Severe measures: the NHS staff survey and restoring the faith

There’s a question missing in the NHS staff survey. Yes, it’s one of the finest health data sets in the world. Yes, it gives the views of 600,000 staff over dozens of questions, providing a number of data points so colossal it comes second only to the number of NHS acronyms used in an average year. But even so there’s something missing. Let’s come back to that in a minute.

You might have caught Severance on Apple TV last year. Its central concept is the ability to ‘sever’ your work from your home life. Every day your home – or ‘outie’ – self enters the office elevator, and remembers nothing until they’re coming down again. For the work (‘innie’) self, it’s the opposite: a day of work, return to the lift, then straight out again wearing different clothes and wondering what gave you the dull headache you’ve suddenly acquired. It’s work/life balance with a vengeance.

So the missing question. If offered, what proportion of NHS staff would sign up for that?

The 2022 results give an impression: 34% of staff said they felt ‘burnt out’ because of work, rising to 49% for operational ambulance staff. Barely half said they achieve a good balance between their work and home life. Two-thirds were enthusiastic about the job – sounds ok, but that figure was three-quarters as recently as 2019.

More than 30% said they thought often about leaving, including 17% saying they will leave as soon as they can find another job. And 45% said they’d felt unwell as a result of work-related stress in the last year; this was 38% back in 2012.

Not just an NHS problem

Obviously this isn’t good for staff, nor – given the weight of evidence linking staff wellbeing to quality of care – good for patients either. In a previous life I worked with Mike Richards when starting out as Chief Inspector of Hospitals. The first bit of data he’d look at when starting an inspection? NHS staff survey.

To explain what’s going on you may want to point to government policy, underfunding, the long-reach of covid, or even the lack of staff facilities. You may rail against useless bureaucrats and demand payment in chief executive blood, or think about what ICSs can do to ‘sort it out’.

But all of this neglects that this isn’t just an NHS problem, nor just about the past few pandemic-blighted years. It’s global, and has been going on for some time. Canada has recently established a Coalition for Action for Health Workers to advise on solutions to address ‘significant health workforce challenges’.

Some of this is about global pressures related to pay and cost of living: in Australia there’s an active debate as to whether staff should be allowed to supplement their income through OnlyFans.

There is an urgent need for strong leadership at all levels to say that the staff survey results are incompatible with the NHS reaching its 100th birthday.

There’s something far deeper going on here than a temporary blip.

“What’s burning out health care workers is less the gruelling conditions we practise under and more our dwindling faith in the systems for which we work,” wrote Eric Reinhart in the New York Times. This has sparked a debate that the cure is to move the US towards universal health care. But that’s equally to miss the point: we have universal health care, yet the issues steadfastly remain.

However, Reinhart’s point that this is fundamentally about ‘faith in the systems for which we work’ appears spot-on. This is the key argument of Victor Montori’s magisterial Why we Revolt: that healthcare has fundamentally lost touch with its core business of care. That we value industrial efficiency over kind, careful elegance.

The language used by Montori, Dominique Allwood and others about revolution is quite right: this isn’t tweaking round the edges, it’s a root and branch review of what on earth healthcare is all about in the first place. It’s the same point David Haslam makes in Side Effects.

“Great,” you may well think, “a global problem of fundamental importance, nice and easy then.” There is certainly a point about the level of importance we devote to this. No one really disagrees with Montori’s diagnosis, best expressed in the UK through the Rethinking Medicine movement. But very little is actually happening to progress these ideas.

There is an urgent need for strong leadership at all levels to say that the staff survey results are incompatible with the NHS reaching its 100th birthday.

Starting with purpose

But there’s also a place anyone can start. Our work at Kaleidoscope always involves a discussion of purpose: what are we really here for? It’s the first characteristic in how we support both high-performing teams, and collaborations.

It’s at the centre of how we help organisations develop strategy – and it’s great to see the wonderful Oxleas NHS FT, with whom we’ve been privileged to work with for a number of years, be one of the biggest improvers in this year’s survey.

In the seven years since Kaleidoscope started, it’s been the conversations that have reconnected individuals to their own personal purpose, why they entered this profession in the first place, that have given me greatest joy.

Severance in healthcare should be a sick joke. Jobs in health should be the finest, most rewarding jobs anywhere. There should be no greater priority for any healthcare organisation, system, or country, than finding the path to make this happen.

This blog was first published in the BMJ.