Published: 24/03/2005, Volume II5, No. 5947 Page 14 15

With violence and discrimination towards NHS staff still rife, it is up to managers to offer support against workplace hazards. But are they delivering? Nick Edwards reports on the disturbing findings of a Healthcare Commission survey

Many NHS staff are facing harassment, violence, discrimination and dangerous practices, and remain unconvinced of senior managers' commitment to supporting them, according to a staff survey published by the Healthcare Commission on Tuesday.

Although the report on almost 250,000 employees suggests that 'progress has already been made at a national level' since the last survey in 2003, the improvements are small.

Staff who say they have been attacked by patients or their relatives in the past year fell one percentage point to 14 per cent and harassment by patients or relatives has fallen by the same level to 27 per cent.

More significantly, the proportion of staff who felt their trust would take effective action in these respective circumstances rose just two percentage points each to 54 and 48 per cent.

In other words, most staff do not feel they can rely on employers to help them in the face of harassment and abuse. In all questions about effective action in these areas the 'do not knows' were above 40 per cent, showing high levels of uncertainty among staff.

Healthcare Commission chief executive Anna Walker says: 'It is clear that NHS staff remain committed to providing good patient care and helping colleagues. Staff are generally satisfied with their work, and there are welcome increases in training and appraisals.

'However, it is worrying that little has changed with regards to the harassment and violence towards NHS staff. A staggering 14 per cent said they had been physically attacked at work in the past 12 months. The fact that over a third of staff say they suffer from workrelated stress is a major concern.' Given the fact that the majority of staff do not feel their employer will act effectively on harassment, access to counselling jumped significantly.

Eighty per cent now say they can use these services, up from 73 per cent.

Why does all this matter? As the Healthcare Commission says in a report on the survey, staff attitudes are known to affect organisational outcomes, especially patient care.

'Staff with positive attitudes towards their work are generally likely to work more effectively; staff who feel over-worked are more likely to suffer from stress and be away from work as a result; and staff who feel dissatisfied with their job are more likely to leave the organisation, which leads to staff shortages and a greater strain on resources, ' says the report. 'Good management and leadership (as reported by staff) also strongly predict hospital performance.' Staff were asked about whistleblowing for the first time - and the results suggest there is some way to go in creating a culture of blame-free reporting. Only 59 per cent said they were aware of a confidential system in place. And only 60 per cent were convinced that people reporting errors or near misses would be treated fairly. Ten per cent actively thought the employer would punish or blame people making errors.

Eighty-eight per cent of general managers said they were working extra hours due to job pressures.

However, they also had the highest levels of work-life balance and job satisfaction of all staff groups. They also gave higher ratings to both supervisors and senior managers than any other staff group.

More than a third of all staff said they suffered from work-related stress - down 3 percentage points on 2003 to 36 per cent. And 44 per cent had a work-related illness or injury in 2004 - again down from 48 per cent.

Only 46 per cent of staff thought their senior managers set out a clear vision for the trust - exactly the same as last year - while 54 per cent said they supported new ideas for improving services.

But almost a third of staff did not feel they knew enough to comment on both questions. Quality of senior management leadership got an average score of 4.1 out of five, one of the highest in the survey.

The best-managed trust of all was Airedale primary care trust with a score of 4.9, while the worst was North Somerset PCT with 2.8.

Fifty-five per cent of staff routinely worked unpaid overtime.

About three quarters of these reported that they thought it was impossible to do their job otherwise - but about half of the same also gave job enjoyment as a reason.

Sixteen per cent said it was necessary for career progression.

However, the proportion of staff who have requested flexible working options fell significantly from 2003 - down from 33 to 26 per cent. The report suggests this may be because existing flexible working is at a higher level, lessening new requests.

It does not speculate whether this may also be because previous requests have been refused or because initial enthusiasm has genuinely diminished.

However, access to childcare has increased from 30 to 35 per cent for those with dependants. Subsided childcare rose from 22 to 25 per cent.

Although 48 per cent of staff said they worked in well-structured teams, this was only true of 40 per cent of acute trusts, with large organisations doing slightly worse than small ones.

In terms of people development, 63 per cent of staff received an appraisal, although only 38 per cent were judged to have had a wellstructured one. Fifty-one per cent of staff now say they have a personal development plan, up 2 per cent on the last survey. Staff having training rose to 93 per cent, with the proportion using taught courses down 4 per cent to 77 per cent.

Although overall job satisfaction was in line with last year's survey, a quarter of all staff still said they were considering finding a new job, slightly down on 2003. Of these, 9 per cent said they no longer want to work in the NHS.

Staff confidence in their employers' equal opportunities policies rose 4 percentage points to 73 per cent - although the proportion of staff getting training in related areas fell slightly. Fiftyeight per cent had not had any awareness training.

Only nine per cent of staff thought their employer discriminated unfairly on career progression and promotion.

Eighty-eight per cent of respondents were white, with black and Asian staff accounting for 4 and 6 per cent respectively. Non-white staff rated senior management higher and were more positive about their organisation than white staff.

However, they were more likely to have experienced harassment or abuse from patients or relatives - 18 per cent compared to 14 per cent of white staff.

NHS Employers director Steve Barnett said the survey contained some good news, but underlined that there were still many issues that needed to be addressed by managers: 'The results are an encouraging reflection of the views of staff and show that generally NHS employees are satisfied with working in the NHS.

'But it is also clear that there is more work to be done. The figures relating to violence and bullying in the workplace are still unacceptable.'

www. healthcarecommission. org. uk/ staffsurveys


Strategic health authorities

Staff assessment of the quality of senior management varied markedly. Dorset and Somerset and West Yorkshire both scored 4.9 (the highest in the survey).

But Thames Valley and North West London both scored well below average at 3.6. The same two SHAs also had the lowest score for 'positive feeling within the organisation' at 2.9 and 2.7 respectively.

The most successful SHA for management quality and staff positivity was County Durham and Tees Valley, with the highest average score in both (4.4 and 3.3). The least successful SHA on the same basis was Avon, Gloucestershire and Wiltshire and South West Peninsula (with 3.8 and 3.0).

Ambulance trusts

These fared badly again this year. The average quality of senior management and immediate line managers was rated 3.3 and 3.0 respectively, with overall averages of 4.1 and 3.5.

This was lower than any other trust group.

The two trusts with the lowest scores for senior management (both 2.5) were Avon and Gloucestershire - both part of an SHA review.

Only 19 per cent said they worked in wellstructured teams (average of 48 per cent) forty two per cent had suffered a work-related injury (average of 18 per cent). forty five per cent suffered harassment or abuse from patients/ relatives (average of 25 per cent)

Mental health trusts

Tavistock and Portman, Tees and North East Yorkshire, Oxleas and South Essex Partnership all scored 4.5 on senior management quality.

The least successful was East Sussex County Healthcare, which scored 3.0 on senior management and 2.8 on staff positivity - both the lowest in the sector.


The bad news

More than one in four staff faced harassment or abuse by patients or their relatives in the last year - and one in seven has been physically attacked.

More than half are working unpaid overtime, with one in eight doing six or more hours a week.

Thirty-six per cent said they suffered from work-related stress, down 3 per cent on last year.

Forty-four per cent of staff had seen one potentially dangerous error, down from 47 per cent last year.

Reasons to be cheerful

Ninety-three per cent of staff received training in 2004, up from 89 per cent in the 2003 survey - however more than a third did not get an annual appraisal.

Eighty-three per cent of staff were offered at least one form of flexible working - the most common were job sharing, working fewer hours and flexi-time.

Just over a third had access to a childcare coordinator, up 5 per cent on last year, and 25 per cent could access subsidised childcare.

Eighty per cent had access to counselling services, up from 73 per cent last year.

Forty per cent of staff now work in 'well-structured teams', up 2 per cent.

The staff survey was based on responses from 217,968 staff, with a response up 4 per cent to 60 per cent. All NHS trusts took part.