Flex the NHS

How can the NHS become more flexible? Jane Galloway, Head of Flexible Working at NHS England and NHS Improvement, explained how her team is working on cultural change in the health service.

Woman in bed with ventilator and nurse in PPE


The NHS has long faced recruitment and retention challenges. The combination of Covid exhaustion and Brexit is likely to make those challenges even harder. That’s where flexible working can make a difference. Improving flexible working is a huge challenge in an organisation as big and complex as the NHS, but by its very nature – as a 24/7 365 days a year organisation – it must be possible. The key is getting the culture right.

That task has fallen to Jane Galloway, Head of Flexible Working at NHS England and NHS Improvement. Her three-person team has its work set out for it, but is tackling it full on. Jane has 21 years in the NHS and her own reasons for championing flexibility. She compressed her hours to look after her two sons and her mum who had terminal breast cancer and died last year.

She outlined how her team are making flexible working ‘just the way we work’ at a recent Flexibility Matters Action Learning Group.

She started by showing the scale of the retention problem. Between 2011 and 2018 56,000 people left the NHS citing lack of work life balance as one of the main reasons – a figure which Jane thinks is likely to be hugely underestimated.

In addition, absence and sickness levels are over twice as high as for the rest of the economy and just 54% to a 2019 staff survey said they were satisfied or very satisfied with the opportunities for flexible working in the NHS.

Although Jane says flexible working should be for everyone and not just about those with caring responsibilities, she pointed out that 77% of NHS staff are women and one in five health care workers in England is an unpaid carer. Moreover, 44% of public health care workers say a lack of flexible working is a barrier to career progression.

Business case

Jane said there was a clear business case for greater flexible working, from reducing the gender pay gap and attracting and retaining a diverse staff to retaining experienced staff and reducing absences. Flexible working also brings more engagement and that improves patient care, she added.

So what are the barriers? Jane listed lack of support for managers, gender bias around caring responsibilities, different interpretations of policy, lack of clear understanding of what flexible working means for the NHS [she said there was no clear definition of it], lack of a supportive culture and systemic issues, although she said there were pockets of great practice.

Jane wants to see flexible working as the default setting in recruitment and flexible working available from day one in a job. To change the culture requires senior leaders role modelling flexible working and creating an army of champions, she said. It’s not enough to talk about e-rostering. “The shift won’t happen unless there is a culture change,” she stated.

From there the team can drill down to the practical issues of shift working, what particular workers or teams require and the importance of compassionate conversations between managers and staff which are about give and take, including taking into account the impact of flexible working patterns on patients and other colleagues.


Jane is working in partnership with other health bodies, including Health Education England who are looking at implementing less than full time roles for junior doctors; primary care teams; NHS Employers; and the Centre for Ageing Better.

The importance that the NHS gives her work is clear from the pages given to flexible working in the recent NHS People Plan and in the Long Term Plan.

Jane said her focus this year is on line managers, working carer passports and making the business case for flexible working. She also highlighted the importance of measuring impact, adding that informal flexible working could be difficult to capture in statistics. Qualitative methods such as doing case studies and how tos could be a better way of capturing this, she said. Other priorities for the team include engagement, surveys, reviewing barriers to flexible working, communications, exploring an NHS Power 50 and considering how to promote job shares.

Jane ended by making three crucial points about flexible working. Firstly, she said, Covid remote working is not remote working – it is crisis working – and remote working is not the only form of flexible working. Secondly, she said it was important to start from “a position of yes” and thirdly, it is important to enable people to think creatively.

Other speakers in the Action Learning Group included David Blackburn from the Financial Services Compensation Scheme who said flexible working is not a problem to solve but a benefit to embrace. Dagmar Albers, UK Lead on Diversity & Inclusion at pharmaceutical company Pfizer, said that using a graduate army of flexible working cheerleaders was a highly effective way to filter the benefits through the business.  Dr Robert Coles of The Roffey Park Institute stated that those able to think radically and deal with uncertainty came to the fore during the pandemic and using them to enable others had defined their success. And Jessica Hornsby, Business Psychologist from aerospace company Thales, said many assumptions had been smashed by Covid-19, the most impactful being how few roles ‘have’ to be office based. At Thales, she said, the term ‘smart’ working has replaced flexible working to reflect this fundamental shift in outlook.

*More information on the Flexibility Matters Action Learning Group is available here.

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