Bullying in NHS must be “called out,” says head of NHS ImprovementBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2923 (Published 15 June 2017) Cite this as: BMJ 2017;357:j2923
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I don't want to make this personal about NHS Improvement Chief Executive, Jim Mackey, who was a very well respected hospital chief executive in a trust that scored better than most on staff morale and engagement and who always strikes me as someone who would feel more at home going back to such a role rather than heading up a national regulator.
However, what his speech failed to acknowledge was the "Elephant in the Room" that the bullying culture in the NHS starts right at the top from the Department of Health and from NHS England, NHS Improvement and the Care Quality Commission. I don't say for a moment that this is their only modus operandi, nor that there aren't some very well intentioned people in those roles.
However, time and again, we have seen instances of huge pressure around targets, finances and news management placed onto already struggling NHS organisations. We have also seen inspection reports that were damning, with the regulator sometimes appearing to relish the media spotlight gained from talking tough. The behaviour of the Secretary of State in fomenting and perpetuating a completely avoidable stand off with junior doctors was reprehensible and NHS Employers sadly colluded in this.
In an NHS that is already struggling with a huge funding shortfall, rising demand and a workforce crisis, the top down "targets and terror" culture from central bodies wanting to maintain "grip" and in turn stay the right side of government ministers is singularly unhelpful. It even extended to Strategic Transformation Plans being told to promise unevidenced redutions in activity and unachievable savings plans in their iniital communications; or acute providers in winter being told to play down bad news about the urgent care crisis.
In such an environment, it's no wonder that we struggle to attract or keep senior NHS managers in post for long enough to provide stability. Nor that many of them pass the pressure they are subject to down the line to clinical teams, further affecting their morale and on occasion making them feel bullied.
One need only see the percentage of comments on the Health Service Journal message boards which remain anonymous to see how worried many NHS managers are about speaking up.
As Mr Mackey is moving on soon and therefore able to speak his mind, it's a shame he didn't use his speech to point out that national NHS leadership from Whitehall downwards plays a huge part in the bullying culture and needs to do more to support rather than blame or pressurise NHS providers and commissioners.
Competing interests: No competing interests