All present and correct? Getting on top of ‘presenteeism’ and ‘leavism’


Presenteeism (struggling into work when unwell) and leavism (using holidays or time off for catching up) can be as damaging to individuals and organisations as absence and sick leave. They can also be a sign of damaging deep-seated environmental, management or cultural problems. Steve Jackson outlines what organisations need to know and how OH can help.

A business dictionary definition of presenteeism describes it as “the practice of staying at work longer than usual or when you are ill or are suffering from a work-affecting injury, to show that you work hard and are important to your employer”. This type of behaviour can very quickly cause employees to grow tired more easily, have reduced morale and to be less productive than usual.

“Leaveism”, in turn, occurs where employees either use allocated time off (such as annual leave or rostered rest days) for sickness, take work home that they cannot complete in normal hours, or work while on holiday or during other leave to catch up. Employees demonstrating leavism are also more likely to be fatigued, struggle with morale and develop impaired cognitive functioning.

About the author

Steve Jackson is health, safety, and sustainability director at Make UK

Moreover, it may not be an either/or scenario. It is common for presenteeism to feed into leaveism, with stress-related illness resulting in unproductive time at work.

From a health and safety and occupational health perspective, both presenteeism and leaveism can have serious repercussions for workers and employers. They create risks that, with an effective health and safety management system in place (such as occupational health provision), can be avoided and can, in turn, reduce the impact on productivity, employee wellness and incidents.

Presenteeism and leavism are clear indicators of the deteriorating (mental) health and wellbeing of individuals. An unhealthy workforce can carry with it increased levels of stress. This in turn increases risks and accident rates in the workplace, all of which can ultimately result in the reduction of productivity in a business.

Research by the Centre for Mental Health, for example, has found that presenteeism arising from mental health problems alone costs the UK economy some £15.1bn a year, compared with £8.4bn a year from absenteeism. And these costs are only rising. The 2018 workplace absence survey by the CIPD/Simplyhealth showed the problem of presenteeism has more than tripled since 2010.

Signs of presenteeism or leaveism

Presenteeism and leaveism aren’t always easy to spot, especially when managers themselves are feeling under time or deadline pressure. Here are some of the warning signs to be looking out for.


  • Noticeable level of mistakes. Making more mistakes than usual is common
  • Poor quality work and/or low levels of productivity. This can be accompanied by a seeming lack of care or pride in the employee’s work
  • Poor time-keeping. Arriving late and leaving early, particularly if the employee is ill and can only just manage to work their contracted hours
  • Excessively long hours. In contrast to the above, others might sit at their desk for hours but struggle to get anything done
  • Working whilst obviously sick. This naturally isn’t so difficult to spot – tissues and paracetamol on the desk are often a clue
  • Showing signs of tiredness and exhaustion. Sometimes this can be accompanied by poor appearance or personal grooming
  • Erratic or aggressive behaviour, tearfulness and low mood. Deteriorating relationships with colleagues and poor communication can also be evident


  • Constant connection. Employees are rarely logged off, constantly available on the phone and frequently emailing outside of business hours
  • Reluctance to book or take annual leave. HR have to chase an employee to take their annual leave or they routinely carry over unused leave
  • Lack of trust and inability to hand over projects. Inability to “let go” of a project or entrust it to a colleague during annual leave
  • Cancelling annual leave at the last minute. Cancelling or postponing leave as soon as an important event occurs at work where the employee is reluctant to hand over to others
  • Finishing off work at the weekend or taking it on holiday in order to meet deadlines. Never completing proper holiday notes because the employee would prefer to complete the work themselves

Risks of presenteeism or leaveism

In our report Unlocking Employee Productivity, Make UK found that more than 60% of manufacturers intervene to assess the risk of physical injury and to promote better physical safety. Yet fewer than 15% assessed the risk that work can also damage mental health, and only one in five invested in measures to promote mental health.

Although there was a strong commitment among many manufacturers to employee health, safety and wellbeing, the majority of investment was still in traditional areas of risk assessment, prevention and the rehabilitation of those workers exposed to physical hazards.

However, for an employer, if you’re unable to spot leaveism or presenteeism in the workplace, you could be facing significant health and safety risks to you and to others in the workplace. Presenteeism and leaveism can trigger a range of employment law liabilities for your organisation.

These can include breaches of health and safety laws and risk of non-compliance. Having a robust health and safety management system such as ISO45001 in place can help to effectively manage and avoid unnecessary risk across your organisation, by ensuring your workplace is safe when carrying out tasks.

There are also potential business or operational issues, including the cost of an increased number of mistakes, low productivity poor performance including fatigue and stress and high employee turnover. The government’s Thriving at Work report estimated that presenteeism costs employers in the UK between £17bn and £26bn every year.

UK manufacturers are missing out on the chance to boost their productivity by failing to attach enough priority to the mental and emotional wellbeing of their employees. Improving manufacturing workforce wellbeing – as distinct from health and safety alone – we argue has the potential to improve labour productivity by on average 10% and in one study as much as 17%. This productivity impact is most pronounced when the mental health of employees is positive and when employees operating in “lean” production environments are given appropriate support, training and a “voice” in the way production processes are run.

Ways for occupational health to take action

A healthy workforce reduces levels of stress and subsequent risks in the workplace, leading to fewer accidents and, ultimately, reduced costs to businesses.

It is therefore crucial that employers recognise the need to support employees’ most important assets: their physical and mental health and wellbeing. We recommend a number of measures that organisations can take (or be advised to take by their occupational health provider) to help tackle leaveism and presenteeism in the workplace.

  • Monitor workload and compliance with legal obligations. In the current climate of job insecurity and “lean working practices”, many employees are susceptible to workload pressures. There are not always easy (or easily affordable) answers to improving workload distribution. However, organisations must be aware of their legal obligations when it comes to health and safety, as well as duties to make reasonable adjustments for employees who may be struggling due to a disability.
  • Do not rely on absence data as the sole indicator of employee wellbeing. Restricting the focus to absenteeism will often a give a misleading picture of employee wellbeing. Because of the often-secretive nature of leaveism and presenteeism, those responsible for health and safety need to look beyond absence statistics to judge how healthy their workforce is, and be alert to the warning signs mentioned earlier.
  • Encourage role modelling and a culture which doesn’t ignore (or promote) presenteeism or leaveism. Senior management can make a significant impact on reducing attendance problems by displaying positive wellbeing practices. These can include not working excessively long hours, encouraging regular, short breaks to replenish energy, and actually use their annual leave. Further to these, they can help by disconnecting from technology when on leave and making it clear this should be the norm for their employees, working flexibly, focusing on work outputs rather than hours or visibility, and removing the stigma associated with mental health conditions by sharing first hand experiences of dealing with stress or mental illness. Creating an “open door” policy across all managers is a great way for employees to feel less stigmatised and open to getting the support they need to operate safely and productively.
  • Cross-train employees. If people are showing up for work while they’re sick because there is no one else to take on their activities or they feel there’s no “back up” or cover, then cross-training employees may help alleviate that particular pressure.
  • Explore flexible working arrangements. More flexibility can help create a better work/life balance. Could the organisation look into initiatives such as flexi-time, compressed working weeks, job shares or shift work? It is also important to make sure people remain at home to recuperate properly or use flexible working arrangements in times of illness or personal trauma.
  • Provide line managers with training so that they can spot warning signs. Line managers need to be able to pick up the early warning signs of presenteeism and leaveism. They should be equipped to provide an adequate first response. This can be anything from holding sensitive conversations that highlight the problem through to signposting employees to specialist help. Mental health first aid training is one option that could be beneficial. Stress awareness, emotional intelligence and resilience training can also help build understanding and knowledge in key areas.
  • Develop an employee wellbeing strategy with buy-in from senior managers. An effective strategy engages employees and supports them in improving their wellbeing. This is relevant for both HR as well as health and safety. Affordable measures that target the actual needs of a particular workforce are recommended (rather than, say, just offering free fruit and yoga classes under a generic “wellbeing” approach and hoping for the best). A wellbeing strategy in any business should be supported and should work alongside a robust health and safety management system such as ISO45001.

Case study – ‘first you need to know where things are going wrong (and right)’

When a global technology company identified issues with presenteeism and mental health absence, it brought in Make UK to benchmark wellbeing across its UK and Ireland workforce, and help identify and prioritise improvements, writes Make UK senior HR consultant Clare Riches.

The company in question was a Fortune 500 multinational technology production company, active in the areas of robotics, power, heavy electrical equipment and automation. It employs nearly 150,000 employees worldwide, with 2,000 employees based in the UK and Ireland.

When the divisional HR manager looked into the most recent absence reporting figures, she discovered that the figures did not reflect the true picture. “We have people with anxiety, depression and mental health issues – but they often present with presenteeism rather than absenteeism – those individuals still come to work because they need the routine and structure,” she said.

Only by reviewing both the absence figures and details of individual cases, were they able to get a better view of the situation.

At a national level, one of the country HSE (health, safety and environment) managers looked into the number of days lost through stress, depression and mental health issues, and found these were significantly higher than those lost through safety incidents.

“We began to ask ourselves why our focus is much more on safety and less on health,” the divisional HR manager added.

Workplace wellbeing survey

These concerns led the company to engage Make UK to carry out a workplace wellbeing survey. This looks at the pressure on workers and whether this is affecting their physical and/or mental health.

The aim was twofold. First, to benchmark the wellbeing of the company’s local workforce and use that solid data to identify and prioritise the best course of action to improve wellbeing. Secondly, to create a baseline from which to gauge improvement and identify the next steps.

It was decided that participants in key company locations would have a confidential face-to-face conversation with a Make UK HR consultant around wellbeing. This would be supported by a wider workforce population completing an online wellbeing survey, thereby engaging the entire local workforce.

Good and bad in results

There were encouraging results. These included that people felt respected at work and that there were no issues with bullying or harassment.

But the results also showed line managers needed to become more flexible in their management style and improve their communication to their teams. Another significant issue that was flagged was working hours; it became apparent there could be unrealistic time pressures. Some people also felt they had little power to influence change.

Actions and benefits

The company immediately acted upon the results by improving its communications. One of these actions was to share the survey results with all the participating staff as a move towards more transparency.

A second action was the roll-out of a “Dignity, Diversity and Inclusion in the Workplace” course with the help of Make UK to ensure continued cultural change and best practice sharing and learning.

Thirdly, mental health first aiders were introduced, supported by a two-day mental health first aid course. Meanwhile, the national management teams were engaged in building a new UK and Ireland wellbeing strategy, as well as creating a set of training packages to support business improvements based on the key stressors identified in the survey results.

Although these campaigns and initiatives are still in their infancy and the outcomes cannot yet be quantified, what can be identified at this stage are the benefits of undertaking a wellbeing survey.

The company now clearly knows what is working well, how to build on this, and which areas need addressing. The company also now knows how to ensure behaviours are aligned with its company culture and values.

By living and breathing the survey results and recommendations, the company has sent a clear message to their workforce: your physical and mental health are as important to us as achieving our business objectives.

With this investment in its people, the company has clearly begun its journey to winning the hearts and minds of its workforce.

Make UK will re-run the online survey at least bi-annually to establish exactly how far the organisations has continued to come on its health and wellbeing “journey”.

Mental health at work: The business costs ten years on, Centre for Mental Health, September 2017,

Health and Well-being At Work, 2018, absence management survey, CIPD/Simplyhealth, 2018,

Unlocking Employee Productivity, EEF (now Make UK) with Westfield Health, May 2018,

Thriving at Work: a review of mental health and employers: An independent review of mental health and employers by Lord Dennis Stevenson and Paul Farmer, October 2017, Department of Health and Social Care and Department for Work and Pensions,

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