Cultural issues related to allegations of bullying and harassment in NHS Highland: independent review report

Appendix 2: Excerpts from the Gallanders' Report

A2.1 I refer to this appendix in chapter 12 at paragraph 12.33. It contains much which is useful and, I think, consistent with the contents of this report.

A2.2 The report noted that "The NHS Highland Preventing and Dealing with Bullying and Harassment Policy is based on an NHS Scotland PIN policy" and went on:

"53. The policy is very comprehensive and written in the formal style which is fairly conventional in employment policy documents of this type.

54. The policy is in line with the ACAS Guide on Bullying and Harassment and contains the components of good practice which would be expected, such as;

• Definitions and examples of bullying and harassment
• An informal stage aimed at early resolution of issues
• Access to confidential advice and other support such as mediation through HR contacts Formal investigation stage
• Right for review of outcome by the complainant
• Potential for management referral of employee or alleged bully / harasser to Occupational Health for support / counselling."

56. It has been acknowledged to me anecdotally that the policy approach is something of an unattractive and blunt instrument in addressing very sensitive, nuanced issues affecting people who may be feeling demotivated, vulnerable or isolated. Larger organisations in particular face this type of difficulty.

57. It is a commonly expressed view that once an issue of alleged bullying and harassment is positioned within a formal process of investigation, the already damaged relationship is extremely difficult to recover.

58. A formal policy is desirable to manage cases of potential misconduct and formal action may be required and the policy is fit for purpose in this respect. There appears scope however making it more accessible, particularly in simplifying language, presentation and volume.

59.In addition, it would be useful to explore the use of face to face interventions and confidential access to an independent trusted professional resource such as self-referred counselling support and mediation. This may help offer an alternative to recourse to the formal policy.

Consideration of Next Steps:

61. Today's workforces will no longer tolerate, to the same extent as their predecessors, bad behaviour which may stop short of what would be traditionally categorised as bullying. Substantial research evidence is emerging on incivility, which manifests as low level negative behaviours such as rudeness, disregard for others, or treating others with disrespect. These behaviours are seen as contributing to the creation of cultures that tacitly accept bullying and, as such, need to be addressed. This may be partly behind the growing perception of the existence of bullying behaviour across organisations.

62. Traditional approaches based on policy documents, prescribed procedures and the injection of support for employees within the procedural framework are not working in the way that was envisaged when they were established. This is recognised by ACAS who were the authors of the best practice guide on Bullying and Harassment at Work upon which most workplace bullying policies are based.

63. Solutions are increasingly being seen as workplace climate or culture focused with a greater emphasis on issues such as people management skills and emotional intelligence in managers. This is referenced in the ACAS Policy Discussion Paper – "Seeking better solutions: tackling bullying and ill-treatment in Britain's workplaces".

64. Particular challenges exist in workplaces, such as the NHS specifically and public sector more widely, where there are pressures relating to customer / patient expectations, demographic pressures and finite resources. The recent BMA Survey, "Caring, Supportive, Collaborative", demonstrated significant concerns among doctors regarding, amongst other things, inadequate resources, fear of making errors, workload pressures, and problems with bullying, harassment and undermining.

65. …

66. In terms of good practice elsewhere, there are also examples which can be learned from.

67. London Ambulance Service (LAS) was placed in special measures in 2015 and concerns were raised about bullying and harassment. A number of measures were taken to address the problem including the nomination of a non-Executive Director sponsor, the appointment of a bullying and harassment specialist who provided training and workshops and engaged teams in dialogue around tackling bullying and culture. There have been tangible improvements in the number of staff recommending LAS as a place to work as well as sickness and turnover statistics.

68. Arising from the Mid Staffs Scandal public enquiry, "Freedom To Speak Up" originated in NHS England as a means by which concerns regarding patient safety could be raised and escalated. Bullying and harassment is one dimension of this. FTSU "Guardians" have been appointed in a number of NHS providers as a safe point of contact for concerns to be raised. Appointees have generally been clinicians who carry out the role in addition to their day job. Networks of Guardians are now in place and they are well established as an important and trusted resource for staff.

69. A "Fair Treatment at Work" initiative was implemented by Fife Council which saw two Fair Treatment Advisers appointed on a full-time basis within the HR team at a time when grievance rates were high, bullying was emerging as an issue which the trade unions were increasingly highlighting and sickness absence was above the local government average. Their role was partly educational, involving visiting management teams, trade union meetings and staff groups and partly operational, entailing coordinating investigations and producing management reports. This was part of a wider employee care programme and was credited with improvements in performance in employee relations indicators.

70. The instances where organisations can claim some success in tackling bullying and harassment generally have issues of culture and employee engagement at their heart."