When staff stop believing their voice matters: Response to the 2025 NHS Staff Survey

When Staff stop believing their voice matters

The 2025 NHS Staff Survey makes for difficult reading. Burnout is up. Morale is down. Fewer staff would recommend the NHS as a place to work than at almost any point on record.

But buried in the data is a finding that deserves more attention than it’s getting.

The proportion of staff who feel involved in decisions that affect their work has fallen below half for the first time in four years. The proportion who feel able to make improvements in their area has also fallen to 54%.

These are not peripheral metrics. They speak to the heart of how change happens, or does not, in healthcare organisations.

What the numbers are really saying

It is easy to read these figures as a morale problem. And they are, in part. But they are also a quality and safety problem. When staff feel powerless to shape their work, the pipeline of frontline insight closes. The people closest to patients disengage from the work of improving care.

The survey shows that 63% of staff would be happy with the standard of care their organisation provides for a friend or family member. That is the lowest this figure has ever been. These two things are not unrelated. A workforce that feels unheard is less likely to raise concerns, spot problems, or push for the improvements that keep care safe.

The bright spot that makes the gap harder to ignore

Here is what makes this particularly striking. Line manager metrics are, against the grain, genuinely positive. 73% of staff say their immediate manager encourages them, values their work, and listens when they describe challenges. The metric for managers asking for staff opinion before making decisions that affect their work is at an all-time high (60%).

So the issue is not that relationships are broken at the team level. It is that the broader organisational conditions, the structures, the systems, the cultures of decision-making above the team, are not following through.

Staff feel supported by the person next to them. They do not feel heard by the organisation they work for.

Why this matters for change

Real change in healthcare does not come from the top down, delivered to a passive workforce. It comes from shaping decisions with the people they affect, building alignment, ownership and trust across teams and systems.

When organisations cut staff involvement from the change process, under financial pressure, under time pressure, in the name of efficiency, they do not speed things up. They store up problems. Decisions do not land. Improvement does not stick. Staff disengage further.

We saw this first-hand when we led the staff engagement workstream for the 10 Year Health Plan, reaching more than 3,700 staff across all NHS regions, including many, such as porters, healthcare assistants and primary care support staff, who are rarely asked for their views. The consistent message from staff was not that they lacked ideas or commitment. It was that they rarely felt genuinely heard. When they did, the energy in the room was palpable.

The 10 Year Workforce Plan is an opportunity to change course. It needs to do more than set targets for headcount and retention. It needs to set out how NHS organisations will rebuild the conditions in which staff feel genuinely able to shape the work they do every day. That means investment in organisational development, not just clinical capacity. It means treating staff voice as infrastructure, not an optional extra.

What good looks like

The organisations that consistently outperform on staff experience tend to share some common features. Staff are involved early in change, not consulted after decisions are made. Leaders at every level create space for challenge and honest conversation. Improvement is treated as everyone’s business, not a specialist function.

We have seen what this looks like in practice. Working with Oxleas NHS Foundation Trust, we co-designed a strategy development process that heard from approximately a third of all staff, alongside service users, carers and community members. The process did not just produce a strategy: it changed the relationship between leadership and staff, leading to the creation of staff assemblies with real autonomy to co-design local improvements. Three years on, the Trust reported staff survey results that buck the national trend.

None of this is easy to sustain, especially under the financial and operational pressures the NHS is currently facing. But the survey data tells us that the cost of not doing it is already showing up, in disengaged staff, declining morale, and a workforce that feels increasingly distant from the decisions that shape their working lives.