The positivity so evident in the NHS and its staff should be celebrated - and the stain of bullying eradicated, writes Rob Webster

Rob Webster

Rob Webster

You can have opinions about the NHS for free and by the ton – open any newspaper or look at Twitter to access this in full flow. Take a closer look and assertion appears to be, for many, a substitute for evidence and analysis.

Data wise

We should take a leaf out of W Edwards Deming’s book. He is widely quoted as being the author of a quote I have used often: “In God we trust, all others bring data”.

In the current febrile and challenging environment, we would do well to be guided to the real issues by data, not divine faith in the goodness of the NHS, our staff and our place in the hearts of modern Britain. The good news is that we have a credible, consistent, longitudinal and incredibly rich dataset in the annual staff survey.

This was published last week and brings a degree of hope as well as insight into the issues that affect us. There have been significant improvements in the majority of key indicators including on staff engagement and reporting concerns.

Positive environments for engaged staff, with a connection to purpose, deliver better outcomes for patients

We can be encouraged by the increase in willingness to recommend the service, where 69 per cent of staff now would do so, and that eight out of 10 staff said they are proud of the standard of care they deliver – which is higher than it was in 2011.

This is important. We know from the work of researchers like Michael West and Beverly Almo Metcalfe that positive environments for engaged staff, with a connection to purpose, deliver better outcomes for patients. This good news sits alongside other evidence of the commitment of staff to change and improvement for the benefit of patients.

This latent power is unleashed in organisations across the country – as seen by the avalanche of activity on the Academy of Fab NHS Stuff, NHS Change Day and the School for Healthcare Radicals. Whenever we provide an opportunity, thousands of our staff step up to share, learn and engage.

There are lessons here for the creation of NHS Improvement that must not be lost. This also chimes with my time on the frontline each week, where I find parallel worlds of board leadership struggling with regulators and the system – and services trying hard to build a way out of the current pressures.  

A dark reality

This is not a universal experience and the staff survey points to another darker reality. What makes painful reading for NHS leaders across the country is the rise in staff feeling bullied or harassed at work.

A culture that tacitly accepts bullying is immoral, anti-social and inefficient. This is everyone’s business

Almost one in four staff report being bullied – which suggests that over 300,000 people feel this way. Sometimes numbers get so big they become difficult to comprehend.

These are big numbers – equivalent to the whole population of Nottingham or Newcastle and Hereford combined. And the rates for black and minority ethnic staff are worse.  

This is a stain on our collective leadership that we must wash away. Because it is a moral imperative, a social imperative and an economic imperative.

Everyone’s business

A culture that tacitly accepts bullying is immoral, anti-social and inefficient. This is everyone’s business.

Leaders set the tone in the system within which we operate. That means everyone from the public accounts committee and health select committee to the ministerial team, arm’s length bodies and every front line chief executive.

All of us must behave in ways that drive a culture of openness and freedom to speak up.

As NHS chief executives, all of us can look long and hard into the mirror of the staff survey and ask a simple question. ”Is it me?” 

Fortunately, help is at hand. NHS Employers has developed a range of support tools that start to address these issues and there are good examples across the country. Umesh Prabhu and Andrew Foster will tell you that their journey in Wigan started with a set of bad staff survey results that forced them into a programme of work that has made them exemplars in engagement and quality improvement.

All of us must behave in ways that drive a culture of openness and freedom to speak up

The critical lesson I take from them is that they could address the issues in their control and did so, rather than bemoaning the tone set by the wider system. The wider system issues are an obsession of mine and a priority for the NHS Confederation.

I believe we should set values and behaviours in the system that are modelled by each of us, including the ministerial team and ALBs. We should use the “Well Led” Care Quality Commission domain or the NHS Constitution to set these and then have a new compact between the frontline and the ALBs.

Their performance should be judged on the feedback from frontline teams on how they are living the values of the NHS. That would set a tone of engagement and support that would support our frontline efforts to address bullying and harassment in the NHS.  

The NHS was established almost 70 years ago at a time of extreme austerity, when health was given the biggest economic priority and was based on a set of values that persist today. At the start of 2016, let’s take the positive pride that staff feel in their work and cultivate it, support them and celebrate the difference they make each day.

Let’s then wash away the stain of bullying and harassment in the NHS because the people we employ and the people we care for deserve much better.  

Rob Webster, chief executive, NHS Confederation