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Managers have to realise that, 'for some staff, a 12-year-old dog who becomes sick is just as important as a child becoming ill', delegates to a seminar on family-friendly policies were told last week.

Negotiating care leave for pets may be a bit far-fetched - even at Kingston Hospital trust, which has introduced 'special care' leave for adoption, bereavement and domestic disasters such as burst pipes.

But according to Pay and Workforce Research consultant Cheryl Kershaw, who raised the issue, the idea behind such flexibility is that 'happy staff mean good quality care'.

And her argument that flexible working arrangements could recognise the importance some staff attach to animals won the backing of some delegates. 'In our area it is horses,' Wigan and Leigh Health Services trust human resources director Martin Glover told HSJ.

The NHS is under considerable pressure to change the culture by introducing family-friendly policies to improve recruitment and retention, particularly of women nurses.

It is part of the government's human resources strategy, a big element of the new Employment Relations Act and implicit in European directives, including the regulations on part-time workers and working time.

But some elements of such policies will be alien to managers, a minority of whom remain the biggest obstacle to development, according to evidence presented to the seminar.

Ms Kershaw - who was introduced as having a 19-year-old daughter, a husband, three cats, two rabbits and a budgie - said her own survey of 11,200 staff working in three different trusts found that 31 per cent of managers had 'negative attitudes'. They thought staff abused the system and lied about their need for time off.

They also complained about a 'two-tier' system emergingbetween those with children and those without, a view that also emerged from other speakers.

But the hardest attitude to shift was the one where themanager said: 'When I was bringing up six kids and working full-time...'

The key to success, Ms Kershaw said, was to teach managers how to do it and give them support in the process, not simply hand them a policy and tell them to get on with it.

The present system, she suggested, does not produce happy staff. Just 10 per cent of doctors and 5 per cent of nurses said their trust was a good employer,compared with 95 per cent of administrative and clerical staff, who were the main beneficiaries where flexible working was an option.

And 6 per cent of staff having difficulties with childcare solved their problem by ringing in sick.

Among the 12 per cent who said they found 'other' solutions were a number who felt that they had no choice 'because of peer, manager and service pressures but to leave their children to care for themselves'.

Ms Kershaw said the survey had not gone into enough depth to discover the age of children left to fend for themselves, or how long they were left alone.

But flexible policies do change staff behaviour, the seminar was told. Mr Glover said sickness absence had fallen by a fifth -'saving a huge amount of money' - since the trust introduced 'time care', a computerised system which allows staff to choose their hours (see box).

The system is one of seven pilots in 11 trusts set up by the NHS Executive's equal opportunities unit, which were project-managed by Mr Glover's colleague, senior project nurse Anne Vernengo, while she was on an 18-month secondment.

The pilots, she explained, were intended to give women more balance between their working and home lives so they could develop their professional careers. 'Anything else is a bonus,' she said.

At Wigan and Leigh, people no longer rang in sick because they could take time out of a 'time bank', and make it up later. It is a 'bottom- up' system with no fixed shifts and staff deciding when they work, provided that minimum staffing is covered.

Similar benefits have come from a 'top-down' system of annualised hours introduced three years ago at Grampian University Hospitals trust. Assistant HR director Ed Rennie said that, for the system to work, only 25-30 per cent of staff need to volunteer to work annualised hours.

The system is backed up by an 'on call' rota, enabling the trust to call in people if things get 'totally out of hand'. And there is a 'stand down' system so staff can be sent home if there are too many on duty.

Mr Rennie said: 'The proof of the pudding is ultimately how close we are to matching staff to workload. In every area we have implemented it, we manage to close the gap. It is much,much closer - and it has certainly saved money.'

The trust is saving by using bank and agency nurses less, and by more efficient and cost-effective use of staff.

Mr Rennie said there were no longer peaks and troughs of people having either too much work to do or not enough.

'We now have over 200 staff working this system and we will continue to increase the numbers and spread it to other areas.'

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What staff say about the 'time care' system

'I have dogs and cats and can now care for them much better.'

'I don't feel guilty requesting time off for leisure and family commitments now.'

'I use the time bank for emergencies, then I don't have to ring in sick or use my holidays.'

'I now work three days instead of five, so I save on petrol, travel time, and childminder costs. Brilliant.'

'It gives you control and makes you feel good about coming to work.'