NHS staff experience: moving on up?

The NHS Staff Survey results for 2023 saw positive movement in scores across most People Promise indicators. In particular, there was an increase in scores compassionate and inclusive leadership, reward and recognition, flexible working and morale. Staff engagement only just missed being classified as improved.

Due to technical issues, it was not possible to calculate the overall score for a healthy workplace, but it would mostly likely have improved due to the improvements seen in staff perception of employer action on health and wellbeing. There was even a fall in staff thinking of leaving.

"On almost all indicators, perceptions of working in the NHS have improved in 2023 compared to 2022"

Viewed as an annual assessment of progress the evidence is clear. On almost all indicators, perceptions of working in the NHS have improved in 2023 compared to 2022. The most dramatic example of this is in the question on whether staff would recommend the NHS as a place to work, rising from 57 to 61 per cent and now almost back at its pre-pandemic level. 

There are other top-level scores which are back to where they were before the COVID-19 pandemic, such as learning and development. The trends in scores across all key staff experience areas are discussed in our NHS Staff Survey pages.

These improvements are a huge achievement in the context of ongoing pressure on the service, the long-term impact of COVID-19 and the disruptive impact of industrial action. Efforts taken by employers can clearly be seen in the faster-than-average improvement in the People Promise exemplar trusts, and in other trusts with comparable comprehensive approaches. 

It is also clear that comprehensive approaches based on sustaining positive workplace cultures, compassionate leadership, well-supported line managers, staff involvement and health and wellbeing have the most impact. 

Action to promote retention also played a role, one tool which can boost engagement and help retain staff is a stay interview, discussed further in our guidance. 

For these reasons, NHS Employers has welcomed these results and will be working to continue progress in 2024 through developing our programmes on health and wellbeing, staff experience and staff engagement. 

"The biggest caveat to the picture of improvement is on equality"

There is, however, another lens through which to view the results and a big caveat around the data on improved experience. Scores are still below 2019-levels in key areas such as reward and recognition, where satisfaction with pay has improved - but from a low base - and is still below 2019-levels. 

The experience of staff in relation to stress, burnout, and bullying and harassment is clearly unacceptable, even if there are small improvements compared to 2022. 

Looking in-depth at staff engagement, the overall level was stable, with a significant improvement in advocacy and staff reporting being involved. However, the willingness to recommend the NHS as an employer was highly variable, with some trusts having twice as many recommending as others. Good scores for involvement at ward level dropped sharply and varied widely for involvement outside the ward or department. 

The biggest caveat to the picture of improvement is on equality and diversity. The experience of staff with protected characteristics - who make up a majority of the workforce - continues to be worse than that of counterparts. There have been improvements in experience overall, but the gap has actually widened. 

There are other issues where the gap in experience is stark, for example in sexual harassment, and in bullying and abuse levels.

Until the NHS can offer a more equal experience for all staff it will not truly have delivered on the aims of the NHS People Promise, and these negative perceptions of experience will fuel the levels of staff thinking about leaving the workforce.

Learning and looking ahead

Trusts can use the NHS Staff Survey interactive tool to explore their own information further and share and learn from others across the NHS. We will shortly be sharing a series of case studies from trusts that have made improvements. 

Get in touch to learn more via steven.weeks@nhsemployers.org.