What does flexible working mean to you?

It could help the NHS retain nurses – but should mean more than accommodating childcare needs

It could help the NHS retain nurses – but should mean more than accommodating childcare needs

  • Flexible work practices in nursing are seen as patchy, ad hoc and reliant on managers’ goodwill
  • NHS has focused on the benefits for efficiency, rather than work-life balance for staff
  • Options such as job sharing, fewer hours and purchased leave should be open to all staff, not just those with children

The Timewise approach to team-based rostering encourages staff to discuss what they
want and contribute to an e-rostering system.

What does the NHS need to do to improve retention and recruitment of nurses? One thing that always features high on any list is provide more opportunities for flexible working to allow a better work-life balance.

The issue was debated at  RCN congress 2019 with a motion on how role design and job flexibility could help the health service to recruit and retain staff.

The motion said employers ‘seriously need to design roles across their organisations that are flexible and carer friendly, and this needs to start from the top of the health service down’.

‘We believe that changing the NHS’s approach would create huge opportunities for retaining talented people’

Claire Campbell, Timewise programme director

RCN south west London branch’s Mike Smith was one of the members who put forward the matter for discussion because of concern over the level of nursing vacancies and the strain that is putting on remaining staff. In England alone, nurse vacancies stand at an estimated 40,000.

‘We are facing a crisis,’ he says. ‘Flexible working needs to be addressed, because we can’t just let the haemorrhaging of the workforce happen.’

In a 2018 report on flexible working in the NHS, community interest group Timewise described the health service’s approach as ‘underdeveloped’. Its programme director Claire Campbell said: ‘We believe that changing this approach would create huge opportunities for retaining talented people.’

‘Flexibility is actually predictability’

Health and social care secretary Matt Hancock has said the NHS’s working culture needs to ‘accommodate how people expect to live and work now’. He is pushing for digital rotas to allow staff more input into choosing shifts that suit their lifestyle and for more roles that are not full-time.

But what is meant by flexible working? Many nurses already work flexibly – working different shifts, for example – but that is often about meeting the demands of the employer and may not feel flexible to the nurses. Unlike many other workplaces that have adopted more flexible approaches to the working day, the NHS has to deliver a 24-hour service and balance the needs of staff and patients.

NHS Employers chief executive
Danny Mortimer.

NHS Employers chief executive Danny Mortimer says: ‘Flexible working means different things to different people, but the most common themes are having a degree of control and influence on their rota and predictability. Much of what our staff mean by flexibility is actually predictability.’

Reliant on goodwill

Flexible working can go far beyond part-time work to include job sharing, seasonal work, career breaks, ‘purchased’ leave, phased retirement, and arrangements such as annualised or zero hours contracts.

The motion before congress 2019 said adoption of flexible practices in nursing ‘can be patchy, often ad hoc and reliant on the goodwill of individual managers’.

But it argued there is a strong business case for offering staff these opportunities. Employers who barely tolerate flexible working will find it harder to attract new staff, and end up spending more on agency staff.

Solution that suits everyone proves elusive

Nursing Standard asked members of a nursing forum about their experiences of flexible working. Many who responded were doing agency work – or considering switching to it – and said flexibility was an important issue for them that had not always been accommodated in the NHS.

One had asked a previous employer for fixed shifts but had then been given the shifts no one else wanted – a late day shift on Monday and Friday nights – as part of the deal. They eventually left. Another had turned to agency work when a request for part-time working was declined.

Others said short staffing on wards meant there was less flexibility, with nurses being made to work three or four consecutive long days or being put on a long day 24 hours after finishing a night shift.

Incompatible with family life

Established work patterns for some staff meant that others had to work around them and were unlikely to have their own requests met – something that the Timewise report picked up on. The main reason for many of them moving to agency work concerned spending enough time with families.

‘The NHS and 12-hour shifts are not compatible with family life,’ said one, with another saying childcare was the reason they turned away from permanent work. ‘I can work around childcare instead of trying to fit my children around work.’

Ultimately what emerged from nurses in the forum was that there was no single solution that suited everyone.


Greater job satisfaction

Mr Mortimer points to a report by the Chartered Institute of Public Finance and Accountancy that said people working flexible hours have greater job satisfaction, more commitment and are more likely to increase discretionary effort, compared with those in non-flexible jobs.

Flexibility can reduce staff turnover, which makes it attractive to employers. Restricting the opportunities for flexible working can result in staff leaving trusts – or leaving the NHS entirely.

‘What has been established is a hierarchy of staff needs, with childcare at the top’

Charlotte Gascoigne, Timewise director of research and consultancy

Charlotte Gascoigne of Timewise.

Historically – and on occasions grudgingly – the NHS has offered flexible working to staff with children, sometimes shortening their working day to allow them to collect children from school, introducing term time-only working or excusing them from shift work.

But the NHS should be thinking about staff with different reasons for wanting to work flexibly and ensuring they are also offered the opportunity to do so, says Timewise director of research and consultancy Charlotte Gascoigne.

She says some NHS organisations have tended to ‘ration’ special arrangements: ‘What has been established is a hierarchy of needs, with childcare at the top.’

Feelings of unfairness and resentment

Mr Mortimer says: ‘We know organisations can go further to support staff who work in different ways. Some NHS trusts are using different models of flexible working and developing more permissive cultures around flexible working to enable this.’

    Tweaking the roster to achieve work-life balance

    Helen Watson: Approach helps staff
    understand rota complexities.

    Birmingham Women’s and Children’s NHS Foundation Trust was the first trust to pioneer the Timewise approach to team-based rostering, with three wards involved.

    Nurses are encouraged to discuss what they want and contribute to an e-rostering system. This can help them to understand the constraints of the system better. Inevitably, not everyone can get what they want but the approach gives them a chance to air their views.

    Associate director of nursing for workforce Helen Watson says staff like the approach and feel more confident they will be listened to.

    The needs of the ward

    ‘On one of the wards there are clear examples of staff we have been able to retain and in one case increase their hours because they were assured they could get the hours they needed to balance their work and home life,’ she says.

    The team-based approach emphasises a shared responsibility to meet the needs of the ward – such as maintaining safe staffing or skill mix levels – and a ‘reason neutral’ approach to why staff want to work or not work at particular times, which values everyone’s reasons equally. There has been no resistance to the approach from staff who have children.

    Accommodating preferences

    While it may take longer to sort out the rota and accommodate people’s preferences, Ms Watson says it has widened the understanding of how complex drawing up a rota is. Ward sisters have the task of pulling together all the teams’ rotas.

    The trust offers nurses the opportunity to work flexibly and tries to accommodate requests where possible – even if it means working on a different ward.

    A full evaluation of the project is expected soon and the trust will then decide whether to extend it to other areas.

    While childcare may be the motivation for many requests for flexible working, there are many other reasons why people may not want to work full-time or want to avoid certain times of the year.

    Responsibility for older relatives is one, but nurses may also want a ‘portfolio’ career doing something different for a day or so a week, they may want to reduce commitments in their 50s and 60s ahead of retirement, or they may just want to get to a yoga class on time each week.

    Work-life balance and individuals' priorities outside of work can be factored into rotas
    and work patterns. Picture: iStock

    Offering some workers flexibility when there is a shift-based system can affect others and may lead to feelings of unfairness and resentment, Ms Gascoigne says. The language of flexibility has been focused on its effect on efficiency rather than the work-life balance that it can offer staff.

    Timewise has been piloting a new approach to flexible working in a number of NHS trusts, working with 250 nurses across seven wards in three trusts.

    ‘Reason neutral’ approach

    This has involved getting them to discuss what work-life balance means to them and moving towards a ‘reason neutral’ approach where everyone’s reason for wanting time away from the workplace is equally valued (see box).

    Mr Mortimer agrees that NHS organisations need to work with staff to understand what is important to them – and then develop solutions based on the needs of both services and staff.

    He says organisation leaders need to be clear, transparent and honest about the flexibility of flexible working in their trusts, and managers need to have the confidence to work with staff on solutions.

    Alison Moore is a health journalist

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