My plan for today was to largely talk about the results of the 2024 National NHS Staff Survey, which were published yesterday for all Trusts in England including East Lancashire Hospitals (ELHT).
The survey is one of the largest of its kind in the world and designed to help understand what working here feels like for colleagues in all teams, services and settings – so it’s important, no doubt.
But there is a lot of other stuff going on in the NHS currently which I will try and cover too.
To this point, this will also be my last blog until after the local elections in May in recognition that the NHS is a publicly funded organisation at the heart of national policy and politics – and it’s right I step out whilst campaigning and, ultimately, voting takes place.
It is my opinion that to understand the results of the survey we need to appreciate the context provided by the wider NHS too. The staff survey has been in place for decades and I have said before that the history of the NHS over more than 75 years is both its strength and weakness equally.
The way we have grown and expanded into new services, embracing new research and developments in treatment is, quite frankly, amazing when you consider where we started, but often our buildings, our processes, our soft and hardware struggles to keep up and, no doubt, it’s a challenge to afford everything when more and more patients need more and more care.
Most NHS organisations – and particularly ‘providers’ like ELHT (named as we literally ‘provide’ care on the front line) – analyse, track and utilise responses from the survey diligently to understand issues, agree new areas to focus on and improve and, generally, understand what life in our bit of the NHS is really like.
Of course, it’s important because it is a base line for us to see where we progress or deteriorate, shaping key priorities. The survey helps us to see if we have made a difference by focusing on something and, in turn, helps us to determine if we’re effective in our work to support our teams.
And while the survey has come in for criticism for its length at 119 questions in total, the beauty of everyone doing the same thing means we can compare and, ultimately, learn from others who may be achieving more or breaking new ground in a way we are not.
We always encourage and support all colleagues to complete the survey when it is open for a couple of months in the autumn and when the results are published we spend time sharing the specific details with individual teams and working up action plans. I remain of the mind it is a worthwhile, valuable exercise and there are myriad examples of what we have done or changed over the years because of the feedback we have had.
But it is clear too that the NHS has had a tumultuous few years which have taken a toll on everyone who works within it. I spoke last week about the first national Day of Reflection last Sunday, introduced by the Government in response to the inquiry into the pandemic. I won’t repeat myself but it is clear and unequivocal that Covid had a huge impact on everyone in health and social care and some of the emotional challenges that emerged during that time are very much still alive.
If we add to that the immense pressure to reduce waiting lists that followed and remains, the record-breaking numbers of people attending each and every day for urgent and emergency care, the impact of this across every team in the Trust, both in hospital and in the community, and the inevitable strain on our budget – the picture of what it feels like to be part of the NHS and ELHT starts to take shape.
It is no surprise that this week we learned that the number of people applying to become nurses has dropped significantly and steadily in recent years. This I am sure is a direct result of the narrative in the media and the feedback from existing nurses about how hard it is.
In recent years we have also been working with providers across Lancashire and South Cumbria to bring our corporate services together as one team supporting our front line activity as effectively as possible. The culmination of this work was that around 4,000 colleagues from as far afield as Morecambe Bay, Blackpool, Preston and all of East Lancashire were officially transferred into a new entity called One LSC in November and I know this was and remains an anxious time for that team too.
These are just some of the challenges that spring to mind when I consider staff morale and well being and it is, in some ways, surprising that anyone was able to find the time or motivation to complete 119 questions at all.
Yet an amazing 4,218 colleagues did and I am grateful to them for doing so, amongst everything else they were dealing with, both at work and at home. That is about 42 per cent of the team at ELHT, a slight drop from the number who responded in 2023, but nevertheless it’s never been more important to hear this feedback and to act upon it too.
The survey is incredibly detailed and over the coming weeks the specifics will be broken down and shared with teams, services and settings, so that they can explore and plan improvements that matter. I want to share some of the headlines here too, the main one being that it is an obvious disappointment we have deteriorated in some areas, albeit to my points above I can understand why.
Part of the survey is based around the themes included in the national NHS People Promise which, as it sounds, looks at how we treat people and, more importantly, how they feel treated by us. There are nine themes in total, graded across England from the ‘best’ to the ‘worst’ performances of Trusts. ELHT has always done well in this area, but in 2024 we find ourselves in the ‘average’ bracket. I would quantify it as somewhere in the middle, not the best, not the worst.
I was pleased to see that we had held our own on learning and working as a team – and regular readers of this blog and, indeed, colleagues who work in ELHT will recognise our enduring strength and commitment to both of these areas I think.
Out of the 119 questions asked, 79 showed no real change for ELHT from 2023 to 2024. Six were significantly better and 15 worse. Compared with other Trusts who used the same company to deliver the survey to ensure its anonymity, ELHT was better than others on 26 questions, the same for 64 and worse for 11. Whilst not an excuse, this clearly shows that colleagues in similar organisations are grappling with some similar issues and we are, on the whole, holding our own, even though we really want to do better.
It was pleasing to see that areas picked up as issues last year and prioritised for improvement showed an upward trend – things like having an appraisal, not working lots of extra hours or coming in when not well and having a manager who cares about concerns and works with colleagues to understand problems all got improved scores.
But it would be remiss of me not to be honest and highlight that some really important and key areas declined and this includes recommending the organisation as a place to work or as a place for family and friends to receive care. These scores deteriorated by 4.9 per cent and 3.9 per cent respectively which is particularly important when you consider over 80 per cent of the team live in East Lancashire and our services are the ones they turn to when they need care too.
I appreciate a lot of these concerns will be rooted in the experiences of colleagues who have had to care for people on corridors and witness some long waits to be seen for patients and acknowledge, again, this isn’t what anyone in the NHS wants or joins the team to do.
Within the staff survey, there is a huge amount of focus on the culture of the organisation and, in particular, experiences of colleagues with protected characteristics such as gender, sexuality, disability, ethnicity, age, race or religion. I remain committed to a compassionate culture at the Trust which values, recognises and treats everyone equally. This stands for patients and colleagues alike and I find it difficult to tolerate someone who doesn’t feel strongly about this, truth be told.
For this reason we have prioritised some resources to improve experiences of people in recent years including creating staff networks offering support and leadership, promotion of a ‘speaking up’ culture, a comprehensive and hard-hitting anti-racism campaign which you will see throughout the Trust and a health and well being programme available to all.
Our 2024 results show a mixed bag of progress. We do have lower harassment rates than the national average and, whilst there is still a gap between white and ethnic minority colleagues, it is reducing. The responses show that this is worse for colleagues with a disability, but that we are better than the national average on this too. Worryingly we have seen a rise in the number of people with a disability reporting bullying and/or harassment from managers and colleagues and ethnic colleagues are three times as likely to experience it than others.
Our scores on equal opportunities – and colleagues believing this is the case – remains reasonably stable but there is an undeniable gap here too between how white and ethnic minority candidates are treated.
My wish is that we continue our work on improving these experiences so that everyone feels safe and healthy, rewarded, recognised and valued at the Trust no matter their background or which service or setting they are in. There is a lot more to do, no doubt.
And this is where the current operating climate and a lot of moving parts across the NHS nationally come into the picture – and not least the need for us to reduce our costs and balance our budget immediately, without compromising on patient safety and the quality of services. To protect – enhance even – colleague experience as part of this is going to be a huge challenge for all of us.
It looks likely that in the next few weeks we will close our financial position for 2024-25 significantly over drawn and committing to reducing spending by a similar amount in 2025-26. I have been clear with colleagues here at ELHT, within the region and nationally that this will require some difficult decisions around services, managing through improvement and transformation where possible, but it is inevitable that we will have to reduce the number of people who work at the Trust as part of this.
In addition, just in the last few days and weeks, we have heard that key colleagues will leave, partner organisations such as the Integrated Care Board will shrink significantly and NHS England as a central body will be demolished. No matter your view or political persuasion on this, it must be remembered that behind each of these decisions are people who came to work to do a good job and have their own out goings and lives in the background.
It is an anxious time for everyone but this doesn’t negate from the work we have to do for our patients and their families. I want to say a huge thank you to all colleagues, across all teams, for their ongoing compassion and dedication. I am determined that whilst safe and high-quality services and our patients and their families remain a priority, colleagues are supported and recognised for everything they are doing and dealing with too.
I have said many times before that when we are going through tough times there is nowhere else I would rather be – and no other team could manage it any better either. ELHT is blessed to have brilliant people with incredible talent and personal resilience in spades.
We will continue to work through this together, supporting each other.
Please, keeping talking, sharing your experience and giving your ideas and feedback, whether you are a colleague, patient, visitor or partner. This will be key as we face the challenges and determine the future for the Trust.
Martin