NHS staff survey: Taking the pulse

As staff surveys go, they don’t get much bigger than this.

The recently released NHS national staff survey takes in the views of more than 128,000 employees across 326 healthcare trusts in England. Undertaken by the Healthcare Commission watchdog, it is believed to be the largest annual study of its kind in the world.

As to be expected from a survey on this scale, it draws a complicated picture. The real value comes from looking at developments over time, and the commission has been able to draw a number of conclusions on trends among NHS staff.

The percentage of NHS employees who admitted to having suffered work-related stress is down from 39% in 2003 to 33% last year. There has also been a downturn in the proportion of the workforce suffering injury or illness because of work, from 22% in 2003 to 17% in 2006.

Safety also showed a long-term improvement, with the percentage of staff saying they saw errors, incidents or ‘near misses’ with potential to harm patients falling from 49% in 2003 to 38% in 2006.

However, on the flip side, positive levels of job satisfaction, although still significant, have edged down over the past few years, while the amount of violence and abuse being experienced by staff in the NHS remains depressingly high. The figures showed a slight increase from last year, with 31% experiencing violence or abuse in 2006, compared with 30% in 2005.

Perhaps unsurprisingly, the findings have been interpreted in different ways. At NHS Employers, the organisation responsible for workforce issues in the service, director Steve Barnett said the results vindicated a number of campaigns launched in the recent past, which have been aimed at educating employees to identify signs of stress and bullying in the workplace.

“On balance, the NHS is a better place to work, with more support for employees,” he said. “We are improving working lives and making it a place that people want to work and stay.”

However, at public services union Unison, which represents more than 400,000 health professionals across the UK, the view is rather different, especially in the light of below-inflation pay awards for health service employees announced earlier this year (after the survey had been carried out).

Unison said there was a culture of unpaid overtime in many trusts, and a persistent threat to staff safety from aggressive members of the public. “Despite well-meaning initiatives in the health service to tackle violence against workers, this survey confirms that a much more robust deterrent is needed to crack down completely on abuse and attacks on health staff,” said national secretary for health, Karen Jennings.

“NHS workers are seeing their pay packets and personal safety gradually deteriorate,” she added.

This is a major bugbear for Unison, which has campaigned for more protection for its members. Earlier this year, it called for the Emergency Workers (Obstruction) Act – which legally protects ambulance workers, coastguards and firefighters from hindrance when responding to an emergency – to be extended to all healthcare workers.

But according to Richard Hampton, head of the NHS Security Management Service, the body that deals specifically with NHS staff safety, there has been a 1,600% increase in the number of prosecutions against those who assault NHS staff.

He cited ‘get tough’ agreements between the NHS Security Management Service, the Crown Prosecution Service and the Association of Chief Police Officers as a sign of the commitment to drive down the number of assaults and hit offenders, using harsher punishments.

“This progress has meant that more staff feel confident about reporting violence, because they believe action will be taken,” he said.

And therein lies one problem with trying to draw definitive conclusions from staff surveys, warned Jim Buchan, a specialist in workforce policy at independent health policy think-tank, the Kings Fund.

“As ever with staff surveys, the answers throw up more questions,” he said. “The report shows more attacks on staff were reported, but what we don’t know is the extent to which this is down to different reporting measures in some trusts, or an actual increase in attacks.”

In addition, said Buchan, the NHS can no longer be seen as one huge organisation with uniform practices across the board.

“Today, [the NHS] is made up of hundreds of quasi-independent trusts, all with different approaches to HR. The picture is mixed and there is a diversity of responses,” he said.

NHS staff survey: key findings

  • Job satisfaction

75% of primary care trust employees were generally satisfied with their jobs, compared with 77% in 2005, 78% in 2004, and 79% in 2003.

  • Violence and bullying

28% of ambulance trust employees have experienced physical violence from patients or their relatives in the previous 12 months, compared with 27% in 2005, 30% in 2004, and 31% in 2003.

26% of employees in acute trusts said they had experienced bullying, harassment or abuse from patients or their relatives in the previous 12 months (25% in 2005, 23% in 2004, and 27% in 2003).

  • Errors, near misses and incidents

31% of employees in mental health and learning disability trusts had seen an incident that could have harmed staff or patients, compared with 35% in 2005, 38% in 2004, and 41% in 2003.

  • Injuries and illnesses

17% of staff in acute trusts suffered a work-related injury or illness during the previous 12 months. This has fallen from 21% in 2005, 22% in 2004, and 24% in 2003.

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