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Karen Steadman
Senior Researcher
Karen Steadman

Behind the mask of low sickness absence

Authors: Karen Steadman Karen Steadman

03 September 2013

I was interested to read the claim in today’s Metro (3rd September) that Brits are “less likely to pull a sickie than other European workers”. The study, based largely on data from the 2009 European Company Survey, notes the apparent drop in absenteeism in the UK between 2004 and 2009, contrasted with an increase in Germany (from 18% to 25%). Let’s all applaud our excellent health and strong work ethic… or is the picture perhaps a tad more complicated?

Leaving aside the difference between genuine sickness absence and “pulling sickies” in this story (for data on non-genuine sickness absence, see CIPD 2012 and CBI 2013), there are also other pressures which drive people take time off “sick” when not genuinely unwell. Inflexible workplaces can make it impossible for someone to take time off work at short notice, leaving ‘taking a sickie’ as the only option, for example when  there is a emergency related to their  caring responsibilities, or indeed, just to attend a medical appointment.

What the coverage of this study also fails to consider is that not being absent from work, doesn’t necessarily mean you are well enough to be there. Turning up for work when ill, or ‘presenteeism’ as it is commonly known, often masks levels of ill health in the workforce. Indeed, research undertaken  by The Work Foundation, at a large organisation, found that sickness presence was more prevalent than sickness absence, with 45 per cent of employees reporting one or more days of sickness presence compared with 18 per cent reporting sickness absence over the same period. Such high levels of presenteeism are reflected in the broader literature (see Johns 2010; CIPD 2012)

Not all employers consider presenteeism in their employees a bad thing, with a few still seeing it as a sign that their sickness absence strategy is working. However, the costs of presenteeism can be considerable – not just for the employee themselves in terms of their health and well-being, but also for the organisation.  On a basic level, someone attending work with a contagious illness may have implications for the health of other employees and exacerbate the issue – most of us know what it’s like when colds and flu circulate the office. More broadly though, presenteeism is related to lower workplace productivity. Some estimates put the costs at higher than those of absenteeism – the Centre for Mental Health estimated that mental health presenteeism alone  is 1.5 times the cost of absenteeism.

Presenteeism is often a reaction to various pressures – in and out of the workplace. A report by the Work Foundation identified self-reported reasons by employees for coming into work while unwell. Along with the nature of the illness itself, this included factors such as feeling pressure from managers and colleagues as well as self-pressure to come into work despite being unwell. Being stressed at work, and having a sense of responsibility for your workload and to your team are also often cited. This is compounded by factors such as having no-one to cover their workload, or indeed not trusting agency staff to cover their workload – this was raised in the Boorman Review of the NHS, where concerns about the quality of agency and temporary (ad hoc) staff cover were highlighted as a driver of presenteeism.

The external environment also creates pressure – in times of labour market insecurity, employees won’t want to give employers any reason to doubt their commitment – indeed, the CIPD found that organisations that are expecting redundancies were more likely to report an increase in presenteeism.  Given the data from the UK in the ECS report (Table 25) that almost a quarter of organisations surveyed (in 2008) cited a need to reduce staff levels, we can understand their concerns.

The implications of presenteeism don’t stop there – evidence indicates there may be an association between unwillingness to disclose ill-health at work, and unwillingness to disclose it anywhere – meaning that they might not be getting any support. Not raising awareness of, or seeking treatment for, a health concern at work may also lead to an exacerbation of the illness – turning what was once a manageable condition, into something more serious. This might then lead to poorer health and longer-term sickness absence – with serious implications for the employer, but also the labour market, the health and welfare system in addition to the individual and their family.

So, while there may be positives to take from the indications that sickness absence in the UK is decreasing, this must be taken with a pinch of salt - data like this can obscure the real health and well-being concerns of our workforce.