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'Is the NHS turning its staff into people who are failing to care for each other?'

  • 10 Comments

Ever watched that film Groundhog Day? The one where Bill Murray wakes up every morning and relives the same day?

Sometimes writing about the NHS is a bit like that – nursing workforce shortages, winter pressures and workplace bullying.

We have done a lot of work at Nursing Times to encourage nurses and other healthcare staff to be able to speak out about concerns at work and how they affect the safety and quality of care.

Our award-winning Speak out Safely campaign, launched in 2013, urged nurses to raise concerns, and employers to support them to do so.

Coming on the back of the Francis report, it was released at something of a zeitgeist for openness and transparency in the NHS, and we heard from thousands of staff who felt it chimed with their experience of the challenges they had faced at work.

Subsequently, the Freedom to Speak up Guardians were set up with the intention to help support those ambitions and create a culture where people were able to share their views.

I have heard a lot of positive things about that work, and about individual initiatives at trusts that will inspire and stimulate healthcare workers to raise anxieties. Many leaders have also thought creatively about ways to encourage their staff to speak up.

But it seems all this is still not enough. This week, we have heard from a review at Arrowe Park Hospital, run by Wirral University Teaching Hospitals Foundation Trust. It states that the hospital has been plagued by a culture of nurses undermining colleagues, aggressively challenging decisions and withholding information.

While this sort of poor behaviour among nursing colleagues is something we have heard of before, I was shocked to read about some of the findings at Arrowe Park. For example, the way staff were allocated to each area in the emergency department deliberately isolated and punished people, setting up less experienced staff to fail by putting them in teams with less capacity.

Nursing is a profession that should – and often does – pride itself on compassion and empathy. So why does it keep finding itself in this situation?

Are we recruiting people with the wrong values in the first place or creating clinicians with the wrong values, by putting them in a system that fundamentally rinses out the behaviours we want to see in our NHS staff?

Have high-pressure, time-poor, financially under-resourced circumstances created an environment where staff are so driven to meet targets that they forget about caring for each other – and patients?

What makes clinicians behave in a way that sounds at odds with their professional codes of conduct? What makes “good” people do “bad” things – or ignore bad things happening around them?

I want to believe that it is indeed the system that is corrupting and changing people. But by admitting that, I feel uncomfortable. Is the NHS turning its staff into people who are failing to care for each other, and as a result putting their patients at risk?

Our story about Arrowe Park attracted a lot of attention from readers, who expressed familiarity with such behaviour and said it was common in parts of their organisations.

Health and social care secretary Jeremy Hunt has publicly advocated speaking out for many years – and it is under his reign that the Freedom to Speak Up Guardians have been established.

So why is it not working in some trusts, while it is successful in others? Why is there such variation in the cultures within organisations, where some wards vary greatly from others just a few metres away in the same building? What more can employers do to listen to their staff and encourage them to nurture their teams and hear their anxieties?

How can we transform parts of the NHS from a bullying culture to one where all staff are supported and cared for?

As it starts its 70th anniversary year, what will make our NHS a better employer, and a safer provider of care? Because something is sick in the health service – and there currently seems to be no cure. 

  • 10 Comments

Readers' comments (10)

  • Having worked in the NHS since 1989 I have not seen a single bully brought to task. The opposite seems to happen, they are moved to another area and seem to climb the promotion ladder with ease. Many of the bullies are in senior positions and as they are being seen to get the job done, nobody more senior wants to discipline them. Consequently the ones being bullied choose to move. I am being bullied by my Clinical Director, my line manager is aware, my colleagues all recognise her behaviour. However I have been in the NHS long enough to know it is pointless to rattle the cage as she is seen in a very positive light by the Executive team. We too have speak up guardians and one brave soul used this route to escalate to escalate the CD's behaviour. The result was the bully had a meeting with her line manager who was very dismissive of the allegations made and said it sounded like someone with a grudge. She continues her bullying behaviour secure in the knowledge she is teflon!

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  • Why? I think this is a multi faceted issue which exists not only in nursing but across British Society. We are living in a hierarchical blame culture that isolates individuals in a 'me-me' consumer capitalist society. Instead of a socialist society working together, learning together for the benefit of all.

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  • Such an interesting article as behaviours are evident in the workplace moreso now as a result of the pressures and stress staff are under i.e limited resources, high acuity and short staff.There is a need for continuous pastoral suppprt and clinical supervision
    under a target driven culture. Not having the right skills, knowledge and behaviours to drive and suppprt their workforce is far too common. In addition the ability to manage increased sickness and poor performance can take forever. It's frustrating which is a reflection of how staff communicate with each other.

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  • No matter what we grunts do, the upper ranks have the upper hand. Just keep your head down, do your job and stay tough. It's only a job.

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  • In my role as a trainer and coach I am continually impressed by the level and quality of work done by NHS staff. I have never heard of them treating patients with anything less than compassion and understanding...and yet, they will readily admit that they do not treat colleagues the same way.
    As staff are placed under more and more pressure they report frequently exhibiting 'short fuse' behaviours with each other, often expecting higher output and are less supportive.
    What I have seen reported as bullying, i feel that in reality is actually a lack of appropriate support for individuals and increasing pressure due to service demands.

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  • I agree with the first comment, bullies do seem to get promoted and supported. It is usually senior management.

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  • I too agree with the first comment, bullies get promoted and breed more bullies, it is these staff that can make going to work a nightmare, and of course good staff move on.
    We have staff who have been to university that now think it is beneath them to do the more menial tasks with comments like 'I didn't go to Uni to do that' ... as a ward manager for very many years, nothing was beneath me, because I cared.
    Some staff stay on one ward too long and think nobody can do the job better than they can, all staff should be rotated regularly to avoid creating 'cliques' or staff losing skills in other areas.

    It does appear to be that the longer the time since a nurse qualified, the more frumpy grumpy they become, thinking only they know best,when it is in fact their own skills that need upgrading.
    On any ward, a supportive team that works together, provides the best care.

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  • I've worked in local authority, the NHS and in Higher Education over a 24 year period. This syndrome is not NHS-specific, it is simply highlighted more so based on those 'caring' bits of what its supposed to accomplish. A philosophical clash you might say.
    What I believe to be happening is, as one commentator has implied, a UK-wide or even global phenomenon in what are broadly speaking 'public sector' arenas. We ask professionals in these field to embrace within their very souls the principles and values that the professions hold dear, BUT, we then ask them to practice in a neoliberal landscape, hellbent on the eb and flow of free market economics, return on investment, best value, as a result of the impact on New Public Management dragged in from the private sector efficiencies paradigm. The 'pain' people feel are the strands of cognitive and professional dissonance being strained and tensioned in a clash of values, attitudes and warped perspectives. Sadly this is reinforced by the media exposure of leadership positions we once held dear, like Mr Trump and the fractured leadership in Westminster which are pervasive of a hyper-right wing dog-eat-dog culture and not one of compassion, citizenship, collectivism. Public sector is obviously political, both in its philosophical stance, but also in the pressures submitted to it to return a tangible 'thing that's better'. I would not be surprised at all if the NHS staff are asked in the future to wear an electronic device asking 'please rate your satisfaction with your health care practitioner'; no doubt outsourced to an algorithmic platform like Tripadvisor who may show adverts for products you might like between ratings.

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  • I’ve been saying this for many years.
    CQC are also creating a mistrust society with some of the exaggerated policies.

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  • This is a widely written about phenomenon when you look at target cultures. If you measure an individual by a set of targets, however well meaning those targets are, they will work to meet them, especially if that is all they appear to be managed by.

    quantifying caring is a difficult process, we all know it when we see it, but how it can ever be captured in a system that can then be reported in a spread sheet to senior managers and commissioners? You therefore encourage the ward manager, who is the key local leader, to spend time in their office improving their stats, and not undertaking tasks which don't directly translate into an improved KPI.

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