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Are NHS staff really getting happier, despite everything?

Or is their goodwill being stretched to breaking point? The latest surveys of NHS staff paint a mixed picture.

The latest annual NHS staff survey results came out this month – and they were “surprisingly” good, at least according to NHS England.

NHS England optimistically celebrated improvements in staff morale and motivation in the NHS, pointing out that “across 32 key findings, over 80% were more positive than last year.”

Simon Stevens, Chief Executive of NHS England, said: “perhaps surprisingly given the well understood pressures, it’s encouraging to see that frontline NHS staff say their experience at work continues to improve, with overall employee engagement scores at a five year high.”

The survey found that over half of all staff (59%) reported that they often or always look forward to going to work, with 74% of staff feeling enthusiastic about their job. 77% of staff felt that time passes quickly whilst they are at work. It found 80% of frontline NHS staff say they are able to do their job to a standard they are personally pleased with, 90% of staff say their job makes a difference for patients, and 92% of staff feel trusted to do their jobs.

So is staff morale really back up to where it was before 2012’s disastrous Health & Social Care Act?

In contrast, the 14 NHS trade unions have – as we highlighted in our latest submission to the NHS Pay Review process - found “dangerously declining levels of morale” as a result of cuts, staffing shortages and rising workload and work intensity.

For example Unite’s survey of NHS members found that 80% of respondents reported morale was ‘worse’ or ‘a lot worse’ than a year ago. Similarly Unison found that 56% of respondents reported morale being low or very low in their workplace and around two thirds said it had fallen over the last year.

The Royal College of Nursing’s three national staff surveys undertaken last year found “high levels of workload...insufficient staffing levels...a large proportion also indicated they regularly work additional hours; that they have experienced work-related stress and have turned up for work despite not feeling well enough to do so.”

And a Chartered Society of Physiotherapy survey of members who have recently left the NHS found many cited dissatisfaction with the quality of care they felt about to provide, workload, stress and staffing cuts as reasons for leaving.

It’s not only NHS trade unions that have found poor morale in the NHS. Just a few days after the NHS staff survey was released Wilmington Healthcare UK released a poll of nurses, GPs and hospital doctors across the UK. This found that 64% blamed staff retention problems on the continuous and “demoralising” national changes that had occurred since 2000.

So what’s really going on?

What is the cause of this obvious disconnect? There is no doubting that NHS staff surveys are robust in their coverage.

But as always, it’s about what you are actually measuring, and how you ask the questions.

Many of the points in the NHS staff survey infer motivation from a broad set of questions about the how workers intrinsically value their own jobs, rather than how they feel under the current climate.

The union surveys ask specifically about morale.

And – though they are related - there’s a difference between motivation and morale.

All surveys continue to show that NHS staff are highly motivated by their work and the vital roles they play in delivering our National Health Service. There is a strongly held public service ethos within the NHS and staff who work under enormous pressure would not do so if they were not motivated to help patients and do their best for those in need.

In contrast morale refers to how staff feel about how they are valued, their working conditions, pay and terms and also how able they are to carry out their job given the resources available to them.

Whilst the surveys may not be directly comparable, of course we shouldn’t knock any improvements shown.

But dig a little deeper into the NHS staff survey figures, and it’s clear there is less cause for celebration.

Many of the survey results that show the biggest improvements are related to management behaviour such as how well they engage with staff and whether staff are confident reporting incidents. These are all welcome changes - possibly a result of the CQC’s increased emphasis on whether an organisation is “well led”, the NHS Workforce Race Equality Standard and the financial incentives for organisations to promote staff health and wellbeing.

That said, in some cases they may mask the issues that staff really experience, for example while reporting of discrimination and violence went up, so too did actual cases of both.

Another worrying issue is that the NHS staff survey found that 59% of NHS staff are, on average, doing unpaid overtime, and nearly three quarters (72%) are doing overtime.

The steady increase in both paid and unpaid overtime since 2012 shows not enough has been done to address workload levels and staff shortages. Relying on tired and over-worked staff can lead to poorer standards of care. And of course, Brexit is set to make this worse unless the tens of thousands of EU nationals working in the NHS are granted the right to remain in the UK.

The NHS staff survey highlights that more than half of staff (56%) report having attended work in the last three months despite feeling unwell, due to pressure from either their manager, colleagues or themselves. While this is a significant improvement since 2012, when 64% attended work despite illness, it is simply not good enough for over half of all staff to be attending work when they are sick.

The survey also points out that “the proportion of staff who reported feeling unwell due to work-related stress is at its lowest since 2012, down to 37%.” It is hardly cause for celebration when well over a third of staff have been so stressed that they have been unwell. Unite’s survey found that 79% of respondents had experienced work-related stress over the previous year. Taken together it implies that just under half of those staff experiencing stress were being made ill by it.

Given that long term exposure to stress is one of the worst killers in the workplace and has huge impacts on people’s mental health, what does that say about the state of our health service? Are we happy to watch the people who care for our sick and infirm, die from health service jobs?

As the NHS unions have said,

“The NHS fundamentally depends on the psychological contract with their staff – to provide care and compassion, to go the extra mile, to cope with organisational change and financial challenge.”

Government not listening

We have a government that simply refuses to understand. Instead of investing in staff and the service they have imposed the worst financial settlement in its history and capped staff pay below inflation for seven years.

Nothing highlights this short-sightedness more than Jeremy Hunt’s comments last week at the Chief Nursing Officers Summit, where he said the priority was to increase nursing numbers, rather than increase their pay or professional development.

Staff shortages, pay cuts, reorganisations, high levels of sickness and stress are all major reasons why it is so hard to recruit and keep staff. You cannot deal with recruitment without dealing with the working conditions that are preventing it. We need to make the NHS a more appealing place to work through more investment, stability, better pay and terms, and then people will want to work there. This is not rocket science.

Our members tell us that things are not going to get better any time soon. The Government is demanding even more efficiency savings (ie, cuts), through controversial sustainability and transformation plans (STPs) that are being rolled out across England. These plans force through yet another top down reorganisation of services, in some areas closing hospitals and departments and potentially opening more services to privatisation. The new ‘footprint areas’ also pose a serious threat to national staff terms and conditions as each area strives to make cuts.

As Wilmington Healthcare UK’s survey shows, constant reorganisation has been a major disruption to NHS staff over the last few decades and the same is true now. It is testament to the quality and belief that staff have in the NHS that they remain motivated in this current climate.

NHS staff are carrying a health service that this government has brought to its knees. How long can we take advantage of their good will without something snapping?


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