A depressing picture of thousands of hospital staff worn down and utterly demotivated has been painted in a sweeping survey which has put two Westcountry hospitals at the bottom of the league.
Across the region, NHS staff said they felt overworked and undervalued, with many confessing that they could not recommend their hospital as a place to work – or be treated.
Union leaders said they were not remotely surprised and urged health bosses to take heed.
Tracey Roberts, regional spokesman for the Royal College of Nursing, said members were truly fed up.
"We are finding that people are so de-motivated that they are saying it's hard to drag themselves out of bed.
"They feel their trust don't understand the work they do and they don't appreciate or value their contribution.
"Reps at hospital level are telling us that morale has plummeted."
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Joanne Kaye, regional secretary of the Unison, said a sense of hopelessness was rife in the workforce.
"NHS workers, like all public sector workers, are struggling," she said.
"They are going to work, but not getting a pay rise while struggling with inflation and then all they get is a constant message that they are not good enough.
"People are feeling that it doesn't matter what they do, it won't be good enough."
Ms Kaye urged managers to join workers "at the coalface" and make staff feel as though "they are fighting their corner".
The NHS staff survey is a massive annual exercise designed to compare similar types of health trusts and reveal whether employees are engaged with their work, their team and the health trust which employs them.
The 2012 results reflect a time of unprecedented upheaval in the NHS and a sense of staff being unsettled is tangible in the questionnaire, which covers issues like job satisfaction or experiences of workplace bullying.
Unions claim that in the Westcountry, morale has taken a further battering thanks to the creation of the South West Pay Consortium, of which 18 trusts are members and it is feared is a vehicle for driving down pay and conditions.
Broadly speaking, the NHS staff survey delivers some blunt conclusions for the Royal Cornwall Hospital Trust (RCHT) and Plymouth Hospital Trust, usually known as Derriford, saying staff are "poorly engaged" and revealing scores which put them both in the worst fifth of hospitals.
The two trusts, which between them treat the overwhelming majority of patients from Cornwall, both rank in the worst 20 per cent of hospitals in key benchmarks such as staff feeling they can contribute towards improvements at work.
At the RCHT, staff were revealed to be the least motivated in the country, while in terms of being able to recommend it as a place to work, only four other hospitals returned lower scores.
The Truro-based trust in general gathered an unenviable set of results courtesy of their staff who, compared with the rest of the region's hospitals, felt the least satisfied with the quality of their work, the most pressured to come into work while ill and suffered the most from stress.
On the upside, 90 per cent of staff reported feeling that their work made a difference.
At Derriford, 39 per cent of staff reported feeling work-related stress and just 19 per cent of staff said there was good communication between them and senior managers – one of the lowest rankings in the NHS.
At the Royal Devon and Exeter Hospital (RD&E) and Northern Devon Healthcare Trust, the results of the staff survey made for better reading than their western counterparts with a judgment that they were average in terms of staff engagement.
At the Devon trust, 69 per cent of staff were said to be working extra hours – the highest in the region. In North Devon, 19 per cent of staff reported physical violence from patients – the highest in the region.
The picture was still brighter at South Devon Healthcare, which was judged above average. The staff at the Torbay trust were revealed to be the most motivated in the region, but worryingly the score was still below the national average.
At the RCHT, chief executive Lezli Boswell conceded the results were a blow, but said there were also encouraging signs, such as healthy levels of satisfaction with care delivered and staff feeling their role made a difference to patients.
"The 2012 staff survey results are disappointing and reflect a long history of poor engagement and instability at RCHT. There is no quick fix to changing the culture within an organisation, but that said, the views expressed do show some early signs of improvement in important areas compared to recent years.
"In contrast to the overall staff survey results, our most recent patient survey shows that 96% would recommend us to their friends and family."
Chief executive at Derriford Ann James said work had already started to address staff concerns.
"The results reinforce what we already know – that we have work to do to improve our culture and make this a happier place for staff to work in," she said.
Mrs James said the survey was gathered between September and December last year – a time of great change at the hospital.
"Since then, we have started to change our culture so that we work more in partnership with our staff and other organisations," she said. "It will take time."
At the RD&E, a spokesman praised their "dedicated and professional staff" as "the lifeblood of our organisation, providing 24/7 care and often going above and beyond the call of duty for our patients".
She said the trust had embarked on a "transformation and restructuring programme" which involved listening to staff and understanding the issues they face.
Maureen Bignell, director of personnel and development at Northern Devon Healthcare, said: "We were very encouraged by the results of the NHS Staff Survey, which showed we were ranked better than average in 19 of the 28 key findings and among the top 20% of trusts in the country in nine of them."
She added: "We will be looking at the survey results in closer detail and, as ever, will work with our staff to address areas where we can improve."
Chief executive of South Devon Healthcare, Paula Vasco-Knight, said the survey was an important exercise.
"To that end I am particularly heartened to see that staff continue to rank our trust in the top 20 per cent of acute trusts in the country as a place to work or receive treatment as a patient. Increasingly, the evidence shows us that there is a clear link between strong staff survey results and the quality of services that are provided."
North Devon District Hospital, Barnstaple: There has been a gradually improving picture of staff engagement at Northern Devon Healthcare. The Barnstaple-based trust was average when compared with the results from other hospitals, but managers can reflect on slightly better results than last year. However, 19 per cent of staff said they had experienced physical violence from patients in the last 12 months. Furthermore: -78 per cent of staff were satisfied with the quality of their work -68 per cent of staff reported working extra hours -36 per cent of staff had suffered work-related stress -26 per cent of staff reported feeling pressured to come into work despite feeling unwell -69 per cent of staff felt able to contribute to improvements at work -24 per cent of staff said there were good communications with senior management. Royal Cornwall Hospital, Truro: The annual staff survey will make sobering reading for bosses at the Royal Cornwall Hospital Trust. According to the results, staff at its three hospitals in Truro, Penzance and Hayle are the least motivated in the country. Only four hospitals rank worse when it comes to whether staff would recommend it as a place to work or be treated. The hospital also has the lowest job satisfaction score in the Westcountry. Additionally: -44 per cent have reported work-related stress -69 per cent have reported working extra hours -69 per cent are satisfied with their quality of their work -17 per cent have experienced physical violence from patients -60 per cent feel able to contribute to workplace improvements. Only six hospitals have lower ratings. -19 per cent of staff report good communications with senior managers Torbay Hospital, Torquay: The annual NHS Staff Survey delivers encouraging results for just one hospital trust in the Westcountry. South Devon Healthcare was judged to be better than the national average, although motivation rates are worse than average. The Torbay-based trust has the highest numbers of staff in the region who would actually recommend working there or being a patient, and: -79 per cent of staff are satisfied with their quality of their work -62 per cent work extra hours – the lowest in the region. -36 per cent of staff suffer from work-related stress -29 per cent of staff feel pressured to come into work despite being unwell -13 per cent of staff have experienced violence from patients -Two thirds feel able to contribute to improvements at work -27 per cent report good communications with managers Royal Devon and Exeter Hospital: At the Royal Devon and Exeter Hospital, the NHS Staff Survey delivered average scores on the whole, although levels of motivation among the workforce were in the worst fifth of all hospitals. The trust has the staff who suffer the lowest rates of work-related stress in the Westcountry and, at 10 per cent, the smallest numbers who report violence from patients. The survey also found: -71 per cent of staff were satisfied with the quality of their work -69 per cent of staff work extra hours -88 per cent of staff feel they make a difference -31 per cent of staff feel pressured to come into work despite being unwell -67 per cent of staff feel able to contribute to improvements at work -A fifth of staff report good communications with senior managers. Derriford Hospital, Plymouth: Managers at Plymouth Hospital Trust must take a serious look at how to improve staff engagement, according to the results of the NHS survey. The Derriford-based trust's results on staff engagement put it in the lowest 20 per cent of hospitals. Elements of that score include staff motivation and whether staff would recommend it as a place to work. The hospital has one of the lowest rates of violence from patients towards staff in the region, measuring just 11 per cent. However: -77 per cent of staff say they are satisfied with the quality of their work -65 per cent of staff report working extra hours -39 per cent of staff have suffered from work-related stress -31 per cent of staff say they have felt pressured to come into work despite being unwell -19 per cent of staff report good communications with senior managers