NHS Improving On Stress And Safety Finds Healthcare Watchdog In Annual NHS

NHS staff say they are less stressed, suffer fewer work-related injuries and see fewer potentially-harmful errors, incidents or "near misses", according to the healthcare watchdog.

But results highlight levels of violence and abuse


NHS staff say they are less stressed, suffer fewer work-related injuries and see fewer potentially-harmful errors, incidents or “near misses”, according to the healthcare watchdog.

The findings were revealed in the annual NHS staff survey run by the Healthcare Commission. In October last year, more than 128,000 staff in 326 trusts gave their views and experiences of working for the NHS in England – there was a response rate of 53 per cent.

The survey provides trusts with information they can use to make changes to improve the working conditions and experiences of their staff. The findings will also be used as part of the Healthcare Commission’s annual assessment of NHS trusts.

The Commission welcomed figures showing the percentage of staff saying they suffered work-related stress declining from 39 per cent in 2003 to 33 per cent in 2006.  There was also a considerable decrease in the number of staff suffering injury or illness because of work, down from 22 per cent in
2003 to 17 per cent in 2006.

The Commission praised trusts for other improvements in safety. This was illustrated by a fall in the percentage of staff saying they saw errors, incidents or “near misses” with potential to harm patients, down from 49 per cent in 2003 to 38 per cent in 2006.

However, the Commission said there was room for improvement in making hand washing equipment available. Survey figures showed that 69 per cent of nurses and midwives (61 per cent of NHS staff overall) said that hot water, soap, paper towels or alcohol rub was always available to them when needed, slightly up from 68 per cent the previous year. In 2006, a further 26 per cent of nurses and midwives said these items were available most of the time (the same in 2005).

In its most recent annual state of healthcare report the Commission urged the NHS to do more to put patients first. Staff were asked if they believed patients were the top priority for their trust: 45 per cent agreed and 26 per cent disagreed, the latter figure rising five percentage points since the previous survey. Staff were also asked whether they would be happy with the standard of care provided in their trust if they were a patient: 39 per cent agreed and 27 per cent disagreed.

The Commission remains worried by unacceptably high levels of violence and abuse being experienced by staff in the NHS.

Figures show a slight increase from last year, although the number of people experiencing violence or abuse from patients remains relatively steady over four years (31 per cent experienced violence or abuse in 2006, 30 per cent in 2005, and 32 per cent in 2003 and 2004). Thirteen per cent of staff said they experienced violence from patients last year, while levels of harassment, bullying and abuse edged up by two percentage points.

Anna Walker, Chief Executive of the Healthcare Commission, said: “The NHS is the fourth largest employer in the world and this is believed to be the largest annual survey of staff in the world. It is vital that we hear loud and clear how staff are coping.

“It is a credit to trusts that, during a period of change, staff say they are less stressed than four years ago. Ambulance trusts underwent significant change last year and yet the percentage of staff reporting work-related stress has dropped four percentage points since 2005.

“The progress we’ve seen in terms of safety is to be commended. Trusts should be looking at ways they can further improve, in particular by ensuring that all staff have access to hand washing and cleaning facilities whenever they need it. This is vital in the fight against healthcare associated infection.

“I know there has been a lot of action by trusts to tackle the problem of violence and abuse in the workplace, but more must be done. We are calling on trusts to redouble their efforts in this area. Much of the violence and abuse experienced by staff is from patients and their relatives. We must all adopt a zero tolerance policy to such behaviour.  NHS staff deserve our respect and praise for what is often life-saving work, not violence and abuse.”

This year, in response to requests from the healthcare sector, the results of the survey have been presented on the basis of trust type. This has allowed a unique analysis of the survey responses to separately identify issues of significance to acute, primary care, ambulance and mental health trusts.

In ambulance trusts, for example, almost half of staff reported that they had experienced bullying, harassment or abuse from patients or their relatives. This is partly a reflection of the environment in which ambulance staff work, but the figure has increased five percentage points compared with last year (48 per cent in 2006).

Staff in ambulance trusts also report getting less support from immediate managers and the lowest rates of job satisfaction compared with their colleagues in other types of trust. But more ambulance staff say they are paid for overtime and fewer say they to want to leave their jobs.

Many primary care trusts also changed dramatically in 2006. It was not possible to survey staff at trusts involved in reconfiguration because of the timing of the survey. The Commission, however, is keen to see how staff were affected by change when it undertakes the staff survey again in autumn this year.

Looking at key issues in each trust type:

Job satisfaction: Figures show overall significant job satisfaction, although it has edged down across trust types.
·     More than two thirds (68 per cent) in acute trusts reported that they were generally satisfied with their jobs, this figure has decreased slightly since 2005 (69 per cent), continuing the downward trend from 72 per cent in 2003 and 2004.
·     Three quarters (75 per cent) of staff in primary care trusts reported that they were generally satisfied with their jobs, compared with 77 per cent in 2005, 78 per cent in 2004 and 79 per cent in 2003.
·     Fifty-six per cent of staff at ambulance trusts reported that they were generally satisfied with their jobs, compared with 58 per cent in 2005, 59 per cent in 2004 and 57 per cent in 2003.
·     Nearly three quarters (73 per cent) of staff in mental health and learning disability trusts said they are generally satisfied with their job. This is in line with findings from 2005 (73 per cent) but a slight
decrease from 2004 (75 per cent) and 2003 (75 per cent).

Violence and bullying: Violence and abuse remains unacceptably high, particularly in ambulance trusts and mental health and learning disability trusts. The number of staff saying they experienced physical violence has remained relatively unchanged since 2005 across all trust types. However, the number of staff who experienced bullying, harassment or abuse increased in almost all trusts types, with a five per cent increase in ambulance trusts.
·     Eleven per cent of staff in acute trusts said that they experienced physical violence from patients or their relatives in previous 12 months (11 per cent in 2005, 13 per cent in 2004, 14 per cent in 2003). Twenty-six per cent of staff said they experienced bullying, harassment or abuse from patients or their relatives in the previous 12 months (25 per cent in 2005, 23 per cent in 2004 and 27 per cent in 2003). The percentage of staff who said they experienced bullying, harassment or abuse from other staff increased to 18 per cent (from 16 per cent in 2005, 13 per cent in 2004 and 17 per cent in 2003) – its highest point in three years.
·     Six per cent of staff in primary care trusts said they experienced physical violence from patients or their relatives in the previous 12 months, compared with 9 per cent in 2005, and 10 per cent in 2004 and 2003. In 2006, 21 per cent of staff said they experienced bullying, harassment or abuse from patients or their relatives in the previous 12 months, compared with 21 per cent in 2005, 23 per cent in 2004 and 24 per cent in 2003.
·     Twenty-eight per cent of staff in ambulance trusts said they experienced physical violence from patients or their relatives in the previous 12 months, compared with 27 per cent in 2005, 30 per cent in 2004 and 31 per cent in 2003. In 2006, 48 per cent of staff said they had experienced bullying, harassment or abuse from patients or their relatives in the previous 12 months – a substantial increase compared with 43 per cent in 2005, and higher than the 46 per cent seen in 2004 and 2003.
·     Twenty-two per cent of staff in mental health and learning disability trusts said they had experienced physical violence from people who use services or their relatives in the previous 12 months (22 per cent in 2005, 25 per cent in 2004 and 26 per cent in 2003). The percentage of staff who said they had experienced bullying, harassment or abuse in the previous 12 months increased to 34 per cent in 2006 (32 per cent in 2005, 33 per cent in 2004 and 34 per cent in 2003).

Errors, near misses and incidents: There has been a downward trend in the number of staff who said they witnessed an error, near miss or incident in the previous 12 months. There had been a slight upward trend in numbers of people saying it was reported.
·     Forty per cent of staff in acute trusts said that they had seen at least one error, near miss or incident that could have hurt staff or patients, compared with 44 per cent in 2005, 49 per cent in 2004 and 52 per cent in 2003. In 2006, 92 per cent of staff also said that the most recent error, near miss or incident they had seen had been reported (92 per cent in 2005, 90 per cent in 2004).
·     Twenty-five per cent of staff in primary care trusts said they had seen an incident that could have hurt staff or patients in 2006, compared with 29 per cent in 2005, 34 per cent in 2004 and 38 per cent in 2003. In 2006, 93 per cent of staff said that the most recent error, near miss or incident they had seen had been reported (93 per cent in 2005, 90 per cent in 2004).
·     Forty-one per cent of staff in ambulance trusts said they had seen at least one error, near miss or incident that could have hurt staff or patients, compared with 47 per cent in 2005, 49 per cent in 2004 and 53 per cent in 2003. In 2006, 83per cent said that the most recent error, near miss or incident they had seen had been reported (85 per cent in 2005, 80 per cent in 2004).
·     Thirty-one per cent of staff in mental health and learning disability trusts said they had seen an incident that could have harmed staff or patients, compared with 35 per cent in 2005, 38 per cent in 2004 and 41 per cent in 2003. In 2006, 94 per cent said that the most recent error, near miss or incident they had seen was reported (93 per cent in 2005, 92 per cent in 2004).

Hygiene control and infection: It was the second year that staff were asked about the availability of hand-washing items and figures show there is room for improvement.
·     Almost two-thirds (63 per cent) of staff in acute trusts said that these items were always available when they needed them and 55 per cent said they were always available to patients. These figures have changed little since 2005 (64 per cent and 55 per cent respectively).
·     Just over half (54 per cent) of staff in primary care trusts said that hot water, soap, paper towels or alcohol rubs were always available when they needed them; 42 per cent said they were always available to patients. These figures suggest a slight improvement in the availability of these items for staff (52 per cent in 2005) but no change for patients.
·     Just over half (52 per cent) of staff in ambulance trusts said that hot water, soap, paper towels or alcohol rubs were always available when they needed them; 37 per cent said they were always available to patients. These figures suggest a slight improvement in the availability of these
items for staff (50 per cent in 2005) but no change for patients.
·     Just over half (53 per cent) of staff in mental health and learning disability trusts said that hot water, soap, paper towels or alcohol rubs were always available when they needed them; 47 per cent said they were always available to patients. These figures suggest a slight improvement in the availability of these items for both staff and patients (52 per cent and 46 per cent in 2005 respectively).

Injuries and stress: Injury or illness related to work has decreased in all trusts, except for ambulance trusts, where it remained the same. Staff in ambulance trusts were more likely to suffer from injury or illness because of work. Work-related stress has been decreasing steadily over the years and this trend continued in 2006 across all trust types.
·     Seventeen per cent of staff in acute trusts said they had suffered a work-related injury or illness during the previous 12 months. This has decreased substantially from 21 per cent in 2005, 22 per cent in 2004 and 24 per cent in 2003. In 2006, the percentage of staff who said they had suffered from work-related stress also fell to 32 per cent (35% in 2005, 36% in 2004 and 39% in 2003).
·     Twelve per cent of staff in primary care trusts said they suffered a work-related injury or illness. This is a slight decrease from 13 per cent in 2005, 15 per cent in 2004 and 16 per cent in 2003. In 2006, fewer staff (33 per cent) said they suffered from work-related stress when compared with previous years (35% in 2005, 36% in 2004 and 38% in 2003).
·     Thirty-six per cent of staff in ambulance trusts said they suffered work-related injury or illness during the previous 12 months (36% in 2005, 41% in 2004 and 2003). The percentage of staff saying they suffered work-related stress in the previous 12 months decreased again in 2006 to 33 per cent. This is substantially lower than previous years, continuing the downward trend from 37 per cent in 2004 and 2005 and 42 per cent in 2003.
·     Ten per cent of staff in mental health and learning disability trusts said they suffered injury or illness related to their work in the previous 12 months, compared with 11 per cent in 2005, 13 per cent in 2004 and 14 per cent in 2003. In 2006, the percentage of staff saying they suffered from work-related stress also decreased to 34 per cent from 37 per cent in 2005, 38 per cent in 2004 and 40 per cent in 2003.

Discrimination: The number of staff who say they experience discrimination in the work place has increased slightly in all trust types.
·     Eight per cent of staff in acute trusts said they experienced some form of discrimination at work in the previous 12 months, compared with seven per cent in 2005.
·     Seven per cent of staff in primary care trusts said they experienced some form of discrimination at work in the previous 12 months, compared with six per cent in 2005.
·     Twelve per cent of staff in ambulance trusts said they experienced some form of discrimination at work in the previous 12 months, the same as 2005.
·     Nine per cent of staff in mental health and learning disability trusts said they experienced some form of discrimination at work in the previous 12 months up from eight per cent in 2005.

Appraisals: In every type of trust, a significant number of staff are not receiving appraisals or performance development reviews. Of those who said they did receive an appraisal or performance development review, most are not finding it helpful. Systematic improvement is clearly needed here if staff are to perform at their best.
·     Fifty-seven per cent of staff in acute trusts said they had received an appraisal or performance development review in the previous 12 months (59% in 2005, 63% in 2004 and 60% in 2003). Only 29 per cent said their appraisal had helped them to improve how they worked, set clear objectives
and left them feeling their work was valued.
·     Sixty-four per cent of staff in primary care trusts said they had received an appraisal or performance development review in the previous 12 months (64% in 2005, 67% in 2004 and 63% in 2003). Only 36 per cent said their appraisal had helped them to improve how they worked, set clear objectives and left them feeling their work was valued.
·     Forty-six per cent of staff in ambulance trusts had received an appraisal or performance development review in the previous 12 months (49% in 2005, 39% in 2004 and 40% in 2003). Only 18 per cent said their appraisal had helped them to improve how they worked, set clear objectives
and left them feeling their work was valued.
·     Sixty-one per cent of staff in mental health and learning disability trusts had received an appraisal or performance development review in the previous 12 months (62% in 2005, 63% in 2004 and 61% in 2003). Only 34 per cent said their appraisal had helped them to improve how they worked, set clear objectives and left them feeling their work was valued.

Working hours and overtime: A very high proportion of NHS staff report working more than their contracted hours. Ambulance staff were more likely than staff from other trusts to work overtime, but were also more likely to be paid for the extra hours.
·     Seventy per cent of staff in acute trusts reported that they regularly worked more than their contracted hours (71% in 2005, 69% in 2004 and 75 % in 2003). Thirty-four per cent were paid for the extra hours they worked and 57 per cent regularly worked extra hours unpaid.
·     Sixty-eight per cent of staff in primary care trusts reported that they regularly worked more than their contracted hours (69% in 2004 and 2005, 75% in 2003). Twenty-two per cent were paid for the extra hours they worked and 59 per cent regularly worked extra hours unpaid.
·     Eighty-four per cent of staff in ambulance trusts regularly worked more than their contracted hours (82% in 2005, 83% in 2004 and 84% in 2003). Three quarters were paid for working extra hours and the number of people regularly working unpaid extra hours decreased to 32 per cent from 35 per cent in 2005.
·     Sixty-eight per cent of staff in mental health and learning disability trusts reported that they regularly worked more than their contracted hours (70% in 2005, 70% in 2004 and 73% in 2003). Thirty-one per cent were paid for the extra hours they worked and 54 per cent regularly worked unpaid extra hours.

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