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.