Colchester NHS Foundation Trust has been in the news this week for all the wrong reasons. Junior administrative staff have been told to fiddle cancer patient data by their managers. Patients may have suffered, may have died. We do not know. The administrative staff alleged that they had been bullied into this malpractice and some of them had blown the whistle up to the CEO who had ignored them. CQC has passed this information on to Essex Police. Good. Few things concentrate the mind as much as the appearance of a policeman.
The narrative of NHS culture that has been emerging since the Francis Inquiry is one in which many healthcare professionals are afraid to raise concerns about patient care. When they do they are ignored even by senior management and bullied into toeing the line. In the past this might have progressed through suspension, disciplinary procedures and on to dismissal. Thank God we now have a regulator and a Whistleblower-in-Chief willing to listen to and protect the Colchester whistleblowers. And to make sure their intelligence is acted on to protect patients. That is all whistleblowers want.
In 2009 after 7 years as head of the paediatric department at Walsall Healthcare NHS Trust I encountered a situation where managerial bullying was rife. My book “Little Stories of Life and Death @NHSWhistleblowr” will be published in the New Year. I am pre-releasing chapter 25 on my blog. It is a timely reminder that culture is driven from the top of organisations and in closed cultures senior managers are unlikely to welcome attempts to address problems.
A Royal College of Paediatrics review of the paediatric department in Walsall in 2010 concluded that inappropriate appointments had been made by the executive to lead the department. The managers concerned were described as having no knowledge or experience in paediatrics, exhibiting an aggressive management style (a posh way of saying bullying?) and failing to engage with senior frontline clinical staff. This was at a time when swingeing cuts to the cost base were being made to pay the mortgage on the new PFI and prepare us for FT application. Bullying became a part of the daily routine as a consequence of these appointments.
Chapter 25 is my account of this. I do of course have all the willing witnesses I need, and the minutes and emails, to verify this account.
Bullies: Challenging the Culture.
“I was never a bully. I was a hard man.”
Roger Daltrey of The Who.
Years ago our youngest son came home with a badly broken nose. He’d come between a bully and his victim on the school bus and suffered the painful consequences. I was proud of him. He had been true to our family’s zero tolerance of bullying. I have always challenged bullying myself and more than once suffered physical injury. When it erupted in the paediatric department in 2008 onwards I found myself on a collision course with the bullies and those who sheltered them. Bullying is a difficult problem to grapple with. Bullies often do not recognise themselves for what they are. And they never admit to it. There is no badge that I have seen anyone wearing that proclaims, “A Bully and Proud of it”.
On 26 October 2009 I had written my comprehensive disclosure of the department’s problems to Sue James, our Chief Executive. In it I stated that “over a period of about 18 months a culture of institutionalised bullying has developed in the paediatric department.” I went on, “Although some of this may have escaped your attention I will present evidence that you have to some extent been aware of this and for reasons which are hard to understand have chosen to ignore it. I believe that in certain instances, which I will also refer to, your actions have compounded and even given sustenance to this culture.” Naively, I still believed that evidence was the solution to the problems we were facing. I gave many examples of this culture. Here is one from the same letter:
“Take for example one of our nursing staff who the Divisional Director rang at home. This nurse’s husband overheard the Divisional Director speaking to his wife as the phone was on loudspeaker. The Divisional Director’s conversation was so aggressive and peppered with expletives (effing and blinding as it was reported to me) that her husband told her he was going to the HR Department the following day to report this manager. The nurse begged her husband not to go as it was likely to cause her more grief. I am afraid this is how institutionalised bullying works. The bullied come to tolerate that kind of behaviour. They try to keep their heads down. When they are bullied they fail to take any action because they believe that it can only produce more difficulties for themselves in their work environment.”
On Bonfire Night I met with the Trust Chairman, Ben Reid and the BMA. He agreed to an independent hearing of my grievance and a departmental review by the Royal College of Paediatrics. I experienced an immediate surge of relief. I wrote to Bruce George the Labour MP for Walsall South who had agreed to meet me and cancelled. I had total confidence that the College would send its team in and the impasse would be resolved.
But within days of that meeting there was an outcry from senior nurses in the department over bullying. The head nurse, Karen Palmer, was singled out as the main culprit. I therefore arranged for the senior paediatric nurses supported by the paediatric consultants to meet Sue James, and the Nursing Director. It was obvious that it might take six months for the College to complete the review and for its report to be implemented. That was too long for nurses who were in tears every day to wait. Sue James was clearly fed up with me and did not want me to attend. I withdrew in order to let the nurses speak from themselves. But they lacked the confidence to go to the meeting without me being there to support them. I informed Sue James that as a result I would be attending. “I regret that you have gone back on your word…” she emailed me. I was by this time immune to these barbs, designed to make me feel bad about myself. I regarded them as another manifestation of the bullying culture I had complained of.
We met on Friday 20 November. Sue James and Brigid Stacey, the Director of Nursing, were faced with the two paediatric matrons who had suffered the brunt of the bullying and six consultants. Sue James had made no provision for the meeting to be minuted. I asked for this to be done. She told us she did not want minutes taken. I took extensive notes anyway and circulated them as minutes afterwards. I was an obsessional recorder of meetings and that has served me well.
The matrons were invited to describe their experiences of bullying. These included being shouted at and sworn at. They reported physical threat. They had been sent emails by the head nurse in which they were told to either toe the line or their jobs would be under threat. They were also told in the same emails to be grateful that they had a job. They complained of being ignored by management (that is a form of bullying recognised in trust policy). The head nurse had changed the ward nursing rotas without them, the matrons, being consulted. The head nurse had made derogatory comments about them at a meeting with human resources. They also raised the problem of how impending redundancies were dealt with in the department by the head nurse in 2008. Individual nurses had not been told of their possible impending redundancy. The whole establishment had been informed by what was essentially a circular. Management had made no attempt to mitigate the consequent widespread anxiety. This was not an exhaustive list of allegations. Bullying is often trivialized, passed off as “robust conversation” etc. In this case the level of distress it was causing was near intolerable.
The Chief Executive and Nursing Director did not engage with us. Disinterest was written on their faces although from time to time they gave each other an anxious look when a particularly horrible experience was being described. They promised to meet with the managers concerned and scheduled a meeting with us to feed back. This was later postponed.
I missed the second, rescheduled, meeting through illness. Ironically the meeting was minuted by our safeguarding nurse who had recently resigned after being sworn at by the Divisional Director. It was clear at this second meeting that no formal investigation had been carried out, nor would it be. No action was to be taken against the managers, not even a warning. Sue James mused as to why it was that others who worked under the same managers were not experiencing the problems we were. Of course, why hadn’t we thought of this? It must be our fault! This is the remorseless faulty logic that I encountered every time I tried to address a serious problem in the department. What was I doing wrong? What were we doing wrong? Senior and middle management were always in the clear and always tried to reflect the blame onto the clinicians. This culture of managerial cronyism was deeply frustrating to all of us on the front line. It was absolutely unassailable. The dice was loaded.
Sue James told the clinicians that the paediatric department was thought to be a “basket case” and that the PCT and Walsall Council had lost faith in it. She went to some lengths to create further insecurity by saying that a number of paediatric units would be closing. We’d heard this repeatedly and would hear it again. The nurses had already heard the head nurse telling them to toe the line or lose their jobs. The matrons were then warned by Sue James not to register formal grievances against management. She later told the employment tribunal that she had done this “in the interest of the paediatric service.”
This was a disappointing outcome. The nursing staff in particular had put their necks on the line. The Trust had a Harassment and Bullying policy. It stated quite clearly that:
“The Chief Executive will take lead responsibility for ensuring the Policy is correctly implemented and that the trust takes effective action to tackle harassment/bullying in the workplace.”
But here we were, 8 of the most senior clinical staff in the paediatric department, with allegations of bullying so serious that we had gone to the Chief Executive herself and she had blatantly disregarded the policy she was responsible for.
The Policy also gives a clear instruction:
“Where it is clear there is a pattern of unacceptable behaviour within a particular area, a full investigation will be carried out.”
But what could possibly be clearer than the allegations made by the clinicians. Again the Chief Executive was able, with impunity, to breach the policy for which she had executive responsibility.
In my experience such policies are a waste of paper. Most employees are insufficiently familiar with them to make use of them. HR departments are often well acquainted with them but disregard them. I imagine that it was unusual if not unique for Sue James to be on the sharp end of one of her policies as she had been at these two meetings. Later, under cross examination at my employment tribunal she demonstrated her flimsy knowledge of her own policies. But these policies contain some useful and often wise words. The Trust policy at that time had a section describing the damaging effects on individuals and organizations when bullying is tolerated.
“Employees are unable to work effectively. Team work is damaged. Absenteeism due to stress increases. Motivation and morale are damaged. Staff lose confidence in the organization. Staff leave.”
But here was Mrs. James actively tolerating managerial bullying reported en masse.
We all knew the nurses were being badly bullied. At the employment tribunal 4 senior witnesses (3 were consultants) named the head nurse, Karen Palmer, as a serial bully giving graphic descriptions of the support they had had to give to nursing staff as a result. The hospitals head of HR, Sue Wakeman, was present throughout that testimony but sat unmoved. Those within the managerial clique typically enjoy a startling level of immunity so no-one should have expected anything else.
At the second meeting David Cremenosini, a new consultant and the husband of Louise, the safeguarding nurse, expressed incredulity at Sue James’s refusal to take any action. His comments were disregarded. He resigned shortly afterwards. The Royal College of Paediatrics review which reported 4 months later instructed the Trust to remove Karen Palmer from line management in paediatrics. The report described her “aggressive managerial style”. On the evidence presented to Sue James this should have been done when the bullying was first drawn to her attention. Her failure to act resulted in months of unnecessary suffering in a group of golden hearted nurses who wanted nothing other than a protected environment in which they could do their work.
Following the meeting there was an atmosphere of doom and despair. Sir Ian Kennedy QC had given his last interview as Head of the Health Care Commission to the Health Service Journal in April that year. He chose to speak on bullying. It was, he said, the most important problem facing the NHS. Four years later Robert Francis QC was telling us the same. NHS staff surveys regularly show a high level of bullying, much higher than in other organisations. Of course no trust ever admits to this problem. Few that I have heard of deal with it decisively. In some trusts bullying is a management tool. In our own department it was sapping energy and destroying morale but the Chief Executive whose responsibility it was to enforce the Bullying Policy could not have cared less. That was the only conclusion we clinicians could reach.
I suppressed my inclination to react immediately but after 2 weeks wrote to the Chairman and a non-executive director. I described the content of both meetings and the unsatisfactory outcome. I tried to get to the heart at the problem and wrote. “Sue James, on both occasions, has told these nurses effectively not to cause any more trouble. She advised them at the second meeting against any more complaints and against lodging a formal grievance as this was likely to cause more problems and would hazard the unit’s future and jeopardise their jobs. She also used me as an example of how unpleasant lodging a formal grievance could get. I am afraid that this approach is tantamount to intimidation of our senior nursing staff.”
His reply was unhelpful. I complained about too many things, he wrote. That spoke eloquently of the organisation and its culture which had its fountainhead in its Chair and Chief Executive.
The postscript is that the two matrons who made those complaints were later replaced by an outside appointment. They were both excellent paediatric nurses and with the right personal development plans would have risen through their profession. They both left hospital paediatric nursing soon afterwards. The limited opportunities provided and the stress of workplace bullying took their toll. Two of the consultants present at the meetings would soon resign and leave. As for me the bullet with my name on it was already being loaded into the breech.