At the ILN we have worked with a number of organisations across the UK on some of the key challenges the health and social care sector currently faces. Workforce is undoubtedly the biggest challenge at the moment, and one of the workforce development programmes we offer at the ILN isthe Shadow Board programme. This programme is aimed at supporting the aspirant directors of the future, working with organisations to identify and develop these people, using a unique blend of modular and experiential learning.
There is a shortage of board directors in the North of England (1 in 3 have a vacancy) and 31% of current board level vacancies are filled on an interim basis. More shockingly, only 5.1% of Very Senior Managers in the North are from a BAME background.
So, what is it that holds people back and prevents them from aspiring and wanting to take on a board role?
These and many other challenges to the next leaders in health and social care was part of the debate and discussion at the inaugural Shadow Board Network alumni event, hosted in partnership with Yorkshire and Humber Leadership Academy, held earlier in May.
Since its inception, the Shadow Board programme has worked with more than 300 individuals from 22 organisations and 5 systems including Sheffield Children’s Hospital, Rotherham District FT, Bolton NHS FT, a Mental Health Collaborative Shadow Board with SWYPFT, Leeds and York Partnership and Bradford Care Trust, and East Lancashire Care Trust. It’s always been our aim at the ILN to create a network of alumni, bring them together for the greater good to continue their learning, development and support, ensuring that the leaders, directors and board members of the future are equipped to face the workforce challenges in health and social care.
A number of these alumni came along to the network to hear from some excellent and engaging guest speakers; Andrea Overton from YHLA, Daniel Hartley, Regional Director for People and OD at NHS England, Julian Hartley, CEO of Leeds Teaching Hospital and Steve Russell, CEO of Harrogate District Trust. Attendees also had the opportunity to share their thoughts, ideas and experiences, and start a discussion about what a Network could look like.
What was clear to me across the day was the similarities across all the sectors in attendance – healthcare, local government and the voluntary and community sector – particularly around current leadership challenges in the system and the support needed.
A number of themes emerged, including having the capacity to do both organisational and system working, the inability of some leaders to let go of a previous culture of competitive ways of working, the pace of transformation leading to little time available for thinking and the current political working environment (a challenge for all of us!).
But what really stood out for me, was the discussion around leadership behaviours and skills needed, and the requirement to define what ‘good’ looks like or have a framework for system leadership. There is a need for better succession planning and development of new leaders, developing a pipeline of these to support system succession planning not just organisational.
And when commonality of experiences and challenges were discussed, it was interesting to see that a lot of it was around behaviours. Current culture was one of the biggest challenges to effective system organisational development work, and also perceived gaps and risk in current leadership culture, and the feeling of being disconnected from the lived reality when talking about systems working.
The current challenges of regulation were seen to drive behaviours in leadership that sometimes felt as though it pushed away from the ‘new style’ of collaboration and integration. We know this to be true and this is why when we work with system Shadow Boards it’s important to also take time to understand and appreciate the constraints in system working, such as organisational regulation and funding flows.
A shift from competition to collaboration isn’t as simple as just developing good working relationships (although this is an essential prerequisite): the constraints are real and felt every day.
At the ILN we know that there is a huge learning gap between being a senior manager and a functional specialist, and that it’s not only leadership behaviours that enable and equip people to be directors, it’s the leadership task.
The Shadow Board safely supports people to understand and appreciate the reality of life as board member and what corporate accountability feels like. It bridges the gap in knowledge and experience to support people to be board ready.
It was fantastic to hear from alumni on the day who had gained promotions following their time on the Shadow Board programme, and it always gives me a sense of pride and satisfaction to hear that the work the ILN does has an impact for people and therefore for patients.
The day felt a great success and brought together people from different organisations to work together and to build meaningful, wholehearted and trusting relationships. There was debate, discussion, learning and real-life problem solving, and connections were made across a system that will support and build foundations for future work.
I’d like to thank everyone who attended and the Yorkshire and Humber Leadership Academy as a partner in what felt like the beginning of something fantastic.
We’ll be hosting more Networks in the future, quarterly events and also masterclasses. See our website programme page for more information on the Shadow Board Programme, or get in touch with me at firstname.lastname@example.org
Kirstie Stott, The Inspiring Leaders Network, 14 May 2019
I think it’s safe to say that most of us welcomed Matt Hancock’s comments last week around supporting and enabling women to reach (I prefer ‘ be appointed’) to senior positions and to close the gender pay gap. The Secretary of State for Health and Social Care says he won’t rest until it has. In his article in the Guardian on 25 April he said that despite doing around 80% of the life-saving and caring roles across our NHS, the uncomfortable truth is that women are paid less, promoted less and systematically underrepresented among the top jobs. Whilst he is right in the latter of this sentence, it’s not just the caring and lifesaving roles which are impacted and I don’t believe it’s as simple as focusing just at the top of organisations. The truth is that gender inequality is not just a senior leadership issue, nor is the gender pay gap which doesn’t appear to be closing any time soon.
In his solutions to this he discusses getting more women into senior leadership roles, seeing tailor made training programmes, more role modelling to inspire women and better support networks to help women navigate their careers successfully, of course because women in the NHS need more training just for them. We also need inspiration to reach senior positions because we don’t already aspire to this and, of course, we need more networks for women as we independently can’t navigate our own path. Ok so I’m being somewhat facetious here because, let’s face it, we’ve been doing this for years and it’s not working!
What I really welcomed was the thinking around flexible working and ‘the need to create a working culture that truly embraces flexible working and encourages women to stay in the workforce and helps them move up the career ladder, even after career breaks to have children’. Hurrah and Amen to that, but ‘simply expanding the use of smart rotas for shift workers’ won’t achieve this alone.
For starters, it’s not just clinical staff that need flexible working, there’s a broader societal issue here, if we continue to see flexibility as a women’s issue because they have kids. We need to also be supporting Dads, many of whom want to play a more active part in parenting and spending time with children. We all need a supportive employee to enable us to live a fulfilling life both in and out of work. It affects everyone, at all levels and roles in healthcare, all ages and all genders. Badging this as a woman’s issue is dangerous and unhelpful, whilst we know it is part of the solution to gender equality it’s not just about women, flexible working is about people and being a good and responsible employer.
There are some really great examples of where some companies are leading the way in encouraging and normalising shared parental leave Aviva is one of the brands leading the way who introduced equal parental leave, offering all male and female employees up to 12 months leave, with six months at full pay. To date, 67% of new dads working at Aviva have taken six months off and a further 95% have taken more than the statutory two weeks paid paternity leave. Many other companies are following suit such as Linkedin, O2 and Spotify to name just some. I’m sure this will really start to create a culture where flexibility is the cultural norm and where things such as childcare as seen as both men and women’s responsibilities.
I’ve written previously about closing the gender pay gap (see http://www.nationalhealthexecutive.com/Comment/is-the-glass-ceiling-much-lower-than-we-realised) and about what traps women into low paid jobs, The Modern Families Index (2016) suggests that seniority in roles allows flexibility. Nearly 80% of those surveyed earning £50,000 to £70,000 reported that they had access to flexible working, whilst in contrast only 50% of those earning less than £30,000 did. Do we therefore need to extend our efforts to middle and lower grade staff not just senior leadership?
I’ve also said many times that I believe we have a generational workforce challenge ahead of us that will impact significantly on recruitment and retention as well as gender equality. Evidence demonstrates that generation Y want flexible working above promotion or pay, they want flexibility in role not just hours. When Matt Hancock talks of supporting ‘those in the early stages of management who are the future leaders of the NHS’ I can’t help but think of the NHS Graduate Management Training Scheme (which I myself went through and loved and am thankful for), however I am curious and wonder if the application and requirements disadvantage women, especially those with families. For starters, it’s full time (no part time version), you’re not guaranteed to be placed in your region, it’s incredibly full on with study and work placement, working a full time job whilst studying for a professional qualification, especially the finance stream. We advertise the scheme as recruiting and developing the best and it takes on only 1% of applicants. These are the future senior leaders, the ones who will be fast tracked to influential positions in the system. So, what happens if I can’t work full time hours, or if I’m dependent on family support to raise my kids and can’t relocate. What if the pressure of doing work and a professional qualification and manage a toddler or teen is too much, does this mean I’m not resilient or maybe it’s just unrealistic?
So, SoS, I welcome your enthusiasm and ambition, but let’s not make this a woman’s issue, let’s not just talk about networks, and training programmes for women. Women know how to lead, we know how to influence, we know how to do the role.
We need the culture to change to make practicalities a reality and to develop a vision and culture of flexibility that’s owned by everyone, that’s coproduced within the system, by the people, for the people supported by policy at the highest level.
Here are some thoughts on some of the things I believe will help steer the changes required to make this a reality not just rhetoric:
Kirstie Stott, The Inspiring Leaders Network, 30 April 2019
Kirstie Stott Director of The Inspiring Leaders Network and Equilibrium asks:
At a time when Health and Social Care are facing their biggest challenges, financial constraints, more for less and enhanced integration and partnership working, it seems imperative to ensure that we are utilising our best talent to think differently, challenge cultural norms which lead to poor patient care and outcomes and to manage and enhance new and existing relationships to drive forward, innovate and lead through new ways of working and models of care and best practice.
There is a plethora of evidence to demonstrate that having a more gender balanced and diverse board benefits not only the organisation but has significant benefits to the economy. There is much more than an anecdotal need for us to review, develop, support and transform our workforce.
The importance of women on boards across sectors has been evidenced widely. According to McKinsey, companies across all sectors with the most women on their boards of directors significantly and consistently outperform those with no female representation – by 41% in terms of return on equity and by 56% in terms of operating results. Furthermore addressing the gender balance in senior posts is particularly important; the Women and Work Commission found that allowing women’s full potential in the work place could be worth £23 billion a year to the Exchequer.
In a study of the Fortune 500, Catalyst reveals that companies in the highest percentile of women on their boards outperformed those in the lowest percentile by 53% higher return on equity, 42% higher return on sales, and 66% higher return on invested capital.
More locally, Leeds University Business School reports that having at least one woman as director on the board appears to cut a company’s chances of going bust by about 20%. Having two or three female directors lowers the risk further and during 2011, companies in the STOXX 600 Index with more than 30% women managers outperformed those with less than 20% women managers by nearly 8%.
So, having this evidence, what is it that still prevents equality in senior posts across the Health and Care landscape?
We know that in comparison the NHS performs better in terms of gender balance than the private sector, and that’s something we should absolutely be proud of, and, it’s not enough, how long should we have to wait for equality?
Women currently make up approx. 47% of the workforce, although currently women’s unemployment is at a 24 year high. Women are as ambitious as men; and with 1 in 3 female graduates having a degree in health related study compared with 1 in 11 males, maybe consideration to working practices viewed as the norm should be reviewed.
The traditional management role of 9-5 doesn’t conform to most people’s lives these days, people have different responsibilities and it would seem sensible to have a more fluid approach.
Lack of flexible working is not only a barrier to gender balance, but to talent management and succession planning. With an aging population, and an increase in diseases such as Dementia, more people are requiring the flexibility to care for elderly family, in addition people living with a disability may require the flexibility to work reduced hours, or just simply work in different ways that support their needs and enhance their ability to do a good job.
There is a clear business case to review and innovate our working and recruitment practices, this article serves to stimulate thoughts and showcase several good areas of practice.
Research from CIPD and Westfield Health suggested only a third of employers (34%) have a formal, written policy or an informal, verbal policy in place to support working carers in their workplace, this is concerning, given that 3 in 5 people will end up being a care for someone at some point in their lives. Caring comes in all shapes and sizes, but the commonality remains, employees need to support them in the workplace before they lose the talent.
Employee support and access to flexible working can greatly increase staff morale, engagement, attraction and retention, it also reduces staff absenteeism, as people will not need to take time off work sick to care for family due to the lack of options presented to them. In addition, burning the candle, attempting to juggle, has an impact on health and wellbeing, reduction in productivity at work and also reduced motivation.
Looking more broadly, most companies do offer some degree of flexible working; most frequently these consist of part-time or job share, variable/compressed hours and career breaks. The Confederation of British Industry (CBI) found in 2011 that 96% of UK companies offered at least 1 form of flexible working and 70% offered three or more types. However, The CBI further found that companies are extremely reluctant to extend these flexible-working patterns further and to larger groups of employees, as they feared that it would have a negative impact upon productivity. The Future of Work survey 2012 concluded that many UK companies were fearful of extending the boundaries of flexible working due to concerns around competitiveness.
The NHS offers similar flexible working practices, however it would appear that these options reduce significantly, the more senior the post and also there is huge variation in availability and practices, seemingly dependent upon local practices and culture. However how often do we actively recruit flexibly?
In 2009 the Family Friendly Working Hours Taskforce under the lead of Yvette Cooper was established by the Department for Work and Pensions. It highlighted a number of compelling business reasons for flexible working such as falling absenteeism, greater retention of staff, increased productivity, greater staff loyalty and importantly the ability to recruit from a wider and more diverse talent pool of workers. After looking at business examples and hearing from employers and employees the Taskforce concluded there was a very strong business case for flexible working. In addition there was also a strong social case, which integrates improvements in child poverty and the gender pay gap.
Despite the case being made within recent years for an increase in flexible working opportunities, employers are still not providing the opportunities for work-life balance that employees feel they require particularly in more senior roles. Public perception is still very much behind the times in this also with 72% of the population not believing it possible to work part time in the case of senior roles thus demonstrating that the stigma of working part time persists. In fact it is the case that 1 in 10 workers earning over £40000 FTE do work part time. The reasons for working part time hours are varied, from childcare responsibilities, leisure commitments to caring for elderly relatives. However, the negative associations persist and many part time workers fear their commitment to their role is questioned and worry it may impact their chances of promotion.
Research has highlighted that for true flexible working to occur senior management must be enabling factors in the cultural shift. Demonstrating to senior managers the real savings that can made and the increasing productivity, which is possible, is crucial if agile working is to be followed through. Where senior managers play an active role in encouraging flexible working the benefits are clear.
Flexible working relies on mutual trust and the breaking down of tradition working patterns of presenteeism. The Future of Work Institute highlight that even though companies are aware that change is needed they can remain hesitant (2012). This aversion to risk is certainly a barrier for some companies particularly the more traditional roles.
In the case of job share the benefits to employers are clear. Employers keep two valued employees who might otherwise feel they need to leave in order to pursue work-family issues. In turn the employer retains two sets of positivity and creativity and also skill mix.
Working as a job share means the employees must communicate extremely effectively in order to plan goals and share achievements. Covering for illness and holidays is simpler and with less disruption in term of customer service.
In a UK survey by My Family Care and Hydrogen (a recruitment company) of 1.587 employees and 310 employers found that 54% of the working population want to work remotely or from home but just a third were encouraged to do so. 81% of workers seek flexible working above other benefits such as enhanced pensions or healthcare schemes. A further 45% would choose flexible working over a 10% salary increase. The survey concluded that flexible working is in fact ‘the future’ especially given the increasing numbers of working mothers in the UK, the increasing pension age and the rise of the ‘sandwich generation’ with dual caring responsibilities of children and aging parents.
Returning to diversity of boards, it would seem that at a time of great change, we need to enable and liberate all of our talent, prevent workforce exclusion and adapt and challenge current practices so that we can really begin to fully utilise the cognitive diversity of everyone, not just those who can work a 9-5, Monday to Friday week.
Senior positions are tougher than ever, there is a shortage of CEOs, and senior level leaders are suffering burnout and high levels of stress. This coupled with the recent shift in retirement age provides yet another argument in favour of flexible working and recruitment. We should be looking to retain our senior leaders and their wealth of knowledge and experience, rather than seeing hem walk into consultancy firms with all of their experience, skills and knowledge.
In the New Year we will be launching Equilibrium, an organisation, which is ambitious in its mission to, supports both individuals and organisations, to think differently about how they employ people. Equilibrium has been established to support organisations to be more flexible employers, and to support talented individuals to gain a place in the senior teams of public sector workforces.
The aims are to build a better future for both employees and organisations across the Public Sector to enhance quality, efficiency and innovation and ultimately lead to better service user outcomes. Equilibrium will facilitate and empower positive practical solutions to the workforce exclusion and talent drain currently facing today’s workforce market. We don’t want to just talk about it; we want to make a change!
We know that offering flexible work opportunities at the point of hiring can increase the talent pool, there is a great deal of evidence to suggest that many women are working below their ability and potential due the lack of flexible options, and we know its not just women who want flexibility.
Flexible working option can enable organisations to get the skills & experience they need, whilst reducing costs, to increase performance and engagement with employees and to enhance innovation through cognitive diversity.
We work with organisations to help fit the jigsaw together – flexible hiring as well as working opportunities, not recruiting what we had, but rethinking and designing what would work
‘We need to stop hiring like for like and think about how we can hire differently and better’