D ISCUSSION AND CONCLUSIONS

102

Management implications

The management of the NHS has to develop a full understanding of this major, structural change. First, data provided in the previous paragraph should be detailed, integrated, and updated regularly. Moreover, for several figures data should be collected and analysed for the whole labour market and not only for the NHS staff. This is particularly the case for support staff, much employed in nursing homes and social services needing health assistance.

Another limitation of our analysis derives from the structure of the database that does not permit to assess if older cohorts of employed NHS staff are less likely to work full time. This sensible information should be integrated into the analysis and could be collected on a relevant sample of NHS staff.

In spite of these (surmountable) limitations, it is clear that this rapid ageing of workforce needs a deep assessment of actual organisational culture and HRM systems in many healthcare organisations. Here, at least the following areas should be addressed with “proactive” policies in the Italian NHS organisations:

- communication. Older workers want to be talked with and appreciate direct, clear communication. They also value to give suggestions and contributions and to be recognised for it;

- careers' design and compensation. Career paths can improve the opportunities for jobs able to develop skills and competences of younger workers, for example creating mentoring programmes etc. In terms of compensation, older workers could be more interested in suitable benefits than in pay increases;

- internal mobility. When managing long careers, employers should promote active mobility procedures. Job rotation may reduce boredom and improve cross-departmental communication/cooperation;

- continuous learning. This is an important dimension to look after, because older staff could have less incentives and motivation to apply to courses and other continuous development programs. In addition, employers could discriminate older workers, preferring younger staff for which the investment could have greater and long-lasting returns. Usually it is important to be clear, insisting that all employees become and remain technologically literate, not allowing some of them to “opt out” of acquiring new needed skills;

104 - more cautious policies for assessing limitations and special conditions of employed

staff. Ageing at work has both positive and negative effects for the worker’s health.

From one side, the social environment provided by the organisation and the colleagues, together with stimuli and satisfaction that can be obtained, are strong factors of health improvement. On the other side, there are some age-related health problems, such as the high incidence of back injury amongst older nurses, often causing absences from work and early retirement or in any case a health condition making them unsuited to physically demanding jobs. In the Italian public service – ad so also in the NHS staff – the established culture has favoured the very common recognition of work injuries among employees or other health conditions that limit the normal utilisation of workers in their jobs. Examples include lifting limitation to 5, 10 or 20 kg because of back pain, limitations to teamwork because of agoraphobia, or exclusion from nightshifts because of several possible health conditions. Ageing will lead to an increase of these health conditions, so employers have to be extremely careful in recognising those limitations, if they want to safeguard the functionality of the healthcare organisation;

- procedures and safeguards in order to manage severe impairment of employed staff. In some cases, ageing could lower the quality of services that a certain employee is able to provide. For example, this is the case with impairment. In order to avoid quality risks for the patients but also to maintain a proper relation with the health professional, the employer should develop measures able to identify potential problems before they become clear, sustain the health professional concerned, but also provide

“outplacement” solutions for the cases without solutions⁴⁸.

Finally, older staff also has positive characteristics. Not only they are more experienced, but also they are often more reliable and stable, that is less subject to the organisational cost of

48 Peisah et al. (2007: 826-827) report the case of doctors’ impairment: «Having to extricate the impaired older doctor from clinical practice after a lifetime of contribution to patient care is an unpleasant scenario […]. A recent descriptive study of 41 older impaired doctors referred to the New South Wales (NSW) Medical Board included five doctors with frank dementia. Twenty-nine per cent were diagnosed with substance abuse, 22% with depression and 17% with two comorbid psychiatric conditions. Almost 70%

were deregistered, suspended from practice or encouraged to retire. Continued practice by such physicians puts the public at risk and forced retirement is a humiliating experience for the doctor. We have a responsibility as a medical community to prevent this». While in this reported case we have not salaried employment, the example remains relevant also for the Italian NHS were doctors are salaried staff.

loosing these experienced staff. This constitutes a major value in labour markets and for professional figures highly volatile, who imply high costs of turn over in terms of recruitment and selection procedures, orientation programmes, etc.

Unfortunately, despite the central role that ageing plays in shaping the challenges for HRM in the Italian NHS, experience does not seem to show any sign of active HRM policies and practices addressing the ageing issue in a creative and effective way. Here, a real green field for innovation and experiments is required and warmly welcome.

6. DOCTORS’ FEMINISATION IN ITALY: HOW MUCH? WHICH