Family-friendly working initiatives are widespread in the NHS, but are managers matching policies to what staff really want? John Northrop finds out

Family-friendly initiatives are in vogue following The New NHS white paper. The NHS Executive, in particular, sees them as a means of improving recruitment and retention. They look set to play a key part in the new human resources strategy to be announced shortly.

Introducing family-friendly initiatives will therefore take up a considerable amount of management time and resources. But how effective are they? Do they make it easier to recruit and retain staff? Are they as effective as their protagonists claim, or are there problems with them?

To answer these questions, Pay & Workforce Research is investigating the types of schemes offered by NHS employers.

In May, we surveyed 59 organisations in England and Scotland, comprising 52 trusts and seven health authorities. Questionnaires were sent to their human resources directors.

The results show that NHS employers are offering a broad range of family- friendly schemes (see chart). Nearly all employers in the survey had a policy of offering staff part-time working or job sharing, for example. Around 90 per cent offered flexi-time, although mainly to auxiliary and clerical staff - only 10 per cent offered flexi-time to nurses and midwives.

By October 1999, employers will be obliged, under an EC directive, to offer fathers three months' unpaid leave, following the birth or adoption of a child. Three-quarters of the employers in this survey were already doing so, although uptake was poor.

Only 35 per cent of the employers in the survey offered term-time working and career breaks and only 10 per cent provided childcare arrangements, such as creches, out-of-school schemes and holiday playschemes.

One of the most surprising results of the survey is how widespread family- friendly initiatives are in the NHS compared with the private sector. Only around 9 per cent of employers in the private sector offered some form of childcare help, according to a Department for Education and Employment survey of 1,500 employers published in 1996.1

A worrying aspect of our survey is the difference between the schemes on offer and those most widely used by staff. It appears that the schemes most popular with staff are those which are least widely offered by employers. Childcare assistance, for example, is popular with staff, but very few employers offer it.

Around 70 per cent of NHS employers offering workplace nurseries said they were widely used by staff. But only 37 per cent of NHS employers offer them. Of those NHS employers offering creches and holiday playschemes, 40-50 per cent said they were popular with staff. But fewer than 10 per cent offer them.

Conversely, most trusts offer job share arrangements and yet they are not widely used. Comments made in the survey would suggest that job sharing was unpopular with both staff and managers.

Childcare schemes, such as workplace nurseries, are popular with staff because they offer reliability and continuity of care (something that can be a problem with individual carers). Workplace schemes are also easy to get to and subsidised places are a tax-free benefit.

A surprising finding from our research is that only a fifth of employers had asked staff about the sort of policies they would find most useful. Only four of the organisations in the sample had actively promoted their family-friendly initiatives. Most simply include policies in staff handbooks and rely on word of mouth. Some managers resist these policies because they mean extra work, or because they feel they conflict with providing a quality service or will be abused by staff.

Staff, it appears, are worried about making use of available family-friendly initiatives. They worry that moving to part-time work or taking carer leave will indicate a lack of commitment, and that it could have implications for job security, especially when trusts are reorganising or when workloads

are high.

But only a fifth of the organisations in the survey reported problems. These were mostly in providing cover for staff on leave, especially in areas where recruitment was difficult. There were also concerns about equal opportunities, and staff abusing provisions such as carer leave.

Achieving a balance between family and work responsibilities through traditional methods, such as part-time working, is proving difficult.

Many private sector employers are finding that having large numbers of part-time staff makes training and communication difficult, and are therefore reducing the number they employ. Also, by the time they have paid for a carer, many employees do not find part-time work


Supporters of family-friendly initiatives claim they make it easier for women to return to work after having a child, and so make it easier to recruit staff and to retain them, at the same time as reducing absence rates.

Although there is considerable evidence available from the private sector that family-friendly policies are effective, our own survey suggested that there was scant information in the health sector.

Less than a fifth of employers had done any research on the effect of these initiatives on recruitment and retention. Of those, most said it helped with retention. But only 13 per cent said it helped recruitment.

If family-friendly policies are to be effective, employers need a clear picture of the sorts of initiatives staff find most useful.

There needs to be greater emphasis on childcare arrangements, rather than on schemes such as job-sharing and career breaks, which are not widely used by staff.

Employers need to promote their family-friendly initiatives far more actively. If potential recruits and staff in post are not aware of the schemes available, then the schemes are unlikely to have an impact on recruitment and retention.

Managers need persuading that family-friendly policies do not create the headache they fear, and do not conflict with the provision of a quality service. However, more clearly needs to be done to identify which initiatives help staff achieve a balance between work and family responsibilities, before large amounts of time and money are invested.


1 Department for Education and Employment. Family-friendly Working Arrangements in Britain - 1996. Research Report No 16. Stationery Office. 1997.

Family-friendly initiatives are popular with staff, but little research has been done to determine their effect.

Employers should ask staff what sort of schemes would be most useful to avoid wasting managers' time.

Under half the employers surveyed offered creches, nurseries or holiday

play schemes. Where they are offered, they are very popular with staff.

Employers should specify what they offer in advertisements for staff.