MPs are to tackle 'poor communication' between managers and frontline clinical staff in a wide-ranging inquiry into the NHS workforce.
This has emerged as one of the key issues from written evidence submitted to the health select committee, which is to begin taking oral evidence as part of its staffing inquiry later this month.
Select committee chair David Hinchliffe told HSJ that the evidence so far presented a stark picture. In one hospital, nurses found it so difficult to raise concerns about staffing levels that they had started keeping their own confidential record of dangerous events on the ward.
Nurses were logging 'dangerously low' staff numbers and worries about the 'competence of agency staff', Mr Hinchliffe, a former social worker, said.
'This is a mechanism to sound off and to cover their backs if something goes wrong,' he added.
Across the NHS as a whole there was 'a very big gap between ward-level staff and those who take the decisions,' Mr Hinchcliffe added. 'There appear to be missing links in communications.'
In some trusts, clinicians felt that 'gagging clauses' in their contracts prevented them from speaking out and in others the risks of assault at work 'were not taken seriously'.
But the NHS Confederation hit back. Head of policy Derek Day said the nursing and medical professions 'had a duty' according to their respective regulatory bodies to 'make sure management knows their concerns' if patient care was suffering from poor staffing levels.
'There should be no question of professionals keeping a book to cover their own backs and not reporting issues,' he added.
The select committee inquiry will consider staffing levels, pay conditions, and recruitment and retention of all grades of workers, 'from porters to managers and consultants'.
The MPs are due to start a series of visits to regions across the UK later this month and plan to report in January.
Mr Hinchliffe said he wanted the committee to make 'practical recommendations' about issues 'over and above' pay. The MPs could also outline steps for trusts 'to make staff feel that their views are valued and listened to'.
Some managers are sympathetic to Mr Hinchliffe's views. Ian Stone, human resources director at the United Bristol healthcare trust, which runs the Bristol Royal Infirmary, is well aware of the dangers of failing to deal with clinicians' concerns.
'Failure to listen is a cause of serious stress and anxiety,' he said.
The issue was a 'real problem for managers', who were often 'so hard- pressed' they found it difficult to take the time to listen to staff.
Mr Stone, who is also president of the Association of Healthcare Human Resource Management, said HR leaders have a responsibility 'to grow a management culture that realises we can save a lot of time by lending a listening ear at an early stage'.
Mr Day said: 'It is vitally important that management communicate to nurses and doctors at the coal face that they are trying to find solutions to problems so they don't feel ignored.'