Published: 24/02/2005, Volume II5, No. 5944 Page 29

Q: We are having problems with flexible working. We work in a close, multidisciplinary way in a rehabilitation unit, and need to meet frequently to discuss patients and treatment plans. The more absent people, the harder it is. Are there any models that we could adopt so rotas had a coherence and balance? We are losing good people after maternity leave because it is hard to accommodate job share or part-time therapists.

A: You are between a rock and a hard place. You are right to focus on your patients' needs and you and your colleagues are in the best position to assess them.

But you are facing the realities of 21st century recruitment and retention. We are experiencing a fundamental change in attitudes to work. People willing to work long hours - and even full time - will be increasingly hard to find.

I doubt that there are any models of working from elsewhere that will be a great deal of help to you. The best approach is to work it through with your existing staff. They know the patients' needs and they know their own circumstances better than anyone else, and understand the views of people like them who will be looking for work.

It is in their interest to help you design rotas that have 'coherence and balance'. It is their problem and it needs to be their solution.

You say you cannot use part-time staff. You need to be sure that you have tested each option to see if there is another way of organising the work that would make it easier to employ more part-timers. There may be several ways of meeting patients' needs. Redesigning the work needs to go hand in hand with redesigning rotas.

Make contact with a local colleague who works in service improvement and role redesign; they may be able to look at your situation with fresh eyes and expertise. Also see what help your human resources colleagues can give you from their experience elsewhere in the organisation. And see if you can get service improvement and HR to work together to support your discussions with your colleagues.

Ken Jarrold is chief executive of County Durham and Tees Valley strategic health authority. E-mail your question in confidence to hsjcontributions@emap. com