Far from it. While the survey results can be presented from a ‘glass half full’ perspective, if we see the glass as half empty then the results are disturbing. They suggest that of the 1.4 million people who make up the NHS workforce:
- 41 per cent would not recommend their trust as a place to work
- 57 per cent say they are unable to meet the conflicting demands on them at work
- 13 per cent report being bullied by their managers
- 15 per cent have been assaulted at work in the previous year
- only 39 per cent feel they are able to deliver the quality of care they wish to patients
- 31 per cent did not agree that they would feel happy with the quality of care in their organisations if a friend or relative needed treatment
- only 42 per cent agreed that their roles actually make a difference to patients.
And the list goes on: only 52 per cent of staff report feeling satisfied with the recognition for their contributions; only 42 per cent feel their work is valued by their organisations; 27 per cent do not have the opportunity to show initiative and 25 per cent do not feel able to make suggestions to improve the work of their team or department; and only 56 per cent say they are able to make improvements happen in their area of work.
NHS staff are highly skilled and extraordinarily motivated. They dedicate their working lives to caring for those in their communities. They are motivated by a core value of compassion and almost all of them wish to provide the best quality care that resources will allow. Compassion is therefore at the heart of the NHS and the staff who make up the service. Yet the Staff Survey data suggests that the way the service is being led and managed is creating conditions that do not enable staff to fully live that value at work, or to fulfil their personal missions of delivering high-quality care.
How are managers and leaders to respond? Not by making financial performance the overriding priority, but by developing models of compassionate leadership in the NHS. Compassion is paying attention and listening with fascination to the other person (patients for example); understanding their distress or difficulties; having an empathic response; and taking skilful or intelligent action to help. So we need leaders to lead with compassion, and this means paying attention to staff. Leaders play a powerful role in shaping cultures, and when their behaviour is less than compassionate they contribute to a drift in culture that produces the disheartening responses in the Staff Survey.
This compassionate style of leadership is required at every level of the system. Bullying at senior levels, as we know, can be replicated up to five levels down in organisations. So compassion will similarly be replicated if it is established as the dominant style of interaction. Of course there are tough situations to face alongside financial pressures, but then all the more reason for listening, understanding, empathising and taking intelligent action to help at every level. At The King’s Fund we’re currently working with NHS Improvement to provide a series of online tools which will help trusts to support positive cultural change and compassionate leadership.
So returning to the Staff Survey results, why then is engagement shown to be up? It’s possible that all the pressures in the system mean staff are having to give more of themselves to enable high-quality patient care; they are having to put in more effort, longer hours, and give greater emotional support and creativity than they would have had to otherwise.
But ever-increasing levels of engagement without increased support are not sustainable. The high levels of staff stress in the NHS tell us that the system is under huge strain, and that it is NHS staff who are suffering. Only 31 per cent agreed there were enough staff for them to be able to do their jobs properly; 60 per cent were working unpaid overtime; 63 per cent attended work when feeling too unwell to perform their duties; and 37 per cent reported feeling unwell as a result of work related stress in the previous year. Ultimately high levels of staff stress begin to erode compassion and affect care quality, patient experience and patient outcomes. It is vital that all NHS leaders recognise the imperative of developing a style of compassionate leadership to sustain the core values of the NHS. The real cost will be too great if they do not.