I’ve been sitting here since just after Christmas wondering if we all need an existential challenge occasionally in order to either confirm our current position, or refocus us in a new direction.
I say this because I have just had one myself, and as a result, relearned that things are sometimes not at all as they seem to be and that even people you have known for some years, can view a situation in a completely different way than you expected, based on what you know of them.
The thing that started all this off was a procedure adopted by the NHS HR department to help staff at work develop better team relationships and the lower grades to have a more equal relationship with their managers. Unfortunately, it seems to me that they hadn’t thought through all the possible unforeseen consequences of adopting it; or maybe they did and thought it was the right way to proceed?
I will tell the story and you can decide for yourself what position you would adopt in the circumstances.
The procedure that has been adopted is “the freedom to speak” protocol. The version that has been adopted by the NHS is freely available to read on the internet for anyone interested and all government departments are asked to adapt and implement the basic policy framework for use in their organisations.
This is not the same as the whistle blowing policy. There is a ‘freedom to speak officer’ who can be approached by any staff member about anything that is making them feel uncomfortable or worried at work. The basic idea is that the officer will listen confidentially to what they have to say and if they think it is important enough, will pass it up to the head of HR, or to the appropriate director to decide what to do next. The officer can also just give confidential advice or point the person in the direction they need to go to address the presented problem.
Sounds great doesn’t it? Unfortunately, in the NHS internal politics is ever ready to seize golden opportunities like this.
Over the last couple of months, I have heard from several trusts whose mental health teams have interpreted this as an ideal way of jumping over normal procedures and punishing their team leaders for asking them to do things they don’t want to. Bullying upwards seems to have become an organisational sport, and I shudder to think what will happen in the physical part of the NHS once the unions get the bit between their teeth. It will make strike action look positively benign.
But back to mental health. Staff who are seeking out the freedom to speak officer say it is because it is their belief that they cannot resolve differences with their leads, and they are too intimidated and afraid to complain openly and use the grievance procedure. They believe their leads disrespect them and do not accept their professionalism, resulting in their complaints being ignored. This causes them to feel acute anxiety at the thought of going to work and seriously affects their mental health.
A further result is that the team felt unable to function properly because of the attitude of the leads towards their complaints and what they believe is an acute disinterest in resolving the situation.
So what has been going on that has caused this catastrophic breakdown? Well, some examples that have been conveyed to me have been as follows:
People objecting to being asked to work on a Friday, because they need three days stead of two to recover from delivering therapy. They wish to work four long days instead of five, but this does not mean they are willing to see any more patients to make up for the extra rest day.
People objecting to working to the national standard, saying that it is detrimental to their mental health and work life balance.
When faced with discussing this to work something out, saying that it makes them feel disrespected as both a professional and a person because the team leader should respect the fact that they know what’s best for themselves.
People who have asked for reasonable adjustments at work after illness or accident assuming that the adjustments will be there for the rest of their working life without evaluation or revision. Of course some will, if the person is left with long term problems such as mobility issues; but one case cited was of a person who had client contact hours per week halved from twenty to ten, due to anxiety problems after the death of a family member. The complaint was that twelve months later, the team leader wanted to talk to them about beginning a phased return to normal hours. Up until then, they had been doing admin work for most of the time on therapist wages. Expensive agency staff had to be employed to cover the ten hours that were lost, and the accountants were complaining that the agency bill was too much.
Other complaints were from people who took a full-time post and then a week later wanted to work in term time only, to save on childcare. One new starter complained that asking them to work five days a week meant they could no longer join their mid-week dog walking group. which was vital for their mental health.
In giving these examples, the one thing all these people had in common was that in spite of accepting the job description and undertaking the training that went with it, they took the job, expecting a full week’s wage, but only on condition that they worked when and how they liked. When interviewed for the post, they all declared that they were able to work to the times and job description specified.
Now, things do change through no fault of their own for some people, but it is the duty of the team lead to support people back into their contracted role if possible, so that the service can reliably treat patients and maintain quality of service delivery.
The problem here is that people see any effort in this direction as cruel and unusual treatment.
To date, I know of two service leads who have been removed from their duties and given other roles, whilst “difficult challenges” are looked at from “a team perspective”. From what I’ve been told, this is solely because some of the team members have said they feel too uncomfortable engaging in this work if the lead is there. It is doubtful that either of the two leads will be able to return to their posts because of this, but no one seems particularly worried about it, or of the effect on their future careers.
To a man and woman, since Covid, no one wants to work in the office, or offer face to face therapy if they can avoid it. This not only comprises patient choice, but working solely online or via phone, could result in symptoms being missed and a potentially incorrect diagnosis made when assessing.
For instance, in schizophrenia, just before the onset of a psychotic episode, there are physical signs that all is not well, even if the patient is verbally presenting in a normal way. Clammy skin and a certain scent, which is hard to describe unless you’ve experienced it, plus sometimes a visual disturbance and often an inability to judge distance.
These cannot be picked up online and so therapists are asked to give at least one or two days to the office to do face to face assessments of new patients.
I hope that by going into this in some detail, people will understand that this protocol, although created for the benefit of ordinary staff team members, can also be very much abused if said staff don’t take responsibility for using it wisely.
The sense of entitlement, especially amongst the newly qualified staff and the rage if they are not allowed to do things their way, is set to become a real problem if the policy is not revised. In the past, leads and operational managers have bullied and intimidated staff, and that is definitely not acceptable. However, bullying upwards is also not acceptable, if for nothing else, that it will cause a breakdown in the functioning of the unit if everyone is allowed to do their own thing without question.
A lot of these appeals for freedom to speak support are accepted without much investigation to placate staff, because it is extremely difficult to fill posts in services after training is completed. A lot of staff have no problem working to the set standards during training, but when completed either ask for reduced hours, or leave immediately and either set up in private practice, or join an agency so they can work for agency pay rates in the service they have just resigned from! They hire themselves back to make up for those lost hours, with no penalties for leaving the service that paid for their training. They are entitled to do that of course under current rules, but unlike statutory units, there is no guarantee of standards of practice competence in either psychology or therapy when offered privately or through an agency.
The more they are given into, the more they feel entitled. It is a very adolescent attitude which threatens “if you don’t give me what you want, you’ll be sorry”.
At the other end of course, there are leads who seem to be able to get away with treating their staff like serfs and despite many investigations, always come up smelling of roses, so it often is a joint problem which needs all staff to come together to resolve.
However, no one in a team, no matter what their position should be working the system to a degree where service delivery is under threat.
And what about the service leaders who told me their tales of woe?
Well, they were quite smart. They have calculated all the adjustments that have been made to accommodate staff demands over the last financial year and the number of clinic hours that have had to be bought in to cover it. They are going to present this to the board of their trusts and say if you want to allow the freedom to speak protocol to continue to operate in the way it does, then this is what it will cost you in replacement agency staff to keep the unit operating.
If you don’t want to pay this, you will need to revise how you use the protocol, or the services will not meet their targets and waiting times will go through the roof.
But what about my existential threat? Well, I was discussing these problems with some colleagues the other week, some of whom I’ve known for quite a few years, assuming that they would see the problems that could arise in a similar way to me. Well, most of them didn’t.
They were on the side of the complainants no matter what they did because of what they called the “power imbalance”, which meant they believed the complainants really were entitled to their demands, no matter what the effect on the service.
My colleagues are by no means all rampant lefties, but to a man they had imbibed the victim perpetrator culture and applied it to this situation without hesitation. As the lower orders are always victims, especially if they aren’t white or straight, they should be allowed to do whatever makes them feel comfortable, so that they will stay in work and not go off sick or leave to join an agency.
I countered that when trusts hire the same people who left because they couldn’t stand the pressure, they have no problem working the hours they are asked to, because if they don’t they don’t get paid. I also said that this made me think that a lot of the demands such as those I mentioned were only made because they knew that higher management would take their side to keep them in the trust.
I further opined that in some circumstances, the freedom to speak protocol could be a career saver for staff in certain truly difficult situations, but that treating it as a way of circumventing normal procedures wasn’t helping anyone. All this fell on completely deaf ears, and they kept saying how sad they were for staff who felt so bad at the thought of coming to work. I did start to wonder if I was being unduly harsh at this point, but in reconsidering the examples I had been given, I thought not in those particular circumstances.
In the end, I was a bit shocked but shrugged my shoulders as they are entitled to their opinion. It never occurred to them that the situation might be a bit more subtle than victim/ perpetrator and there could be more than one hidden subtext which might need investigating, rather than just acceptance.
I had foolishly thought that although they might have a different focus than me, they would want to have a good old pros and cons discussion to make things better for everyone.
Apparently not!
Since then, I have had several people speak to me privately and say they agree with my perspective but would never say so in public. I was tempted to refer them to the freedom to speak officer, but I don’t think they would appreciate the irony.