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Regulator boss criticises bullying culture of NHS

A radical shift in the culture of the NHS is needed to rid it of outdated working practices, cure it of widespread bullying and heal the damaging rift between managers and clinicians, the head of its official regulator has warned.

David Prior North Norfolk Trust chair CQC preferred candidate

CQC chair David Prior

David Prior, chair of the Care Quality Commission, also called for serious “transformational change” of the health service, without which it will “go bust”.

Writing in the Sunday Telegraph, Mr Prior highlighted the “alarming” revelation that a survey of 100,000 NHS staff found one in four had been bullied.

He also described the NHS as having a culture that “stigmatises and ostracises” whistleblowers who raise concerns or complaints.

His warning comes at a time when the NHS is struggling to emerge from crises such as the Mid Staffordshire Foundation Trust scandal, where hundreds of patients died and suffered neglect, as well as facing rising costs and an ageing population.

Mr Prior, a former MP and deputy chair of the Conservative Party, who was appointed to run the CQC last year, said: “Too often it [the NHS] delights in the ritual humiliation of those deemed to fail, tolerates and institutionalises outdated working practices and old-fashioned hierarchies, and can almost encourage ‘managers’ and ‘clinicians’ to occupy opposing camps.

“I have worked in the NHS for 12 years. I love it – I am often overwhelmed by the kindness, care and skills of its staff – and yet am too often shocked by some of the behaviour I see.”

He also described a “them and us” relationship between hospital managers and clinicians, a dangerous rift he said needed “radically altering” to avoid jeopardising patients’ safety and blocking care improvements.

Mr Prior called for a major restructuring in healthcare provision, with more successful hospitals taking over failing ones, shared services, improved community services and better care outside hospitals.

More competition – with more entrants into the market from private sector companies, the voluntary sector and other care providers – is needed to drive up standards, and measures of hospital performance need to change, he said.

“We need the government to change the way it holds the NHS to account: an end to trusts being blindsided by waiting targets that miss the point, skew priorities and have unintended consequences.”

Mr Prior added: “Without serious change, the NHS will deliver poor care, and ultimately go bust.”

A Department of Health spokesman said: “Significant changes to the NHS are already under way.

“We have taken swift and strong action to create an NHS culture of transparency and openness where staff and patients are free to raise concerns,” he said. “Whistleblowers are now better protected and cannot be ignored.”

He added: “The CQC is helping to drive this culture change through rigorous, independent inspections under three powerful new chief inspectors.”


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Readers' comments (15)

  • You've got to hand it to the Tories: who'd have thought that they could spin privatisation as a cure-all to bullying?

    Seriously though, bullying is endemic in the NHS and it's not just senior managers dishing it out either.

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  • michael stone

    The only point I'm not necessarily agreeing with in there, is that the benefits of 'private/voluntary competition' re NHS service provision, will outweigh the fragmentation of joined-up service provision that will probably lead to.

    However, as the CQC sent me an e-mail last week promising an answer to a fundamental issue which I'd not even sent to them as a question (I'd sent it as a comment, in response to a comment it had made in an e-mail to me), I'm currently fairly happy 'with the CQC'. Steve Field sent me a very considered and adequate reply to an earlier question, then I got a sensible answer to my comment about an issue Steve's reply raised - I quite like the CQC.

    By contrast, I don't get much sense out of the RCN.

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  • tinkerbell

    fully paid up tory member who can't wait to see nhs sold off.

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  • tinkerbell

    Bullying also exists in private sector. Doh!

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  • michael stone

    tinkerbell | 3-Feb-2014 4:22 pm

    Perhaps you are right Tink - my 'sensible' responses have been from Steve Field (Inspector of Primary Care) and the CQC Chief Executive: I've not had anything from David Prior. But I've not asked him anything, either.

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  • Bullying is endemic within the NHS for sure.

    When are staff going to wake up and realise that the NHS management operates like an abusive and controlling partner in a sick relationship akin to Stockholm Syndrome where the (mostly) female nurses are guilt tripped and manipulated into trying ever harder until they crash and burn.

    There is so much anger, hostility and resentment within the profession because so many cannot raise concerns or make complaints in an assertive and constructive manner; instead it's released upon those perceived as too weak to fight back or those seen as some kind of threat.

    It's an occupational psychologist's dream and a forward thinking government would commission groundbreaking research. The quality of the interpersonal relationships at work is the biggest factor in ensuring patient safety, quality, efficiency and effectiveness, as well as being vital in maintaining a safe workplace that complies with current employment law.

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  • Anonymous 6-Feb 10:44
    In my experience as a male nurse (although my gender should be irrelevant), it is the females that are the worst at using bullying tactics.
    People change as soon as they change from Band 5 to Band 6 and from Band 6 to Band 7. Perfectly nice Dr. Jekylls suddenly become intolerant, patronising, uncaring, bullying Mr. Hydes as soon as they move up a band.

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  • The higher you go, the more you become a===h==e lickers, if you want to survive. Can't see it ever changing - been the same for the 40 years seen

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  • Why just criticise, do something!

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  • Do something? Oh I did that. Along with my fellow complainants we experienced the rehashing of issues raised which sent the investigators down the wrong path, meaning the key bully and her henchmen got off. We had to be redeployed because HR said it was unsafe for us all to work together. So the bullies were rewarded and we were punished. The same old sick NHS story.

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  • tinkerbell

    Apart from the speak out safely compaign what is really being done about the bullying culture of the nhs. Shouldn't all managers go on some kind of training to make themselves more aware that they in fact might be a bullying manager? Francis highlighted this and what actually is being done to resolve it or will it just continue, like short staffing, without anything much changing?

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  • Too many layers and layers of management. I say break down the layers and put the senior nurses on the ward closely monitoring and assisting with care and training, not locked away all the time stuck in paper work.
    The Nurse Directors must do some walking around speaking to patients, nurses, student nurses and health care assistants. Whenever we see our Nurse Director, about twice a year she is walking with an entourage. They pass us by without even saying hello.

    Bullying happens anywhere when there is some sick fool who wants to be unkind to their fellow human.
    Bullying does not always come from above, I have seen Health Care Assistants bully nurses.

    Getting in the private sector for more competition. Is that competition to deliver better care or cheaper care or better management of care?
    Why do we need to compete?
    We need to work towards good care and good management of care.
    The fact is, if there is good management of care every thing else will fall into place.

    Successful hospitals taking over failing ones.
    Why the take over when first and foremost we need to find out WHY a hospital is failing and SORT the problems out.
    Is takeover not a bullying concept?
    A non bullying way of doing things is to help the failing hospital by solving its problems to get it going again.

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  • tinkerbell

    Anonymous | 13-Feb-2014 7:58 pm

    Yep, I agree, Unfortunately no one is going to listen to you cos' you are talking far too much sense and the focus is on destruction rather than resolution.

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  • Bullying is rife in NHS no matter which band. And it start with bullying student nurses then they wonder 'why such a high attrition rate
    ?' doh
    Independent adjudicators should be used to prevent situations like 'Anonymous' 8th Feb 2014.

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  • society has changed and with many but not all bullying is used for appropriate delegation of an increased work load i.e. estavlishments (numbers) are set for the worse case scinario, yet, when busy days come & hard work is called for then management is blamed for "short staffing" it was never a easy job and the weak/faint hearted should not be encouraged to join the service as it is tough. 2014 bullying then turn the clocks back to the 70/80's when it was regimented military approach, seldom a RN about 3rd year students in charge of acute Units and much less staffing levels than today, backbone was the irish & they knew how to work hard and deliver.
    as long as we blame everyone above us for in many cases doing their job good then we will never stop bullying at the bedside.

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