Staff morale is dropping as NHS money pressures grow, says King’s Fund report

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g6539
  1. Adrian O’Dowd
  1. 1London

Worries over deteriorating staff morale and worsening performance are growing among managers as a result of financial pressure on the NHS.

The view has emerged from results of the latest quarterly monitoring report by the health think tank the King’s Fund, published on 30 October.1

Views were sought from 248 NHS trust finance directors, 90 of whom responded, for the three months of July to September and from 202 clinical commissioning group (CCG) finance leads, of whom 43 responded.

Almost half (47%) of the trust finance directors who responded listed staff morale as highest of their top three concerns, twice the proportion in the previous quarter. The report’s authors said this was a significant cause for concern because of the close link between staff engagement and quality of care.

Financial pressure on trusts and commissioning groups was evident, the authors said. “Our latest survey of finance directors reveals the highest level of pessimism about the financial position of health organisations since we began surveying in the autumn of 2011,” the report said. “For the first time since we began our quarterly survey, no one expressed any degree of optimism about the financial state of their local health economies over the next year.”

More than a third (37%) of trust finance directors forecast that their organisation would be in deficit by the end of the year, the highest proportion since the survey began. Around half of all acute trust directors included in the survey forecast a deficit at the end of the financial year. In addition, more than half (57%) were concerned that their trust might not be able to meet its cost improvement target for the current year, which indicated that it was getting more difficult to find efficiency savings.

Commissioners were more optimistic about their financial position, with around 70% of CCG finance leads surveyed saying that they expected to end the year in surplus.

Pressure on the NHS was having an effect on performance, said the report, with waiting times targets being missed across the quarter for emergency departments, hospital treatment for inpatients, and cancer treatment.

The results showed that 5% of patients spent four or more hours in the emergency department over the quarter, the highest level at this time of year for a decade.

Richard Murray, director of policy at the King’s Fund, said, “The NHS relies on the dedication of its staff, so the growing concern about staff morale is worrying. Given the close association between staff engagement and quality of care, this is a warning sign that should be taken seriously by NHS leaders.”

Murray told The BMJ, “This was a survey of finance directors, not medical or nursing directors or to HR [human resources], so you might wonder: how bad does it have to get before finance directors are putting this as their number one concern above any issue directly related to finance or performance?

“From conversations we have been having with acute hospitals, there are growing concerns over workload. Also, the number of people being admitted to hospital through A&E [accident and emergency departments] and the number of people being referred by GPs goes up and up and is growing quite quickly. That is placing more and more demand on staff.”


Cite this as: BMJ 2014;349:g6539


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