“It’s revolutionised what we do”: Can NHS wards embrace flexible working?

Roughly ten years ago Rob Galloway, an A&E consultant in Sussex, was finding it harder and harder to balance career and family. The existing hospital rota system was rigid and unworkable for many parents. And so he invented his own.

“I wouldn’t be able to do my job [without] the system I’ve helped to create,” says Galloway, a father of four. “I basically invented it because I was so frustrated…I just couldn’t make it work for me and the kids, so it was either that I was going to leave medicine or do this.”

Galloway, who is now the workforce lead for roughly 400 doctors at the University Hospitals Sussex NHS Foundation Trust, has switched his teams to an “annualised hours” rota system. Staff are contracted to work a total number of hours across their whole contract, rather than per week or month. They can choose when they work and commit to different hours in different weeks.

Galloway with the youngest of his four children

 “It’s revolutionised what we do,” says Galloway, who has also helped to develop a flexible rota software that is now used by around 50 NHS Trusts. “And we keep people…from giving up medicine.”

The NHS has been in the headlines all winter, as healthcare workers struggle with overwhelming workloads, staff shortages, and real-terms pay cuts. Thousands of nurses and ambulance drivers are on strike this week, in the latest of a series of walkouts. Junior doctors have been balloted on strike action, with results due later this month. 

When it comes to the strikes, unions’ demands are focused on pay and directed towards the government. There is also a separate issue fuelling staff shortages – that of medics leaving because of work-life balance and stress. In this regard, NHS Trusts have a lot of power to bring about change and some are taking on this challenge.

Galloway can now work long days on Mondays and Tuesdays, when his children are with his ex-wife, and then finish work in time for school pick-ups on the other days. Some parents use the system to work more hours when they have grandparents visiting to help with childcare, and they can then take entire weeks off afterwards. 

“A chronic workforce shortage”

In its latest staffing analysis, the British Medical Association stated that “the NHS is in the midst of a chronic workforce crisis” with shortages across several areas. There is a cocktail of reasons for this, including the UK not training enough medics, Brexit deterring foreign medics, and stress and poor work-life balance pushing existing staff to resign. 

The number of NHS staff leaving their roles due to work-life balance has almost tripled in recent years, a 2019 analysis by the Health Foundation think-tank found. Amongst nurses, an area where 12% of posts are vacant, work-life balance is now the second most common reason for leaving a role, the Nuffield Foundation found last year.

Roughly 100 miles north of Galloway’s hospitals, another NHS Trust is also piloting a flexible rota system. Milton Keynes University Hospital’s “Any Hours” system allows staff to state what hours they can work – whether that is certain hours each day, certain days of the week, or any other pattern. The pilot started last year and will be evaluated in the spring.

“The premise is that we want to have you for [whatever hours] you can work,” says Kate Jarman, director of corporate affairs at Milton Keynes University Hospital NHS Foundation Trust. “If you can work four hours a day, we want you for that four hours. Because we might have other people who can work 2-3 hours a day, and all of that together fills a vacancy.” 

Both Galloway and Jarman have seen how flexibility has helped parents, especially mothers, to keep working. Any issues that affect working mothers are particularly acute in the NHS, where over 75% of staff are women, rising to nearly 90% amongst nurses.

Galloway’s system in Sussex has been underway for nine years, although it has expanded particularly over the last five years. An evaluation last year found that his A&E teams had better weekend staffing, found it easier to recruit doctors, and had dramatically reduced the £1.3m that they used to spend every year on locum doctors to cover shortages. Galloway has also seen a rise in the number of female consultants, and male consultants spending more time with their families.

But what about the admin?

Putting together a flexible rota is, of course, more labour-intensive. Galloway has a team of four administrative staff who put together rotas in four-month blocks, which are prepared 10 weeks in advance. Another smaller team oversees the rotas day-to-day in case of last-minute changes, such as staff sickness.

“It’s a lot of upfront work, but then we don’t have the problems after,” Galloway says, referring to the costs, stresses, and dangers of under-staffed wards. He also worked with developers to create Health Rota, a specialised flexible rota software, after finding that Excel spreadsheets and existing NHS software didn’t fully meet his teams’ needs. He is now Health Rota’s medical advisor and he says this software has been central to his flexible rostering’s success over the last five years.

In 2019, the social enterprise Timewise piloted a flexible rota system called “team-based rostering” with nurses at three hospitals. In its final report, Timewise found there were some upfront costs, such as training managers and rota staff, plus the extra hours needed to put together flexible rotas. But they were “optimistic” overall given the huge benefits for staff.

Timewise found that team-based rostering not only helped individual nurses with work-life balance – it also helped teams of nurses to work together to swap shifts and fill gaps as needed, because everyone felt that their needs were listened to. In the final report, one ward manager said: “People seem more caring and flexible towards each other.”

Trying to turn around a big ship

During a winter that has seen the NHS in crisis – with staff strikes, post-pandemic backlogs, and patients dying due to ambulance and A&E delays – it might feel counterintuitive to talk about flexible working trials. Is this really a pressing issue?

“It’s hard to do [this] in the midst of a very pressured workforce climate – but we really have to do it, because unless we make this change, we’re just simply not going to keep people,” says Jarman, who is also the co-founder of the Flex NHS campaign, which advocates for more flexible working across the health service.

“The challenge is to say: ‘Okay, it’s really difficult today, so how do we make it less difficult next year, in five years’ time, in 10 years’ time?’ ”

Both Jarman and Galloway also point out that younger generations of NHS staff increasingly expect flexibility and part-time options, whether that is because of childcare, caring for older relatives, interests outside of work, or preventing burnout in a high-stress career.

In some ways, the NHS has been ahead of the game on flexible working – it introduced day-one flexible working requests in 2021, over a year before this became national law, and individual Trusts are doing innovative things. But when it comes to the NHS, the UK’s biggest employer, turning around the entire ship is tricky.

“There’s loads of really good practice. I think if we took the best of everywhere in the NHS, and then everybody did those things, it would be phenomenal,” Jarman says. “It’s about: how do we do that, how do we act at scale, and get these things rolled out?”

• Vote  
• 2
• 0
• You already voted!