Roger Kline – Research Fellow at Middlesex University Business School, comments on the latest evidence

We know from research that managing healthcare staff with respect and compassion correlates with improved patient satisfaction, infection and mortality rates, Care Quality Commission (CQC) ratings and financial performance as well as lower turnover and absenteeism.

We know that bullying in healthcare undermines patient care and safety making staff less willing to admit mistakes, report concerns and work in effective teams – as well as costing the NHS at least £2.3 billion a year.

We know that discrimination against NHS staff (especially race discrimination) impacts adversely on patient experience and care.

So anyone who cares about the NHS should listen carefully to the 500,000 staff responses to the 2019 NHS staff survey:

  • 12.3% staff (almost one in eight) experiencing bullying and harassment from managers and 19.0% (almost one in five) from colleagues
  • Just 48.0% say they feel their organisation values their work
  • Twice as many black and minority ethnic staff as white staff do not believe there are equal opportunities for career progression or promotion
  • Under one third of staff think there enough staff in their organisation for them to do their jobs properly and three quarters report unrealistic time pressures.
  • Almost a third of staff (31.5%) do not believe they are able to deliver care at the level they aspire to, and 40% report work-related stress.

The survey gives a sense. These symptoms of the workload, vacancy and funding pressures the NHS faces are the culmination of a decade of real-terms spending cuts at the very time when healthcare needs are rising.

Faced with such pressures the evidence that treating staff better improves patient care (a no brainer really) and reduces turnover, stress, and staff ill-health is even more powerful. That research has finally started to feed through into some local NHS employer practices and now into NHS Improvement’s Interim People Plan which explicitly seeks to reverse some of the more common poor work practices in the NHS.

But there is a major potential problem. NHS funding became a major election theme so more money for staffing and for capital infrastructure was promised. But the long arm of Dominic Cummings is already risking a reversion to the worst sort of Ministerial bullying in an attempt to blame NHS managers for the difficulties in delivering the mythical 40 new hospitals and the 50,000 new nurses contained in his election manifesto.

Health Service Journal (HSJ reported in February that “senior government officials are challenging NHS England’s plans for boosting retention to deliver the prime minister’s target of 50,000 more nurses.”

A leaked email from the Department of Health and Social Care to NHS England set out “particular concerns” about the “retention delivery plan” for the target. The DHSC has ramped up its involvement in the NHS’ staffing plans and says ministers would expect a “clearer model of change in the delivery plan” on “culture”.

A similar pattern of pressure from No.10 can be seen on the mythical 40 new hospitals, with NHS England/Improvement’s head of estates telling HSJ “we’re already feeling the heat from the administration to ensure we’re running at pace.”

“As Dominic Cummings gets drawn into the standoff, the epidemic of bullying he has already triggered across Whitehall will risk cascading down to Trusts.”

 

 

Some may remember the last time Ministers pushed inappropriate national NHS targets with the creation of Foundation Trusts. The impact on patients was a bullying culture – led by Ministers – that led to disasters like Mid Staffs. The subsequent Francis inquiry blamed the Mid Staffordshire failings on an institutional culture which put the ‘business of the system ahead of patients’. The Public Inquiry was told there was a “pervasive culture of fear in the NHS and certain elements of the Department for Health. The NHS has developed a widespread culture more of fear and compliance, than of learning, innovation and enthusiastic participation in improvement.”

The Election Manifesto promised impossible targets. These will inevitably collide with the refreshingly positive approach to staff culture in the NHS People Plan. You don’t have to like every comma in the Plan to recognise it is potentially a major step forward.

But as Cummings gets drawn into the stand-off, the epidemic of bullying he has already triggered across Whitehall will risk cascading down to Trusts. If that happens staff survey data will deteriorate even further, bullying and turnover will increase, more staff will burn out or walk away – and care will deteriorate.

If and when the DH seeks to counterpose ministers’ fantasy recruitment and building programme to real efforts to retain and treat staff better, the rest of us (staff and patients) might just join them in telling No.10 to back off.

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Roger Kline
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