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  • Staff safety and wellbeing in the NHS: The difference between vision and reality

    Patient Safety Learning


    In this blog the Safer Healthcare and Biosafety Network and Patient Safety Learning reflect on the results of the NHS Staff Survey 2020, considering how staff safety relates to patient safety in the context of this.


    Every year, the NHS surveys its staff to find out about their experiences of working for their respective organisations. This week saw the publication of the 2020 NHS Staff Survey, which had almost 600,000 respondents, representing 47% of NHS staff across 280 NHS organisations.[1] This huge response testifies to the increased pressure placed on healthcare services over the last year. While the results do suggest improvement in some areas, including health and wellbeing, it is clear more work needs to be done as we begin our transition out of the COVID-19 pandemic.

    We can see, for example, that the percentage of staff involved in a safety incident who feel they are treated fairly afterwards has increased in the last year part of a steady increase over the last five years to 60.9%. While improvements are always important, this still leaves shockingly almost 40% of staff who do not feel they would be fairly treated after such an incident. The Survey also reports 73% of staff said their organisation takes action to ensure such accidents do not happen again. This is also an improvement, but raises the question of whether or not these actions actually result in errors not being repeated and harm being avoided. In fact, patient safety incident statistics suggest that they are not being avoided. 

    Some of the lack of action may come from lack of trust within the NHS, as 13.3% of staff said they did not feel safe speaking up about concerns in their organisation. This statistic rises among staff from BME backgrounds or those with long-lasting health conditions. Furthermore, people from those groups were also less likely to say that they felt safe in their work. This surely correlates with the rising workplace discrimination experienced by NHS staff, with 8.4% of staff reporting personally experiencing it in the last 12 months, a 5-year high. 

    Other concerning statistics include: 

    • Over 25% of staff faced bullying, harassment or abuse from a patient, and over 30% faced it from colleagues or a manager.
    • 46% of staff had gone to work in the last 3 months despite not feeling well enough.
    •  44% of staff reported feeling unwell as a result of work related stress, part of a steady increase over the last 5 years.

    Overall, these results make for grim reading and help highlight the major gap between the NHS’s vision for staff safety and wellbeing and the reality on the ground. Even more alarming is the knock-on effects this is having on patient safety standards, where there is now a clear body of evidence that poor healthcare worker safety standards directly contribute to patient safety incidents, with the two intrinsically linked.[2]

    In fact, the 2020 World Patient safety Day saw the World Health Organization formally recognise the interrelation between healthcare worker safety and patient safety, making the day’s official theme, “Health Worker Safety: A Priority for Patient safety”.

    Patient safety remains one of the NHS’s biggest challenges, with research indicating that there are still 11,000 avoidable deaths in the UK each year because of patient safety incidents.[3] This causes not only untold physical and emotional damage for those involved but is estimated at costing the NHS £5 billion a year.[4] However, up to 70% of patient safety events are preventable, meaning that with the correct structures, systems and procedures in place many thousands of lives could be saved each year.

    There are many different ways in which healthcare worker safety can impact patient safety, from the burnout of staff; from working long hours and having a high workload; to the culture of blame preventing learning from safety incidents; to the breakdown in communication and errors in the prescribing of drugs due to outdated technology; and insufficient systems. The multitude of ways that healthcare worker safety can impact patient safety makes it almost impossible to improve standards just by implementing lessons from individual events, and the government must change structures and behaviour to take a holistic systems and standards based approach to both healthcare worker safety and patient safety if they are to achieve their own patient safety ambitions.

    Patient Safety Learning and the Safer Healthcare and Biosafety Network have been calling for action from the government and the NHS to formally recognise the symbiotic interrelationship between healthcare worker safety and patient safety and to implement nationwide standards, practice and structures on patient safety, which combine both improvements in patient safety and healthcare worker safety. The conclusion to be drawn from the results of the 2020 NHS staff survey is that there is still a very long way to go to make this is a reality.

    • You can find the full survey results here.
    • You can also find a range of resources on staff safety issues on the hub here.


    1. NHS Staff Surveys. NHS Staff Survey Results: Results for the 2020 NHS Staff Survey, Last Accessed 16 March 2021.
    2. Patient Safety Learning, Why is staff safety a patient safety issue, 3 September 2020.
    3. NHS England and NHS Improvement. The NHS Patient Safety Strategy: Safer culture, safe systems, safer patients, July 2019.
    4. Patient Safety Learning, The Patient-Safe Future: A Blueprint For Action, 2019. Estimated at a £2.2bn annual cost of litigation and approximately £2.5bn cost of unsafe care.

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