Can flexible working become the default in the NHS?

Blog posts

9 Sep 2024

Astrid Allen, Senior Research Fellow

Echoing a pledge made by the outgoing Conservative government in 2019, the newly elected Labour government has announced they will make flexible working the default. Many will be asking if this will turn out to be another empty promise. Is it really possible to make flexible working the default for everyone, for example, in the NHS?

The challenges for flexible working in the NHS

The NHS is the UK’s largest employer and has many frontline roles that are considered ‘hard to flex’. A recent IES flexible working review conducted with NHS staff revealed that, while managers recognise the benefits of flexible working in principle, they often find requests difficult to implement in practice.

Ensuring that the required skill mix is in the right place at the right time is an enormous logistical effort for NHS managers. A request from a member of staff to have more control over when or where they work presents a challenge, as managers do not always have a pool of skilled staff readily available to backfill gaps. Flexible working requests are, therefore, often dealt with through a process of prioritisation and negotiation, to minimise change and immediate impact. Employees we consulted said that that, as well as job role, staff’s access to flexible working was dependent on the perceived level of personal need for flexibility, their seniority/influence and level of trust with their line managers.

You may have thought that we would find that clinical staff resent the flexible working options afforded to their non-clinical colleagues. However, our research revealed that non-clinical staff in lower-level administrative roles felt excluded from flexible working (when compared with senior clinician colleagues, who were sometimes working flexible hours from home).

Other challenges are very much like those we see in other sectors. Desk-based staff feel that there is a pressure to return to more in-office working. More generally, staff that have informal flexible working arrangements are fearful of losing them, particularly when a new manager comes in.

“…at the moment the rotas are covered voluntarily and there's a new manager who wants to make the duties compulsory and have everything on e-roster … and since we've had discussions about changing over to this compulsory rota, where people no longer have the flexibility to work voluntarily at the weekends and do night duties, we've gradually been losing quite a few very good and experienced staff.”

Clinical employee

Why is flexible working important to the NHS?

Recruiting and retaining skilled staff is crucial to deliver the NHS services we need now and in the future. However, work-life balance has become the main reason given by staff for leaving the NHS. It is, therefore, essential that the NHS can find a way to widen access to flexible working opportunities and enable all staff to achieve the work life balance they need.

Our research showed that when staff feel their requests have not been sufficiently considered or accommodated, they can disengage, take more sickness absence and/or leave their jobs. It also revealed significant latent demand for flexible working. Although managers perceived a high level of expectation from staff for flexible working requests to be granted, staff said they are often reluctant to request it in the first place.

Despite this disconnect, there was a strong consensus that flexible working is central to the recruitment and retention of staff in all roles across the NHS. When it comes to competing with other sectors for talent, improving diversity and supporting people to work in a productive and sustainable way – flexible working was seen as key.

“Already we're seeing, you know, people may leave us to go somewhere else because they're giving them more chance to work from home or work remotely. And, so, you're competing with cultures that might well be much more flexible than [our organisation] is.”

Office based employee

A way forward for the NHS and beyond

Where it works well, flexible working is seen as the solution, not the problem.

Our research identified opportunities to adapt processes around how NHS services are delivered to support flexible working and service improvement. For example, some employees suggested that services could be delivered outside of traditional office hours.

“We use only a third of our assets as a Trust, because the buildings, the clinics, all these areas, are only used 8 to 5. I’m sure a lot of admin teams and a lot of the nurses would probably feel better if they did a clinic from 5 to 8:30pm, the way a lot of GP surgeries work. It would suit their childcare. It might suit their partner’s pattern of work. They just need to ask people if they are willing to do that, because we’re just programmed to do 9 to 5 jobs for elective work.”

Clinical employee

Our recommendations focused on changing the way work is done by asking teams to take the lead, bringing about culture change through piloting new approaches and sharing success stories.

Testing the water with a flexible working review is the first step, creating a safe space for employees to voice their experiences and expectations of flexible working. It allows employers to assess the need for change, gain invaluable insights on how existing ways of working can be shifted, and pave the way for future pilots. Useful outcomes from our research included:

1)    Revealing a latent need and policy to practice gap and a need for parity of opportunity for staff in different roles, providing the impetus for widening access to flexible working to become an HR priority.

2)    Identifying potential avenues and opportunities to expand flexible working and highlighting the importance of taking a bottom-up approach to generate solutions.

3)    Building mutual understanding of the issues and momentum for change among staff, laying the foundations for future pilots and engagement.

The reasons why flexible working in the NHS presents a challenge are the same reasons that change is required in the NHS, and beyond. To access and retain the full range of talent that is available, we need to take a proactive and considered approach to offer flexibility to all employees.

If your organisation is interested in commissioning an IES flexible working review, please contact Astrid Allen.

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Any views expressed are those of the author and not necessarily those of the Institute as a whole.