Extending Working Lives in the NHS: Opportunities, Challenges and Prospects

The proposed research, a case study of the management of employment change in the NHS, is advanced against the backdrop of far-reaching changes in the UK state pension age and the abolition of the mandatory retirement age. The NHS is the world's largest publicly funded health service and as such provides a critical reference point for the generation of new knowledge and understandings of how organisations are responding to the challenges of the ageing population. Can working lives be extended in ways that reconcile the possibly conflicting aims of supporting and promoting health and well being on the one hand and the quality and efficiency of service provision on the other? Is it possible to identify the management practices and employment systems that best promote the internal organisational flexibilities that serve to reconcile these critical policy objectives?
The raising of the NHS occupational pension age to 66 (2020) and 68 years (2028), depending on occupation, is a large-scale challenge to the NHS employment system and this dynamic setting provides the opportunity to improve our understanding of the implications of an ageing workforce for working-life longevity, healthy ageing, and performance within the NHS and more broadly.
Our investigation of the public health sector will deepen theoretical and empirical knowledge of how an ageing workforce, health and work interact, and thus improve the quality of information available to managers and other stakeholders to better understand how policies might be changed to improve outcomes. It will enable a better assessment of the impact of an ageing workforce on organisational performance, with three distinctive issues under consideration. First, whereas previous research on labour productivity has been highly aggregated and focused on crucially important measurement issues, our research will also investigate the processes underlying age-wage-productivity dynamics through a mixture of quantitative and qualitative research at Trust and occupational level. Second, it will allow interrogation of the connections between inputs (differentiated by skill, gender, age and occupation), processes (eg, employee voice, participation, joint consultation) and outputs (absenteeism, response times, exit rates). Finally, it will explore perceived (and real) differences in interests between groups (eg, intergenerational and management/employees).
Taking a dynamic, longitudinal approach, our research will recognise that employees are members of teams within inter-related strategic functions in health care delivery. Attitudes and behaviour are thus formed within specific social settings and against particular histories that bear on current choice sets. It will examine the formation of individual beliefs and knowledge (mental models) and their impact on employee decision making over working life and retirement planning. A key focus is how aspects of the decision architecture rooted in employer practices impact on employee behaviour at key points of transition in career pathways, retirement planning, and pension choices. How do, for example, the availability of flexible working and the scope for redeployment construct and constrain behaviour? The significance of job design and redesign, and management support for disability and rehabilitation, will also be investigated.

The research, a case study of the management of employment change in the NHS, is advanced against the backdrop of far-reaching changes in the UK state pension age, the abolition of the mandatory retirement age and raising of the NHS occupational pension age. Using quantitative and qualitative methods and taking a dynamic, longitudinal approach, our research will recognise that employees are members of teams within inter-related strategic functions in health care delivery. Attitudes and behaviour are thus formed within specific social settings and against particular histories that bear on current choice sets. It will examine the formation of individual beliefs and knowledge and their impact on employee decision making over working life and retirement planning. A focus is how the decision architecture rooted in employer practices impact on behaviour at key points of transition in career pathways, retirement planning, and pension choices. How do, eg, the availability of flexible working and the scope for redeployment construct and constrain behaviour? The significance of job design and redesign will also be investigated. Our study will deepen theoretical and empirical knowledge of how an ageing workforce, health and work interact. It will enable a better assessment of the impact of an ageing workforce on organisational performance, with three distinctive focuses: 1) previous research on labour productivity has been highly aggregated and focused on crucially important measurement issues; we will also investigate the processes underlying age-wage-productivity dynamics through quantitative and qualitative research at Trust and occupational level. 2) we will interrogate the connections between inputs (differentiated by skill, gender, age and occupation), processes (eg, employee voice, participation) and outputs (absenteeism, response times, exit rates). It will explore perceived/real differences in interests between groups (eg, intergenerational and management/employees).

The research design anticipates significant impacts within policy, academic, and practitioner spheres. Beneficiaries will include policy makers seeking to adapt to the ageing population (notably the Department of Work and Pensions and the HSE in the UK), employers faced with an ageing workforce and trade unions faced with policies to extend working lives. For each, the research will provide a better understanding of the implications of an ageing workforce and identify good practice in response. More widely, this should translate into improved health and well-being for older people and improved economic performance, as the ageing workforce is utilised more effectively.

The research will contribute to three core areas of concern: the interconnections between ageing, health and working lives; productivity dynamics; and the formation of individual beliefs and knowledge (mental models). Understanding how the latter impact on decision making over working lives and retirement planning will be a key focus. The project will generate new empirical and theoretical knowledge, through a combination of qualitative and quantitative methods, with direct relevance to a range of research users.

We anticipate benefits for medical officers, occupational health practitioners, strategic and human resource managers grappling with the task of reconciling longer working lives, improvements in health and well-being and the quality and efficiency of service provision. The provision of a high quality, longitudinal evidence base will provide a more secure foundation for the development of policy and practice in respect of managing retirement and extended working lives. We anticipate benefits for policy makers in the UK and other European member states who are tasked to facilitate shifts in (paid) work patterns over the life-course in response to the challenge of ageing populations and declining birth rates.

We would expect the impact to be most rapid within the NHS and, particularly within the case study Trusts: during the course of the study we would expect the research to influence how human resource policies and the employment of older staff. Wider dissemination (to other employers, trade unions and policy makers) will start during the study, particularly after the third year. Outside the NHS, we would expect impact to occur first with policy makers, trade unions and professional practitioners, followed by any impact on employer's practices.