MB925: MANAGING PEOPLE IN

ORGANISATIONS
INDIVIDUAL REPORT

NAME: Nizar Ahamed Abdul Rahim

REGISTRATION NO: 202353174
DATE OF SUBMISSION: 08TH June 2023
WORD COUNT: 3498
 EXECUTIVE SUMMARY
This report focuses on three key human resource challenges faced by the National Health Service (NHS).
Through various research methods, the issues of culture, attrition due to pay, and employee well-being have been
examined. The findings indicate the existence of an unhealthy internal culture characterized by fear of negative
consequences, as well as instances of bullying, harassment, and discrimination within the organization.
Furthermore, the report highlights a shortage of doctors and nurses per 10,000 population and identifies work-life
balance issues leading to staff attrition. To tackle these challenges, several recommendations are proposed. Firstly,
establishing a confidential reporting system and providing training on communication and conflict resolution can
empower employees to address problems and foster a culture of speaking up. Secondly, implementing
comprehensive anti-discrimination policies, regularly reviewing, and communicating them, and providing targeted
training for managers can mitigate discrimination and bullying issues. Additionally, reducing administrative
expenditures, improving recruitment strategies, and promoting income equality can address attrition due to pay
and recruitment difficulties. Lastly, initiatives such as stress management workshops, and workload management
techniques are suggested to enhance employee well-being. By implementing these recommendations, the NHS
can create a positive culture, improve retention and recruitment, enhance employee well-being, and ultimately
deliver better patient care while achieving organizational success.

INTRODUCTION
The NHS is an essential cornerstone of healthcare, characterized by its commitment to providing
compassionate care. It serves as the lifeline of a nation, delivering healing and support to individuals across
hospitals and clinics. As a symbol of unwavering dedication, the NHS brings hope and promotes wellness to millions
of people. It is deeply ingrained in the hearts of a grateful nation, and no other country provides such service to its
people. Since its establishment in 1948, the NHS has consistently offered high-quality care to all, irrespective of
their financial status. Through its tireless efforts, it saves lives and nurtures the well-being of countless individuals
for generations to come. But in recent times particularly since COVID-19 hits the NHS is facing several challenges,
including staff shortages, rising demand for services, and financial pressures.
In this context, organisational culture, employee well-being, and attrition due to pay are all important factors
that can impact patient health directly. This report effectively addresses these three human resource challenges
faced by the NHS. It provides a cohesive overview of the current state of knowledge on these topics, highlighting
key issues and debates to create a comprehensive understanding of the challenges. The primary purpose of this
report is to identify these challenges and propose well-informed recommendations to overcome them, improve
the NHS's performance, and enhance patient care. It begins by examining the culture within the NHS, delving into
criticisms and challenges related to internal culture, including fear, bullying, harassment, and discrimination. This
establishes a foundation for understanding the cultural issues that impact employee well-being and organizational
performance. Moving on, the report seamlessly transitions to the challenge of attrition due to pay, providing
 insights on workforce shortages, low pay, funding challenges, and their implications for employee management.
By highlighting the connection between pay-related issues and attrition, the report underscores the significance of
addressing this challenge for the NHS's success. Furthermore, the report effectively addresses the critical issue of
employee well-being, thoroughly discussing health issues, stress, work-life balance, and work-related mental
health. This section not only acknowledges the importance of supporting employees' well-being but also
demonstrates how it directly impacts the overall functioning of the NHS and patient care.

The proposed recommendations encompass various aspects, such as establishing a confidential reporting
system, providing training on conflict resolution, reducing administrative expenditures, promoting income equality,
and implementing initiatives like stress management workshops and workload management techniques. These
recommendations are tailored to address the specific challenges and offer practical solutions to enhance the NHS's
human resource management. By implementing these recommendations, the report envisions a positive
transformation within the NHS. It emphasizes the creation of a positive culture, improved retention and
recruitment, enhanced employee well-being, and ultimately, the delivery of better patient care. The
recommendations offered in this report culminate in a comprehensive conclusion that reinforces the significance
of addressing these challenges to achieve organizational success within the NHS.

Key terms:
 Culture: The shared beliefs, values, attitudes, behaviours, and practices that characterize a group or organization.
 Attrition due to pay: The gradual reduction in the size of a workforce because employees leave the organization
due to dissatisfaction with their compensation.
 Employee well-being: The physical, mental, and emotional health and happiness of employees in the workplace.
 Employee Assistance Programs: They are workplace-based programs that provide confidential and professional
support to employees facing personal or work-related challenges.
 British Psychological Society: It is a professional organization that represents psychologists and promotes the
advancement of psychology as a science and profession in the United Kingdom
 METHODOLOGY
The comprehensive approach taken in this critical report addresses the human resource challenges
faced by the National Health Service through a combination of research methods. These methods include
professional expertise, qualitative analysis, quantitative analysis, and organizational evidence. The report
benefits from the input of human resource professionals, healthcare practitioners, and researchers familiar
with the NHS, whose knowledge and experience contribute to a thorough understanding of the challenges and
inform the recommendations. The qualitative analysis provides insights into the culture, challenges, and issues
within the NHS (Sutton and Austin, 2015) by reviewing existing literature, reports, and studies related to
organizational culture, bullying, harassment, discrimination, attrition due to pay, and employee well-being. In
addition, the quantitative analysis examines specific data related to workforce shortages, pay, employee health
issues, and other relevant factors, providing a quantitative perspective on the challenges faced by the NHS.
Organizational evidence gathered from various sources within the NHS, including reports, and official
documents, further enhances the analysis by providing insights into the experiences, perceptions, and
feedback of NHS employees. Finally, SWOT and PESTEL analysis are also used to draw potential threats, and
issues (refer to appendix). By employing these research methods, the report aims to provide a comprehensive
understanding of the human resource challenges faced by the NHS and formulates recommendations to
address the identified issues and improve overall performance, employee well-being, and patient care within
the NHS.

FINDINGS
In this section, there are totally three main pressing human resource issues that are facing NHS are discussed.
Starting from the culture of the organisation, attrition problems due to wages, and finally issues that staffs are
facing in terms of well-being. Since those issues are holistic, it has been divided into sub-headings to get a
better idea and understanding.

1. Culture

 The Significance of Organizational Culture in the NHS: Challenges and Criticisms

Culture is a fundamental pillar of any organization, playing a direct and indirect role in its profitability,
customer satisfaction, competitive advantage, and overall growth. According to KPMG (2015), 32% of HR
professionals identify corporate culture as the primary hindrance to adopting evidence-based practices in
people management within their organizations. The NHS is renowned for its patient-centric approach,
emphasizing empathy and respect. However, experts argue that the internal culture, particularly the culture
among employees is unhealthy. Criticism has been directed at the organization's use of financial rewards as a
motivational tool, resembling a carrot and stick approach (Stevenson, 2019). The staff in the NHS tend to avoid
addressing and acknowledging problems. Instead, they often choose to ignore or deny them rather than
 confront them directly. Transparency is not actively promoted, and issues are frequently concealed or
minimized. Taking responsibility or admitting mistakes is actively avoided. Individuals who observe concerning
issues are hesitant to speak up due to the fear of negative consequences from higher officials. There is a general
reluctance to take a stand or be held accountable for actions (Pope, 2018).

 Challenges Faced by NHS Employees: Bullying, Harassment, and Discrimination

NHS employees consistently express concerns about high levels of bullying, harassment, and
discrimination at work. They also face significant pressures due to workforce shortages, making it difficult to
recruit, train, and retain sufficient staff to meet the demands of the services (The King's Fund, 2019). In a survey
of 7,887 doctors, including GPs, junior doctors, and consultants, a considerable number reported experiencing
bullying, harassment, or undermining in their workplaces. About 29% of doctors stated that it was sometimes
a problem, while 10% said it was often a problem. Interestingly, black, and Asian minority ethnic (BAME)
doctors were more than twice as likely as white doctors to indicate frequent issues with bullying, harassment,
or undermining, with 18% of BAME doctors expressing concerns compared to 7% of white doctors (Dyson,
2021).
According to the 2021 survey conducted by the National Guardian's Office (NGO), there was a 5%
decrease in the number of Freedom to Speak Up Guardians who reported a positive culture of speaking up in
their workplace compared to the previous year. Discrimination is still prevalent in the NHS, affecting 13.1% of
workers due to factors like gender, ethnicity, or age, and ethnic background is the primary cause of
discrimination, mentioned by 48.2% of staff (Physiotherapy, 2021). Also, it is observed that 13.2% of workers
reported being bullied or harassed by their managers at least once (Kumar, 2019). In juxtaposition, some argue
that managers recognize the critical importance of their actions and behaviours in shaping the culture of an
organization. Values are considered central to good leadership. It is believed that boards or governing bodies
that expect managers to exhibit changed behaviours must also model those behaviours themselves. If boards
demand changed behaviours from managers without practicing them, they are likely to fail. This highlights the
significance of leaders leading by example and aligning their behaviours with the values they expect from
others (Kline, 2019). All these findings highlight the need for addressing issues related to organizational culture,
promoting a safe and inclusive workplace, and fostering an environment where employees feel empowered to
speak up and address concerns.

2. Attrition due to pay

 Workforce Shortage and Low Pay: Challenges Faced by the NHS

The NHS is facing a tremendous level of workforce shortage, according to an NHS England workforce
plan presented to government officials in March, the healthcare system currently faces a shortage of 154,000
full-time employees, and this number could potentially increase to 571,000 staff by 2036 if current trends
 persist (Hall, 2023). Low pay has been identified as a key reason for NHS staff shortages, with more than a
quarter of trusts in England operating food banks for staff (Walker, 2022). Surprisingly, the UK has only 2.8
doctors per 1,000 population (Taylor, 2020). And Figure 1 represents the number of nurses and doctors per
1,000 people in 2021. This supply-demand issue delays doctors’ appointments and risks patients’ life. And the
pay issues are mainly caused by funding, political factors, and inflation.

 Challenges in NHS Funding, Resource Allocation, and the Implications for Employee Management
The NHS has also experienced a decrease in funding and resources compared to the increasing demand
for high-quality services. As a result, there has been a challenge in maintaining the desired level of service
quality and providing fair wages to the NHS staff. The available funding has not kept pace with the growing
demand, leading to a relative reduction in
resources available for the healthcare system
(Taylor, 2023). An advocate for women's rights
mentioned that the Conservatives lack faith in the
NHS but hide it and they underinvest, make jobs
unappealing, and create waiting lists to push
people towards private healthcare (Wendy
Figure 1. Number of practising nurses and doctors per 1,000
Savage, 2022). Moreover, the rapidly rising cost of
people
living and years of poor pay increases for NHS
(Triggle, 2021)
staff, which have not kept pace with inflation,
means more are struggling with day-to-day living costs (Midwives, 2022). NHS employees are being presented
with a salary increase of 5 percent for the fiscal year 2023-24. However, health unions warn of an escalation in
strikes despite this offer (Finnis, 2023). Here, people management professionals can play a pivotal role in
addressing the workforce shortage and pay issues within the NHS and this will affect employee retention, and
recruitment difficulties.

3. Wellbeing

 Employees’ health issues and Long-Term Absence

Since COVID-19 happened mental ill health is the top cause of long-term absence, followed by
musculoskeletal injuries and stress. Approximately 51% of NHS organizations have a strategic approach to
employee well-being, while 36% are more reactive than proactive (Sinclair, 2022). Additionally, Staff Council
(2022) observed a daunting percentage of long-term illness among shift workers based on gender (refer to
Figure 2). This point is strengthened by Keane (2023) stating half a million working days in the NHS were lost
due to anxiety and mental health issues in January 2023.
 Figure 2. Illness percentage in shift work gender-wise
(Staff Council, 2022)

 Impact of Stress and Work-life Balance on NHS Staff

As far as well-being is concerned, stress levels remain a key topic of discussion. A survey conducted
among over 1000 NHS workers revealed that two-thirds of them feel that the public has forgotten about NHS
staff, despite services being busier than during the peak of the Covid pandemic (Together, 2022). The alarming
statistics continue with NHSGGC (NHS Greater Glasgow and Clyde) hospital staff experiencing 2,479 instances
of assaults and threats from January to July 2021, and nearly 100 attacks occurring within the first eight days
of August (Williams, 2021). These incidents have had a significant impact on the staff's stress levels. Adding to
the concerns, a third of the well-being hubs for working staff are either closing or at risk of closure, as
highlighted by the Psychological Society (2023), further exacerbating the situation. Moreover, the data on
working hours is distressing, with Ocean and Meyer (2023) revealing that over the past decade, an additional
567 workers leave NHS jobs each year due to work-life balance issues. The concerning trend is illustrated in
Figure 3, which shows that the NHS has lost over 10,000 staff members due to increased challenges in achieving
a satisfactory work-life balance.

Figure 3. Number of staff lost due to work-life balance issues in 2022

(van der Merwe, 2023)

 Prevalence of Work-related Mental Health Issues among Young Employees

The Health and Safety Executive's 2021 survey highlighted that the 25-34 age group had the highest
prevalence rate of work-related stress, depression, or anxiety (refer to figure 4). This data, supported by
 Richard Money-Kyrle's analysis in 2022, emphasizes the significant mental pressure faced by young employees,
particularly junior doctors, from 2018 to 2021. His workforce stability percentages further indicate the
challenges, with Year Two Foundation Doctors having the
lowest stability at 52.7% in December 2019 (Money-Kyrle,
2022). As a result, job dissatisfaction is prevalent, leading
younger doctors to increasingly pursue alternative career
paths. In 2018, only 37.7% of F2 doctors continued directly into
core or specialty training programs (Medical Association,
2020). To address the rising issues HR departments can
prioritize proactive well-being strategies and support systems Figure 4. Prevalence of work-related stress,
depression, or anxiety varied by age and gender per
including promoting work-life balance, enhancing mental
100,000 workers from 2018-21.
health resources, and creating a supportive environment to
(Safety Executive, 2021)
retain and nurture the healthcare workforce.

RECOMMENDATIONS
1. Culture
 People professionals can mitigate the issues of fear of negative consequences, and staff avoiding
addressing problems by establishing a confidential reporting system and communicating its purpose and
protections. Providing training on communication and conflict resolution to empower employees can help
to address this issue. Also, educate them on the importance of speaking up and the impact on patient care.
 HR professionals can prioritize holding individuals accountable for their actions through appropriate
disciplinary measures to mitigate bullying, harassment, and discrimination issues in the NHS. It is crucial
to ensure that the disciplinary actions are consistent and proportional to the severity of the misconduct.
Additionally, providing support to victims including access to counselling, employee assistance programs,
and resources for their recovery is essential.
 Implementing comprehensive anti-discrimination and anti-bullying policies, explicitly prohibiting all
forms of misconduct, including manager-to-employee bullying. Regularly review and communicate these
policies to all employees, emphasizing their importance. Provide targeted training programs for managers,
highlighting their responsibility in preventing discrimination and bullying, and promoting diversity,
inclusion, and respectful behaviour.
 Finally, emphasising people culture, an organisational culture established by Harrison and Stokes (1992)
will aid NHS in significantly boosting interpersonal relationships, teamwork, and collaboration within an
organization. Individuals can expect cooperation, mutual support, and the development of personal
relationships. This type of culture highly promotes satisfaction of employees which will lead to affective
commitment and striving to create a supportive and nurturing work environment.
2. Attrition due to pay
 By reducing expenditures in administrative functions, and forming collaborative partnerships across
organizations, it is possible to achieve the necessary cost savings and can invest it in the training and
development of employees while still ensuring operational efficiency considering the current financial
situation.
 Hiring more local staff and reducing the dependency on international ones, emphasising more on retire
and return practise will hugely aid the organisation to reduce costs. Also. Focusing on metrics such as the
cost of HR per employee, healthcare costs per employee, and training return on investment will be
beneficial.
 Implementing regular employee engagement programs, conducting exit interviews to gather feedback
and address any underlying issues, and providing mentorship and coaching programs to support the
development and retention of new and existing staff can significantly reduce attrition rates.
 Strengthen recruitment strategies which include developing targeted recruitment campaigns to attract
healthcare professionals, collaborating with educational institutions to create pipeline programs for
training and developing future professionals also to reduce dependency on agencies for recruitment, and
streamlining recruitment processes to ensure timely and efficient hiring can reduce unnecessary cost and
recruitment difficulties.
 HR managers could prioritize promoting a more equal distribution of income for the same level of roles
to avoid disparities and inequality. HR managers can also use performance-related pay that recognizes and
reward exceptional work and contributions but should emphasize more on fostering individual intrinsic
rewards, providing growth opportunities, and promoting teamwork and cooperation within the
organization.

3. Wellbeing
 Implement initiatives that prioritize employee well-being, such as stress management workshops,
resilience training, and providing resources and support systems to address specific health issues. Educate
employees on stress reduction techniques and coping mechanisms to help them effectively manage
workplace stress. These efforts will not only enhance employee well-being but also contribute to long-
term productivity and overall organizational success.
 To support employees facing mental health challenges, organizations can implement confidential
counselling services or Employee Assistance Programs (EAPs) as a means of providing professional support.
Additionally, training managers and supervisors to recognize signs of mental distress and equipping them
with resources to effectively support employees can be beneficial. Psychological appraisals can also be
utilized to assess employees' psychological well-being and provide valuable insights for tailored support
 and interventions. Additionally focusing on the six stressors such as “role ambiguity, role conflict, work
overload, responsibility for people, underutilization of skills, and career development” provided by Andrzej
and Huczynski will be helpful to cut the cause of stress from the root (Andrzej A. Huczynski, 2019).
 Provide training and support to higher-level professionals on workload management techniques and
encourage open communication between employees and their supervisors to identify and address
excessive workloads.
 People managers could communicate with higher management, emphasizing the importance of mental
health and well-being support/hubs for NHS staff. Present evidence, such as the BPS (British Psychological
Society) analysis of sickness absence data, to demonstrate the significant impact of mental health issues
on staff well-being and productivity.
 Implementing a rotation system that shifts staff between high and low-stress settings pairs less
experienced employees with experienced colleagues, fostering support and enabling professional growth.
This approach reduces work-related mental health issues by ensuring young employees feel supported and
valued, positively impacting their well-being.

CONCLUSION
This report analyses three major people management issues that the NHS is facing: unhealthy
organizational culture, high attrition rate due to pay, and employee well-being problems. The findings reveal
the unhealthy internal culture characterized mainly by fear and instances of bullying and discrimination in the
workplace. The report highlights workforce shortages caused by low pay as factors contributing to attrition.
Additionally, it identifies employee health issues and stress as affecting the well-being of staff, particularly since
COVID-19. Recommendations include establishing a confidential reporting system, implementing anti-
discrimination policies, reducing administrative expenditures, improving recruitment strategies, and
promoting employee well-being. Recognizing that not all evidence corresponds to the suggested
recommendations is crucial, as there are diverse viewpoints in the available literature. Nevertheless, most of
the literature affirms the identified difficulties and the suggested remedies. Overall, addressing the challenges
of culture, attrition due to pay, and employee well-being requires a multifaceted approach that involves
changes in policies, procedures, organizational practices, and most of it involves line managers’ involvement.
It is crucial to prioritize the well-being and satisfaction of NHS employees, as they play a vital role in providing
quality healthcare services to the population. By adopting these recommendations, the NHS can foster a
favourable atmosphere, enhance staff retention and recruitment, improve employee welfare, and ultimately
provide superior patient care while achieving organizational success and for the good of society.
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21457695 [Accessed 10 May 2023].
 Appendix
SWOT analysis

Strength Weakness

People, skill, and capabilities People, skill, and capabilities

 Making Every Contact Count (MECC) approach  Training for line managers
 Dedication Employee assistance  Workforce shortage
 Diversity and inclusion  Employee wellbeing
 Philosophy and value  Communication
 Engagement levels  Discrimination
 Remote work  Bureaucracy
 Benefits  Delay service
Resource and assets  Culture
 cutting-edge medical research Resource and assets
 Innovation  Dated equipments
 Expertise  Infrastructure
Internal approach  Wage
 Performance management Internal approach
 Limited career progression
 Work life balance
 Retaining talent
 Skill gaps
Opportunities Threats

People, skill, and capabilities People, skill, and capabilities

 Collaborations and Partnerships  Changing Regulations and Legislation
 Public Awareness and Support  Cost for investments and trainings
 Government Initiatives  Impact of Brexit on recruitment
 Industry trends  Changes in the market
 Digitalisation  Workforce Shortages
Resource and assets  Budget Constraints
 Technological advancement  Life expectancy
 Global Talent Pool
 Data analytics
PESTLE analysis
External factors to
consider
 Industry regulations
 Health care funding
 Government policy
Political  Ruling party
 Immigration
 Brexit
 Health care expenditure
 Economic condition
 Budget constraints
Economic  Globalisation
 Labour costs
 Inflation
 Public attitudes towards
healthcare
 Social expectations
regarding healthcare
services
 Cultural diversity
Social
Factors affected within health care industry Importance to
organisation
Changes in healthcare regulations, funding allocation, and High
priorities impact the NHS's operations, service delivery
models, and workforce planning.
The UK's withdrawal from the EU affects NHS workforce
recruitment, procurement of medical supplies, and Medium
collaborations with international partners.
Government funding decisions significantly impact the High
NHS's financial resources for delivering quality healthcare
services, infrastructure maintenance, and staffing levels.
The NHS adheres to regulations and standards for patient Medium
safety, data protection, and care quality. Changes in
regulations require adaptations in HR policies, training, and
compliance measures.
Globalization brings cultural diversity to the healthcare Medium
workforce creating challenges in communication,
collaboration, and culturally sensitive care.
Inflation affecting the recruitment, wage, and retention of High
skilled professionals, potentially leading to workforce
shortages and challenges in delivering quality healthcare
services.
Labour costs changes including wages and benefits have Medium
direct impact on the human resource management.
Budget constraints and resource limitations affect HR's High
ability to effectively manage staffing levels and allocate
resource.
Healthcare professionals often face demanding work High
schedules and high levels of stress, which impact their well-
being and job satisfaction.
The size of the population impacts the healthcare services Medium
in ways such as population growth, aging population, and
changes in disease prevalence.
  Work-life balance
 Social attitudes
 Demographics
 health trends
 Population
 Electronic health records
 Disruptive technologies
 Artificial Intelligence
 Medical equipment
 Digital healthcare
Technology  Telemedicine
 Automation
 Innovations
 Robotics
 Security
 National Minimum Wage
 Equal employment
opportunities
 Health and safety
Legal regulations
 Employee rights
 Data protection
 Working Time
Regulations
 ESG (Environmental,
Social and Governance)
 Transportation of
international workers
Environmental  Employee well-being
 Energy consumption
 Waste management
 Future pandemics
Varying public attitudes towards healthcare impact Medium
developing patient-centered care strategies, enhancing
communication skills of healthcare professionals.
Social attitudes, including values, beliefs, and norms affects Medium
healthcare professionals' engagement with diverse patient
populations.
Need high level of automation technologies to streamline Medium
administrative tasks, optimize workflows, and enhance
operational efficiency within NHS.
Need to facilitate training and education on AI technologies High
for healthcare professionals to effectively utilize and trust
these systems.
Need high security for data protection and operational High
stability.
Need for specialized training in telehealth technologies and Medium
the development of new roles for remote healthcare
delivery.
Increase in wage and national minimum wage rates. High
Gig economy affecting employment status and long-term High
growth.
Need transparent policies and procedures and provide Medium
support to employees in exercising their rights.
Adhering Working Time Regulations is essential to manage High
work schedules effectively.
Delay service leads patients move to expensive private Medium
hospitals.
Cost of transporting, hiring, and retaining international High
staffs is increasing.
The healthcare industry generates a significant amount of High
waste, including hazardous and medical waste.
Healthcare facilities consume substantial amounts of High
energy to operate medical equipment, maintain optimal
environmental conditions, and provide essential services.