Hospital consultants and nurses are turning up for work even though they are ill themselves - because they feel under so much pressure to keep services running.
A new survey of NHS staff found that many are stressed through overwork and staff shortages, and at risk of attack from the patients they are trying to help.
But it did find that an overwhelming majority believe they are able to deliver the high standard of care they aspire to.
The 2017 NHS staff survey found that more than one in three NHS staff at University Hospitals Birmingham NHS Foundation Trust, 37%, reported feeling unwell due to work-related stress in the past 12 months.
The trust manages the Queen Elizabeth Hospital in Edgbaston.
And 53%, more than half, said they had come to work in the last three months despite feeling unwell, “because they felt pressure from their manager, colleagues or themselves”.
The survey found 14% of staff, more than one in eight, had experienced physical violence from patients, relatives or the public in last 12 months.
A University Hospitals Birmingham NHS Foundation Trust spokesperson said: “The Trust is proactive in promoting positive health and wellbeing amongst its staff. They can access over 20 topic areas for advice and guidance via a staff portal, and can also refer themselves to the staff access physiotherapy and counselling services.
“There are on-site mindfulness sessions and quiet rooms, plus the Trust offers a health check where staff undergo a complete assessment. Any necessary referrals can then be undertaken here at the Trust or passed back to the member of staff’s GP.”
It was a similar situation at other trusts.
At Sandwell And West Birmingham Hospitals NHS Trust, which runs City Hospital in Birmingham and Sandwell General Hospital, the figure was 60%.
However the poll - conducted on behalf of NHS England - found that three quarters of NHS staff nationwide are enthusiastic about their job and seven in 10 said that if a friend or relative needed treatment, they would be happy with the standard of care provided by their organisation.
Danny Mortimer, chief executive of NHS Employers, which represents employers in the health service, said: “The country needs to take these challenging results seriously. We cannot expect staff to absorb additional work pressures year on year without it having an adverse effect on their experience of work.
“It’s disappointing but understandable that staff are less satisfied with the standard of care they are able to provide and that they are feeling more stressed.
“I am however encouraged that staff continue to be willing to recommend the NHS as a place to be cared for.”
Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “These figures bear out the warnings from nurses on the NHS frontline - patient care standards are heading in the wrong direction and nursing staff will not accept it.
“But it also reveals the sharpest of all rises in dissatisfaction with pay, now standing at 45% of the workforce - up by more than 7% in a single year. It is a timely reminder for the Chancellor that years of unfair pay deals have taken their toll and a meaningful rise is long overdue.
“More than half of NHS staff report working unpaid overtime every single week. Ministers must stop treating the goodwill and dedication of NHS staff as a replacement for adequate funding and proper workforce planning. Continuing down this path is unfair, and untenable.”