Five things we learnt from our work on the health and wellbeing of lower paid NHS staff

1. Lower paid staff make up close to half of the overall NHS workforce 

Lower paid workers comprise 45% of the NHS workforce, with women making up 85% of this group. The jobs fulfilled by lower paid staff include clinical support roles such as health care assistants, and non-clinical support roles such as cleaners, porters, facilities, security and administration. Some of these workers are employed directly by the NHS, while others are employed through subsidiaries or private companies.  

The views of lower paid staff are often underrepresented. For example, the annual NHS staff survey attracted a 47% response rate, but of these only 3.2% of respondents were maintenance and ancillary staff. Many of the NHS workers who are part of this ‘hidden workforce’ of support roles are involved in direct patient contact, form a crucial part of a patient’s experience of the NHS, and are an essential building block as the health service recovers from COVID-19.  

2. Poor health and wellbeing is more common among lower paid NHS workers 

Issues regarding the health and wellbeing of NHS staff are increasingly well-documented. The 2019 NHS Staff Survey, reported that 40% of employees have felt unwell from work-related stress in the past year, compared to 1.8% of the entire UK workforce. These higher rates of ill-health amongst NHS staff cost the NHS £2.4bn per year and can negatively impact quality of care and patient outcomes.  

Our research examined the health and wellbeing of lower paid workers in particular, to complement work with other staff groups. We heard that lower paid NHS staff have higher rates of workplace stress, sickness absence and are at increased risk of long-term conditions such as diabetes and heart disease. They are also more likely to retire early due to ill-health.  

3. Lower paid staff face specific challenges around pay, career progression and feeling valued 

While some of the factors that affect the health and wellbeing of lower paid staff are applicable to other NHS staff, such as the impact of shift work and high workload, there are other factors that are specific to this group. They are more likely to be affected by socioeconomic conditions which can lead to poorer health and wellbeing, such as poverty and job insecurity. Some may face stressors created by working in more than one job.  

Many lower paid NHS workers report a lack of opportunity to progress to better paid roles and say that they feel undervalued and unsupported at work, with a sense of feeling ‘invisible’ unless something goes wrong. And while having a sense of autonomy at work is closely linked to job satisfaction, lower paid workers often feel they have no autonomy at all. The 2019 NHS Staff Survey reported that 52% of the overall workforce felt involved in making decisions related to their area, team or department, but only 39% of maintenance/ancillary staff and 41% of health care assistants felt the same way.

Other factors affecting the health and wellbeing of lower paid staff include increased exposure to racial discrimination, being involved in physically demanding work or working with potentially hazardous materials such as in cleaning, laundry and catering roles.