NHS bosses up and down the country are appropriately lauding the herculean efforts made by staff to brave the elements and ensure services could continue – some using innovative methods to get to work, others instead pulling double or triple shifts because colleagues were unable to come in to relieve them.

In some corners smug smirks could be seen where institutions had put structures in place to facilitate home working and this enlightenment was paying dividends in such circumstances. But for every such smirk was there also a gnashing of teeth – if we had put these things in place then we wouldn’t lose manpower…

In other corners still, there will be large swathes of professionals who realised they would be unable to attend the workplace and used their time constructively by undertaking online mandatory training or other similar Supporting Professional Activities – almost certainty with the thought to swap into additional clinical duties upon return. This will potentially be embraced as constructive use of time in some quarters, whilst I suspect in many more workplaces they will return to work to find a day of annual leave has automatically been docked whilst they diligently undertook NHS duties from home.

But here’s the rub. The NHS, as everyone knows, continues to operate at full capacity solely due to the goodwill of its staff.  Leaders by and large sanction flexible working practices only when business cases can prove blood is being squeezed from a stone. Hardly ever do we hear of infrastructure changes being adopted in the public sector without hard quantifiable metrics purely because it might be “the right thing to do” – I will explore what I mean by this statement later…

You’ve read enough of these articles now to know what comes next – cue flashback music and dreamscape blurring of imagery…

Several years ago, well before “home working” became a fad, I offered to explore this as a proof of concept at my workplace alongside our CTO. We proposed to pursue this as pet hobby using our own time and equipment that was slated for replacement. You are all well-versed in the arguments by now as this is considered appropriate practice. But back then it was deemed an innovation too far, met with cynicism and suspicion. Ultimately it was not enough to be presented a fully worked up solution for free, using the free time of 2 full time employees. I was asked to predict how many scans an unproven solution might allow me to report and to offer a couple hundred scans for free for the privilege of arranging (and subsequently using) it. You will no doubt be surprised to learn I refused; the hospital in turn declined the opportunity to explore the concept.

My point in this context is not the lost opportunity, so much as the demonstration of the typical mind-set within the service. Study after study has demonstrated that minor investments in the comfort of a person’s working environment can provide reproducible albeit not necessarily quantifiable improvements in safety and efficiency. But whilst we will continue to splurge money on hardware, software and outsourcing solutions to cope with an underfunded and under-resourced service, the idea of optimising the ambient conditions of employees – being it air-conditioning, lighting, better quality desking or chairs or indeed flexible working practices which might suit a person’s lifestyle whilst continuing to allow productivity seem anathema to those who sign off these things.

There is a similar and equally inexplicable objection to home working for those tasks such as mandatory training, audit or other such supporting professional activities which simply require access to a computer and no need to be on-site.

What is the blocker? Fear of certain well-known media outlets being able to run with a story of entitled staff squandering tax payers’ money on luxury chairs and air-conditioning? Lack of sophistication of decision makers unable to envision benefits to a service without recourse to a document listing an £x = y man-hours? I suspect it is all these things, with a strong dose of ennui thrown in. Home working shouldn’t be invested in just as a method to eke out more productivity. Institutions should invest in the workplace wellbeing of employees simply because “it’s the right thing to do”.

By this, of course, I mean there is a wealth of shared learning both nationally and internationally which identifies the benefits of modernised and flexible employment and working practices. It seems utterly nonsensical, for example, for an organisation whose very ethos is to promote health to consistently ignore the wellbeing of the very staff it employs to provide this service – particularly when the challenging conditions they serve under is common knowledge. The importance of championing the welfare of the nation should be manifest from the very core of the service: in seeking to promote it for those providing the service by way of developing a flexible and adaptable workplace. At the crudest level this would most likely help reduce sickness and absence rates for staff – an immediate quantifiable metric.

At some point, we hope, the public sector will learn the lessons from the most successful commercial enterprises: treat your employees well and they will pay you back many times over. Sadly, at the moment all we seem to think is “they do it because they can afford it”

And, of course, in the meantime NHS staff rise above it: continuing to perform above and beyond in substandard conditions for 1 very simple reason: it’s the right thing to do – and someone needs to do it. Of course, the hollow platitudes always help too….as you leave a perfectly serviceable home office to battle arctic conditions to reach your less comfortable work office… And a further atom of goodwill dies as you do so....

Until then, “Home reporting because it helps in the snow” will continue to irk me as it should be “we set up home reporting because it was useful for the radiologist and look a benefit is we have sustained productivity when the adverse weather hits”.

Karma – who knew?

Categories: Blog

Dr Rizwan Malik

Dr Rizwan Malik. MBBS MA(Cantab) FRCR Dr Malik is a consultant radiologist at Royal Bolton NHS Foundation Trust, where he is Divisional Medical Director and Associate CCIO. Prior to this he was the Trust PACS and Imaging Lead, Divisional Clinical Governance Lead, as well as Clinical Lead for Radiology. He is also the Clinical Lead for the Greater Manchester Collaborative Imaging Procurement Project. Dr Rizwan Malik Dr Rizwan Malik Recognised as a leading Digital Health thinker in the NHS, his agenda setting blog posts on LinkedIn are closely followed by both Industry and NHS colleagues. He is an invited International Speaker at conferences about PACS and around the role of AI in Imaging in particular. Curator for UKIO informatics workstream 2018 & 2019 where he aimed to diversify the range of presentations and engage the supplier community in shared learning activities, he is now the Vice President (Industry Liaison) for UKIO. He provides mentorship and strategic steer to a number of Health IT companies. He is Clinical Advisor for InHealth reporting, and has previously worked in the role of Medical Advisor for Wellbeing Software. After completing his medical training at the University of Cambridge; United Medical and Dental Schools of Guy’s & St Thomas’ in London; and Manchester’s Radiology Training Scheme Dr Mallik took up his post at Bolton in 2006 as a general radiologist with subspecialty interests in chest, nuclear medical radiology, developing a particular interest in healthcare informatics. In addition he has experience in medico-legal reporting and a history of working closely with primary care colleagues to establish community radiology services.


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