Beneath the surface: what does the 2023 NHS Staff Survey really tell us?

In some areas, the results of the 2023 staff survey were more positive than expected; despite ongoing industrial action and rising demand leading to ever-higher pressure on staff, some measures of satisfaction have increased.

But improvement does not mean satisfaction is where it should be. For example, while stress levels are lower than last year, it is still concerning that two in five staff (281,000 people) felt unwell due to work-related stress in 2023. Also concerning is the variation hidden behind this data, with over half of staff in some groups experiencing acute stress levels.

This is just one reason why staff are leaving the NHS in droves (the number of staff leaving due to health or work–life balance has more than tripled since 2011). A report from The King’s Fund in 2020, The courage of compassion, found that to minimise workplace stress and ensure wellbeing and motivation (both of which are essential to retain staff), people have three core needs (see Figure 1 below).

The 2023 NHS Staff Survey highlights that there are serious issues across all three areas. As with stress, these issues are often particularly acute for certain roles or demographic groups. For people to flourish at work, these issues need to be urgently addressed.

Autonomy

It is hard to put the situation down in writing because of the fear that the management may see it as an attack on them.

Nurse

One aspect of autonomy is being able to make suggestions to improve the work of your team or department. The proportion of NHS staff who feel able to do this fell from 75% in 2018 to 72% in 2023 (192,000 people did not agree they could do this). Some groups feel even less able to make suggestions, such as those with disabilities or long-term conditions. And the fall over time is greater for some groups, such as midwives (74% in 2018, 67% in 2023) – particularly concerning given the ongoing safety issues in maternity services.

Another way in which staff have autonomy is being able to choose how to do their work. The proportion who feel they can do this has fallen from 57% in 2018 to 54% in 2023 (307,000 people did not agree they could do this). Again, it is lower and/or falling faster for some groups, including those with disabilities or long-term conditions, younger workers, paramedics and midwives.

Belonging

The team atmosphere is good and they have been very welcoming, which is part of the reason I have stayed in this role.

Nurse

The importance of good managers and colleagues to workplace wellbeing cannot be overstated. So it is concerning that in some aspects workplace leadership and culture is deteriorating, with a fall since 2018 in the percentage of staff who feel their work is valued (and a greater fall for younger staff and midwives), and an increase in those experiencing discrimination from other staff.

It is also concerning that some groups have notably worse experiences than others. Overall, 9% of staff (61,000 people) report experiencing discrimination from other staff, but this rises to 15% of ethnic minority staff, and 13% of staff with disabilities or long-term conditions. These two groups are also less likely to agree that their organisation acts fairly with regards to career progression.

Contribution

I feel like I’m drowning.

Midwife

One aspect of contribution is workload – if staff have too much work, they cannot deliver the standard of care they would like. Excessive workloads are a serious and worsening issue throughout the NHS. Staff reporting that there are enough staff at their organisation for them to do their job properly fell from a (relative) high of 38% in 2020 to 32% in 2023 (457,000 people do not agree there are enough staff). Within this, there are groups of staff who are even more pressured by excessive work demands.

New joiners report a more positive experience

By and large, those who have been in their organisation less than a year report more positive experiences, as shown in the table below. Cynical conclusions would be that these new staff haven’t had time to get burnt out or disillusioned, or don’t yet feel safe enough to be honest in the survey. Whatever the reason, the fact that satisfaction often falls after just one year’s service is cause for concern.

Conclusion

To retain staff effectively, satisfaction should not be low. It should not be noticeably lower for some demographic groups or job roles. And it should not be falling after one year’s service. While the NHS Long Term Workforce Plan is welcomed for its recruitment aims, more needs to be done to tackle these low satisfaction levels – without this, retaining staff will continue to be a challenge.

Our briefing Making careers in health and social care more attractive suggests what government can do if it wants to tackle these issues. Actions include expanding the flexible working offer, supporting the development of high-quality, compassionate and inclusive leaders in health and care, and ringfencing funding for staff wellbeing hubs.