Presenteeism v sickness absence: which is more costly?

Absence is pretty easy to get your head around but, according to think-tank The Work Foundation, HR also needs to address the issue of presenteeism. Nic Paton looks at a growing, yet not always acknowledged, problem.

In a report published in April, in conjunction with health provider Axa PPP, The Work Foundation argued that the cost of presenteeism could match or account for one-and-a-half times more working time lost than the estimated £13bn annual cost of sickness absence (see key findings in box below).

The report also argued sickness presence was a much more prevalent malaise than sickness absence and could prompt higher levels of the latter, as well as simply being a drain on productivity and competitiveness – both key issues for employers as we come out of the recession and the economy moves into (albeit slow) recovery.

As the report’s lead author Katherine Ashby explains: “If you are tackling the underlying factors related to sickness presence, you will be reducing absence, too.

“For HR, it is about raising awareness around sickness presence. It is being aware of it as an issue, acknowledging it could be having a negative impact, and monitoring it. Is it something line managers know about and could be looking at more?” she adds.

Key findings

  • Sickness presence is significantly related to performance, associated with lower line manager supervision and assessment, reduced psychological wellbeing and increased levels of sickness absence.
  • It is more prevalent than sickness absence, with 45% of employees reporting one or more days of sickness presence against 18% reporting sickness absence over the same period
  • Personal financial difficulties, work-related stress, perceived workplace pressure (from senior managers, line managers and colleagues) to attend work when unwell were found to be key contributing factors.
  • As well as reporting a higher number of days’ sickness presence, employees who perceived pressure from managers and colleagues to work when unwell were also more likely to report their performance was adversely affected by working when unwell.
  • Employees who were unable to adjust their work around their health problem were also more likely to report that their performance was adversely affected by working while unwell, while employees who had money worries had a significantly higher number of sickness presence days.
  • Sickness presence can act for employers as a useful bellwether of general employee health and wellbeing.
  • Employers that focus solely on sickness absence may be at risk of underestimating employee ill health and missing important warning signs.









The Work Foundation report follows on from a survey last September by healthcare provider SimplyHealth, which argued that fears over job security and redundancy during the recession had led to a sharp rise in presenteeism, with two out of five workers admitting to not having taken a day off sick in the previous 12 months.

In March, the TUC announced that around a fifth of public sector employees had worked when ill during the previous month, while more than four in 10 had done so over the previous year – as well as more than a third of private sector employees.

Key recommendations

  • Organisations should look at how they are applying absence management policies and how, or whether, these are properly understood by managers.
  • The capability of line managers to deal with work-related stress, including any managerial and organisational causes of reduced psychological wellbeing and stress, should be prioritised.
  • Organisations should embrace the fit note as a constructive opportunity to review how managers and their teams are working together to adjust work for employees and accommodate any health problems.
  • Employers should consider whether it makes sense to offer workplace-based financial support for employees.
  • HR should assess the need for ongoing monitoring and evaluation of employee health and wellbeing, and evaluate the effectiveness of any targeted interventions.

But when it comes to presenteeism, the challenge for most hard-pressed employers is neatly summed up by Ivan Robertson, managing director of Robertson Cooper. He says: “If someone is working at 80% capacity, for a lot of employers that is going to be 80% better than them not being there at all.”

Another challenge for HR, argues Sayeed Khan, chief medical adviser at manufacturers’ organisation EEF, is “how ill is ill” when we are talking about sickness presence.

“Then there is also the issue of the work you do,” he adds. “Are you the only person doing that job in your workplace, and so will have a huge pile of work to come back to if you do take any time off? In that scenario, struggling into work if you are not too seriously ill can seem like the lesser of the two evils.”

To complicate matters, there are other forms of presenteeism, many of which are simply performance management-based, Khan suggests. “You can get unmotivated presenteeism, or simply incompetent presenteeism, for example. So it needs to be broadened out and dealt with as a wider performance issue.

“It is important for HR to not just be concentrating on sickness presenteeism, but identifying those workers who are unmotivated, lacking training or are just incompetent. What is going to help them to do their jobs better?”

But there is a strong argument for HR to be taking a more innovative approach to health and wellbeing and not getting so overly focused on absence and attendance, argues Ian Clabby, employee engagement manager at Axa PPP.

He says: “It seems to me that this ought to be challenging us to think more innovatively. There is an emphasis within the HR world on absence management and I am beginning to think that may be misplaced, and we ought instead to be focusing on health management.

“A lot of organisations track absence and monitor trends, but how many organisations map health? Absence management is clearly a key issue, but perhaps it ought to be a sub-set of the whole wellbeing agenda, rather than the other way around,” he suggests.

“Education is going to be the key. A lot of presenteeism can be characterised around psychological rather than physical ill health. If you are stressed or anxious and still trying to perform, you are not going to be able to concentrate as well for however many hours you are there. So it is about helping managers to be receptive to these issues and how to detect early-stage mental ill health,” he adds.

HR should be thinking of presenteeism as simply another risk issue related to performance and competitiveness, and which needs to be tackled in much the same way as any other equivalent risk issue, argues Adrian Farley, HR director at Maidenhead-based software consultancy Strategic Thought Group.

“For us as a small company – with just 80 employees in the UK and US – and where everyone will have laptops, there is often a blurring about whether people need to be in the office to work. So in that context, a lot of the time if someone is feeling under the weather they may ring in but then may also continue to do some work from home,” he points out.

“A worse problem, if anything, is people struggling in and then spreading bugs around the organisation. I think there are various degrees of wellness and sickness, and it is different for everyone. If you have a workplace that has flexible arrangements, it makes it much easier to make these decisions.

“It is HR’s responsibility to reduce risk and increase opportunities for the workforce,” he adds. “So it may be about looking at putting in more flexible working, and whether the business can afford to accommodate that model. But then you have to ensure that if people are working from home, that it is not under sufferance.”

Another issue is whether the new fit note will be a help or hindrance in terms of dealing with presenteeism.

The EEF’s Khan argues it may actually help, by generating a more formalised, structured debate between GPs, employers and (if they have access to them) occupational health departments around exactly what it is “sick present” workers can and cannot do, particularly when they are manual workers.

Similarly, Axa’s Clabby argues the fit note will in time lead to more of a focus on adjustments and how they should be made.

“The fit note is potentially a very good thing. It will require people to be more inventive and creative when considering return-to-work opportunities. But at the same time, you don’t want to be creating a climate where people are coming into work when they should not be,” he argues.

What employers need to be doing, advises the Work Foundation’s Ashby, is exploring the reasons behind sickness presence, particularly any work-related “triggers” that could lead to sickness presence becoming more prevalent. And what a lot of this debate leads back to is the whole issue of “good work”, or how well-designed jobs – where there is flexibility, good management and workers feel more in control – can all help improve motivation, job satisfaction and productivity.

Ultimately, businesses have to ensure they understand how to create the best, most productive working environment possible, argues Alex Gourlay, chairman of Business Action on Health and chief executive of the health and beauty division at Alliance Boots.

Too often in this context, health and wellbeing initiatives will simply focus on things such as healthy eating, physical activity or health promotions. While often popular in workplaces, there is an argument for employers – with HR taking the lead – to think more widely around this issue and look more closely at the relationship between health, presence and performance.

“People who are fully present will be physically and mentally much more productive. Employers need to be prepared to listen and develop their line managers to understand their responsibilities,” Gourlay argues.

“The cost of absenteeism is a relatively easy one for the business to focus on. But there is a bigger prize underneath,” he adds.

Further reading

Majority of staff return to work while sick

Sickness absence debate: can absence be cured?


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