A culture of bullying is still endemic in the NHS 18 months after ministers promised to remove the climate of fear created by the internal market, MPs have been told.

One trade unionist likened the problem to 'child abuse' in evidence last week to a health select committee hearing into future NHS staffing requirements.

MPs who have visited NHS organisations as part of their investigation also said they they had found evidence of bullying - particularly of ancillary staff.

'We have more and more bullying going on. It is a very difficult environment because people are not prepared to put their heads above the parapet - they are terrified,' said Louise Silverton, deputy general secretary of the Royal College of Midwives.

She blamed the internal market period of the early 1990s, with its emphasis on commercial confidentiality, gagging clauses, and secrecy, for institutionalising a culture of fear.

'A generation of managers were appointed and brought up under that environment,' she said.

MSF's national secretary for health, Roger Kline, said: 'It's like child abuse, it runs in the family. There are a lot of organisations where it will be very difficult to change the culture.'

Sir Alexander Macara, former British Medical Association council chair, pointed out that managers were themselves under stress. In this situation 'it is the most vulnerable person at the end of the line who gets clobbered', he said.

Labour MP Audrey Wise said a lack of cover often forced managers into difficult situations.

She had been told of an NHS worker who been informed of a bereavement while on duty. Her immediate boss had been ordered to tell her that she would not be able to leave work for four hours.

'He refused to do that. But if he had not, would that have meant he was a bully?'

Earlier in the session, Unison head of health Bob Abberley said long- term staffing problems could only be tackled through the creation of a new pay structure which would force the diffferent NHS professions to become less 'compartmentalised'.

He added: 'I would describe the NHS as the British class system writ large - and it is.'