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Keith Brown: 'Give nurses the skills to create transparent and safe cultures'


We need leadership training that focuses on the care of the patient, says Keith Brown

In the past year, we have seen endless reports slamming nurses in a “culture of neglect”, “culture of cruelty” or the “culture of assumption” for their care of older and vulnerable patients.

Judge Neil Ford QC sent two nurses and nine support workers from Winterbourne View to jail, citing the “culture of cruelty”.

Much of the focus has been on nurses themselves, but there has been very little discussion about what is behind these “cultures” - and, perhaps even worse, all those who knew what was going on but remained silent or were not listened to.

The question that has really concerned me is how could there be so many people working in Winterbourne View who did not raise the alarm? How does a culture like that start in a hospital or residential home and who is looking at the leadership that can allow it to happen?

There has to be a radical change in the way health bodies train those working with vulnerable people so they know how to raise the alarm when they find an abusive culture and how to exercise professional judgement in complex and often difficult situations.

“I want the student nurse, the shift nurse leader and the cleaner all to know what to do, how to raise concerns and to ensure they are listened to”

The only way to stop abuse persisting is by giving everyone - from cleaners to nurses to chief executives - the skills and confidence to raise their concerns if they suspect abuse and, importantly, to overcome resistance to their suspicions. That means they must work through what we call “crunch moments”. You have to give people the opportunity to develop their capability and skills to manage themselves and their stresses so that during crunch moments they are able to make the right decisions. At Bournemouth University, we call this “self leadership”.

Millions of pounds are spent on training in healthcare every year. We are working with 36 NHS employer partners and know that only a tiny fraction of this training is ever assessed to see if it makes a difference and that nurses and colleagues are performing more effectively as a result of it. We are calling for greater impact evaluation to measure the effectiveness of training in the health sector.

It is too easy for us just to put the spotlight on St George’s Hospital in London, Mid Staffordshire Foundation Trust or Winterbourne View. Many abuses occur but are not reported. I want the student nurse, the shift nurse leader and the cleaner all to know what to do, how to raise concerns and to ensure they are listened to.

Just as critically, directors of hospitals and clinical leaders must be given the leadership skills to create transparent cultures. This training needs to be tailored to the specific issues of hospitals and community care. Generic leadership courses are not good enough - we need leadership that focuses on the care of the patient.

While commercial management training has its place, it has often not been focused enough on the healthcare sector. These qualifications are too focused on commercial, private sector principles such as making a profit. Budgets must be managed but financial skills are not enough - you need professionals with self-leadership skills who can exercise professional judgement to develop a culture that prevents abuse of any kind.

Self-leadership skills are needed for everyone, not just senior managers, so that all are able to discharge their responsibility to care for patients. Impact assessments and evaluations are needed to ensure this is all working and making a difference in every health organisation.

It is time to stop making nurses the culprits in these abuse scandals. Instead, nurses must be given the skills to create transparent and safe cultures.

Keith Brown is director of the National Centre for Post Qualifying Social Work at Bournemouth University



Readers' comments (6)

  • What leadership training?

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  • I hope I'm around to see the world when Managers lead with respect rather than with fear.

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  • michael stone

    'I want the student nurse, the shift nurse leader and the cleaner all to know what to do, how to raise concerns and to ensure they are listened to.'

    What is needed, is the certainty that one can raise concerns without being 'bullied/victimised' for doing that.

    Doubtless, that already happens in good organisations - but it needs to be true in all organisations !

    Genuine transparency - often absent in the NHS - would help greatly: how will this be achieved ?

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  • Exactly Mike, "Genuine transparency - often absent in the NHS - would help greatly"

    Not only "often" but almost certainly 99% absent, otherwise there would not be a 1:3 incidence of bullying. And some off shoots of the NHS are higher than others too.

    Keith Browne needs to get out of his ivory tower and come down to the real world to have a good look round, if he lurks in the sluice rooms and talks to staff who are not being tracked by the Powers that be, he will certainly find that the bullying net works go all the way to the top. When I made my reports in Tower Hamlets about bullying, it did no good and they bullied me some more. When I reported the Bullying in Hackney, everyone then pitched in. And when I reported the NHSD nurse management to first their Chief Nurse( she sat on her hands either literally or metaphorically). NHSD continued to bully me even though I had left the organization. So now I have reported them to the NMC, and well, the NMC are going to take 16 weeks to read my report. But i will not be surprised if I find the NMC bend over backwards for them. All the while they are busy destroying nurses who are still shackled to them.Where do you go, who can one appeal to?

    What sort of confidence does that give anyone?

    "Give nurses the skills to create transparent and safe cultures'" I am quite sure that if good nurses were allowed to flourish then we would have the skills to set up safe cultures but currently the weeds are choking the good nurses out of existence.

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  • michael stone

    Anonymous | 11-Dec-2012 8:14 pm

    Because I'm observing loosely from outside, I restrict myself to 'often' - my instinct, would be closer to 'usually' but I don't have the data to support that. So your '99%' from an insider is interesting - but I don't really think it is quite that bad: I do think, it is bad way beyond acceptable.

    'But i will not be surprised if I find the NMC bend over backwards for them'

    I had a problem with my PCT - mainly that they didn't listen or actually discuss things properly - and my own experience of complaints all the way to the Parliamentary and Health Service Ombudsman was that the complaints system is systemically-biased towards not finding in favour of the complainant. So the NMC probably will 'bend over backwards for them', or at least it will seem to be doing that from your position (part of the problem, is that the investigators rely on written documentation and become involved much too late in events).

    Good luck - my PCT was 'less than honest and open' with the PHSO, and complaints systems re the NHS just do not work very well !

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  • tinkerbell

    patients, what are they? They don't feature in this at all. It's all about the money now. We are going to become a heartless society until some semblence of morals and sanity returns.

    Society, that's us, has to decide what it values most.

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