Intended for healthcare professionals


The NHS is failing to look after its staff and patients, expert warns

BMJ 2014; 349 doi: (Published 24 November 2014) Cite this as: BMJ 2014;349:g7171
  1. Abi Rimmer
  1. 1BMJ Careers

The NHS is failing to look after its staff properly as well as its patients, a psychotherapist who specialises in group behaviour has warned.

Gerhard Wilke, an organisational consultant and group analyst, raised the issue at an event in London at which doctors and other clinicians discussed their experience of working in the NHS. He said that the NHS and its staff had developed a “learned helplessness.”

“What we need to do is move out of that and to start to act,” he said. “The NHS used to be the ‘good enough’ mother of the nation, where it had the delegated task of looking after the staff and the patients. What we have now is the failing mother who looks after neither the staff nor the patients properly, and we have the father ‘daddy state’ who is looking for a divorce or reduced alimony payments.”

Healthcare professionals need to look after themselves to ensure that they can properly look after their patients, he said. “I have advocated [the argument that] self care comes before patient care, which was news to doctors. They thought it was morally wrong.”

Wilke said that one thing that he hoped the meeting could produce was wider consideration of the question, “How much self care do I need before I can even begin to be of any use to a patient?” He said that NHS staff needed to talk more honestly about certain “cultural patterns” in the NHS, such as the desire for “inclusivity and a demand to know everything.”

He said, “A lot of time and resources are wasted on meetings with far too many people in them, that are far too long and are far too irrelevant, to serve some fetishised idea of democracy. More hierarchy [is needed] in certain areas, less in others,” Wilke said.

At the listening event, NHS staff from across the UK spoke about the difficulties that they faced working in the NHS. Problems included a lack of time to complete tasks, a lack of resources, increasing demands from patients, and a lack of support for staff from managers and superiors. Delegates also expressed concern about the increasing emotional burden of working in the NHS.

Clare Gerada, former chair of the Royal College of General Practitioners, is a member of the Founders Network, which organised the meeting. The network is a group of individuals and organisations that are working together to try to improve the health of the NHS. Speaking at the event, she said that NHS staff were experiencing a rise in the prevalence of bullying and that “minor transgressions” by staff were increasingly being referred to regulators or disciplinary bodies.

“What we are seeing is warfare going on within the NHS,” she said. “We are seeing people who, in the past, would sort things out through communication and through relationships but who are now sorting things out through the regulators.”

Gerada is also medical director of the Practitioner Health Programme, a confidential London based health service for doctors and dentists. She said that the programme had treated 1500 doctors with mental health problems. “We have gone from a rate of seeing three [doctors with mental health problems] per week to 15 per week,” she said. “It is this constant anxiety that people are feeling and this constant sense of change going on in their organisations.”

View Abstract