Chris Graham, CEO of Picker, a not-for-profit research charity working across health and social care, which helped to carry out the recent NHS staff survey, explains some of the results
Employee experience is an issue of increasing importance for employers. Studies across a variety of sectors have shown links between workforce experience and organisational success, creating a robust business case – as well as a clear moral case – for ensuring that individuals have positive experiences of work. Better employee experience is associated with higher engagement, productivity, and retention, as well as wider outcomes.
The NHS in England is frequently cited as one of the world’s largest employers. Indeed, its workforce numbers some 1.5 million people – more than one in thirty of all working age adults in England – and staffing accounts for the lion’s share of the service’s expenditure. It’s fitting, then, that the NHS can call itself a global leader on measuring and reporting staff experience. The annual NHS Staff Survey, overseen by NHS England and coordinated on their behalf by Picker, is the largest published workforce survey in the world, now attracting more than 600,000 responses each year. Detailed results are available at national and local levels, along with a set of interactive dashboards. It is a remarkable and highly transparent collection that provides detailed evidence about the experiences of people working in the NHS.
The 2022 NHS Staff Survey
Results from the 2022 NHS Staff Survey were published earlier this year. The survey was conducted mainly in October and November 2022, prior to the current rounds of industrial action – but nevertheless in the context of significant pressures on the workforce. There has been extensive discussion of the challenges the service faces around staffing levels, with high rates of vacancy in some key areas such as midwifery, and in dealing with an unprecedented backlog of care following the COVID pandemic.
Given the wider context, many readers will have jumped straight to the question on staff satisfaction with pay. Unsurprisingly, this had declined – only 26 per cent were satisfied with their pay in 2022, compared to 33 per cent in 2021 and 37 per cent in 2020. But in some ways, this is one of the less illuminating findings to be gleaned from a survey that includes more than one hundred questions and that allows significant disaggregation of data. After all, you don’t need a survey to tell you that staff are dissatisfied with pay when the same staff are on strike over their salaries.
Elsewhere, results from the survey show the quality of staff experience largely holding steady since 2021, when results had fallen in many areas after the pandemic. Two thirds of staff (67 per cent) agreed that they were “enthusiastic about their job” and, as in 2021, slightly more than half (53 per cent) said that they look forward to going to work. Some of the most positive results were about teamworking: in many organisations, there seems to be a sense of camaraderie that supports working culture.
There were also some encouraging signs of improvement in certain problem areas from the 2021 survey. For example, the proportion of staff who had felt unwell due to work related stress in the past year fell from 47 per cent to 45 per cent: still a worryingly high proportion, but a positive development in light of wider pressures.
Despite these findings, one change stood out as particularly concerning. There was a steep drop in the proportion of staff who said that they are happy with the standard of care provided by their own organisation, which fell to 63 per cent in 2022 from 68 per cent in 2021, having peaked at 74 per cent during the first year of the COVID pandemic. By the standards of a survey of this scale, where question level results typically move by only one or two percentage points each year, this is an alarming drop.
A crisis of faith?
Back in 1992, the recently late Nigel Lawson remarked with evident frustration that “the NHS is the closest thing the English have to a religion, with those who practise it regarding themselves as a priesthood”. If that were to be read literally, we might choose to interpret this finding about satisfaction with standards of care as indicating a collective crisis of faith – especially as confidence is lower still amongst front line staff, including doctors and nurses.
Personally I find this rather too reactionary a viewpoint. The vast majority of NHS staff (87 per cent) still believe that their role makes a difference to patients and that patient care is their employer’s top priority (74 per cent). And although headlines have highlighted the finding that almost a third of staff (32 per cent) “often think about leaving” their organisation, the more detailed results suggest that a far smaller proportion of staff actively wish to leave the NHS as a whole.
Instead, we might look at staff experience as a bellwether of patient experience and clinical quality across the service. Perhaps unsurprisingly, there is good evidence that staff wellbeing should be seen as an antecedent of patient experience. If staff are reporting concerns about the standard of care in their organisations, then employers must take these concerns seriously; work with their staff to understand the causes for their concerns; and commit to doing what they can to remedy them.
Improving staff experiences
Despite the huge scale and scope of the NHS Staff Survey, it should be seen as simply one part of the puzzle of understanding and improving staff experience. Analysis of organisational results will allow employers to understand the areas of workforce experience where they have the greatest challenges, and to assess how they are progressing against their own people plans and staffing strategies. But the causes of problems, and their remedies, may resist simple explanations.
It would be all too easy to write off poor staff experience within an NHS organisation as a consequence of essentially external factors that are beyond local control. Dissatisfaction with pay is a national issue, subject to collective bargaining and agreement; similarly, the towering elective care backlog is best viewed as a consequence of whole system pressures following the pandemic. But such a simplistic reading of the complex causes of staff experience would serve only to negate organisations’ own agency in determining working conditions, workforce wellbeing, and wider outcomes.
In fact, the range of results for organisations within each sector – acute trusts, ambulance trusts, and so on – shows how variable workforce experience can be within different NHS employers and, by extension, indicates how much influence local employment practice does have. All employers would therefore be well advised to engage with their workforces to explore the detailed local factors contributing to staff experience, and to understand that changes that could be made that would have the greatest impact on improving people’s experiences.
The range of results also provides opportunities for good practice to be shared and spread. With more than 200 organisations participating in the survey, NHS employers with specific challenges can often find a peer who has worked through the same issue. At Picker, we hold national workshop events each year to bring together organisations and we have seen first hand how this can help catalyse innovation.
Looking to the future
As an annual survey, the NHS Staff Survey can be relied upon to provide a robust timeline of data on workforce experience in the health service. This enables organisations to evaluate the success of their organisational development activities and test whether the changes they make are improving people’s work experiences. But it’s important to be realistic: meaningful change often takes time, and demands a strategic approach.
The best advice for organisations looking to improve workforce experience is, therefore, to create a strategic plan that is rooted in good evidence about staff experience; to maintain this, taking a continuous improvement approach to building on change; and to critically evaluate progress over time. By retaining a strategic focus on improving staff experience, employers can demonstrate how they value their staff and continue to provide high quality care to those who need it most.
About the author
Chris has been Picker’s CEO since 2017, leading the organisation as well as contributing to its research and practice.
Prior to becoming CEO, Chris led Picker’s research division from 2011 to 2016. In this post, he was responsible for overseeing the development and coordination of large-scale research and evaluation projects, including the NHS Patient and Staff Survey Coordination Centres, run on behalf of the Care Quality Commission (CQC) and NHS England, respectively. He has also worked at the CQC and its predecessor, the Healthcare Commission, as well as undertaking other roles at Picker from 2004 to 2007.
Chris has particular interests in person centred-care and in research on staff, patient, and user experiences of health and care. He has undertaken research and written widely on these subjects. Chris read Experimental Psychology at Pembroke College, University of Oxford.