BRIEFING NOTE: ISSUES HIGHLIGHTED BY THE 2010 NHS STAFF SURVEY IN ENGLAND

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1 BRIEFING NOTE: ISSUES HIGHLIGHTED BY THE 2010 NHS STAFF SURVEY IN ENGLAND Introduction This briefing note provides a simple compendium of key findings, without interpretation, from the eighth annual national survey of NHS staff. Between October and December 2010, almost 310,000 NHS staff were asked about their experiences of working in their local NHS trust. The results are primarily intended for use by NHS trusts to help them review and improve work experiences so that staff can provide better patient care. The Care Quality Commission will use the results from the survey in a range of ways, including setting out national findings, informing patients and the public of trusts results; and using the results to monitor ongoing compliance with essential standards of quality and safety. The Department of Health is working to ensure that accountability for improving staff experience and well-being is part of the new Health and Social Care system. The survey will also support accountability of the Secretary of State for Health to Parliament for delivery of the NHS Constitution. Background The briefing note provides results from the 2010 survey structured around the four pledges to staff in the NHS Constitution, with an additional theme of equality and diversity. Where the same questions were asked in 2009, it provides figures that are comparable with the 2009 survey. In January 2009, the NHS Constitution outlined the principles and values of the NHS in England including four pledges 1 that set out what staff should expect from NHS employers. They are part of the commitment of the NHS to provide high-quality working environments for staff: Pledge 1: To provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers, and to communities. Pledge 2: To provide all staff with personal development plans, access to appropriate training for their jobs and the support of line management to succeed. Pledge 3: To provide support and opportunities for staff to maintain their health, wellbeing and safety Pledge 4: To engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working 1 1

2 arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families. The results in summary This briefing note describes 38 key findings about working in the NHS. Of these, thirteen show an improvement from 2009, eight have deteriorated and ten have remained unchanged (See Appendix 1). The wording or the response options of the questions used to calculate seven key findings changed in 2010 as part of the ongoing survey improvement. These changes mean that statistically valid comparisons with data from previous years cannot be made. The survey shows an improvement in the proportion of staff receiving appraisals, up from 69% in the 2009 survey to 77% in 2010, and increases in the proportion of staff saying these appraisals were effective. However, there has been a slight decrease in the proportion of staff saying they have good opportunities to develop in their work (41% compared with 44% in 2009). Around half of staff (53% in 2010, 55% in 2009) indicated they would recommend their trust as a place to work, while just under two thirds (64%, 62% in 2009) would be happy with the standard of care provided by their trust. Overall, a third of staff (33%) were satisfied with the extent to which they feel that their trust values their work. Many staff, however, felt excluded from decision-making with only 30% saying that senior managers act on their feedback (29% 2009). There has been no change since 2009 in the proportion of NHS staff who felt that they could deliver the level of care to which they aspired (69%), but a small increase in the proportion who thought that they were able to do their job to a standard with which they were pleased (62%, compared with 61% 2009). Eight percent of NHS staff reported experiencing physical violence from patients, their relatives or other members of the public in the previous 12 months and 15% report that they experienced bullying, harassment and abuse from patients, their relatives or other members of the public in the previous 12 months. As the wording of the question has changed since 2009, no statistically valid comparisons can be made. The reporting of incidents of violence, harassment and abuse has increased; nearly three-quarters (73%) of incidents of physical violence (71% in 2009) and over half of bullying, harassment or abuse cases were reported (54% in 2010 compared with 53% in 2009). It should be noted that ambulance staff work in a distinct and different environment to others in the NHS. As in previous year s, staff working in NHS ambulance trusts report poorer experiences on many of these issues although there are significant improvements since the 2009 survey. There has been an increase in the proportion of ambulance trust staff receiving an appraisal (increasing from 47% in 2009 to 70% in 2010), training in health and safety (up from 45% in 2009 to 55% in 2010) and equality and diversity (up from 31% in 2009 to 45% in 2010). The percentage of ambulance staff witnessing potentially harmful errors, incidents and near misses has decreased from 37% in 2009 to 34% in A large decrease is seen in the proportion of PCT staff saying they have good opportunities to develop in their work (40% compared with 47% in 2009). Just under half of PCT staff would 2

3 now recommend their trust as a place to work (decreasing from 54% in 2009 to 48% this year) and the proportion saying they would look for a new job in the next 12 months has increased from 22% in 2009 to 28% in Pledge 1: Roles, responsibilities and rewarding jobs Unchanged on 2009, the majority of NHS employees feel that they are making a difference to patients and the majority say they have rewarding jobs. More than three-quarters of staff said that they knew their responsibilities and over two-thirds felt that they had clear objectives. However, only 37% of staff said they received clear feedback on how well they are doing their job; this figure falls to only 20% amongst ambulance staff. Three-quarters of staff report being satisfied with support received from colleagues (76%), but fewer staff, two-thirds, are satisfied with the support received from their immediate manager (62%). Seventy-eight percent of staff feel their colleagues treat them with respect. A higher proportion of NHS staff (64%, compared with 62% in 2009) are happy with the standard of care provided by their trust but this figure remains lower for staff working in mental health trusts (58%, compared with 54% in 2009). More than a quarter of staff (29%) said that they often feel like leaving their organisation. Making a difference to patients The survey asked a series of questions about NHS employees perceptions of their contribution to the care of patients and service users. Ninety per cent of staff felt that their role ultimately made a difference to patients and 87% reported being satisfied with the quality of the care they provided. Both figures are unchanged from Over two-thirds of staff (69%) felt that they were able to deliver the level of care to which they aspired (unchanged on 2009), and that they were able to do their job to a standard with which they were pleased (62% compared with 61% in 2009). Staff were also asked about pressure at work. Fifty-eight per cent of staff felt that they had adequate materials, supplies and equipment to do their work (same as 2009) although this was lower in ambulance trusts where only 47% felt that this was the case (43% in 2009). Nearly half of all staff (45%, 46% in 2009) said that they feel they do not have enough time, and nearly one third (32%, unchanged) felt that there are not enough staff to enable them to do their jobs properly. Forty-two percent of staff reported conflicting demands on their time at work. Clearly defined job roles Eighty per cent of staff (79% in 2009) responded that they knew their responsibilities and over two-thirds felt that they had clear objectives (71%, up from 67% in 2009). Sixty-two percent of ambulance staff indicated they had clear objectives, which, although lower than the national average, is markedly better than the 55% reported in However, only 37% of all staff said they received clear feedback on how they were doing in their job and this figure falls to 20% amongst ambulance staff (17% in 2009). Conversely, over half of staff (57%) said that their immediate manager gave clear feedback on their work (55% in 2009). Team working Over 90% of NHS employees said that they work in teams but only three-quarters (75%) agreed that team members had a set of shared objectives or that team members communicated closely to achieve those objectives (78%). Less than two thirds of staff (60%) 3

4 felt that team members reflected on the team s performance and this is particularly low amongst ambulance trust staff (29%). This is a new measure of team working introduced in Working hours and work-life balance Nearly two-thirds of staff (65%) across the NHS reported working more than their contracted hours (the same as in 2009). A lower proportion of all staff (29%) were paid for these extra hours compared with 31% in Fifty three percent of staff regularly worked extra unpaid hours (compared with 51% in 2009). Ambulance staff were both more likely to work additional hours (79% said they had done so) and to be paid for them (69% compared with 29% for the NHS as a whole). Sixty-five per cent of all staff felt that they could discuss flexible working with their manager (unchanged since 2009), and 56% of staff felt that their manager would help them to achieve a good work-life balance (55% in 2009). However, only 43% of staff felt that their trust was committed to helping its staff balance their work and home life (44% in 2009). Job satisfaction Overall, job satisfaction levels remain similar to last year. The majority of staff (76%, 77% in 2009) were satisfied with the support they received from colleagues and from their immediate manager (62%, 61% in 2009). Similarly, most were satisfied with the levels of responsibility they were given (72%) and the opportunities they have to use their skills (67%) and choose their working methods (63%), all unchanged on However, less than a half (45%, 44% in 2009 ) were satisfied with the recognition they received and only a third were satisfied with the extent to which they felt that their trust values their work (33% same as in 2009). A higher proportion of staff are satisfied with their level of pay (40% compared to 38% in 2009) and this rises to 46% in PCTs (42% in 2009). Ambulance staff are generally less satisfied, with less than half (48%) satisfied with support received from their immediate manager, or feeling that they had the freedom to choose their working methods (45%). Around a quarter (27%) of ambulance staff are satisfied with the recognition they receive or the extent to which they felt that their trust values their work (20%). Satisfaction with their level of pay is unchanged (30%). Staff turnover More than a quarter (29%) of staff reported that they often felt like leaving their trust, 21% that they would probably look for another job in the next year, and 15% that they would leave as soon as they could find another job, a slight increase on 2009 (28%, 20% and 14% respectively). For staff in primary care trusts, 30% of staff (27% in 2009) said that they often felt like leaving their trust, 28% (22% in 2009) reported that they would probably look for another job in the next year, and 18% (14% in 2009) said that they would leave as soon as they could find another job. Pledge 2: Personal development, access to training and support from line management Results from the 2010 survey show greater participation in training and development. Health and safety training has increased by two percentage points overall, ten percentage points amongst ambulance trust staff. Despite high levels of training, only just over one third of staff reported good opportunities to progress at work. The percentage of staff receiving an 4

5 appraisal has also continued to rise, with more than three-quarters of all NHS staff having had an appraisal in the last twelve months. In particular, there has been a substantial increase in the number of ambulance trust staff receiving an appraisal, increasing from 47% in 2009 to 70% in Despite this increase, only a third (34%, 31% in 2009) of all staff felt that their review was well structured in that it improved how they worked, set clear objectives and left them feeling that their work was valued. Staff appraisals Seventy-seven percent of staff had an appraisal. This is markedly higher than in 2009 (69%). There has been a substantial increase in the number of ambulance trust staff receiving an appraisal, increasing from 47% in 2009 to 70% in However, despite this increase, only a third (34%, 31% in 2009) of all staff felt that their review was well structured in that it improved how they worked, set clear objectives and left them feeling that their work was valued. This figure falls to only one-in-five (20%) amongst ambulance trust staff although this is an improvement on the 14% reported in The percentage of staff agreeing a personal development plan as part of their appraisal review has also increased, up from 60% in 2009 to 67% in Opportunities to develop and access to training The majority of staff (94%, 95% in 2009) reported that they had taken part in at least one form of employer-supported training, learning or development in the last 12 months. Formalized training courses and self-directed learning activities remain the commonest forms of training, learning or development, but there has been a continued rise in e-learning and online training. Despite high levels of training, only thirty five percent of staff across the NHS reported that they had good opportunities to progress at work, which is a decrease of five percentage points since There has been a substantial decrease amongst staff in PCTs (28% in 2010, compared with 38% in 2009) and ambulance trusts (38% in 2010 compared with 44% in 2009) feeling that there were opportunities to progress. Forty-four per cent of staff overall agreed that there has been strong support for training in their area of work (46% in 2009). Fifty-six per cent of all staff felt supported to keep up to date with developments in their field (57% in 2009) and 57% felt encouraged to develop their own expertise (58% in 2009). Health and Safety training (78%) and infection control training (67%) remain the commonest areas where staff participated. Training in these areas has risen amongst ambulance staff, with the proportion of staff participating in health and safety training increasing from 45% to 55% in 2010 and in infection control training from 53% to 58% in Participation in equality and diversity training has also risen in ambulance trusts from 31% in 2009 to 45% in Of those staff who had received some kind of training, learning or development in the past 12 months, 66% felt that it had helped them to do their job better; 69% felt that it helped them to stay up-to-date with the requirements of their job and 68% felt that it helped them to stay upto-date with professional requirements which is similar to last year. These figures are lower (59%, 62% and 59% respectively) amongst ambulance staff. Line management and supervisor support The levels of satisfaction with support from line management are comparable with previous years, but are lower amongst ambulance trust staff. Overall sixty nine percent of staff reported 5

6 that their manager helped them with difficult tasks (same as 2009) and 72% felt supported in a personal crisis (71% in 2009). More than half felt that their manager gave them feedback (57%, 55% in 2009), asked for their opinion before making decisions that affected their work (53% unchanged from 2009), or took a positive interest in their health and well-being (53%, 52% 2009). These figures are substantially lower amongst ambulance trust staff where only 41% (37% in 2009) felt that their manager gave them feedback, 34% (33% in 2009) felt that their manager asked for their opinion before making decisions that affected their work, and 35% (31% in 2009) that they took a positive interest in their health and well-being. Pledge 3: Maintaining health, wellbeing and safety Since 2009, there has been a fall in the proportion of staff witnessing potentially harmful errors near misses or incidents that could harm patients. Thirty-two per cent of staff said that they had seen at least one error, near miss or incident that could have hurt staff or patients in the last month (compared with 33% in 2009). There has been an increase in the proportion of staff reporting a perception of fair and effective procedures for reporting these incidents. Two thirds of all NHS staff (66%) reported that they had attended work in the previous three months when they felt unwell. Of those who had attended work while unwell, the majority (91%) stated that they had put themselves under pressure to attend work, 30% felt pressure from their manager and 21% from other colleagues to attend. A larger proportion of staff in ambulance, mental health and primary care trusts reported work-related stress when compared with staff in acute trusts. Health and well-being Sixty-three percent of staff indicated that they had not experienced any difficulties in completing their daily work because of their physical health (62% in 2009). The same proportion (63%) indicated that that their daily work had not been affected by any personal or emotional problems (unchanged from 2009). Sixty-six percent of staff reported that they had attended work in the previous three months when they felt unwell compared with 67% in Of those who had attended work while unwell, 91%, unchanged from 2009, stated that they had put themselves under pressure to attend; 30% (28% in 2009) felt under pressure from their manager and 21% (unchanged from 2009) from other colleagues to attend. Staff in ambulance trusts were only slightly more likely to attend work when unwell (69%), and 44% reported pressure from their manager to attend (41% in 2009), while only 12% of ambulance staff (13% in 2009) reporting pressure from colleagues to attend work. Work-related stress and injuries Table 1 shows the types of injuries that staff suffered in the last twelve months. Just under a third (29%, 28% in 2009) of NHS staff overall reported they had suffered from work-related stress. Moving and handling injuries (10%) were the second most common cause of workrelated injuries or illness across the NHS; unsurprisingly, these are more common (29%, 30% in 2009) among ambulance trust staff. 6

7 Table 1: Percentage of staff reporting work related injuries, by trust type % saying they have suffered injuries or Mental have felt unwell in the last 12 months as a Overall Acute PCT Health result of: Moving and handling 10% 11% 7% 5% 29% Needlestick and sharps injuries 2% 3% 1% 1% 2% Slips, trips and fails 3% 4% 2% 3% 10% Exposure to dangerous substances 1% 2% 1% 1% 2% Work-related stress 29% 28% 30% 31% 32% Ambulance Errors, near misses and incidents Thirty-two per cent of staff said that they had seen at least one error, near miss or incident that could have hurt staff or patients in the last month (compared with 33% in 2009). Among staff on the front line, 42% said that they had witnessed at least one such adverse event and among staff with frequent face-to-face patient contact it was 36%. The number of ambulance staff witnessing errors, near misses or incidents has decreased over the past two years from 37% in 2009 to 34% in Nearly all staff (96%, unchanged on 2009) said that either they or a colleague had reported the most recent error, near miss or incident they had witnessed. Data were comparable across all types of trust with the exception of ambulance trusts, where a lower percentage of staff (90% in 2010, 89% in 2009) said that their witnessed errors, incidents and near misses had been reported. This is an increase of one percentage point from Overall, eighty-two percent of all staff felt encouraged by their trust to report errors, near misses and incidents (compared with 80% in 2009), although this is lower in ambulance trusts (70%, 67% in 2009). A comparatively small proportion (11%, unchanged on 2009) felt that reporting of errors would lead to punishment or blaming of those involved (25% in ambulance trusts, 26% in 2009). Sixty percent of staff felt that incident reporting was handled confidentially (59% in 2009), while 55% (unchanged on 2009) thought that action was taken to prevent similar errors occurring in the future (42% and 35% respectively in ambulance trusts, but still increasing from 40% and 33% in 2009). Although reporting rates were high, the percentage of staff that felt informed about (35%, 32% in 2009), or given feedback on changes made as a result of errors, near misses and incidents remains low (37%, 35% in 2009), and these figures are even lower (but improving) amongst staff in ambulance trusts (19% and 22% respectively but up from 16% and 20% in 2009). Violence, harassment, bullying and abuse Table 2 shows 8% of NHS staff overall reported experiencing physical violence from patients, their relatives or other members of the public in the previous 12 months. Not surprisingly, the figures are higher at 12% among front-line staff and among all staff in mental health (15%) 7

8 and ambulance trusts (19%). Around 1% of all staff said they had experienced physical violence from other staff. Fifteen per cent of staff reported that they experienced bullying, harassment and abuse from patients, their relatives or other members of the public in the previous 12 months. Again, not surprisingly, the figures are higher at 18% among front-line staff and among all staff in mental health (18%) and ambulance trusts (27%). Around 15% of staff reported they had experienced bullying, harassment or abuse from either their line manager or other colleagues. As the wording of the question has changed since 2009, we do not recommend that comparisons are made. Table 2: Assaults, harassment, bullying and abuse of NHS staff, by trust type Overall Acute PCT Mental Health Ambulance % saying they had experienced an incident of physical violence from: Patients / service users, their relatives or other members of the public 8% 8% 3% 15% 19% Manager / team leader or other colleagues 1% 1% 1% 2% 2% % saying they had experienced an incident of harassment, bullying or abuse from: Patients / service users, their relatives or other members of the public 15% 14% 10% 18% 27% Manager / team leader or other colleagues 15% 16% 12% 14% 16% The survey suggests an improvement in the reporting of incidents of violence and abuse. Nearly three-quarters (73%) of incidents of physical violence and over half of bullying, harassment or abuse cases (54%) were reported. Fifty-seven percent of staff said they felt that their trust would take effective action if staff were physically attacked by patients, relatives or other members of the public (56% in 2009). About half of the staff (51% in 2009 and 2010) who have actually experienced an incident of physical violence from patients or staff themselves and around forty percent (41% in 2010, 42% in 2009) of those who have experienced bullying, harassment or abuse, felt that their trust would take effective action. Availability of hand-washing materials Two thirds (68%) of staff said that hot water, soap and paper towels or alcohol rubs were always available when they needed them (down on the 71% in 2009). A further 25% reported that they were available most of the time (23% in 2009). Hand-washing materials are less likely to be always available in ambulance trusts (51%), 37% of ambulance staff report their availability as most of the time. Sixty percent of staff said that hand-washing materials were always available to patients, compared with 63% in A further 22% reported that they were available most of the time (21% in 2009). The majority of staff in acute trusts (the questions are only asked of staff in acute trusts) agreed that their trust does enough to promote hand-washing for staff (88% compared with 89% in 2009), and for patients or visitors (79%, compared with 80% in 2009). Overall, 85% of staff (the same as in 2009) agreed that infection control applies to them in their role, a figure that rises to 89% among frontline staff and to 94% among those with frequent face-to-face contact with patients (89% and 83% respectively in 2009). 8

9 Pledge 4: Engaging staff in decisions that affect them While a large proportion of staff feel they have influence to improve the way things are done, less than half of all staff across the NHS (46%, compared with 45% in 2009) felt that healthcare professionals and managers worked well together, and only a quarter (27%, same as in 2009) felt that managers involved staff in important decisions. Just over one third of staff felt that managers encouraged them to suggest new ideas (38%, compared with 36% in 2009), and less than a third (30%) of staff reported that senior managers acted on feedback from staff. There has been no change in the proportion of NHS staff who reported that they felt that patient care was the top priority at their trust (57%, unchanged from 2009). Trust management Less than half of all staff across the NHS (46%, compared with 45% in 2009) felt that healthcare professionals and managers worked well together. While just over two-thirds of staff (70%, unchanged from 2009) could identify who the senior managers are in their trust, and only a quarter (27%, unchanged from 2009) felt that their managers involved staff in important decisions. Just over one third of staff felt that managers encouraged them to suggest new ideas (38%, compared with 36% in 2009), although less than a third (30%) reported that senior managers acted on feedback from staff (29% in 2009). Improving the way we work The majority of staff (70%, unchanged from 2009) felt able to make suggestions on how they could improve the work of their team or department and felt that they have frequent opportunities to show initiative in their role (63%, unchanged from 2009), although only just over half of staff (54%, unchanged from 2009) agreed that they were able to make these improvements a reality. However, these figures are lower amongst staff in ambulance trusts (44%, 45% and 27% respectively). Responses are similar to 2009 (43%, 46% and 27%) Staff as advocates Just over half (53%) of staff would recommend their trust as a place to work (down from 55% in 2009) but this is significantly lower in ambulance trusts at 41% (42% in 2009). Sixty-four percent of all staff agreed they were happy with the standard of care provided by the trust (an increase from 62% in 2009) but this figure is lower at 58% for staff working in mental health trusts. Fifty-seven percent of staff felt that patient care was the top priority of their trust (unchanged from 2009), although only 39% of staff agreed with this statement in ambulance trusts (an increase on 34% reported in 2009). Finally, only fifty percent of staff felt that senior managers were committed to patient care (31% amongst ambulance trusts) which is similar to last year (51% and 29% respectively). Staff motivation Just over half (52%, 54% in 2009) of all staff indicated that they looked forward to going to work. Two thirds (67%, 68% in 2009) were enthusiastic about their jobs and three-quarters (74%, 76% in 2009) said that time passed by quickly when they were working. Staff engagement An overall measure of staff engagement (calculated from the three areas described above) would indicate that there has been a slight decrease in staff engagement nationally 9

10 (3.62*,compared with 3.63 in 2009), with the most noticeable decrease being seen amongst PCT staff (3.65 compared with 3.68 in 2009) Additional theme We report additional themes in this section not mentioned specifically by the staff pledges, but still covered by the NHS Constitution. Raising concerns (Whistle-blowing) Eighty seven percent of NHS staff said that they would know how to report any concerns they had about fraud, malpractice or wrongdoing, 74% would feel safe raising these concerns and just over half (54%) would feel confident that their trust would address them. Findings were lower for staff in ambulances trusts (85%, 67% and 44% respectively). Equality and diversity Overall, 89% of staff across the NHS agree that their trust acts fairly in terms of career progression and promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age. However, 7% of staff said that they had experienced discrimination at work from patients, relatives or other members of the public in the previous 12 months, and 9% of staff that they had experienced discrimination at work from other colleagues. This is the first time the survey has measured the source of discrimination experienced by staff. The majority of staff (87%) did not experience discrimination. Of the remainder of staff that did, 4% reported this was on the basis of their ethnic background, 2% on the basis of their gender or age, 1% on the basis of religion, disability or sexual orientation and 4 % cited other reasons. Notes on the survey The 2010 NHS staff survey involved all 388 NHS trusts in England. More than 306,000 NHS staff were invited to participate using a self-completion postal questionnaire survey method. We received responses from 164,916 NHS staff, a response rate of 54% (55% in 2009). All full time and part-time staff who were directly employed by an NHS trust on September 1 st 2010 were eligible. Fieldwork for the survey was carried out between late September and early December This briefing note provides percentage results for England as a whole by aggregating responses from individual respondents at each trust. As employees in smaller organisations have a higher chance of being selected to participate in the survey, and because response rates vary between organisations, the results are weighted so that they reflect unbiased estimates of all NHS staff in England. Doing this means that responses from each trust contribute an amount to the total that is directly proportional to the number of staff employed. All NHS trusts have now received their individual survey results, including detailed feedback on how they compare with trusts of a similar type. A report for each trust is available on the Care Quality Commission s website: 2 Note: the overall staff engagement score is a composite score calculated on a likert scale from 1=very low staff engagement to 5=very high staff engagement. 10

11 The Care Quality Commission will cease its management of the survey in June We have agreed with the Department of Health that it is no longer necessary for CQC to coordinate the detailed administration of the NHS staff survey. To secure the future survey arrangements, the Department of Health is working to appoint a new organisation to undertake the established co-ordination activities currently delivered by the Care Quality Commission and the NHS staff survey Advice Centre. The NHS staff survey will continue to support us to deliver effective system regulation through continuing use of the results data as we have described earlier. 11

12 Appendix 1: Changes in Key Finding scores between 2009 and Difference KF1. % feeling satisfied with the quality of work and patient care they are able to deliver KF2. % agreeing that their role makes a difference to patients KF3. % feeling valued by their work colleagues 74% 74% - 90% 90% - 77% 77% - KF4. Quality of job design KF5. Work pressure felt by staff KF6. % working in a well structured team environment * KF7. Trust commitment to work-life balance KF8. % working extra hours 65% 65% - KF9. % using flexible working options * - 65% - KF10. % feeling there are good opportunities to develop their potential at work KF11. % receiving job-relevant training, learning or development in last 12 months 44% 41% -3% 79% 78% -1% KF12. % appraised in last 12 months 69% 77% +8% KF13. % having well structured appraisals in last 12 months KF14. % appraised with personal development plans in last 12 months 31% 34% +3% 60% 67% +7% KF15. Support from immediate managers KF16. % receiving health and safety training in last 12 months KF17. % suffering work-related injury in last 12 months KF18. % suffering work-related stress in last 12 months 76% 78% +2% 15% 14% -1% 28% 29% +1% KF19. % saying hand washing materials are always available 64% 62% -2% Note: - *Changes to the question format mean it is not possible to make valid comparisons with results from previous years. Note: KF4, 5, 6, 7,15, 22, 27, 28, 32, 33, 34 and 35 are composite based scores calculated on a 1-5 likert scale. 12

13 Difference KF20. % witnessing potentially harmful errors, near misses or incidents in last month KF21. % reporting errors, near misses or incidents witnessed in the last month KF22. Fairness and effectiveness of incident reporting procedures KF23. % experiencing physical violence from patients / relatives in last 12 months * KF24. % experiencing physical violence from staff in last 12 months * KF25. % experiencing harassment, bullying or abuse from patients / relatives in last 12 months * KF26. % experiencing harassment, bullying or abuse from staff in last 12 months * KF27. Perceptions of effective action from employer towards violence and harassment KF28. Impact of health and well-being on ability to perform work or daily activities KF29. % feeling pressure to attend work when feeling unwell in last 3 months KF30. % reporting good communication between senior management and staff KF31. % able to contribute towards improvements at work 33% 32% -1% 96% 96% % - - 1% % % % 24% +1% 27% 28% +1% 63% 63% - KF32. Staff job satisfaction KF33. Staff intention to leave jobs KF34. Staff recommendation of the trust as a place to work or receive treatment KF35. Staff motivation at work KF36. % having equality and diversity training in last 12 months KF37. % believing trust provides equal opportunities for career progression or promotion KF38. % experiencing discrimination at work in last 12 months * 40% 45% +5% 90% 89% -1% - 13% - Note: - *Changes to the question format mean it is not possible to make valid comparisons with results from previous years. Note: KF4, 5, 6, 7,15, 22, 27, 28, 32, 33, 34 and 35 are composite based scores calculated on a 1-5 likert scale. 13

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