The latest research into employee relations in the NHS has focused, again, on the problems with line managers.

The most common cause of workplace conflict was found to be ‘line managers’, because of some heavy-handed practices and lack of communication skills, according to A critical reappraisal of the effectiveness of employee relations in the NHS, commissioned by CMP and the HPMA. Almost half of the senior HR managers interviewed said ‘improving line manager capabilities’ was their number one priority for the coming year when it came to employee relations (up from 33% in 2022).

At the same time, the participants involved with the research — 211 responses and 33 in-depth interviews with HR leaders, senior staff and Trade Union reps — argued that the issues shouldn’t be oversimplified: line managers aren’t to blame in themselves. That’s too easy a conclusion, and misleading.

Relationships have further declined

The research, carried out by a team from iROWE (the Institute for Research into Organisations, Work and Employment) at the University of Central Lancashire (UCLan), suggests that relationships between staff in the NHS in general has declined markedly since the same survey was carried out in 2022. The major causes of conflict have remained the same: poor line management, personal disagreements and relationship issues, bullying, and issues of capability and performance. Meanwhile, the relationships between management and staff have seen a slight improvement.

Digging into the realities beyond the headline figures, the interviewees highlighted the importance of the wider organisational context and culture. Line managers, it was accepted, were the staff who suffered most from the ‘pressure cooker’ environment in the NHS. More than anyone else, their performance was scrutinised, they were under the most pressure in terms of balancing time spent on operational duties as well as people management. There were obvious limits when to the support being given to them, and the resources they had to work with — and ultimately there need to be realistic expectations from senior managers and HR.Another important consideration was found to be the way HR and line managers have been working together on employee relations: like a ‘tug of war’, with line managers trying to shift problem cases over to HR and vice-versa, at least looking for HR to tell them what to do.

A shift in focus is needed

So the actual conclusion was that while line managers were central to better employee relations in the NHS, and for ensuring a more positive ‘no-blame’ culture, change was dependent less on highlighting line manager performance and more on how they can be supported. Their role in people management needs to be recognised, appreciated and given the space and energy to grow and flourish. Specific and ongoing training and support from HR. As well as the autonomy to respond with informal approaches and solutions, putting the real people skills into practice.

More fundamentally, there has to be attention to job design and that critical balance between operational duties and managing people. This was still seen to be at the root of management issues in the NHS. Too many people were needing to climb up dual career ladders, both clinical and management. Clinicians were being promoted into operational roles in recognition of their technical abilities and then feeling stranded, finding that the support, relationships and collaboration over the people side wasn’t there.

Key recommendations in the report, then, are for the NHS to change its approach to succession planning, identifying more future managers on the basis of people skills; also, making sure there are regular opportunities for managers at all levels to refine their capabilities — ahead of  promotion as well as while they are in a post involving line management — and not promoting staff because they are ‘next in line’ or just because of technical competence.

In turn, a more strategic approach to selection and development, rooted in people skills, will lead to more confidence in dealing with employee relations, better role models and sharing of good practice. And that’s important for everyone, working anywhere in the system, because it’s the basis of good employee relations, where issues are picked up early and there can be win-win solutions, and a good work culture.

The report, A critical reappraisal of the effectiveness of employee relations in the NHS, can be found here.

Photos by Niklas Jeromin and James Henderson