The NHS – and its workforce- are facing increasing pressure as the funding squeeze continues. In this article, Steven Weeks of NHS Employers analyses the results of the NHS Staff Survey – the biggest of its kind in Europe. He finds that the picture is mixed; whereas recent progress on employee engagement has stalled in the face of growing pressures for the service, there has still been progress in some important areas.

The NHS staff survey 2014 results were released on 24^th February. The survey is the largest of its kind in Europe and surveyed 600 000 NHS staff with 255 000 responses. It is fully confidential with the surveys undertaken by recognised survey providers working with a survey designed by NHS England, NHS Employers and staff side. Individual organisations get their own aggregate results and analysis of trends to take into account in their employment policy.

The results present a challenging picture after a period of sustained progress. The Survey tracks 30 key findings in areas ranging from staff perception of quality of care to views on staff experience in areas such as health and well-being and staff engagement.  This year 11 have shown improvement since 2013, 1 remained the same, 15 have deteriorated and 2 cannot be compared due to changes in the questions. This follows several years of consistent progress across most survey indicators. For example in 2014 all bar three indicators improved. The movements were relatively small on most indicators.

The results reflect the pressure on NHS Staff with the indicator of work pressure rising from 3.06 to 3.09. This together with the discontent over the 2014 pay offer and other negative factors appears to have had an impact on scores. In addition financial problems in a significant minority of Trusts are an additional factor.

Quality of care

Following the Francis report around the Mid Staffordshire scandal there has been a lot of work to safeguard quality in the NHS. The survey shows a mixed picture on this. There has been an improvement in the staff confidence in patient care being the top priority for organisations. Staff remain very confident about the quality of care they provide individually. They are however less willing to recommend the care delivered by their organization. The percentage willing to do so fell from 65% to 64% perhaps reflecting the pressures on the service.

Health and Well Being

There is a mixed picture on health and well being. Levels of reported physical violence from patients fell as did the reported level of bullying and harassment. By contrast the percentage reporting bullying and harassment by colleagues and managers rose (from 23.20 to 23.68 %) which is cause of concern. Perhaps reflecting the work pressure in the service there was an increase in the percentage of staff reporting stress related illness and attending work when unwell. In the main the pressure to do so came from their own commitment to patients and colleagues rather than from managers.

Staff Engagement

The overall staff engagement index slipped from 3.71 to 3.70 following three years of improvement. The overall score is derived from measures of the three dimensions of engagement (satisfaction/motivation, advocacy and involvement). There was a small fall in measures of motivation and satisfaction perhaps reflecting the demands on the service. The unhappiness of staff over pay issues may have influenced the fall in willingness to recommend the NHS as a place to work which fell from 58% to 56 %. By contrast on measures of staff involvement the NHS has maintained or improved its position reflecting the work in many Trusts to seek staff feedback and use staff ideas. Staff feel most able to make and implement contributions in their own work area with 75% reporting that they are able to do so (up from 74% in 2013). Some organisations – including most of those identified as top performers by the IPA in its May 2014 report on engagement in the NHS – improved their scores despite the wider pressures. NHS Employers will be seeking to identify and share experience including from rapid improvers.

Staff also reported an improvement in the level of support that they feel they get from their immediate managers (the index score on this rose from 3.66 to 3.68. There were less positive rating of senior managers although scores on this had also improved perhaps reflecting the efforts by some senior leaders to be more visible and open.

Raising concerns a concern

There has been a lot of media attention about the issue of staff raising concerns in the NHS (sometimes known as whistleblowing). A new question was introduced on the survey to focus on raising concern about unsafe clinical practice. Almost two thirds of staff stay they would feel safe to do so. One in ten would not and rest did not give a view. There is clearly a need for further work on this issue and NHS Employers will shortly be launching a campaign to raise awareness on this and share best practice.

Other issues

The survey covers a range of others issue from training and appraisal (small improvement) to equalities (overall a good record but differential experience for BME and a clear issue on which more action is needed) through to communication (an improvement from a very low base) to staffing levels (not seen as adequate) and pay (most staff satisfied but rise in dissatisfaction). Individual employers will identify action plans locally to tackle key issues. It is also now used as a key indicator of potential quality issues as research has shown a clear link between staff and patient experience.

Overall the results are a challenge to the service to sustain the progress that has been made in recent years in an ever tougher environment. NHS Employers will work with staff side colleagues to seek to sustain progress, get back on track in some key areas and improve staff experience with the aim of safeguarding patient care.

Steven Weeks is Policy Manager for Staff Engagement at NHS Employers.