NHS reform: has it affected staff morale?

"…staff morale is at rock-bottom following a re-organisation no-one wanted."

Andy Burnham, Shadow Health Secretary, 1 April 2014

NHS staff morale is only one of the challenges said to be facing Simon Stevens as he takes up the post of chief executive of NHS England today.

Mr Burnham's information on staff morale comes from a report published by the King's Fund which found that staff morale was the issue of greatest concern to the finance directors of NHS trusts who answered its survey.

But the report doesn't necessarily reflect lower morale among staff, just greater relative concern about the issue on the part of directors. And it doesn't give us enough information to attribute their concerns to NHS reform.

The survey and its findings

The survey is conducted every three months. The most recent report asked 79 finance directors to select from a list the three aspects of their organisation's performance that were causing them the most concern. 'Staff morale' was chosen by 31 of them. This was more than any other option, and was the first time staff morale had come top of the list.

But there are limits to what the surveys can tell us about changes to staff morale.

Firstly, the number of respondents to the survey is relatively low, which makes its results open to fluctuations due to who happens to have been asked. The methodology of this and past reports are different; some earlier editions of the survey asked for a single concern, not three, and had used smaller 'panels' of directors.

Secondly, the extent to which morale is a concern to directors doesn't tell us the extent to which morale has fallen. For example, directors might be more likely to identify it as a concern because other issues have become less concerning.

We don't know how NHS structural changes affected the results

The report doesn't tell us anything about why morale might have become a bigger concern - the survey it's based on doesn't ask this.  There are likely to be a number of factors that affect morale; staff might be unhappy with their wages, or their workload, or a combination of both.

While the report does come in the wake of reforms, the link between its findings and the reforms is far from clear. The changes have been going on for the last year while the rise in concern about staff morale is more recent. The debate over the NHS pay freeze corresponds more closely to the timing of the findings, but without further information we can't draw any conclusions about a link.