The 2016 NHS Staff Survey results are a mixed bag. Close to a million staff were invited to take part in the survey, more than 400,000 responded, and overall staff engagement has increased incrementally over the past four years.
The survey highlights that there are many organisations with well-motivated and engaged staff who are delivering high-quality care day-after-day. This performance is a testament to the dedication of people in the NHS against a backdrop of many organisations working at the edge of their capacity. We should give these dedicated people our collective thanks because they keep the system going despite being under huge pressure.
We know that high levels of staff engagement correlate to better-quality patient care. We also know that the NHS is in a period of immense change and uncertainty and the only way to create a sustainable service that is fit for purpose is by involving, engaging and working with the people that deliver the service. The Staff Survey should be viewed as a leadership tool: NHS leaders, nationally and locally, should consider the results, not just as a source of good news, but also as a key indicator of the health of the system they lead. Understanding and making sense of the key themes emerging from the survey, and the action required, should be a crucial element of every board's strategic plan. The 2016 results could also be regarded as a baseline against which the impact of NHS Improvement’s national framework for improvement and leadership should be measured.
At a national level there are some persistently worrying indicators that the NHS leadership effort should focus on.
The survey indicates that one in eight staff (13 per cent) reported that they have experienced harassment or bullying from their manager on more than one occasion. This increases slightly – to 18 per cent – when you look at bullying and harassment from other colleagues. It’s a matter of human decency that people should be able to come to work and feel safe, supported and able to share the best of themselves with their patients. This is not a ‘nice-to-have’ but an imperative. While working pressures and shortage of staff may confound the issue, they cannot be excuses. Our work here at The King’s Fund underlines the importance of compassionate leadership in creating cultures of continuous improvement; addressing this level of bullying and harassment must be a priority for leaders.
Another equally shocking figure is that 8 per cent of staff reported having faced discrimination from their own team or managers. While the survey reflects discrimination being felt by staff, it is only a short jump to conclude that the same discrimination is experienced by patients. Discrimination of any kind fundamentally conflicts with the core values of the NHS and demands action right across the system, as we argued in our 2015 report on diversity and inclusion in the NHS.
Another key indicator in the survey is the ‘friends and family’ question. Among the best- performing trusts more than 90 per cent of staff who responded to the survey said they would recommend their own organisation to family and friends. These trusts should be congratulated. However, at the worst-performing trusts only 40 and 50 per cent of staff would recommend their own organisation to their family and friends. The average score across NHS trusts is 69 per cent, which means nationally more than 30 per cent of staff wouldn’t recommend their organisation to friends and family. This is a cause for concern and again reflects a system under immense pressure.
When it comes to the questions about errors and incidents, results are still mixed. The proportion of staff reporting that they had witnessed errors or incidents is the lowest it has been since 2012, and 90 per cent of staff who had witnessed an error or incident said it had been reported. However, only 45 per cent of staff reported that their organisations had treated staff involved in near-misses fairly. An additional 31 per cent neither agreed nor disagreed, which represents a level of doubt that should be of concern.
Developing a culture where quality and improvement are central to an organisation’s strategy requires high levels of trust, and trust that issues can be raised and dealt with as an opportunity for improvement. There is no doubt that without this learning culture, with trust as a central behaviour, errors and incidents will only increase.
It is also encouraging that many staff feel involved in their work and in decisions that affect them. The proportion of staff reporting that they can contribute towards improvements has increased since 2012; three-quarters of staff feel they can make suggestions to improve the work of the team or department and more than half felt that they are personally able to make improvements. While this could be higher, it does represent positive progress and will make a difference.
Above all, the NHS should regard the Staff Survey as an annual report on the quality of leadership within the service. It’s an opportunity for staff to give feedback that highlights areas of good practice but also pinpoints where improvements must be made. The danger is that the NHS pats itself on the back and congratulates itself that the figures aren’t worse than this. The focus on compassionate leadership in the national framework for improvement and leadership is the right approach to creating long-term and sustained staff engagement. It’s now important that at a local level, every leader takes the survey results seriously and demonstrates to staff that they are listening and will do what they can to improve.