Trusts have been urged to address a ‘breakdown’ in the relationship between senior managers and staff, following the results of the fifth annual NHS staff survey.

It is the first time the Healthcare Commission’s survey of every trust in England has asked specific questions about senior management.

The survey reveals that large numbers of staff think they are being kept in the dark about important decisions and that many feel communication with senior management is poor.

More than half (53 per cent) of staff who took part disagreed with the statement: “Communication between trust headquarters and other parts of the trust is good”.

Only 23 per cent said communication between senior management and staff was effective. But there were large variations, from 50 per cent of staff at Tavistock and Portman foundation trust to 5 per cent at Great Western Ambulance Service trust.

Unison head of health Karen Jennings said the survey showed “a breakdown in the relationship between NHS staff and senior managers”. A quarter of staff agreed that senior managers tried to involve staff in important decisions, compared with 47 per cent who disagreed.

Thirty-five per cent said they felt undervalued. This was the most common reason given by people wanting to leave their jobs.

Healthcare Commission chief executive Anna Walker said: “Staff in the NHS provide vital, often life-saving, care. Yet they do not feel their work is valued by their trust and that communication with senior management is poor. These are things that trusts can and must change.”

NHS Employers deputy director Alastair Henderson said that although senior managers had many competing priorities, they needed to look at how they communicated decisions to staff.

With many acute trusts merging and primary care trusts getting bigger, staff may feel distant, he said. “Managers must look at what they can do to create a sense of identity among staff in a larger organisation.”

Across the NHS, staff satisfaction remained constant, at 3.4 out of 5, based on weighted questions.

Phil Kenmore, head of public sector business delivery at the Hay Group, said the relationship between staff and management in the NHS compared unfavourably with some parts of the private sector.

The problem was partly down to the negative way in which some clinicians viewed management, which differed from the private sector where “professionals often aspire to be leaders and managers”.

Despite the poor scores relating to senior management, line managers were rated highly. Seventy-one per cent of people said their immediate manager encouraged team working and the same number said their manager was supportive.

But 8 per cent of respondents said they had been harassed, bullied or abused at work by managers or team leaders. This is a “surprisingly high proportion”, according to the Healthcare Commission, although the figures have not changed since 2006.

Jon Restell, chief executive of trade union Managers in Partnership, said he had seen an increase in the number of members asking for help with bullying in the past six to 12 months. This included people who were having accusations levelled at them and those being bullied.

Current MiP figures suggest that there are around 120-150 cases of bullying in the NHS at any one time across the UK. “During turnaround, the pressure is on and that’s when actions become more pronounced,” Mr Restell added. The survey was carried out between October and November last year, when the NHS was perceived as settling down after a period of mass restructuring, job losses and financial deficit.

Infection control results had improved, with 82 per cent of staff saying their trust does enough to promote the importance of hand-washing to staff, up from 70 per cent in 2005.

Less than half of people agreed that care of patients and service users was their trust’s top priority. Again, there were big variations, with 3 per cent at Papworth Hospital disagreeing, compared with 65 per cent at Great Western Ambulance Service trust. The survey results will feed into this year’s annual health check ratings.

What do staff say?

  • 8% have been bullied or harassed by managers, just 12% rate communication with trust HQ as good

  • 47% do not think senior managers involve staff in big decisions; only a third say managers encourage them to suggest ways to improve services

  • 65% in the worst trusts do not think care of patients is their organisation’s top priority

  • 12% do not think enough is done to promote patient hand hygiene

  • 26% have been bullied or harassed by patients or their relatives

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