Staffing is the issue keeping NHS leaders awake at night — and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence

“Brilliant that NHS staff are happier and more likely to recommend where they work than last year.” So tweeted health and social care secretary Matt Hancock the day after the annual staff survey results were released.

This statement jarred with a letter published by Mr Hancock and directed at all NHS staff the day before. In this letter, Mr Hancock said he was “horrified” at the level of violence and abuse reported by NHS staff in this year’s survey and highlighted its findings that 15 per cent of all staff had experienced violence in the last year. 

Mr Hancock also set out the situation was much worse for black and minority ethnic staff – HSJ analysis of the data revealed 16.4 per cent of BME staff experienced violence compared to 14.4 per cent of white staff.

Ambulance trusts and mental health and learning disability trusts continue to report some of the highest levels of violence against staff in the NHS, a consistent trend over the last five years.

HSJ’s own research with Unison in 2018 revealed increasing threats and violence directed at staff has been on the rise – our figures based on freedom of information request data suggested there were more than 200 violent attacks on NHS workers every day.

Until 2017 trusts were required to report attacks on staff nationally but after the demise of NHS Protect, that was no longer a requirement.

However, at the end of 2018 it was said the NHS’ “violence reduction strategy” would be underpinned by a new national reporting system, a partnership between the NHS and Crown Prosecution Service and better training for staff to deal with violence and aggression.

Unions are clear that despite “tough talk” from the health and social care secretary, real action is now needed. In response, Mr Hancock announced measures to come in from April that would ensure staff could bar any non-emergency patient or visitor who harasses and abuses staff – the key here is not just that violent behaviour won’t be tolerated but also discrimination. But more on that below.

Pressure cooker 

It’s currently unclear how these measures would act in practice; withholding care is a controversial subject. A few NHS leaders from the mental health sector have already expressed concern about how these measures would work, for example, would community mental health services count as non-emergency?

What about mental health inpatient units? If someone has been sectioned, treatment cannot be refused.

The question remains – does refusing treatment get to the root of the problem? Staff shortages and the bubbling pressure-cooker environment of long waits are certainly contributing factors.

For example, The Design Council’s “A&E challenge” programme found that aggression was particularly prevalent in A&E because of the complex and high-pressure nature of the department.

Staff training, improved support for staff and public awareness campaigns are all important, but none can be successful without proper funding.

Discrimination on the rise

It’s impossible to ignore the shocking increase in racial discrimination faced by staff. The percentage of staff experiencing discrimination from patients has risen since 2015 and between 2018 and 2019, the share of BME staff who experienced discrimination increased sharply.

Unions have called for this behaviour to be “stamped out” and NHS Providers deputy chief executive Saffron Cordery said more staff experiencing discrimination was “unacceptable”. She also stressed there was “no notable decline in instances of discrimination or bullying from managers or colleagues”.

The first analysis of figures for disabled staff shows they also report higher rates of abuse, harassment and bullying.

There is of course much to improve but there is some positivity still to be found in the survey – an increasing number of staff are satisfied with the quality of care they give (although this is still below 2016 results), more staff would recommended their organisation as a place to work, and fewer staff are working unpaid hours. Flexible working opportunities are also more readily available for staff – a key “People Plan” measure.

Satisfaction with pay – although only on 38 per cent of staff reporting this – is also higher than it has been since 2015, perhaps down to the successful negotiation of Agenda for Change pay growth from 2018.

Will these glimmers of hope be enough to hit the government’s ambitious retention target set just before the election?

We’re all now very familiar with the 50,000 more nurse pledge, but according to the Conservatives’ briefed out figures, 18,500 of them are already in the NHS and would be retained. Leaked NHSE/I figures reported by HSJ told a slightly different story – suggesting 12,400 would be retained over five years.

Whatever the figure, the point remains – with discrimination, violence and bullying still rife in the NHS (from patients and staff), is it an attractive place to work? Or rather, “the best place to work” — the objective of the forthcoming People Plan.

The Health Foundation’s assistant director of policy Hugh Alderwick said: “The findings suggest that there is more work needed to make the NHS a better and more attractive place to work and build a career.

“Rising numbers of staff are reporting illness as a result of work-related stress, and almost one in five say they have experienced bullying and harassment from their colleagues, with BAME and disabled staff members worse affected.

“The public relies on NHS staff for their health and wellbeing, so it’s only right that theirs is taken just as seriously.”

Well over half a million staff took part in this survey – almost half of all those working for the NHS – and if the government wants to keep them far more must to done to ensure violence and discrimination are not – and never are – part of the job.