Poor mental health costs UK employers around £51bn a year, and the single largest part of it is not absence. It is presenteeism: people who are at work but unwell, depleted or distracted, and performing well below their capacity. Deloitte puts that figure at roughly £24bn a year. It is the biggest line in the bill, and the one that never shows up on an absence report. That is exactly why it goes under-managed.
Why presenteeism costs more than the absence it hides
Most organisations manage attendance carefully. Absence is logged, reported and reviewed, because it is visible and easy to count. Presenteeism is the opposite. The person is at their desk, marked as working, and counted as a full day’s contribution. The lost capacity is real, but nothing in the system records it.
This is why the costs are so lopsided. When someone works through illness, stress or exhaustion, the output drops, mistakes increase, decisions slow down and the work takes longer. The cost does not disappear because the person showed up. It just stops being measured.
The Centre for Mental Health has estimated that presenteeism accounts for around 1.5 times as much lost working time as absence, and that it costs employers more, partly because it is concentrated among higher-paid staff who feel the most pressure to keep going. The expensive half of the problem is the half nobody is counting.
Presenteeism costs UK employers around £24bn a year, the single largest component of the £51bn annual cost of poor mental health, and more than absence. Deloitte, Mental Health and Employers, 2024
Presenteeism isn’t absence, and it isn’t burnout
Presenteeism is easy to confuse with two things it is not. It is not absence, because the defining feature is that the person is present. And it is not burnout. Burnout is a clinical state of chronic exhaustion that builds over a long period. Presenteeism is a behaviour: turning up and working anyway when you are not in a fit state to do your best work.
The distinction matters because the causes are so much broader. Someone can be present and underperforming because of a heavy cold, a migraine, poor sleep, caring responsibilities at home, anxiety, grief or money worries. Most of those have nothing to do with burnout, and they can affect anyone in any week. Treating presenteeism as only a burnout problem misses the great majority of where it actually comes from.
It also matters for measurement. Burnout shows up eventually as absence, attrition or a crisis. Presenteeism, by design, shows up as nothing at all. Which leads to the trap most reporting falls into.
A falling absence rate is usually read as good news. It can be. It can also mean people are pushing through instead of recovering, which stores up bigger problems later. The number looks the same either way, so it cannot be trusted on its own as a measure of how your people are actually doing.
How presenteeism shows up day to day
You will not catch presenteeism with a symptom checklist, because it is a pattern rather than a single behaviour. CIPD research has found that over half of UK employees have worked while unwell in the previous three months. So the question is not whether it is happening in your organisation. It is where, and how much. These are the signals worth watching.
- People logging on while signed off sick. A reported absence that comes with emails, messages or quiet work behind the scenes is presenteeism wearing absence’s clothes.
- Output drifting down while attendance stays full. When the hours are all there but the work is slower, thinner or more error-prone, capacity has dropped even though presence has not.
- The hybrid always-on pattern. Team members online early, late and at weekends, where constant availability gets read as commitment rather than as a warning that someone cannot switch off.
- Low absence and low engagement together. This is the clearest single signal, and the one most reporting never surfaces, because the two numbers almost never sit on the same page.
None of these are visible in an absence report on their own. The way to see presenteeism is to put capacity signals, engagement, energy and quality, next to the attendance data you already collect, and look at where they disagree.
Building resilience is how you reduce presenteeism
The instinctive response to presenteeism is to tighten attendance policy. It does not work, because attendance was never the problem. People are already showing up. Tightening the rules just pushes the lost capacity further out of sight. The real lever is capacity itself, and the most direct way to build it is resilience across the workforce.
Resilience is the practical ability to adapt to pressure, recover from setbacks and sustain energy over time. It is a set of teachable skills, not a personality trait, and when people have them, being present is much more likely to mean being able to perform. Because presenteeism happens at every level, the capability needs to be built across the whole workforce rather than reserved for managers.
Skills alone are not enough if the culture works against them. Two things make the difference. The first is permission: people only step back to recover when they genuinely believe it will not count against them, and that belief is set by what leaders do, not by what the policy says. The second is what gets rewarded. If hours and visible availability earn approval, people will keep supplying them on empty. Recognise output and recovery instead, and watch for the tell-tale gap of full attendance with falling output.
Finally, measure it. Put engagement and wellbeing signals alongside absence data, segmented by team and manager, and treat low absence with low engagement as a flag to investigate rather than a result to celebrate. What gets measured is what gets managed, and right now most organisations only measure the cheaper half.
Q3 tends to be quieter, which makes it the natural window to build resilience across the workforce. Put the capability in place over the summer and it is ready for the autumn workload and the winter illness season, rather than being a scramble once people are already running on empty.
Build a more resilient workforce
Our Resilience training gives your people practical tools to handle pressure, recover from setbacks and sustain their energy, so being present means being able to perform.
Enquire about Resilience training