Ambulance services have been told to eradicate bullying and sexual harassment after the publication of a damning report into their workplace culture.
An independent review was commissioned by NHS England after the National Guardian’s Office issued a report last year showing that workers in ambulance trusts felt uncomfortable reporting misconduct.
The review, led by Siobhan Melia, chief executive of Sussex Community NHS Foundation Trust, aimed to uncover why “deeply concerning cultural issues” were impacting workers in ambulance services in England, and make recommendations as to how things could be improved.
Melia uncovered similar findings to those of the NGO last year, with staff telling her they “continue to face harassment, discrimination and bullying”, and if they try to report it, this is met with “scepticism”.
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Her report also found that many trusts tend to prioritise operational performance over ensuring that employees feel comfortable in the workplace. One of its six key recommendations is that “operational performance is balanced with people performance at all levels”.
The report found: “Staff shortages and limited opportunities for development mean that any work beyond direct clinical care is seen as a luxury or is rushed.
“Despite this, there is a clear link between positive organisational culture and improved patient outcomes. However, trusts often focus on meeting response time standards for urgent calls, whilst side-lining training, professional development, and research.”
It also found that there is a prevalence of a “command and control” culture in the service, characterised by strict hierarchy and strict adherence to rules.
“As the sector changes to encompass patient demand, there’s a growing recognition of the need for a more adaptive management style,” the report advised.
On bullying and sexual harassment, there was a consensus that staff safety should be prioritised, but the review found that the operational pressures faced by staff sometimes amplified a “blame culture”, or that reports were delayed or ignored to focus on patients.
The review also recommends that all ambulance staff have sexual safety training and bystander training to deal with sexual harassment incidents promptly and appropriately.
A further recommendation made by the review is that greater investment goes into supporting HR and organisational development functions.
This includes a recommendation that NHS England and trade unions come up with a collaborative statement on cultural change and the “empowerment” of HR.
It also advises that NHS England develops a bespoke HR and OD plan for cultural and employee relations challenges within the ambulance service, and a separate equality, diversity and inclusion improvement plan.
HR policies should be harmonised and more consistent across all services, it adds, and they should create a suitable infrastructure to enable a more effective “speak-up culture” – one of the key issues identified by the National Guardian’s Office last year.
Learnings from other sectors such as the fire and police services – which have also dealt with workplace culture issues – could also prove useful, it added.
Melia said: “My experience has highlighted to me that the ambulance sector is different to other parts of the wider NHS. Therefore, this review was an opportunity to shine a light on that fact and to consider how the local, regional, and national NHS architecture can work differently with ambulance trusts and in a way that is more enabling of cultural improvement.
“A focus on operational performance often overshadows a focus on people and culture, creating a disconnect between the two, and this is an opportunity for change. That is why the recommendations include actions for us all, and not just for ambulance trusts.”
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