Less than half of NHS staff believe that patient care is the top priority where they work, according to the annual survey of staff opinion run by the Healthcare Commission. One in four does not believe that health trusts see patient care as their most important issue, with 29 per cent undecided.

The poll also indicated that only 26 per cent of NHS staff think their employers value their work; just 22 per cent believe there is effective communication between staff and senior managers, and only 23 per cent feel staff are involved in important decisions.

Survey forms were returned by 155,922 employees from all 391 NHS trusts — a response rate of 54 per cent.

The poll found wide variations between hospitals on measures taken to fight infections such as Clostridium difficile and MRSA. Only 61 per cent said handwashing equipment was always available when they needed it.

The number saying it was always available varied from the 39 per cent at Homerton University Hospital NHS Foundation Trust in East London, to 82 per cent at the Queen Victoria Hospital NHS Foundation Trust in East Grinstead.

Thirteen per cent of those questioned had suffered physical violence at the hands of a patient or their relatives in the past year, the same as in 2006 and 1 per cent more than in 2005.

Among those working in ambulance trusts, 29 per cent reported being attacked, while the figure was 22 per cent for mental health trusts.

Anna Walker, the commission’s chief executive, said: “We know that health workers are more likely to experience violence, harassment and abuse than workers from other sectors and the NHS has made a concerted effort to address this problem.

“Trusts must continue to step up to this challenge because it is unacceptable for NHS staff, who provide vital, often life-saving care, to be put in the position where they face violence and abuse as they go about their work.”

The findings were released as a second survey showed that GPs are pessimistic about the future of the NHS. The poll in Pulse, the medical magazine, suggests that the advance of the private sector into primary care is unstoppable.

A quarter of the 500 GPs who responded to the poll said that they had already been approached by a private firm with an offer to team up in providing primary care. About 40 per cent of the GPs said they were prepared to practise in a surgery owned by a private company, and a third said that they were willing to work for a private concern.

Meanwhile, figures released by the Department of Health show that GPs are still failing to offer patients a choice of hospitals for elective operations.

The annual patient choice survey showed that, in November 2007, 44 per cent of patients said that they had been offered a choice of hospitals. This was down from the figure of 45 per cent in September 2007 and 48 per cent recorded in March 2007.

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