ANALYSIS OF STAFF SURVEY RESULTS & OTHER WORKFORCE DATA 2014

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1 APPENDIX 3 ANALYSIS OF STAFF SURVEY RESULTS & OTHER WORKFORCE DATA 2014 Background For many years Kingston Hospital has had historically poor staff survey results. Despite this, it has exceptional clinical outcomes, and good financial and operational performance. However, this performance will not continue unless staff are happier at work and this needs to be a key priority. Historical Staff Survey Results Key Findings in top 20% Key Findings in bottom 20% Apart from in 2012, results have been nearer the bottom than to the top. Areas that have been consistently poor when compared to other Trusts include: - There are enough staff at this organisation for me to do my job properly - I am satisfied with my level of pay - Support from immediate manager - Recognition of good work - Concerns around discrimination and bullying Areas that have been consistently above other Trusts include: - Levels of Statutory and Mandatory training - Levels of appraisal - Communications and involvement of senior managers These trends are repeated in this year s survey. A more detailed analysis shows some interesting aspects that point to areas of action that have worked and areas that need more attention. The Trust has other sources of information relating to staff satisfaction and retention with which it can triangulate staff survey results. These are: - Board / staff engagement event - Aggregated data from exit interviews and retention surveys - Feedback from occupational health Board / staff engagement event The Board recently held a conversation with staff around turnover rates. Key messages were concerns around: - Pay and overall deterioration in Terms & Conditions in the NHS - Lack of commitment to staff development and career progression opportunities - Concerns around style and support from some managers - Not feeling valued - Concerns about staffing levels and associated intensity of the working day 1

2 Feedback from Exit interviews Recent exit interview information has highlighted that the top five reasons for leaving are for the following reasons: 1. Career development, 2. Moving home, 3. Staffing levels, 4. Work related stress 5. Workload. Occupational Health Feedback from occupational health has highlighted that inflexibility, bullying and harassment from staff and inequality of treatment from management staff have been reasons why staff have left the Trust. When asked what the Trust could do to make working more enjoyable, a number of staff leaving the Trust suggested improving staffing levels. This was followed by valuing staff. When staff that were leaving were asked what could be done to enable them to stay, better managers, increased pay and clarity in job role were the highest responses. (Appendix A) Feedback from 100 survey with new starters The Trust has a fifth source of information. Retention data from new starters tended to show that some of their initial good impression of the Trust had changed as a result of poor organisation, staffing levels, induction, structure and support. When asked if there was anything that the Trust could do to improve retention, new starters suggested increasing staffing levels, better training and development, more practical local Induction, living the values and improving the environment. 15 new starters have indicated that they will be looking for a new job within the year. (Appendix B) Triangulation Issue identified Staffing levels and the relentlessness of work pressures Pay and reward feeling valued Style and capability of line managers Supporting staff development Discrimination and bullying Staff survey Exit interview Occupational Health Retention surveys Conversation with the Board yes yes yes yes yes yes - yes - yes yes - yes yes yes yes yes - yes yes yes - yes - - Discussion Summary of staff happiness analysis While there are areas in which the Trust benchmarks well, in general staff are less satisfied than the average UK or London trust, for a subset of key findings most closely linked to staff happiness (Appendix C). Interestingly, London is more satisfied than the UK average for most of this subset 2

3 of key findings. Specifically, London staff score their immediate managers higher, are more likely to recommend their trust as a place to work or receive treatment, are more likely to consider their organisation have enough staff, and are more motivated. However, London staff are more likely to work additional hours, feel unwell due to work-related stress, or experience abuse from patients or service users. When viewing the Trusts scores across staff groups, for a subset of key findings most closely linked to staff happiness, there are also some clear patterns. AHPs, scientists and technical staff tend to be the happiest staff group, although nursing and healthcare assistants also score highly in some areas. Doctors are most likely to feel pressure, work extra hours and feel unsupported by managers. Nurses and midwives are most likely to experience abuse from patients or service users, although this is perhaps not surprising. They are also most likely to go to work despite not feeling well enough. The wider healthcare team, which comprises admin and clerical, central and corporate functions, and maintenance and ancillary, is in general the least happy for this subset of key findings, specifically for the questions around job satisfaction, recommendation of the organisation as a place to work, and motivation. For the questions where staff are less happy in 2014 than 2013, there are also some clear patterns by staff group (Appendix D). Nursing and healthcare assistants are actually happier in several areas in 2014, and AHPs also feel more supported and valued. Doctors, however, feel under more pressure, and are much more likely in 2014 to have felt unwell as a result of work stress. Admin and clerical, and central functions, are less happy in all areas where trust satisfaction has fallen. Areas of action that have proven effective and we should do more of 1. Percentage agreeing feedback from patients and service users is used to make informed decisions in their department. The work the Trust has been doing to actively use patient feedback to make decisions and improvement has been reflected within the staff survey results, with Kingston Hospital faring better in all 3 of the questions in this section, and in top 20% of hospitals. Kingston Hospital Average for Acute Trusts Is patient/service user experience Feedback collated within your directorate/ department % of staff who receive regular updates on patient/service user experience feedback in my directorate/department % of staff who say feedback from patients/service users is used to make informed decisions within my directorate/department Actions which have been taken in this area have included: A move away from an inpatient survey action plan just focused on responding to the survey an inpatient experience plan encompassing the feedback from multiple sources, with focus on tackling the key themes rather than individual questions FFT in all parts of the Trust The you said, we did campaign outlining key changes made in response to feedback and heavily publicised such as the menu changes, ward sister uniforms, visitors chairs 3

4 A greater visibility and analysis of qualitative information from the Friends & Family test at departmental level Communications in team brief, CEO weekly and on screens around the Trust of programmes of work undertaken in response to patient feedback The Leading for Improvement team development sessions include focus on what local areas can do to improve team working and patient experience using feedback although these sessions had not taken place by the time the staff survey was conducted, the sisters/charge nurses had commenced their facilitation training for these team days at this point, which included how they can use experience information to drive improvement. The concept of you said, we did could be easily applied and publicised in relation to staff feedback and changes made as a result. The need for ongoing qualitative as well as quantitative analysis of staff feedback is also key to identify tangible actions and drive improvements. 2. Improvements in nursing scores & nursing assistant scores Within the staff survey report when the analysis is broken down by staff group, for questions related to happiness (Appendix C) and when compared to last year (Appendix D) there are some noticeable areas of improvement and difference to other staff groups. Actions Improved induction of new nurses & nursing assistants to the organisation Continued focus on reducing vacancies and keeping communications regarding the importance of this high Celebratory measures the monthly flowers award for nurses & midwives, the nursing & midwifery celebratory conference Development programmes for band 6 nurses, theatre sisters, site practitioners and A&E sisters Greater visibility of opportunities for nursing assistants to apply for sponsorship to nurse training Leading for Improvement team development sessions have been commissioned and although teams had not completed at the time of the survey, the sisters had started to undertake the facilitator & quality improvement technique development Increased practice development involvement at ward level Areas where more action is required Alongside detailed action plans in specific service lines and in specific professional groups, there are some key issues that the Trust should address: 1. Staffing levels and the relentlessness of work pressures 2. Pay and reward 3. Style and capability of line managers 4. Supporting staff development 5. Discrimination and bullying 1. Staffing levels and the relentlessness of work pressures Kingston Hospital is the most efficient hospital in the country as measured by reference costs. It also has exceptional clinical outcomes. But this is coming at the cost of staff. Key questions from this year s Staff Survey highlight this: 4

5 Kingston Hospital Average for Acute Trusts % of Staff working additional hours In general, my job is good for my health % saying they have felt unwell in the last 12 months as a result of work related stress There are enough staff at this organisation for me to do my job properly I am unable to meet all the conflicting demands on my time at work I am able to do my job to a standard I personally pleased with Interestingly, the greatest pressures seem to be being felt in some unusual areas of the Trust. Corporate Functions are least satisfied about the quality of work they can deliver and are amongst the highest percentage working extra hours at 90%. This has significantly changed over the last year. This may be due to changes that corporate services are going through with the introduction of service line management, coupled with the fact that over the last few years they have taken a greater proportion of the savings in order to try to protect front line services, and are now too lean to be able to deliver the increased demands placed on them, as service lines have begun (appropriately) to seek more information and support from corporate services. A development program was commissioned from Beech Consultancy to provide support to corporate departments through change, but it has been ineffective. In addition, senior leaders of corporate departments may not have been able to give the time to their teams as they too are struggling with their workloads. Doctors are another group who stand out as being particularly under pressure as do Physiotherapists. However, all staff report work pressure to be an issue. 2. Pay and Reward NHS Staff are on a national pay scheme that is designed to create equality across the country. However, St Georges is just up the road and as an inner London Trust it is able to pay a higher high cost area allowance. Key relevant questions from the staff survey are: Kingston Hospital Average for Acute Trusts % satisfied with their level of pay % satisfied with the extent to which the organisation values their work % satisfied with the recognition I get for good work Nursing and healthcare assistants are the least satisfied with their level of pay (7%), with doctors most satisfied (47%). Satisfaction with pay has fallen since 2013, when it was 30% overall. The most and least satisfied staff groups are unchanged (doctors 58%; nursing/healthcare assistants 13%). 5

6 At the Conversation with the Board session, staff also raised concerns about working alongside agency staff who were paid more than they were for the same role. There were also concerns that some Trusts might be more flexible with increment levels, bandings and bank pay rates. More work needs to be carried out about how the Trust might use its our freedoms as a foundation trust to reward staff fairly and equitably. In terms of how good work is valued and recognised, admin / central functions are the least satisfied. For related questions, however (not shown here, see Appendix B), around the amount of freedom, responsibility and opportunities the Trust gives to staff, if we score above average. In addition, more needs to be done to ensure staff feel and believe that the Trust values them and their work. 3. Style and Capability of Line Managers This has been a consistent theme from past staff surveys as well as anecdote, feedback from walkabouts and the recent conversations with the Board sessions. Relevant questions from the recent staff survey include: Kingston Hospital Average for Acute Trusts % satisfied of support I get from my immediate line manager % agree my immediate line manager encourages those who work for them to do work as a team % agree my immediate manager can be counted on to help with a difficult task at work In addition, despite being in the top 20% for the proportion of staff having an appraisal, they are not done well by their line manager and are not having the impact they should have. Questions posed to staff included: Kingston Hospital Average for Acute Trusts % saying they had received an appraisal or performance development in the last 12 months % saying their appraisal or development review had helped them to improve how they do their job % saying their appraisal or development review had helped them agree clear objectives for their work % saying their appraisal or development review had made them feel their work was valued by the organisation

7 % saying their appraisal or development review had identified training, learning or development needs % saying their manager supported them to receive training, learning and development There have been a range of interventions to improve in this area including enabling feedback to line managers from their direct reports, coaching as well as training and development. However, these have not made a significant difference. Recent training was put in place for all managers on how to do an effective 1:1 meeting with their staff. The trainers have met significant resistance from many line managers to the concept of holding 1:1 meetings with the people they manage. A bolder new approach is needed here, which ensures that managers at all levels in the organisation have the people management skills to effective engage their staff. Doctors and administrative staff report the lowest satisfaction with their support from immediate managers and corporate services the most satisfied. 4. Supporting Staff Development Whilst staff report good levels of statutory and mandatory training in the staff survey, they do not always find it useful in helping them to deliver better care and staff often report that are not supported by their line manager to undertake the more discretionary personal development. Relevant questions the staff survey include; Kingston Hospital Average Acute Trust The training and development I have received has helped me to do my job more effectively The training and development I have received has helped me stay up-to-date with professional requirements The training and development I have received has helped me to deliver a better patient/ service user experience % saying their manager supported them to receive training, learning and development in general, doctors report the lowest levels of satisfaction with aspects of the appraisal process, although nurses and midwives were least likely to say their manager supported them to receive training, learning or development. More work will need to be undertaken to ensure that the launch of the new appraisal process makes sure that personal development plans are not only completed, but also acted on and training that is commissioned has been developed from the learning needs analysis take from the personal development plans of staff themselves. 7

8 5. Discrimination & bullying Whilst small numbers, bullying and discrimination has always been historically higher than average here at Kingston Hospital NHS Foundation Trust. Key questions from the staff survey are: Kingston Hospital Average Acute Trust % believing the Trust provides equal opportunities for career progression or production % experiencing discriminations at work in last 12 Months From patients and public From manager or colleague 11 8 % experiencing harassment, bullying or abuse from staff in last 12 months % experiencing harassment, bullying or abuse from patients or public in last 12 months Again, there are significant differences between staff groups. 44% of adult general nurses report bullying or harassment from staff followed by doctors at 33%. Key areas for action around staff believing the Trust provides equal opportunities for career progression are with nurses and administrative staff. Healthcare assistants and doctors and to a slightly lower extent nurses have the highest proportion of staff believing they have experienced discrimination. Specific service lines have particular issues e.g. in both anaesthetics & theatres and ICU service lines more than 50% of staff report experiencing bullying and abuse from staff. The granularity of the data allows for targeted action to take place. There are also significant differences between ethnicity. 23% of BME staff report personal experience of discrimination at work as compared to 8% of white staff. More work will need to be undertaken to determine why staff feel this is the case and to address their concerns. 8

9 APPENDIX A EXIT INTERVIEW BREAKDOWN Introduction Since a dedicated Co-ordinator and interviewer has been in place the number exit questionnaires received has increased. To date 45 Exit Questionnaire/interviews have been undertaken and 42 have been entered onto survey monkey. This has meant an increased overall response rate from 6% to 47%. Please table 1 below. Table 1 The highest number of respondents is from the A&E and AAU Service Line. Further information on March leavers indicates that from AAU alone there are 7 up and coming leavers. The staff group with the highest number of respondents is qualified nursing and the highest pay band is 5. The highest number of respondents had between 2 and 3 years service. It is worthwhile noting that 7 or 16% of staff have left with less than a year s service. Reasons for Leaving 1) 57% or 24 leavers in this time period left earlier than they thought they would. 33% or 14 staff cited career development as one of their top three reasons for leaving, 28% or 12 staff cited moving home, 23% or 10 staff cited staffing levels, 21% or 9 staff cited work related stress and 16% or 7 cited workload. 6 each cited job dissatisfaction, lack of development opportunities and family (See Table 2 below) 9

10 Table 2 Answers (weighted) % 1 Career development / broaden experience % 2 Moving home % 3 Staffing Levels % 4 Stress - Work realted % 5 Workload % Job Dissatisfaction % Lack of development opportunities 6 Personal / family commitments 6 Retirement 6 Change of speciality 6 11 Job didn't meet expectations % Journey to work 5 13 Career change % 14 End of Fixed Term contract % Promotion / job with more pay 3 16 Relationship with colleagues % Relationship with manager 2 Shift patterns 2 19 Ill Health % Lack of appraisal/pdp 1 Undertaking education 1 Occupational Health evidence of leaving reasons. Prior to leaving the Trust many staff self-refer to Occupational Health as a result of work related problems or personal issues which they feel are impacting upon their general health and wellbeing. Whilst the referrals are confidential and only recorded on the Occupational Health clinical system, the occupational health advisors are increasingly reporting the following themes as reasons why staff are leaving: 1. Inflexibility over roster and child care commitments-the rosters are not available in time to arrange childcare and shifts are changed at short notice, which creates problems when arrangements have to be changed. This problem has been reported on more than 4 occasions in the past 3 months and staff have left, for jobs with regular hours. 2. Staff who live a long distance and who need to use public transport Sundays are particularly problematic with engineering works etc. and staff who have requested Sundays off have not been granted this. Some staff report 16 hour days with travel on Sundays which is impacting upon their health in terms of exhaustion. These clients are looking for positions elsewhere to avoid the travel problems. 3. Bullying and harassment from staff- This appears to be a recurrent theme, although it is not reported via the EAP as a major issue. There have been some cases where staff have decided to leave rather than challenge the system. 4. Complaints about how some staff are allowed to get away with long and short term sickness absence, while some staff are managed to the letter inequity of treatment from management. 5. Having to work longer hours (2 hours over) when already on a long day to complete patient notes- several new nurses are finding this difficult and reporting that mentoring support on the wards is poor, breaks are not being taken and nurses do not generally feel empowered to ask for their break. Several of the new nurses are leaving as a result of this and many are already looking for their next posts. 10

11 6. Maternity are particularly problematic with rotational night duties, long hours and limited breaks during shifts. 7. The number of pregnant workers reporting to Occupational Health has increased recently, with many staff reporting that risk assessments are not being completed. The other issues include lack of rest facilities, lack of breaks and the attitude of some managers that they are only pregnant and this is not a disease. Many staff are working until very late in their pregnancy, which is causing a problem within some areas, as mobility is limited and tasks such as resus difficult. 11

12 Appendix B 100 Day Survey 1. Response breakdown Between December 2014 and February new starters completed the 100 day survey. The highest number of respondents were from the Elderly Care (12 staff), A&E and AAU (10 staff) and Cardiology service lines (9 staff). These service lines also have very high turnover rates of 24%, 30% and 31% respectively. See Appendix A table 1 for break down by service line. Qualified Nursing had the highest number of respondents (30 staff) followed by Admin and Estates (12 staff). The pay band with highest number of respondents is band 5 (30 staff). 2. Recruitment and Induction 57 staff or 89% of staff surveyed either strongly agreed or tended to agree that the recruitment into their post was smooth and efficient and 60 of our new starters either strongly agreed or tended to agree that first impressions of the Trust at interview were good. 52 out of 64 staff either strongly agreed or tended to agree that they had received a thorough induction and 62 staff similarly felt welcomed by the Trust. However, 25 staff either strongly disagreed or tended to disagree with the statement that their opinion of the Trust changed from their initial impression. The reason for this change could be roughly categorised into organisation, staffing levels, induction, structure and support. Some staff felt there was disorganisation with more support needed for new starters and more clarity about start dates. Staffing levels were a concern for at least 5 new starters and there was a feeling that people leaving were not replaced quickly enough. Some staff reported not having an induction and where they did have one that it was not practical enough. In relation to support, a new starter reported that junior staff perception of the consultants had changed as they were not supportive. Inadequate Equipment, uniform and training were also reasons why some staff changed their initial opinion of the Trust.(See Attachment 2) 3. Regular information about what is going on within the Trust 55 staff felt that they received regular information about what was going on in the Trust, where as 9 new starters did not feel that they did. Staff felt that they knew what was going on in the Trust mostly by and bulletins; a small percentage (7.5%) reported that they knew what was going on by team meetings or monthly team brief. One member of staff stated that 1-1 meetings only happen because they are requested and make sure that they happen. 4. Regular 1-1 meetings with your line manager 34 new starters out of 64 new starters stated that they did not have regular 1-1 meetings with their line manager. 22 new starters stated that they did not have regular team briefings. 5. Training and Development The survey found that 22 new starters were not made aware of the training and development opportunities offered by the Trust and 41 new starters did not have a Personal Training and Development Plan. 17 new starters out of the 64 new starters 12

13 reported that they did not receive the relevant training to enable them to do their job effectively and 25 reported that they were not able to fully utilise their skills in their current position. 22 new starters felt that they were not encouraged to take up opportunities for self-development and 22 new starters either strongly disagreed or tended to disagree that they had agreed targets with their manager. 6. Are you happy with your working environment (working conditions) When asked if they were happy with their working environment 19 new starters said that there were not. When asked to expand some staff said lack of equipment for patients, disorganisation and storage space. 7. How do you feel about working at Kingston Hospital When asked if they think about leaving the Trust 20 new starters said that they either strongly agree or tend to agree with the statement that they think about leaving the Trust. In relation to the Trust values 18 new starters either strongly disagreed or tended to disagree with the statement that they see the Trust values being lived and 15 tended to disagree and strongly disagree with the statement I receive thanks and recognition for the work I have done. 8. I will probably look or a job at a new organisation One new starter will look for a job as soon as they can find one, 14 new starters stated that they would look within the next 12 months, 18 stated that they would look within 1-2 years and 31 stated that they were not looking at all. 13 new starters would not recommend this Trust as a place to work. 9. Is there anything you thing that the Trust could be doing to help improve retention When asked if there was anything that the Trust could do to improve retention, staff response could be roughly categorised into the following areas: Staffing levels Training and development Induction Values Environment Roughly 17 staff suggested increasing staffing levels, but this also included changing the long 12 hour shifts, organisation, support and teamwork. 8 new starters suggest we improve training and development, but this included improving induction for new nurses. 5 new starters suggested improving induction, that includes making it more structured, having feedback and a chance to practice skills with supervision. 4 new starters suggested that more work needs to be done on values this included listening to staff needs, showing appreciation at service line/department level and providing support to staff who are new to the country. Environment was a suggestion to improve retention from a small number of staff, this included improving staff facilities, cleaning uniforms and better equipment. One new starter suggested the 100 day retention questionnaire and more monitoring of new starters as well a project like secret shopper or undercover boss to see what was going on. Additional comments highlight staff shortages, a proper induction, HR induction, handover and role definition. 13

14 Attachment 2 The Recruitment into my post was smooth and efficient My first impressions of the Trust at interview were good I have received a thorough induction I felt welcomed by the Trust My opinion of the Trust has changed from my intital Impression Strongly Tend to Tend to Strongly Total Agree Agree Disagree Disagree % 31.25% 57.81% 7.81% 3.13% Number % 70.31% 23.44% 4.69% 1.56% Number % 31.25% 50.00% 14.06% 4.69% Number % 67.19% 29.69% 3.13% 0.00% Number % 28.13% 32.81% 17.19% 21.88% Number

15 KF3 KF5 KF9 KF11 KF17 KF19 KF20 KF23 KF24 KF25 Appendix C: Summary statistics for subset of key findings and questions felt to be most related to staff happiness Work pressure felt by staff % working extra hours Support from immediate managers % suffering work-related stress in last 12 mths % experiencing physical violence from staff in last 12 mths % experiencing harassment, bullying or abuse from staff in last 12 mths % feeling pressure in last 3 mths to attend work when feeling unwell Staff job satisfaction Staff recommendation of the trust as a place to work or receive treatment Staff motivation at work 2013 KHFT score KHFT score London median UK median Allied Health Professionals / Healthcare Scientists / Scientific and Technical General Medical and Management Dental Nursing or Healthcare Assistants Registered Nurses and Midwives Wider Healthcare Team I am unable to meet all the conflicting demands on my time at work NULL I have adequate materials, supplies and equipment to do my work NULL There are enough staff at this organisation for me to do my job properly NULL % working additional PAID hours NULL % working additional UNPAID hours NULL My immediate manager encourages those who work for her/him to work as a team NULL My immediate manager can be counted on to help me with a difficult task at work NULL My immediate manager gives me clear feedback on my work NULL My immediate manager asks for my opinion before making decisions that affect my work NULL My immediate manager is supportive in a personal crisis NULL % saying they have have felt unwell in the last 12 months as a result of work related stress % experiencing physical violence at work from managers / team leaders or other colleagues in last 12 months % experiencing harassment, bullying or abuse at work from patients / service users in last 12 months % saying in the last three months they had gone to work despite not feeling well enough to perform their duties NULL NULL NULL NULL had felt pressure from their manager to come to work NULL 22 NULL had felt pressure from their colleagues to come to work NULL 35 NULL The recognition I get for good work NULL The support I get from my immediate manager NULL The freedom I have to choose my own method of working NULL The support I get from my work colleagues NULL The amount of responsibility I am given NULL The opportunities I have to use my skills NULL The extent to which my organisation values my work NULL % agreeing / strongly agreeing with: Care of patients / service users is my organisation's top priority NULL % agreeing / strongly agreeing with: I would recommend my organisation as a place to work NULL % agreeing / strongly agreeing with: If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation NULL % saying often or always to the following statements: I look forward to going to work NULL % saying often or always to the following statements: I am enthusiastic about my job NULL % saying often or always to the following statements: Time passes quickly when I am working NULL My level of pay [satisfaction with] NULL % saying they had received an appraisal or performance development review in the last 12 months NULL % saying their appraisal or development review had helped them to improve how they do their job NULL % saying their appraisal or development review had helped them agree clear objectives for their work NULL % saying their appraisal or development review had made them feel their work was valued by the organisation NULL % saying their appraisal or development review had identified training, learning or development needs NULL % saying their manager supported them to receive training, learning or development NULL 91 NULL Enclosure F 15

16 Appendix D: Staff group responses for questions where performance has deteriorated I am unable to meet all the conflicting demands on my time at work Allied Health Professionals / Healthcare Scientists / Scientific and Technical Medical and Dental Allied Health Professionals / Nursing or Registered Wider Nursing or Healthcare Medical and Healthcare Nurses and Healthcare Healthcare Scientists / Dental Assistants Midwives Team Assistants Scientific and Technical Registered Nurses and Midwives Wider Healthcare Team Allied Health Professionals / Healthcare Scientists / Scientific and Technical Medical and Dental Nursing or Healthcare Assistants Registered Nurses and Midwives Wider Healthcare Team % 55% -61% 0% 49% % working additional PAID hours % 43% -46% 15% 129% % working additional UNPAID hours % 6% 4% 17% 16% % saying they have have felt unwell in the last 12 months as a result of work related stress % experiencing harassment, bullying or abuse at work from patients / service users in last 12 months % 139% -20% 5% 31% % 62% -43% 12% 75% The recognition I get for good work % -25% 4% -2% -23% The support I get from my immediate manager The support I get from my work colleagues % agreeing / strongly agreeing with: Care of patients / service users is my organisation's top priority % agreeing / strongly agreeing with: I would recommend my organisation as a place to work % saying often or always to the following statements: I look forward to going to work % saying often or always to the following statements: I am enthusiastic about my job % -13% 22% -7% -15% % -11% 1% 2% -25% % 8% -23% -3% -7% % -13% -4% -5% -29% % -37% 53% -2% -53% % -17% 24% -9% -24% 16

17 % activity that is emergency % activity that is emergency % activity that is emergency Enclosure F Correlation with percentage, emergency work KF24: Staff recommendation of the trust as a place to work or receive treatment 55% 12a) Care of patients / service users is my organisation's top priority 50% 45% 40% 35% 30% 25% 20% 15% 10% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% agree or strongly agree 55% 12c) I would recommend my organisation as a place to work 50% 45% 40% 35% 30% 25% 20% 15% 10% 40% 50% 60% 70% 80% 90% 100% agree or strongly agree 55% 12d) I would recommend my organisation to a friend or relative who needed treatment 50% 45% 40% 35% 30% 25% 20% 15% 10% 40% 50% 60% 70% 80% 90% 100% agree or strongly agree 17