Flexible working – enablers for change

We have updated our flexible working enablers for change to support employers embed the key changes to section 33 of the NHS terms and conditions.

4 August 2021

To achieve excellent staff experience, it is essential that employers create a work environment where staff feel valued, encouraged, and supported to succeed in their roles and to deliver high-quality patient care.

As part of the NHS People Plan, the NHS People Promise sets out a series of commitments, one of which is we work flexibly which states:

We do not have to sacrifice our family, our friends or our interests for work.

We have predictable and flexible working patterns – and, if we do need to take time off, we are supported to do so.

This ambition is to give people greater choice over their working patterns, helping them to achieve a better work-life balance. The aspiration is that this will help the NHS remain an employer of choice, as well as act as part of the solution in addressing the current workforce shortages in the NHS, through attracting new joiners and returnees and better retaining current staff.

There is a need to understand how to bridge the gap between this vision and the successful implementation of the policy. This includes understanding the barriers to change that are currently preventing the NHS from realising the full benefit of greater flexible working for its people.

The pandemic has been an unexpected catalyst for different ways of working across the NHS workforce. It is important that the NHS builds on the flexible working lessons learned from the pandemic and avoids reverting to the old ways of working. Through doing so, the NHS will increase the chances of successfully embedding a culture of flexible working to ensure that the NHS People Promise to its staff is kept.

Employers should foster an organisational culture which promotes and enables good flexible working practices. Through embodying these when reviewing local policies, an organisation will increase the chances of successfully embedding the new flexible working contractual changes and ensure flexible working can be locally embraced and delivered.

Now is a great opportunity for organisations to challenge the traditional ideology of how work has previously been delivered and support our NHS people and managers to explore flexible working options. This gives everyone an opportunity to achieve a work-life balance that suits them and the organisation, and which could support with workforce retention.

There is no single solution that enables a culture of flexible working to thrive. This web page identifies ten enablers to promote a culture of flexible working, which when looked at together, can improve opportunities for the NHS workforce to achieve a better work-life balance. Use this guidance to help focus your conversations on flexible working.

This guidance can be used:

  • to facilitate a culture change that promotes better flexible working practices
  • to inform senior leadership conversations and enhance board level discussions
  • as a basis for producing a clear commitment statement that can be communicated to staff.

Take a look at our flexible working enablers poster for a digestible printable version of the enablers. 

Read our guidance for joint union and employer partnerships on reviewing flexible working policies (PDF) to further support you.

  • Leaders will provoke cultural change, challenge status quo and enable the principle of flexibility by default.

    Leadership teams have the power to create waves of top-down behaviour change that can influence the culture of an organisation. Senior leaders, who both model and champion flexible approaches to working, play a key role in setting the tone, demonstrating achievability, showing the possibility for career progression and dispelling myths. Executives should make flexibility a strategic issue for the whole organisation, a top-down approach sends a clear message of commitment to enable a flexible working culture to be valued and embedded by all.

    Leaders at every level should actively promote the benefits of flexible working and dispel negative perceptions. Negative perceptions are one of the biggest barriers to successful adoption. Those working flexibly can be seen as less productive or engaged, and more readily passed over for promotion. There is a disproportionate impact on certain groups, such as working mothers/parents and those with caring responsibilities as they need to have a more flexible working pattern to accommodate their caring needs. The way staff perceive themselves, or their role in the organisation and/or within society, may affect their willingness to take up flexible working, for example by compromising their perceived status or skills. Such perceptions are largely based on expectations around traditional working practices, such as valuing time in the workplace over contributions made. By making flexible working the default, rather than the exception, these perceptions will disappear as more benefits are realised and demonstrated.

    Leaders should also question cultural norms from previous ways of working, which are one of flexible working’s biggest blockers. Concern about complexity or additional costs involved can impact negatively on the willingness to embrace flexible working, particularly for frontline NHS roles where clinical, resource, and staffing parameters can make rostering complex. Leaders, at every level in the organisation, should challenge assumptions about the way work is done, asking with curiosity why things are done the way they are and trialling new ways of working. They play a vital role in helping foster a culture that is open to change with all staff adopting a test and learn mindset that forms part of the organisation’s culture.

    A key success factor to improving access to flexible working is trust. All our people should feel trusted to deliver their role in a productive, effective way. Leaders need to encourage a culture of permission, making it clear to managers that flexible working will not compromise an individual’s position or prospects. They need to ensure there is an environment to enable this to happen in practice and to provide the tools for people to be able to work flexibly so that they can focus on providing the tools for people to be able to work flexibly and do their job. When behaviours are displayed which inhibit working in this way, these should be addressed. Clear and consistent direction setting from senior leaders enables effective implementation and a more positive culture.


    Top tips:

    1. Engage a board level champion for flexible working, who will ensure flexibility remains as a strategic priority for the organisation and role model effective flexible working practices.
    2. Identify the cultural norms and negative perceptions that are blocking flexible working in your organisation and how you can work with your leaders to dispel them.
    3. Seek board buy in to adopt a ‘test and learn’ mindset for flexible working that is open to change and experimenting with new ideas.
  • Talk to staff and use data to find out what they want in terms of flexibility. Support teams to define and improve flexible working practices that meets the needs of them and patients / services.

    By regularly engaging with your staff, you can capture and learn whether they are happy with their working patterns and understand the enablers and barriers that currently exist within their roles, and how they can be shared or overcome. Regular engagement should also include communications through existing staff networks to enable a fully inclusive approach to be developed. The use of a framework to aid discussions and health and wellbeing conversations at regular catch ups and key career development points, such as in annual appraisals and performance reviews, is also advised.

    Employers should seek to understand the reasons behind flexible working requests. This will help employers change the way they think about flexibility by challenging stereotypes as well as enhance the organisation’s ability to better facilitate workable solutions that meets the needs of their staff. Employers should actively seek to understand both what is not working / areas for improvement, as well as what is working well / success factors. By identifying those teams and services where uptake of flexible working practices is particularly low, employers can actively work to target and support those teams to improve flexible working practices. They should also gather regular feedback on how current flexible working arrangements impact on the trust, inclusion and mental wellbeing. 

    Facilitate and support NHS staff to define and improve flexible working practices that meets the needs of the individual and patients. It is important employers set clear expectations and create ownership by actively involving staff in the creation and implementation of flexible working arrangements. Balancing organisational and individual needs may best be done at a team level, using discussion and negotiation among frontline teams to help match staff needs with the constraints of service and finance.. Complex dynamics in teams can impact on flexible working, for instance, camaraderie, guilt, favouritism, and seniority which can all impact on uptake. Employers should support and educate teams on how to create their own agile routines (that they review and adapt regularly) and provide tools that empowers people to work flexibly without sacrificing teamwork.

    Top tips:

    1. Regularly engage with staff and trade unions to find out what is and isn’t working well.
    2. Create opportunities for staff to influence and co-create flexible working practices that meets their needs.
    3. Use staff networks to inclusively engage with groups who experience discrimination and disadvantage.
  • Ensure your policy and processes are up to date and are easily accessible by staff.

    To embed a more general flexible culture, policies for flexible working need to be universal rather than segmented by gender, age, parenthood, or other specific demographics. Framing flexible working in terms other than ‘family-friendly’ and tying them to more neutral organisational priorities, for example around diversity and inclusion or health and wellbeing.

    Having a robust policy in place will help in considering flexible working applications and shows trust-wide commitment. This may be a standalone policy or incorporated into other documents and should include information on how to make a request and how it will be considered. A clear policy with leadership buy-in is essential, it should outline a simple process that defines the roles and responsibilities of HR and line managers.

    Corporate policies play an important role in embedding flexible working. Policies and processes alone are ineffective if nobody makes use of them, or employees are unaware that they exist. If individuals are supported by the organisation, this can provide them with further options if their line manager raises any objections, which will be supported by the introduction of a new escalation stage when the changes to the NHS terms and conditions of service (NHS TCS) handbook, Section 33 comes into effect on 13 September 2021.

    Top tips:

    1. Check to see if there are any existing policies in place that need to be reviewed.
    2. Simplify the process for requesting a flexible working arrangement with short and clear forms. Remove any restrictions on when individuals can make requests and ensure that the process is clearly signposted to employees.
    3. Create objectives and expectations that accepting flexible working requests should be the default with the onus online managers to provide a clear compelling reason for refusal.
  • Influence the attitudes and actions of managers by providing permission, support, and training to equip managers to deal with flexible working requests effectively.

    The perceptions, training and approach of line managers are key factors in determining whether flexible working is taken up in practice, even in cases where a clear organisational direction or policy is in place. With manager perceptions, and resistance, forming a large part of difficulties with implementation of flexible working, shifting their perceptions can be a key enabler through:

    • training
    • senior-role modelling
    • constructive challenge
    • positive reinforcements,
    • sharing good practice
    • practical support.

    Training those with line management responsibilities to deal with the complexities and issues around flexible working is also important.

    Line managers are key to the successful roll out of flexible working, as they have responsibility for managing flexible working requests by understanding the priorities of their teams and the needs of the service. Supporting line managers to have supportive conversations about flexible working will empower line managers to explore possibilities and support their teams to work more flexibly to suit individual work-life needs, whilst maintaining safe and effective services.

    Leaders should give managers the permission, training, and the tools to support flexible working especially as getting used to new ways of working can sometimes feel difficult to manage. Providing training to raise awareness and equip managers to deal effectively with flexible working requests is essential, as well as, ensuring managers have protected time to support their staff with flexibility at work. Leaders should lead by example when undertaking line management responsibilities themselves and support their staff to work flexibly.

    Staff need to trust that their line managers will support their working arrangements and that it will not compromise their position or prospects in the future. The importance of communication cannot be underestimated, maintaining an open and honest dialogue between line managers and staff is essential.

    Top tips:

    1. Encourage and train line managers about how to support and manage flexible working.
    2. Encourage line managers to have flexible working conversations with staff.
    3. Promote the benefits of a flexible working culture and share good practice examples to highlight how flexible working can be embedded.
  • Design jobs with flexibility in mind as standard, recognising that flexibility is role dependant. Ask ‘why not’ rather than ‘why’.

    Jobs should be reviewed and/or designed with an open mind to enable consideration to be given as to how flexibility could be applied whilst considering the needs of individuals, of teams and of service demands.

    While flexible working for parents and carers has become more acceptable, in many workplaces it is still seen to be a perk or concession that is made to those circumstances only. Flexible working needs to be regarded as the option for everybody. The NHS terms and conditions of service handbook (Annex 33) will, from the 13 September 2021, provide for a day one right to request flexible working. This will align with and support the NHS People Plan’s encouragement of employers to implement flexibility by default for all roles from day one.

    Most of the research and interventions on flexible working have focused on people in office-based roles, including working from home or changing start and finish times to suit the individual’s non-work needs. However, in a shift-based environment, jobs are not designed around individuals. The job is, in effect, designed by the roster, and that means that the work-life needs of most clinical colleagues are entwined with the needs of all the other clinical colleagues on their roster. In NHS England and NHS Improvements guidance on e-rostering (PDF) for nursing and midwifery, they advise publishing rosters at least six weeks in advance to support better work/life planning.

    Top tips:

    1. Work with managers and trade unions to define how different roles could look if they were to be done more flexibly.
    2. When offering flexible working in a job advert, ensure this is positive, clear, and positioned in a place the candidate will notice it, such as in the body of the job advert, or listed alongside other benefits such as pension and holiday entitlement.
    3. Consider when and how much people work. How many hours are needed to carry out the role, where do activities need to be carried out and when?
    4. Ensure that staff have access to clear information about the implications of different contractual arrangements so that they can make informed decisions.
  • Technological solutions can improve rostering and help to manage live rotas. Rota design should be a collaborative process involving both employers and staff.

    The NHS can significantly increase flexible working through a combination of technology and changes in people practices. Once a job has been designed flexibly and staff requests taken into consideration, you can use software to make rostering easier. Rota design should be collaborative, with equal opportunity for both employers and staff to input into it, and a commitment to reach agreement on final rota design through a clear and transparent process. Technological solutions can improve rostering and the managing of a live rota should be used wherever possible, particularly to support safe shift swapping where needed.

    Types of rostering:

    • E-rostering – systems allocate staff to shifts based on their working patterns and preferences as well as the needs of the ward, enabling managers to quickly build rotas and allocate shifts.
    • Team-based rostering – staff put forward the times they would like to work and times they would like to protect away from work. This information is then used to compile shift patterns that match individual preferences as closely as possible, while maintaining agreed levels of cover at all times.
    • Self-rostering – staff choose their own upcoming work schedules with blank rosters being released, and employees bidding for the shifts they would like to work.

    Top tips:

    1. Consider how you can use different types of rostering to enhance better access to and uptake of flexible working for your staff.
    2. Technology needs to be complimented by the other enablers highlighted throughout this webpage in order to harness the true benefits.
    3. Consider how you can ensure a collaborative approach to developing and implementing technological solutions for flexible working.
  • Educate everyone on how to work flexibly so they can find the right balance. Promote flexible working to staff and managers to ensure that staff know what their options are. 

    Ensure wellbeing conversations are supportive and consider introducing coaching style one-to-one conversations which focus on building individual and team resilience. Having health and wellbeing conversations could lead to discussions around flexible working, this is an opportunity for line managers to increase understanding and the use of flexible working options with their direct reports.

    The language, metaphors, myths and stories that are used in organisations are key to the culture of the organisation - how language is used to describe flexible working arrangements can signify organisational intent and attitudes. Ensuring that good practice examples of flexible working are being shared, will enable staff to see that flexible working is supported by the organisation. The more people in your organisation that champion flexible working and talk about how they make it work for themselves and their team, the more normal and accepted it will become.

    The FlexNHS movement was established to create a supportive, encouraging, and resourceful network to promote and enable flexible working in the NHS for every profession, role, and grade. It is available to everyone, helping to generate more conversations about the benefits of flexible working and dispel any myths.

    You can follow and engage with the network on Twitter at @flexnhs. One of the co-founders of FlexNHS works at Milton Keynes University Hospital NHS Foundation Trust and the trusts website has a section dedicated to flexible working and the FlexNHS campaign.

    Top tips:

    1. Signpost to your organisational policy and ensure it is up to date and clearly accessible to staff. Include your policy in new staff inductions and promote it on your intranet.
    2. Use your intranet to make information visible and include things like request forms and promotion of the benefits.
    3. Introduce flexible working ambassadors, share case studies and make existing staff working flexibly more visible within the organisation. Build a staff network and encourage its members to act as mentors for staff starting out on their flexible working journey.
  • Collaborate with other organisations in your area to provide greater opportunities for staff to work flexibly.

    With the implementation of integrated care systems (ICSs), there is an increased demand to develop a multidisciplinary and adaptive NHS workforce that can deliver care flexibly across primary, community and acute care. By working collaboratively across organisational boundaries, system working can lead to improved decision making and accomplishment of shared goals that cannot be achieved by working in isolation.

    Increasing opportunities across the NHS for staff to work flexibly will require organisations to shift towards a collaborative approach. This means having an openness to embrace different ways of working, cultivating and building relationships, as well as encouraging a dialogue between all organisations involved. The Leadership Academy conversation cards are a practical resource to help get groups talking and working together. Try using them with colleagues to encourage a different way of thinking about collaboration.

    In time, as the capacity and maturity of ICSs develop, it is the ambition that these collaborative approaches become the norm, and good practice and learning are shared to support other NHS organisations in the system.

    Top tips:

    1. Consider what benefits your organisation would get from a collaborative systems approach to enhance flexible working.
    2. Build relationships with trusts from your local integrated care system to explore opportunities for collaborative approaches that promote better flexible working.
    3. Use collaboration as a tool for sharing learning and good practice that will serve to strengthen local approaches.
  • Flexible working will be inclusive and gender neutral.

    An inclusive and gender-neutral approach should be taken when developing and implementing a flexible working policy. Flexibility is a great retention tool and demonstrates an employer’s ability to support everyone.

    Gender stereotyping has an ongoing and significant impact on the uptake and perception of flexible working in many organisations. We must break down out-of-date gender stereotypes and challenge gender norms by demonstrating that flexible working is an important issue for everyone. For example, there is a perception amongst some people that flexible working could impact career progression and that this might deter some employees from seeking flexible working. Employers should actively dispel negative perceptions that people who want to work flexibly are less serious about their careers.

    Flexible working should be open for all. A perceived hierarchy of need around flexible working may limit opportunities for staff without childcare responsibilities or other ‘good reason’. The current ‘request-response’ process creates a sense that flexible working is something that requires a specific set of circumstances, rather than being open to all. If it were proactively offered to everyone, and more accessible to those in shift-based roles, flexible working would become more widespread, and ultimately more inclusive.  

    For some people the ability to work flexibly can be critical. For instance, some older workers, some people with disabilities and some people with caring responsibilities can only work if they have flexibility in their role. Women continue to bear disproportionate responsibility for child and other forms of care

    Flexible working policies, processes and arrangements should be equality impact assessed to ensure they do not unfairly exclude anyone on the grounds of age, disability, gender, sexual orientation, religion, or any other aspect of the Equality Act and that the rights enshrined in the Act are recognised when making decisions on requests. See dedicated advice from the equality, diversity and inclusion group (EDIG) of the NHS Staff Council on conducting an equality assessment of changes to your flexible working policy (PDF). Employers should engage and collaborate with their local staff networks and trade union representatives to understand the specific flexible working needs and barriers different staff groups are facing.  

    Top tips:

    1. Equality impact assess your flexible working policy to ensure it is inclusive and gender-neutral.
    2. Work in partnership with your staff networks and trade unions to understand the specific flexible working needs of their respective members.
    3. Proactively offer flexible working to everyone so that it becomes widespread across the organisation.
  • Clearly define what successful flexible working looks and feels like. Regularly monitor and measure the effectiveness of flexible working practices to demonstrate its positive impact on patients and colleagues.

    The success of any job comes from achieving outcomes that are aligned with the strategic goals of the organisation and team. Setting measures of success at an organisational level is an excellent way to accelerate behavioural change. A fact-based evaluation of performance that does not criticize those who work flexibly is necessary. Performance should be managed by output, not the number of hours someone is in the office. Success and effectiveness should also be judged by this measure.

    Pilot, monitor and track progress. Identifying early adopters to pilot new flexible working practices is key. Honest reflection, as well as systematic evaluation of the success or impact of the pilot, will help to create momentum, resolve issues and drive change in other areas.

    Employers should monitor flexible working practices and use this data to share best practice across teams. Organisations should review how many flexible working requests are made, approved and how many are turned down to ensure a consistent approach is being taken across the organisation and that flexible working opportunities are available to all. Employers should regularly seek feedback from staff about what is and isn’t working well about flexibility at work, including topics like trust, inclusion and mental wellbeing. See dedicated advice from the equality, diversity and inclusion group (EDIG) of the NHS Staff Council on monitoring and reporting your flexible working policy.  

    Robust evaluation will help you communicate your successes to your organisation’s leadership and can help you identify elements that are critical to success, along with challenges and things that could be improved. It is also useful to use as a baseline for other initiatives that your organisation would like to introduce. Sharing stories about the positive impact of successful flexible working on patients and colleagues to win the hearts and minds of leaders.

    Top tips:

    1. Challenge perceptions of successful flexible working that are linked to hours served and instead focus on how flexible working can drive forward the organisation’s strategic goals.
    2. Test the success of a new flexible working practice by piloting the change with early adopters.
    3. Identify measures for success relating to flexible working to monitor uptake and usage across the organisation.
    4. Use a variety of methods to identify what is and isn’t working well about flexibility at work to identify elements that are critical to success, challenges and things that could have been improved.