NHS staff survey: Signs of stress?

Ian Blunt, Nuffield Trust, explores new analysis into the levels of NHS staff reporting work related-stress as the reason for feeling unwell.

Blog post

Published: 15/04/2014

Newly compiled analysis published by QualityWatch, a joint research programme from the Nuffield Trust and Health Foundation, includes a number of measures based on the NHS survey of staff.

Though it may not always be appreciated by those completing it, it is the biggest workforce survey in the world, with over 200,000 responses every year, and provides extensive and robust evidence on the experiences of those that work in the NHS.

One story that particularly stands out is the way NHS staff report the pressures of their job. In general, staff survey results don’t change much year on year, but there appears to be a striking pattern emerging from one question about whether work related-stress has led staff to feel unwell.

As a proportion of all staff it had been falling since the first surveys in 2003 – reaching a low of 28% in 2008. The bad news is that it has been climbing steadily since 2009. The average value across all NHS organisations is now 38%, the highest level since the survey was started. The scores for many individual trusts are even higher.

47% reported there were not enough staff to enable them to do their job properly

It is clear that work-related stress is a growing problem for the NHS; one which may well get worse as the NHS continues to face unprecedented levels of rising demand and constrained funding. Aside from the legal requirement that organisations implement measures to reduce the causes of work-related stress, there is a financial argument for prioritising action on the issue.

Work-related stress has been estimated to be responsible for 30% of sickness absence in the NHS, which costs the service around £400 million each year. There is also evidence that staff become more productive when stresses are eased. Finally, it has been shown that work related stress in the NHS has a negative impact on patient experience and outcomes.

There are no simple explanations for what lies behind these survey results. Our analysis shows that the type of NHS Trust people work in is clearly important. Ambulance trusts have the highest levels: just a fraction less than half of all respondents reporting being made to feel unwell by work related stress.

Across the wider NHS, it seems that workload and staff shortages may contribute something to the problem: the staff survey reports that 44% of respondents said that they were unable to manage conflicting demands on their time and 47% reported there were not enough staff to enable them to do their job properly.

However, the survey’s composite “work pressures” measure (formed from those two questions and a third about supplies and equipment) has varied little over a decade. Other causes that have been identified in the literature include additional workload from lack of administrative staff, high patient demand and verbal abuse and aggression towards staff.

Interestingly, staff not involved in the direct care of patients (such as administrative and catering staff) reported the same sources of stress as those providing direct care.

How does working in the NHS compare with working in other industries? It’s difficult to say as other surveys of work related stress ask the question in different ways. The Labour Force Survey (LFS) asks a sample of all working adults in the UK whether they have suffered from any illness, disability or other physical or mental problem that was caused or made worse by their job, and in 2011/12 found 1.4% of respondents reported that they had.

Though this uses a different methodology, it did find that LFS respondents performing health and social work activities reported much higher rates of work related stress (2.2%) than the average. It is also notable that that the health and social care measure has been rising since 2008/09, whereas the all industries measure has been static.

Whatever the underlying cause, the omens on this issue do not look good. Fortunately there are a number of actions NHS trusts can take to reduce work-related stress. The first step is to use the staff survey results to understand how big an issue they have compared with similar organisations. There are a wide range of standards, toolkits and checklists to help organisations address this issue.

The biggest challenge will be resourcing new stress reducing initiatives while dealing with all the other demands placed on the service (although it should be possible to recover some costs from reducing lost work days and increasing productivity). As financial conditions continue to get harder for the NHS, the alternative appears to be losing more valuable time and people because of work related stress.