OBJECTIVES: Previous studies have shown an association between staff sentiment and quality of care. This study aims to delineate the impact of staff on patient safety within the National Health System (NHS), analysing data from the NHS Staff Survey.

METHODS: Staff intention to leave, as reported in the survey, was used as a proxy for staff sentiment. The outcome was the rate of safety incidents published by the NHS. Deprivation data at NHS trust level were aggregated into quintiles and used in model adjustment. A fixed-effects Poisson regression model was used to control for unmeasured characteristics among NHS trusts and over time.

RESULTS: Between April 2018 and March 2020, staff sentiment across the acute trusts analysed (n=118) improved slightly, with the mean percentage of staff intending to leave decreasing from 20.9% in 2018 to 19.5% in 2020. Conversely, the safety incidents rate for the acute sector during this period increased from 42.1 to 48.9 incidents per 1,000 bed days. In both the univariable and multivariable models, the percentage of staff intending to leave at the trust level had no effect on the safety incidents rate (unadjusted rate ratio (RR)=1.00, 95% CI 0.99-1.01; adjusted RR=1.00, 95% CI 0.99-1.01). In the multivariable model, increasing deprivation quintile was significantly associated with increasing safety incidents in a nearly stepwise fashion (likelihood ratio test p-value<0.0001), with the most deprived quintile exhibiting a 38% higher rate of safety incidents than the least deprived quintile (RR=1.38, 95% CI 1.27-1.49).

CONCLUSIONS: Despite evidence on a link between staff sentiment and patient safety outcomes, this analysis demonstrated no link before and after adjusting for potential confounding by deprivation. However, we found a strong, nearly linear relationship between higher levels of deprivation and increasing safety incidents, suggesting that area-level socioeconomic factors exert more influence on patient safety than staff sentiment.