Lewisham & Greenwich NHS Trust’s maternity service has found a unique way to fill vacant slots on the roster – by carving shifts up into smaller slices and offering choice.
Lewisham and Greenwich NHS Trust are an accredited Timewise Trust – an accolade that is awarded to Trusts that demonstrate commitment to enabling flexible working for their teams Part of this is developing creative and innovative approaches to working patterns and arrangements.
Any Hours is an example of such innovation. The immediate post-pandemic period inspired ‘Any Hours’, the brainchild of Susanne Chatterley, Associate Director of Midwifery & Neonatal services at Lewisham and Greenwich NHS Trust. More than 300 midwives work across the Trust, delivering 5,000 – 7,000 babies a year.
A standard shift in midwifery is 12.5 hours and is set at 8.00am – 8.30pm, or 8.00pm – 8.30am.
A full time job requires working 13 shifts across a month – 3 weeks of 3 x shifts and 1 week of 4 x shifts. There are typically unfilled shifts within any NHS roster. The Nuffield Trust estimates that there around and around 8,000 to 12,000 unfilled nursing vacancies on a given day in England. In many cases, existing staff try to take on extra shifts where they can, or else agency staff are used. Traditionally in the NHS taking on an extra shift requires commitment to the full 12.5 hour day.
Susanne realised she could boost capacity by challenging the ’12.5hrs only’ mindset, when it came to filling vacant shifts.
She says: “In 2022, we had just gone through the second significant bout of Covid. I recognised that we had one group of experienced midwives who routinely picked up one or two extra 12.5 hour shifts a week – and these were the staff who were burning out. There was also a second group, with just as much experience, but who simply couldn’t pick up such lengthy additional shifts. They wanted to help their colleagues – but had young children to pick up from school, or elderly relatives to look after in their day. I thought to myself – how do I unlock this group, and how can I help the staff experiencing burnout? Then I thought – what if staff could choose their extra hours? What if they could stipulate how much extra time they could give – 3, 4, 8 hours, whatever it is – and choose when to work them?”
Susanne had a conversation with the midwifery team and followed with a survey to see if they’d like to work extra paid shifts and what hours they would pick if it was up to them. The results came back showing a strong desire to work more, especially against the background of the cost of living crisis, but that for many midwives, an extra 12.5 hour shift was too long. Susanne says: “All I had to do, was make it work.”
That was two years ago. The scheme has been an outstanding success. Wherever there are shifts that are unfilled, Any Hours allows midwives to choose the number of additional hours they want to work, and when they would like to work them. Lewisham and Greenwich NHS Trust data shows that since the Any Hours Scheme was enacted, it has it has enabled, on average, 300 hours of shifts to be filled each month, equalling two whole time equivalent midwives. This has reduced reliance on agency staff, and increased satisfaction with the team.
This has been achieved without buying in any additional software or making significant changes to the online rostering system staff already use to book shifts via their phones.
Susanne says: “The key difference is that all unfilled shifts are open to ‘Any hours’ – I let them ask for any additional hours they want, whatever the length and whenever they are. We always end up with a much fuller roster than we have had in previous years.”
“I also have a rule which is ‘hard stop’. We let staff finish their shift exactly when expected. If we start keeping people beyond the agreed shifts then the whole system starts to fall apart. It works because people feel they have autonomy, control and balance.”
“We also worked hard on making sure the extra shifts would work. Patient safety is of course our paramount concern. We spent time with senior clinical colleagues to think about how a 3, 4, or 5 hour extra shift would work. In terms of patient care, we wanted to ensure women have the same person with them as much as possible through their journey.”
“When you start thinking about shorter chunks of time, say a 3 or 4 hour shift rather than a 12.5 hour one, you need to think through – what can you usefully do in that period? It isn’t enough time to start a birthing journey with a patient. But you can support the whole ward and the midwives who are doing that. You can do baby checks so others can go home sooner, you can do the drug rounds, you could maybe host 1 clinic, or do postnatal visits. The key was finding jobs that fit the shorter hours.”
“And what I found was – people got really creative! One midwife comes at 11pm and she stays until 5 or 6am. I would never ask anyone to do that kind of shift routinely, but for her, it means she can work while her own children sleep and she is back for the school run. It fits her life.”
“We really saw the benefits over the Christmas period. Staffing is always a headache at that time of year, you usually end up redoing the rota 2 or 3 times and invariably end up short of staff.”
“But last year, I crunched the numbers after Christmas and realised we had equal to 4 whole-time equivalents more than usual– the best fill rate we have ever had. All those shifts would have otherwise been unfilled. People came in, working in 3 or 4 hour bursts to help out, and for the extra money at an expensive time of year. I felt all warm and fluffy on the inside when I saw that! I spoke to colleagues – they said they would never have come in to work a full extra shift because it would have interfered with their plans. What’s brilliant is – we are retaining staff known to us, with experience and skill who knows the service inside out, rather than having to just use agency staff.”
“The scheme has been going for two years now, and is well established. I don’t think I have ever turned anyone down – we are always able to offer what people want. The key has been flexibility and handing over a sense of control. People now have their regular patterns they have fallen into. Patterns that suit their lives.”
“What’s exciting is that Any Hours is completely replicable across the board. It works within the existing system. It can work in other departments, and for other Trusts.”
Any Hours is a part of Susanne’s doctorate, focusing on midwives who take up and use the offer, and colleagues who work with them. Susanne is completing a DBA in Business Administration at Aston University; Business School in Birmingham.
Susanne is already working on her next innovation project: ‘Any Speciality’, aiming to retain midwives who are 5 years + qualified (though those who are less qualified can also take part).
Any Speciality is a programme that encourages all midwives to spend 15 hours a month, or two days, in a different speciality of their choice. This allows colleagues to improve the competencies and skills needed to help their career progression, or even to directly apply for a specialist midwife role at the trust. To date, speciality teams have recruited nine midwives following Any Speciality contact at Lewisham and Greenwich NHS Trust.
Susanne says: “The opportunity is to ‘try before you buy’, when looking at another speciality as a possibility. I took one of the many of vacancies I had and chopped it up into 10 pieces, which leaves you with 15 hours a month (one tenth of a full time job). We offer this to anyone who has an interest in another speciality. The jump between core to speciality midwife is really big nowadays. And often, when someone makes the jump they don’t realise what they are signing up to – and they drop out or move on quickly if the role is not what they expected it to be.”
“Any Speciality is available for 1 year after that time – you may realise you hate it! That’s ok – you have tried it. You aren’t locked in. Or you just might love it. When the right job comes up, you can apply for it as you have the lived experience.”
Published July 2024
