The threat of public spending cuts is affecting NHS staff performance, according to HR managers and directors working in the health service.
And they added the uncertainty over the future is threatening to widen the divide between clinical and non-clinical staff.
According to a survey carried out by Right Management, NHS HR managers believe staff have responded positively to the threat of job losses.
More than half of those questioned in the survey said NHS staff do not believe there is long-term job security or job opportunities within the health service.
But almost two thirds (60%) said workers had become more resilient and agile.
The divide between clinical staff and non-clinical workers has been fuelled by the announcement that NHS management costs will be slashed by £850 million by 2014.
And staff believe clinical staff will be less affected by job losses.
Andy Lowe, practice leader at Right Management, said HR is going through huge changes to ensure people with the right skills are in place within the NHS.
He said: "There are good intentions with the talent management strategies already in place, now would be the key time to ensure these strategies are executed to guarantee the NHS doesn't just survive the next few difficult years, but that it succeeds."