The Financial Cost to the NHS of Bullying: 5 Questions 

Siobhan Harris

October 24, 2018

Bullying and harassment in the NHS in England could be costing the organisation over £2 billion a year, according to new research.

The study published in Public Money & Management is the first comprehensive estimate of the financial costs of bullying and harassment in the NHS.

It used data from NHS Digital to gauge the impact of bullying upon sickness absence, employee turnover, productivity, sickness presenteeism, and employment relations.


Roger Kline

The study was undertaken by Professor Duncan Lewis of the University of Plymouth and Roger Kline, research fellow at Middlesex University, and NHS England's former Director, Workforce Race Equality Standard (Research and Engagement).

Medscape UK asked Roger Kline about the findings.


Medscape UK: How did you estimate the cost implications of bullying and harassment in the NHS in England?

Roger Kline: We conducted an extensive literature search to identify the main drivers of the financial cost of bullying in the NHS. We drew on the general literature and were specifically interested in any research specific to healthcare. From that we identified six costs we could have confidence of quantifying and some others that we could not.

The drivers we decided we could quantify with some confidence were the costs of sickness absenteeism, the costs of cover for absenteeism, the costs of turnover, the impact on productivity arising primarily from the productivity loss from employing new staff until they are at full speed, the impact of sickness presenteeism due to bullying and industrial relations and litigation costs.

Although our conclusion is an estimate we have some confidence it is not an over-estimate because we excluded some very considerable costs we could not quantify – the impact of incivility (less research on its impact and no NHS data), the impact on bystanders (similarly) even though we know both are very considerable indeed. Nor did we estimate the cost in management time of dealing with the everyday consequences of bullying, higher insurance premiums, costs of lawyers, any external investigations or any additional regulatory inspections.

Medscape UK: What types of bullying and harassment did you examine?

Roger Kline: There is no statutory definition of bullying so we started from the ACAS definition of bullying which is offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means that undermine, humiliate, denigrate or injure the recipient.

We recognise that the NHS staff survey does not use a definition when asking staff about bullying but staff answering the survey are likely to recognise the definition as it is in every trust bullying policy. We did not include incivility (rudeness) even though research now suggests its impact is huge.

Medscape UK: Is bullying and harassment in the NHS in England a particular problem?

Roger Kline: Data for the UK suggests that bullying is higher is certain occupation – notably public service roles such as health, social care and teaching.

The current levels of bullying report by NHS staff are very high (24%) and since that is an average, it is much higher in some organisations. It is a real problem for the NHS because it impacts directly and seriously not only on staff well-being but on organisational effectiveness and on patient care and safety. We now have a raft of research explaining how bullying in healthcare is likely to lead to poor care and safety and that is a cost we have not even started to estimate.

Medscape UK: How can the issue of bullying and harassment be better dealt with in the NHS?

Roger Kline: The first step is to acknowledge the problem. Too many organisations do not take the data seriously enough. It is a serious risk. Our paper’s prime aim is to flag up one aspect of the risk – the financial cost.

The second step is to understand that bullying needs to be addressed by changing the organisational climate which permits or encourages bullies, rather than just dealing with individual grievances as they arise.

The third is that leaders and managers have to model the behaviours they expect of others. There is no point in announcing a policy of zero tolerance of bullying if those who proclaim the policy shown signs of being bullies themselves.

The fourth is to create a climate where staff feel able to challenge and discuss bullying and have confidence that in doing so it is safe to speak out.

Finally, interventions have to be swift and will sometimes need to demonstrate that repeat bullying or the bullying of those who raise concerns is completely unacceptable and has disciplinary consequences. 

Medscape UK: As the NHS is so "cash-strapped" is there a financial as well as a moral obligation to tackle bullying and harassment?

Roger Kline: The financial pressures on the NHS make bullying more likely. Staff shortages and rising workloads are drivers of increased bullying as is the constant structural change.

Our paper is intended to take the discussions about bullying into new ground. It is not just morally wrong and damaging to patient care, it costs the NHS a very large amount of money – even without including a whole range of costs we did not include. This is an issue for finance directors not just for those leading frontline services.

Public Money & Management . The price of fear: estimating the financial cost of bullying and harassment to the NHS in England. Roger Kline & Duncan Lewis. Published online: 24 Oct 2018. Article.


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