Posted on: April 23rd, 2019
I have quite a lot to do with the National Health Service. Not only have I had to draw on its fantastic services from time to time, I also worked for it some years ago, and was married to one of its employees for 16 years. I now run the company that provides it with mediation, dispute resolution services, and all levels of training. The NHS matters to me in all sorts of ways: personally, professionally, and politically.
That’s why I get particularly upset when I hear that we still have such an issue with bullying, harassment, and unprofessional conduct in the NHS.
Recent data shows that reports of bullying and harassment in England rose from 420 in 2013-14 to 585 in 2017-18. That’s nearly a 40% increase! An article in the Guardian last month, following a Freedom of Information request, showed that only a fraction of these cases ever led to dismissal or disciplinary action (1).
Other research recently conducted by the British Medical Association (BMA) found that one in five doctors had been bullied at work, and that two in five (39%) of the nearly 8,000 professionals surveyed believed there was a problem with bullying and/or harassment in their workplace (2).
But we already know about the problem, and I have written about these sorts of figures before. I only quote them here to show that, not only has the problem not gone away, it has got worse.
And what has also become clearer over time is that it is not just about high levels of bullying and harassment, but now the parallel phenomenon of disrespectful and undermining behaviours between colleagues. A General Medical Council (GMC) survey found recently that 40% of doctors felt that some colleagues ‘undermine respect and prevent effective collaboration (3).
So, four in 10 NHS professionals know of colleagues whose behavioural standards have dropped below what was expected: meaning they were at least impolite or obstructive with colleagues, and at worse, were undermining or ‘rude and aggressive’, according to the GMC survey.
So what can we do? Depressingly, all of the same things that I have been saying for the last 10-15 years!
But before I bring you down, perhaps I should comment instead on a couple of the more positive initiatives that have happened recently.
Only last week, at their annual conference, the GMC chair Dame Clare Marx announced that a pilot training scheme for GPs is to be launched in response to what she called the ‘growing evidence’ of unprofessional behaviour: GPs will be trained to develop the ‘skills and confidence’ to address such behaviours amongst colleagues. Very good.
And we do also still have ringing in our ears the recommendations from Sir Robert Francis’ ‘Freedom to Speak Up’ initiative, looking at the need for open and honest reporting in the NHS after some major failings in the Mid Staffordshire NHS Trust: he spoke about how poor working relationships and workplace disputes can ultimately impact on patient care and safety, because of how such disputes can affect communication, morale and the willingness for people to blow the whistle on colleagues.
He said: ‘Mediation and dispute resolution techniques can play a role in resolving disputes at a much earlier stage, before positions become entrenched or relationships break down irretrievably. They can be used to rebuild trust within a team after a difficult period. Mediation needs to be done by trained experts and by people who understand the context within which they are operating.’ Even better.
Incidentally, as well as this sage advice (which, with respect Lord Francis, we already knew!), another thing that came out of the Francis Report was the appointment of Freedom to Speak Up (FTSU) Guardians within all NHS Trusts. They have a role in hearing confidential reports from staff members about any professional or procedural failings that potentially need to be investigated.
My trainers, mediators, and I spend a lot of our time working with NHS Trusts. What we have found very telling over the last couple of years is that the FTSU Guardians up and down the country are receiving a high proportion of reports from staff about bullying and harassment: they are there to hear about the full range of professional errors, failings and risk issues, but what they are actually getting every week is people tugging at their sleeves to tell them they are being bullied and harassed.
So, the bad news is that we know the problem still exists, and we know it is getting worse. The good news is that we know that bodies like the GMC are taking action to mitigate the problem, that Francis had the right idea about how to address the issue of using mediation to repair working relationships, and that there is now an easier way for people to report bullying through FTSU Guardians.
With all of the NHS Trusts that UK Mediation works in, we are gathering data on how our mediation, dispute resolution services, and training are impacting on levels of bullying and harassment. It is difficult because Non-Disclosure Agreements are unfortunately still being used in cases of settlement agreements when a claimant leaves the Trust. And, of course, in spite of the good news above, there is still a lot of under-reporting of bullying and harassment. The GMC survey actually found that 60% of the survey’s 1,000 respondents said they ‘would not be confident that they’d be supported by clinical leaders and other managers if they raised a concern (3). Truly shocking.
In my personal and professional assessment, we need to ramp up our efforts to address this awful and worsening problem. Yes, we have to train people to use mediation skills and confident conversation techniques, and sometimes we need to bring in external mediators. Francis said it; we gladly do it.
Yes, we need the professional bodies like the GMC to take the problem seriously and to act.
Yes, we should make the most of every means of confidential reporting of incidents of bullying and harassment, such as happens with the FTSU guardians.
But change now clearly needs to happen at a more cultural level: every individual in the NHS should feel confident that if they blow the whistle when either they or someone else is bullied or harassed, that they will be taken seriously and supported by colleagues at all levels. I think that without this, I may well be back again in another couple of years writing a similar article. And I really don’t want to be doing that.
(1) ‘Bullying and sexual harassment ‘endemic’ in NHS hospitals’, The Guardian, 2019
(2) ‘Bullying and Harassment: how to address it and create a supportive and inclusive culture’, British Medical Association, 2018
(3) ‘Medical Professionalism Matters’, General Medical Council, 2016