A partnership approach to redesigning working patterns

Overview

North East Ambulance Service (NEAS) worked with staff and trade unions to develop safer and more flexible ways of working. The programme aimed to address long-standing challenges in shift design for unscheduled care teams and improve staff wellbeing while maintaining high-quality patient care. By working collaboratively at every stage, NEAS moved beyond consultation to shared ownership. The programme delivered sustainable change to support staff and patients. 

The issue faced

NEAS introduced a new staff rota in 2019. Although the trust maintained its performance, staff were dissatisfied with the rota’s inflexibility and its impact on work-life balance. In 2022, the trust reviewed working patterns for unscheduled care staff and invited them to share their views and concerns.

The trust recognised that it needed to work with staff to address the challenges they had raised. These included short turnaround times between shifts and how to cover sickness, annual leave and other absences. This led to the development of the Working Partners Programme, which aimed to improve staff working conditions while maintaining a high standard of patient care and service delivery.

The actions taken

• Prioritised partnership working from the outset. NEAS worked with trade union representatives to identify the challenges the programme should address and agree priorities. A dedicated change manager, operational lead and multi-disciplinary team contributed their expertise.
• Used a structured approach. The work began with a rapid process improvement workshop informed by staff survey findings. An external facilitator helped create a neutral, inclusive environment that removed hierarchy and supported open, collaborative decision making. 
• Established robust governance. The trust reported progress at formal trust meetings and joint consultative committee meetings with trust and trade union representatives. This supported delivery and helped establish a sustainable model for partnership working across future change initiatives. 
• Engaged an independent rota specialist. The specialist supported the design phase and helped ensure that proposed solutions were informed by evidence-based practice.
• Involved staff directly. Staff took part in key workstreams, particularly on flexible working and managing absences. A staff-only reference group was also established to strengthen the staff voice.
• Used stakeholder feedback to shape solutions. This helped ensure that proposals were practical, evidence-based, jointly owned and reflected both operational requirements and workforce needs.
• Delivered change in partnership with trade unions. Key outputs included new rota design principles, working patterns and criteria for moving staff between patterns.
• Reviewed progress after six months. The review was carried out in partnership to identify what had gone well and where further work was needed.

Results and benefits

• Improved staff satisfaction. In a survey conducted in March and April 2026, 58 per cent of respondents said they were satisfied with shift turnaround times, compared with 12 per cent in late 2022 and early 2023. Satisfaction with how absences are covered increased from 4.9 per cent to 28 per cent.
• Made meaningful progress through partnership. Although not all challenges were fully resolved, the approach reduced short turnaround times between night and day shifts.
• Maintained performance and patient care. Since the changes were implemented, patient care has continued without a negative impact on performance. NEAS is currently the best-performing ambulance service in the country against national Ambulance Response Programme (ARP) targets.
• Helped staff feel more involved and listened to. NHS Staff Survey results show that the proportion of staff who feel involved in change increased from 23 per cent in 2023 to 28 per cent in 2025. 
• Strengthened working relationships. The programme and its partnership arrangements have helped to build trust between leadership, trade unions and staff.
• Shared learning and supported continuous improvement. Learning has already been shared with other service lines undertaking similar rota reviews. 
• Created a model for future partnership working. The programme was recognised internally as a gold standard for partnership working and received an internal award.

Social partnership working: lessons learned

• Working with trade unions from the outset can help senior teams achieve good outcomes by balancing organisational and individual needs for the benefit of staff and patients. 
• Meaningful partnership working goes beyond engagement. It requires shared ownership, transparency and trust. 
• Joint ownership, transparency and shared accountability can help partners address challenges constructively. 
• The trust now has a robust model for working with trade unions to achieve shared goals.

Summary

Working in partnership with trade unions, Royal Free London NHS Foundation Trust successfully transferred more than 300 soft facilities management staff onto AfC contracts. 

The programme improved pay, terms and conditions, career opportunities and staff experience, while reducing sickness absence and reliance on temporary staffing. It also strengthened trust between staff, managers and trade unions, creating a sustainable model for partnership working and organisational change.

The approach demonstrates how early engagement, shared decision-making and a commitment to fairness can deliver positive outcomes for both staff and organisations, providing a practical model that can be adapted and replicated by other NHS organisations.