Turning it around: Northamptonshire Healthcare NHS Foundation Trust (NHFT)

NHFT have progressed from a CQC rating of ‘Requires improvement’ in August 2015 to ‘Outstanding’ in 2018. They achieved this by putting in place a vision “to be a leading provider of outstanding, compassionate care”.

Knowing that staff engagement is a key component of positive patient experience, the Trust have made staff engagement a high priority in their improvement programme. Using Picker’s help to analyse the Staff Friends and Family Test has been essential in supporting the Trust to maintain a strong cycle of measuring and acting on staff feedback.


The CQC rating of ‘Requires improvement’ motivated NHFT to re-evaluate their values and their vision of the care that they wanted to provide to patients and service users.

The 2016 Staff Friends and Family Test showed the Trust’s engagement score had decreased to 3.85 and only 57% of staff said they would recommend it as a place to work. They also had a vacancy rate of over 15 per cent, resulting in a financial deficit due to excessive usage of agency staff, which impacted staff morale.


Using evidence-based research (‘The risks to care quality and staff wellbeing of an NHS system under pressure’ Sizmur and Raleigh 2018) the Trust developed a two-year strategy ‘Let’s Talk’ which focused on staff engagement and support.

This was directly informed by key issues raised in staff surveys, such as supporting health and wellbeing, listening to staff ideas, and reducing instances of bullying and harassment. The strategy is supported by initiatives such as the Employer Promise, the Respect and Compassion Staff Charter, the NHFT Quality Awards and the Freedom to Speak Up Guardian support system.


In the 2018 NHS Staff Survey, NHFT saw significant improvements in 35 of 82 questions comparable with 2017, including key questions such as ‘Care of patients/service users is organisation’s top priority’ and ‘Would recommend organisation as a place to work’. The Trust’s staff engagement score, a key metric of staff motivation, advocacy and involvement, has gone from 3.85 in 2016, to 3.91 in 2017, to 4.01 in 2018 (or 7.5 on the new scale). This cycle of staff feedback and support has played a significant role in the rapid improvements the Trust has made to the quality of care since 2015. In 2018, the Trust was awarded:

  • an Outstanding rating by the CQC
  • the winner of ‘Best Product or Innovation’ at the 2018 Patient Safety Awards
  • Trust of the Year in the HSJ Awards 2018
  • Shortlisted in the CIPD Best employee experience initiative People Management Awards 2019

And, in 2019 won Best employee experience initiative in the CIPD People Management Awards.

Looking forward

For the Staff Friends and Family Test 2019/20, NHFT have added their own questions to collect feedback on the experience of bullying and harassment, as this has been identified as a high priority for staff. Through the quarterly reports Picker produce, NHFT will be able to measure the progress of actions they are taking to address this issue.

Working with Picker on the Staff FFT has enabled us to effectively monitor staff engagement, and by adding in questions that are directly relevant to our new strategy, we can understand the effect our changes are having.

Matthew Asbrey, Freedom to Speak Up Guardian/Staff Engagement Lead, NHFT

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