Bullying in healthcare

Resources and guidance to help build a positive culture and a supportive environment.

1 January 2019

This guidance was produced by the NHS Staff Council's Health Safety and Wellbeing Partnership Group (HSWPG), through partnership working between unions, management and specialist advisors.


The group wishes to ensure this guidance is implemented with the same partnership approach. HSWG recognises that partnership working ensures best outcomes for patients and staff in protecting their health, safety and wellbeing.


Find further HSWG resources to support you in your organisation.   

The HSWPG recognises that bullying can have a detrimental effect on an individual’s overall health and wellbeing. The group aims to support NHS organisations to build a culture where employees can work in an environment that is free from fear of intimidating behaviour. 

What is workplace bullying?

Workplace bullying can take many forms. Acas defines bullying as: 'offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means that undermine, humiliate, denigrate or injure the recipient (Acas 2014).'

The bullying perpetrator can be a work colleague or peer, a manager or a subordinate. Bullying can lead to increases in individual stress levels. The Health and Safety Executive’s Management Standards on stress states that relationships can be a potential risk, increasing strain on an individual if not managed properly. 

Poor organisational cultures may lead to environments where bullying can thrive, especially where there is a focus on targets over patient outcomes and where staff concerns are not listened to. As we have seen with Mid Staffordshire and the subsequent Francis report, bullying cultures can impact negatively on patient outcomes, as well as having devastating effects on individuals concerned. 

The extent of the problem

Bullying has become an extensive problem within healthcare. Twenty per cent of all NHS staff report they have been bullied within the workplace and 29.9 per cent of all NHS staff indicated experience of psychological distress due to bullying behaviours. For further information on the impacts of bullying and harassment and what can be done by an organisation and an individual to tackle it, take a look at the bullying and harassment in the NHS infographic. 

The Health, Safety and Wellbeing Partnership Group’s (HSWPG) core principles:


  • HSWPG recognises the importance of managers and trade union representatives working in partnership on this agenda. This includes the development of a proactive approach, joint training, jointly agreed policies and early identification of problems. This approach can promote trust, a shared understanding and create a positive culture.

  • Every organisation should have a strong message on bullying - that is not tolerated in any shape or form and is regarded as gross misconduct within the conduct policy. Creating a working environment where all staff are treated with respect and everyone feels valued is key to the prevention of bullying behaviours. 

    It is important to have a policy that promotes dignity at work along with a learning and development programme to promote respectful relationships. Proactive initiatives such as values based recruitment, effective and timely appraisals, fair and transparent application of absence management or flexible working policies and raising concerns policies can also contribute to prevention. The prevention and management of work related stress is key to developing dignified working environments. 

  • The results of staff surveys show that workplace stress audits and data such as grievances, sickness absence, exit interviews, organisations, can identify problem areas or hot spots within organisations. The HSWPG stress guidance supports the need for prevention through early identification and effective stress management.

  • Bullying is defined largely by its impact rather than its intent. All reports of bullying must be taken seriously and be responded to promptly. Policies and procedures that facilitate informal resolution, joint working between managers and trade union representatives, mediation and early resolution of conflicts should be implemented, further details for this are found in the Acas guidance.

  • Being bullied or accused of bullying can have a devastating impact on individuals concerned, including their work colleagues/teams. The provision of counselling/employee assistance programmes along with dignity advocates or cultural ambassadors should be encouraged. Trade unions can provide support for individuals and there are organisations that provide contactable help and advice regarding bullying and harassment in the workplace such as UNISONRoyal College of NursingUniteRoyal College of Midwives and Society of Radiographers.