Is the NHS Staff Survey driving change or just ticking a box?
As a former NHS insider who once ran the annual NHS National Staff Survey, I’ve seen first-hand how hard it is to translate the survey results into real action. Every NHS trust dutifully runs this survey each year, but are leaders actively using it to improve workplace culture, or just going through the motions?
Here’s a candid look at the issues....
Data-rich but action-poor
The NHS Staff Survey generates a wealth of data on employee experience. Yet too often, that data doesn’t turn into change. Only about one-third of NHS staff in a recent survey felt their hospital took positive action on their feedback about well-being (Johnson et al, 2022). In other words, two out of three staff saw no follow-up. It’s no surprise that many employees might doubt their input will lead to anything.
This scepticism becomes a vicious cycle: if people feel “no one will listen to, care about, or action their concerns,” many won’t even bother responding. This results in HR teams ending up with survey reports that look comprehensive, but a workforce that’s cynical and disengaged with the whole process.
Is the survey still fit for purpose?
There’s no denying the NHS Staff Survey’s scale and pedigree – it’s the largest and longest-running workforce survey in the world, with 20 years of data for over half a million staff each year. Researchers have mined this data to identify what drives outcomes like care quality and staff retention (staff engagement being the top factor). In that sense, the survey is backed by evidence and has value. But if it’s so “evidence-based,” why aren’t we seeing better results? Many core metrics like staff engagement, morale, and feeling valued have barely shifted for years. The 2024 national results showed no improvement at all in the key People Promise theme scores compared to 2023. It’s essentially the same story year after year – which begs the question of whether the annual survey approach is achieving real change. The same issues are uncovered repeatedly (staff shortages, burnout, lack of voice) without a robust mechanism to address them before the next survey comes around.
Response rates vs. real action
It seems that NHS trusts are almost fixated on boosting survey response rates – eg. celebrating a 60% response or being “above average.” Of course, a healthy response rate matters for good data. But hitting a high percentage is not a victory if the feedback isn’t acted on. The truth is, even at 50-60% response, nearly half of staff aren’t speaking up. Are they the staff with the lowest morale who may feel “no point expressing their viewpoint because no one will listen… or action their concerns” or are they those that are content with the status quo and therefore apathetic about providing their feedback on the matter? Chasing a higher response rate shouldn’t distract from the real metric that matters: what is done with those responses. An obsession with participation numbers can create a false sense of progress, while plans to actually improve things languish.
Where are the improvements?
After decades of surveys, one could well ask: what improvements can be attributed to this giant feedback exercise? The evidence is not encouraging. At a national level, staff survey scores on crucial topics (like health & wellbeing, engagement, feeling valued) are flat – 2024’s results were broadly identical to 2023’s. Some problem areas have remained stubbornly poor for the last 5–10 years. For example, around 18-19% of staff still report incidents of bullying/harassment by colleagues – unchanged for at least two years despite numerous anti-bullying initiatives. Nearly half of staff feel their voices aren’t heard in decision-making, a figure that has hovered around 50% since before 2018. And only about 42% feel valued by their organisation, virtually the same as back in 2017. In short, the survey keeps flagging these endemic cultural issues, but there’s little evidence that they are being fixed. There are pockets of progress (for instance, recent hiring boosted the percentage of staff who feel they have enough colleagues to do their job properly, from 26% in 2022 to 34% in 2024). But those modest gains are the exception. The overall picture is one of stalled improvement – a sign that survey results aren't being used to deliver the changes that staff desperately need.
The summer lull (and looming next survey)
Another telling pattern is that by late spring or summer, many NHS trusts have barely begun acting on the last survey’s findings, just as the next survey cycle is on the horizon. I’ve seen it happen too often: the results get released in March, a flurry of PowerPoint slides and briefings follow… then not much else. Come May/June, meaningful action plans are still “in development,” and suddenly it’s time to plan the autumn rollout of the next questionnaire. This delay means momentum is lost (and credibility), with staff left wondering if their feedback went into a black hole. It’s crucial to close the gap between surveying and doing. Experts warn that without prompt, transparent follow-up on surveys, the whole exercise backfires – time is wasted, and staff grow disillusioned. Staff surveys shouldn't be annual rituals that yield a report, a polite 'thank you' to staff, and then get shelved until next year.
Bottom line:
The NHS National Staff Survey is a potentially powerful tool – the evidence inside it matters – but right now it’s not living up to its promise. HR and OD professionals in the NHS need to pivot from measuring engagement to actually improving engagement. That means less fanfare about response rates and benchmarking, and more honest discussion about action planning, accountability, and impact. If a survey result isn’t followed by visible change, its credibility (and that of leaders) erodes.
Call to Action for NHS leaders: How can you break this cycle?
Share concrete examples of how you’ve turned staff survey feedback into real workplace improvements.
What’s one thing your trust is doing differently this year to act on the survey results before the next survey arrives?
If you’ve found an approach that works - or learned a hard lesson about what doesn’t - please share it.
This is precisely why I created Culture Gauge (TM)
Culture Gauge can help NHS trusts (and any organisation) move from feedback to action, fast. It gives you a clear, structured way to respond to survey results at both organisational and team level. Organisations using Culture Gauge are already seeing meaningful improvements in culture, engagement and wellbeing over time.
It’s time to stop treating the Staff Survey as a tick-box exercise and start using it as a springboard for genuine, measurable culture change in the NHS. Its people deserve nothing less.
Interested in knowing more about Culture Gauge?
References
Johnson, A., Conroy, S., Thompson, D., Hassett, G., Clayton, A., & Backhouse, E. (2022). Staff experience in the NHS: A National Study—an Experience-Based Design Approach. Journal of Patient Experience, 9, 23743735221143921.
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