'He gave me a photo of Mussolini. He was laughing. It was totally demeaning and humiliating'

Despite greater recognition of the cost of bullying in the NHS - to individuals and the service itself - there has been little success in addressing it. Daloni Carlisle reports

Mention bullying in the NHS and most people will think of browbeaten nurses and junior doctors at the wrong end of a sharp-tongued ward sister/consultant or an overbearing manager hell bent on reaching targets.

But managers are the victims of bullying, too. Anyone watching the current run of hospital drama Bodies on BBC2 will have seen feisty new manager Chrissy Farrell suffer verbal abuse from the lecherous consultant obstetrician Tony Whitman. 'I see the hospital has been forced to lower recruitment standards yet again, ' he sneers as she challenges him on his behaviour to junior female colleagues.

And There is the rub. It is precisely because of the nature of manager-bashing - it is usually done by senior colleagues such as consultants or executive directors - that too often they are let down by the procedures they seek to uphold.

At least that is middle manager Ian's experience of bullying by a consultant. When he complained, he found himself out on a limb and eventually out of a job while the consultant carried on as normal during a three-month investigation.

Ian has now left the health service - taking with him 10 years' experience in nursing management - while the consultant is still in post after having his wrist slapped.

Ian is anxious not to be identified, as he fears it would have knock-on effects. 'I can't afford to get a reputation, ' he explains. He wants to share his story as he knows others are in the same boat and might learn from his experience.

'Most of my friends are in the medical world and I am not naive about what awkward buggers consultants can be, ' he says. 'But when I started this job I realised that this was something more serious.' There was no handover from the previous incumbent; there had been no budget meetings, so the department was running in deficit.

Activity-reporting was so backlogged as to be a joke.

'The team meetings were just awful. There were 25 of us from the secretary to the consultant, but only four people ever said anything, ' says Ian. 'When I tried to change the culture by introducing outside speakers or asking a team member to talk about their work the senior consultant was basically very rude.

He would arrive late, swear at other staff and then sit opening his e-mails on his laptop. It felt as though it was deliberate.' Outside meetings he was rude to staff, calling them stupid. He refused to share any information.

It was Ian's job to get the budgets into shape and bring reporting up to date. 'When I arranged meetings he was late or didn't turn up, saying afterwards he had forgotten, or he sent a lead nurse in his place, ' says Ian.

Eventually Ian took his concerns to the director of nursing. Still trying to smooth over the cracks in their relationship, Ian agreed to a meeting where he was stonewalled. 'I asked the consultant why he offered me the job if he thought I was no good.

He refused to answer.' The crunch point came after that meeting. 'The consultant came up to me smiling, saying he had noticed I didn't have any pictures in my office.

He presented me with a photograph of Mussolini. He was laughing. It was totally demeaning and humiliating.' Ian made a written complaint accusing the consultant of bullying, intimidation and unprofessional behaviour. 'I had spoken to senior managers who said I had no option but to resign, ' says Ian. 'I was so miserable I decided to do it.' Ian refused mediation. 'This had been going on for four months for me and longer for the staff. It wasn't right.' He refused to reconsider his resignation and was offered three options: leave immediately, work his notice out in another area of the trust, or work from home-coming in once or twice a week.

'I was presented with this and I thought, 'Hang on, I am the victim here and I am expected to work from home in total isolation with no access to e-mails while an investigation into the person I have accused of bullying carries on as normal?'' The investigation - such as it was - took three months. Team members were interviewed and transcripts given to the consultant. Eventually the consultant was called before a board and asked to answer for himself. 'I am told he had his British Medical Association rep alongside and said all the right things, ' says Ian. 'He had his wrist slapped. Nothing has changed.' Ian, meanwhile, has left the NHS and is now working in the private sector. 'When I complained, it was because I wanted to improve patient care and improve team morale and protect services. I do not think I achieved any of that. I just damaged myself.' He adds: 'The process stinks.

Part of the delay in concluding the investigation was because staff were too afraid to submit their statements as they knew the consultant would see them.' Ian at least feels he held his head high throughout. 'My only regret is that I didn't have any union representation. I didn't know managers could have unions.' It is a familiar lament, says Ian McKivett, national officer for the newly formed Managers in Partnership, a joint venture between the First Division Association (which represents senior civil servants) and Unison (Interview, page 18, 13 October).

'It works both ways as managers do not expect managers to be represented, ' he says. 'The view from the top is that It is just not cricket when managers are represented.' Information about bullying of managers is thin on the ground, although it is pretty much accepted that the NHS has something of a bullying culture.

According to the Healthcare Commission's 2004 NHS staff survey, which with 217,000 respondents in 572 organisations is the largest workforce survey in the world, around one in 10 NHS staff report bullying, abuse or harassment by colleagues.

This rises to 37 per cent if abuse from patients and their relatives is included.

NHS Employers head of workplace health and employment Julian Topping condemns bullying outright. 'Any form of bullying or harassment of NHS staff, whether by colleagues, patients or relatives, is entirely unacceptable and we must do what we can to prevent it, ' he says.

Yes, he agrees, managers can be bullied too. 'They tend to bully because they get bullied, and so it works its way down through an organisation.' Bullying is expensive, costing the NHS in sick pay and lost staff. A forthcoming report on bullying to the Department of Health is likely to indicate that cutting its incidence by just 1 per cent could save£9m annually.

Mr Topping feels that Ian's experience is unfortunately all too common. 'Managers do fear getting a reputation and they do not like to use the formal procedures. We really do have to work hard to address the problem.' Which is why NHS Employers has brought forward a campaign to help NHS trusts develop anti-bullying strategies planned for next year. 'We are going to start later this year, ' says Mr Topping. 'It is a major problem.' Not a moment too soon, says Mr McKivett. Bullying of managers is on the increase, he believes. 'It is affecting everyone from chief executives down.

We are finding that as the NHS gears up for the latest reconfiguration people are being leaned on not to apply for positions they want.' Managers in Partnership is already talking to NHS Employers about an input to human resources strategies for the forthcoming restructuring.

The bully's latest tool seems to be performance management. 'It is not taking place with the frequency it should and the targets can be very vague, ' says McKivett. 'No-one should be called in for their first performance-management review and told that their performance is not up to scratch and we want you out.' But it is happening.

As Mr McKivett points out, there are possible redundancies in the pipeline and the pressure appears to be on to lose 'expensive' staff with costly redundancy or early retirement packages due to them.

He says: 'They are being threatened with disciplinary action or being downgraded or dismissed through misuse of performance management. People are jumping rather than hanging on and taking what is rightfully theirs.' Mr McKivett says cases can be defended, although he agrees with Ian that the formal complaint route is often not the best one for managers.

'The procedures I have used for years representing health workers are very good, ' he says. 'But at executive or anything down to third tier [of management] there is a different set of rules that apply and the procedures do not cover it.' 'If it is a performance issue then we can trawl through the paperwork and challenge it, ' he says. 'But usually it is a case of turning a disciplinary [action] into a compromise agreement.' Which might be good for the individual but does nothing to tackle the underlying macho culture that pervades too many NHS organisations. As Mr McKivett says:

'The case work can be gratifying, but It is short term work and usually too little too late. We want to encourage a fair, transparent and equitable system where managers can defend themselves openly.' As for Ian, he is showing the resilience of a true professional. 'It is over now and I want to move on, ' he says. 'I want to put it behind me.' Bodies watchers must wait to find out what sort of a fight Chrissy puts up. .