Health and social care - staff experience: report 2021

Staff Governance Standards – Components

Staff Governance is a key component of the governance framework used to monitor and manage the performance of NHS Scotland organisations. Staff Governance considers both how effectively staff are managed and also how staff feel they are managed. The standard was underpinned in legislation in 2004 and its component strands as shown below continue to be monitored, both locally and nationally.

Staff Governance Standard – Scores

The strands of the Staff Governance Standard were mapped against the 20 components forming part of the Staff Experience Framework (see Appendix 12). The 28 questions were then mapped to the 20 components and Staff Governance Standards to provide a measure of Employee Engagement (see Appendix 13).

The highest scores are for being 'well informed' and 'being treated fairly and consistently, with dignity and respect', with 69% and 64% respectively scoring Strive & Celebrate. The lowest scores are for 'involvement in decisions' and for 'appropriate training and development'.

The Staff Governance Standard Strand reported scores had remained unchanged in 2019 from their 2018 scores. 2021 has seen movement in 4 of the 5 Strands, with 'Well Informed' declining by 2 points.

Staff Governance Standards – Scores	Weighted Index Value
	2017	2018	2019	2021	Movement 2021 - 2019
Well informed	80	80	80	78	-2
Appropriately trained and developed	73	74	74	73	-1
Involved in decisions	71	71	71	70	-1
Treated fairly & consistently, with dignity & respect, in an environment where diversity is valued	77	77	77	77	0
Provided with a continuously improving & safe working environment, promoting health & wellbeing of staff, patients & the wider community	76	77	77	76	-1

Summary

Strengths in the Staff Governance Standards are around the way staff are treated, clarity around their role and the relationship staff have with their line manager. These aspects all score above 80 and typically remained unchanged from 2019.

Areas of continued and growing concern are staff not feeling involved in decisions that affect them, visibility of and confidence in, Board Members and the extent to which performance is managed. This suggests that as we emerge from the COVID-19 pandemic, the organisations should look to engage and involve staff more and put focus back into personal and career development for staff.

Survey Questions

iMatter 2021

Experience as an Individual
I am clear about my duties and responsibilities	86
I am treated with dignity and respect as an individual	83
I am treated fairly and consistently	81
My work gives me a sense of achievement	79
I get the information I need to do my job well	79
I have sufficient support to do my job well	76
I am confident my ideas and suggestions are listened to	74
I feel appreciated for the work I do	73
I get enough helpful feedback on how well I do my work	73
I am given the time and resources to support my learning growth	70
I am confident my ideas and suggestion are acted upon	70
I feel involved in decisions relating to my job	70
My Team/My Direct Line Manager
My direct line manager is sufficiently approachable	87
I feel my direct line manager cares about my health and well-being	84
I have confidence and trust in my direct line manager	84
I would recommend my team as a good one to be a part of	83
My team works well together	82
I am confident performance is managed well within my team	77
I feel involved in decisions relating to my team	75
My Organisation
I understand how my role contributes to the goals of my organisation	82
I would be happy for a friend or relative to access services within my organisation	77
I would recommend my organisation as a good place to work	73
I get the help and support I need from other teams and services within the organisation to do my job	70
I feel my organisation cares about my health and wellbeing	70
I am confident performance is managed well within my organisation	62
I have confidence and trust in senior managers/Board Members responsible for the wider organisation*	61
I feel senior managers/Board Members responsible for the wider organisation are sufficiently visible*	55
I feel involved in decisions relating to my organisation	55

Experience as an Individual

Results are aggregated for each question presented under the heading 'As an Individual'.

Overall, the highest scores within Experience as an Individual are seen for:

• Clear about duties and responsibilities (86)
• Treated with dignity & respect (83)
• Treated fairly & consistently (81)

This suggests that despite the disruption through the COVID-19 pandemic, staff were treated well and remained clear about what their role was, even if that role had changed as it did for so many staff.

The lowest scores in 'Experience as an Individual' are for:

• I get enough helpful feedback on how well I do my work (70)
• I am given the time and resources to support my learning growth (70)
• I am confident my ideas and suggestions are acted upon (70)

The first two of these statements relate to staff development and the third to staff feeling they are heard. The lower scores for these areas suggest a need for focus going forward to be on the future and staff development, rather than the short-term immediate crisis which has understandably been the focus over the last 18 months.

Movement in scores from 2019 range from no change to a drop of 2 points. The four that have not moved from 2019 are:

• I am treated with dignity and respect as an individual
• I am treated fairly and consistently
• I feel involved in decisions relating to my job
• I get enough helpful feedback on how well I do my work

Four areas have declined by 2 points from 2019:

• My work gives me a sense of achievement
• I get the information I need to do my job well
• I have sufficient support to do my job well
• I am given the time and resources to support my learning growth

The decline in these scores, emphasises the need for staff support, both to help them perform well in their current role through information and support, but also the need to support their future development.

Experience as an Individual	2017	2018	2019	2021	Movement 2021 - 2019
I am clear about my duties and responsibilities	88	88	87	86	-1
I am treated with dignity and respect as an individual	82	83	83	83	0
I am treated fairly and consistently	81	81	81	81	0
My work gives me a sense of achievement	81	81	81	79	-2
I get the information I need to do my job well	81	81	81	79	-2
I have sufficient support to do my job well	77	78	78	76	-2
I am confident my ideas and suggestions are listened to	75	75	75	74	-1
I feel appreciated for the work I do	73	74	74	73	-1
I get enough helpful feedback on how well I do my work	73	73	73	73	0
I am given the time and resources to support my learning growth	71	72	72	70	-2
I am confident my ideas and suggestion are acted upon	71	71	71	70	-1
I feel involved in decisions relating to my job	71	71	70	70	0

The table above illustrates how the distribution of ratings within each component has changed from 2019 to 2021. A number of points stand out in this analysis:

• There has been a drop of 5 percentage points in the share of staff rating 'I get the information I need to do my job well' as 'Strive and Celebrate', with that movement then distributed across the other points on the answer scale. This suggests staff are less content with this aspect of their experience
• The proportion of staff scoring 'Focus to Improve' or Improve to Monitor for 'I am given the time and resources to support my learning and development' has increased by 4 percentage points, a notable increase in the share of people who are actively dissatisfied with this aspect of their work

Individual Boards

Appendix 14 contains Experience as an Individual scores for each Board.

There is a reasonably high level of consistency across the Geographic Boards, with NHS Lanarkshire and NHS Shetland typically scoring highest and NHS Orkney lowest. In terms of movement from 2019, NHS Western Isles is the only patient-facing Board that has achieved increases in many of the Experience as an Individual components

• 'I am treated with dignity and respect as an individual' and 'I feel appreciated for the work I do' have both increased by 2 points from 2019
• In contrast, NHS Orkney 2021 experience as an Individual scores have declined by 4 to 7 points from 2019

It is notable that 'My work gives me a sense of achievement' has declined in all Geographic Boards, illustrating that despite the public recognition of the work done by Health & Social Care staff through the COVID-19 pandemic, staff's own sense of achievement has gone down. This may also link to concerns seen elsewhere around personal development.

Among the patient-facing National Boards, Scottish Ambulance Service typically has the lowest scores, though is similar to other Boards for:

• I am clear about my duties and responsibilities (84)
• My work gives me a sense of achievement (77)

The lowest for the Scottish Ambulance Service is in 'I am given the time and resources to support my learning growth' (down 2 points to 54), again highlighting the need going forward to focus on staff development.

NHS 24 and The State Hospital have the highest scores of all Boards for 'I am clear about my duties and responsibilities' (88)

Golden Jubilee Foundation scores have moved the most from 2017, all down by between 3 and 6 points, the largest declines (-6 points) being in:

• I get the information I need to do my job well
• I am given the time and resources to support my learning growth

Among the National Boards, NHS Education for Scotland has the highest scores and these have typically increased by 2 points from 2019. Healthcare Improvement Scotland and National Services Scotland have also seen increases in many of the Experience as an Individual components.

Staff Groupings

Staff in Local Authority roles rate their Experience as an Individual 1 point higher than NHSScotland staff for eight of the eleven measures. The exceptions are:

• 'I am clear about my duties and responsibilities', scored 86 by both Local Authority and NHSScotland staff
• 'I get enough helpful feedback on how well I do my work' and 'My work gives me a sense of achievement' for which Local Authority staff score 2 points higher than NHSScotland staff

Appendix 15 illustrates how My Organisation scores differ across the staff groupings in NHSScotland and Local Authorities.

NHSScotland Staff Groupings

Across staff in NHSScotland roles, Senior Managers have the highest scores for most of the statements in Experience as an Individual, and Ambulance Services staff score lowest. The two ratings not scored highest by Senior Managers are 'I am given the time and resources to support my learning growth' and 'I have sufficient support to do my job well', where Personal & Social Care and Personal & Social Care /Administrative Services have the highest scores respectively.

It is important to note the consistency in scores across all NHSScotland staff groupings for 'I am clear about my duties and responsibilities' with a range of only 3 points from the highest to lowest scores. In contrast 'I feel involved in decisions relating to my job' varies by 26 points from 55 for Ambulance Service to 81 for Senior Managers.

Local Authority Staff Groupings

Across staff in Local Authority roles, Senior Managers typically have the highest scores for their Experience as an Individual. There are four exceptions to this:

• 'I am treated with dignity and respect as an individual' and 'I get enough helpful feedback on how well I do my work', both of which score highest among staff in Strategic Development
• 'I am given the time and resources to support my learning growth' and 'I have sufficient support to do my job well' where those in Criminal Justice have the highest scores

The smallest variation in scores across the Local Authority staff grouping is for 'My work gives me a sense of achievement' and the largest is in 'I feel involved in decisions relating to my job' where staff in Older People services score 16 points lower than Senior Managers.

Movement from 2021

Across the NHSScotland staff groupings, movements in scores for My Experience as an Individual from 2019 to 2021 are typically between -3 and +1. The only movement greater than that is among Nursing and Midwifery staff for 'I am given the time and resources to support my learning growth', where the score has declined 4 points.

All scores for My Experience as an Individual among Nursing and Midwifery staff have gone down in 2021 compared to 2019. In contrast, most scores have gone up or remained the same for staff in Administrative Services and Personal and Social Care.

Among Local Authority staff, those in Adult Services and Older People Services are generally scoring lower than in 2019. The largest declines are in Older People Services and suggest a need for more support and acknowledgement of the work done by these staff

• I feel appreciated for the work I do (-5 points)
• I get enough helpful feedback on how well I do my work (-5 points)

In contrast several Local Authority staff groupings have scores that are much higher than in 2019. Of particular note are Senior Managers, where most scores have increased, with the largest being 'I feel involved in decisions relating to my job', up 12 points from 2018, 'I am confident my ideas and suggestions are listened to', up 9 points and 'I am confident my ideas and suggestion are acted upon', up 8 points.

NHS Highland feedback on Local Authority Senior Managers:

"The newly appointed Chief Officer to the Argyll and Bute HSCP has actively encouraged engagement with the iMatter process across all levels. Through the senior leadership team and local iMatter lead, managers were supported though all aspects of the timeline and were provided access to relevant support, guidance and information designed to increase effective engagement."

NHS Fife Health & Social Care Partnership staff comments:

"The work done across SLT and ELT to co-produce and embed the revised structure has helped to improve connectivity and a belief in senior leadership's ability to co-design and drive change / improvement

The SLT and ELT development forums introduced have allowed iMatter to stay on the leadership agenda and raised expectations of engagement through the system

The use of a variety of communications approaches to keep iMatter live, e.g.

• The weekly Directors brief,
• Increased visibility of the Director and Senior Leadership Team across the Partnership,
• Bitesize held by leaders for staff,
• Ongoing engagement with the LPF"

My Team / My Direct Line Manager

Results are aggregated for each question presented under the heading 'My Team / My Direct Line Manager'.

All but one of the Team/Line Manager components are unchanged from 2019 (Involved in decisions has gone down 1 point). Given the unprecedented experiences of the last 18 months this is testament to the strength of in-team collaboration and the support given by line managers to their staff.

Highest scores are for 'My direct line manager is sufficiently approachable' (84) and 'I have confidence and trust in my direct line manager' (84).

Areas for focus for the future are 'I feel involved in decisions relating to my team' (75) and 'I am confident performance is managed well within my team' (77).

My Team/My Direct Line Manager	2017	2018	2019	2021	Movement 2021 - 2019
My direct line manager is sufficiently approachable	86	87	87	87	0
I feel my direct line manager cares about my health and well-being	84	84	84	84	0
I have confidence and trust in my direct line manager	83	84	84	84	0
I would recommend my team as a good one to be a part of	82	83	83	83	0
My team works well together	81	82	82	82	0
I am confident performance is managed well within my team	77	77	77	77	0
I feel involved in decisions relating to my team	75	76	76	75	-1

The chart following illustrates how the distribution of ratings within each component has changed from 2019 to 2021. It illustrates how consistent responses are to the My Team/My Line Manager components. The only movement of more than 1 percentage point is the increase from 10% to 12% of staff scoring 'I feel involved in decisions relating to my team' as Focus to Improve.

Individual Boards

Again, there is considerable consistency in scores across the majority of Geographic Boards, with most measures scoring 80 or above, the exception being 'I am confident performance is managed well within my team', that ranges from 69 in NHS Orkney to 84 in NHS Lanarkshire. See Appendix 16 for details.

NHS Western Isles scores have all increased by 2 points from 2019, contrasting with NHS Orkney that has the lowest scores of the Geographic Boards. NHS Orkney scores have gone down between 3 and 6 points from 2019

Scottish Ambulance Service has the lowest score for all measures, with particular concerns around performance management with 'I am confident performance is managed well within my team' down 2 points from 2017 to a score of 67 in 2021.

However, the scores for 'My team works well together' and 'I would recommend my team as a good one to be a part of' have both improved by 2 points from 2019, reflecting the high levels of 'team spirit' within the Scottish Ambulance Service.

Among the National Boards, Healthcare Improvement Scotland, Public Health Scotland and NHS Education for Scotland score above 90 for the three measures relating directly to the line manager relationship:

• I feel my direct line manager cares about my health and well-being
• My direct line manager is sufficiently approachable
• I have confidence and trust in my direct line manager

NHS Education for Scotland scores have increased by 3 or 4 points from 2019.

Staff Groupings

Local Authority staff score their Team/Direct Line Manager the same or one point higher than NHSScotland Staff.

Appendix 17 illustrates how My Organisation scores differ across the staff groupings in NHSScotland and Local Authorities.

NHSScotland Staff Groupings

Across staff in NHSScotland roles, Senior Managers have the highest scores for all of the statements in My Team/My Line Manager, and Ambulance Services staff score lowest. Allied Health Profession and Nursing & Midwifery share the same highest score (83) as Senior Management for 'My team works well together'.

The smallest variations in scores across the NHSScotland staff grouping are 'My team works well together' (6 points) and 'I would recommend my team as a good one to be a part of' (8 points). The largest variation is in 'I feel my direct line manager cares about my health and well-being', ranging from 77 among Ambulance Service to 90 among Senior Managers.

Local Authority Staff Groupings

Across staff in Local Authority roles, Senior Managers and staff in Strategic Development have the highest scores for My Team/My Direct Line Manager and Older people Services have the lowest scores.

The variation in scores across Local Authority staff groupings is lowest for 'I would recommend my team as a good one to be a part of', with a range of only 4 points. The greatest variation is in 'I feel involved in decisions relating to my team' where Senior Managers score 86 and Older People Services score 72.

Movement from 2021

Across the NHSScotland staff groupings, movements in scores for My Team/My Direct Line Manager are very small, with all measures moving no more than plus or minus two points. Three staff groupings have seen increases in all their scores from 2019:

• Senior Managers
• Other Therapeutic
• Health Science Services

Among Local Authority staff there is contrast with most staff groupings seeing improvements in scores from 2019, while Older People Services and Adult Services have both declined. The biggest improvement in scores is again among Senior Managers with an 8 point increase in 'I feel involved in decisions relating to my team'.

My Organisation

Results are aggregated for each question presented under the heading 'My Organisation', where Organisation refers to and includes both the relevant NHS Board and Health & Social Care Partnership(s).

Many of the scores with My Organisation are lower than those seen for Experience as an Individual and My Team/My Line Manager. The lowest scores are for:

• I feel Board Members responsible for the wider organisation are sufficiently visible* (55)
• I feel involved in decisions relating to my organisation (55)

The two components that have declined the most from 2019 are ones that have had wording changes this year (see following for further details):

• I have confidence and trust in senior managers/Board Members responsible for the wider organisation*, down 3 points from 2017 to 61
• I feel senior managers/Board Members responsible for the wider organisation are sufficiently visible*, down 7 points from 2017 to 55

The two components that have otherwise declined the most, down 2 points from 2019 are:

• Involvement in decisions relating to my organisation
• Confident that performance is managed well within my organisation

Question Wording Changes

• Between 2019 and 2021 the wording changed for:
  • 'I have confidence and trust in senior managers responsible for the wider organisation' changed to 'I have confidence and trust in Board members who are responsible for my organisation'
  • 'I feel senior managers responsible for the wider organisation are sufficiently visible changed' to 'I feel that Board members who are responsible for my organisation are sufficiently visible'
• There are large and somewhat inconsistent movements between 2019 and 2021 for these questions, which suggests that at least some of the movement may be a result of the question wording changes.

My Organisation	2017	2018	2019	2021	Movement 2021 – 2019
I understand how my role contributes to the goals of my organisation	82	83	82	82	-1
I would be happy for a friend or relative to access services within my organisation	78	78	78	77	-1
I would recommend my organisation as a good place to work	74	74	74	73	-1
I get the help and support I need from other teams and services within the organisation to do my job	71	72	71	70	-1
I feel my organisation cares about my health and wellbeing	70	71	70	70	0
I am confident performance is managed well within my organisation	64	64	64	62	-2
I have confidence and trust in senior managers/Board Members responsible for the wider organisation*	64	65	64	61	-3
I feel senior managers/Board Members responsible for the wider organisation are sufficiently visible*	62	62	62	55	-7
I feel involved in decisions relating to my organisation	57	57	57	55	-2

* Question wording changes from 2021

The chart following shows the distribution of answers given for each component within my Organisation. The following points are of note:

• 34% of staff score Focus to Improve for 'I feel Board Members responsible for the wider organisation are sufficiently visible', suggesting this is area of concern for staff, that should be addressed
• 33% of staff score Focus to Improve for 'I feel involved in decisions relating to my organisation' which again suggests action to improve staff involvement and engagement in their organisation would be beneficial to the overall staff experience

Individual Boards

There is a polarising of performance and movement over time between the National Boards providing support services and the patient-facing Geographic and National Boards: See Appendix 18 for details.

High scores are recorded for NHS Education for Scotland and Healthcare Improvement Scotland, with both Boards seeing increases in all components for NHS Education for Scotland, and all but two for and Healthcare Improvement Scotland.

NHS Western Isles is the only patient-facing Board (National or Geographic) to increase scores in this strand by more than 1 point. The three scores that have increased are:

• 'I have confidence and trust in Board members who are responsible for my organisation' up 4 points to 64
• 'I am confident performance is managed well within my organisation' up 3 points to 62
• 'I feel sufficiently involved in decisions relative to my organisation' up 2 points to 57

NHS Western Isles have taken a number of proactive steps to engage with staff throughout the COVID-19 pandemic. Following are examples that the NHS Western Isles team feel have been particularly important:

NHS Western Isles Proactive Engagement

• Very clear objectives over the last 20 months relating both to pandemic and non-pandemic service delivery.
• Streamlined decision making covering both areas above emanating from the Pandemic/Winter Resilience Group.
• Daily communication in a variety of formats. Unprecedented scale of communications in terms of volume, content, updating.
• Many more staff, more easily engaged and involved through Teams.
• Regular review of performance against objectives. Several times a week and sometimes daily.
• Nightly social media update from CEO.
• Continued emphasis on living by the Staff Governance Standards
• Multiple changes to the 'ask' of the workforce, with a clear focus on fairness and equity.

Organisational Development & Learning Manager

In contrast NHS Orkney has low scores and has seen considerable declines from 2019 with scores going down by between 5 and 8 points. The State Hospital has also seen scores go down typically between 4 and 6 points.

While Scottish Ambulance Service scores are low, three of the seven have remained unchanged, three have declined by 1 point and only one 'I am confident performance is managed well within my organisation' has gone down by 2 points.

Staff Groupings

Six of the nine My Organisation measures are rated 2 points higher by Local Authority staff than NHSScotland staff. The exceptions are:

• 'I would be happy for a friend or relative to access services within my organisation' scored 77 by both Local Authority and NHSScotland staff
• 'I have confidence and trust in Board members who are responsible for my organisation' scored 61 by both Local Authority and NHSScotland staff
• 'I am confident performance is managed well within my organisation' scores 3 points higher by Local Authority staff (65) than NHSScotland staff (62)

Appendix 19 illustrates how My Organisation scores differ across the staff groupings in NHSScotland and Local Authorities.

NHSScotland Staff Groupings

Across staff in NHSScotland roles, Senior Managers have the highest scores for all but one of the statements in My Organisation. The exception is 'I am confident performance is managed well within my organisation' which is scored highest among Personal & Social Care staff. Ambulance Services staff rate lowest on all My Organisation statements, often by a considerable margin.

The smallest variation in scores across the NHSScotland staff grouping is in 'I understand how my role contributes to the goals of my organisation', with a difference of 9 points between the highest (Senior Managers 87) and lowest (Ambulance Services 78). The largest variation is in 'I feel sufficiently involved in decisions relating to my organisation', ranging from 44 among Ambulance service staff to 71 among Senior Managers.

Local Authority Staff Groupings

Across staff in Local Authority roles, Senior Managers have the highest scores for The Organisation, perhaps reflecting their role within it as part the leadership teams.

The smallest variation in scores across the Local Authority staff grouping is 'I would be happy for a friend or relative to access services within my organisation' and the largest variations are in 'I have confidence and trust in Board members who are responsible for my organisation' and 'I have confidence and trust in Board members who are responsible for my organisation' with ranges of 16 and 15 points respectively between Senior Managers and Older People Services.

Movement from 2019

Scores for My Organisation have generally moved between -2 and +2 points from 2019. Nursing and Midwifery staff are an exception to this with the score for 'I would recommend my organisation as a good place to work' declining by 4 points from 2019. The other exception to this is Ambulance Services among whom, 'I understand how my role contributes to the goals of the organisation' is down 5 points in 2021.

Nursing and Midwifery is the only NHSScotland staff grouping where all scores for My Organisation have gone down in 2021 from their 2019 levels.

Within Local Authority staff there is again variation across the staff groupings:

• Business Services, Senior Managers and Strategic Development have increased all scores in My Organisation
• Children's Service and Criminal Justice are largely unchanged from 2019
• Business Services, Senior Managers and Strategic Development scores have all gone up. The largest positive movements being in 'I understand how my role contributes to the goals of my organisation' and 'I am confident performance is managed well within my organisation'.