NHS Staff Survey 2020

But it highlights that there remains some way to go to improve staff experience – particularly among ethnic minority staff – as the service recovers from the acute phase of the pandemic. In particular, it highlights the need for a renewed focus on equality and further progress on bullying, harassment and violence. 

This briefing highlights the headline findings and our view on what this means for the health service in the year ahead. 

Key points

• Despite the pressures of the pandemic, there have been improvements in a number of areas, including employer action on health and wellbeing, staff views on feeling equipped to do a job properly, opportunities for flexible working, and opinions on recommending the NHS as a place to work. The overall indicator on staff perception of quality of care remains stable. Staff also felt they were able to provide good quality care. 
• Yet while the survey points to welcome improvements, challenges remain and will require concerted action in the year ahead. Staff from black and minority ethnic (BME) backgrounds continue to have more a negative experience of working in the NHS and have lower confidence in organisations providing equal opportunities. The toll of the pandemic has also seen a rise in work-related stress.
• A third of staff are considering leaving their jobs and nearly one in five are thinking of leaving the health service entirely.
• While there has been an increase in the number of staff agreeing that their organisation has enough staff for them to do their job properly, this is still less than two in five, and reinforces the need for a funded workforce plan to give staff hope that the vacancies in their teams will be filled longer term.
• Allowing NHS staff the time and space they need to decompress needs to be at the heart of recovery plans, and ongoing investment will be needed. Our letter to the Prime Minister last month called for a steady approach to recovering patient services, which protects health and care staff from burning out after the extreme and sustained pressures of the pandemic.

Background

The annual NHS Staff Survey asks NHS staff in England about their experiences of working for their organisation. The latest survey was conducted between October and November 2020, as the second wave of the COVID-19 pandemic took hold. In total 280 NHS organisations took part, including all 220 trusts in England. The results for 2020 were published on 11 March 2021.

What the survey found: in brief

Despite the pressures of the pandemic, there have been improvements in a number of areas. But challenges remain and will require concerted action in the year ahead:

• Recommending the NHS as a place to work: 66.8 per cent of staff would recommend their organisation as a place to work (up by 3.4 per cent).
• Resources: 38.4 per cent of staff reported that there were enough staff at their organisation for them to do their job properly (up by 6.1). This demonstrates that investment in staffing during this period has had an impact. Staff also generally believed they were able to provide safe care.
• Health and wellbeing: 33.4 per cent of staff said their organisation takes positive action on health and wellbeing, up by 4 per cent from 29 per cent. (If the 59 per cent who answered ‘to some extent’ are added, this rises to 92 per cent).
• Working when unwell: The percentage of staff working when unwell fell from 56 per cent to 44 per cent. This is a welcome shift that needs to be sustained, but remains too high.
• Violence, bullying and harassment: There were small falls in levels of violence and bullying and harassment, but again, levels remained unacceptably high.
• BME staff: Staff from black and minority ethnic (BME) backgrounds continued to have a more negative experience and have lower confidence in organisations providing equal opportunities.
• Work-related stress: There were severe pressures on staff during the pandemic, which is reflected in the rising levels of stress. 44 per cent of staff reported feeling unwell as a result of work-related stress. This increased by 3.6 and is the highest level recorded in the survey. Stress is a long-standing issue in the NHS.
• Line manager support and team working: There were falls in some scores for line manager support (although staff did feel supported on health and wellbeing issues) and a more negative perception on team working.
• Pay and flexible working: There was an increase in dissatisfaction on pay levels but an improvement on views on flexible working.
• COVID-19 wards: On almost all indicators, staff on COVID-19 wards reported less favourable experiences, as did staff who were redeployed or shielding. There was a mixed picture for staff who were working at home, with a more positive experience on some indicators. 

What the survey found: in detail

Staff experience

• The results reveal a complex picture on staff experience. 
• On health and wellbeing, the score for staff perception of positive employer action improved, rising to 33 per cent from a previous 29 per cent. There was also a reduction in staff working when unwell, from 56 per cent to 44 per cent. 
• The toll of the pandemic is, however, demonstrated in the rise in stress levels, which has increased to 44 per cent (up from 40 per cent).
• The overall staff engagement indicator held steady at 7.04. This was bolstered by an increase in staff willingness to recommend the NHS as a place to work, which rose to over two-thirds of staff. 
• There were small falls in staff enthusiasm for work and measures of involvement. 

Experiences of BME staff

• Staff from black and minority ethnic (BME) backgrounds continued to have a more negative experience and have lower confidence in organisations providing equal opportunities: 69 per cent of BME staff said their organisation provided equal opportunities compared to 87.3 per cent of white staff. Full data will be released shortly and underline the need for ongoing action to address disparities on experience of BME staff, LBGTQ+ staff and staff with disabilities. 
• There continues to be a gap in experience between white and BME staff on key Workforce Race Equality Standard (WRES) measures. Compared to 2019, results for 2020 show an improvement across indicator 5 (bullying and harassment by patients, relatives) for both white and BME staff. However, indicators 6 (bullying and harassment by staff) and 7 (equal access to promotion) have both improved for white staff but declined for BME staff, widening the disparity. Indicator 8 (experiencing discrimination) has deteriorated for both groups since 2019. Full details can be found on the NHS Staff Survey website.

Quality of care

The overall indicator of staff perception of quality of care remains stable. Despite the pressures of the pandemic, staff felt they were able to provide good quality care. 

• 82.1 per cent of staff are satisfied with the quality of care they give to patients (a 1.0 percentage point increase on 2019 and a 1.4 percentage point increase on 2018).  
• 69.7 per cent of staff felt able to deliver the care they aspire to, compared to 68.6 per cent in 2019. This is the highest proportion of the last five years and continues an increasing trend since 2017.
• 89.4 per cent of staff feel that their role makes a difference to patients (similar to 2019 at 89.6 per cent). 

Resources

There were positive improvements in staff view of whether they had adequate materials and resources to do their job, and that they had adequate staff.

• 38.4 per cent of staff agree there are enough staff for them to do their job properly (a 6.0 percentage point increase on 2019 and the highest across the past five years).
• 74.8 per cent of staff believe that their organisation acts on concerns raised by patients (a 1.0 percentage point increase on 2019).
• 60.3 per cent of staff agree that they have adequate materials, supplies and equipment to do their job properly (a 4.1 percentage point increase on 2019 and the highest for the past five years). This is lower across staff who have worked on a COVID-19 specific ward or area (56.4 per cent), compared to those who have not (62.4 per cent).

Raising concerns

There were also welcome improvements in staff feeling able to raise concerns and that their organisation acted on issues raised. 

• 88.3 per cent of staff agree that their organisation encourages them to report errors, near misses or incidents (similar to 2019 at 88.4 per cent).
• 60.9 per cent of staff agree that their organisation treats staff who are involved in an error, near miss or incident fairly (a 1.2 percentage point increase on 2019 and a 7.0 percentage point increase on 2016).
• 73.4 per cent of staff agree that their organisation acts on reported errors, near misses or incidents to ensure that they don’t happen again (a 2.3 percentage point increase on 2019 and a 4.7 percentage point increase on 2016).
• 62.7 per cent of staff agree that they are given feedback about changes made in response to reported errors, near misses and incidents.

Staff confidence in care 

Overall, the proportion of staff who would be happy with the standard of care provided at their organisation increased. 

• The percentage of staff who would recommend their organisation if a friend or relative needed treatment rose by 2.8 percentage point increase to 74.2 per cent in 2020), and staff who feel that care of patients and service users is their organisation’s top priority (2.2 percentage point increase to 79.5 per cent in 2020).

Viewpoint

Overall the picture is encouraging given the unprecedented and challenging nature of the past 12 months. It is positive that staff felt supported by their employer, that staff continue to be proud to work for the NHS, and are confident in the care they have been able to deliver.

It is testament to the efforts of NHS leaders that, against the backdrop of a global crisis, over 90 per cent of staff feel their organisation had taken positive action on staff health and wellbeing.

There are, however, significant areas of concern and the recent data on the continued poorer experience of ethnic minority staff starkly reminds NHS leaders that staff experience varies unacceptably in their organisations. We must continue to work to create a fairer healthcare system that recognises and supports all its staff. Across the NHS Confederation, including through our BME Leadership Network and NHS Employers, we will be working with employers on the practical actions to take to address this.

The results on bullying and violence against staff are very disappointing. No staff member should face bullying, harassment and threats of violence at work, and this is something for which there can be zero tolerance.

With the government once again reiterating its intention to offer only a 1 per pay rise there can be no room for complacency when the results also show that around a third of staff are considering leaving their jobs, of which nearly one in five are thinking of quitting the health service entirely.

While there has been an increase in the number of staff agreeing that their organisation has enough staff for them to do their job properly, this is still less than two in five, and reinforces the need for a funded workforce plan to give staff hope that the vacancies in their teams will be filled longer term.

After an exceptional and extreme year, we must all be mindful of the need to allow NHS staff the time and space they need to decompress, particularly as experts continue to warn that we could face another COVID-19 wave again in the coming months. We need an honest conversation which acknowledges that the full resumption of health service activity in the short term must be carefully paced to protect the health of our people.

Last month, we wrote to the Prime Minister to call for a steady approach to recovering patient services, which protects health and care staff from burning out after the extreme and sustained pressures of the pandemic.