‘NHS Success Story.’ Not a headline you see very often but the results of the NHS Staff Survey 2013 show that the NHS is making progress on staff involvement. The NHS Staff Survey is the largest survey of staff opinion in the world involving over 200 000 staff. It asks a range of questions on how staff feel they are being treated and their view of NHS services. The results of the survey are measured on 28 Key Findings related to the NHS Staff Pledges and other national objectives. 21 out of 28 key findings improved and in particular the measures of staff engagement in the service increased. This follows increases in 2012 and comes in the context of financial pressures and rising workload. Strangely this positive story about the NHS generated almost no national media coverage...

Staff Engagement in the NHS-moving in the right direction

Staff Engagement in the NHS is measured in the staff survey using a composite measure that takes into account worker motivation/satisfaction, degree of involvement and willingness to recommend the service (advocacy). Levels of staff engagement improved in all three dimensions with the fastest improvement in advocacy. The indicators are derived from a number of questions which are generally measured on a five point scale (ranging from strongly agree to strongly disagree). This is considered a reliable and methodologically valid approach to assessing engagement. The survey questions are developed in discussion between NHS employers and staff side representatives together with NHS England, which has overall responsibility for the survey. The surveys are undertaken by a number of survey companies working for the NHS and replies are confidential.

The NHS has traditionally had high levels of job commitment amongst its workforce and this has remained true in the 2013 survey with 90% of staff feeling that their role makes a difference for patients. The indicator of work pressure remained steady as did levels of motivation. Perhaps surprisingly job satisfaction even increased during the period from 3.58 to 3.61

The NHS is committed via one of the NHS Constitution Staff Pledges, to enabling staff to be involved in decisions affecting their working lives. There are various measures of involvement in the staff survey. The overall measure of involvement improved slightly from 67 to 68% although the scores were much better for involvement in ward level decisions rather than wider decisions. Staff felt more able to make suggestions for improvement but still did not feel properly consulted about change. It is also clear that there is considerable variation on this indicator between organisations. Those employers that have had a focus on involvement of staff through initiatives or changing culture managed to improve their scores. In some areas for example Wigan and Leigh, Countess of Chester and Nottingham University Hospitals’ staff involvement has helped the Trust generate considerable savings as part of overall programmes. There is though much untapped potential for this as has been shown by the success of NHS Change Day.

Overall perception of communication between senior managers and staff in trusts remained poor with only 29% reporting good communication although this was an improvement from 2012. Many Trusts have improved visibility of senior leaders through "back to the floor" initiatives or face to face discussions and some have begun to use social media as an effective communication tool.

There was a clear positive link between good Partnership Working with Staff Side organisations, and good staff engagement scores in areas such as Guys and St Thomas Hospital, South West Yorkshire and Oxleas Trusts.

There were mixed scores on the line managers’ role. The overall score for line manager support increased from 3.63 to 3.66. Line managers are seen as generally supportive in a personal crisis but not as good at seeking and acting on feedback. There are a range of initiatives underway or planned aimed at improving line manager capacity in these areas.

Whether staff in the NHS would recommend the service has become seen an increasingly important indicator of engagement. The scores on this improved both in terms of recommendation as a place to work (54 to 57%) and a place to be treated 62 to 64%. Overall 10% would not recommend and the remainder were neutral though these figures were poorer in a significant minority of Trusts. From April this year this will now be measured in a different way through a Staff Friends and Family Test. The increase in staff perception of quality of care, these scores and improvements on other measures are a major vote of confidence in the NHS from NHS staff.


Steven Weeks is Policy Manager at NHS Employers


The IPA are due to release a major project for NHS Employers and HPMA on employee engagement in the NHS. Find out more and sign up for the launch event on our website – www.ipa-involve.com/events