1. Ralph Fevre, School of Social Sciences, Cardiff University Duncan Lewis, Business School, Plymouth University

2. Our Research Robust, representative, replicable Details of sampling 552 employees in health and social work Details of questionnaire including the questions about ill-treatment (not bullying) Details of qualitative case studies NHS trust case study

3. Key Health and Social Work Characteristics The first key characteristic is simply that many employees in the sector are providing a public service (along with employees in public administration and education) Key characteristics two to four all concern things people said about the nature of their work in the survey, specifically whether they thought that, over the last year I now have less control over my work than I did The pace of work in my present job is too intense The nature of my work has changed The pace of work in my job has increased

4. The fifth key characteristic concerns the proportion of employees in the sector who had a a disability or long-term health problem. The last key characteristic concerns a battery of questions (the FARE Questions) which refer to employees’ values, specifically the answers to these question from our survey: Where I work, the needs of the organisation always come before the needs of people Where I work, you have to compromise your principles Where I work, people are treated as individuals We will come back to the battery of questions about values, but the next slide summarises the evidence on characteristics two to five.

6. Key Characteristic 6: the FARE Questions

9. UNREASONABLE MANAGEMENT 47% DENIGRATION & DISRESPECT 40% VIOLENCE 6% 33% 5% 1%

10. Unreasonable ManagementIncivility and disrespectViolence 1. Someone withholding information which affects your performance 9. Being humiliated or ridiculed in connection with your work 20. Actual physical violence at work 2. Pressure from someone else to do work below your level of competence 10. Gossip and rumours being spread about you or having allegations made against you 21. Injury in some way as a result of violence or aggression at work 3. Having your views and opinions ignored 11. Being insulted or having offensive remarks made about you 4. Someone continually checking up on your or your work when it is not necessary 12. Being treated in a disrespectful or rude way 5. Pressure from someone else not to claim something which by right you are entitled to 13. People excluding you from their group 6. Being given an unmanageable workload or impossible deadlines 14. Hints or signals from others that you should quit your job 7. Your employer not following proper procedures 15. Persistent criticism of your work or performance which is unfair 8. Being treated unfairly compared to others in your workplace 16. Teasing, mocking, sarcasm or jokes which go too far 17. Being shouted at or someone losing their temper with you 18. Intimidating behaviour from people at work 19. Feeling threatened in any way while at work

11. Risk Factors for 3 Kinds of Ill-treatment Risk factors for all three: Employees with impairments, including learning difficulties, or had a long-term health condition Employees for whom the pace of work was too intense Risk factors for unreasonable treatment and incivility and disrespect: Having less control over your work increased the risk of seven out of eight types of unreasonable treatment The biggest risk was working where you felt the needs of the organisation always came before the needs of people, you had to compromise your principles and people were not treated as individuals (the FARE questions)

12. Risk factors for unreasonable treatment alone Employees for whom nature of work had changed and/or the pace of their work had increased Risk factor for incivility and disrespect alone: Public sector employees at greater risk, particularly from humiliation, insults, rudeness, teasing, shouting, intimidation and threats Most of this is down to clients or the public Once you control for this, the only extra risk from working in the public sector is from humiliation Risk factor for violence alone: Not only are those who provide a public service more at risk of violence but health and social work even more at risk than public administration or education. Health and social work has greater risk of injury as well.

13. Health and Social Work at Risk All three types of ill-treatment were more common in health and social work (and in public administration and defence) Some but not all of this is due to clients and the general public. In the whole study Three-quarters of violent incidents down to clients and public Just over two-thirds of all incidents of unreasonable treatment were blamed on employers, managers or supervisors Employers, managers or supervisors were mainly responsible for incivility and disrespect (40%); clients/customers and the general public accounted for 27 per cent and co-workers for (22 per cent)

14. For a good example of the way in which some risk factors affect the behaviour of all three groups, lets take employees with disabilities Employees with ‘other’ disabilities or conditions, and those with psychological conditions, were 3 times as likely to say their employer had not followed proper procedures. Employees with impairments put at risk of unreasonable treatment because of the manner in which employers deal with sick leave, returning to work after sickness absence, the management of ongoing conditions and ‘reasonable adjustments’. Fair enough, but roughly half of the types of incivility and disrespect experienced by people with psychological problems or learning disabilities were of the type which were more likely to come from clients, customers or the general public. The other half were of the kind more likely to originate with co-workers

15. Or for another example of the impact of the risk factors lets take the FARE questions Equally important for explaining incivility and disrespect from managers and co-workers and clients or the general public. The FARE questions point to workplaces which have (a) been less able to protect employees from incivility and disrespect and (b) actually generated incivility and disrespect from clients, employees and managers. The important point to take from all of this is that the risks which Health and Social Work faces do not come from one direction at a time. Less control, super-intense work, compromised principles etc.,. lead to 360 degree challenges from ill-treatment coming from managers and co-workers and clients (or the public) and experienced by all three groups.

16. We did not survey the clients of the health and social work sector of course But others have produced data which show that ill- treatment between clients and employees is not all one way It is plausible that some or all of the risk factors we have identified in our analysis are associated with ill-treatment of clients and the general public by employees Less control, super-intense work, speed-up, change in the nature of work, compromised principles and failing to provide for disabled employees are all associated with troubled workplaces and it seems likely this means trouble for clients and not just employees.

17. Solutions and Responses No other sector has this combination of challenges but can our case studies help here? Drawing on our case studies outside Health and Social Work we will suggest some dos and don’ts for Less control Change Super intense work Increased pace Disability and health problems Compromising principles

18. Reduced Control Reducing employees’ control over their work devalues their past contribution and undermines their knowledge and expertise. If this devaluation and undermining is any part of the employer’s goal (for example, when asserting the right to manage) ill-treatment will follow. Less troubled workplaces give recognition to past contributions and make sure the reasons for reduced control are communicated and well understood. They explain how employees are being given new knowledge and skills.

19. Change in the nature of work Change for its own sake, or change which is an unintended consequence, is not seen as rational. It has to be a means to a considered and proportional end. This is not possible unless employees are convinced that those making the changes fully understand the existing situation (and employees’ investment in it). Less troubled workplaces effectively communicate their understanding of the situation, its problems, and what their solutions are. They also review the progress they make (which increases trust for further changes).

20. Super-intense Work Our case studies have many examples of employees working harder and longer than is sensible for them or their families. Where this was not seen as ill-treatment the employer and employee had made a (collective or individual) bargain, often when the employee took on their current role. They exchanged a commitment to intense working for a promise of career development or increased income or flexibility or job security or something similar. In troubled workplaces employees usually believed their employer had failed to fulfil their side of the bargain (or not made one in the first place).

21. Increased Pace As before, employees in less troubled workplaces did not believe that increasing the pace of work was being pursued as an end in itself. They accepted speed up to keep their jobs, to meet the expectation of clients/customers and so on. Speed up for the wrong reasons (for example, poor planning and administration, organisational politics) was associated with ill-treatment. Not only must speed up be rational to avoid ill- treatment, but it must also be fair and applied across the board.

22. Disability and Health Problems Ill-treatment was inversely related to the level of understanding of disability discrimination legislation amongst all employees (with/without supervisory duties; without/without disabilities). Less troubled workplaces did not sideline or ignore occupational health professionals. Less troubled workplaces recognise the challenging nature of the judgements between long-term conditions which can and cannot be managed at work, and which can and cannot be expected to result in permanent incapacity. Ill treatment is often associated with work-related health problems because of confusion over questions of liability.

23. Compromising Principles Employees in troubled workplaces reported being told that ethical behaviour which had previously been commended, or obligatory, was no longer desired. To avoid this trouble (as ever) employees required reasons, and not simply an account of a process, for example a collective agreement. Employees still felt that they were compromising their principles if the reasons they were given did not include an ethical justification of the change. Ethical justification of this kind requires a moral framework of the kind aspired to in the NHS Values and the Partnership on Dignity in Care.

24. Small group discussion At your tables, think about and discuss: do the findings from this research resonate with the reality in your trust / organisation? if so, what things are your organisation / trust doing to address these issues? if the findings do not resonate, what has your organisation done to avoid these problems and what is your organisation doing that others can learn from?