Battling against the odds: what does the latest NHS staff survey tell us?

The NHS staff survey is the largest workforce survey in the world and has been conducted every year since 2003. In 2017, there were 487,227 respondents – an overall response rate of 45%. That is an increase of 1% from the previous year, but a significant fall from the 54% response rate in 2007.

Looking back at survey responses over the last five years, they are striking for their lack of variation year on year, with the survey question response rates shifting by only one or two percentage points each year.

The results of the 2017 staff survey, published last week, showed there was only one question with a change of 5% or more from the previous year – staff satisfaction with the level of pay. The percentage saying they were satisfied or very satisfied with their level of pay fell by 6% from 37% to 31%. That is 12% lower than in 2010 (43%) – something to galvanise the current pay negotiations.   

Warning signs

The most worrying responses in absolute terms spoke to the pressures faced by the system as demand goes up but funding and resourcing don’t. Less than a third (31%) of staff felt there were enough staff to do their job properly, and 58% of staff are working additional unpaid hours – showing how dependent the NHS is on discretionary effort. Perhaps not surprising then that nearly two-fifths of staff (38%) have felt unwell due to work-related stress (underlining the risks from burnout I flagged in my last blog).

The survey also captures the consequent risks to patient safety. 29% of staff, including 50% of consultants, said they had witnessed errors, near misses or incidents that could have hurt patients and service users. And it is not just patients that are being affected, as nearly a quarter (24%) of staff said they had experienced harassment, bullying or abuse from other staff.

Where progress is being made

Surprisingly, despite this negative environment, the survey suggests that over the last five years there has been generally positive progression with a number of measures associated with quality of care. The percentage of staff saying that “the care of patients/service users is my organisation’s top priority” has risen from 67% in 2013 to 75% in 2017, while the percentage saying that “if a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation” has risen from 65% to 70% in the same time.

Similarly, measures of the quality of management are also going in the right direction (albeit slowly). The percentage of staff saying they would recommend their organisation as a place to work has risen from 58% to 60% since 2013, while those saying that “my immediate manager encourages those who work for him/her to work as a team” have increased from 70% to 74% in the same time. The percentage of staff who are satisfied/very satisfied with the support they get from their manager has grown from 66% to 68% in the same period.

Where problems lie

But communication with senior management is still a problem. Only around a third of staff felt involved in important decisions, and a similarly small proportion felt that senior managers acted on staff feedback.

Within the data, a worrying picture emerges for ambulance trusts. They have distinctively worse results across most measures, but particularly on indicators around the quality of staff management and engagement. For example, the percentage of staff feeling they can make improvements happen in their area of work was only 45% (versus 70% across all trusts), and the recognition and value of staff by managers and the organisation achieved a score of 3.02 out of 5 (versus 3.57 in mental health/learning disability trusts and 3.46 across all trusts).

The national averages also conceal wide variation between individual organisations. For acute trusts, response rates to the survey varied from 29% to 73%. The average score for staff recommending their organisation as a place to work ranged from 3.34 to 4.12 out of 5. The percentage of staff who had experienced discrimination varied from 8% to 25%, and those who had suffered harassment, bullying or abuse ranged from 19% to 38%.

The results can’t be ignored

The staff survey may at first sight seem to offer little to get excited about, but look underneath the bonnet and there is a lot of immensely rich data. The current survey paints a picture of staff and their managers battling against the odds to do their best for staff and patients, but with some organisations and sectors having more success than others.

The government needs to pay heed to the rapidly falling satisfaction with pay, but also the high levels of work-related stress and concern about staffing levels – a concern that the recent British Social Attitudes survey showed is also shared by patients. Individual organisations need to pay heed to their relative position across all measures. If we are to improve staff retention rates, the survey provides important insight to guide any local strategy.