The NHS Staff Survey (NSS) is one of the largest workforce surveys in the world. It has been carried out each autumn since 2003.
The results of the survey are used by NHS organisations to understand staff experience on a local and national level.
These insights can then be used to improve working conditions and then ultimately patient care.
Because it is carried out annually, researchers, leaders and interested parties can compare views over time. They can also compare the experiences of those working similar organisations.
The NHS Staff Survey is designed to capture a clear picture of working life through carefully tested and validated questions. Its development follows a gold standard process, drawing on proven questions from other surveys, engaging widely with experts and stakeholders, and trialling with staff across diverse roles and backgrounds to ensure reliability and relevance.
All NHS Trusts are required to participate in the NHS Staff Survey. Commissioning support units, social enterprises, ICBs and other NHS organisations are invited to take part on a voluntary basis. Staff working at an organisation on 1 September will be included in that year’s survey.
Participation is not compulsory for staff, but it strongly encouraged, so that staff can have their voices heard. It is important that as many people as possible take part so the results are wide and representative.
The survey is carried out in the autumn with the results published the following spring.
From 2023, NHS Trusts with at least 200 eligible in-house bank only workers were required to extend the survey to those workers.
The data from the survey is anonymised and publicly available.
The Staff Survey is owned by NHS England and the Survey Coordination Centre at Picker Institute Europe and the independent Staff Survey Advisory Group support them with the implementation.
The People Promise
The NSS is aligned to the People Promise, which is to work together to improve the experience of working in the NHS for everyone. The People Promise describes, through the voices of NHS staff, the changes that would most enhance their working lives. It highlights priorities such as access to health and wellbeing support, greater flexibility in how work is arranged, and fostering a sense of belonging for everyone, regardless of role or background.
The NSS reports on the seven elements of the People Promise: we are compassionate and inclusive; we are recognised and rewarded; we each have a voice that counts; we are safe and healthy; we are always learning; we work flexibly; and we are a team. It also reports on two longstanding themes: staff engagement and morale.
The results
On the whole, results from the 2024 survey have remained steady and generate similar results across all categories. Of the nine criteria, two of these have unchanged scores from 2023, which are rated out of ten: ‘We are recognised and rewarded’ (5.99), ‘We are a team’ (6.80). Four of these saw marginal gains: ‘We are safe and healthy’ (6.14 up from 6.13), ‘We are always learning’ (5.67 up from 5.64), ‘We work flexibly’ (6.31 up from 6.28), and morale (5.96 up from 5.94), and three of these saw slight decreases: ‘We are compassionate and inclusive’ (7.28 down from 7.30), ‘We each have a voice that counts’ (6.69 down from 6.72), and staff engagement (6.85 down from 6.89). Although most statements were met with similar responses to 2023, some are still considerably lower than 2020 outcomes, such as morale (6.08), staff engagement (7.05), although these have steadily increased since the COVID-19 pandemic.
Under the ‘We are safe and healthy bracket,’ staff gave ‘negative experiences’ a sub-score of 7.82 out of ten, a slight decrease from 7.83 in 2023. Although this may seem like a positive score, and few negative experiences among survey respondents, one in seven staff (14.38 per cent) have experienced at least one incident of violence by patients, service users, their relatives, or other members of the public, making this the highest proportion since 2021. 0.78 per cent of staff experienced at least one incident of physical violence from managers, again up from 2023 (0.72 per cent), and 1.89 per cent from other colleagues, the highest proportion in a while.
Harassment, bullying and abuse, while incrementally decreasing, was still high: more than one quarter (25.08 per cent) of staff have experienced at least one incident of this within the past year from patients, service users, their relatives or other members of the public. Almost one in ten (9.46 per cent) and more than one sixth of survey respondents experienced this from managers and colleagues: both statistics are part of a wider decline, but these figures are still alarmingly high.
Since 2023, staff have been asked if they have received unwanted behaviour of a sexual nature, including jokes, touching, and assault, within the last year. 8.82 per cent of staff reported at least one incident from patients, service users, their relatives or other members of the public, an increase from last year (8.79 per cent). From staff and colleagues, this figure has seen a slight decrease, from 3.85 per cent in 2023 to 3.66 per cent in 2024. These figures starkly differ across sectors: around one in ten nurses and midwives said they have been the target of unwanted sexual behaviour at work, with ambulance staff most likely to experience this: incidents here were more than one in four (28.79 per cent).
The survey revealed a diversity and equality sub-score of 8.08, which although higher than its ‘We are compassionate and inclusive’ rating (7.28), is the lowest diversity score in five years (8.1 in 2021). In a similar vein, less than six in ten (55.93 per cent) of staff in 2024 felt that the NHS acts fairly towards career progression or promotion, regardless of protected characteristics like gender, religion or ethnic background. Discrimination among staff has also increased to its highest level in five years, with almost one in ten staff reporting discrimination within the last twelve months from patients, service users, their relatives, or other members of the public (9.25 per cent) and from managers, team leaders or colleagues (9.22 per cent). The latter has seen a steady climb over the years, from 8.37 per cent in 2020, with 66 per cent citing discrimination on the grounds of their ethnicity.
Again, ambulance staff have reported the most incidents of workplace discrimination, (18.60 per cent), although nursing and healthcare assistants have been the biggest jump, from 14.38 percent reporting discrimination in 2023, to a concerning 16.44 per cent reporting discrimination in 2024.
