Promoting partnership working in the NHS

Tackling Bullying in the NHS - A collective call to action

To deliver excellent care to patients, our NHS organisations need to be well led and have healthy, supportive, positive cultures.

However, with a quarter of staff responding to the NHS Staff Survey reporting they have been bullied in the last 12 months, we know there is much more to do.

Bullying can have serious consequences for affected individuals and those they work with, reducing productivity and risking poorer patient care.

To explore the issue, former Department of Health (DH) minister, Ben Gummer chaired a roundtable of NHS leaders and academic experts after which he asked the SPF to develop a plan to tackle bullying in the NHS.

The SPF Workforce Issues Group (WIG) has led the work, drawing together evidence and front line experiences which have resulted in a strong case for change. A range of suggested actions supported by resources, advice, guidance and good practice are available to help organisations develop their own plans in partnership to tackle bullying. Work on developing these resources will continue. 

This call to action invites all NHS organisations to:

• achieve the overarching leadership and cultural change to tackle bullying

• support staff to respectfully challenge problem behaviours

• publish their plans and progress so staff, patients and the public can hold them to account.

SPF is supporting partnership action:

• by system leaders led by DH and NHS Improvement

• by organisations supported by NHS Employers

• by individuals and teams supported by unions working with their members.

The SPF will keep progress under regular review through its quarterly meetings.

The views of NHS leaders/experts on tackling bullying and building positive workforce cultures

In his blog, rethinking disciplinary action in the NHS, Roger Kline looks at the cost of unnecessary disciplinary investigations, and considers how a different approach could not only save the NHS millions of pounds each year, but most importantly would benefit patient care and safety.

Roger notes that automatically resorting to disciplinary action can create a blame culture where staff do not feel comfortable admitting mistakes. Some staff find the disciplinary investigation to be distressing and demoralising, while the process can be time consuming and costly for the employer.

He proposes that NHS organisations must work towards creating a positive workplace culture, which aims to prevent issues from escalating, and encourages learning from mistakes. By creating an open and supportive environment, improvements will be seen across patient care, staff wellbeing, and the use of NHS resources.  

Read Roger’s blog post here.  

Listen to Jim Mackey, Chief Executive of NHS Improvement speaking at Confed17 on the importance of talking openly about bullying, and the need for individuals to 'call it out' if, in their interactions with the NHS regulators, they feel they are being bullied.

SPF partner organisations have developed some useful tools and resources, to help tackle bullying in NHS:

NHS Employers website includes tools and resources to help tackle bullying and harassment.

In the first of a two part series of podcasts on the NHS Employers website, Jon Restell, Jon Lenney and Dr Madeline Carter talk about bullying and harassment, the problems the NHS face and how they can be tackled.

Part two in the tackling bullying and harassment series of podcasts features Birmingham and Solihull Mental Health Foundation Trust talking about their cultural ambassadors project, which was a 2016 HPMA partnership award finalist. 

You can listen to the first episode of the hot topics podcast series, produced by NHS Employers for Capsticks' HR advisory service (HRA). This new series will focus on culture and behaviour in the workplace.

UNISON's website features some useful information about bullying and harassment. Tackling bullying at work is a UNISON guide for safety representatives. Harassment at work is a guide used by UNISON branches and stewards to negotiate policies which prevent, tackle and deal with incidences of harassment and bullying in the workplace.

The Royal College of Obstetricians and Gynaecologists working with the Royal College of Midwives produced the undermining toolkit, to address the challenge of undermining and bullying behaviour in maternity and gynaecology services.

The Royal College of Nursing website has a section on bullying and harassment for members who experience bullying or harassment at work.

The Health, Safety and Wellbeing Partnership Group (HSWPG) has published material on bullying in healthcare. This includes a tackling bullying and harassment in the NHS infographic

The Chartered Institute of Personnel and Development (CIPD) has produced a guide called Bullying at Work: Beyond Policies to a culture of respect​ to help personnel professionals and others deal more effectively with bullying, harassment and interpersonal conflict at work. 

The British Medical Association (BMA) website includes information on how to address bullying and harassment at work​​​. The BMA has also published a promoting dignity at work booklet and workplace bullying and harassment of doctors: a review of recent research and policy recommendations.

The Health & Safety Executive has produced advice for individuals who are being bullied. 

The Society of Radiographers website includes information on a campaign to stamp out bullying

Stonewall has produced a guide called Bullying – preventing the bullying and harassment of gay employees

The TUC has published information on its website on workplace bullying with a messages to staff – don’t suffer in silence

The Royal College of Surgeons of Edinburgh’s bullying and undermining campaign aims to lead and support cultural change in the surgical and dental workplace. They have produced resources including literature on the effects that bullying and undermining behaviour has on patient care, as well as posters and presentations to spread the word that bullying is not acceptable. They also offer advice on self-reflection and tips on what you can do to challenge bullying in your workplace. 

NHS Improvement’s Creating a culture of compassionate and inclusive leadership provides practical support and resources to help providers improve their workplace culture. The programme has now moved into phase two - Develop your collective leadership strategy to address the issues. Read more about this on the NHS Improvement website.  

ACAS has produced a policy discussion paper on tackling bullying and ill-treatment in Britain’s workplaces. This includes information on what is bullying, its causes, its impact and what can be done to prevent and tackle bullying. ACAS also offers free online courses in bullying and harassment, conflict resolution, managing people and performance management.

Here are some examples of successful partnership working to support a positive workplace cultures and tackle bullying:

Hull and East Yorkshire Hospitals developed a project and are doing ongoing work in partnership, to tackle bullying and harassment in their trust.

Often staff don’t feel comfortable or able to challenge poor behaviour. Somerset Partnership NHS Foundation Trust’s See Something, Say Something campaign sought to address this by giving staff the tools and language to empower them to challenge poor behaviour and to tackle low level concerns.

West Suffolk NHS Foundation Trust gave staff the freedom to speak up about behaviour or safety issues with a key element being positive framing for conversations. This led to the percentage of staff at the trust reporting most recent experience of harassment, bullying or abuse increasing from 25 per cent in 2015 to 51 per cent in 2016.  

HR policies and the use of these policies can sometimes have a negative impact on staff and their morale and in some cases leave them feeling like they are being bullied. Norfolk and Norwich University Hospitals NHS Foundation Trust, in partnership, developed a new attendance policy and encouraged a more flexible approach to its use – so all staff are treated as individuals. This has led to fewer staff going off sick and fewer staff being sanctioned for being off sick a number of times.

Unwieldy and lengthy disciplinary processes can result in staff feeling bullied or stressed and often going off sick during the process. Management and trade unions at University Hospital Birmingham NHS Foundation Trust worked in partnership to develop a fast track disciplinary process which led to fewer cases going to formal hearings. Staff and managers alike at the trust view the process much more positively as it is quicker and less stressful for all parties.

The experience of working in the NHS can be less positive for staff from a black and minority ethnic background. The Cultural Ambassadors Project led by Birmingham and Solihull Mental Health NHS Foundation Trust & Royal College of Nursing aimed to address this through tackling the disproportionate rates of disciplinary action among BME staff.

If management do not have the skills or confidence to carry out employee relations cases effectively, then this is likely to have a detrimental impact on how it feels to work in an organisation. At Guy's and St Thomas' NHS Foundation Trust, HR, learning & development and trade unions designed a bespoke and targeted programme of development for managers to give them with tools and techniques to manage workforce relations cases much more effectively. This became known as the Passport to Management programme.

You can find these and more examples of shared learning on our case studies web page.

The SPF creating positive cultures summit brought together NHS employers, ALB's and trade unions to reflect on the first year of the call to action, and set priorities for the year ahead. For further information, please see the summit notes

Mandy Williams, Inspection Manager, CQC, discussed the tackling bullying call to action and how it can link to the well-led domain. The CQC slides can be downloaded here.

Regions and trusts were each asked to complete a poster to share their tackling bullying projects and initiatives. The posters were displayed at the summit, and show the excellent progress being made to create positive workplace cultures within the NHS. Download our template and share your tackling bullying projects by emailing

Following the summit, SPF colleagues attended a follow up meeting to further discuss the year two priorities. The slides from this meeting can be found here