Abstract
Background: NHS England has an ageing workforce. Approximately 30 percent of the NHS England workforce are aged 50 years and over, and the British Medical Association has argued that it is important that employers meet the needs of their ageing workforce and retain their skills and expertise. Objective: This sought to explore how NHS England Trusts support employees with fluctuating long-term health conditions, investigating systemic workforce challenges to providing adequate support and identifying opportunities for more inclusive and sustainable employment practices. Methods: Qualitative interviews were conducted with staff working in human resources, occupational health staff and clinical line managers involved in the support and management of staff with fluctuating long-term health conditions (n = 17). Results: The research found a misalignment between clinical managerial practices, human resource procedures, and the overarching NHS human resource policy framework, which was often seen as rigid and poorly suited to the fluctuating nature of some long-term conditions. These tensions were exacerbated by high staff turnover and limited organisational capacity. Nonetheless, instances of effective, person-centred support were also reported, typically occurring where cross-departmental collaboration and flexible, locally adapted approaches were in place. Conclusions: Findings suggest that targeted, flexible interventions for NHS employees with fluctuating long-term health conditions could enhance staff retention, reduce absenteeism, and promote more resilient workforce strategies. Identifying and scaling examples of good practice may be key to fostering a more inclusive and adaptive NHS employment model.