NHS Staff Standards

The Association of Breast Surgery welcomes measures designed to improve staff wellbeing, safety and support across NHS services. Breast units rely on multidisciplinary teams working under considerable pressure, and national standards have the potential to support safer, more sustainable working environments. However, feedback from our members suggests that any staff standards must also address the wider service pressures that affect morale, retention, patient experience and the ability of teams to deliver timely, high-quality breast care.

The NHS Staff Standards focus on key areas of:

• Line management, including how best to support line managers
• Health and wellbeing, including the physical environment, rest spaces, and occupational health and wellbeing support
• Preventing and reducing violence against staff
• Championing sexual safety
• Tackling racism
• Promoting flexible working

1)    Line management (including how to best support line managers)

Many ABS members undertake leadership, supervisory and service development responsibilities across both medical and nursing roles. It is therefore essential that they have the training, authority and organisational support required to manage teams effectively, address concerns promptly and support colleagues working in pressured clinical environments. Strengthening line management should also include better support for managers dealing with sickness absence, prolonged disciplinary processes, performance concerns, poor behaviour, bullying, rudeness and team conflict, so that issues are handled fairly, consistently and without unnecessary delay.

2)    Health and wellbeing (physical environment, rest spaces, and occupational health and wellbeing support)

ABS has recently appointed Carol-Ann Courtney as Equality and Diversity Lead. At the ABS Conference, we aim to support delegates with different access, wellbeing and faith needs. ABS Members can also access free, expert advice and support on a range of personal and professional issues through the Surgical Advisory Service (SAS) Helpline.

While these measures are important, our members have also emphasised that wellbeing is closely linked to safe staffing, manageable workloads, adequate service capacity and effective service oversight. The increasing complexity of breast cancer care has created significant pressure across breast services, including pathology delays, shortages in breast radiology and insufficient oncology capacity to keep pace with new treatments. These pressures can prolong pathways, increase the number and length of appointments, extend MDT discussions and leave staff managing understandable patient frustration. Members are also concerned about the defunding of screening quality assurance, the limited enforcement power of GIRFT quality assurance and the loss of peer review, all of which have historically helped breast units identify resource needs and maintain high-quality services.

3)    Preventing and reducing violence against staff

ABS supports the role of Freedom to Speak Up Guardians and signposts members to appropriate routes for advice and support. Violence and aggression towards staff are often exacerbated by pathway delays, cancelled or repeated appointments and patient frustration with system pressures. Addressing the root causes of these pressures, including under-resourcing and capacity constraints, is therefore an important part of reducing conflict in clinical settings.

4)    Championing sexual safety

ABS supports safe, respectful working environments for all staff and patients. Professional standards, appropriate chaperoning, clear reporting routes and visible organisational commitment are all important in ensuring that breast services remain safe and inclusive places to work and receive care.

5)    Tackling racism

Tackling racism is essential to fair, inclusive and safe workplaces. Trusts must ensure that staff are protected from discrimination and that employment processes are transparent, equitable and consistent for all staff. Staff confidence depends on knowing that concerns will be addressed appropriately, without discrimination, and that all colleagues will be treated fairly.

6)    Promoting flexible working

Flexible working should be part of a broader approach to making NHS careers sustainable and family friendly. Members have highlighted particular concerns around national recruitment for training posts, very large regional rotations and the impact these can have on trainees and their families. Greater consideration of family life, caring responsibilities and return-to-work support would help improve retention and the sustainability of NHS careers. Training Programme Directors should be supported and expected to take account of these issues wherever possible.

ABS also notes the importance of return-to-work support and is developing a return-to-work framework that may be relevant to this area once published.

ABS support for members

ABS supports members in these areas through professional guidance, education, peer networks and signposting to relevant resources. This includes management-related content within its courses, guidance such as job planning for consultant breast surgeons, and ongoing work looking at the current roles and responsibilities of nursing members. Other areas of support include:

• The ABS Information Hub brings together professional guidance, resources and advice
• The Members Support area, which signposts members to useful help and support
• ABS Regional Representatives provide a route for member feedback and escalation to the ABS Clinical Standards and Practice Committee. Find your Regional Representative here.
• Our Health Inequity resource page on the ABS website offers resources, advice and guidance on tackling health inequities.
• The Surgical Advisory Service (SAS) Helpline is a free source of guidance and support for ABS Members, whatever the issue faced. Whether employment concerns, a medico-legal issue or a bullying/harassment concern, their team of experienced consultant surgeons and specialists are here to help.