Working in the NHS

The staff pledges that are part of the NHS Constitution define what the NHS expects from staff and what staff can expect from NHS employers. One of these pledges is to provide support and opportunities for staff to maintain their health, wellbeing and safety. Further to this, the NHS England Chief Executive announced a major drive to improve the health and wellbeing of health service staff, in a bid to benefit both staff and taxpayers (September 2015).

Staff satisfaction with resourcing and support

In 2015, the scale used to measure the work pressure felt by staff was adjusted to measure staff satisfaction with resources and support and is not comparable with previous findings. Staff were asked to rate on a scale of 1 to 5 how satisfied they were with the resources (e.g. materials, supplies and adequate staff numbers) and support from colleagues to do their work and meet conflicting demands.

Nationally, staff were quite satisfied (3.3 out of 5) with the resources in 2016. This was similar across staff groups, although ambulance staff gave the lowest score of 3.1. The highest score came from mental health and learning disability staff.

Updated April 2017.

How many staff report working extra hours?

One way work pressure may manifest itself is staff working extra hours (more than five hours per week) than they are contracted to do (either paid or unpaid).

Between 2003 and 2006 a large proportion (over 70%) of NHS staff were reporting that they had worked extra hours. This then fell in 2007 and remained relatively static around at 65-66% until 2011. From 2012 to 2014 the percentage of NHS staff working extra hours began to increase again, to 72% in 2014. Data from 2015 onwards is not directly comparable with the years before as the scores from 2015 on are weighted. As of 2016, 72% of staff reported that they had worked extra hours.

Although responses from staff in ambulance trusts follow a similar u-shaped trend over time they consistently report working extra hours more than staff in other trust types. In 2016 for example, 85% of ambulance trust staff reported working extra hours.

Updated April 2017.

Are there differences between staff groups in reporting working extra hours?

The extent to which different staff groups report working extra hours varies quite dramatically between the groups. Across the NHS in England the percentage of staff reporting that they worked extra hours has stayed around 70% over the period between 2004 (71%) to 2016 (72%).

In 2016, general managers had the largest percentage reporting working extra hours (89%) followed by medical and dental staff (86%). The lowest levels are seen in staff working as healthcare assistants (61%) and in the wider health team (60%).

Updated April 2017.

Have there been changes in staff reporting being ill due to work-related stress?

Another way work pressure may manifest itself is in staff becoming ill due to work-related stress. Overall, less than half of staff reported feeling unwell due to work-related stress.

In 2004 and 2005, nationally around 35% of staff reported that they had been ill due to work-related stress. This fell by approximately 7 percentage points to lows in 2008 and 2009. From 2010, the number of staff reporting stress began to increase again. Between 2009 and 2013 the percentage of staff reporting that they had been ill due to work stress increased by 10 percentage points. As of 2016, 37% of staff in the NHS in England reported being ill due to work stress.

Up until 2011 there were similar levels of reporting between the different trust types, although on average lower numbers of staff from acute trusts reported illness due to work-related stress than staff from ambulance and mental health & learning disability trusts. However, from 2012 the number of staff in ambulance trusts reporting illness due to work-related stress began to rise markedly above the other staff groups. In 2016, almost half (49%) of ambulance staff reported being ill due to work stress.

Updated April 2017.

Are there differences between staff groups in reporting being ill due to work-related stress?

50% of staff with a disability reported being ill due to work-related stress, compared to 32% of staff without a disability.
More females reported being ill due to work-related stress compared to men; in 2015 36% of females compared to 33% of male staff reported being ill due to work related stress. White staff were more likely to report being ill due to work related stress (36%) than non-white staff (30%). (Data not shown)

What do staff say about feeling pressured to work when unwell and how has this changed?

Many staff feel pressure to attend work despite being ill. In 2009, just over one fifth of staff reported that they felt pressure to attend work when feeling unwell in the previous three months. Subsequently, there was a year-on-year increase in staff reporting feeling pressure to work when feeling unwell, rising to 27% in 2012. This dropped to a quarter of all staff in 2013 and 23% in 2014, which is still greater than when the data was first collected in 2009.

Ambulance trust staff consistently reported feeling more pressure to attend work when feeling unwell in the previous three months when compared to acute, mental health & learning disability, and community trusts.

In 2015, this indicator was changed to ask not only whether staff members feel under pressure from colleagues to come to work while unwell but also whether they additionally put themselves under pressure to come to work. Once this was included, the percentage of staff feeling under pressure to go to work when unwell increased dramatically and in 2016 the figure stood at 59% of staff.

Updated April 2017.

Are there differences between staff groups in reporting feeling pressure to work when unwell?

In line with staff reporting that they have been ill due to work related stress, the proportion of disabled staff who say that they felt pressure to attend work when ill is consistently greater than in staff who are not disabled. In 2014, 34% of disabled staff said that they felt pressure to work, compared to 20% of staff who are not disabled. This doubled in 2015, given the addition of the questions as to whether there was self-inflicted pressure to go to work when unwell.

About this data

For more information on the methodology used in the survey (weighted and unweighted scores etc.), please see NHS Staff Survey 2016.

Weighting is applied to scores from the survey as NHS organisations of the same type are likely to have different numbers of employees in each occupational group. This can be for a number of reasons: for example, some organisations issue contracts for services such as catering and cleaning, while other organisations supply them in-house.

These differences can have a significant effect on organisation results, as it is known that different occupational groups tend to answer some questions in different ways. For instance, managers are known to respond more positively than other groups to some questions and an organisation that has a particularly large number of managers may have more positive results simply because of this imbalance. This is why the data is weighted. The weighting procedure described below ensures that no organisation will appear better or worse than others because of any occupational group differences.

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