NHS staff experiences are improving – but discrimination from patients & the public is up

The experiences of people working in England’s NHS have improved in recent years, according to results from the largest ever survey of NHS employees. The proportion of staff recommending their organisations as places to work, saying that they feel valued, and expressing satisfaction with pay have all risen to five-year highs. But staff have faced rising levels of discrimination from patients and the public, particularly with regard to race and ethnicity.

The 2019 NHS Staff Survey, coordinated by Picker for NHS England, included responses from more than 550,000 people – half of the service’s workforce. The survey is conducted annually and covers more than 200 NHS organisations across a range of care settings, providing the most detailed insight available into the state of the NHS from the point of view of the people who make it work.

This year, 63% of staff said that they would recommend their organisation as a place to work: a 2% point improvement from 2018 and a 5% point improvement since 2015. Only 14% said that they would not recommend their organisation as a place to work – although this still represents more than 150,000 people, indicating considerable further room for improvement. The biggest improvements over the last five years have come in the ambulance and community sectors, which have historically reported worse staff experiences: both have increased by more than 10% points since 2015.

Similarly, the proportion of staff who say that they are satisfied with their level of pay has improved from 36% in 2018 to 38% in 2019. With 36% saying they were dissatisfied with pay, this is the first time in five years that more staff say they are satisfied than dissatisfied with their pay – and a 15% point improvement in net satisfaction since its low point in 2017. But there remains considerable variation in pay satisfaction for different groups. For example, whilst pay satisfaction for registered nurses and midwives has improved by 3% points to 36% in 2019, less than a quarter (25%) of nursing and healthcare assistants say they are satisfied.

Despite encouraging improvements in many areas of staff experience, there are areas that have declined or remained static. Firstly, results relating to staff health and wellbeing have continued to worsen: this year, 40% of staff reported experiencing work-related stress and 28% said that they had suffered musculoskeletal problems due to work in the last year. Both of these proportions have increased by 3% points since 2015, which is a concern given that research shows links between staff wellbeing, experiences, and the quality of care.

Sadly, staff have continued to report increasing levels of discrimination from patients and the public. This year, 7.2% of staff – representing around 80,000 NHS employees – said that they had personally experienced discrimination from patients, service users, their relatives, and other members of the public in the last year. This figure has grown by around a quarter (24%) from 5.8% in 2015. Of staff who said they had experienced discrimination, this was most often related to their ethnic background. The proportion of staff experiencing discrimination who said that this was related to their ethnicity rose sharply from 42% in 2018 to 46% in 2019. Similarly, staff from black and minority ethnic groups remain markedly less likely than white staff to say that their organisations provide equal opportunities.

Commenting on the findings, Chris Graham, CEO of Picker, the charity that coordinated the survey, said:

NHS employers should reflect with justified satisfaction on the findings of the NHS Staff Survey, which have shown workforce experiences improving in many key areas despite a background of political upheaval. This is evidence of how engaged and committed NHS staff are, and of the efforts made by NHS organisations to prioritise staff experiences.

But employers should not rest too long on the positive results from the survey, because the survey continues to show substantial room for improvement. Organisations should look to build momentum and, in line with the aspirations set out in the NHS’s interim people plan, should continue to focus on making the NHS the best place to work – for everyone. Tackling issues around equalities and staff wellbeing should be particular priorities, as these are important to ensuring that all staff are supported to provide person centred care.

Notes to editors

• 569,440 people responded to the survey, from 300 NHS organisations, including 229 Trusts across England, with a response rate of 48%.
• Full details of the survey methodology, questions, and results are available on the dedicated survey website at nhsstaffsurveys.com.