Promoting partnership working in the NHS

Creating a culture of civility, compassion & respect - tackling negative behaviour, bullying & harassment

The SPF’s collective call to action tasks employers and trade unions in NHS organisations to work in partnership to create a culture of civility, compassion and respect where poor behaviour, bullying and harassment are less likely to arise and, if they do, they are tackled successfully.

To support this work, the SPF is publicising the views of NHS leaders and experts on this topic and signposting information, tools and resources and case studies which can help partnership initiatives.

There is still much to do to improve workplace cultures in the NHS. In the 2018 NHS Staff Survey, a quarter of staff responded that they had experienced bullying, harassment or abuse by other staff in the last 12 months. 

See our latest news web page to find out what's happening across the system to build positive workplace cultures.

This includes a toolkit to equip staff to deal with unprofessional behaviour; methods used by senior medical leaders to build or sustain positive cultures; a just and learning organisational culture resources from Mersey Care and the SPF call to action – progress report.

We have created a library of useful tools and resources, to help improve workplace cultures and tackle bullying in NHS.

What is bullying and harassment? 

The British Medical Association (BMA) website includes information on what is bullying and harassment.  

The BMA report Workplace bullying and harassment of doctors includes definitions of bullying and harassment. 

UNISON's website includes a definition of bullying and harassment. 

ACAS policy discussion paper on tackling bullying and ill treatment in Britain’s workplaces includes a description on what bullying and ill treatment looks like. 

What is impact of bullying and harassment in the workplace? 

The Royal College of Surgeons of Edinburgh has published information on how destructive behaviour can affect a team. This is part of their anti-bullying and undermining campaign #LetsRemoveIt

The price of fear: estimating the financial cost of bullying and harassment to the NHS in England. Article published in October 2018.

Civility saves lives aims to raise awareness of the power of civility in medicine. They show the impact of rudeness on the recipient, staff on-looking and patients and their relatives.

The BMA website and report Workplace bullying and harassment of doctors includes information on the impact of bullying and harassment on an individual and on organisations.  

ACAS policy discussion paper on tackling bullying and ill treatment in Britain’s workplaces includes the likely causes and impact of bullying on an individual and organisation.

Resources for employers

A free online resource, published in July 2019, produced by Mersey Care and available on their website can help build a just and learning organisational culture. 

NHS Improvement’s Kahootz platform contains resources and information related to addressing bullying and harassment. Users of the platform can network and engage through posting questions, comments or discussion points. An improving working lives: tackling bullying & harassment toolkit will be added to the platform. Trusts will be able to use this to diagnose issues, take action and evaluate the impact of those actions. To access the platform, please send a request to:

Tackling bullying in ambulance trusts: a guide for action, published in November 2018, contains information and good practice case studies, which can be used by all NHS organisations to help embed positive workplace cultures.

The BMA report Bullying and harassment: how to address it and create a supportive inclusive culture, published in October 2018, includes recommendations for taking action. These come under three headings: ending the silence, improving the resolution of problems and creating a more supportive and inclusive culture.

An earlier BMA report Workplace bullying and harassment of doctors includes the possible causes of bullying and harassment and evidence based policy recommendations for eliminating bullying and harassment.

BMA poster - Addressing bullying and harassment of doctors in the workplace and promoting dignity at work.

NHS Employers website includes case studies, good practice and tools and resources to help employers tackle bullying.

NHS Employers website also features useful information and tools to assist effective line managers, which supports a positive workplace culture.  

The Health, Safety and Wellbeing Partnership Group of the NHS Staff Council produced an infographic on bullying and harassment in the NHS and what an organisation and individuals can do about it.

NHS Improvement’s Creating a culture of compassionate and inclusive leadership provides practical support and resources to help NHS organisations improve their workplace culture. 

The Royal College of Surgeons of Edinburgh has published resources to help change the culture 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. This includes guidance for trusts and departments and teams.

An advice leaflet: bullying and harassment at work: a guide for managers and employers is available on the ACAS website.

ACAS also offers free online courses in bullying and harassment, conflict resolution, managing people and performance management.

Managing conflict at work, an ACAS booklet published in June 2014, gives an overview of how to manage the relationships in an organisation between individuals, teams and larger groups of employees. 

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. 

Mediation: an approach to resolving workplace issues, produced by ACAS and the CIPD and published in February 2013, is a guide to help employers decide if mediation could help improving working relationships in their organisation and the factors and processes to be considered in the implementation of mediation.

Stonewall has produced a practical resource for organisations called Bullying – preventing the bullying and harassment of gay employees

Resources for trade unions

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.

Resources for staff

The Royal College of Surgeons of Edinburgh has published information to help individuals who think they may be being bullied or be a bully.

The BMA website includes guidance for staff who feel they are being bullied and details how the BMA can support doctors who are being bullied or abused.

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

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives’ undermining toolkit includes information to deal with bullying at an individual level. 

An advice leaflet: bullying and harassment at work: a guide for employees is available on the ACAS website.

The TUC has published steps employees can take if they are being bullied and the support a trade union can provide. Their message to staff is: don’t suffer in silence


Here are some examples of successful partnership working to create positive workplace cultures:

The Christie NHS Foundation Trust went from negative to positive by developing an informal approach to addressing conflict and promoting positive working environments and relationships.

Mersey Care is creating a just and learning culture by asking what happened, instead of who is responsible, following errors. This is facilitating learning and improvement in patient and staff care and experience and improving staff morale through the reduction in formal HR interventions, such as disciplinaries.

North Staffordshire Combined Healthcare NHS Trust, UNISON North Staffs Community Health Branch and RCN North Staffordshire Branch worked to embed a culture of diversity and inclusion, by promoting awareness and accelerating positive change to improve the experience of staff, especially those in minority groups.

Hull and East Yorkshire Hospitals are working 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, 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 as a result of their sickness absence record. 

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.

Take a look at our case studies and more examples of shared learning.

The SPF creating positive cultures summit brought together NHS employers, Arms Length Bodies 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, Care Quality Commission (CQC), discussed the tackling bullying call to action and how it can link to the well-led domain. Download the CQC slides.

Organisations at the summit were 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

Some of the organisations at the summit have completed a follow up poster charting progress made over the year. These posters have been collated and provide useful information that can be used by others who want to replicate or learn from existing practice.

SPF colleagues attended a follow up meeting to further discuss the year two priorities. Take a look at the slides from this meeting.



The SPF's tackling bullying in the NHS: a collective call to action, was signed in December 2016 by Danny Mortimer, Chief Executive, NHS Employers and former Minister of State for Health, Philip Dunne, and Christina McAnea, former Head of Health at UNISON. 

The 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.

The SPF Workforce Issues Group (WIG) is leading the SPF’s work on the call to action drawing together evidence and front-line experiences to make a strong case for change.  

In 2018/19 the WIG led webinars on:

  • the role of line management in tackling bullying
  • raising awareness of the impact of bullying on patient experience 
  • connecting the work going on across the NHS to support positive workplace cultures.

For a summary of each of these webinar discussions and a copy of the presentations used, see the following web page.

In July 2019, the SPF published a progress report on Creating positive workplace cultures and tackling bullying in the NHS: a collective call to action, which included priorities for year three. These priorities include Creating a culture of civility compassion and respect in the NHS (the new name for the initiative) to have a wider focus, which includes tackling violence and sexual harassment against staff and encouraging action to support disabled, BME and LGBT staff, who tend to have a worse experience at work and suffer higher rates of bullying, harassment and abuse.


In 2019, partners agreed to extend the focus of the SPF's call to action to include tackling sexual harassment in the NHS.

Definition of sexual harassment

Sexual harassment is a legal term, defined in the Equality Act 2010 as unwanted conduct of a sexual nature, which has the purpose or effect of violating an individual’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual.

Sexual harassment in the NHS

There is limited information on the level of sexual harassment in the NHS. It’s Never OK: a report on sexual harassment against healthcare staff, published by UNISON in June 2019, found eight per cent of respondents said they had been sexually harassed in the last year. The report also gives information on the types of sexual harassment, the perpetrators and level of reporting and concludes by requesting employers and the government be more proactive in tackling sexual harassment.

In response to the survey results, Sara Gorton, SPF trade union chair said:

“These findings show why the SPF focus on creating safe and compassionate workplaces is so important to recruiting and retaining staff. Making sure staff are safe and treated with respect is a crucial part of partnership working and would urge local partnerships to look at the findings of the survey and consider how they can use the SPF's call to action to start a constructive and honest conversation about addressing sexual harassment in the workplace.”

Danny Mortimer, SPF employer chair, said:

“NHS organisations have clear policies in place to deal with reports of harassment or bullying. It is not always easy for concerns to be raised – especially when the perpetrators are in positions of authority or patients, but it is important staff report incidents. Most NHS organisations have specially trained staff in place to help colleagues raise concerns about such utterly abhorrent behaviour. Freedom to speak up guardians as well as Guardians of Safe Working, chaplaincy, trade union and HR staff are also on hand to offer support.”

Sexual harassment in the workplace

Lifting the lid on sexual harassment and power in the workplace, a conference paper produced by Dr Virginia Fisher and Dr Sue Kinsey, University of Plymouth for the CIPD Applied Research Conference 2018 identifies ways to prevent sexual harassment, including: 

  • organisations being clear on what is meant by sexual harassment
  • an organisation’s policy on sexual harassment should be easily accessible to current and potential employees
  • training should be used to help the policy be effective
  • managers should receive conflict management training with a focus on emotional skills – enabling them to effectively support victims
  • there needs to be anonymous reporting channels in an organisation and for management to take reported sexual harassment seriously and respond in a timely manner
  • organisational culture, especially where there is gender inequality between men in senior and women in less senior grades, can result in higher levels of sexual harassment. Where this is the case, employers should acknowledge and seek to address this imbalance.

To read the research paper in full, see the CIPD website.

Sexual harassment at work – free legal advice for women.

RIGHTS of WOMEN is a women's charity that provides free legal advice for women in the UK who are experiencing sexual harassment in the workplace. Have a look on their website for more information and advice on the support available. 

NHS leaders and experts on building positive workforce cultures

Henrietta Hughes, NHS national guardian, in an interview with Healthcare Manager highlighted a link between staff being able to speak up and an organisation's CQC rating. She says, in trusts rated outstanding, managers are far more likely to encourage staff to speak up than in trusts rated inadequate. 

In the interview, Henrietta mentioned the importance of freedom to speak up guardians working closely with managers and trade union representatives to identify issues within an organisation and escalate them, if required. Her call to leaders in the NHS was for them to be "genuinely interested in the views of all your staff, patients and carers. They're bringing gifts of information that will help you fix and improve your systems."   

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.  

Jim Mackey, former chief executive of NHS Improvement, spoke 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.