The NHS has not started 2006 in fine fettle. Criticism over poor productivity returns on massive investment, crippling financial deficits and potential hospital closures have put health service management on the back foot.
And it hasn’t ended there. Reports published by the Healthcare Commission earlier this month investigating bullying and harassment in the NHS demonstrated how difficult the problem remains for health service employers.
The NHS watchdog scrutinised two separate NHS trusts and found significant weaknesses in HR policies and procedures around bullying, as well as lack of action by senior management in tackling the issue.
NHS Employers, the body responsible for workforce conditions in the NHS, insists that widespread bullying and harassment is only a problem in a “very small minority of NHS trusts”.
But the Healthcare Commission’s latest staff survey shows that bullying remains a stubbornly persistent problem.
In 2004, 16% of staff surveyed said they had been bullied, harassed or abused by colleagues, the same as the previous year. Taken across the NHS as a whole this equates to more than 200,000 workers being bullied every year. Of those that had been bullied, only 52% had reported it, suggesting that the problem is bigger than the NHS believes.
Royal College of Nursing (RCN) data certainly suggests as much. Its annual workforce survey, due to be published next month, puts the figure at 23%, up from 17% in 2000.
As far back as 1997, trade union and academic research highlighted persistently high levels of bullying in the NHS. Back then, employers accepted there was a problem and a culture change was needed. So why has there been little, if any, progress?
“We are not shying away from the issue,” said Julian Topping, head of workplace health and employment at NHS Employers. “There is recognition from employers that something has to be done.”
The organisation is currently developing a programme that will pull together best practice from across the NHS and the wider public sector. It also plans to launch guidance for employers later this year.
But don’t expect to see any immediate progress. It will be mid-2007 before any improvements are recorded in the annual staff survey, Topping said.
The main problem is the everyday working environment for NHS employees.
Sharon Bolton, organisational analyst at Lancaster University Management School, said NHS workers are victims of what she termed “corporate bullying”.
This type of bullying is commonplace in organisations that are going through huge amounts of change and where there are work-related pressures, she said.
“In the NHS there are conflicting demands, especially on nurses on the front line of patient care,” Bolton said. “The humanity gets lost and those [managers] at the top of the organisation forget that.”
Tough NHS targets mean staff feel under great pressure to deliver, according to Mike Pyrah, president of the Healthcare People Management Association. “But I don’t think that pressure gives people licence to bully,” he said. “It means that managers have to monitor this type of behaviour and be aware when it’s happening.”
The hierarchical structure of the NHS also fuels bullying behaviour, said Bolton.
“There is a very rigid division of professions – managers, doctors, nurses and ancillary staff,” she said. “This can lead to more pressure and more conflict.”
Tackling bullying would not just be beneficial in terms of workforce well-being. The potential financial savings are enormous. Cutting the level of bullying and harassment by just 1% would save the health service 9m annually, according to Department of Health estimates.
This represents a real opportunity for health service HR departments to prove their worth. “HR people in the NHS know there is a job to do to tackle bullying,” Pyrah said. “But like all sectors, the challenge of improving people management is wider than the HR department.”
Leading from the front
Interestingly, the two trusts investigated by the Healthcare Commission have both started to make real strides in tackling bullying since appointing new chief executives.
It is important to have senior management leading from the front, according to Pyrah.
“The NHS needs a culture that says bullying and harassment are not acceptable,” he said. “[Trusts] must create a culture that allows people to come forward and talk about bullying in confidence.”
But Sheelagh Brewer, senior employment relations adviser at the RCN, said she was unsure whether NHS managers have the right skills to deal with “sensitive” bullying incidents.
“There needs to be more emphasis on people skills rather than technical expertise,” she said. “Managers must be equipped to deal with conflict in their teams and handle sensitive investigations [into bullying].”
HR shake-up delivers results
Devon Partnership NHS Trust has reduced reported levels of bullying and harassment from nearly a third of staff in 2003 to about 10% in 2005.
Liz Davenport, the trust’s workforce director, said a shake-up of the HR department, improving communication with staff and implementing new policies, has made a real difference.
The trust has adopted an HR business partner model to give line managers more support on a day-to-day basis. It has also introduced a senior staff forum and a hotline so staff can raise issues directly with the chief executive.
“We want our staff to feel more involved. This has been very important in rebuilding confidence and improving communications,” she said. But she added that the trust still had a lot of work to do as culture change “takes a while”.