Care Quality Commission
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Many more NHS staff say they are trained in infection control and that hand-washing materials are always available when they need them, the Healthcare Commission said today (Wednesday).

Findings of the sixth annual survey of NHS staff also show a decline in the number of workers who say they experienced bullying, harassment or abuse by patients or their relatives and that nine out of 10 feel they make a difference for patients.

Believed to be one of the largest surveys of staff in the world, the 2008 NHS Staff survey questionnaires were completed between October and December by 160,000 workers from all 390 NHS trusts.

The Commission said the results highlight some real and significant progress that is to be celebrated. However, it said the results also indicate a need to improve the way that leaders in the NHS communicate their vision for the service and how managers act on feedback from staff. The findings also point to a need to improve the structure of teams and to clarify teams’ objectives.

The survey provides a wealth of local and national data about what NHS staff experience in their day to day working lives. The results are used by trusts and the government to develop strategies to improve working conditions.

The NHS Constitution, published in January this year, has focused attention on improving the experiences of staff. Twenty-six new questions were added to the survey this year, many of which will help to gauge the Constitution’s impact.

Anna Walker, the Commission’s chief executive, said: “We know that a good working environment for staff means better care for patients. Infection control, work-related stress and harassment and abuse by patients have been tough nuts to crack for the NHS. This survey shows real progress is being made to tackle some of the issues that impact negatively on NHS staff – this can only improve quality of care for patients.

“It’s good to see the NHS is generally moving away from the old ‘blame culture’, to an environment where more staff feel encouraged to report mistakes. But many staff say they’re not told if changes are made as a result of reports. This is a vital part of the process that trusts must carry out if they are truly serious about tackling the causes of incidents and preventing unnecessary harm to patients or staff.

“There are real lessons to be learnt from this survey about leadership, management and team work. Staff feel informed, but not involved in decisions that affect their working life and don’t feel valued by their trust. Yet the survey shows that NHS staff are dedicated to their jobs and to their patients. They want to provide a high standard of care and they want to make a difference. Leaders and managers need to harness this dedication and drive forward their vision for the National Health Service, so that all staff understand what their organisation and the Service are working towards.

“Trusts should be studying their results, comparing themselves with similar NHS organisations and identifying opportunities to make real and lasting improvements to the working lives of their staff.”

Findings from the 2008 NHS Staff Survey include:

Significant positive improvements in questions relating to infection control: The survey results show a considerable increase in the number of staff who say hand-washing materials are “always” available when needed – 71% in 2008, up from 61% the previous year. There was also a substantial rise in the number of staff who say they were trained in the past 12 months in infection control - 62% compared with 53% in 2007. Overall, 85% of staff agree that infection control applies to them in their role. This figure is unchanged since 2007.

Work-related stress is down: Fewer staff say they experienced work-related stress in the past year, down to 28% in 2008 from 33% in 2007.

Violence against staff remains the same, but bullying, harassment & abuse is declining: The percentage of staff who say they experienced physical violence from patients or their relatives in the past year remained relatively unchanged at 12%. Looking at specific sectors, ambulance staff (27%) and mental health staff (20%) are more likely to say they had experienced physical violence from patients. These figures have not changed since the previous survey.

However, the proportion of staff reporting bullying, harassment or abuse from patients or relatives is down from 26% in 2007 to 23% in 2008. There has been an increase in the numbers of staff having training to handle violence and abuse, up from 49% in 2007 to 53% in 2008. The figures also show an improvement in reporting, with 71% of staff who experienced violence and 53% of those who experienced bullying, harassment or abuse, saying it was reported. This compares with 66% and 49% respectively in 2007.

Reporting of errors and incidents has improved but trusts need to tell staff about changes made as a result: Thirty-five per cent of staff say they witnessed an incident in the previous month that could have hurt staff or patients, up from 31% in 2007, but down from 38% in 2006. Positively, 96% say the incident was reported, up from 94% in 2007, although 29% of staff do not feel informed about changes.

Leaders need to communicate the vision for the NHS and for individual trusts: Fifty-one per cent of respondents say they understand the national vision for the NHS, however 15% do not and a further 32% answered that they neither agreed or disagreed with the statement. Twenty-one per cent of staff say their trust does not communicate clearly about what it is trying to achieve.

Staff want to provide a high standard of care but many feel there is not enough time or staff: Eighty-three per cent of staff are “satisfied” with the standard of care they provide, but 23% are not “personally pleased”. Forty-seven per cent say there are not enough staff to do the job properly, an improvement since 2007 when 51% reported this. Forty-six per cent say they do not have enough time to do their jobs properly.

Staff feel their job is rewarding and makes a difference, but they don’t feel valued by their trust or that senior managers act on their feedback: Ninety per cent of staff feel their role makes a difference to patients and 80% say their job is interesting. But 31% of staff say they do not feel valued by their trust, although this is an improvement since 2007 when 36% reported this. In response to a new question in 2008, 26% of staff say that senior managers to do not act on feedback.

Teams need to be better structured with clearer objectives: Ninety per cent of NHS employees work in teams. However, 58% of those working in teams say they are not well-structured with clear objectives and that they don’t regularly review performance.

Some staff still face discrimination at work, but most agree that their trust acts fairly in promoting staff: Eight per cent of staff said they experienced some sort of discrimination at work in the previous 12 months. This includes 3% who say they experienced discrimination on the basis of their ethnic background, rising to 12% among black and minority ethnic employees. These figures are unchanged since 2007.

Eighty-nine per cent of staff agree that their trust acts fairly with regard to career progression and promotion regardless of ethnic background, gender, religion, sexual orientation, disability or age. This is an improvement on the 2007 figure (87%).

Ambulance staff report poorer working environments: The majority of ambulance staff (53%) report that ambulance vehicles are not kept in a good state of repair, although the figure has improved since 2007 (56%). Ambulance staff are also less likely to report having training to deal with aggressive patients and on health and safety, despite reporting higher levels of violence and work-related injuries. They are also less likely than other NHS staff to be satisfied with their job, less likely to say managers act on feedback from staff and more likely to feel that teams do not work effectively. The Commission said the poorer work experiences reported by ambulance staff need to be explored further.

Notes to editors

What the Commission is publishing:

. Briefing note highlighting national trends and significant issues
. Tables of key scores at a national level, including comparisons to 2007
. Excel spreadsheets of with percentage responses for each trusts for each question. This data has not been weighted to account for differences such as trust size or response rate. It therefore cannot be used to compare trusts.
. Reports for each trust, comparing performance to similar trusts.

Overall the survey provides 37 “key scores”, which group together questions to indicate performance in important areas such as job satisfaction and work-life balance. Of these 18 show improvements since 2007, three have deteriorated and five have remained unchanged. The remaining 11 key scores are new to the survey in 2008.

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

For further information contact the press office on 0207 448 9210, or on 07917 232 143 after hours

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