Unfortunately, it is difficult to objectively measure the possible impacts on performance and productivity. This is a fundamental charge often levelled at public bodies, apparently lacking of the free-market mechanisms to clearly identify output and value. Arguably this extends to the individual employee level, where insufficient routine evaluation prohibits the kind of performance-related benefits that drive productivity in the private sector [6]. The recent Messenger Review on NHS leadership finds \u201ca lack of consistency with appraisals \u2013 and in some areas, these were absent altogether\u201d [7]. Without such assessments, reliably measuring performance is just not possible, and so any review on the impact of home-working can be only subjective at best.<\/p>\n
Yet subjectivity is vulnerable to bias. Surveys show that people actually quite like working from home \u2013 they like the flexibility, the leisure opportunities, and the greater time with family [8]. And this is supported by the markedly slow return to the office in this country compared to others. So, putting aside those unswayed by personal preference, what incentives exist to draw oneself closer to something unliked by considering and promoting its benefits? It\u2019d be like turkeys voting for Christmas.<\/p>\n
Leaders should also consider their role in this \u2013 in embracing the personal preferences of staff within an increasingly visible attention on employee \u2018wellbeing\u2019. Like other parts of the civil service, the NHS has noticeably strengthened its wellbeing message in recent years [9]. While staff satisfaction and productivity are undeniably linked, there is surely a limit on how far this association can be taken. The worry is that employee-wants<\/em> are put ahead of business-needs<\/em>, and the taxpaying public are left to wonder whether the raison d’etre of their NHS is really to provide them with the best possible healthcare, or to provide the happiest possible place for its workforce.<\/p>\n And how does this all stack with another of the NHS\u2019s increasingly visible priorities \u2013 of addressing inequalities. While the predominantly middle-class (former) office-workers can now avoid commute and childcare costs through routine home-based working, there is no such option for the relatively poorer nurses, porters and cleaners who have no choice but to travel in each day come rain or shine (and have little insulation from the currently exorbitant fuel prices). Should we also expect them to fit, as they do, their personal lives around work commitments, while better-paid home-working colleagues are able to do much the opposite. And what of the wider impacts on local economies, and the Resolution Foundation\u2019s recent finding that \u201cthose areas that are expected to do relatively well out of working from home tend to [already] be relatively advantaged\u201d [10].<\/p>\n This is not to reject home-working out of hand. Not least as it will be required in some form in order to compete in a labour market saturated by employers offering it as standard. For the NHS, avoiding such disincentives will be particularly important given the pressing concern over the adequacy of its future workforce, as recently highlighted by the House of Commons Health and Social Care Committee [11]. And while the findings of hitherto published academic studies are not exactly unanimous (likely indicative of insufficient time for proper examination), there is some evidence to suggest that in general \u201cmoderate levels\u201d of home-working could actually increase productivity [12]. And, of course, there is the lower estates cost to factor in.<\/p>\n In summary, much has been made of the positives of working from home, but little attention has been given to its negatives. Yet, as we continue to emerge from the pandemic, there is still an opportunity for NHS leadership to shape future long-term working practices to ensure the best possible service can be provided to patients. To do so will require robust empirical evaluation of performance and productivity, combined with an acknowledgement that workforce happiness and wellbeing are important only as far as they allow the organisation to meet its fundamental aims and purpose.<\/p>\n <\/p>\n References<\/strong><\/p>\n <\/p>\n Dr Richard Wood<\/strong><\/p>\n Dr Richard Wood is an applied mathematician and senior analyst working in England\u2019s National Health Service. As Head of Modelling and Analytics within a large Integrated Care System in the South West, his role involves designing novel quantitative approaches to help address the various operational and strategic problems facing the NHS. He has authored 30 academic papers and is a Senior Visiting Research Fellow at a local university. Before working in healthcare, he has enjoyed careers in bioterrorism analysis, financial risk, and capital modelling.<\/p>\n Declaration of interests<\/strong><\/p>\n I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.<\/p>\n","protected":false},"excerpt":{"rendered":" The COVID-19 pandemic has had a lasting effect on the working practices in many industries and organisations, and the NHS is no exception. Video outpatient appointments have become increasingly common for many hospital specialties and over one in three GP consultations are now conducted virtually, compared with one in seven before the pandemic [1,2]. But […]<\/p>\n\n
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