Pay, staffing and work pressures among key issues in latest NHS Staff survey in England

Staff concerns about pay levels, staffing, workloads and quality and safety of patient care among key issues that emerge in the latest NHS staff survey, published today.  

NHS’ annual staff experience survey [John Gomez/Alamy Stock Photo]

The NHS Staff survey, which covers England, was conducted between September and November 2022, and due to the large sample size is one of the most keenly watched indicates of staff sentiment in the NHS.

Only a little over a quarter of staff indicated satisfaction with their pay, a fall of seven percentage points, while a similarly smallproportion agreed that there were enough staff at their organisation for them to do their job properly, the lowest level in five years for both measures.

Less than half said they had adequate materials, supplies and equipment to do their work, a four-year low. 

The proportion who said they were coming to work in the last three months despite not feeling well enough to perform their duties was on the rise for the third successive year. The survey’s “work pressure” sub-score has deteriorated to a five-year low.

About 45 per cent of staff have felt unwell as a result of work-related stress in the previous twelve months, better than the previous year, but an unacceptably large proportion nonetheless. 

Enthusiasm for the job continued to wane and the proportion who would recommend their organisation as a place to work has dropped nine percentage points since 2020.  

Staff retention and standards of care

The survey also highlighted deepening retention problems: around a third often think about leaving this organisation, with just under a quarter saying they will probably look for a job at a new organisation in the next 12 months and just over one in six say that they will leave their organisation as soon as they can find another job - all measures at the highest level in five years.  

After a sharp decline between 2020 and 2021, those who would recommend their organisation as a place to work, at 57 per cent, has fallen a further two percentage points since last year and is now more than nine percentage points lower than in 2020.

Just under three quarterssaid that care of patients/service users is their organisation's top priority. A decline by a further 1.6 percentage points since 2021, and now at a five-year low, as is the proportion who would said be happy with the standard of care provided by the organisation if a friend or relative needed treatment. 

Violence, harassment and raising concerns


There were declines on all measures relating to raising concerns, both relating to raising concerns about clinical safety and speaking up more generally with the greatest deterioration seen in the percentage of staff who would feel secure raising concerns about unsafe clinical practice.

Having improved between 2019 and 2021, this measure declined by 3.1 percentage points from 75 per cent to 71.9 per cent, with a return to the 2019 level.  

The percentage of staff saying they experienced physical violence from patients/service users, their relatives or other members of the public in the course of their work the last year has stayed stubbornly consistent across the last five years, at 14.7 per cent in 2022.

Levels of harassment, bullying and abuse from patients/service users, their relatives or other members of the public are also similar to previous years. Over a quarter say they or colleagues don’t report violence and more than half don’t report harassment, bullying or abuse. 

Overall, the results presented a bleak picture even if the changes in headline indicators suggested a mixed picture.  

There were some brighter patches in the survey: sentiments around autonomy on decision-making and being listened to within teams and immediate work area; the percentage of staff who say they are able to access the right learning and development opportunities when they need to; and the increase in staff who said they feel they can approach their immediate manager to talk openly about flexible working. 

CSP reaction 

Commenting on the survey's findings, Jim Fahie, CSP assistant director, said: ‘Staff concerns about pay come through strongly in this survey. This adds further evidence for a decent pay rise in the NHS in England. We hope government negotiators, now thankfully talking to unions, will take note.

Survey results indicating the levels of harassment, bullying or abuse against staff has remainedessentially unchanged yet again. This is completely unacceptable and must be addressed with urgency, alongside the low level of reporting

‘The results on safety and quality of care are also very worrying. Taken together with evidence of unsustainable stress levels, the fact that staff are saying they are more readily considering leaving the NHS is no surprise.

‘There are some clear if mostly modest improvements, such as flexible workingan area in which partnership working has delivered some notable gains recentlyworkingwithin teams and a sense of greater autonomy and control within staff’s immediate work environment.

‘However, overall, the picture is of an NHS workforce under great strain. The government needs to invest in NHS staff, to show it cares as much about NHS staff as NHS staff do about their patients, despite an extremely tough work environment.

I would encourage all CSP members in the NHS to look at your employer-levelresults and identify areas to improve, with the support of your reps workingin partnership with the employer

‘It is imperative that we improve the working conditions for all staff in the NHS, that bullying, harassment, discrimination and abuse are challenged and eradicated from the workplace, in order to create a culture where staff feel they belong and supported in their work which is proven to improve quality of care and outcomes for patients.’

Key indicators 

Of the survey’s “People Promise” seven summary indicators of staff experience, one decreased and two increased: we are compassionate and inclusive (unchanged); we are recognised and rewarded: (decreased); we each have a voice that counts (unchanged); we are safe and healthy (unchanged) we are always learning (increased); we work flexibly (unchanged); we are a team (increased); staff engagement and morale - scores relating to two of the ten themes previously reported by the survey – were unchanged and decreased respectively.  

About the survey  

The NHS staff survey is one of the largest workforce surveys in the world. Over 1.3 million NHS employees in England were invited to participate in the survey between September and December 2022 with 264 NHS organisations taking part, including all 215 trusts in England.

At each organisation, all eligible staff were invited to take part in the survey.  

636,348 staff responded, slightly down on the 648,594 who did so in 2021. With a 46 per cent response rate, that represents a two-point fall on 2021).

Participation is mandatory for trusts and voluntary for non-trust organisations (ICBs, CSUs, social enterprises). The survey does not cover primary care staff. 

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