Intended for healthcare professionals


Stress levels of NHS staff are “astonishingly high” and need treating as a public health problem, says King’s Fund

BMJ 2015; 351 doi: (Published 06 November 2015) Cite this as: BMJ 2015;351:h6003
  1. Matthew Limb
  1. 1BMJ Careers
  1. limb{at}

Levels of stress among NHS staff are “astonishingly high,” probably getting worse, and should be treated as a public health problem, the head of thought leadership at the King’s Fund has said.

Michael West said that widespread action was needed and that politicians should think carefully about the sort of health service they were creating. “At the national level the idea we can keep providing higher and higher quality care and more and more sophisticated treatments on a shrinking budget means that the pressures just increase on the staff, who are being asked to do more with less continually,” he said. “It’s such a huge problem across the NHS, and it’s as though we’ve come to accept it as being part of the territory—when it’s really unacceptable.”

West was speaking to BMJ Careers about the findings in the fund’s latest quarterly monitoring report, the fifth in a row to show staff morale topping the list of concerns of directors of NHS foundation trusts.1 The issue was mentioned by nearly a quarter of trusts and came higher up the list than a host of other concerns, such as delayed transfers of care and waiting times for treatment.

West said, “The evidence we have is that the level of staff stress in the NHS is astonishingly high and has been so for some years.” He said that problems were deep seated and that it was “highly likely” that the situation was getting worse. Evidence from the past 12 years showed that growing economic pressure affected staff who worked extra hours without pay, he said.

West said that the latest quarterly report findings of the King’s Fund were not surprising, as staff were now exposed to a “perfect and continuous storm” of pressures, including “great uncertainty,” increasing demand, and constraints on funding. “There’s an inherent irony or paradox that here is a sector that’s charged with promoting the health and wellbeing of the population but is damaging the health and wellbeing of staff in the process,” he said. “Stress kills people—it damages immune function, it damages people’s quality of life, it damages family relationships—so it’s very much a public health problem.”

He said that NHS staff consistently came highest in the Health and Safety Executive’s ranking for levels of work related stress, depression, and anxiety. But in the last NHS Staff Survey only 43% of staff said that their organisation acted positively on health and wellbeing.

West has written in a blog for the Kings’ Fund about how NHS leaders should respond ( He said that stress was the result of a “toxic cocktail” of high work demands coupled with low levels of control and support, so all three of these elements must be dealt with. “It’s not just about financial resources: it’s about using existing resources in more intelligent ways,” he told BMJ Careers. “It’s about time, and it’s about focusing on ways of enabling staff to deliver the services they want to deliver, so giving more autonomy and more freedom to make decisions at a frontline level.”

Trusts should ensure better team working, helping staff to review performance and free them from unnecessary tasks, he believes. “Managers should see that their role is not to whip staff ever harder but to listen and learn about what they need to do to support staff to do their jobs more effectively,” he said. “You may say that’s using up more resources, but the evidence we have is that when teams do that they’re 25% more effective and productive than teams that don’t.”

He said that some NHS trusts were dealing effectively with stress problems among staff, so other trusts “should be beating a path to their doors to learn about how they’re achieving that.” He added, “The national bodies, it seems to me, have a real role to play in that. Standing on the sidelines waving big sticks is not really going to help the situation. It’s much more about improvement and disseminating good practice.”


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