This article reflects the conversations in the breakout group on this topic at the Recently Appointed Consultants symposium on Thursday 5 June 2014. Last reviewed July 2021.


A sound knowledge of the NHS senior team structure is  key to good communication. Communication is important in both directions along the authority gradient and low morale may be caused by a lack of communication in either direction. Lack of communication from senior managers about change can cause low morale amongst staff; as can failure to communicate problems amongst staff to managers.

Problems of staff dissatisfaction, low morale and patient safety are best communicated to your clinical or nursing director. It is sensible to collect objective data and evidence of the problem is a good idea before making the approach. Solutions can also be discussed as a team first and ideas then presented as a group. Try to gain input from various points of view. These methods are also important if approaching managers in order to implement new services. If problems are related to one or two individuals it may be better for the team to approach these colleagues initially. Multidisciplinary team meetings (MDTs) are also a useful platform for discussion.

Breakout group leader: Dr David Murdoch, Clinical Director for Cardiology, NHS Greater Glasgow and Clyde.