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March 2023 saw the publication of the full 2022 NHS Staff Survey results with 636,348 respondents taking part, 46 per cent of the 1.3 million workforce who were invited to participate, down from 48 per cent in 2021. The drop in response between 2021 and 2022 means that we did not hear from more than 12,000 members of staff this year.
Given the work pressures across all areas of the health service and the ongoing problems with retaining staff, ensuring all voices were heard in the survey this year was critical. The drop in responses reveals the confidence that staff have in the NHS’s ability to change following the results and is important feedback that we need to pay attention to. What else do the results tell us?
Workforce morale
Overall morale of the workforce has declined for a second year, with nearly a third of respondents often thinking about leaving their organisation, an increase of 5.7 per cent since 2020. The acknowledged five-year-low figure showed an ongoing annual deterioration in the result, with 32.3 per cent of staff reporting thinking about leaving their organisation, and nursing staff, healthcare assistants and ambulance staff reporting the highest levels of dissatisfaction and looking to leave as soon as they can find another job. The intention to leave is more likely to be acted upon than in previous years and career abandonment to move to a role outside of the NHS becoming a considered alternative.
The impact of shortages
The workforce shortages are a consistent theme through this year’s survey and not likely to change in the short term, given the extent of vacancies in the system. The recent Health Foundation report across 10 high-income countries confirms that the UK primary care system is under resounding pressure, with 71 per cent of respondents within the UK saying their job is extremely or very stressful. This was the highest rate within all the 10 countries surveyed and again prompted the question of career abandonment with only 14 per cent of GPs feeling it could be improved.
Pay dissatisfaction
Pay remains an issue at the forefront of criticism from staff, which we can also see that within the industrial action being taken and proposed. With only a quarter of staff report being satisfied with their pay, the impact of the rising cost of living is at the forefront of people’s minds. This is at a time when only 42.9 per cent of staff feel able to meet all their conflicting demands and only 26.4 per cent feel that they have enough staff to do the job properly.
Recruitment challenges
While the government has acknowledged the challenges that staff within the NHS and social care experience following the pandemic and has also expressed the desire to recruit more people into the system, a rise in the number of people working within the NHS may only cover the reduced discretionary effort of the existing workforce. If staff are not feeling that this is a place they want to remain in the longer term, then that will challenge the ability to attract new people to join the service. The question that asks whether staff would recommend the NHS as a place to work saw a 2 per cent drop this year alone, reaching a 5-year-low.
Staff wellbeing
Staff continue to report working when unwell and not being able to deliver, so it is time that the NHS hear this clearly and build a response that sees the workforce reducing the day-to-day workload and expectations. If the teams delivering the care do not feel confident in the standard they can deliver when they are under-staffed, then organisations need to be paying more attention. Listening to the stories from The Kings Fund own annual leadership conference in March, the impact of the pandemic and the constant demand across NHS colleagues without the hope of change will only continue to see people exit their professions.
What does this all mean?
The Food Foundation has recently reported that one in four households where an NHS or social worker lives are struggling to afford food. While we perceive the current industrial action as a desire to have better pay and recognition for the critical work being delivered, we need to acknowledge that people in lower banded roles also need to earn more now just to make ends meet. The strength of voice that people feel they have within the survey does give us the hope that staff are being asked what they think and how things could improve, even if the solutions are not yet there. The long-awaited national workforce strategy is hoped to acknowledge and build a plan to address the fundamental areas of NHS staffing, ensuring both attraction to the work and retention to ensure people stay. While we await the release of the plan, it is important that everyone is working to build solutions. as Dr Navina Evans, the NHS Chief Workforce Officer shared with us during our recent leadership and workforce conference, the solutions are held by us all.
Finally, as we celebrate 75 years since the arrival of HMT Empire Windrush and the contribution of the Windrush generation to the National Health Service, and we reflect on the messages the survey is telling us about those areas of diversity and inclusion that need to be improved, we should ask ourselves: why haven’t we made real progress? There has been much discussion around the need for the experience of staff from ethnic minority groups to improve has been made time and again, but the actual change of staff’s experience is not matching the discussion. While the overall reports of individual staff feeling valued and part of their team overall in the survey, this is not yet reflected in the experience of all our NHS colleagues, especially where they have a black, Asian or minority background. The need to act not just discuss is way overdue.