A Crisis of Trust as Bullying Threatens the Government’s Transformation of the NHS

Introduction

The Labour Government’s vision of a trusted, resilient NHS is at risk unless it tackles the deeply rooted culture of bullying. The cost of inaction is staggering: bullying in the NHS is projected to drain GBP 109.3 billion over the next decade. These losses grow daily through lower productivity, increased turnover, reliance on costly agency employees, and constant backlogs requiring expensive overtime. Although some backlogs are slowly decreasing, many cases still endure long delays, becoming more complex and costly to treat, which puts patients at greater risk and prolongs their suffering. Complaints, litigation, and missed opportunities further strain resources. Ultimately, this results in diminished returns on critical investments meant to strengthen and transform the NHS. Without urgent reform to address bullying, this cycle will continue to consume funds essential for the government’s broader commitments, ultimately threatening the quality-of-care NHS employees provide to millions.

Persistent Problem: Bullying Data Analysis

Despite concerted efforts to curb bullying, the problem persists across NHS England. The latest data highlights how entrenched this issue remains: in 2017, 13% of employees reported bullying by managers, 18% by co-workers, and 28% by patients or relatives. By 2023, these figures had only marginally decreased to 9.94% for bullying by managers, 17.66% by colleagues, and 25.15% by patients, service users, their relatives, or other members of the public. However, while these percentages indicate slight declines, the actual prevalence of bullying may be higher. With 48.20% of affected employees choosing not to report incidents, the problem could be significantly underrepresented, as unreported cases remain hidden from official data.

This underreporting is a critical factor, suggesting that despite recorded reductions, bullying may have actually increased in real terms. Nearly half of those experiencing harassment or bullying do not report it, often due to fears of retaliation, disbelief in the reporting process, or concerns that raising the issue will have no meaningful outcome. This reluctance to report further underscores a pervasive lack of trust in the NHS’s ability to handle bullying effectively and highlights how deeply embedded cultural issues continue to undermine both morale and safety.

The persistence of bullying across all levels, coupled with the high rate of underreporting, suggests that the NHS has yet to address the foundational cultural issues that allow such behaviours to endure. Without tackling these deep-rooted problems, efforts to improve the NHS’s workplace culture will fall short, allowing distrust and disengagement to persist.

Structural Failures in Addressing Bullying: Outdated Policies and Procedures

It is clear from the bullying data analysis that the NHS’s over-reliance on documented policies and procedures as the primary tool for risk identification and resolution has proven ineffective. While these documents may aim to provide rule-based guidance, they fall short of offering actionable solutions where they are most needed. The structures essential for responsive and effective decision-making are often weak, or even missing, leaving employees without a reliable framework to navigate complex situations. In today’s NHS, relying on these static, analogue documents is no longer a viable approach for fostering a supportive and accountable environment.

The nature of word documents is that they are a poor medium for being rigorously tested for usability and real-world impact. Complex, jargon-filled documents are handed down to employees who are left to navigate them without clarity or confidence. Rather than offering a clear pathway for addressing bullying, these documents contribute to a culture of confusion and inaction, further eroding trust and limiting effective responses.

Moreover, these policies are typically signed off by senior leaders and auditors who appear more focused on maintaining bureaucratic compliance than fostering genuine cultural change. This top-down endorsement solidifies a reactive, compliance-driven culture, where bullying is handled as an administrative checkbox rather than as a serious organisational risk. The analogue nature of these systems delays the identification and resolution of issues, allowing bullying to persist longer than necessary and worsening its impact across the organisation. Without a digital approach, the NHS loses the speed and precision required to identify, address, and prevent bullying effectively.

The cost of inaction is staggering: bullying in the NHS is projected to drain GBP 109.3 billion over the next decade if left unaddressed. To genuinely address bullying, the NHS needs a paradigm shift away from an over-reliance on word documents for policy and procedural rules. This is a shift from analogue to digital for bullying risk identification.

The evidence is clear: without this shift, the NHS will remain trapped in a cycle of ineffective policies, wasting critical resources and allowing a damaging culture of bullying to persist unchecked. It is time for the NHS to act decisively, embrace a digital solution, and prevent further harm to its workforce, its mission, and the quality of care it provides to millions.

The Challenge of Hierarchy and Silos: How Bullying Suppresses Positive Change

A deeper challenge within the NHS’s organisational culture lies in its rigid hierarchies and entrenched silos. These structures not only allow bullying to persist but amplify its impact, especially when it originates from those in managerial positions. The latest data indicates that 9.94% of NHS employees report bullying by managers, but this figure may be substantially higher due to the 48.20% of incidents that go unreported. Bullying by managers is particularly damaging because of the authority they wield, creating a ripple effect that extends far beyond individual cases and permeates entire teams and departments. This power dynamic amplifies the impact of managerial bullying, normalising intimidation, enforcing silence, and punishing dissent across the organisation. Such behaviour is not just an individual problem, it is a cultural issue embedded within the NHS’s hierarchical structure, reinforcing an environment where employees feel unsafe to speak out.

In such a hierarchical setting, speaking out is fraught with risk. For many employees, becoming a whistleblower is a last resort, as it can easily end a career. Whistleblowers who challenge unsafe practices or expose misconduct often find themselves ostracised, facing not only resistance but active retaliation from those in authority. This treatment discourages others from reporting issues or suggesting improvements, as the consequences of whistleblowing can be severe. The threat of career-ending repercussions for speaking up creates a chilling effect, where employees feel compelled to remain silent rather than risk their livelihoods.

The Way Forward: Behavioural Science to Measure Social Risks

Imagine a vision for the NHS where employees at every level feel empowered to speak up about issues without fear of retaliation, and where addressing social risks is seamlessly embedded into the organisation’s culture. This vision is now within reach, powered by a Behavioural Science approach and cutting-edge technology that enables the NHS to measure and manage bullying risks with precision and transparency.

In this transformed NHS, an employee notices a troubling pattern of bullying. Rather than feeling unsupported, they turn to an independent AI Expert, which actively guides them through a clear, consistent, step-by-step narrative to identify the risks. This guidance is precise and built on the latest knowledge, ensuring that every detail is accurate. For each identified bullying risk, the AI Expert prompts the employee to provide specific types of supportive evidence, helping to create a robust, credible record.

Every response is recorded in real-time, and each identified risk condition is automatically classified, building an organised record of risks, insights, and specific behaviours that require attention. As employees interact with the AI Expert, they know their input is safeguarded, auditable, and free from bureaucratic delays. At the end of the process, the AI Expert offers the option to participate confidentially in an independent remediation service designed to create a safety net for everyone involved, ultimately fostering a safer environment for all.

The automated, anonymised classification of bullying risks generates ground-breaking data for measurement and benchmarking, building a reliable dataset over time that enables the creation of Key Risk Indicators and heat maps. These reports go directly to the Board, ensuring that every incident is taken seriously and acted upon.

The Hawthorne effect, where the awareness of monitoring encourages positive behaviour, fosters a culture of respect and accountability. Every entry, report, and follow-up action become part of a secure, transparent audit trail, aligning with the highest standards of policy compliance and regulations.

Over time, as data accumulates, a powerful transformation unfolds. Patterns and trends that once went unnoticed become clear, equipping NHS leadership with invaluable insights. These insights aren’t just numbers on a spreadsheet; they provide a real-time pulse on the organisation’s health, revealing where support is needed and where preventative action can make a difference before issues escalate. The system’s reports highlight risk areas and pinpoint emerging issues, enabling the NHS to take pre-emptive steps toward a safer, more resilient workplace.

This new approach, grounded in Behavioural Science, shifts the NHS from a reactive stance to a proactive, preventative strategy. By embracing this approach, the NHS sets a new standard for cultural resilience, building a safer, more transparent, and truly supportive workplace where every voice is valued and every concern addressed.

The Challenge of Speed and Scale

The NHS’s vast scale and complex structure present formidable obstacles to achieving meaningful cultural transformation. With a workforce of 1.4 million full-time equivalents, attempts by dedicated individuals to combat bullying are quickly overshadowed by an entrenched reliance on static, policy-based solutions that lack agility. The NHS’s size, compounded by its deeply siloed organisational structure, severely limits the reach and effectiveness of isolated, piecemeal anti-bullying measures, which struggle to penetrate departments and hierarchies meaningfully.

To truly address bullying, the NHS must rapidly transition from an over-reliance on word documents for policy and procedural guidance to a more cohesive, digital approach that enables swift, unified action across all levels. Change of this magnitude demands a level of speed and scale rarely seen in organisations of this size, yet it is essential. The NHS must mobilise a coordinated, system-wide response within a 12-month timeframe to dismantle the structural and cultural barriers that allow bullying to flourish. Without immediate, unified action, the Labour Government’s transformational agenda risks stalling within its first term.

The urgency of this challenge cannot be overstated. If left unaddressed, the current culture of bullying and silence will continue to erode employees’ morale, trust, and the overall effectiveness of the healthcare system. The vision of a reformed, resilient NHS will remain out of reach, jeopardising the Labour Government’s commitment to delivering a healthcare system rooted in safety, support, and respect for all employees.