‘LiA NHS Trusts' Early Warning System for CEOs’ (based on LiA analysis of 2017 NHS National Survey Results 32 Key Findings)
Based on the latest NHS National Staff Survey results, the Listening into Action (LiA) analysis – in its eighth year now – looks particularly at how staff rate leadership and culture at their Trust.
If we take care of our staff, they will take care of our patients. Every leader knows this to be true, and never has it been more important to engage, value and empower the 1.4 million staff working under immense pressure in the NHS every day.
So, what are staff saying and what should we do about it? The votes are in, and the big picture does not make pretty reading.
Staff it seems, are fed up with how things are and – aside from those who are voting with their feet – are quite happy to record their displeasure this year more than any other.
Listening into Action (LiA) Scatter Maps
The LiA Scatter Maps show an analysis of the 32 Key Findings from the latest National Staff Survey (NSS) results – produced by Picker Europe for the NHS. Each Trusts' results are reflected at a grid reference on a 32 by 32 ‘Scatter Map’ that shows how staff have rated the Trust’s leadership and culture over the past year. It's simple to understand:
- The higher up you are, the better your Trust is performing against your peers in the eyes of your staff
- The further to the right you are, the more positive your trend, year-on-year
- The red and green boxes reflect whether an individual Trust’s results are better or worse than last year: red for worse, green for better.
So, the best quadrant to find your Trust in is 'top right': an above average performance and a positive trend. Second best is 'top left': a positive relative performance according to staff, but they are less positive than the same time last year. The second worst quadrant is 'bottom right': below median performance with some encouraging positivity from staff to soften the blow. The worst quadrant is 'bottom left', with staff views on leadership and culture resoundingly negative.
The associated League Tables show how much each Trust has risen or fallen in the rankings from last year.
What the results show this year…
There are 92 Acute-only Trusts this year, with 5 having transitioned to Acute and Community status or merged to form new Trusts.
Last year showed a far more even distribution across all quadrants and within quadrants than this year’s ‘clustering tendency’ which is further left and further down the overall grid. On top of that, the red/green colour-coding shows that 39 out of 92 Trusts have improved, whilst 53 out of 92 Trusts have seen worse results. Last year there were 43 Trusts in the ‘top-right’ quadrant, this year only 34, down 9. Last year there were 21 Trusts in the ‘bottom-right’, this year only 12, down 9. Last year there were ‘only’ 15 Trusts in the worst quadrant, this year there are 27, up 12.
This is a 21% shift away from the best-performers quadrant, a 42% deteriorating trend in staff positivity away from the ‘bottom right’ quadrant, and a massive 80% increase in Trusts finding themselves in the ‘bottom left’ quadrant.
The rate of decline is alarming on a national level.
In terms of individual Trusts, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust has bucked the trend in the current national context and taken top position. At the other end of the spectrum, Brighton and Sussex University Hospitals NHS Trust are at the bottom of all 92 Acutes, and down one place from their 96 out of 97 Acute Trusts last year.
Two ‘Quadrant Shifters’ have jumped from ‘bottom-left’ to ‘top-right’: Burton, and Ipswich. Unfortunately, the list of those on the reverse journey is longer: Barking, Havering and Redbridge; Basildon and Thurrock; Calderdale and Huddersfield; Countess of Chester; University Hospitals of Leicester; University Hospitals of South Manchester; and Wirral. In addition to these Trusts, 3 others have seen a dramatic drop in their results: East and North Herts; Mid Essex, and Oxford University.
Acute and Community Trusts
The trend from the 92 Acute-only sector sustains for their peers in the combined Acute and Community Sector.
There are 37 Acute and Community Trusts this year whose results bear strict comparison, with a small number of new or existing Trusts whose results can’t be assessed against 2016-2017 for several different reasons, so they are not included here.
The ‘movement’ is, once again, downwards and leftwards.
You know something big is happening when National leaders on staff well-being indicators – such as Guy’s and St Thomas’ FT or The Newcastle-Upon-Tyne Hospitals FT – have vacated the top performing quadrant. These Trusts, and others like them, have historically been fixtures in the ‘top right’.
The rate of decline is stark. In 2016-2017, there were 14 Trusts in the ‘top right’ quadrant. This year it’s down to six – a 43% reduction. 9 Trusts were in the ‘bottom right’ quadrant – trying to get better – and now there are only 5 – a 56% shift away from trending positively. And they have almost all landed in the ‘bottom left’ quadrant, which has seen a rise from 5 Trusts last year to 14 this year.
In summary, 16 out of 37 Trusts have improved, 20 out of 37 Trusts have seen worse results, and one has remined the same (no mean feat in the current climate).
In terms of individual Trusts, top dog this year is Northern Devon Healthcare NHS Trust – a non-FT no less. Not faring so well is Lewisham and Greenwich who have dropped four places from 2016-2017 to claim bottom spot. Sandwell and West Birmingham, and South Tyneside have made notable improvements. Moving in the wrong direction are: Great Western, Wye Valley, and York Teaching.
Mental Health and Learning Disability Trusts
Birmingham & Solihull Mental Health FT look away now. South Staffordshire and Shropshire Healthcare FT break out the bunting!
There are 25 Mental Health & Learning Disability Trusts this year whose results bear strict comparison. In similar fashion to the Acute sector, the ‘movement’ is downwards and leftwards. A similar rate of decline shows that this is not an ‘acute hospital pressure’ thing.
In 2016-2017: 13 Trusts were in the ‘top right’ quadrant, down this year to 11 – a 15% decline; 8 Trusts were in the ‘bottom right’ quadrant – trying to get better – down this year to 3 – a 62% shift away from trending positively. No prizes for guessing where they’ve gone: 100% increase in ‘bottom left’ Trusts and 66% increase in ‘top left’.
The ‘clustering tendency’ is, once again, left and further down the overall grid. 7 out of 25 Trusts have improved, whilst 17 out of 25 Trusts have seen worse results.
In terms of individual Trusts, retaining top slot is SSSFT, although even the best-of-the-best have declined in their Staff Survey results. Birmingham and Solihull’s have declined from third bottom last year to last this year. Tavistock and Portman are a positive ‘Quadrant Shifter’, and others with good improvements include Lincs Partnership, North Staffs Combined, and West London. Moving the wrong way are Sheffield H&SC, and South West London & St George’s.
The established trend continues.
In terms of individual Trusts, Cambridgeshire are at the top, up one place in the rankings from 2016-2017, and Lincolnshire Community are another ‘Quadrant Shifter’, moving up to 6th place in the ranking this year.
Heading the other way, Gloucestershire Care Services takes bottom spot in 2017-2018, following a really promising turnaround in the previous year. Bridgewater are down 6 places, and Staffordshire and Stoke-on-Trent Partnership, have dropped 12 places in a 17-strong cohort.
Mental Health, Learning Disability and Community Trusts
Surprise, surprise, no change to the national trend. Although this cohort has held up better than most, things are still deteriorating in terms of how staff rank leadership and culture.
Of the 28 Trusts, 14 have improved and 14 have declined. Two positive ‘Quadrant Shifters’: NE London, and Cumbria Partnership. Not so good at RDaSH, Notts Healthcare and Lancashire Care this year.
Acute Specialist Trusts
There has been a huge amount of movement this year, bucking the ‘downwards and leftwards’ trend visible in the other cohorts. Acute Specialist Trusts have largely vacated the ‘bottom left’ quadrant, apart from Great Ormond Street Children’s Hospital who have remained there. Other than this anomaly, Trusts have replaced peers in each quadrant as some have improved and others have declined.
Overall, 9 of the 15 Trusts have seen some improvement, 6 have dropped back. Top spot goes to the Royal Marsden, up 2 places in the League Table, just overtaking Liverpool Heart and Chest in the run for first place. Bottom of the pile are GOSH.
5 Trusts have managed to move themselves out of 'bottom left': Queen Victoria, Royal Orthopaedic, Liverpool Women’s, Papworth, and The Robert Jones and Agnes Hunt Ortho - the latter two of which are 'quadrant shifters' to 'top right'. Struggling and going the wrong way: Royal Brompton, The Clatterbridge, and The Christie.
Interestingly, the ‘downwards and leftwards’ trend visible in the other cohorts is not reflected here either.
7 Trusts out of 11 Trusts have improved their position, with 4 deteriorating. North East Ambulance Service FT have risen to top spot in the rankings, up 2 places from last year. South East Coast Ambulance Service FT remain at the bottom for the second year running, albeit with a healthy move to the 'bottom right' quadrant from their worse position last year.
Big positive movers are West Midlands Ambulance Service FT – up into the 'top right' quadrant – and South Central Ambulance FT, up to second place in the League Table. London Ambulance Service leadership are the poorest performers, dropping into the 'bottom left' this year, whilst South Western have taken a tumble from 'top right', down 2 places in the League Table.
Thresholds for the whole ambulance community remain the lowest of all Trust cohorts, reflecting that, for staff, this is one of the toughest gigs in the whole of the NHS.
Even in the best Trusts…
If anyone anywhere in the NHS is thinking we’re fine – think again. We took a closer look at some of the best Trusts in the country, and here are some of the headlines:
- 1 in 50 staff have experienced violence from a fellow staff member in the last 12 months (in an average Trust of 5000 staff, that’s 100 staff members)
- 1 in 5 staff have experienced harassment, bullying or abuse from a colleague in the last 12 months ( that’s 1000 staff!)
- 1 in 4 staff have witnessed a potentially harmful error, near miss or incidents in the last month (1250 staff)
- 1 in 3 staff report feeling unwell due to work related stress in last 12 months (1650 staff)
- 1 in 2 staff have attended work in the last 3 months despite feeling unwell because they felt pressured to do so (2500 staff)
- Over 60% staff feel that communication between senior management and staff is not good
- Over 70% staff have worked extra hours (unpaid and unvalued?).
Is this really the environment we want and expect frontline teams to work in as they strive to deliver top quality, safe care, day in day out? Even if you’re not a member of staff feeling this way, you are most certainly working right alongside someone who is.
Changing the game
The benefits of 1.4 million staff feeling positive, engaged, valued and supported are beyond question. They deserve great leadership and a positive culture.
The usual tendency when the NHS National Staff Survey results are out, is to breathe a huge sigh of relief and get on with ‘all the usual responses’. Delegating responsibility to HR/OD to shift the results; believing it’s an intractable problem that can’t be fixed; imposition of ‘National medicine’ of more command and control, and imposed ‘interventions’ that cripple local leaders; SI/QI programmes ‘done to’ staff instead of empowering them to do it for themselves… This is not it.
Take care of our staff, and they will take care of our patients.
Be a ‘game-changer’. Break the cycle. Let’s make that our legacy.
Contact: Gordon Forbes on 07734 812311 firstname.lastname@example.org