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03.10.18

A radical rethink on flexible working

Source: NHE Sept/Oct 2018

The world of work is rapidly changing, and the NHS needs a radical rethink on its approach, argues Dean Royles, strategic workforce advisor at Skills for Health.

The recent NHS funding pledge came with the usual comments about the need to change services, use technology more effectively, and become more efficient. The fact that the announcement has strings is not uncommon. Indeed, it is expected.

Whatever the politics of where the money will come from, it is still a significant investment, and it’s right that politicians expect as big a bang as possible for their buck – taxpayers should too. The problem is that getting extra efficiency above and beyond the yearly cost improvement exercises will require radical thinking rather than incremental change. This can be scary for the public, staff, regulators, and politicians.

The announcement comes at the time we are in the grip of the Fourth Industrial Revolution; the first used steam, the second electricity, the third electronics and information and communication technology. We now have the fourth: the digital revolution.

Combine significant investment with large NHS vacancies, uncertainty about Brexit, and the rapid advancement of digital technology, and we have the opportunity, indeed the obligation, to think about the NHS workforce differently. Unfortunately, it will scare some people and challenge some norms about how we see the NHS workforce. Boards will need help and support. This is about cultural change, from the bottom up.

In the NHS we have come to believe a permanently employed workforce is good, and a temporary workforce, or agency staff (or contingent workforce), are suboptimal for effective patient care. It’s easy to understand how this narrative has developed.

Agency staff can be more expensive (although they are often not). They may not know the organisation they are working within well, so are unclear about the appropriate policies, procedures and protocols. There has also been a national push to reduce agency spend. This made sense given costs had been escalating. However, if we are to really think differently and to improve efficiency and productivity, we need to change the underpinning narrative.

There has been much in the media about the ‘gig economy.’ Much of this has been negative, centred on poor contractual regulations and minimum pay or zero-hour contracts. Much of that criticism is entirely justified; some of the working practices have been exploitative and abusive.

However, it’s also clear that an increasing number of people across all generations want more flexibility of both hours and roles. There has been a plethora of information, digital technology and apps to support this. We have a stark choice: ignore these developments and potentially alienate existing and future staff; or embrace the changing nature of work, the changing nature of workers and the changing nature of the workplace, and secure engagement from talented people wanting to make a contribution in the NHS.

We need to see these workers not as a resource of last resort, but as a core and essential part of the workforce of the future. I believe we can overcome some of the concerns people will have around terms and conditions and health and safety by working closely with trade unions about how these staff are engaged both contractually and psychologically.

Given technological advances, it is easy to foresee that we will have employees that work for five or six different NHS organisations with increased flexibility. They may work in one trust on Monday to deliver clinical services and gain experience, but in another trust closer to home on Friday because that’s the day they do the school run. They may work as a nurse or allied health professional one day, with patient contact, but in admin or management on another day because they want flexibility of role.

There is an increasing number of people this would appeal to and would fit in with their work/life flow. We must respond to this positively and rapidly. If we don’t, as progressive employers, others will capitalise on the latent demand.

These workers are ready now. How quickly can we, as employers, respond?

 

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