The plan’s focus on flexible working marks another step forward – now the NHS needs to take action to turn its commitments into reality. Here’s how to do it.
By Melissa Buntine, Principal Consultant, Timewise
The launch of the NHS Long Term Workforce Plan is a hugely welcome development. The staffing crisis has been an ongoing issue within the service, with the RCN seeking legislation to protect safe staffing levels as far back as 2017. And in the intervening years, organisations within and outside the medical sphere – including Parliament’s cross-party Health and Social Care Committee – have warned that the number of unfilled posts (currently standing at 112,000) is a risk to patient safety.
The NHS took a big step towards tackling the problem with the publication of its People Plan 2020/21, which recognised the importance of flexible working as an attraction and retention tool, and committed to encouraging its employers to offer it from day one. And here at Timewise, we’ve also been focusing on this issue, working with 93 English NHS organisations last year on the Flex for the Future programme, to support the transition to more flexible working practices.
So we’re delighted that the Workforce Plan puts flexible working in the NHS at the heart of its measures, and recognises the impact it can have on staff shortages. But we also know that it will take a concerted effort to bring these commitments to life.
The plan’s commitment to “highlighting the flexibility and autonomy that NHS staff enjoy” is hugely positive, but making sure that this flexibility is fit for purpose is something else entirely. And while the People Plan’s day one flex commitment put the NHS ahead of the flexible working curve, the new legislation that makes this a UK-wide right softens that edge – and increases the likelihood of potential employees finding better-paid flexible opportunities elsewhere.
The NHS therefore needs to not just offer and highlight flexible working, but to champion it, from top to bottom, and make sure it works in practice. Here are four actions that the service could take to make this a reality.
1. Be more proactive about designing part-time and flexible roles
As in many organisations, there’s a tendency within the NHS to wait until people are about to leave, panic, then try to work out how to persuade them to stay. Flexible working is a brilliant retention tool – but instead of waiting until people have had enough, it makes more sense to offer it proactively, and to work with each individual to explore what kind of flexible working matches their needs.
We know from experience that there’s a real lack of confidence within the service about flexible job design, but it isn’t rocket science; at its core, it involves looking at when, where and how much people want or need to work, and designing the job to match. We can help.
2. Offer alternatives to the 12.5-hour shift norm
Again, as in many longstanding organisations, there’s a feeling across the NHS of “It’s always been done this way… if it ain’t broke, don’t fix it.” The length of a standard shift – a back-breaking 12.5 hours – is a perfect example of something that could merit a fresh look.
Leaders need to have the confidence to challenge this norm, and explore whether other alternatives could also work. Would it be possible to offer 6-hour shifts instead, which might be easier for people who are juggling family or caring responsibilities, or with health conditions? What would be the impact on staffing levels if they did?
3. Embrace self-rostering to give staff a say in when they work
The NHS has a high proportion of frontline staff, who work on a 24/7 shift pattern. Historically, these employees have had shifts imposed on them, and have needed to be available at any time, which is not helpful for anyone’s work-life balance. But thanks to developments in technology, it’s now possible to build rosters which take people’s preferences about when they do and don’t work into account.
We’ve previously piloted a team-based approach to rostering within nursing, using our ‘shift-life balance’ model, and found that it increased the feeling that work-life preferences were being met (from 39% to 51%), and improved the sense of a strong collective responsibility (from 16% to 36%). Both of which, clearly, are key to creating an environment in which people want to stay.
And right now, we’re working with several clients, including UCLH and Guys & St Thomas’, to introduce a self-rostering model. This allows team members to input their preferences into a roster, with ward managers then making final decisions to ensure safe staffing levels and the right skills mix. It’s a win-win, with staff really valuing the chance to have some input, and managers finding it can make the roster building and approval process much more efficient.
4. Make sure that all training can be done flexibly
The plan rightly places a big emphasis on training, both in terms of growing and upskilling the workforce. But in both cases, this training needs to be delivered in a way that is accessible to those who need to work flexibly. Otherwise, key groups who need flexibility to work – including, but not restricted to, parents, carers and those with health conditions – will fall behind their peers and potentially fall out of the workforce, or be prevented from joining it in the first place.
Clearly, changes like these take time to implement – and they won’t happen without board-level buy-in. So the NHS needs its leaders to step up now, and lead from the top, driving the behaviour change that the service needs, and even incorporating flexibility around ways of working as a design principle for their services. Professor Joe Harrison and his leadership team at Milton Keynes University Hospital are great examples of what can be achieved when leaders are vocal about the benefits of flexible working within the NHS.
It also needs to make sure that managers and HR teams have the skills they need to design and implement flexible roles. That means teaching them about the benefits of flexible working for the organisation and its staff; upskilling them in flexible job design; and training them in how to manage flexible teams. Our Flex for the Future programme set out how this can be done.
And finally, for all these recommendations to really take hold, they need to be applied across NHS systems, rather than on a trust-by-trust basis. We’re currently working with three systems –Lincolnshire, Kent & Medway, and Hampshire & the Isle of Wight – and are already seeing the value of bringing together the different parts of a local health and care system to collaborate on strategy, resources and learning. Implementing flexible working across the NHS in this way could be transformational.
And a transformational approach is what’s needed; as the Workforce Plan acknowledges, “Inaction in the face of demographic change is forecast to leave us with a shortfall of between 260,000 and 360,000 staff by 2036/37.” Patient safety is already at risk with today’s shortfall, and we can’t afford to let it get worse. The plan is an important step in the right direction; now let’s act on it.
Published October 2023
