Flex Evelina: embedding a fair and inclusive flexible working culture

Overview

Flex Evelina is a staff‑led, equity‑focused, cultural transformation programme at Evelina London, part of Guy’s and St Thomas’ NHS Foundation Trust. After identifying racial disparities in access to flexible working, the programme has increased and improved opportunities for flexible working across the organisation. As a result, Flex Evelina is supporting a fairer, more inclusive culture for the 4,000 staff working across Evelina’s specialist and community children’s services.

Cheryl Samuels, people and culture director, explains why Flex Evelina matters, how it was developed, and why change was imperative for the organisation.

Key benefits and outcomes

• Formal uptake of flexible working increased from 32 per cent to 34.6 per cent (October 2023–October 2025).
• Flexible Working rejection rates fell from 23.3 per cent to 6.2 per cent. 
• Disability declarations rose from 5.5 per cent to 7.5 per cent, and ethnicity “not stated” fell from 4.9 per cent to 3.5 per cent.  
• Evelina London’s People Promise score for “We Work Flexibly” has improved from 5.71 in 2023 to 6.33 in 2025. 

In this video, Gubby Ayida, ceo, shares what drove Flex Evelina and the real impact it has had across the organisation.

What the organisation faced

Flex Evelina was established in 2023 at Evelina London in response to clear workforce challenges and strategic priorities, including: 

• NHS Staff Survey results highlighting burnout, morale challenges, and a need for better flexibility 
• trust-wide equity, diversity and inclusion priorities across Guy’s and St Thomas’ NHS Foundation Trust 
• retention risks within a complex, diverse specialist and community service 
• workforce data showing inequitable outcomes in flexible working decisions 
• staff feedback revealing low awareness of options, inconsistent decision‑making, and a lack of confidence to request flexible working 
• the 10 Year Health Plan for England recognising flexible working as essential in improving experience for NHS staff, their wellbeing and work/life balance. This included a clear ambition in the NHS People Plan, with “We Work Flexibly” as a People Promise.  
• external research, including from the CIPD where flexible working was found to be pivotal in attracting and retaining staff.
• one of Guy’s & St. Thomas’ NHS Foundation Trust’s key deliverables in its strategy was embracing and enabling flexibility for colleagues, recognising the benefits to our staff’s health and wellbeing. 

Although flexible working existed in policy, inconsistent application created inclusion and retention risks, particularly in for Global Majority staff, carers and those with long-term conditions. This reflected wider structural disadvantage that could not be solved through policy alone.

What the organisation did

Evelina London delivered a structured, evidence-led programme to embed flexible working through culture change, not just policy. Its approach focused on service delivery and on staff who needed a greater work life balance.  

A diverse staff working group was established to co-design the approach, representing a range of roles, bands and lived experiences. Launched in October 2023, Flex Evelina has delivered sustained improvement, with positive shifts in workforce metrics evident by October 2025. 

Insight gathering combined quantitative workforce data with a co-design staff survey (410 responses; 10 per cent of the workforce) and nine focus groups involving staff and managers. This identified barriers, inconsistencies and inequitable outcomes.  

As a result of the information gathered, and supported by our quantitative workforce data, the group agreed on a comprehensive improvement strategy, which was detailed in a report that was published internally to all staff. This included:

• a clinical group-wide action plan with clear expectations and monitoring 
• a transparent data dashboard tracking flexible working uptake and outcomes by protected characteristics, staff group, and band. 
• a targeted communications campaign to raise awareness and confidence 
• manager training with clear guidance and accountability mechanisms to ensure equitable decisions 
• a manager toolkit and consistent decision-making framework to remove ambiguity and reduce inequity. 

The working group ensured oversight of the programme. Updates are also provided to our senior leaders, who have advocated our aim of achieving a flexible working culture that enables flexibility to all. The approach has seen a real shift in attitudes and behaviours towards flexible working from the Board to frontline. 

Flex Evelina is now recognised and an NHS exemplar. It’s evidence-based, co-designed and equity focused model has been shared regionally and nationally. Evelina London has also developed a flexible working toolkit so other NHS organisations can adopt and adapt its approach (link to PDF toolkit), which complements the NHS Employers Think Flex First Toolkit. 

Results and benefits

Flex Evelina has delivered clear improvements in equity, culture, wellbeing and retention. There has been: 

• a decrease in staff turnover from 13.7 per cent to 8 per cent 
• a significant reduction in inequities in flexible working decisions. Rejection rates fell sharply for Black staff (23.3 per cent to 6.2 per cent) and Asian staff (24.1 per cent to 7.9 per cent).  
• an improvement in the People Promise “We work flexibly” score from 5.71 in 2023 to 6.13 in 2025 
• increased awareness of flexible working among staff and managers and a greater willingness to be flexible by default in various services 
• increased staff confidence in applying for flexible working, and managers feeling empowered - making informed decisions that balance the needs of staff and the service 
• a greater level of understanding of how inequality penetrates systems, processes and decisions, which was evident from the data in ESR 
• improved psychological safety, shown by disability declarations rising from 5.5 per cent to 7.5 per cent and ethnicity “not stated” reducing from 4.9 per cent to 3.5 per cent 
• more than 200 staff completing the first Flex Evelina quiz, with the majority understanding the flexible working policy, the role of managers and basic legal entitlements.

Flex Evelina is a long-term, staff-led programme embedded across Evelina London, keeping flexible working visible, fair and always improving. A quarterly dashboard tracks access and inequity alongside workforce metrics, staff survey and WRES/WDES data, ensuring accountability and continuous progress.

Hear from Ogechi Anodu, general manager, children's medicine and neonates, as she tells us how flexible working has positively transformed her work–life balance.

Overcoming obstacles

An early obstacle was recognising the limitations the available flexible working data. While the introduction of a dashboard improved visibility, it also revealed gaps where flexible working was not being formally recorded, including team-based rostering and informal arrangements. The organisation worked with colleagues to understand and close these gaps and is taking steps to ensure all arrangements are captured consistently, providing a more accurate picture of access to flexible working across Evelina London.  

The data also showed that many staff equated flexible working solely with working from home, with limited awareness of the broader range of flexible patterns available. To address this, the organisation introduced short, QR-code accessible quizzes to support learning in a low-pressure way. These support reflection, gently challenge assumptions without judgement and build confidence in understanding what flexible working can look like in practice. 

Changing attitudes towards flexible working was also a challenge. Historic arrangements had, in some cases, led to service disruption, reinforcing concerns about operational impact and exit interview data indicated lack of flexibility as a reason for leaving. From the outset Flex Evelina was clear that flexible working must put patients first. The organisation encouraged open conversations between managers and staff, with greater exploration of alternative options where requests could not be fully accommodated. 

The data exposed clear racial disparities in access to flexible working. Making this visible generated discomfort and challenge but the organisation remained focused on open discussion and consistent use of data to move decision-making forward. This has driven more deliberate and fairer decisions by leaders.

Takeaway tips

• Keeping patients come first at the centre reframes flexible working as a tool to sustain safe, high quality services, not a compromise to care. 
• Engage early. The challenges presented by system working at scale require early engagement of all partners. 
• Informal learning can build confidence and capability. 
• Consider and communicate the added value of taking action at scale across a large population with multiple partners. 
• Set clear and specific objectives for what you want to achieve. This helps to evaluate and evidence your success. 
• Accurate workforce data is critical to understanding access to flexible working and identifying inequities that would otherwise remain hidden. 
• Visible leadership support legitimises flexible working and drives cultural change across services. 
•  A diverse working group drawn from across services ensures decisions are shaped by lived experience and reflect the wider organisation. 
• Flexible working comes in many forms; with open discussions, solutions can usually be found that meet both staff needs and service requirements.