The recent national staff survey offers a chance to see what NHS staff really think of where they work. One set of questions is used to 'assess the extent to which they believe that their trust and immediate manager are committed to helping them find a good balance between their work and home life'. This is set alongside the percentage of staff working extra hours and how many use flexible working options to shape an overall assessment.

The recent national staff survey offers a chance to see what NHS staff really think of where they work. One set of questions is used to 'assess the extent to which they believe that their trust and immediate manager are committed to helping them find a good balance between their work and home life'. This is set alongside the percentage of staff working extra hours and how many use flexible working options to shape an overall assessment.

The results need careful analysis with groups of staff and staff-side representatives, and a continuous programme of action and review. Key to both is an explicit statement about where the parameters lie, which allows a sense of individual control, combined with an understanding that healthcare operates 24 hours a day, seven days a week.

In my organisation, 88 per cent of respondents said that they had taken advantage of one or more of a range of flexible working options.

Careful negotiation has ensured the needs of the organisation and employee are considered. Staff state the trust's commitment is real. Patients have benefited from the commitment and attendance levels of staff.

While performing comparatively well, we have a large number of staff working too many hours. Some of this can be offset when individuals reclaim time, but the figures warrant analysis to understand and address underlying pressures and working patterns.

As we increase the range of services we commission in community settings we need to ensure they are properly costed and resourced and deliver value for money. As we play a greater part in local community discussions, we need to meet people at times that suit them. And we are ensuring our decisions are based on business intelligence.

As managers, we need to ensure we are using resources wisely and that we balance competing demands on individuals' time. At executive level, we need to acknowledge the impact of the way we as individuals work - and the role model we provide.

Take a PCT chief executive working somewhere in the North West. Perhaps we can go along with the argument that the very long hours Monday to Friday are necessary to keep on top of the breadth of work; ensure she can be around for residents' workshops, councillors' meetings and civic events; and enable her to miss those frustrating 'sitting in traffic on the M62' moments.

Unless on call, she chooses to balance the hectic working week (and the paperwork-filled evenings) with work-free weekends to catch up with family and enjoy other aspects of her life. That suits her. Colleagues make different choices.

Balance conjures up a single fixed image of equilibrium. Yet it must also allow for the weighing of actions and opinions, and the power to decide. And that, surely, is what is key - being able to make choices and having some control over where one's individual work-life balance lies.

As we develop our responses to this year's staff survey, the trick will be to facilitate individual flexibility while retaining our organisational responsiveness. This is a complex balancing act, but it is well worth striving for.

Gail Richards is chief executive of Oldham PCT, winner of the primary care organisation of the year category in last year's HSJ Awards.

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