Work in the modern world. Work for the NHS?

Over the next few weeks, I want to post about the experience of working for the NHS and what policy and practice might be able to do to improve this experience.

For most people work is a very important part of their lives. What they do at work plays a role in defining their life. Whilst I believe that this is as true for people in their 20s and 30s today as it was 50 years ago, I also think there are different contemporary meanings of work. As an older person I might rail against the “youth of today” not being as committed to work as we were in my day (Yes, I know, those of you that read Monday’s post will know that I do indeed spend too much time reading the Telegraph). Or we could just stand back and appreciate the differences between generations.

However we approach the contemporary meaning of work it looks to be very important to understand why more clinicians between their 20s and 40 s (and probably, when they get there, between their 40s and 60s) want to work fewer days week than previous generations. Because if we don’t understand that, however much we pretend to ‘long term plan’ the NHS workforce, we won’t be able to make sense of what how many days a week people will actually work. And that, after all, is what a long-term workforce plan, is meant to be planning.

My parents’ generation –  my Dad was 20 in 1931 – spent their lives being very anxious about the possibility of losing their jobs and the impact that unemployment would have on the whole of their lives. This anxiety about work security was passed on to me and, until my late 30s, left me highly anxious about how the labour market might ruin my life. Which led me to behave with extreme caution.  Up until the age of 37 I only applied for 2 jobs and got them both. By then I had begun to realise that the labour market could be my friend rather than just creating a terror of unemployment. I applied for lots of jobs and always secured one eventually.

I outline my own  history, not from of any stance of  moral rectitude, but because it was shaped by a generational history of high anxiety and created a particular experience of work. I was not just pleased to have it but hungry for it to play a big role in who I was. In common parlance – I learnt to live for work. (Put away the violins – all my life I’ve had great jobs which both stretched me and allowed me to contribute to wider parts of society.) But work defined me. It consumed me. (It still does)

Until I was 60, I could not really ever contemplate the notion of having anything like a “portfolio” approach to work. The notion of moving from full time to part time in order to do something different would never have crossed my mind – because what if they sacked me?

(A number of biographical provisos – I have no children and until my 70s had no significant caring responsibilities. So this emphasis on work had no personal pressing countervailing life experience moving against it)

I mention this not because I think it’s unusual, (I think it is probably very typical for my generation) but because it is different from many professionals who are currently in their 20s, 30s and 40s.

And to bring it back to the central focus of what this blog is usually about, if we want to understand the composition of lhe NHS and social care workforce in a decade’s time, I’m suggesting that we need to have a broader understanding of the current meaning of work to people’s lives. We must not start from the lazy position of believing that what happened in the past is in some way morally right and must be repeated in the present or the future.

In 2024 and almost certainly even more so in 2034, more people want to work in order to live – not live to work.

Our workforce planning needs to take that on board.

But (still my father’s son) when talking about work, I can’t move completely away from my strong belief in class. My own biography is that of an upper middle-class professional, and we have a tendency to see the NHS and social care workforce as being within these class parameters.

If you are a basic grade domiciliary care worker, a job that in the 1950s (when my mum did it) was called a Home Help) I don’t think the wages you earned left you thinking that you could have a portfolio approach to work. On minimum wage you need all the hours at work you can get. And if there is overtime, you snap it up if you possible can. The same is true for most nurses.

Because of what they earn the labour market is much easier on established professionals than on those who don’t really have the choice of a three-day working week in their main job.

Over the next few weeks, I will return to class issues within the workforce, but for now the point I am making is that for a significant section of the NHS and care workforce, the next few decades are likely to see many of them wanting to commit to their main work part time.

This changes the balance of power between an employer, the NHS, and a professional employee. If an employer wants employees to work 4 rather than 3 days a week, then they have to create an environment in which employees want to work that extra day.

On the other hand consider an employer who treats an employee at all badly.  Given the competition with their portfolio of other work (say researching for a med tech company for one or two days a week) working an extra day – or at all – for such an employer becomes less attractive.

The NHS as an employer is in constant competition with other employers for let’s say the 20% of work time that the employee is thinking about shifting.

Behave badly as an employer and you lose that 20%. Behave well and you might gain it.

And THAT is what modern workforce planning must be about.

We can train 10,000 extra consultants. Treat them badly and they may only work 2 days a week for the NHS. The 10,000 you trained now only work the equivalent of 2,000.

Plan all you like. Train all you like. But treat your workforce badly and it diminishes.

Treat them well and by every measure your workforce increases.

That’s why how the NHS treats all its employees is at the core of workforce planning.

Never forget that as a whole the NHS employs more people trained in science than any other organisation.  They are people with choices. Treat them as such.