Safety culture in the NHS

This indicator uses data from the NHS Staff Survey to look at safety culture in the NHS.



Last updated: 14/12/2023


A good safety culture in healthcare is one that includes value and respect for diversity, strong leadership and teamwork, openness to learning, and staff who feel psychologically safe (an environment where each individual feels they will be treated fairly and compassionately if they speak up). The NHS Patient Safety Strategy aims to monitor and support the development of a strong patient safety culture in the NHS to continuously improve the safety of care.

Caregivers are accountable for being capable, conscientious and engaging in safe behaviour, but should not be held accountable for system failures. Leaders should hear patients’ and caregivers’ concerns regarding defects which interfere with the delivery of safe care, and promote improvements in safety.

Safety culture and burnout

NHS Staff Survey respondents are asked a number of questions relating to health and safety at work. These include if they have the resources they require to do their work, if they are able to fulfil the various tasks required of them, and if they feel supported by their organisation to do their job properly. Failure in these areas risk compromising the safety of both staff and patients. Although positive responses increased in 2020 compared with the previous year, they declined from 2021 onwards. The biggest decline was seen in the percentage of staff agreeing that there were enough staff in their organisation to facilitate them doing their job, which decreased from 38% in 2020 to 26% in 2022. Furthermore, in 2022, only 56% of staff agreed to having adequate materials to work with and only 43% said they were able to meet conflicting demands on their time at work. This data suggests that the current shortage of human resource may poses a great risk to effective service delivery.

In 2021, staff were asked questions specifically relating to burnout for the first time. The proportion of surveyed staff who either ‘Often’ or ‘Always’ felt burnt out because of their work was 34% in 2021 and 2022. This provides further evidence regarding the adverse effects of resource and staff strain. Burnout affects not only the individuals who are experiencing it, but also the quality of care they provide.

Raising concerns about safety

In the 2022 NHS Staff Survey, nurses and midwives were amongst those who felt the most secure raising concerns about unsafe clinical practice. Others who reported feeling secure were social workers, allied health professionals, and those in public health, with at least 77% of each group agreeing or strongly agreeing with the statement. This compares with 74% of medical/dental consultants and 65% of both medical/dental trainees and ambulance staff.

Since the previous survey in 2021, scores have decreased for all groups apart from nurses and midwives. The decrease is particularly stark for ambulance staff and medical/dental trainees. 


About this data

This indicator uses data from the NHS Staff Survey. The scores are calculated as the percentage of respondents who gave a specific answer to a question, or a defined set of responses to a series of questions. The responses for each respondent have been summarised for each organisation using a weighting procedure. In order to make NHS organisations’ scores comparable, individuals’ scores are weighted so that the occupational group profile of the organisation reflects that of a typical organisation of its type. For comparisons between scores over time, scores from previous years are re-weighted according to the 2020 weights.

For more information, please see NHS Staff Survey – 2022 Results.