Bullying: the 'corrosive' problem the NHS must address

Sir Ian Kennedy issued a sombre warning about the “corrosive” impact of bullying among NHS staff earlier this month.

In a farewell interview as he stepped down from his role as Healthcare Commission chair, Sir Ian said bullying worried him “more than anything else” in the NHS and was “permeating the delivery of care”, before calling on managers to stamp it out.

His fears regarding the scale of the problem appear to be well founded if the annual staff survey, published last month, is anything to go by.

Twelve per cent of staff surveyed said they had suffered bullying, harassment or abuse at work by colleagues in the previous year and 8 per cent said this was by managers or team leaders.

At some trusts the problem is more widespread. The highest rates were at St George’s Healthcare trust in London, where 23 per cent of staff said they had been bullied, harassed or abused by their colleagues.

A spokeswoman said the figures were “of great concern” and the trust was looking at how to address the problem. A joint letter from the chief executive and a staff representative will go out with this month’s pay slips stating the trust’s commitment to tackling bullying and encouraging staff to speak out if they experience or witness bullying behaviour.

It is reassuring to see trusts taking action, but why is bullying so widespread in an institution devoted to caring?

Managers in Partnership chief executive Jon Restell says it is embedded in the culture of the NHS. “People tell themselves they do it for patients,” he says. “But to think we have to be brutal [to our colleagues] to be nice to patients - I don’t see how that works.”

To make matters worse, top doctors have had bullying “hardwired” into their training, he says. This is borne out in the 2007 survey of junior doctors by the Postgraduate Medical Education and Training Board, which found half of trainees in non-foundation posts who reported being bullied said it came from consultants.

Department of Health director general of workforce Clare Chapman says undergraduate and postgraduate medical programmes must be adapted to discourage the behaviours that lead to bullying.

However, far from being an isolated issue, many feel the problem is systemic in the medical profession.

Ms Chapman says there is a recognition that action must be taken but “the challenge is that not all trusts are tackling it”.

The Pacesetters programme is working to tackle bullying and discrimination, and the NHS constitution sets out the right to an environment free from harassment, bullying or violence.

Another barometer will be the review of the health and wellbeing of the NHS workforce, which is being led by Dr Steve Boorman and is due to report back by the end of this year.

Trouble from the top

Given the frequency with which NHS chief executives face sudden departures and complain about harsh performance management, is bullying being driven by the target culture?

There are also questions for regulators: Mr Restell asks whether they perpetuate the problem through their “tough” interactions with organisations.

While bullying occurs at all levels of the health service, close examination of the staff survey reveals stark disparities. For example, 11 per cent of white British staff complained of bullying, harassment or abuse from colleagues in the past year, compared with 19 per cent of Bangladeshi employees.

Bangladeshi staff are followed by Asian/Asian British and Pakistani staff (both 15 per cent), black African, black British, Chinese and Indian staff (14 per cent), and white Irish and black Caribbean staff (13 per cent).

In acute trusts, the proportion of workers saying they were bullied by colleagues was more than a fifth (21 per cent) among staff from white and black African backgrounds as well as employees classing themselves as “other Asian”, meaning they did not define themselves as Pakistani, Bangladeshi, Indian, Chinese or Asian British.

For white British staff the figure was 13 per cent. These statistics will fuel fears that the NHS does not always treat staff from different ethnic groups equally, backing up findings by HSJ and the NHS South East Coast black and minority ethnic network.

Evidence shows the NHS also needs to provide more support to staff with disabilities, who were almost twice as likely to say they had been bullied, harassed or abused by managers (13 per cent) than those who had no disabilities (7 per cent).

In acute trusts, one in five of the 7,486 disabled staff surveyed said they had been bullied by colleagues, compared with 13 per cent of non-disabled workers.

An Equality and Human Rights Commission spokesman said the figures were a “cause for concern”. A report by the commission last year highlighted the “profoundly different” experiences at work of people with long term illnesses or disabilities from their colleagues.

There are also clear distinctions between staff from different professional groups.

Social care managers were the group most likely to say they had suffered bullying, harassment or abuse by their managers in the past 12 months - 16 per cent compared with 4 per cent among arts therapy staff, the group with the lowest figures.

The figure was 13 per cent for midwives, who are also the occupational group most likely to say they have suffered bullying, harassment or abuse from colleagues - 17 per cent, compared with 8 per cent of physiotherapists.

Pressure cooker

Royal College of Midwives director of employment relations Jon Skewes puts this partly down to the “pressure cooker” atmosphere of busy maternity units and acute trusts in general.

However, this is no excuse for bullying, he says. “The midwifery profession has to work towards exemplary behaviour, but it’s also the responsibility of senior managers and boards.”

Investing in organisational development, bringing experts in from outside if necessary, will help tackle bullying, he says. But where will the money come from in a recession?

Mr Skewes says this is a moot point. “Last time the NHS was struggling with deficits there was no money for organisational development and training. That might be a problem again if spending gets cut.”

Before slashing budgets, finance directors may want to read an unpublished report carried out for the DH and released last year under freedom of information legislation.

It calculated that the cost of bullying and harassment to the NHS, taking account of sickness absence, replacement costs, productivity losses, litigation, service delivery, damage to employer brands, and bullying by patients and their families, was an “immense” £325m a year.

If this is true it means for every 1 per cent of an organisation’s workforce that experiences bullying and harassment, it costs it more than £8.7m a year.