Safety culture in the NHS

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



Last updated: 25/08/2022


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 not engaging in unsafe 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. This includes whether they have the resources they require to do their work, whether they are able to fulfil the various tasks required of them, and whether there are enough staff enabling them to do their job properly. Failures in these areas risk compromising the safety of both staff and patients. Although scores rose in 2020 compared with the previous year, they have seen a decline in the 2021 survey. The percentage of staff agreeing that there are enough staff in their organisation to facilitate them doing their job properly decreased by 11 percentage points, from 38% in 2020 to 27% in 2021. This data suggests an overwhelming perception that the current availability of human resources poses a great risk to effective service delivery, and that this is a bigger issue than the availability of material resources and equipment.

In 2021, staff were asked questions specifically relating to burnout for the first time, leading to the finding that 34% of surveyed staff either ‘Often’ or ‘Always’ felt burnt out as a result of their work. This provides further evidence regarding the adverse effects of resource strain. Not only does burnout negatively affect the individuals who are experiencing it, but also, studies suggest, the quality of care they provide.

Raising concerns about safety

In the 2021 NHS Staff Survey, nurses and midwives were still amongst those who felt the most secure raising concerns about unsafe clinical practice, but were joined at the top by social workers and those in public health, with 80% of each group agreeing or strongly agreeing with the statement. This compares to 78% of medical/dental consultants, 70% of medical/dental trainees and 71% of ambulance staff.

Since the previous survey in 2020, scores for all groups either remained consistent or increased, with the exception of healthcare assistants, who saw scores decrease 1 percentage point from 76% to 75%. Medical/dental trainees remain the only group to have lower scores in 2021 than 2015.

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, the data from previous years are re-weighted according to the 2020 weights.

For more information, please see the NHS Staff Survey – Basic guide for 2020 results and the Technical Guide to the 2020 Staff Survey Data.