The Kings Fund, in collaboration with Picker, (an international charity dedicated to high quality health and social care), have produced an excellent report which examines the impact the current NHS pressures are placing on staff and patient care.

There is a wealth of evidence to demonstrate a strong link exists between the health and wellbeing of staff and the impact on patient outcomes, safety, and quality of care.  Given the unprecedented pressures the NHS is currently facing – financial, staffing shortages, staff dissatisfaction with pay and work pressures etc, and the potential impact this may have on quality of care – it is important that staff welfare is continually reviewed.

This report focuses on the following questions:

  • How does NHS staff experience vary with levels of staffing, sickness absence, spend on agency staff and bed occupancy in NHS hospitals, and is there an association with the size of trust?
  • How does patient experience vary with these same factors?
  • What is the relationship between staff and patient perspectives on care?

Data relating to staff and patient experience, workforce numbers, and contextual variables, (e.g. number of admissions, number of beds etc), at 134 general acute trusts in England was analysed for this report.


The key findings are summarised under four main headings:

  1. Distribution of the workforce variables and staff and patient experience responses

This data was collected as background information.  The analysis showed that sick absence rates were evenly distributed across trusts.  Most trusts had bed occupancy rates above the recommended 85% with minimum occupancy over 70%.  There were a number of outliers when looking at staffing ratios with relatively high numbers of doctors and nurses per bed.  Agency staffing spend was only available as a ranking.

  1. Associations between workforce variables and staff experience

The strongest association with staff experience were sickness absence rates and spend on agency staff.   Staff reported experience was generally more negative in trusts where sickness absence rates were higher and was highlighted in the feedback to three questions relating to the quality of care they were able to provide to patients, to the organisation’s prioritisation of patient care, and to ability to act on patient feedback.  In trusts with higher sick absence rates, the proportions of staff happy with the standard of care that would be provided to a friend or relative were lower.

  1. Associations between workforce variables and patient experience

Patient reported feedback showed a strong association with spend on agency staff, (the higher the spend, the lower the patient satisfaction), the number of nurses per occupied bed, bed occupancy, and the number of doctors per bed.  The negative associations with spend on agency staff were strongest for questions relating to: communication with doctors, staff working well together, confidence/trust in doctors,  confidence in decisions relating to care/treatment,  finding someone to talk to about worries, and overall patient experience rating.

  1. Associations between staff experience and patient

There was a clear relationship between staff-reported experience and patient feedback in several areas – particularly between staff perceptions of patient care and patient experience such as staff responses to; “care of patients/service users is my organisation’s top priority”, “my organisation acts on concerns raised by patients/service users”, and “I would recommend my organisation as a place to work”.  Patient experience was generally more positive in trusts where staff reported lower rates of work-related stress.

The authors conclude that whilst it is not possible to demonstrate cause and effect, their findings of associations between workforce factors, bed availability, and staff and patient experience, are in line with the findings of other research.  This would imply an urgent need to address the workforce and NHS capacity issues highlighted by others. The authors suggest that trust managers note these findings as they have implications for organisational workforce policies and protocols, and the authors re-iterate their recommendation to monitor these associations on an ongoing basis.

To read the full text of this  Kings Fund/Picker report please click here.