What does the 2019 NHS Staff Survey truly tell us about how staff needs are being met?

Chronic excessive workload in the NHS is causing staff stress and illness, and results in health care professionals quitting the service and patients not getting the quality of care they expect.

Such workloads have become like the pattern in the wallpaper we no longer see. But we must acknowledge, address and continue to address this issue. It can’t be right that a sector focused on promoting the health and wellbeing of our population is putting at risk the health and wellbeing of 1 in 20 of its national workforce (increasing to 1 in 9 if we also include social care). It’s no surprise, then, that NHS sickness absence is twice the level in the private sector, that there are huge vacancy rates (currently 40,000 nurses short) and that high numbers of staff intend to quit (35 per cent of GPs). What are we to do?

To start, we must be honest. The 2019 NHS Staff Survey results shows that though staff experience overall has improved slightly on many measures it has simply not changed substantially. Over the past five years there has been little meaningful change.

Second, we must understand the basic core needs of NHS staff at work and ensure that we are meeting them for the sake of staff wellbeing and the ability to provide compassionate, high quality care. They are the needs for autonomy and control (in practice, voice and influence) in a fair culture; a sense of belonging and community in a supportive team and compassionate culture; and feeling of competence and effectiveness rather than a sense of moral distress that an excessive workload leads to compromising quality care.

The 2019 NHS Staff Survey

The NHS Staff Survey reveals the responses of half a million members of staff. The 2019 survey shows that in terms of autonomy and control, the percentage of staff saying they are involved in changes affecting their team has been stuck at 52 per cent since 2015, and only 56 per cent say they have a choice in deciding how to do their work. Just over one third (34.5 per cent) say that senior managers act on staff feedback, and only 36 per cent say senior managers try to involve staff in important decisions.

It can’t be right that a sector focused on promoting the health and wellbeing of our population is putting at risk the health and wellbeing of 1 in 20 of its national workforce.

In relation to belonging, the percentages of staff experiencing bullying and harassment from managers (13.5 per cent in 2015, 12.3 per cent in 2019) and colleagues (18.1 per cent in 2015 and 19.0 per cent in 2019) have shown little or no decrease. Over half (53.4 per cent) report strained relationships at work and less than half (48.0 per cent) agree they feel their organisation values their work. Teamworking similarly has not meaningfully improved. The key finding relating to equality, diversity and inclusion shows a decline since 2015. The percentage of Black, Asian and minority ethnic (BAME) staff believing that their trust provides equal opportunities for career progression or promotion has declined from 73.4 per cent in 2016 to 69.9 per cent in 2019.

And what about competence – feeling able to do the job well? This is undermined by the problem of chronic excessive workload. The percentage of respondents saying there are enough staff in their organisation for them to do their jobs properly has increased from 30.3 per cent to a paltry 32.3 per cent, and 77 per cent report unrealistic time pressures. Nearly one in three (31.5 per cent) do not believe they are able to deliver care at the level they aspire to.

Given this data, it is not surprising the health and wellbeing of staff is not improving. The percentage reporting work-related stress illnesses has increased from 37.1 per cent in 2014 to its highest level of 40.3 per cent today. More than half (56 per cent) are working additional unpaid hours (a key predictor of stress), and the percentage reporting that their organisations take positive action on the health and wellbeing of staff has dropped from 30.1 per cent to 29.3 per cent. And we know that staff in the NHS are 50 per cent more likely to have high levels of work stress compared with the general working population.

How can national action better support staff?

There are a number of organisations that have brought about and sustained positive change – including Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, among others – by better meeting the basic core needs of staff at work. If one organisation can achieve this, all can.

But we also need national action.

The forthcoming NHS People Plan offers a unique opportunity to courageously ensure transformation change across the NHS, where all staff can be confident the NHS is developing into the best place to work in society. This means ensuring the NHS’s uniquely skilled and motivated staff have voice and influence to shape the effective and compassionate cultures needed for quality care. It requires ensuring that staff can take breaks when needed, have influence over rotas and have good basic facilities (toilets, hot meals, water, functioning IT systems), and that teams have the equipment and staff to do their jobs effectively. It requires diversity and inclusion to be modelled throughout the NHS so that truly just and fair cultures that promote safety, innovation and, above, all humanity can be created.

The forthcoming NHS People Plan... requires diversity and inclusion to be modelled throughout the NHS so that truly just and fair cultures that promote safety, innovation and, above, all humanity can be created.

The NHS People Plan must also promote supportive and effective (and ideally multidisciplinary) teamwork alongside compassionate and collective leadership to reinforce a powerful sense of care and belonging among its dedicated and inspiring staff. And recognition, appreciation and support should be golden threads running through every part of the fabric of the NHS.

The plan must ensure chronic excessive workload is robustly and continually addressed so that staff are clear that striving for high quality, compassionate care is the absolute priority for our health and care services. Staff must also be supported to continue to develop their skills and capabilities to improve care for patients and communities.

When the People Plan is launched, it will be vital that everyone across the NHS responds by helping to ensure its implementation in every part of our health care system. Underpinning this must be an unrelenting commitment to developing compassionate and collective leadership (both individually and institutionally) at every level to ensure staff are understood, cared for and helped. That also requires that the national bodies (such as NHS England and NHS Improvement, the Care Quality Commission and Health Education England) model the compassionate cultures and leadership NHS organisations need.

If we aim to provide high quality, continually improving, compassionate care for patients we have to provide high quality continually improving and compassionate care for all our staff. Then they will be able to deliver the compassionate care to those in their communities that is at the heart of all their work.