This edition of the Work Thought Blog was contributed by WFRC chair Susan Halford.
As the 21st century unfolds, it is rapidly becoming clear that most of us – in the West at least – will have to stretch our working lives far further into old age than the recently retiring generations. The steps taken by governments, employers and financial institutions to deal with the ongoing pensions’ crisis means that most of us will simply not be able to afford to retire in our early or mid-60s. Meanwhile, and in any case, the ageing demography of Western nations will demand that older workers stay in the labour market longer to fuel the emergent recovery and beyond.
Nowhere are the demands for older workers going to be more keenly felt than in the healthcare sector, where the conditions described above are greatly exacerbated by the needs of an ageing population for services and care. In short there’s a double whammy: an ageing workforce must meet the demands of an ageing population. To make matters worse, the healthcare sector currently has one of the worst records for long-term sickness and highest rates of early retirement of any sector in the labour market. It’s a triple whammy.
More generally, one thing is clear: we cannot continue to provide healthcare services in the way we have been doing. Whilst the precise solutions vary, there is widespread recognition that the balance between primary and community care must shift, so that fewer people are treated in expensive hospital beds, and that the traditional boundaries between professions and organizations must be breached to enable more flexible, joined up services. And new technologies are being introduced to underpin these changes, promising improved information, that can be used to manage complex patient trajectories, across multiple boundaries and provide detailed management information from which further lessons can be learnt and efficiency improvements made. But here’s the paradox: research across a range of disciplines suggests that the prevalence of early retirements rises in those organizations with the highest levels of change, particularly change linked to technical innovation. To put it bluntly: we have a looming workforce crisis in public healthcare, that will lead to major social crisis if we can’t resolve it, and current changes designed to secure the future of the health care system may only make things worse!
So it is rather important that we begin to unpick the dynamics of this. What is the relationship between organizational change and early retirements? Is this inevitable? And are there ways that we might intervene? The answer depends on how we understand age and ageing. If, as some research has suggested, older workers are simply more conservative and resistant to learning or change then we have a problem and, in healthcare especially, one that may be exaggerated by the physical demands of clinical work. However, recent research by WFRC in collaboration with colleagues at the University of Tromsø suggests a rather different explanation. This three year project with doctors and nurses over 50 years old, including some in retirement, at two large University hospitals in Norway concluded that it is not age per se that leads to early retirement but rather the conditions of work and organization of the workplace that leads to staff feeling under-valued, out-of step and incapable. It is not age that makes these workers resistant to change; its change – and the way it is (mis)managed – that makes these workers feel old. Feeling old, often for the first time, leads to thoughts of retirement. In particular, changes to the organization of work may make certain skills redundant, whilst staff are sometimes expected to just pick up new skills with very little training (especially related to the use of digital systems). Furthermore, the continued organization of working hours around the standard shift pattern can make the work too much for those with physical limitations, as well as those with domestic responsibilities (ageing parents can be as much of a conflicting demand for time and energy as children, but few employers are willing to recognise this). These points are underscored by the many cases that were found in the research where older workers were happily staying in healthcare work. These were the niches where older workers skills were still valued, where training and support was given, and where line managers made special arrangements to enable appropriate working hours and responsibilities (albeit ‘below the radar’ of senior managers). Notably, the research found that working conditions for nurses were far more likely to produce age than those for doctors reflecting – perhaps – the greater autonomy and higher status of the medical profession and the associated capacity to achieve concessions e.g. reduced hours. Note too the gendering of these professions.
Overall then the challenges of an ageing workforce are not primarily about age, in and of itself, they are about how we design work, how we structure our workplaces and what we expect of our staff. Whilst these points may be very familiar in relation to previous debates about gender at work, to date we have barely scratched the surface in thinking about them in relation to age and ageing. Now is the time to so, to support those of us who must continue working into later years and to ensure that we retain a skilled and committed workforce to care for all of us into the future.