Case Study - Croydon Primary Care Trust

Case study - Croydon Primary Care Trust

[See also the excellent report Changing Times in Health: A practical guide to work-life balance from South West London Strategic Health Authority]

Background

Croydon Primary Care Trust (PCT) has around 1,000 employees, across many sites. About 90% are women, and the largest occupational group is nurses.

It has been operating an informal flexible working policy for some years, and in 2004 performed particularly well in that area in its 'practice standard' as set out in the NHS Improving Working Lives programme. However, it has as yet no corporate flexible working policy and no centralised system of monitoring patterns of working across the Trust.

After receiving funding from the South West London Strategic Health Authority in 2004, Croydon PCT began a more focused project to pilot the development of partnership working to improve staff working lives. This was to involve three pilot projects in specific staff groups, establishing 'changing times champions', running focus groups among staff and surveying staff opinion.

This flexible working project was called Changing Times in Health. It was motivated by a number of factors:

• the regime of NHS standard setting;
• the need to cement the existing good practice with a comprehensive policy;recruitment and retention imperatives; and
• an emerging recognition that well developed and well motivated staff are good for patient care.

The legal right to request flexible working had very little impact.

Flexible working in operation

As there is not a centralised policy at the trust and no centralised record keeping there are no figures available on the numbers of employees across the Trust operating flexible working patterns. (The trust is currently working on both of these issues.)

However, the Trust knows from payroll data that a high proportion of staff - about 51% - work part time. And the HR manager feels there is a 'huge amount' flexible working, quite apart from the pilot projects.

In addition a survey of 550 employees (41% of whom responded) across the trust gave some idea of the range of the scale of flexible working and the range work-life balance options being used. (Some people are clearly using more than one of the options as the numbers add up to a lot more than 100%.)

The most common three arrangements were time off in lieu (used by 55%), flexitime (38%) and part-time working (34%), but significant proportions were also using staggered start and finish times (24%), working from home (18%), team-organised rotas (13%), term-time working (9%) and compressed working hours (8%).

The health visitors team at Shirley Clinic

The most successful pilot, and the one that is still running with the same working arrangements, is the health visitors team based at the Shirley Clinic. This has seven staff - four health visitors, two nursery nurses and one staff nurse. Before the pilot, they often worked late, accruing flexi hours which were difficult to take off.

One of the team, Joy Assa-Darko, said she and others in the team were keen on the idea of compressed hours - enabling them to work a nine-day fortnight. The reasons for their interest in this pattern varied, and in only one case was the interest to care for young children.

Meanwhile, a number of clients had been interested in the baby clinic being open at times when working mothers and fathers could attend. The team distributed a questionnaire to clients on what arrangements they would prefer, and the answers suggested that an evening clinic should be run once a week and early-evening home visits made available.

This could be accommodated by the team if they switched to a new flexible working pattern. They agreed to do this which meant that they could point to benefits of flexible working for the clients, the team members and the trust.

A pilot was run, and had been running for about a year at the time of the interviews, under which those wishing to would work a nine-day fortnight could do so. The rota also meant they would also have an early finish on one day a fortnight.

Four of the original seven staff (all the health visitors) work the nine-day fortnight and one of the nursery nurses, who had previously worked a 4-day week, works a 7-day fortnight. One member of team had not wished to change her pattern but was happy to support the others.

Rejection of requests

There have been some cases of requests being turned down, but HR advice to managers is to try to get to the nub of what people are trying to do in order to find a compromise.

A common sticking point appears to be term-time working. Recently a member of the Shirley health visitors team had a request to work term times only rejected.

The HR manager has also had to turn down requests for term-time working in her own team as it does not fit with service requirements. But when the issue was fully examined, it turned out the issue was mainly about half-term holidays. She agreed that the staff affected could have increased unpaid leave to enable them to take off time during half-term holidays.

Response of line managers

The attitude of line managers to flexible working does vary, with some being a bit afraid and others been almost over-willing to grant requests, leading to inconsistency and in some cases problems with service provision.

It is hoped this situation may be improved when the corporate flexible working policy is completed.

Union involvement

Industrial relations are very positive at Croydon PCT. There has always been a joint consultative committee at the Trust and this has improved recently as it has more staff reps on it. It is chaired by a non-executive director so staff side has access to directors.

These good industrial relations have been a feature of the whole flexible working project. The unions were represented on the Trust's Partnership Forum, which was established right at the start of the Changing Times in Health project to champion flexible working and develop solutions to problems. The Forum also included staff reps and managers from across the Trust.

It worked very well, although attendance became a bit of a problem later on. The atmosphere was very relaxed with no confrontation. Individuals on the Forum are now involved in other ways and will be asked, for example, to comment on the forthcoming draft Trust flexible working policy.

The unions do not tend to be involved on a day-to-day basis with the operation of flexible working issues.