Research suggests that working when sick can reduce productivity substantially and damage health and wellbeing – yet it seems to be on the rise. Becky Spencer reports.

For the last few years, high levels of sickness absence across the workforce have been a cause for concern for employers and government. But while sickness absence has been grabbing all the headlines, its lesser talked about ‘cousin’ presenteeism has been busy spreading in workplaces up and down the country.

Presenteeism is when employees attend work when ill and are unable to perform effectively due to their ill health. This includes working more slowly than usual, producing lower quality work than usual, and, in some cases, making errors which would not have occurred if the employee was in good health.

Although the term ‘presenteeism’ was first coined in the 1980s, its impact on employees in terms of health and its impact on employers in terms of productivity has largely been ignored. And it is easy to see why. Presenteeism, unlike absenteeism, is generally a hidden problem – very few workers are going to freely admit that their output is less and of poorer quality because they are feeling unwell. For their part, employers have seemed to just accept its better to have someone in work doing something than them being off sick.

However, over recent years it has become more difficult to keep the presenteeism genie in the bottle. Study after study has revealed the high cost of not addressing it in terms of loss of productivity and worker health and wellbeing. One of the most recent pieces of research, published by the Institute for Public Policy Research (IPPR) in July, concluded that presenteeism costs UK businesses £25billion a year in lost productivity. This compares to £5billion lost because of sickness absence. According to the IPPR, on average, employees lose the equivalent of 44 days’ productivity each year due to working through sickness.

And don’t think that because your employees work from home for any or all of the working week that your organisation will be exempt from presenteeism. Last year’s Simply Health/ CIPD Health and Wellbeing at Work survey (based on responses from 918 organisations, covering more than 6.5 million employees) found presenteeism is just as prevalent among employees who work at home as it is among employees who work on site. Tackling this culture of digital presenteeism is one of the reasons behind the Government’s plans to introduce a ‘right to switch off’.

The health cost to employees of presenteeism is harder to measure but research shows that not taking time off when sick can slow the recovery time, increase the risk of further sickness later, and spread infectious illnesses to others – all of which lower productivity.

Why is presenteeism so prevalent?

Workers in the UK are among the least likely to take sick days than those in Europe and other OECD countries, the IPPR analysis found, and are more likely to work when unwell.

There are many reasons why employees decide to work when are unwell. One analysis of 24 studies into presenteeism found the self-reported reasons for presenteeism fell into three main themes:

• Organisational factors (organisational policy, presenteeism culture, disciplinary action)
• Job characteristics (lack of cover, professionalism, job demand)
• Personal reasons (burden on colleagues, colleague perceptions, threshold of sickness absence and financial concerns).

One 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. The Centre for Mental Health has calculated that presenteeism due to mental ill health results in losses to the UK economy of £41.8 billion each year.

Actions employers can take to address presenteeism

• Identify the problem: Assess the risks of presenteeism and identify the factors that encourage it, including workplace culture. Workplace culture is set by senior management and in order to stamp out presenteeism they should lead by example. In practice this means managers should: not come into work when they are ill; ensure that all employees know that if they are too unwell to work they should take time off sick; and send employees home when they are visibly unwell in the workplace.
• Review sickness absence policies and procedures. Strict attendance management policies, such as limited entitlement to absence days, threats of disciplinary action, and a lack of entitlement to sick pay encourage presenteeism. Statutory Sick Pay in the UK is £109.40 per week and only begins from the fourth day of sickness. The financial pressure this puts on employees to keep working when they are unwell is clear.
• Don’t incentivise attendance or use it as a trigger for bonuses.
• Ensure return to work procedures are in place following sickness absence and that managers are trained to carry these out.
• Engage with staff: Conduct a staff wellbeing survey to gain insights into factors that can lead to presenteeism, such as heavy workloads and lack of management support.
• Invest in wellbeing: Review what occupational health support is available to staff and promote health and wellbeing in the workplace, e.g. through workplace initiatives and an employee wellbeing programme. Any investment will pay off in the longer term as a result of better attendance and a healthier workforce, both of which improve productivity.
• Train managers to recognise signs of presenteeism (staff working when they are clearly unwell, staff working long hours, not taking breaks, minimising any health issues, becoming withdrawn).
• Check-in regularly with remote workers and ensure they are aware of any wellbeing support available.

Presenteeism is linked to future absences, a negative effect on wellbeing and chronic stress and burnout – all of which lower productivity. By focusing on promoting a positive working culture and developing sickness absence policies that reduce presenteeism, employers will benefit from better staff engagement and retention as well as an improved bottom line.