The NHS bullying culture – when will it end?

The cost of bullying to the NHS

Back in 2019, a study estimated that the cost of bullying and harassment to NHS England is around £2.3 billion per annum. This staggering cost is deemed to be the aggregate of costs to employers of: increased staff sickness, employee turnover, reduced productivity, compensation, litigation and more difficult industrial relations.

The effects of Covid on the NHS bullying culture

The effects on the NHS due to the Covid-19 pandemic are likely to have made matters worse. The increased pressure on all staff, the urgency of the response to overwhelming service demands and the strain on resources, time, and patience, has probably presented the NHS with a challenging peacetime management task.

At Verita, we’ve recently been involved in more assignments that have had workplace culture, particularly bullying and harassment, at the heart of the challenges for NHS organisations. We see no sign of that easing any time soon.

We believe that some bullying and harassment went “underground” during the pandemic, and as things return to normal, it seems inevitable that issues of inappropriate behaviour may re-surface as people reflect on how they have been treated.

Persistent NHS bullying issues

It’s not hard to find evidence of continuing problems in this area. The media regularly features stories from trusts around the country where bad behaviours are being reported.  At a time when the number of staff from ethnic minorities at senior management level has almost doubled between 2020 and 2021 (up from 153 to 298 according to the latest NHS Workforce Race Equality Standard report) we should all be disturbed at the disproportionate impact that bullying and harassment has on staff from ethnic minorities.

This same report showed:

“…the NHS workforce is more diverse than at any point in NHS history with more than 300,000 staff from ethnic minorities– the equivalent of 22.4% of all NHS staff. This is up from 18% in 2017.” 

But it also revealed that

“29% of staff from ethnic minorities experienced bullying, harassment and abuse from patients last year.”

Recent work by NHS Employers has identified that almost 1 in 5 NHS staff have experienced bullying and harassment from their colleagues in the past year.  Around 1 in 8 reported bullying and harassment from their line manager. An astounding 98% of NHS staff reported experiencing incivility in the workplace. So, it’s fair to say that these problems run deep, and wide, across the whole of the NHS.

The puzzle lies in understanding why these problems persist.  We have yet to work with an NHS organisation that doesn’t have an anti-bullying policy, a Freedom to Speak Up process or has not bought in to the Race Equality Standard.

Virtually all these organisations have the full range of policies and processes that should allow them to measure what’s going on, identify early signs of inappropriate behaviour and to take action to investigate and resolve cases that arise.

There is, it seems, a world of difference between having the tools and the mechanisms to fix the problems and having the mindset and determination to use them to make a positive difference.

All too often when we work with NHS organisations, we hear the same refrain:

“The policies and procedures are there, we just don’t seem to follow them”

Leadership at the NHS is key

No-one really sets out to undercut the work needed to improve the experience of NHS staff. But maybe it’s time for leaders to show the way – to demonstrate by their own behaviour that bullying, and harassment, will not be tolerated. To take the lead by calling out inappropriate behaviour, and to commit to a ruthless intolerance of persistent bullying.

There’s an old saying that “what gets measured, gets managed”, but bullying and harassment has been measured and quantified in the NHS for years. These measurements haven’t yet led to things getting much better for large numbers of NHS staff. Conversely, there’s another old saying that “what gets ignored becomes the new standard”. 

So, if you are in the leadership team of your organisation, what are you doing to uphold standards, to behave the right way, and to show your people a good example?  And just as importantly, what behaviours are you putting up with, or letting slide that should be addressed?

In the “shadow of a leader” people quickly learn what is encouraged, what is rewarded and what is celebrated.  Equally, people are also quick to work out what won’t wash in their behaviour and leadership style, and what they need to stop doing if they are to get better at managing team relationships.

This is possibly the best way for leaders to make real and lasting change in their own behaviour, and in the behaviour of people in their organisations. But it requires openness and willingness to seek and accept feedback about your own style. And it takes nerve and persistence to do the right thing credibly and consistently.

Finally, the most meaningful advice I got from an NHS chief executive brought home to me the simplicity and clarity of what having power meant. She said:

“To me, the biggest abuse of power is not misusing it, but failing to use it when you can do good.”

So, all the plans, polices and processes will get you so far, but authentic behaviour will carry you further. This will help you and your people to understand what you have to do to support one another.

Need support with your anti-bullying strategy or investigations?

If you need any help with developing or implementing an anti-bullying strategy, or with investigating incidents of bullying and harassment, please get in touch or book a free 30 minute consultation with us. If you are interested in exploring a cultural audit of your organisation or developing yourself or your top team, we are here to help.