Loyalty in a Sea of Change: Staying True to Ourselves in the NHS

Leeds own Zygmunt Bauman’s warning about loyalty, that we must be careful what we attach ourselves to, is especially pertinent in the shifting landscape of the National Health Service (NHS). Organisational structures change with political tides: trusts merge, new Integrated Care Systems (ICSs) emerge, and long-established institutions are dismantled or rebranded. In such an environment, the question of loyalty becomes not just a professional concern but a deeply personal one. How does one remain loyal—not to an employer, or a vocation, but to oneself—amid continuous restructuring?

The NHS is an institution built on shifting sands. Its form is dictated by the interplay of government policy, financial pressures, and managerial trends, leading to an almost perpetual state of reform (Ham, 2020). Those who work within it are expected to adapt, often at speed, to new operational models, new targets, and new leadership structures. But what happens to the individual— to their sense of identity, integrity, and personal meaning—when the structures they work within are impermanent?

Bauman (2000) might have described the NHS as an example of liquid modernity, where the traditional markers of stability, loyalty to an organisation, a clear career pathway, a fixed professional identity, are increasingly unreliable. In such a context, loyalty to an institution can be dangerous, because that institution may not exist in the same form tomorrow. Yet there remains an expectation that staff will be committed, flexible, and resilient in the face of upheaval.

However, resilience is not the same as self-loyalty. The former is often framed in the language of institutional endurance—coping, adapting, persisting. The latter is something more fundamental: the ability to remain in dialogue with oneself, to resist being shaped entirely by external forces, and to preserve a sense of who one is, even when the environment is in flux. This requires what philosopher Charles Taylor (1989) calls authenticity: the commitment to living in alignment with one’s deepest values, rather than being pulled into conformity by the pressures of the system.

The Temptation of Institutional Loyalty

Loyalty is often framed as a virtue, particularly in public service. The NHS, as a national institution, fosters a strong sense of collective mission. However, institutional loyalty can become a form of self-abandonment when it demands that individuals suppress their own moral and emotional instincts in favour of corporate priorities. Psychologist Donald Winnicott (1960) distinguished between the “true self” and the “false self”: the former is an authentic expression of individual agency, while the latter is a defensive adaptation to external pressures. In an NHS setting, the risk is that continual restructuring and the rhetoric of “resilience” push people towards a false self—one that complies, absorbs, and conforms rather than questions, resists, or seeks alignment with personal truth.

This is particularly relevant in the context of moral distress, a growing phenomenon in healthcare where professionals feel ethically compromised by systemic constraints (Jameton, 1984). When structures impose targets, budgets, and policies that conflict with personal convictions about care, loyalty to the system can become a betrayal of the self.

Reclaiming Loyalty to the Self

The challenge, then, is to cultivate a form of loyalty that is inward-facing rather than institutionally directed. This does not mean disengagement or cynicism but a conscious effort to remain rooted in one’s own values, emotional truth, and intellectual honesty. In practical terms, this might mean:

1. Practising Ethical Reflexivity

Rather than seeing professional identity as something dictated by an employer or system, individuals can engage in ongoing reflection about their ethical stance, questioning not only what they do, but who they are becoming in the process.

2. Embracing Impermanence Without Losing Integrity

If structural change is inevitable, then clinging to organisational loyalty is like tying oneself to a raft in a storm. Instead, one can navigate change by staying loyal to internal anchors; principles, relationships, and ways of being that are not dictated by shifting hierarchies.

3. Creating Spaces for Honest Conversations

In cultures where “loyalty” is often equated with compliance, fostering environments where people can voice ethical discomfort, uncertainty, or resistance is vital. This could be through peer support groups, professional networks, or informal spaces of mutual reflection.

4. Recognising the Limits of Institutional Responsibility

The NHS, for all its ideals, is ultimately a system, not a person. It cannot reciprocate loyalty in the way human relationships do. Understanding this prevents disillusionment and helps individuals avoid the psychological harm that comes from expecting institutions to “care” in the way people do.

5. Resisting the Illusion of the heroic ‘Good Soldier’

Many healthcare workers are drawn into the idea that they must endure suffering for the sake of the system; that exhaustion, moral compromise, and overwork are marks of dedication. This is a dangerous fiction. As Simone Weil (1952) warned, self-sacrifice without purpose can become a kind of spiritual depletion, leaving individuals hollow rather than fulfilled.

Conclusion

Bauman’s warning about loyalty is a call to examine where we place our trust and energy. In the NHS, where the sands of organisational structure shift constantly, loyalty to an institution is precarious. A deeper, more sustaining form of loyalty is the one we owe to ourselves—to our ethical instincts, emotional well-being, and sense of self-worth.

In the face of constant change, the question is not whether we will remain loyal to our employer, our profession, or even our mission, but whether we will remain loyal to our own integrity. If we can do that, then no matter how the structures around us change, we remain whole.

References

• Bauman, Z. (2000). Liquid Modernity. Cambridge: Polity Press.

• Ham, C. (2020). The Changing NHS: What You Need to Know. London: Policy Press.

• Jameton, A. (1984). Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice Hall.

• Taylor, C. (1989). Sources of the Self: The Making of the Modern Identity. Cambridge: Cambridge University Press.

• Weil, S. (1952). Gravity and Grace. London: Routledge.

• Winnicott, D. W. (1960). The Maturational Processes and the Facilitating Environment. London: Hogarth Press.