NHS staff standards: detailed requirements for employers

Question 1

Line management

Accepted Answer

Standard

Staff can expect supportive, fair, developmental and compassionate line management, enabled by employer support for line managers, to help staff to perform well, feel valued and fulfil their potential.

Purpose

The purpose of this standard is to set out the expectations for employers in creating and sustaining the conditions that enable effective line management. It recognises that line management responsibilities vary significantly across roles and levels within organisations and that line managers are staff themselves, whose experience matters.

It establishes employer responsibility for providing the systems, support and organisational environment that allow line managers to deliver a positive, consistent, fair and compassionate staff experience.

Specifically, this standard, through the actions of employers, intends to:

establish clear expectations for effective line management, aligned to the NHS Leadership and Management Framework, by ensuring employers provide the guidance, support and infrastructure to enable line managers to understand and fulfil their responsibilities, and to give staff clarity on what they should expect from their manager
improve staff experience, wellbeing and inclusion by creating the conditions for line managers to foster psychologically safe, fair and inclusive environments and to proactively support health and wellbeing
strengthen staff engagement, development and retention by ensuring that systems, processes and resources are in place to enable:
- high‑quality appraisals with meaningful feedback and clear objectives
- access to learning and development
- transparent job roles and job evaluation
support high-quality patient care and organisational effectiveness by enabling line managers to support staff performance, development and effective teamwork, while meeting legal and contractual duties relating to equality, dignity and respect at work, appraisal, development and job evaluation, including commitments arising from the Messenger and Pollard review (2022)

This standard is an important enabler for the delivery of the wider staff standards. Progress on tackling racism, championing sexual safety, reducing violence, supporting health and wellbeing, and enabling flexible working depends on line managers being properly enabled and supported by employers to make progress against these standards in practice.

It must be used by:

organisations to benchmark current practice, identify gaps, develop improvement plans and demonstrate compliance
boards and leaders to discharge accountability and monitor and demonstrate progress
trade unions and employers working in partnership to address any issues relating to line management
staff to understand their rights and what they should expect from their employer

Actions for employers

This standard sets out the expectations for employers in creating and sustaining the conditions that enable effective line management. It establishes employer responsibility for providing the systems, support and organisational environment that allow line managers to deliver a positive and consistent staff experience.

To support line managers, employers must:

embed the NHS Leadership and Management Framework by aligning local communications, strategies, policies, processes, training, appraisal and recruitment to it to ensure line managers have the skills they need
ensure all managers complete the NHS Leadership and Management Framework self‑assessment tool and undertake development to progress towards achieving the standards within it
ensure comprehensive line management training is offered to all line managers, with a particular focus on first-time managers, through the NHS Leadership and Management Framework, so that they are aware of their responsibilities under the expectations of line management guidance, and monitor line manager performance, taking action to improve quality as necessary
ensure that job plans accurately incorporate and allocate sufficient time for line management responsibilities so that managers have the capacity to meaningfully discharge their role
ensure all roles have clear, accurate and up‑to‑date job descriptions and review role changes promptly through agreed processes when requested, in accordance with the NHS Job Evaluation Scheme
ensure that all line managers have appropriate supervision, mentorship and support from their immediate managers and that line management policies are easily accessible and actively enable line managers to provide timely support and responses to their line reports
ensure board‑level oversight of how line managers are being enabled, by routinely gathering and acting on feedback from line managers about the systemic enablers they need and the barriers that prevent them supporting staff effectively
work in partnership with trade unions through local arrangements to build a more illustrative picture of line management on the ground by reviewing data, health and safety risk assessments and culture trends, and assessing compliance with legal duties in line with the Public Sector Equality Duty to proactively assess fairness and monitor impact, for example through equality impact assessments

Line managers must be enabled by their employers to ensure that:

all employees receive high-quality appraisals, in line with contractual requirements, that set clear, achievable objectives
staff development and career progression is actively supported through regular and meaningful feedback, access to appropriate learning and development, and support to apply learning in practice
a culture is created where line managers model behaviours such as openness, respect and inclusivity, and challenge behaviours that undermine this. To enable that culture change, they must:
- provide compassionate, constructive support to staff, working with staff representatives and trade unions where needed
- enable a psychologically safe environment where staff feel comfortable to raise issues, knowing they will be escalated where necessary
teams are led effectively by setting shared objectives, enabling appropriate autonomy, addressing differences constructively and fostering respectful team environments where staff feel connected to their team and able to make a full contribution

Context

NHS Staff Survey

The 2025 NHS Staff Survey indicates generally positive experiences of line management, with the highest scores in 5 years across 3 of the 4 line management questions, providing a strong baseline across the service. Results show that:

70.25% felt that their immediate manager works together with them to come to an understanding of problems
72.65% felt their immediate manager is interested in listening to them when they describe the challenges they face
71.28% felt that their immediate manager cares about their concerns
68.08% felt that their immediate manager takes effective action to help with any problems they face
73.56% felt that the team they work in has a set of shared objectives
69.92% feel valued by their team
71.23% felt that the people they work with are polite and treat each other with respect

It also shows that retention is closely linked to line management quality, with staff more likely to stay where relationships are positive, problems are addressed effectively, work is valued, progression is perceived as fair, frustration is reduced and development is actively supported.

However, despite high appraisal coverage (86%):

only 26% of staff say appraisals help them improve their job
35% say their appraisal helps agree clear objectives
33% say they leave their appraisal feeling their work is valued

The ‘Development’ sub-score is also at its lowest since 2021:

51.15% feel there are opportunities for them to develop their career in their organisation
55.24% feel supported to develop their potential
58.24% are able to access the right learning and development opportunities when they need to

NHS People Pulse survey

Data from the 2025 People Pulse survey shows that line managers are more likely to report stress than non-line managers, with their stress also increasing at a faster rate than non-manager counterparts. This raises concerns about capacity and the future of leadership within the NHS.

The data also indicates lower engagement among line managers aged 21 to 30, pointing to a need for targeted support for those new to line management.

NHS Leadership and Management Framework

The new NHS Leadership and Management Framework has been developed to recognise, support and professionalise management and leadership consistently across the NHS, in response to the Messenger and Pollard Review (2022). The framework sets consistent, professional standards and competencies across all levels of NHS management, clinical and non-clinical, and for the first time a single, national code of practice across health and social care.

NHS expectations of line managers

The NHS expectations of line managers were developed following an action in The future of NHS human resources and organisational development report, which was published in November 2021 and sets out the 10-year strategy for the NHS people profession. It sets out a clear view on the expectations of line managers in the service in relation to people management and the implications for the provision of people services.

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

The 2026 to 2027 NHS Oversight Framework score will use questions from the NHS Staff Survey as metrics. More detail on how these questions form part of the overall NHS Oversight Framework score for the staff standards will be available in the 2026 NHS Oversight Framework technical guidance.

The questions that will be used for line management are as follows:

Appraisals:

Question 23a - In the last 12 months, have you had an appraisal, annual review, development review, or Knowledge and Skills Framework development review?
Question 23c - It [appraisal] helped me agree clear objectives for my work
Question 23d - It [appraisal] left me feeling that my work is valued by my organisation

Development:

Question 24d - I feel supported to develop my potential
Question 24e - I am able to access the right learning and development opportunities when I need to

Supportive leadership:

Question 9d - My immediate manager… takes a positive interest in my health and wellbeing
Question 9f - My immediate manager… works together with me to come to an understanding of problems
Question 9i - My immediate manager… takes effective action to help me with any problems I face

Team management:

Question 7a - The team I work in has a set of shared objectives
Question 7h - I feel valued by my team

Additional data organisations can access to assure themselves of performance

In addition to the above, organisations should also ensure they review any relevant additional data and metrics sources to support their delivery of the line management standard.

This may include but is not limited to:

data from the National Education and Training Survey
other questions in the NHS Staff Survey
other local data, for example:
- intersectionality measurements to be captured and cross referenced; incorporation of equality, diversity and inclusion (EDI) data
- data from health and safety forums
- Datix
- HR case trends
- staff feedback

Additional metrics we may look to incorporate in future

Throughout 2026 to 2027, the Department of Health and Social Care (DHSC) and NHS England will work in partnership with trade unions and employers to explore what additional metrics could be used to track progress against this standard. This may include:

additional data to inform the NHS Oversight Framework score
data for additional accountability processes
data to recommend organisations use for their own self-assessment

Potential additional sources of evidence, along with further review of those mentioned above could include:

Management and Leadership Framework: data will be collected as part of the initiatives in the Management and Leadership Framework, including numbers undertaking the self-assessment appraisal tool and in time (due to be launched in autumn 2026) accessing development and the 360 feedback tool, as well as the learning needs analysis derived from the tools and trends over time
job evaluation: Job Evaluation Scheme data started being collected in October 2025 as part of the 2023 ‘non-pay’ Agenda for Change deal and is collected quarterly. Data collected includes:
- board and organisational readiness
- job description volumes (broken down by band)
- number of those in review over the last 12 months and 3 years
- review outcomes

We will also look to include metrics relating to the experience of line managers themselves, as well as the experience of those who are managed.

Legal duties

Health and Safety at Work etc. Act 1974

The Health and Safety at Work etc. Act 1974 requires employers to ensure, so far as reasonably practicable, the health, safety and welfare of employees at work, including risks arising from how work is organised and managed.

Management of Health and Safety at Work Regulations 1999

The Management of Health and Safety at Work Regulations 1999 require employers to assess risks to employees’ health and safety (including psychosocial risks such as work‑related stress) and to put in place, monitor and review appropriate preventive and protective measures.

Equality Act 2010

The Equality Act 2010 places duties on employers to prevent discrimination, harassment and victimisation. Therefore employers should ensure fair and non‑discriminatory management practices, including in performance management, appraisal and development.

Contractual obligations

Appraisals are a contractual requirement for all staff, but requirements differ. Agenda for Change staff are appraised annually to progress through pay points, with locally agreed process and outputs. Doctors’ contractual obligations are reinforced by General Medical Council requirements for appraisal as evidence for revalidation.

Job evaluation enabling agreement

As part of the 2023 non-pay commitments, a job evaluation enabling agreement has been developed and agreed in principle by the NHS Staff Council. This agreement has been introduced as a new Annex 31 to the NHS Terms and Conditions of Service Handbook as of April 2026. This annex sets out requirements to support employers, staff and trade unions in operating job evaluation as a contractual obligation.

NHS Constitution - staff rights and pledges in the handbook

Career development

Pledge:

The NHS pledges to provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential.

Job evaluation and appraisals

Pledge:

The NHS pledges to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities.

… Contracts of employment for most NHS staff support this pledge. For example, under Agenda for Change, staff jobs should have been robustly evaluated and linked to pay rates. Staff should receive regular appraisals and opportunities for training and development.

Compassionate leadership

Pledge:

The NHS pledges to provide a positive working environment for staff and to promote supportive, open cultures that help staff do their job to the best of their ability.

Question 2

Health and wellbeing

Accepted Answer

Standard

Staff can expect their organisation to protect their health, safety and wellbeing at work. Employers are responsible for supporting staff wellbeing, preventing ill-health associated with work and helping staff to feel safe, cared for and able to perform well.

Purpose

The purpose of this standard is to set clear requirements for NHS employers’ role in maintaining the health, safety and wellbeing of their staff. Working for the NHS should not negatively impact anyone’s mental or physical wellbeing, and it is the duty of NHS organisations to take action that prevents work-related ill-health and poor wellbeing. This protects staff, reduces absenteeism and facilitates better care for patients.

Specifically, this standard is intended to:

ensure employers develop targeted, local approaches to health and wellbeing that are:
- reflective of local workforce demography
- evidence based
- needs driven
- built on genuine engagement with staff
prioritise prevention and encourage organisations to take proactive steps to preventing ill-health within their workforce. Employers should understand and seek out risk, taking action to mitigate impacts on staff
increase oversight and accountability for health and wellbeing at work that is underpinned by robust data collection, demonstrates needs driven intervention and return on investment. Senior leaders should have a clear understanding of the health and wellbeing of their staff and the board should have oversight of this
improve staff experience and respect for staff by ensuring they can rest, refuel and rehydrate at work, and that managers are equipped to support their staff through health and wellbeing training
align with the impending Nationally Mandated Skills Framework, once published, to ensure a safe and competent workforce, minimising risk to the physical and psychological safety of staff
encourage a shift in health and wellbeing culture across the NHS whereby staff are cared for, protected and feel well at work
align with the requirements of the Equality Act 2010 which, requires employers to protect staff from discrimination related to protected characteristics, including disability, and to make reasonable adjustments to avoid placing disabled staff at a substantial disadvantage in comparison with persons who are not disabled. Employers are required to support the health and wellbeing of staff through occupational health and reasonable adjustments

This standard must be used by:

organisations to benchmark current practice, identify gaps, develop improvement plans and demonstrate compliance
boards and leaders to discharge accountability and monitor and demonstrate progress
trade unions and employers working in partnership to address any issues relating to health and wellbeing
staff to understand their rights and what they should expect from their employer

Actions for employers

NHS organisations should take a co-ordinated approach to keeping staff safe and improving the health and wellbeing of their workforce. This should reflect local need and be evidence based. Opportunities to support staff wellbeing should be proactively identified and openly discussed, and any support should be equitable and inclusive.

Employers must:

appoint a health and wellbeing guardian at board level, who will ensure the organisation is compliant with the standard by ensuring collection of workforce data pertaining to health and wellbeing
use the NHS health and wellbeing framework to produce a localised health and wellbeing strategy that is built on workforce data and provides needs-driven health and wellbeing support. This will be co-produced through staff engagement and partnership working with unions. It will incorporate the 7 core elements of creating health and wellbeing culture. The strategy will have board-level oversight
employers must take steps to ensure that, where practicable, staff have access to safe, non-clinical environments to take their rest periods. Where call demand or operational pressures may disrupt break opportunities, employers must ensure policies and rostering practices support staff to take restorative rest as soon as practicable
employers must ensure that all staff, regardless of work location or shift pattern, have reliable access to nutritious food and drink. For settings where catering or rest space facilities are limited or unavailable, or where the site is too small to sustain such provision (including ambulance stations, community sites and mobile staff), employers should consider implementing practical alternatives. These solutions should prioritise healthier options aligned with NHS food and drink standards and be accessible 24/7 to support staff working irregular hours, including night shifts. Alternatively, employers should ensure that there are safe options available for staff to store and prepare their own food
ensure all managers are supported to complete mandated competencies on safety and health and wellbeing in line with statutory and mandatory training so that all staff can expect health and wellbeing conversations to be embedded into one-to-ones and appraisals, with dedicated health and wellbeing conversations that are supportive and additional to formal HR processes
ensure managers are trained on how to discuss reasonable adjustments with disabled staff and staff with alternative needs as part of these health and wellbeing discussions, as well as trained on how to sensitively support and encourage staff disclosures about being disabled
ensure protection and provision for pregnant and breastfeeding staff and for those experiencing perimenopause and menopause
ensure all staff have access to occupational health and wellbeing support and local services that are needs-driven and in line with the latest specification and ensure that occupational health recommendations are acted upon
work in partnership with trade unions through local arrangements to review data and monitor progress to deliver improvements that meet local need

These actions are intended to build on the requirements of existing legal frameworks as set out in the legal duties section below.

Context

NHS Staff Survey

NHS Staff Survey results show that:

the 2025 average score for the NHS People Promise element ‘We are safe and healthy’ remained similar to previous years, at 6.12 (2024: 6.17; 2023: 6.16; 2022: 5.96; 2021: 5.97)
the percentage of staff that felt their organisation takes positive action on health and wellbeing has reduced compared to recent years, with a decline of more than 2 percentage points in 2025, at 54.80% (2024: 57.05%; 2023: 57.82%; 2022: 56.48%; 2021: 57.00%). This decrease is seen across all trust types with the largest decrease for staff at acute specialist trusts
the percentage of staff who felt unwell as a result of work-related stress has remained consistent in recent years. The 2025 percentage was 42.36% (2024: 41.65%; 2023: 41.82%; 2022: 44.91%; 2021: 47.08%). For medical and dental staff, this percentage has decreased from 2024 (42.19%) to 2025 (41.08%) while for both nursing and healthcare assistants and admin and clerical staff it has increased
the percentage of staff who feel burnt out because of their work increased slightly in 2025 compared to recent years 31.47% (2024: 30.26%; 2023: 30.51%; 2022: 34.14%; 2021: 34.66%)
the ‘burnout’ sub-score has dropped below 5 for the first time since 2022. A higher proportion of staff say their work ‘often’ or ‘always’ frustrates them this year, and more staff report feeling burnt out because of their work. Staff who have worked for their organisation for 6 to 10 years, 11 to 15 years and more than 15 years have seen increases of more than 1 percentage point in the proportion saying they feel burnt out in 2025. Staff with less than 1 year, 1 to 2 years and 3 to 5 years at their organisation report similar levels of burnout to 2024

NHS health and wellbeing framework

The NHS health and wellbeing framework provides a shared model and diagnostic tools to help NHS organisations understand, assess and systematically improve staff health and wellbeing through culture change and evidence-based practice.

Promoting health and wellbeing and attendance at work guidelines

This guidance was produced through partnership working between unions, management and specialist advisors and supports the consistent management of attendance while promoting staff health, safety and wellbeing in line with NHS terms and conditions.

Growing occupational health and wellbeing together strategy

A 5-year NHS strategy setting out a systemwide roadmap to strengthen occupational health and wellbeing services, workforce capability and impact to keep NHS staff safe, healthy and supported.

Welfare facilities for healthcare staff

Guidance setting out the legal requirements, partnership principles and practical expectations for providing high-quality staff welfare facilities that support health, safety and wellbeing in healthcare settings.

Health and wellbeing guardian guidance

Guidance setting out how NHS organisations can implement the health and wellbeing guardian role to provide board level assurance, challenge and leadership in embedding a consistent focus on staff health and wellbeing across different healthcare settings.

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

The 2026 to 2027 NHS Oversight Framework score will use questions from the NHS Staff Survey as metrics. More detail on how these questions form part of the overall NHS Oversight Framework score for the staff standards will be available in the 2026 NHS Oversight Framework technical guidance.

The questions that will be used for health and wellbeing are:

Question 11a - My organisation takes positive action on health and wellbeing
Question 11c - During the last 12 months have you felt unwell as a result of work-related stress?
Question 12b - How often, if at all, do you feel burnt out because of your work?

Additional data organisations can access to assure themselves of performance 

In addition to the above, organisations should also ensure they review any relevant additional data and metrics sources to support their delivery of the health and wellbeing standard. This may include, but is not limited to: 

Additional metrics we may look to incorporate in future 

Throughout 2026 to 2027, DHSC and NHS England will work in partnership with trade unions and employers to explore what additional metrics could be used to track progress against this standard. This may include additional data to inform the NHS Oversight Framework score, data for additional accountability processes, or data to recommend organisations use for their own self-assessment.

Potential additional sources of evidence, along with further review of those mentioned above could include:

retention tracker
staff experience assessment tool
health and safety committees should be used to review and triangulate workforce data relating to health and wellbeing, including NHS Staff Survey results, Datix and incident data, sickness absence, occupational health referrals, and staff intelligence, informing board‑level oversight and continuous improvement

Legal duties

Health and Safety at Work Act 1974 

Employers have a duty to look after the health, safety and welfare of their staff under existing health and safety legislation under the Health and Safety at Work Act 1974, which is underpinned by various regulations including:

Management of Health and Safety at Work Regulations, 1999
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, 2013
Safety Representatives and Safety Committees Regulations, 1977
Health and Safety (Consultation with Employees) Regulations, 1996
Working Time Regulations, 1998

Workplace (Health, Safety and Welfare) Regulations 1992: Drinking water - Regulation 22

In accordance with Workplace (Health, Safety and Welfare) Regulations 1992: Drinking water - Regulation 22, employers must provide:

an adequate supply of wholesome (potable) drinking water for all staff at work
drinking water that is:
- readily accessible at suitable places
- clearly marked where there is any risk of confusion with non-drinking water
- suitable cups or drinking vessels, unless the water is supplied through a drinking fountain or jet

Workplace (Health, Safety and Welfare) Regulations 1992: Rest facilities and eating facilities - Regulation 25

In accordance with Workplace (Health, Safety and Welfare) Regulations 1992: Rest facilities and eating facilities - Regulation 25, employers must provide:

suitable and sufficient rest facilities for workers to rest
suitable facilities to eat meals, where meals are regularly eaten in the workplace
rest facilities that:
- are clean, warm and have adequate seating and tables
- include facilities to eat where food is eaten in the workplace and is otherwise likely to be contaminated (for example, clinical or hazardous areas)
- are suitable for pregnant and breastfeeding workers

Management of Health and Safety at Work Regulations 1999

In accordance with Regulation 3 of the ‘Management of Health and Safety at Work Regulations 1999’, employers must undertake suitable and sufficient assessments of the risks to staff health and safety, including psychosocial risks such as work-related stress.

NHS Constitution - staff rights and pledges in the Handbook

Right:

To work within a healthy and safe workplace and an environment in which the employer has taken all practical steps to ensure the workplace is free from verbal or physical violence from patients, the public or staff… and to take regular breaks from work.

This right means staff should be able to work in conditions that are physically safe and psychologically secure. Employers are expected to take active steps to prevent and address harassment, bullying and violence, so staff are treated with dignity, feel safe at work, and can raise concerns without fear.

Pledge:

The NHS pledges to provide support and opportunities for staff to maintain their health, wellbeing and safety.

Question 3

Violence prevention and reduction

Accepted Answer

Standard

Staff have a right to feel safe and supported at work, in an environment that takes meaningful action to prevent violence, aggression, intimidation or abuse in any form. Staff should have access to simple, safe and supportive channels for reporting violence in the workplace; timely, compassionate support after any violent or harmful incident; and the right training to equip them with the confidence and knowledge to keep themselves and others safe.

Purpose

The Health and Safety Executive (HSE) says violence at work is ‘any incident in which an employee is abused, threatened or assaulted in circumstances relating to their work’. It can include physical attacks, verbal abuse or threats, from anyone including patients, service users, their relatives and other members of the public. The NHS staff standard for violence reduction and prevention sets out the required national standard for how all NHS organisations must prevent, reduce, respond to and learn from incidents of violence, aggression, harassment, abuse and unwanted or harmful behaviours towards staff.

The purpose of this standard is to:

protect the safety, dignity and wellbeing of all NHS staff by establishing a consistent, preventative, evidence-based approach to reducing violence across the NHS
ensure every NHS organisation adopts a common set of principles, governance arrangements, accountability structures and operational practices that strengthen staff safety and align with statutory duties, workforce policies and national NHS priorities
reduce variation in practice by providing a clear, measurable framework that supports organisations, integrated care systems and system partners to deliver safe working environments and respond effectively and compassionately when violence occurs
improve staff experience, retention and psychological safety by embedding trauma informed and public health approaches that address the causes, triggers and impacts of violence
enable systemwide collaboration and shared learning, ensuring that all organisations contribute to a consistent national approach and benefit from collective intelligence, data and interventions

It must be used by:

organisations to benchmark current practice, identify gaps, develop improvement plans and demonstrate compliance with national expectations
boards and leaders to discharge accountability, demonstrate progress and monitor staff safety indicators
regions to co-ordinate systemwide learning, ensure equitable support, and align approaches across providers
trade unions and employers working in partnership to address the issue of violence prevention and reduction
staff to understand their rights and what they should expect from their employer
regulators and assurance bodies to inform oversight, assessment and system performance improvement

Actions for employers

Employers across healthcare must work together and with partners in the police and elsewhere to create a culture whereby violence against NHS staff is unacceptable and organisations take proactive steps to prevent violence, respond effectively when it occurs and ensure staff receive timely, high-quality support.

Employers must:

implement and embed the violence prevention and reduction (VPR) standard. They should have a named senior responsible officer for VPR with an annual VPR improvement plan, using VPR risk assessment tools and evidence-based interventions in relevant settings
ensure that reporting systems are in place and actively promoted, so that all staff feel supported to report any incident of violence or abuse, irrespective of a patient’s circumstances or condition
accurate and timely data should be recorded to inform strategies on tackling and preventing violence and feed into national VPR data collections
ensure staff who are subject to violence or abuse have access to high-quality post-incident psychological and welfare support. Managers should understand how to ensure staff receive post-incident support and where to signpost staff to
develop and implement HR policies and procedures that provide the right support following incidents and during investigations
ensure that all staff receive training appropriate to their role
ensure the appropriate health and safety committee and/or forum is engaged in VPR planning and monitoring
work in partnership with trade unions through local arrangements, staff networks and local VPR groups to provide assurance on support for staff and to encourage staff to call out where organisations are failing. This should ensure that staff voice shapes local improvements with feedback and lived experience underpinning policies and interventions

These actions are intended to build on the requirements of existing legal frameworks as set out in the legal duties section below.

Context

NHS employees have had a consistently higher risk of violence at work than other occupational groups in recent years.

NHS Staff Survey

The 2025 NHS Staff Survey showed that:

the number of staff who have experienced at least one incident of physical violence from patients, service users or members of the public has slightly increased (14.47% in 2025, 14.38% in 2024, 13.88% in 2023)
the number of staff experiencing physical violence from colleagues is at 1.8% down from 1.89% in 2024
however, the reporting of incidents of physical violence has improved (75.36% in 2025 and 74.69% in 2024 compared to 73.62% in 2023)
experiences of violence varies by occupation group with 38.04% of staff in ambulance trusts, 34.33% of staff in nursing and healthcare assistant roles and 11.68% of medical and dental staff reported having experienced at least one incident of physical violence from patients, service users or members of the public in the last year
ethnic minority staff are more likely than White staff to experience bullying, harassment or abuse from patients and the public (29.16% versus 23.54%) and from managers (9.81% versus 8.58%). Disabled staff also experience disproportionately high levels of abuse, with 29.68% reporting harassment, bullying or abuse from patients or the public compared with 25.25% for non‑disabled staff, and 13.62% experiencing these behaviours from managers compared with 9.11% of non‑disabled staff

Violence prevention and reduction standard (2024)

The NHS violence prevention and reduction (VPR) standard, developed in partnership with the Social Partnership Forum (SPF), complements existing health and safety legislation on employers’ duty of care to protect staff from threats and violence at work. The NHS Standard Contract currently encourages provider organisations to take all reasonable endeavours to utilise the VPR Standard. This has been mandated as part of the 2026 to 2027 Standard Contract.

As part of the 2023 Agenda for Change pay deal the SPF VPR subgroup was commissioned to produce a report that scoped existing work on preventing and reducing violence against NHS staff and made recommendations to government on what more might be done. Work is underway to implement these recommendations in partnership with SPF through the Violence Reduction Oversight Group.

Memorandum of understanding

A 2025 multi-agency memorandum of understanding further improves consistency and co-ordination in investigating and prosecuting offences against emergency workers, setting clearer expectations for how cases should be managed and how victims should be supported.

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

The 2026 to 2027 NHS Oversight Framework score will use questions from the NHS Staff Survey as metrics. More detail on how these questions form part of the overall NHS Oversight Framework score for the staff standards will be available in the 2026 NHS Oversight Framework technical guidance.

The questions that will be used for violence prevention and reduction are:

Question 13a, 13b and 13c - In the last 12 months have you personally experienced physical violence at work from (a) patients, service users, their relatives or other members of the public; (b) managers; (c) other colleagues. The results of these questions will be combined to a single metric
Question 13d - The last time you experienced physical violence at work, did you or a colleague report it?

Additional data organisations can access to assure themselves of performance

In addition to the above, organisations should also ensure they review any relevant additional data and metrics sources to support their delivery of the violence prevention and reduction standard. This may include, but is not limited to:

data from the National Education and Training Survey
other local data, for example:
- data from health and safety forums
- Datix
- HR case trends
- staff feedback

Additional metrics we may look to incorporate in future

Throughout 2026 to 2027, DHSC and NHS England will work in partnership with trade unions and employers to explore what additional metrics could be used to track progress against this standard. This may include additional data to inform the NHS Oversight Framework score, data for additional accountability processes, or data to recommend organisations use for their own self-assessment.

Potential additional sources of evidence, along with further review of those mentioned above, could include:

VPR Data Reporting Framework - a national framework to standardise how all NHS provider organisations record and report incidents of violence and aggression against staff is being finalised and tested during 2026 to 2027, with the ambition that this will lead to standardised national reporting, tracking and analysis
NHS Staff Survey - whether there is scope to add additional questions to the NHS Staff Survey, for example, on employer action to prevent or reduce violence
quarterly pulse survey, staff experience assessment tool and/or retention tracker - potential to be used to track staff experience, post incident support, prevention or other interventions
measuring engagement of the new statutory and mandatory training covering VPR training requirements once in place

Legal duties

Health and Safety at Work Act (1974)

Employers have a duty to look after the health, safety and welfare of their staff under existing health and safety legislation (the Health and Safety at Work Act 1974, which is underpinned by various Regulations (Management of Health and Safety at Work Regulations, 1999, Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, 2013, Safety Representatives and Safety Committees Regulations, 1977 and Health and Safety (Consultation with Employees) Regulations, 1996)).

Assaults Against Emergency Workers Act (2018)

The Assaults on Emergency Workers (Offences) Act 2018 is criminal legislation that establishes a framework to support the effective investigation and prosecution of cases where emergency workers are the victim of a crime. This was strengthened by Crown Prosecution Service (CPS) guidance published in April 2025 to support ways of gaining swifter justice against offenders. 

NHS Constitution - staff rights and pledges in the Handbook

Right:

To work within a healthy and safe workplace and an environment in which the employer has taken all practical steps to ensure the workplace is free from verbal or physical violence from patients, the public or staff, to work your contractual hours, take annual leave and to take regular breaks from work.

This right supports staff to have healthy and safe working conditions and an environment free from harassment, bullying or violence. Employers are expected to have made a suitable and sufficient assessment of the risks to the health and safety of employees and to have identified preventive and protective measures to be put in place. This will include arrangements to ensure effective planning, organisation, control, monitoring and review of the preventive and protective measures.

NHS organisations are encouraged to adhere to appropriate security management standards. These should include ensuring that there is top-down organisational support for initiatives to protect staff from violence, providing conflict resolution training, and implementing preventive measures and response systems in case of violent incidents. NHS organisations are also encouraged to have accredited local security management leads in place for work to ensure the safety and security of staff working at the organisation.

Pledge:

The NHS pledges to provide support and opportunities for staff to maintain their health, wellbeing and safety.

Pledge:

The NHS pledges to encourage and support all staff in raising concerns at the earliest reasonable opportunity about safety, malpractice or wrongdoing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Employment Rights Act 1996.

Question 4

Championing sexual safety

Accepted Answer

Standard

Staff have a right to feel safe and supported at work, in an environment that is free from sexual harassment, abuse and unwanted or inappropriate sexual behaviours. Staff can expect their organisation to take clear, consistent action to prevent sexual misconduct and harassment; promote a culture of transparency and openness that ensures incidents are reported and acted upon promptly and appropriately; training to be provided on how to recognise and report inappropriate behaviours; and a victim centred approach, with support provided to those affected and lessons learned to reduce the risk of future incidents.

Purpose

The NHS staff standard for sexual safety sets out the required national standard for how all NHS organisations must prevent, reduce, respond to and learn from incidents of sexual misconduct in the workplace.

The purpose of this standard is to:

protect the safety, dignity and wellbeing of all NHS staff by establishing a consistent, preventative, evidence-based approach to reducing sexual misconduct and harassment across the NHS
ensure every NHS organisation adopts a common set of principles, governance arrangements, accountability structures and operational practices that strengthen sexual safety, aligned with statutory duties, workforce policies and national NHS priorities
reduce variation in practice by providing a clear, measurable framework that supports trusts, integrated care systems and system partners to deliver safe working environments and respond effectively and compassionately when sexual misconduct and harassment occurs
improve staff experience, retention and psychological safety by embedding trauma-informed evidence-based approaches that address the causes, triggers and impacts of sexual misconduct
enable systemwide collaboration and shared learning, ensuring that all organisations contribute to a consistent national approach and benefit from collective intelligence, data and interventions

It must be used by:

organisations to benchmark current practice, identify gaps, develop improvement plans and demonstrate compliance with national expectations
boards and leaders to discharge accountability, demonstrate progress and monitor staff safety indicators
regions to co-ordinate systemwide learning, ensure equitable support and align approaches across organisations
staff to understand their rights and what they should expect from their employer
trade unions and employers working in partnership to address the issue of sexual safety, prevention and avoiding ongoing harm
regulators and assurance bodies to inform oversight, assessment and system performance improvement

Actions for employers

Employers across the healthcare system must work together and individually to tackle unwanted, inappropriate and/or harmful sexual behaviour in the workplace.

Employers must:

fully implement the actions set out in the Sexual safety in healthcare - organisational charter, assessing progress using the sexual safety charter assurance framework, ensuring board level ownership and accountability
ensure all staff complete Understanding sexual misconduct in the workplace e-learning
ensure that investigators of sexual misconduct allegations receive specialist training
ensure they have robust staff policies and processes for dealing with sexual misconduct and that staff do not suffer detriment as a consequence of reporting, in line with victimisation legislation
share concerns about employees with future employers and host organisations
ensure all staff are familiar with the sexual misconduct people policy framework so that they understand how to recognise and report sexual misconduct, and what actions should be taken when sexual misconduct is reported and where staff are the perpetrators, including the other policies that might be used
work in partnership with trade unions and staff networks through local arrangements to provide assurance on support for staff, to shape local plans and to encourage staff to call out where organisations are failing

These actions are intended to build on the requirements of existing legal frameworks as set out in the legal duties section below.

Context

Definition

As set out in NHS England’s sexual misconduct policy, sexual misconduct is uninvited, unwelcome or non-consensual behaviour of a sexual nature. It is behaviour that can be interpreted and/or perceived by an individual as sexual and which offends, embarrasses, harms, humiliates or intimidates an individual or group. It can involve elements of harassment, violence and abuse and can be physical, verbal or visual through different mediums. Unwanted behaviour of a sexual nature can happen to anyone, but it often happens where there is a power imbalance.

Sexual misconduct can include many things, such as:

sexual comments or jokes
unwanted touching or kissing
showing sexual pictures
staring at someone in a sexual way
asking personal questions about someone’s sex life
sexual assault or rape

Sexual misconduct can take place at any time and any place - for example, at social or learning events or while travelling for work. It can take place in person or online (for example, through chat messages, phone calls, voice messages or social media), and, in the context of the NHS, can be committed by patients, their relatives, members of the public or staff.

NHS Staff Survey

The 2025 NHS Staff Survey showed that:

there had been an increase in the proportion of staff reporting unwanted behaviour of a sexual nature from patients, service users, their relatives or other members of the public from 8.82% in 2023 (the first year of reporting) to 9.07% in 2025
staff experiencing these behaviours from staff and colleagues has seen a reduction from 3.86% in 2023 to 3.51% in 2025

Sexual safety charter

In 2023 NHS England launched the healthcare system’s first organisational Sexual Safety Charter. All NHS provider trusts and integrated care boards have signed up to the charter with organisations committing to taking and enforcing a zero-tolerance approach to any unwanted, inappropriate/or harmful sexual behaviours in the workplace. This has been strengthened by the National People Policy Framework on Sexual Misconduct.

National Sexual Misconduct People Policy Framework

NHS England published a National Sexual Misconduct People Policy Framework in October 2024. The framework helps staff to understand their rights and responsibilities, how to recognise and report inappropriate behaviour and how to access advice and support. Alongside the policy is a new e-learning resource designed to equip people working and learning in the NHS with the knowledge and skills to recognise and respond to sexual misconduct.

NHS England also wrote to provider trusts on 20 August 2025 and 5 December 2025 asking for further actions to be taken to identify and act against potential perpetrators of sexual misconduct in the NHS.

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

The 2026 to 2027 NHS Oversight Framework score will use questions from the NHS Staff Survey as metrics. More detail on how these questions form part of the overall NHS Oversight Framework score for the staff standards will be available in the 2026 NHS Oversight Framework technical guidance.

The question that will be used for sexual safety in the workplace is:

Question 17b - In the last 12 months, how many times have you been the target of unwanted behaviour of a sexual nature in the workplace? This may include offensive or inappropriate sexualised conversation (including jokes), touching or assault. This question is specific to such behaviours from other staff/colleagues

Additional data organisations can access to assure themselves of performance

In addition to the above, organisations should also ensure they review any relevant additional data and metrics sources to support their delivery of the sexual safety in the workplace standard. This may include, but is not limited to:

data from the National Education and Training Survey
NHS Staff Survey - organisations can also review question 17a which assesses the workforce’s experience of offensive or inappropriate sexualised conversation (including jokes), touching or assault from the public and patients
data gathered at a local level to enable board leaders to monitor adherence to the NHS Sexual Safety Charter
other local data for example:
- data from health and safety forums
- Datix
- HR case trends
- staff feedback
- sharing of intelligence with relevant professional regulators where appropriate with regard to agreed data sharing protocols

Additional metrics we may look to incorporate in future

Throughout 2026 to 2027, DHSC and NHS England will work in partnership with trade unions and employers to explore what additional metrics could be used to track progress against this standard. This may include additional data to inform the NHS Oversight Framework score, data for additional accountability processes, or data to recommend organisations use for their own self-assessment.

Potential additional sources of evidence, along with further review of those mentioned above could include:

NHS Staff survey - whether there is scope to add additional questions to the NHS Staff Survey, for example, on reporting or employer action against sexual misconduct
quarterly pulse survey, staff experience assessment tool and/or retention tracker - potential to be used to track staff experience, post incident support, prevention or other interventions

Legal duties

Worker Protection (Amendment of Equality Act 2010) Act 2023

The Worker Protection (Amendment of Equality Act 2010) Act 2023 amended the Equality Act 2010 to introduce a stand-alone proactive duty on employers to take reasonable steps to prevent sexual harassment. The Employment Rights Act 2025 strengthens this duty by requiring employers from October 2026 onwards to take “all reasonable steps” to prevent sexual harassment and re-introduces employer liability for harassment by third parties.

The 2 acts amend the Equality Act 2010 to create a statutory duty on employers to focus on prevention, early reporting and accountability. Guidance from the Equality and Human Rights Commission (EHRC) and Advisory, Conciliation and Arbitration Service (ACAS) highlights risk assessments, training, clear policies and reporting channels as crucial.

Employment Rights Act (2025)

Whistleblowing: from 6 April 2026, the Employment Rights Act (2025) will amend the Employment Rights Act 1996 so that workers who ‘blow the whistle’ that sexual harassment that has occurred, is occurring or is likely to occur can benefit from whistleblowing protections against detriment (adverse treatment) and unfair dismissal.

Victimisation: victimisation is negative treatment because an individual has made an allegation, given information or evidence or brought a claim in relation to discrimination or harassment. It is unlawful under the Equality Act 2010.

Both these acts create a single escalating legal framework focused on prevention, early reporting and accountability.

Equality Act 2010 and Protection from Harassment Act 1997

The Equality Act 2010 prohibits harassment based on protected characteristics (for example, sex, race, disability), with the Protection from Harassment Act 1997 covering broader, repeated antisocial behaviour.

The 2010 act focuses on discrimination in employment and services with the 1997 act covering physical, verbal and psychological harassment.

Health and Safety at Work Act 1974

The Health and Safety at Work etc. Act 1974 is the primary legislation for workplace health and safety in Great Britain, requiring employers to ensure, so far as is reasonably practicable, the health, safety and welfare of employees and the public.

NHS Constitution - staff rights and pledges in the Handbook

Right:

To expect reasonable steps are taken by the employer to ensure protection from less favourable treatment by fellow employees, patients and others (for example, bullying or harassment).

Bullying, harassment and discrimination are serious issues and should not be tolerated. Every organisation should have in place a bullying and harassment policy that is easily accessible to staff and managers. This should be monitored on a regular basis by senior managers. It should include details on how such issues will be investigated in a fair and timely way.

Pledge:

The NHS pledges to provide support and opportunities for staff to maintain their health, wellbeing and safety.

Pledge:

The NHS pledges to encourage and support all staff in raising concerns at the earliest reasonable opportunity about safety, malpractice or wrongdoing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Employment Rights Act 1996.

Question 5

Tackling racism

Accepted Answer

Standard

Staff can expect their organisation to take sustained and meaningful action to prevent and root out racism and discrimination in the workplace (encompassing all forms of violence, abuse and/or harassment from patients and/or service users, their relatives, members of the public and staff), ensuring staff experience safe working environments and a supportive culture where they can expect restorative support, clear accountability and defined consequences in the organisation.

Purpose

Given these inequalities exist across our workforce, the NHS staff standard for tackling racism sets out the required national standard for how all NHS organisations must prioritise, prevent, respond to and learn from incidents of racism in the workplace. Race under the Equality Act (2010) is not defined just by reference to colour - it also includes nationality and ethnic or national origins. This standard will encourage NHS organisations to proactively work to eliminate the conditions in which racism and racist behaviour thrive. It also helps support organisations to comply with their Public Sector Equality Duties and create a sense of belonging for all staff.

The purpose of this standard is to:

It must be used by:

organisations to benchmark current practice, identify gaps, develop improvement plans and demonstrate compliance with national expectations, legislation and contractual obligations related to the NHS
boards and leaders to discharge accountability and monitor and demonstrate progress
regions to co-ordinate systemwide learning, ensure equitable support, and align approaches across providers
trade unions and employers working in partnership to address the issue of racism
staff to understand their rights and what they should expect from their employer
regulators and assurance bodies to inform oversight, assessment, and system performance improvement

Actions for employers

Employers across the NHS must ensure that action towards tackling racism and discrimination of NHS staff is clear, consistent, meaningful and sustained across all organisations.

Employers must:

set clear consequential outcomes for misconduct at the individual level, (including bullying, harassment and discrimination both verbal and physical) including from members of the public, patients, service users and their relatives, and at organisational level. This should include a review of policies related to staff misconduct, and where appropriate, explicitly state the standard of behaviour expected from staff and the penalties including up to dismissal for certain behaviours and/or repeated incidents. It should also include the potential for refusal of care for patients in non-emergency situations, as well as consequences for organisational performance and professional non-compliance (Care Quality Commission (CQC) and/or professional regulators)
work in partnership with trade unions to ensure representation of the staff voice, reviewing policies to ensure they are fair/proportionate, supporting staff to speak up safely and support during formal procedures to ensure racism is taken seriously in delivering this standard
ensure implementation and monitoring of the 6 high level impact actions as part of the NHS Equality, Diversity and Inclusion Improvement Plan, and as set out in the NHS Standard Contract
ensure every board member (including non-executive directors) has a published Specific Measurable Achievable Relevant Time-bound objective on tackling racism. Either the chief executive officer or chief operating officer, must be appointed as the senior responsible officer for tackling racism and must be guided by the Race and Health Observatory leadership toolkit and anti-racism principles. They will be held to account against relevant workforce data and there must be clear incentives in place for strong and clear consequences for poor performance
implement inclusive recruitment and talent management practices by developing a recruitment and career progression plan that ensures equity of opportunity (expanding on the high impact actions and the specific measurable targets as part of the current EDI plan and the workforce race equality standard (WRES))
work to create inclusive cultures (embedding basic values of culture and respect) that encourage staff at all levels to report and for employers to consistently work to root out racist behaviour. Employers must ensure that their internal reporting mechanisms and systems capture the experience of racism on an individual basis to enable wider analysis and trend monitoring that contributes to local improvement plans in tackling racism
update emergency protocols and responses to include adequate and appropriate responses that help to maintain safe working environments
update grievance, disciplinary and investigative processes so they are responsive to the experiences of racism and discrimination and are void of biased applications in their process. Ensure they encourage thorough and unbiased investigation, with careful examination of evidence to clarify when and why racism has not been proven
where appropriate, evaluate and implement the recommendations of key leading bodies on good practice, to ensure work is reflective of the evolution and growing body of work to tackle racism at every level

These actions are intended to build on the requirements of existing legal frameworks as set out in the legal duties section below.

Context

NHS Staff Survey

The 2025 Staff Survey showed that:

instances of staff experiencing discrimination from patients, their families and the general public and managers and other colleagues at work had increased again and are higher among ethnic minority staff compared to white staff
the gap in experiences of discrimination between ethnic minority and white staff from patients, their families and the general public has grown compared to last year
ethnic minority staff remain more likely to experience harassment, bullying or abuse from patients, their families and the public (29.16% 2024: 28.63% 2025), compared to their white colleagues (23.5%). This is also the case regarding these behaviours from a manager or other colleagues

Workforce race equality standard

The workforce race equality standard (WRES) report (2024) was published on 25 June 2025. The report highlights signs of progress on representation in leadership positions, with the number of very senior managers in the NHS from black and minority ethnic backgrounds increasing by 85% since 2018.

However, 80% of organisations reported that white applicants were significantly more likely than ethnic minority applicants to be appointed from shortlisting. Just 42.3% of staff from a black background believed their organisation provides equal opportunities for career progression or promotion.

EDI Improvement Plan

NHS England’s EDI improvement plan, published in 2023, set out 6 high-impact actions for board leaders to create an inclusive environment where staff feel psychologically safe, are supported to speak up to raise concerns, and in turn deliver efficient, productive and safe care to patients. The EDI improvement plan is currently being reviewed by NHS England this year in a ’lessons learned’ exercise and a plan to extend this into primary care has been finalised.

NHS Race and Health Observatory 7 anti-racism principles

The NHS Race and Health Observatory’s 7 anti-racism principles underpin the development of this staff standard in the NHS by providing a foundation for leaders to develop local action and/or plans that exemplify these.

Pay gaps

NHS Race and Health Observatory is leading work on pay and progression gap disparity (inclusive of race). The observatory is working with Professor Carol Woodhams (Professor of Human Resource Management at the University of Surrey) and Professor Doyin Atewologun (Professor at the University of Exeter). Findings from the review will be made available in December 2026. The observatory is also undertaking work with Dr Just Aunger at the University of Birmingham and Professor Jeremy Dawson at the University of Sheffield to tackle bullying and harassment across the NHS workforce. The aim of this work is to reduce the overall level of bullying and harassment across all staff, and to close the ethnicity gap in this area.

Lord Mann review

Lord John Mann was asked to lead an urgent review of antisemitism and other forms of racism and the oversight and regulation of healthcare professionals. The independent report, published on 4 June 2026, considered how regulators and the NHS address antisemitism and other forms of racism throughout their processes, from a complaint being raised, to investigation and fitness to practice proceedings. The review also considered how greater transparency can be brought to regulatory processes, including General Medical Council and Medical  Practitioner  Tribunal  Service.

On 17 October, NHS England published a request for action on racism including antisemitism, issued to integrated care boards, NHS trust and foundation trust leadership. The statement: 

reiterates zero tolerance stance to “all forms of hatred, antisemitism, Islamophobia, racism”
formally adopts the International Holocaust Remembrance Alliance (IHRA) working definition of antisemitism within NHS England, as an employer
commits to updating national guidance for uniform and workwear
commits to update the existing NHS Core Skills Framework module on equality, diversity and human rights

Definitions

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

The 2026 to 2027 NHS Oversight Framework score will use questions from the NHS Staff Survey as metrics. More detail on how these questions form part of the overall NHS Oversight Framework score for the staff standards will be available in the 2026 NHS Oversight Framework technical guidance.

The questions that will be used are shown below. Where possible these questions reflect the indicators for the WRES. For the NHS Oversight Framework score, the data used is the responses to the NHS Staff Survey from ethnic minority respondents to reflect this standard’s focus on tackling racism:

Question 15 - Does your organisation act fairly with regard to career progression or promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age?  (WRES indicator 7)
Question 14a - In the last 12 months how many times have you personally experienced harassment, bullying or abuse at work from… Patients and/or service users, their relatives or other members of the public (WRES indicator 5)
Questions 14b and 14c - In the last 12 months how many times have you personally experienced harassment, bullying or abuse at work from… managers or other colleagues. (These questions are combined to give an overall score based on harassment, bullying or abuse at work from other staff in line with WRES indicator 6)
Question 16a - In the last 12 months have you personally experienced discrimination at work from patients or service users, their relatives or other members of the public
Question 16b - In the last 12 months have you personally experienced discrimination at work from any of the following? (manager or team leader or other colleagues) (WRES indicator 8)

Additional data organisations can access to assure themselves of performance

In addition to the above, organisations should also ensure they review any relevant additional data and metrics sources to support their delivery of the tackling racism standard. This may include, but is not limited to:

Workforce race equality standard

Organisations should pay specific regard to the 9 WRES indicators and ensure they have measures in place to track, monitor and improve their performance against each of these. Organisations and individuals can access data demonstrating performance against these indicators from both the main WRES data publications and, for those WRES indicators that use NHS Staff Survey, data from the NHS Staff Survey dashboard. The indicators are:

percentage of staff in each of the Agenda for Change Bands 1 to 9 and Very Senior Management (including executive board members) compared with the percentage of staff in the overall workforce
relative likelihood of staff being appointed from shortlisting across all posts
relative likelihood of staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation
relative likelihood of staff accessing non-mandatory training and continuous professional development
percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months
percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months
percentage believing that trust provides equal opportunities for career progression or promotion
in the last 12 months have you personally experienced discrimination at work from… manager or team leader or other colleagues
percentage difference between the organisations’ board voting membership and its overall workforce

Other

published data, which may include but not be limited to:
- data from the National Education and Training Survey
- other existing questions in the NHS Staff Survey - notably understanding the differences between respondents based on their demographics
internal data on or from:
- measuring uptake of training
- the sharing of intelligence with relevant professional regulators where appropriate, in line with agreed data sharing protocols
- health and safety forms
- Datix
- HR case trends
- staff feedback

Additional metrics we may look to incorporate in future

Throughout 2026 to 2027, DHSC and NHS England will work in partnership with trade unions and employers to explore what additional metrics could be used to track progress against this standard. This may include additional data to inform the NHS Oversight Framework score, data for additional accountability processes, or data to recommend organisations use for their own self-assessment.

Specifically, we will continue developing the NHS Oversight Framework score, alongside additional accountability and compliance processes, to ensure that as many of the WRES indicators as possible are reflected. This may require further development of additional data to support the WRES indicators.

Potential additional sources of evidence could include:

NHS Staff Survey - whether there is scope to add additional questions to the NHS Staff Survey
quarterly pulse survey, staff experience assessment tool and/or retention tracker - potential to be used to track staff experience, post incident support, prevention or other interventions

Legal duties

Equality Act 2010

The key legislation setting out the NHS’s statutory duties with regard to racial discrimination is the Equality Act 2010. Section 149 of the Act outlines the Public Sector Equality Duty, which requires public services to have ‘due regard’ to 3 key needs:  

to eliminate unlawful discrimination, harassment, and victimisation
to advance equality of opportunity
to foster good relations between different groups

Human Rights Act 1998

In accordance with the Human Rights Act (1998) all public bodies, including the NHS, must act in a way that is compatible with the European Convention on Human Rights.  

Health and Safety at Work Act 1974

Employers have a duty to look after the health, safety and welfare of their staff under existing health and safety legislation (the Health and Safety at Work Act 1974 which is underpinned by various Regulations (Management of Health and Safety at Work Regulations, 1999, Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, 2013, Safety Representatives and Safety Committees Regulations, 1977 and Health and Safety (Consultation with Employees) Regulations, 1996).

NHS Constitution- staff rights and pledges in the Handbook

Right:

To work within a healthy and safe workplace and an environment in which the employer has taken all practical steps to ensure the workplace is free from verbal or physical violence from patients, the public or staff, to work your contractual hours, take annual leave and to take regular breaks from work.

Right:

To a working environment (including practices on recruitment and promotion) free from unlawful discrimination on the basis of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status.

These rights support staff to have healthy and safe working conditions and an environment free from harassment, bullying or violence.

Pledge:

The NHS pledges to provide a positive working environment for staff and to promote supportive, open cultures that help staff do their job to the best of their ability.

Pledge:

The NHS pledges to encourage and support all staff in raising concerns at the earliest reasonable opportunity about safety, malpractice or wrongdoing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Employment Rights Act 1996.

Question 6

Promoting flexible working

Accepted Answer

Standard

NHS staff can expect flexible working (flexibility in how, where and when they work) to be openly encouraged and supported, fairly and equitably considered, and embedded into everyday practice, creating a ’flexible first’ culture, rather than treated as an exception. Requests must be considered objectively and not unreasonably refused, and where they cannot be agreed, alternatives will be explored.

Purpose

Flexible working supports recruitment and retention, and can improve staff wellbeing, which helps to build long-term workforce capability and capacity, and improves productivity. The NHS staff standard for promoting flexible working sets out the minimum national expectations for how all NHS organisations must create a positive, fair and transparent culture in which flexible working is normalised operational practice, proactively offered, openly discussed, and consistently applied to improve staff experience, wellbeing and retention.

The purpose of the standard is to:

ensure flexible working becomes culturally embedded, such that it is normalised operational practice from job advert, job interviews and workforce planning, through to appraisal and line manager and employee discussions
ensure board-level responsibility and action to create a positive organisational culture on flexible working which empowers staff to make a request, enables line managers and leaders to implement and respond to employees’ and the service’s needs
capture and report data from the initial request for flexible working, through the process, to the outcome
ensure every NHS organisation adopts a common set of principles, governance arrangements, accountability structures, and operational practices that promotes flexible working and aligns with statutory duties, workforce policies, and national NHS priorities
reduce variation in practice by providing a clear, measurable framework that supports organisations to deliver fair and equitable flexible working approaches that staff want and reduce inequalities of experience by the workforce
enable systemwide collaboration and shared learning, ensuring that all organisations contribute to a consistent national approach and benefit from collective evidence and data on what works
promote the fact that flexible working can be offered in many different forms relating to how, when and where people work, and how far in advance arrangements should be made, and that all job roles in the NHS therefore have the potential to be shaped to have at least some level of flexibility
develop positive mindsets and challenge stereotyped views towards flexible working and ensure that no single manager should act as a gatekeeper in refusing flexible working requests

It must be used by:

organisations to benchmark current practice, identify issues, develop improvement plans and demonstrate compliance with national expectations
boards and leaders to discharge accountability, demonstrate progress, and monitor and share flexible working data
regions to co-ordinate systemwide learning, ensure equitable support, and align approaches across providers
trade unions and employers working in partnership to address the issues and challenges of meaningful flexible working and work locally in partnership to drive improvement
staff to understand their rights and what they should expect from their employer
regulators and assurance bodies to inform oversight, assessment, and system performance improvement

Actions for employers

NHS organisations must ensure that flexible working requests are considered in accordance with legal duties, and with the actions set out in this standard, to ensure a consistent approach across all NHS organisations. Employers must provide clear processes, effective systems, consistent, transparent decision-making, and proactive conversations, ensuring flexibility is accessible to all staff where service needs allow.

Employers must:

appoint a board level flexible working champion who is responsible for:
- promoting and leading improvements in flexible working across the organisation
- recognising and challenging the barriers to accessing flexible working
- ensuring implementation of a flexible working action plan
- promoting a positive organisational culture towards ensuring fair and equitable access to flexible working for all staff
implement a flexible working action plan using organisational workforce data to ensure a consistent approach across the organisation and individual teams which is owned by the board
following an equality impact assessment, implement preference-based team e-rostering for all frontline workers (where operationally appropriate) within the organisation to bring flexibility and choice of shift patterns to staff who need to maintain safe services
collect data on the number of flexible working requests (formal through contractual changes and informal through manager one-to-one discussions) which are approved or rejected, the types of flexible working requests, and broken down by protected characteristic as per the Equality Act 2010, staff groups and/or professions, bands and at department level
publish this data for staff and linked to the flexible working action plan set out what actions will be taken to improve areas where there are concerns. This data should also be available to the CQC as requested
work in partnership with trade unions through local partnership arrangements to assess progress, including by sharing data with unions to enable transparent dialogue in a timely fashion
ensure and evidence that managers, leaders and staff members have training in line with their roles to ensure they are confident to lead flexible teams
include flexible working as an option in all job adverts, job interviews, pre-retirement conversations, and line manager conversations such as appraisals or regular one to one discussion
regularly review (at least every 12 months) flexible working (informal arrangements) with staff to ensure they still meet the staff member, team and service needs. Review discussions should be recorded
ensure your organisation is following the guidance set out in the National Flexible Working People Policy Framework and reference this within the local flexible working policy
ensure staff within the organisation have been trained and supported with digital skills, infrastructure and resources to effectively use systems that change how they do their work, in a more flexible way

These actions are intended to build on the requirements of existing legal frameworks as set out in the legal duties section below.

Context

While there have been some improvements in relation to flexible working in the NHS, there is still a long way to go to ensure all staff have fair and equitable access, which is consistently felt by all staff across the NHS.

2025 NHS Staff Survey

the national flexible working score rose to 6.31 in 2025, up from 6.28 in 2023 and 6.09 in 2022, with steady increases in reported work-life balance and perceived organisational support
although perceived organisational support has dipped just over 0.5% in 2025
however, gaps remain: while non-patient-facing staff scored 6.76 in 2025, those in patient-facing roles scored just 6.14, highlighting a continued need for targeted action

Quarterly Retention Survey

NHS internal data from the quarterly Retention Survey, shows some progress in embedding flexible working.

Structural readiness is improving: the share of organisations with board-level champions rose from 51% (Q1 2023 to 2024) to 65% (Q4 2024 to 2025), and flexible working action plans from 28% (Q4 2023 to 2024) to 43% (Q4 2024 to 2025).

While we do have data from the NHS Staff Survey and Retention Survey related to flexible working, we do not have reliable national data on the number of requests which are made, accepted or rejected, which is broken down by staff group, band, or protected characteristics.

National Flexible Working People Policy Framework

The National Flexible Working People Policy Framework was produced by NHS England to provide support, advice and guidance on flexible working for everyone in the NHS. It builds on a flexible working definition and set of principles, and contractual changes that took effect in September 2021 for employees covered by the NHS Terms and Conditions of Service Handbook.

Flexible working toolkits

The Flexible working toolkit: line managers has been developed in partnership by NHS Employers, NHS England, Timewise and the NHS Staff Council to help managers consider flexible working options, opportunities, lead flexible teams, and put structures and processes in place to implement requests.

The Flexible working toolkit: individuals working in the NHS has been developed in partnership by NHS Employers, NHS England, Timewise and the NHS Staff Council. The toolkit is for all NHS staff to help them understand their options for flexible working and how to make requests for such arrangements.

Agile working

The Decent, agile working: Practical solutions for managers matrix is an academia-practice collaboration between NHS Employers, the Social Partnership Forum and the University of Sussex and was developed by Agilab. It provides practical solutions for managers to a range of workforce challenges (retention, recruitment, burnout, and so on) and how decent, agile working can assist in meeting those challenges.

E-rostering

NHS England have developed detailed guidance for NHS provider organisations on implementing e-rostering systems and their governance so that they can meet the highest level of attainment in e-rostering for clinical staff. The guidance will enable organisations to identify areas of improvement in e-rostering practices.

Union campaigns

Get Ahead on Flex - Let’s Talk About Flex is a campaign led by NHS Unions to improve staff access to flexible working. The campaign page links to several resources and case studies on flexible working in the NHS, and employers should consider signing the pledge to signal support and action to their employees.

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

The 2026 to 2027 NHS Oversight Framework score will use questions from the NHS Staff Survey as metrics. More detail on how these questions form part of the overall NHS Oversight Framework score for the staff standards will be available in the 2026 NHS Oversight Framework technical guidance.

The questions that will be used for flexible working are:

Question 4d - How satisfied are you with… the opportunities for flexible working patterns?
Question 6b - My organisation is committed to helping me balance my work and home life
Question 6d - I can approach my immediate manager to talk openly about flexible working

Additional data organisations can access to assure themselves of performance

In addition to the above, organisations should also ensure they review any relevant additional data and metrics sources to support their delivery of the flexible working standard.

This may include, but is not limited to:

other questions in the NHS Staff Survey
electronic staff record data on flexible working requests and outcomes and the implementation of e-rostering solutions
other local data for example:
- number and reasons for support or not of flexible working requests and relevant equality impact assessments
- intersectionality measurements to be captured and cross referenced, incorporation of EDI data
- data from health and safety forums
- Datix
- HR case trends
- staff feedback

Additional metrics we may look to incorporate in future

Throughout 2026 to 2027, DHSC and NHS England will work in partnership with trade unions and employers to explore what additional metrics could be used to track progress against this standard. This may include additional data to inform the NHS Oversight Framework score, data for additional accountability processes, or data to recommend organisations use for their own self-assessment.

Potential additional sources of evidence, along with further review of those mentioned above could include:

NHS Staff Survey - whether there is scope to add additional questions relating to staff satisfaction with flexible working opportunities within their organisation and team
quarterly pulse survey, staff experience assessment tool and/or retention tracker - to track the number of flexible working requests which were agreed or rejected, and information on the types of flexible working requested, for example reduced or annualised hours, job sharing. This could also include a breakdown by protected characteristics as per the Equality Act 2010 and by staff group. This could also include comparing number of acceptances, and time taken to make a decision across staff groups

Legal duties

Employment Rights Act 1996 and 2023

Part 8A of the Employment Rights Act 1996 is amended by the Employment Relations (Flexible Working) Act 2023 to make flexible working a ‘day one’ right, allowing 2 statutory requests per 12 months, reducing the response time to 2 months, removing the employee’s requirement to explain the request’s impact, and requiring employer consultation with the employee and notifying them of the outcome. An employer must deal with the application in a reasonable manner and can only refuse a request based on one or more of the 8 reasons set out in legislation. These changes strengthen employee rights to request changes to their hours, times or place of work from the first day of employment.

In 2027 the following changes will be introduced through the Employment Rights Act 2025:

introduce a test of reasonableness where an employer refuses a statutory flexible working application
require that notification of the employer’s decision will have to state the statutory ground for refusing the application and explain why the employer considers it reasonable to refuse the application on that ground
set out steps in regulations made by the Secretary of State that the employer must follow to comply with the requirement to consult with the employee before refusing a request for flexible working

Agenda for Change contract

Sections 33, 34 and 35 of the NHS Agenda for Change Handbook set out clear employer duties to support staff in integrating work and personal responsibilities sustainably. This includes providing appropriate support for employees with caring responsibilities for children or adults. These sections, negotiated and agreed in partnership with trade unions, also require employers to have local policies in place. The policies emphasise the importance to staff wellbeing of balancing work and personal life, outline staff rights to request flexible working arrangements, and obligate employers to give reasonable consideration to such requests.  

NHS Constitution - staff rights and pledges in the handbook

Right:

To fair treatment regarding leave, rights and flexible working and other statutory leave requests relating to work and family, including caring for adults with whom you live.

This right supports NHS staff in having a good working environment, with flexible working opportunities, consistent with the needs of patients and the way that staff live their lives. However, flexible working requests need to be balanced with operational, patient and staff safety needs. It means that NHS staff can seek redress through local arrangements to deal with disagreements either on specific contractual issues (terms and conditions) or on more general employment rights. If unsuccessful, NHS staff would have recourse to employment tribunal processes.

Employers are required to make reasonable adjustments for disabled staff and disabled job applicants. This may include adjustments to working hours, working patterns, extra time for applicants on questions and potentially changes to how applicants are assessed.

NHS terms allow for flexible working requests to be considered as a contractual right from day one of employment, following agreement by the NHS Staff Council. Employers are expected to give due consideration to these principles for all staff groups.

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Applies to England

Line management

Standard

Purpose

Actions for employers

Context

NHS Staff Survey

NHS People Pulse survey

NHS Leadership and Management Framework

NHS expectations of line managers

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

Additional data organisations can access to assure themselves of performance

Additional metrics we may look to incorporate in future

Legal duties

Health and Safety at Work etc. Act 1974

Management of Health and Safety at Work Regulations 1999

Equality Act 2010

Contractual obligations

Job evaluation enabling agreement

NHS Constitution - staff rights and pledges in the handbook

Career development

Job evaluation and appraisals

Compassionate leadership

Health and wellbeing

Standard

Purpose

Actions for employers

Context

NHS Staff Survey

NHS health and wellbeing framework

Promoting health and wellbeing and attendance at work guidelines

Growing occupational health and wellbeing together strategy

Welfare facilities for healthcare staff

Health and wellbeing guardian guidance

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

Additional data organisations can access to assure themselves of performance

Additional metrics we may look to incorporate in future

Legal duties

Health and Safety at Work Act 1974

Workplace (Health, Safety and Welfare) Regulations 1992: Drinking water - Regulation 22

Workplace (Health, Safety and Welfare) Regulations 1992: Rest facilities and eating facilities - Regulation 25

Management of Health and Safety at Work Regulations 1999

NHS Constitution - staff rights and pledges in the Handbook

Violence prevention and reduction

Standard

Purpose

Actions for employers

Context

NHS Staff Survey

Violence prevention and reduction standard (2024)

‘Ways to tackle and reduce violence against NHS staff’ - Social Partnership Forum report

Memorandum of understanding

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

Additional data organisations can access to assure themselves of performance

Additional metrics we may look to incorporate in future

Legal duties

Health and Safety at Work Act (1974)

Assaults Against Emergency Workers Act (2018)

NHS Constitution - staff rights and pledges in the Handbook

Championing sexual safety

Standard

Purpose

Actions for employers

Context

Definition

NHS Staff Survey

Sexual safety charter

National Sexual Misconduct People Policy Framework

Metrics

Metrics to be used in the 2026 to 2027 NHS Oversight Framework

Additional data organisations can access to assure themselves of performance

Additional metrics we may look to incorporate in future

Legal duties

Worker Protection (Amendment of Equality Act 2010) Act 2023

Employment Rights Act (2025)

Equality Act 2010 and Protection from Harassment Act 1997

Additional data organisations can access to assure themselves of performance 

Additional metrics we may look to incorporate in future 

Health and Safety at Work Act 1974 