Loads of things are clear from the NHS NSS. Staff locally – or at least those who answer the survey – will be clear on the 9 areas in the staff survey they are most concerned about and within the broad NSS framework it will be obvious which aspects of their work environment and structures most irritates and frustrates them to do their day job to the best of their ability. And it will give HR and workforce teams and managers plenty to ‘go at’ in the months ahead to try to put right.
But it masks a far greater challenge, when the results are viewed in a more holistic way, and when trend is explored:
• Even in the highest ranked Trust in the country last year, less than 1 in 2 staff actually bother to respond, which says a lot about the value they attach to the survey, the results or what Trust management generally do with the results
• Of those who do respond, the vast majority of questions see less than 1 in 4 staff agreeing with the questions – it can be a low as 1 in 3 for many – which means that between 50% of all staff, and approach 70% of all staff have serious issues with how things are
• Not just on minor things, but on big stuff like incident reporting, or bullying and harassment, or the quality and safety of care they can deliver, or how supportive their managers and leaders are; the knock-on effect on their ability to care, day-in-day-out takes a huge hit here.
The trend across all Trusts shows a marked decline of staff positivity over the past 10 years we’ve been reviewing the results. In spite of the Systems efforts – or maybe because of, in part – staff are more demoralized, more ‘put upon’, and more disillusioned with their lot than they have ever been. We don’t just need to rely on the actual results themselves to confirm this spiral. The evidence base speaks for itself:
• 10% vacancy rates across the service in frontline posts
• Sickness levels of between 4-6% of the total workforce
• Turnover rates of between 10-15% per annum
• Eye-watering rates of Agency spend that remains stubbornly high and contributes to the instability of our workforce and the continuity of care that fosters safer care
• More and more Trust CEOs finding themselves on the National Naughty Step, in some form of interminable special measures
None of these statistics will change in the year ahead if we do more of the same with the NSS results this year. Indeed, I venture, things will be worse next year. Quite apart from the huge shifts going on – very slowly it would appear – with the 50 plus STPs/ACOs/ICSs or whatever we’re calling them these days, we’ve now got the latest instalment of change with the announcement of the next 10 year plan. The jist of which would appear to be to shift funding and focus from the acute sector to the primary care sector, which is what by and large we have been trying to do since our involvement with the NHS in 2004. Remember Care Closer to Home? The NHS track record of ‘big change’ isn’t heartening, whether it be in re-structuring, Systems and IT, organisational transformation, or productivity gains. For myriad reasons in all honesty.
The one lever we never really pull, with any conviction, is the one lever that will actually make a difference to the current state. And that’s the one labelled ‘Put your Clinicians Back in Charge’.
All of the issues and challenges we see today have their genesis in the emasculation and sidelining of our best healthcare experts over the past 20 years, our doctors, nurses, therapists and carers, who now take their marching orders from politicians, external business consultants, non-clinical managers, regulatory bodies and investigators and a whole slew of other non-medics. Quite bizarre really.
So if you want to get a fundamental shift in the year ahead, do something fundamentally different with your results this year:
• Ask your best medics what they want to do to improve their patient care in their area
• Stop doing a bunch of stuff that makes no difference to this set of clinical outcomes
• Free up staff across the Trust from what they are doing that doesn’t help deliver the clinical priorities
• Align them to frontline teams to support them lead the way on the clinically-led changes they want to make
• Reward those who excel in all the above: promote them, bonus them, praise them, support them, share their success.