We are world leaders in patient feedback

NHS England’s Director for Experience, Participation and Equalities explains the importance of the NHS Staff Survey:

People often make comparisons between the NHS and other health systems around the world.

But when I meet people from Canada, Australia, the USA or Europe, they often tell me the NHS is a world leader in patient feedback.

This comes in many forms but national surveys are amongst the most useful in setting a benchmark for how well the NHS is performing.

Perhaps the most influential is the NHS Staff Survey, the largest annual assessment of NHS staff opinion, whose latest results – from a response rate of a huge 46% – have just been published.

It might seem surprising that the Staff Survey is so highly valued as an indicator of patient as well as staff experience; yet the biggest determinant of patient experience is how well staff feel supported by their organisations.

I am always struck by a comment from patient leader Katie Clarke-Day – who blogs and tweets her perspectives –  that staff experience and patient experience are two sides of the same coin. Each influences the other and we need to invest in both to deliver sustainably high-quality care.

That’s why we have made real efforts to improve the NHS Staff Survey as a source of insight. This has partly been achieved by increasing the number of responses, which has grown from 100,000 in 2012 to 497,000 in 2018. Although the NHS Staff Survey does not cover general practice, it is a remarkable snapshot of what life is like in NHS Trusts, 209 of whom (out of a total of 230) surveyed all their staff this year.

Yvonne Coghill, director of the NHS Workforce Racial Equality Standard, has also pointed out that where Black and Minority Ethnic staff experience is improving, so is the experience of all staff groups.

There is also a strong positive correlation between BME staff experience and patient experience. Jeremy Dawson, from the University of Sheffield, has concluded from his analysis that ‘the extent to which an organisation values its minority staff is a good barometer of how well patients are likely to feel cared for.’

It’s pleasing, therefore, that in 2018 we had responses from over 78,000 BME staff in the NHS, up 7% on the previous year, itself a 21% improvement on the year before. This means that 16% of responses to the survey are from BME staff, compared with 14% in 2014.

Race is one dimension of inclusion, of course, and the findings from staff with other protected characteristics are equally important. It was good this year to see an improvement in disabled staff believing their trust provides equal opportunities for career progression, although overall there was some deterioration in the NHS’s scores on equality.

At the same time as increasing the number of responses, we’ve also been working to make all our surveys more cost effective. The NHS Staff Survey has seen a distinct shift online in recent years. Only a fifth completed the survey online in 2013. Today, only a fifth rely on paper.

Sadly, we are not yet able to move all our patient surveys completely online – we don’t have email addresses that would make it possible and there are still many patents who don’t use the internet. But the number of patients completing our surveys online is increasing every year too, so we get more for our investment.

Of course, there is only value in insight if it is used. We know that the NHS Staff Survey is one of the first sources of information that inspectors turn to when they visit an NHS trust. Because the survey allows comparisons to be made between trusts, locations and staff groups, it is also a valuable tool for managers, unions and staff networks.

Improvement comes from partnership working between staff and managers and probably the most welcome finding of recent surveys is that such effort is paying off, with improvements in the experience of appraisals, support from line managers and the quality of engagement with staff. But without data, we would not know for sure either what pressures NHS staff are facing or whether their experience is getting better. The results have never been easier to slice and dice according to your interests, via the new online tool.

Our surveys may make the NHS a world leader but their real benefit is helping us to focus relentlessly on those things that make the biggest difference to staff and patients, making world-class care possible.

Dr Neil Churchill

Neil is Director for People and Communities at NHS England, having joined the NHS after a 25-year career in the voluntary sector. His work includes understanding people’s experiences of the NHS, involving people and communities in decision-making and leading change to improve the quality and equality of care. He has a particular focus on strengthening partnerships with unpaid carers, volunteers and the voluntary sector.

Neil has previously been a non-executive director for the NHS in the South of England, is a member of the Strategy Board for the Beryl Institute and Chair of Care for the Carers in East Sussex. He is himself an unpaid carer. Neil tweets as @neilgchurchill


  1. Anne Milstead says:

    I would like to ask Dr Churchill why NHS does not fully support GP Patient Participation Groups on the ground. Where I live, out of over 50 practices, we only have 5 that are allowed to run and are supported by Practice managers and GPs, this despite it still being a contractual requirement.
    A good and active PPG represents a massive resource that can be enrolled to support the GP practices, CCG procurement, and interaction with fellow patients to say the least.
    When we get a really positive steer from NHSE or does NHSE in reality not want Patient Engagement?

    • NHS England says:

      Hi Anne,

      Thank you for your comment.

      We are very supportive of Patient Participation Groups and there is work underway to look at how we can encourage the development of these as meaningful ways to connect General Practice and Primary Care to local people and communities.

      You might be interested in the Primary Care Network Programme which has a specific workstream to look at how networks can work in partnership with people and communities to improve local services and enable people and communities to be involved as essential partners. More information about the programme, including a series of webinars is available here:

      Kind regards
      NHS England