Promoting partnership working in the NHS

Creating positive workplace cultures and tackling bullying in the NHS - a collective call to action

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

A quarter of staff responding to the 2017 NHS Staff Survey report they have been bullied, harassed or abused by a colleague in the last 12 months. Bullying can have serious consequences for affected individuals and those they work with, causing psychological stress, reducing productivity and risking poorer patient care.

The SPF’s collective call to action tasks employers and trade unions in all NHS organisations to work in partnership to create positive workplace cultures and tackle bullying. 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.

Latest news

Sir Ron Kerr, former Guy’s and St Thomas’ NHS Foundation Trust chief executive, led a review which explored the expectations on NHS executive leaders at an organisational and system level and the support available to them. This links with the SPF’s call to action on tackling bullying, as the review seeks to address system level behaviour, which could be perceived as bullying. System level behaviour can also have a detrimental impact on workplace cultures in NHS organisations, increasing the likelihood of bullying.

The review identified, strong evidence of a culture of negative behaviours, which often stemmed from the different relative priorities and pressures between regulators and organisations. The behaviours described fall below the standards of what is expected in a professional setting. The review makes recommendations to deal with negative behaviours including the development of a behavioural compact, co-designed with NHS leaders and led by the chief people officer, which sets out expected behaviour, guidance on handling negative behaviours and the escalation process.

For more information see: Empowering NHS leaders to Lead, published 28 November 2018.

The national ambulance service partnership forum has endorsed a new report Tackling bullying in ambulance trusts: a guide for action. The guide was produced in partnership with ambulance trusts but, includes information that can be used by all health sectors. One of the suggestions in the guide is for managers and trade union representatives is to consider if there is a consistent understanding of what a positive workplace culture looks like, and what constitutes unacceptable behaviour. The guide also provides case studies that help address negative workplace cultures and bullying.

On 31 October 2018, the British medical Association (BMA) published a report called Bullying and harassment: how to address it and create a supportive and inclusive culture. The report revealed the findings of a survey which showed two in five of the nearly 8,000 BMA members who responded, believed bullying and harassment are problems in their workplace.

To tackle bullying and harassment and create a healthier workplace cultures, the report makes recommendations for action at three levels: individual, organisational and system.  

For more information and to read the report, see the BMA website.

SPF webinars 2018/19

As part of the ongoing programme of work, the SPF has hosted two webinars in 2018. The first in June 2018 looked at the role of line management in tackling bullying. The second was held in September 2018 and covered raising awareness of the impact of bullying on patient experience.

The final webinar will be held on 29 January 2019 at 10:30am to 12pm and will focus on connecting the work going on across the NHS on supporting healthy workplace cultures. 

To book onto the webinar please email 

Partner events

Royal College of Surgeons of Edinburgh (RCSEd), hosted a national anti-bullying symposium on 24 September 2018. For more information see the RCSEd website.

The BMA hosted a bullying and harassment: how to address it and create a supportive and inclusive culture event on 1 November 2018. For more information, see the BMA website.

We have created a library of useful tools and resources, to help 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.  

The Health, Safety and Wellbeing Partnership Group has published an infographic which shows the impact of bullying.  

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

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.  

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.

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. 

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

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. 

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.

Christina McAnea, the then head of health at UNISON spoke in a podcast on how partnership working between employers and trade unions can support better workplace culture.

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 a positive workplace culture and tackle bullying:

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.

SPF is supporting partnership action:

  • by system leaders led by DHSC and NHS Improvement
  • by organisations supported by NHS Employers and CQC
  • by individuals and teams supported by unions working with their members.

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.  

The WIG will continue to raise awareness of the call to action and also focus on three broad areas to progress work

  • Evidencing the link between workplace culture and patient care.
  • Connecting the work being undertaken across the system on workplace culture. 
  • Identifying and promoting best practice, in particular linked to supporting line management.


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.