Headache For Health Service

When NHS staff surveys were introduced by Susan Deacon, the then Health Minister, the idea was as a temperature check on the NHS that would identify any issues which deterred people from joining and remaining with the service.

The third and latest such report, passed to The Herald this week, shows the mercury has risen to uncomfortable levels for many of the service’s 150,000 staff.

Like previous reports, it identified workplace bullying as an issue. This has been flagged up previously by the Royal College of Nursing and the British Medical Association, but the latest findings show the problems are widespread and ingrained.

Nearly one in five respondents reported experiencing bullying or harassment, most often in the form of shouting, humiliation and threatening behaviour but also through excessive criticism and “victimisation”.

The perpetrators were reported to be line managers or senior managers in more than one-third (37%) of cases, while the public accounted for more than one-fifth (22%) of cases.

Nearly half of the victims blamed colleagues or other staff for mistreatment.

Christine Grahame, the SNP’s social justice spokeswoman, said the report showed there were serious issues at the heart of NHS management. “Frontline staff feel isolated and dislocated from the decision-making process, with managers seldom communicating with them the key objectives of the organisation or its core values. Not surprising then that the majority of those who responded feel the NHS is not a good place to work,” she said.

“I am in no doubt that the vast majority of NHS staff work very hard indeed, caring for patients often with very complex needs and in highly pressurised environments. But management systems should be there to support and enhance their work. Instead, what we appear to be seeing is a culture, derived from a failing management system, that is actually undermining frontline staff and leading to a poorer quality of service.”

Andy Kerr, Health Minister, said yesterday that he expected health boards to act on the findings. “It is crucial for us that staff have the opportunity to comment on how they feel they are managed, and that boards have robust, well established mechanisms in place for acting on the outcomes,” he said.

Unison yesterday called for a national campaign to tackle workplace bullying in the NHS, which it said should receive the same attention and condemnation as violence against staff.

John Gallacher, the union’s regional officer with responsibility for the NHS, pointed to some positive work that had been done at health board level to tackle workplace bullying, but said there was a need for more high-profile involvement from the Scottish Executive Health Department. “Bullying and harassment really should be taken as seriously as violence and aggression. There is a real need for a Scottish-wide campaign to eradicate this.”

Another cause of unease among staff is the fast pace of reform in the NHS. Sweeping changes, including the centralisation of services and the downgrading of consultant-led units and closure of maternity and A&E wards, appear to have left staff disgruntled and feeling left out.

The survey suggests that, just as health boards have been criticised for not consulting or engaging with the public over reforms, they have failed to bring staff along with them.

Only 19% of respondents said their board managed change effectively, compared with one-third who felt it did not.

The British Medical Association in Scotland said yesterday the NHS was suffering from “change fatigue”. A spokeswoman said: “Numerous structural reforms in the past 12 years or so have been demoralising for staff, many of whom can see no benefits or improvements to their working lives as a result. The BMA has called for a period of stability, where services are given time to bed-in and evolve into a structure that is most appropriate for patient care.”

Colin Poolman, professional officer with the RCN, said he was worried that most staff do not feel confident about making a complaint. “The worrying thing for us,” he said, “is that people don’t feel confident that if they make a complaint it will be dealt with appropriately.

“We support people where there are instances of bullying but, more important, the NHS needs to start thinking about what needs to be done before a situation arises. We need to be more proactive about dealing with issues and promoting a good workplace culture.”

As an example, the RCN has been providing facilitators who undertake workshops with staff teams to examine their ethos and manner of working together. Mr Poolman also mentioned nurse-led medical centres as an example of how nurses could be involved in service reforms and feel valued for their contribution. But he added that many of the reforms were seen by staff as top-down and were not communicated effectively beyond senior management and team leaders.