Annex B
CASE STUDY—THE NATIONAL HEALTH SERVICE
B1. The National Health Service (NHS) is
a 24 hours a day, seven days a week service provider, with all
the additional pressures this can place on its workforce and human
resources systems. Modernising the NHS depends upon operating
more flexibly and being creative in its working arrangement to
maintain an appropriate work-life balance for its staff.
B2. Helping people to balance their commitments
at work and their commitments at home is good for business, good
for the economy and good for individuals. It means more people
can work, parents can be more productive, families are strengthened,
and employers have better motivated and more flexible staff to
work for them. The National Health Service, as the biggest employer
in England, has to be the best employer. The NHS depends upon
its staff. To improve health services, sustained improvements
in the working life of the staff have to be achieved.
B3. There are many good reasons why the
NHS has taken up the work-life balance challenge:
— There are over one million staff
in the NHS;
— Over 170 different careers;
— Over 70% of staff are women;
— 25% of the NHS workforce are parents
with children under 14;
— Women outnumber men at medical school;
— Ageing workforce—more NHS staff
have caring responsibilities for older relatives.
B4. There are a number of initiatives in
place that help to ensure that women are able to progress in the
NHS.
PAY FOR
NON-MEDICAL
STAFF
B5. The aim of Agenda for Change is to bring
fairer pay to more than one million non-medical staff in the NHS,
including women. A major aspect of the new pay system is the improved
career opportunities and greater rewards for those that take on
more demanding roles, and career and pay progression supported
by the NHS Knowledge and Skills Framework (KSF) used in individual
development reviews. All this means a more transparent system,
more varied and stimulating jobs for all staff, and most importantly
a better quality of service for patients in their care.
B6. The NHS KSF is a framework for all staff
and one which recognises the contribution that all staff—including
those who have traditionally been undervalued in the past (such
as women) make to the provision of high quality services for the
public. The development review process provides an equitable process
for all staff. There is a commitment that all staff—whatever
their post, whether they work full or part time, in the day, evenings
or at night—will be supported to learn and develop throughout
their working lives in the NHS.
B7. The implementation of the NHS KSF will
be monitored across all NHS organisations to ensure that all staff
are gaining access to learning and development within their posts
and to develop their careers. The emphasis on equality is particularly
important for women as many work part-time or unsocial hours to
meet their family commitments—Agenda for Change is based
on the principle that it is vital that all staff in the NHS are
supported to develop—for themselves and for the service
as a whole.
B8. The new arrangements are underpinned
by an NHS Job Evaluation scheme that has been developed especially
for the NHS. It covers the diverse range of demands present in
NHS posts to ensure that all jobs and jobholders are treated equally.
In other words, the basic salary that staff receive will reflect
the knowledge, skills and effort required in their job, rather
than their historic job title or occupational group. Many jobs
have been evaluated nationally and profiles for these jobs have
already been published, having been agreed by both management
and staff representatives working in partnership. Where jobs do
not match national profiles, individual local evaluation will
take place to ensure the job is allocated to the correct band.
IMPROVING WORKING
LIVES
B9. In addition to pay and terms and conditions,
the NHS is making an impact in Improving Working Lives and is
generally regarded as being ahead of both the public and private
sector in terms of offering a flexible and supportive working
environment. Better working conditions (including access to childcare),
safety and security at work, access to training, a pension scheme
and a diverse workforce are significant attractions for people
working in the NHS.
B10. The NHS is the leading employer in
terms of childcare and family friendly practices; it is the largest
single employer in the UK of black and minority ethnic staff and
it has a growing network of forums to support the diversity of
its workforce where they can support and learn from each other.
More women are being attracted into medical schools than ever
before.
B11. In June 2004 the Department of Health
launched the NHS Improvement Plan, building on the success of
the NHS Plan, and setting out the strategic direction for the
NHS in relation to improved access; tacking long-term illness
and public health. One of the overall aims supporting Standards
for Better Health, is "furthering the NHS's reputation as
a model employer". The Improving Working Lives Standard
(IWL) is a fundamental part of this process.
B12. The NHS Plan introduced the IWL Standard
for NHS Employers making it clear that every member of staff in
the NHS is entitled to work in an organisation which can demonstrate
its commitment to more flexible working conditions which give
staff more control over their own time.
B13. The IWL initiative aims to make the
NHS a better place to work. It is recognised that improving the
working lives of staff contributes directly to better patient
care. Ensuring the work-life balance of staff allows them to benefit
by being less stressed and happier at both work and home. Employers
also benefit from having a more motivated, more productive workforce.
Being flexible about the way people work means staff are more
likely to stay with their employer, and return after a spell away.
This in turn helps to reduce the costs associated with the recruitment
process, as well as retaining skills and experience. Improving
Working Lives also aims to support organisational cultural change
to embed good Human Resources practices at the heart of service
delivery and is an integral part of the "HR in the NHS Plan"
launched in 2002 which set a comprehensive strategy for growing
and developing the NHS workforce to meet the challenges in the
NHS Plan.
POSITIVELY DIVERSE
B14. Positively Diverse is a national organisational
development programme that aims to develop the knowledge and capacity
of member organisations to build and manage a diverse workforce.
There is a national network consisting of regionally based "lead
sites" exploring, developing and disseminating practical
ways of managing diversity in the NHS for the benefit of both
staff and users of the service in the healthcare workforce. To
date there are 10 Positively Diverse lead sites and 147 NHS Trusts
actively engaged in the Programme.
B15. A national campaign to tackle harassment
of staff by service users and their relatives was launched in
September 2002. This campaign builds on earlier work on violence
undertaken as part of the NHS zero tolerance zone campaign and
the Positively Diverse Programme.
RETURN TO
PRACTICE
B16. In a recent Return to Practice Survey
undertaken on behalf of the Department of Health, covering staff
who had undertaken a "Return to Practice" course in
the last three years, 89% of those still employed were working
in the NHS, with 94% of respondents reporting that they were able
to negotiate flexible working on return to work. The biggest changes
recorded by those returning to the NHS were around flexible working
and training and development.
CHILDCARE
B17. The NHS Childcare Strategy centres
on providing good quality, accessible and affordable childcare
and enables all staff including Doctors and General Practitioners
to have access to childcare co-ordinators, and support through
a variety of options such as childcare vouchers, and subsidies,
emergency places and care at home.
— By the end of March 2003, funding
was allocated for all 150 on-site nurseries of which 140 have
been opened offering 6,000 new subsidised places. There are now
over 230 childcare co-ordinators in post with recruitment continuing.
— Funding of £30 million [£15
million capital and £15 million revenue] was made available
to the NHS last year.
— The emphasis is now shifting to other
forms of support for working parents such as after school clubs;
holiday play schemes; childminding networks and childcare vouchers,
which have revenue but no capital costs.
— From September 2004 the childcare
strategy has been extended to provide childcare support for NHS
students, and funding is being provided centrally to cover the
cost.
FLEXIBLE RETIREMENT
B18. Many NHS staff leaving at 55 are in
good health and still have a lot to offer in terms of skills,
experience and maturity. By offering measures that suit their
circumstances and enable them to work the hours they want, we
are encouraging staff to continue to deliver high quality healthcare
for a longer period.
B19. Flexible retirement, including pension
promotion, is one of the core requirements of the Improving Working
Lives Standard. The NHS Pensions scheme is a huge asset in the
wider HR agenda, supporting both recruitment and retention, as
well as workforce planning. And for retention purposes it is an
excellent tool to support staff and retain their skills and expertise
in a way that values their ongoing commitment to delivering high
quality healthcare.
FLEXIBLE CAREERS
SCHEME (FCS) FOR
DOCTORS
B20. Working less than full time is increasingly
important to many doctors. The desire to work on a part-time basis
is not confined solely to women doctors but increasingly a way
of life for all doctors. The Department of Health is committed
to ensuring the modern NHS operates more flexibly and is creative
in its working arrangement to maintain an appropriate work-life
balance for all staff.
B21. The Flexible Careers Scheme (FCS) for
hospital doctors and GPs enables flexible working, supports return
to the NHS after a career break, and offers flexible retirement
options. It is a key part of the recruitment and retention strategy
and also feeds the Improving Working Lives standard that promotes
work-life balance. A breakdown by strategic health authority,
by speciality and by grade, suggests that the scheme is well embedded
across all trusts. By end of 2003, the number of doctors and GPs
on the scheme had exceeded the April 2004 target of 1,000 doctors.
By end June 2004, the number of doctors on FCS had grown significantly,
with 190 doctors who had been through the scheme, 1,371 were currently
on the scheme and a further 798 will join the scheme over the
next few months. There is now more scope for doctors to draw back
from full-time work without giving up their skills and experience
altogether. The Flexible Careers Scheme has helped 55 hospital
doctors and 64 GPs to take the option of a flexible retirement.
Women in Public Appointments
B22. The Vital Connection (published 2000)
outlined the national target to increase women's representation
in executive posts at board level to 40% by the end of March 2004
across all sectors of the NHS. Recent Health Statistics show that
this target has been met. The key results show that, in England,
as at 1 April 2004:
— 45.69% of people appointed to NHS
Boards were women and 40.21% of the Chairs appointed to NHS Boards
were women. This progress of women in public appointments compares
with 43% in June 2003, 36% in September 2001 and 33% in March
2000.
— At the end of September 2004, 45.69%
of people appointed to NHS Boards were women and 40.68% of Chairs
appointed to NHS Boards were women.
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