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More than 155,000 staff give their views on working for the NHS

The Healthcare Commission today (Tuesday) publishes results from the annual survey of NHS staff, one of the largest staff surveys in the world.

Between October and December last year, a proportionate sample of staff were asked for their views and experiences of working for the NHS in England. Surveys were returned by 155,922 employees from all 391 NHS trusts– a response rate of 54%.

There were a number of positive results from the survey. The results found that staff were generally satisfied in their jobs, with responses consistent to previous years despite the change that has taken place over that time. It also showed that 94% of staff took part in some form of
training. Staff responses indicated strong support from their line managers, with 71% saying their immediate managers encourage team working and are supportive in a personal crisis. Further, 73% said they take advantage of flexible working options.

There are clear improvements in relation to infection control, with 82% of staff saying their trust does enough to promote the importance of hand-washing to staff, up from 70% in 2005. There was also an improvement in the number of staff who were trained in infection control up from 68% in 2005 to 71% in 2007. Also, 83% of staff said infection control is relevant to their job compared to 74% in 2005.

But there remains work to be done in making sure that hand-washing equipment is always available to staff when they need it. Sixty-one per cent of staff said hand-washing equipment was always available when they needed it, compared to 60% in 2005. This figure varied widely between hospital trusts.

The survey also showed that more action is needed to address violence and abuse, which research suggests is relatively high in the health sector compared to other working environments. In 2007, 13% of staff said they had experienced physical violence.

Additionally, only 26% thought their trust valued their work, down from 28% in 2005. Survey responses indicate poor levels of communication between staff and senior management, with only 22% thinking it is effective.

Anna Walker, the Commission’s Chief Executive, said: “As one of the largest employers in the world, the NHS needs to be aware of and responsive to how staff are coping.

“Each trust is a unique working environment and local results highlight the challenges particular to each of them. At a national level, the survey results must be used to drive continual improvement in the working lives of thousands of NHS workers.

“The results show that there are a lot of reasons to work in the NHS, including the satisfaction staff get from their jobs, the ability to work hours that suit through to real training opportunities.

“But there are challenges to making the NHS a better place to work. Some of those will be tough to crack because they are about the environment that the healthcare system operates in. We know that health workers are more likely to experience violence, harassment and abuse than workers from other sectors and the NHS has made a concerted effort to address this problem.
Trusts must continue to step up to this challenge because it is unacceptable for NHS staff, who provide vital, often life-saving care, to be put in the position where they face violence and abuse as they go about their day-to-day work.

“There are other issues that are not about the environment. Staff in the NHS provide vital, often life-saving care. Yet they do not feel their work is valued by their trust and that communication with senior management is poor. These are things that trusts can and must change.

“At a time when public concern about healthcare associated infections is so high, I’m pleased to see some improvements in this area. But trusts must make sure that frontline staff always have the necessary equipment to wash their hands. There are trusts out there who’ve shown that it is possible to do this well, with as many as 82% of staff saying they always had equipment available. But this fell to as few as 39% at other trusts. Every trust should be aiming to make this 100%.”

Highlights of the survey findings include:

· Staff were very positive about the support they receive from immediate managers: In 2007, 71% said their immediate manager encourages team-working and the same number said their manager was supportive in a personal crisis. Sixty-seven per cent said their manager can be counted on to help with a difficult task at work, however only 53% said they received clear feedback on their work and 51% said their manager sought their opinion before making a decision that affected their work.

· More staff say they receive appraisals: Results from previous NHS staff surveys have shown that staff who had received an appraisal in the previous 12 months were more satisfied with their jobs and less likely to consider leaving. The proportion of staff receiving an appraisal or performance development review in the last 12 months (61%) has increased from 58% in 2006. The proportion completing a personal development plan as part of their appraisal rose to 52% from 48% in 2006.

· Staff are working less overtime and have good access to flexible working options: Another trend to emerge from the survey is that staff said they are working less overtime. In total, 66% of staff said they worked more than their contracted hours, down from 71% in 2005. The survey also highlights good access to flexible working options, with 73% saying they took advantage of at least one flexible working option. This figure has remained stable over previous years.

· Staff have opportunities to take up training or education through work: The survey shows widespread investment in the NHS workforce, with 94% of staff saying they had taken part in at least one form of training. Of those, 77% said it had helped them to do their job better or keep up-to-date. (More figures on training are available below in sections specific to infection control and violence and abuse).

· There are fewer staff saying they saw errors or near misses and an improvement in the number who say it was reported: The number of staff who said they had seen a potentially harmful error or near miss in the 12 months before the survey continued to fall, from 40% in 2005 to 31% in 2007. This is a positive sign, however, this does not necessarily indicate that the actual number of errors or near misses has reduced.

For the first time, staff were asked what had caused the error or near miss. Forty-five per cent said it was caused by an incorrect clinical assessment or treatment, 40% said staffing levels was the reason and 27% said communication led to the incident.

The number of staff who said they or a colleague had reported the last error they saw slightly improved, up from 92% in 2005 to 94% in 2007.

When asked whether they thought their trust treated people fairly when they reported an error or incident, 41% agreed or strongly agreed, 6% disagreed or strongly disagreed and 54% had no opinion. When asked whether they thought their trust takes action to ensure incidents don’t happen again, 50% agreed or strongly agreed.

· Staff are generally satisfied with their jobs, but do not feel valued by their trust: The key score for this area, which brings together all questions relating to job satisfaction and gives a ranking out of five. The overall score of 3.4 shows that staff are generally satisfied with their jobs. The score remains consistent with previous years, despite the amount of change taking place across the NHS.

Responding to questions about job satisfaction in 2007, 75% of staff said they were satisfied or very satisfied with the support they get from colleagues, 68% with the responsibility they are given and 64% with the opportunities to use their skills.

However, only 26% of staff were satisfied or very satisfied with the extent to which their trust values their work, down from 28% in 2005. This figure ranged between trusts from 58% to 11%. Further, only 39% of staff were satisfied or very satisfied with the recognition they get for good work, down from 42% in 2005. Not feeling valued was the reason most often given by staff who said they were thinking about leaving their jobs.

· There are encouraging signs of improvement in infection control but more needs to be done to make hand-washing equipment available: The survey again asked staff a number of questions relating to infection control, showing improvements in some aspects.

At a time when all staff members at hospitals are encouraged to view infection control as a personal responsibility, the latest survey showed that 83% of staff at acute hospital trusts agreed infection control applied to their role. This represents a substantial rise from 74% in 2005.

Also, 82% of staff at acute trusts agreed their trust was doing enough to promote hand-washing to staff, up from 70% in 2005. Further, 71% agreed their trust was doing all it could to promote hand-washing to patients and visitors, up from 57% in 2005.

But the Commission said trusts must do more to make hand-washing equipment available to staff and patients.

In 2007, 61% of staff across all trust types said hand-washing equipment was always available to them when they needed it and 30% said it was available most of the time, showing some improvement since the question was first asked in 2005. These figures were broadly the same when looking just at front-line clinical staff.

Looking just at acute trusts in 2007, the number of staff that said hand-washing equipment was always available varied from 39%* to 82%*.

In the 2007 survey, 52% of staff across all types of trust said hand-washing equipment was always available when patients needed it.

The survey results highlight some improvement in training on infection over the 12 months prior to the survey, with 53% of staff saying they received training in that time. A further 18% of staff said they were trained before this period, taking the total to 71% of staff. This is an improvement since 2005, when a total of 68% per cent said they were trained in infection control.

· Staff still report high levels of violence and abuse, but training in this area has improved: The Commission said NHS trusts should renew their efforts to tackle violence and abuse and encourage greater reporting by staff.

Thirteen per cent of staff members said they had experienced physical violence from patients or their relatives in the 12 months prior to the survey in 2007, the same as in 2006 and up one percentage point from 2005.

Violence was most prevalent in ambulance and mental health trusts where 29% and 22% of staff respectively said they had experienced physical violence from patients or their relatives in the previous 12 months.

Twenty-six per cent of staff said they had been harassed, bullied or abused by patients or their relatives in the last 12 months. This showed little improvement over previous years (28% in 2006 and 26% in 2005).

The 2007 survey showed only 66% of those who said they experienced physical violence and 49% of those who said they experienced bullying, harassment and abuse in the last 12 months had reported it.

Trusts are providing training for staff to deal with violence and abuse. In 2007, 26% of staff said they had received training in this area in the 12 months prior to the survey and a further 23% said they received the training, although it was more than 12 months ago. This is an improvement of four percentage points on the previous survey but still demonstratesroom to improve.

· Communication between staff and senior managers is poor: Only 23% said senior managers involved staff in important decisions and only 22% considered communication between staff and senior management to be effective. Thirty-one per cent said senior manages encouraged staff to suggest new ideas and 17% said different parts of the trust communicate effectively with each other.

· Many ambulance staff do not think vehicles are safe to work in: The results suggest that ambulance workers responded more negatively to survey questions than staff at other types of trusts. Also, the survey for the first time asked two questions specific to ambulance staff, showing that 51%* think the vehicles are not in a good state of repair and 42%* feel that the vehicles do not provide a safe working environment.

· Some staff say the patients are not the top priority: Staff were asked whether they thought the care of patients was their trust’s top priority. Ten per cent strongly agreed, 36% agreed. Across all trusts, the number of staff who disagreed or strongly disagreed with this statement ranged from 65%* to 3%*. Those trusts who scored poorly must address this issue.

Notes to editors:

* These figures have not been weighted to take consideration of trust size. All other figures have been weighted so that they reflect unbiased estimates of all NHS staff in England, rather than being biased towards the responses of staff in smaller organisations and those types of trust and regions that had higher responses. The weighting is such that responses from each trust contributed an amount to the total that was directly proportional to the number of staff employed by that trust.

Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

For further information contact the press office on 0207 448 0868, or on 07917232143 after hours.