The health of the health service's staff in the UK

Abstract

This summer, the UK's National Health Service (NHS) will have been in business for 60 years. Much is written about health-service delivery by the NHS, less about the health of the deliverers. However, for the past few years, the Healthcare Commission, the Service's watchdog in England, has been asking staff about their work, attitudes, and experiences, and the results of the 2007 survey have been recently released. Almost 156 000 employees (54% of the total questioned) responded to the survey. So, how fare those who work for the NHS, and how have the responses in the survey changed over the years?Far too high a proportion, 46%, of staff said that their Trust did not put care of patients or service users as a top priority. That is a major worry for the NHS, especially since the “S” stands for “Service”, and here is an area in which ground must be gained in future years. Many staff said they felt left out in decision making and that communication was not good. Nearly half said they were not involved in important decisions made by senior managers, that communication with such managers was not effective, and that their Trust did not communicate well internally.A high proportion of staff, just over two-fifths, reported working 1–5 h overtime a week without pay and 12% did 6 h or more, with little variation between surveys in 2005–07. Mean scores (1, poor; 5, excellent) for the quality of work–life balance have hovered around 3·3 for the same years. There was also little shift in how staff reported their Trust or manager helping them to achieve a good work–life balance. 8% of respondents said they had experienced some form of discrimination (figures for 2006 and 2005 were similar). The NHS does seem to do well in offering flexible working options, with the survey showing that nearly three-quarters of staff work under such an arrangement. About 60% of staff get an annual appraisal and a high proportion (over 90%) get some form of training each year.The findings about physical violence are worrying. 13% of respondents reported such violence from patients or relatives, and the figures for ambulance staff and those in mental health trusts were higher (29% and 22%, respectively). Additionally, 26% of staff reported harassment, bullying, and abuse by patients or relatives. Also, most staff did not report these events. 2% of those surveyed said they had experienced physical violence from another staff member. The underlying number of such staff-on-staff episodes is just over 3000 in the year of the survey and only about a half of those surveyed felt their Trust took effective action.Annual staff surveys are the fashion these days, but the results are always hard to interpret. How much should a percentage response move before one can say that meaningful change occurred? The findings in the Healthcare Commission's staff survey do not alter much each year. In fact, it is hard to find large changes: the proportion receiving e-learning did jump up, (from 17% in 2005 to 26% in 2007), but that can hardly be heralded as a major achievement. One might also worry about natural drift in the answers (up some years, down the next), and the temptation to neither agree nor disagree (on a five-point scale) in many questions once respondents had scored the point or points they felt strongly about. The response rate was also not high. Almost half those approached chose not to reply to the survey, could not be bothered, were disillusioned after previous surveys (perhaps because of a perceived or actual lack of change by the employer), or were perhaps just too busy.The NHS is the largest employer in the UK, with over 1 million staff. It can thus set the lead as an employer and the health of its staff is obviously important. A recent Comment in The Lancet on Carol Black's report Working for a healthier tomorrow called for a fresh look at the employment of people who are not 100% fit, and a reinvigoration of occupational health in the NHS. If these annual staff surveys have a practical purpose, improvements in staff health and how the NHS deals with staff who are ill will be two markers to look out for in the future. After Black's report, occupational health now means more than asking questions about lifting patients and needlestick injuries. The 2007 Healthcare Commission survey did ask about work-related stress: 33% reported such stress, the same as in 2006 although a fraction down on 2005 (36%). Like many employers these days, the NHS does provide health-related advice to staff (eg, on diet, alcohol use, and smoking cessation). But future surveys by the Commission need to ask more overt questions about the health of the health service's staff. This summer, the UK's National Health Service (NHS) will have been in business for 60 years. Much is written about health-service delivery by the NHS, less about the health of the deliverers. However, for the past few years, the Healthcare Commission, the Service's watchdog in England, has been asking staff about their work, attitudes, and experiences, and the results of the 2007 survey have been recently released. Almost 156 000 employees (54% of the total questioned) responded to the survey. So, how fare those who work for the NHS, and how have the responses in the survey changed over the years? Far too high a proportion, 46%, of staff said that their Trust did not put care of patients or service users as a top priority. That is a major worry for the NHS, especially since the “S” stands for “Service”, and here is an area in which ground must be gained in future years. Many staff said they felt left out in decision making and that communication was not good. Nearly half said they were not involved in important decisions made by senior managers, that communication with such managers was not effective, and that their Trust did not communicate well internally. A high proportion of staff, just over two-fifths, reported working 1–5 h overtime a week without pay and 12% did 6 h or more, with little variation between surveys in 2005–07. Mean scores (1, poor; 5, excellent) for the quality of work–life balance have hovered around 3·3 for the same years. There was also little shift in how staff reported their Trust or manager helping them to achieve a good work–life balance. 8% of respondents said they had experienced some form of discrimination (figures for 2006 and 2005 were similar). The NHS does seem to do well in offering flexible working options, with the survey showing that nearly three-quarters of staff work under such an arrangement. About 60% of staff get an annual appraisal and a high proportion (over 90%) get some form of training each year. The findings about physical violence are worrying. 13% of respondents reported such violence from patients or relatives, and the figures for ambulance staff and those in mental health trusts were higher (29% and 22%, respectively). Additionally, 26% of staff reported harassment, bullying, and abuse by patients or relatives. Also, most staff did not report these events. 2% of those surveyed said they had experienced physical violence from another staff member. The underlying number of such staff-on-staff episodes is just over 3000 in the year of the survey and only about a half of those surveyed felt their Trust took effective action. Annual staff surveys are the fashion these days, but the results are always hard to interpret. How much should a percentage response move before one can say that meaningful change occurred? The findings in the Healthcare Commission's staff survey do not alter much each year. In fact, it is hard to find large changes: the proportion receiving e-learning did jump up, (from 17% in 2005 to 26% in 2007), but that can hardly be heralded as a major achievement. One might also worry about natural drift in the answers (up some years, down the next), and the temptation to neither agree nor disagree (on a five-point scale) in many questions once respondents had scored the point or points they felt strongly about. The response rate was also not high. Almost half those approached chose not to reply to the survey, could not be bothered, were disillusioned after previous surveys (perhaps because of a perceived or actual lack of change by the employer), or were perhaps just too busy. The NHS is the largest employer in the UK, with over 1 million staff. It can thus set the lead as an employer and the health of its staff is obviously important. A recent Comment in The Lancet on Carol Black's report Working for a healthier tomorrow called for a fresh look at the employment of people who are not 100% fit, and a reinvigoration of occupational health in the NHS. If these annual staff surveys have a practical purpose, improvements in staff health and how the NHS deals with staff who are ill will be two markers to look out for in the future. After Black's report, occupational health now means more than asking questions about lifting patients and needlestick injuries. The 2007 Healthcare Commission survey did ask about work-related stress: 33% reported such stress, the same as in 2006 although a fraction down on 2005 (36%). Like many employers these days, the NHS does provide health-related advice to staff (eg, on diet, alcohol use, and smoking cessation). But future surveys by the Commission need to ask more overt questions about the health of the health service's staff. Danger: people at workThere has been an historic failure in the UK to address the needs of working age people. This is the striking conclusion of a new report published this week, Working for a healthier tomorrow.1 Full-Text PDF