, all of which will lower productivity. When someone is working when they are unwell they may find it more difficult to concentrate, they may make mistakes or have accidents and may have less patience with colleagues and / or customers because they don’t feel great.
If one employee displays presenteeism, it can spread to their co-workers as they feel the pressure to be present as well, which can soon affect the whole workplace and create a stressful work environment. For example, if employees and or managers respond to a colleague taking a day off sick with the insinuation that they are overplaying their illness or are weak, it could be a sign of a culture of presenteeism that urgently needs addressing.
Working when not well, and working longer work hours have contributed to heightened stress levels amongst UK workers. Between 2020 and 2021, the Health and Safety Executive (HSE) reported that 822,000 workers were suffering from work-related stress, anxiety, and depression. The always-on duty culture of working online and continuing to work despite worsening physical and / or mental health has only enabled presenteeism.
Presenteeism Examples
One classic example of presenteeism was when in 2020, the then Prime Minister Boris Johnson tried to run the country from his hospital bed as he battled serious illness with COVID 19. This sent a very unfortunate message to the country about presenteeism.
Presenteeism in the NHS – It is estimated by the Society of Occupational Medicine that presenteeism costs the NHS around £6.6 billion annually, that is more than the combined costs of absenteeism and employee turnover. The British Medical Association (BMA) has reported that doctors are forced to work though sickness and burnout through guilt. Dr Akinsiku speaking at the BMA annual representative meeting on 5 July 2023 stated “It is not uncommon to see doctors feel genuinely guilty about the rota gap created by their absence, making it to work when they’re genuinely ill”.
Dr Akinsiku also told of instances where doctors were called every day when off sick by medical staffing teams, and occasions where doctors were pestered to come back to work while recovering from major surgery, with staffing teams caring only about the rota. “If you’re at work when you’re supposed to be off sick and a mistake happens, we all know it could spell doom for a doctor’s career, particularly if that doctor is BAME.” said Dr Akinsiku.
Presenteeism in the prison service – Prison officers work under challenging conditions in a highly pressurised environment; they are responsible for the wellbeing and safety of inmates in prisons that are increasingly overcrowded and understaffed, the incidence of threats, assault and trauma is high and staff are at high risk of physical and mental health problems.
In a survey of 1,682 officers working in UK prisons conducted by Gail Kinman, Professor of Occupational Health Psychology at the University of Bedfordshire, eighty-four percent of respondents reported feeling under pressure to work while sick at least sometimes and more than half (53 percent) indicated that they always did so. Some officers described a strong anti-sickness culture in their organisation and a lack of compassion for those who are unwell. Reports of prison governors phoning up staff on their first day of sick leave asking when they would be back at work were common.
Fears about dismissal for medical inefficiency tended to encourage presenteeism in a working environment that required reliable and uninterrupted service. The study found that officers who worked while sick were in poorer mental and physical health; they were also more likely to be emotionally exhausted, feel detached from the job role and have cynical attitudes towards prisoners.
Presenteeism in the UK finance sector – a new study that the Bank Workers Charity conducted entitled “Seeing presenteeism differently revealing the good the bad and the misunderstood”, found that finance employees not seen at their desk were often side-lined, or perceived by colleagues to be less effective, or even skiving, illustrating the deep-rooted negative perceptions that needed challenging. The report also stated that rewarding attendance over output presented a major disincentive to working flexibly owing to the negative attitudes fostered towards those working remotely.
How to Reduce Presenteeism
Employers have a duty of care under the Health and Safety at Work Act 1974 (HASAWA) to protect the wellbeing of their staff. Presenteeism as we have seen earlier has implications for not only the wellbeing of an employee engaging in presenteeism, but also for others. Presenteeism also has wide-ranging costs for employers in terms of for example lower productivity, errors and accidents, and higher sick absence if infectious illness is passed to others in the organisation. Employers can however take action to combat presenteeism and its costs, these actions include:
- Assess the risks and identify the problem – organisations can use existing risk management frameworks, such as those used in workplace health and safety, to assess risks relating to presenteeism and identify the factors that encourage it. These factors might include for example, staff shortages, workloads, financial and / or job insecurity, organisational culture etc. Employers should engage with employees to identify factors that can lead to presenteeism from their perspective such as conducting a staff wellbeing survey. Once these risks and factors have been identified and assessed, interventions to mitigate or minimise them can be generated and precisely targeted, employers should also involve employees in any decisions about how to manage presenteeism.
- Review sickness absence policies – employers should undertake a critical review of sickness management policies to ensure that, wherever possible, employees are not penalised for taking sick leave. Strict attendance procedures such as limited entitlement to sick absence days, threats of disciplinary action, a lack of entitlement to sick pay, and attendance incentives and bonuses only have the effect of encouraging presenteeism. By analysing the hidden costs of presenteeism against any potential additional sick absence costs employers may well highlight cost savings rather than losses in terms of for example, improved productivity and error reductions. Employers should also consider extending their policy to explicitly explain the risks of presenteeism to all employees.
- Train managers– whilst sick absence is visible and easily measured, presenteeism is not as straightforward to evaluate. Managers need to be aware of the growing evidence that presenteeism is the more significant cause of lower productivity, errors and accidents in the workplace. Managers need to undertake training to recognise signs of presenteeism, and be encouraged to adopt a more flexible approach to sick absence in order to avoid causing further presenteeism. They should also be trained in managing performance using performance measures which are sophisticated enough to pick up any significant change in individual performance, these measures should be monitored alongside sickness absence to help identify instances of presenteeism.
- Invest in wellbeing – employers should work closely with occupational health to identify the most appropriate way to manage sick absence and how to rehabilitate employees back into the workplace. Managers and occupational health professionals should work together with employees to identify whether they are fit to return to work, or to do some work if they are for example, waiting for test results, or recovering from illness or injury. In some instances a phased approach to return to work is needed to support people who are struggling with their wellbeing, but managers are sometimes reluctant to implement recommendations for reasonable adjustments from occupational health, so their training should include information of the benefits of working with occupational health professionals to minimise presenteeism. Developing a health and wellbeing strategy that deals with all aspects of employee wellbeing helps to tackle both presenteeism and absenteeism. Introducing an employee wellbeing programme can promote and support health and wellbeing, and any investment will reap benefits in the longer term as a result of better attendance and a healthier workforce, both of which improve productivity.
Good management of ill health and presenteeism in the workplace consists of identifying and minimising the risks and the adverse consequences of poor health, for both for the individual and for the organisation. By focusing on promoting a positive working culture and developing sick absence policies, employee wellbeing strategies, and training managers will help to reduce presenteeism, and employers will benefit from better staff engagement and retention as well as improved productivity and a healthier workforce.
