Health and social care - staff experience: report 2021

iMatter EEI per organisation

The Employee Engagement Index (EEI) is calculated based on the number of responses for each point on the scale (Strongly Agree to Strongly Disagree) multiplied by its number value (6 to 1). These scores are added together and divided by the overall number of responses to give the score to show level of engagement.

The overall EEI score of 75 for Health and Social Care is one point below the 2019 EEI score of 76. This returns the score to the 2017 score. No report was issued in 2018 as the response rate was below the normally observed threshold of 60%.

This overall movement of just one point from 2019, masks some much greater movement in EEI scores for individual Boards (see following chart). Whilst many Boards have declined by one or two points, there are number of notable exceptions:

Three national support Boards, increased their EEI scores in 2021:

• NHS Education for Scotland (+2 points to 84)
• Healthcare Improvement Scotland (+3 points to 81)
• NHS National Service Scotland (+2 points to 78)

NHS Education for Scotland have shared their thoughts on why their already high scores have increased still further:

NHS Education for Scotland

"During the course of the pandemic, NES has been contributing to the overall health and social care system through our Digital, HR, and Clinical Directorate colleagues. We think this will be a source of pride both for those individuals who have made the contributions and also their colleagues.

NES has adopted a proactive, wellbeing focus to supporting our staff throughout the pandemic. A very positive approach to working from home, with lots of practical and psychological support, and clear messages around looking after self and others. We continue to provide a high level of support and flexibility around home working. During lockdown this was especially beneficial in enabling people to balance caring commitments and NES work"

Head of Programme in Workforce

In contrast, patient-facing Boards have EEI scores more than 2 points below their 2019 scores:

• NHS Orkney (-5 points to 70)
• Golden Jubilee Foundation (-5 points to 72)
• The State Hospital (-3 points to 74)
• NHS 24 (-3 points to 75)

Although these are smaller Boards, the movements in EEI scores from 2019 are all statistically significant (see Appendix 6 for details).

Actions are already under way in these Boards to address staff experience concerns as illustrated by these examples:

NHS 24

"We focussed our action plan on involving the workforce in decisions relating to the organisation and their jobs, on building confidence and trust in, and visibility of, the EMT and Board, and on managing performance well and acting on ideas and suggestions where we can."

Learning and Organisational Development Co-ordinator

NHS Orkney

"This year the iMatter did not include Social Care staff, who had already received a staff survey through the Local Authority and so the baseline group was different, which has led to an irregular comparison.

There is an acknowledgement that work needed to take place and has been delivered through our Listening Project. The wellbeing group has also been restarted after an 18-month hiatus and will build in key performance indicators to measure success, including monitoring the iMatter results."

Organisational Development & Improvement Advisor

Comparing 2021 EEI to Previous Years

The long-term trend in EEI scores illustrates how staff experiences are evolving. The table following includes the comparison of 2021 scores to those achieved in 2017.

The Health and Social Care EEI score is currently at the same level as it was in 2017. Of the 18 Boards that have scores for 2017, eight of them achieved the same scores in 2021 as they did in 2017.

The largest positive movement over the five years is for NHS Education for Scotland, up 4 points from the 2017 EEI score of 80.

The largest negative movements are:

• Golden Jubilee Foundation, down 6 points from an EEI of 78 in 2017
• NHS Orkney, down 5 points from an EEI of 75 in 2017

EEI Score	2017	2018	2019	2021	Movement from 2017
Health and Social Care	75	No Report (NR)	76	75	0
Golden Jubilee Foundation	78	78	77	72	-6
NHS 24	75	77	78	75	0
Scottish Ambulance Service	67	67	NR	65	-2
The State Hospital	76	77	77	74	-3
Healthcare Improvement Scotland	80	80	78	81	+1
NHS Education for Scotland	80	81	82	84	+4
NHS National Services Scotland	77	76	76	78	+1
Public Health Scotland				77	New
NHS Health Scotland	81	81	81		N/A
NHS Ayrshire & Arran	76	NR	76	75	-1
NHS Borders	74	NR	NR	74	0
NHS Dumfries & Galloway	75	NR	74	72	-3
NHS Fife	75	NR	76	75	0
NHS Forth Valley	75	75	75	73	-2
NHS Grampian	76	77	77	76	0
NHS Greater Glasgow & Clyde	NR	NR	NR	74	N/A
NHS Highland	NR	NR	74	73	-1
NHS Lanarkshire	77	78	79	77	0
NHS Lothian	76	77	77	76	0
NHS Orkney	75	76	75	70	-5
NHS Shetland	78	NR	78	78	0
NHS Tayside	74	NR	75	74	0
NHS Western Isles	NR	NR	NR	76	N/A

EEI Score Distribution across Teams

Across the whole of Health and Social Care the distribution of teams across each of the score bands is as shown below. 73% of teams that received a report score in Strive to Celebrate (67-100). Across the whole of Health and Social Care there are only 15 teams that have an EEI score of 33 or less (less than 1% of all teams). Teams with 4 or less staff and a response rate of below 100% did not receive a report.

Organisation	Number of Teams	Percentage of Teams
Strive & Celebrate (67-100)	11050	73%
Monitor to Further Improve (51-66)	2075	14%
Improve to Monitor (34-50)	265	2%
Focus to Improve (0-33)	15	<1%
No Report	1778	12%
Total Health and Social Care	15183	100%

The table following shows the number teams in each EEI score band across each of the Boards.

NHS Education for Scotland has 96% of teams scoring in 'Strive & Celebrate' and Healthcare Improvement Scotland has 93%. NHS Shetland is the highest performing Geographic Board with 91% of Teams scoring in 'Strive & Celebrate'. In contrast only 56% of teams in Scottish Ambulance Service score in 'Strive & Celebrate'.

Boards that received a report in 2021	Strive & Celebrate 67-100	Monitor to Further Improve 51-66	Improve to Monitor 34-50	Focus to Improve 0-33	Report Issued
NHS Ayrshire & Arran	761	116	20	1	898
	85%	13%	2%	0%
NHS Borders	219	34	5	0	258
	85%	13%	2%	0%
NHS Dumfries & Galloway	214	50	7	1	272
	79%	18%	3%	0%
NHS Fife	671	93	11	1	776
	86%	12%	1%	0%
NHS Forth Valley	386	99	7	0	492
	78%	20%	1%	0%
NHS Grampian	993	139	12	2	1146
	87%	12%	1%	0%
NHS Greater Glasgow & Clyde	2322	464	61	5	2852
	81%	16%	2%	0%
NHS Highland	502	138	13	1	654
	77%	21%	2%	0%
NHS Lanarkshire	851	134	15	2	1002
	85%	13%	1%	0%
NHS Lothian	1662	264	32	1	1959
	85%	13%	2%	0%
NHS Orkney	66	19	5	0	90
	73%	21%	6%	0%
NHS Shetland	105	11	0	0	116
	91%	9%	0%	0%
NHS Tayside	976	208	29	1	1214
	80%	17%	2%	0%
NHS Western Isles	49	11	0	0	60
	82%	18%	0%	0%
Healthcare Improvement Scotland	125	10	0	0	135
	93%	7%	0%	0%
Public Health Scotland	81	6	2	0	89
	91%	7%	2%	0%
NHS Education for Scotland	180	8	0	0	188
	96%	4%	0%	0%
National Services Scotland	274	23	2	0	299
	92%	8%	1%	0%
Golden Jubilee Foundation	129	28	5	0	162
	80%	17%	3%	0%
Scottish Ambulance Service	250	164	35	0	449
	56%	37%	8%	0%
NHS 24	183	45	4	0	232
	79%	19%	2%	0%
The State Hospital	51	11	0	0	62
	82%	18%	0%	0%

Reports Issued

In previous years this report has contained data on 'No Report'. This included information on the distribution of team EEI scores and analysis of the proportion of teams not receiving an EEI Report because they had not reached the required response rate threshold. The two thresholds previously in place were:

• 60% response rate for teams of 5 or more staff
• 100% response rate for teams with 4 or less staff

With the removal of the 60% threshold, the only teams that will not have received a report in 2021 are those with 4 or less staff and a response rate of below 100%. Consequently, the percentage of teams receiving a report has risen from 76% in 2019 to 88% in 2021.

Almost all Boards have between 87% and 95% of their teams receiving reports. The exceptions are

• NHS 24 where 78% of Teams received a report
• NHS Lothian where 80% of Teams received a report

Board	Report Issued		No Report Issued		Total
	No. of Teams	Percent	No. of Teams	Percent
NHS Ayrshire & Arran	898	89%	110	11%	1,008
NHS Borders	258	87%	38	13%	296
NHS Dumfries & Galloway	272	88%	36	12%	308
NHS Fife	776	88%	104	12%	880
NHS Forth Valley	492	88%	68	12%	560
NHS Grampian	1146	89%	141	11%	1,287
NHS Greater Glasgow & Clyde	2852	89%	357	11%	3,209
NHS Highland	654	88%	85	12%	739
NHS Lanarkshire	1002	91%	97	9%	1,099
NHS Lothian	1959	83%	391	17%	2,350
NHS Orkney	90	95%	5	5%	95
NHS Shetland	116	87%	17	13%	133
NHS Tayside	1214	88%	159	12%	1,373
NHS Western Isles	60	92%	5	8%	65
Healthcare Improvement Scotland	135	91%	14	9%	149
Public Health Scotland	89	95%	5	5%	94
NHS Education for Scotland	188	94%	11	6%	199
National Services Scotland	299	95%	17	5%	316
Golden Jubilee Foundation	162	95%	8	5%	170
Scottish Ambulance Service	449	91%	42	9%	491
NHS 24	232	78%	64	22%	296
The State Hospital	62	94%	4	6%	66

The variation seen in the percentage of teams that did not receive a report is directly impacted by the volume of small teams (less than 5 staff) within each Board. The table following shows the share of teams in each Board with less than 5 staff and the % of those that have received a report.

Overall, 22% of teams have less than 5 staff in them, though this ranges from 73% of teams in Healthcare Improvement Scotland to 11% of teams in NHS Western Isles and Public Health Scotland.

The percentage of small teams receiving a report is 54% across Health and Social Care. Again, there is considerable variation across the Boards, from 90% of small teams in NHS Education for Scotland receiving a report, to 39% of small teams in NHS Forth Valley.

Board	Number of Teams			Small Teams Receiving a Report
	Total	Small Teams	% of all Teams	No. of Small Teams	Percent of Small Teams
Health & Social Care	15,187	3,316	22%	1,800	54%
NHS Ayrshire & Arran	1,008	175	17%	93	53%
NHS Borders	296	55	19%	23	42%
NHS Dumfries & Galloway	308	163	53%	129	79%
NHS Fife	880	214	24%	115	54%
NHS Forth Valley	562	106	19%	41	39%
NHS Grampian	1,287	241	19%	107	44%
NHS Greater Glasgow & Clyde	3,209	557	17%	276	50%
NHS Highland	740	120	16%	49	41%
NHS Lanarkshire	1,099	167	15%	92	55%
NHS Lothian	2,351	581	25%	254	44%
NHS Orkney	95	32	34%	27	84%
NHS Shetland	133	29	22%	12	41%
NHS Tayside	1,373	270	20%	140	52%
NHS Western Isles	65	7	11%	5	71%
NHS Education for Scotland	199	110	55%	99	90%
Healthcare Improvement Scotland	149	109	73%	95	87%
NHS National Services Scotland	316	77	24%	60	78%
Public Health Scotland	94	10	11%	5	50%
NHS Golden Jubilee	170	46	27%	39	85%
NHS 24	296	131	44%	68	52%
Scottish Ambulance Service	491	96	20%	54	56%
The State Hospital	66	20	30%	17	85%