At some point, all employees will experience physical or mental ill health. Depending on its severity, time off may be necessary to recover properly. However, workplace pressures, looming deadlines, job insecurity, or cultural expectations of ‘pushing through’ can discourage employees from actually taking sick leave when they need it.
It is often described as the opposite of absenteeism, but it can be even more prevalent – and even harder to deal with. Left unchecked, presenteeism can quietly undermine both individual health and business performance.
How big a problem is presenteeism?
The Institute for Public Policy Research (IPPR) estimates a £25 billion1 extra ‘hidden cost’ to businesses from lower productivity among people working through sickness – with just £5 billion down to rising sick days.
Workers in the UK are among the least likely to take sick days, especially compared to other OECD and European countries. However, they are more likely to persevere at work through sickness, which can have a productivity cost.
What does presenteeism look like?
Presenteeism occurs when employees attend work despite being unwell—whether physically, mentally, or both—and are therefore unable to operate at their usual capacity.
Why does presenteeism occur?
Research from occupational health bodies and mental health charities identifies several contributing factors:
- Unreasonable workloads and deadlines
- Poor company culture
- Lack of paid sick leave
- Job insecurity
- Pressure to demonstrate loyalty
- Managerial pressure to ‘perform’
- Understaffing
- Fear of negative consequences for taking leave
- Unpaid sick leave
- Burnout and chronic stress
The consequences of presenteeism
1. Productivity loss
Employees working while sick or stressed cannot perform at full capacity. The Society of Occupational Medicine2 highlights that presenteeism often results in greater productivity losses than absenteeism because impaired employees remain at work but produce less effective output.
2. Increased errors and safety risks
Illness and fatigue can impair concentration and judgement. In high-risk sectors such as healthcare, manufacturing, and construction, this can increase the likelihood of accidents or safety breaches.
3. Financial costs
There is a financial cost to underperformance, in terms of lost output, errors, and engagement.
4. Spread of illness
When employees attend work with contagious illnesses they risk infecting colleagues.
5. Long-term health damage
Working through illness can prolong recovery and worsen conditions. Left unchecked, presenteeism can escalate minor health concerns into chronic physical or mental health conditions.
6. Erosion of morale and culture
A workplace that implicitly rewards working while unwell may foster resentment and disengagement. Healthy employees may feel pressured to follow suit, creating a culture where wellbeing is deprioritised. Over time, this can increase turnover and damage employer reputation.
Presenteeism and mental health
The link between presenteeism and mental health is particularly concerning. According to a 2025 YouGov survey of 4,418 UK adults3, 21% reported that high stress or pressure negatively impacted their productivity, yet they did not reduce hours or take time off.
Chronic stress is strongly associated with burnout, anxiety and depression. Mental health-related presenteeism often goes unnoticed because symptoms are less visible than physical illness, but the impact on cognitive performance, decision-making and engagement can be profound.
Creating psychologically safe workplaces—where employees feel able to speak openly about workload and wellbeing—is essential to breaking this cycle
Why tackling presenteeism matters
Managing presenteeism is not simply about encouraging time off; it is about protecting long-term productivity and organisational sustainability.
Reducing presenteeism can help prevent:
- Future absenteeism
- Poor morale
- Reduced engagement
- Increased turnover.
While one employee taking necessary leave may seem disruptive in the short term, across an entire workforce the long-term financial and cultural benefits are substantial.
How to manage presenteeism in your business
1. Create a clear presenteeism policy
Define what constitutes presenteeism, clarify sick leave rules, and outline available support. Transparent sick pay policies reduce financial anxiety and encourage responsible recovery.
Flexible working arrangements—where appropriate—can also reduce pressure while maintaining output.
2. Manage absences effectively
Structured absence management should include:
- Clear reporting procedures
- Recording and monitoring
- Return-to-work discussions
- Reasonable adjustments
- Transparent sick pay guidance.
Effective absence management prevents both misuse and silent overwork.
3. Lead by example
Leadership behaviour sets cultural norms. If senior leaders regularly work while ill or glorify overwork, employees are likely to follow. Modelling healthy boundaries reinforces expectations.
4. Set boundaries in high-risk sectors
In industries where safety is critical, working while impaired poses serious risks. Clear policies and disciplinary procedures may be necessary to protect both employees and the public.
5. Identify root causes
Anonymous surveys and one-to-one discussions can reveal workload issues, unrealistic deadlines or cultural pressures contributing to presenteeism. Addressing root causes—not just symptoms—is essential for sustainable change.
6. Empower line managers to signpost to health support services effectively
Your line managers are on the frontline of dealing with sickness absences, and with presenteeism. It’s really important to train and empower them to signpost to your health support services effectively.
That means, for instance, making sure they understand all the Equipsme health insurance benefits and feel confident in supporting employees to use our services when they need to.
Summary
Presenteeism isn’t always a problem, but it can be a silent cost that accumulates over time. While employees may appear dedicated, the long-term impact on productivity, safety, morale and health can be severe.
Building a culture that prioritises wellbeing is not a soft benefit—it is a strategic investment. By supporting recovery, encouraging open dialogue and implementing clear policies, businesses can protect both their people and their performance.
References
1 www.ippr.org/media-office/revealed-hidden-annual-cost-of-employee-sickness-is-up-30-billion-since-2018
2 Understanding_Sickness_Presenteeism_May2025.pdf
3 Mental-Health-UK-The-Burnout-Report.pdf
All our information is desk-based research from credible sources only, including the NHS and medical/disease charities.
Author: Abi Stevens
Date created: July 2026
