Evidence submitted by the Healthcare Commission
(WP 67)
INTRODUCTION
The Healthcare Commission exists to promote
improvements in the quality of healthcare and public health in
England and Wales.
In England, we are responsible for assessing
and reporting on the performance of both the NHS and independent
healthcare organisations, to ensure they are providing a high
standard of care. We also encourage providers, in both the public
and independent sectors, to continually improve their services
and the way they work. In Wales, our role is more limited and
relates mainly to working on national reviews that cover England
and Wales, as well as to our annual report on the state of healthcare.
While much of the inquiry's terms of reference
is outside our remit, the Healthcare Commission collects some
evidence from NHS staff which is directly pertinent to the inquiry.
The annual survey of NHS staff is conducted to provide information
about the attitudes and experiences of directly employed NHS staff.
Our submission summarises key results from the 2005 survey that
may be of some use to the inquiry into workforce needs and planning
in the NHS.
BRIEF OVERVIEW
OF THE
NATIONAL SURVEYS
OF PATIENTS
AND STAFF
PROGRAMME
The third national survey of NHS staff was conducted
in October 2005 and this followed similar surveys in October 2003
and October 2004. The purpose of the surveys is to provide a variety
of information about NHS staff in England which can be used by
the NHS, the Department of Health and the Healthcare Commission
to improve the quality of care for patients. All 570 NHS trusts
in England took part in the survey. A total of 209,124 NHS employees
responded, 58% of those who were invited to take part.
BACKGROUND TO
THE NHS STAFF
SURVEY
The NHS Staff Survey contributes to the Healthcare
Commission's annual ratings process. Some of the questions and
key scores in the NHS Staff Survey 2005 are directly relevant
to some of the Department of Health's Core Standards and will
be used by the Healthcare Commission in the 2006 annual health
check. The survey results also enable the Department of Health
to assess the effectiveness of national NHS staff policies (such
as training and flexible working) and in particular the Improving
Working Lives initiative.
Summary of Key Findings
WORKING HOURS
Work life balance is an important consideration
for any workforce. Good work life balance is associated with the
wellbeing of staff, low absenteeism and high levels of staff retention.
In the 2003 and 2004 surveys, work life balance was found to have
strong links to outcomes such as job satisfaction, stress, errors
and incidents, and the intention of staff to leave their job.
This survey asked staff how many hours, paid
and unpaid, they worked in addition to their contracted hours
during an average week. In total, 71% said they routinely worked
more than their contracted hours. This is the same proportion
as in 2004. Thirty six per cent said they work extra hours for
which they are paid, and 56% extra hours for which they are not
paid. Sixteen per cent said they worked extra hours, both paid
and unpaid. There has been no significant change in the extent
of additional hours being worked.
One of the key indicators of staff feeling overloaded
is the proportion of staff who work extra hours for reasons that
are due to the pressure and demands of their job. That is, where
they gave at least one of the following reasons: because it is
necessary to meet deadlines; because it is expected by my immediate
manager; because it is expected by colleagues; because it is impossible
to do the job without doing so; or because I don't want to let
down the people I work with. In 2005, 64% of staff said they did
this, compared with 63% in 2004.
QUALITY OF
WORK LIFE
BALANCE
Staff were asked a series of questions to assess
the extent to which they believe that the trust they work for
and their immediate manager are committed to helping them find
a good balance between their work and home life. Possible scores
range from one to five, with one representing almost no commitment
from the trust, and five representing excellent commitment from
the trust.
The average score in the 2005 survey was 3.39,
indicating a generally positive employer attitude towards work
life balance. This compared with 3.42 in 2004 and 3.39 in 2003
and suggests that the attitude of NHS employers is stable.
IMPROVED RECRUITMENT
AND RETENTION
The provision of flexible working arrangements
is important for employers, as it can lead to improved recruitment
and retention of staff. The most common options were working flexi-time
(33%), working reduced hours, for example part time (32%) and
team rostering (27%).
When asked about the care options offered by
their employers, over half of staff with dependant children were
not sure what options were on offer; 38% said they had access
to a childcare coordinator, 30% said that their employer provided
subsidised childcare, and 29% said their employer offered childcare
vouchers. Comparing these figures with those for 2004 and 2003
suggests that either the level of care options is increasing,
or an awareness of them is increasing (or possibly both awareness
and supply are increasing).
Staff were asked a series of questions about
how satisfied they were with different facets of their jobs, including:
recognition for good work; support from their immediate manager
and colleagues; freedom to choose methods of working; amount of
responsibility; opportunities to use their abilities; and the
extent to which the trust values their work. Possible scores range
from one to five, with one representing staff who were very dissatisfied
and five representing staff who were very satisfied. The average
score for job satisfaction was 3.44, indicating that staff in
the NHS are generally fairly satisfied. However, this compares
with scores of 3.55 and 3.50 in 2004 and 2003 respectively, suggesting
a drop in the overall level of satisfaction since 2004.
About a third of NHS staff (34%) either agreed
or strongly agreed that they often think about leaving their current
employer. A quarter (24%) said they would probably look for a
new job at a new organisation within the next year. In the 2004
survey, these figures were 33% and 25% respectively, and in the
2003 survey 34% and 26% respectively, indicating relatively little
change over time.
FLEXIBLE RETIREMENT
The 2005 survey asked whether or not staff had
been provided with information about flexible retirement. Twenty
three per cent of staff aged 51 or over said that their trust
had provided them with this information.
CHANGING ROLES
AND IMPROVING
SKILLS
A good appraisal enables staff to have greater
clarity about their role and to have their training needs identified,
and leads to them feeling valued by their employer. Results from
the 2003 and 2004 surveys have shown that staff who had received
an appraisal in the previous 12 months were more satisfied with
their jobs and less likely to be considering leaving.
In the 2005 survey, 60% of staff had had an
appraisal or performance development review in the previous 12
months. This compares with 63% in the 2004 survey, and 60% in
the 2003 survey, suggesting that the apparent increase in 2004
was not a lasting improvement.
Personal development plans (PDPs) are an important
feature of systems for appraising staff. Nearly half (47%) of
all respondents had agreed a PDP with their line manager as part
of their appraisal in the previous 12 months. Of those who had
agreed a PDP in the previous 12 months, 56% had since received
the training, learning and development that was identified in
the plan while 25% said their PDP had taken place too recently
to say.
Training, learning and development have been
shown in many studies to be linked with good organisational, and
individual, performance. Ninety five per cent of staff said they
had taken part in at least one type of training, learning or development
that was supported by their employer in the previous 12 months.
This compares with 93% in 2004 and 89% in the 2003 survey. It
is possible that this increase is because a larger number of types
of training were mentioned specifically on the questionnaire in
2005 compared with previous years. Staff were also asked whether
they had experienced difficulties obtaining training, learning
or development from their trust in the previous 12 months. Overall,
79% said they had experienced some difficulty. The most commonly
experienced difficulties were getting time off work and getting
cover for work to attend training, training at inconvenient times
and a lack of funding for training.
Copies of the report, National Survey of
NHS staff 2005, Summary of key findings, will be available
on the Healthcare Commission's website www.healthcarecommission.org.uk,
from Wednesday 22 March 2006.
Healthcare Commission
17 March 2006
| 
