A DAMNING report into bullying at NHS Lothian has described an “undermining, intimidating, demeaning, threatening and hostile working environment” at the health board.
The probe said the evidence it uncovered painted “an extremely disturbing picture of the culture of some parts of NHS Lothian”, with the health board’s credo of the “Lothian Way” – supposed to refer to its official key values – commonly referred to by staff as “the bullying way”.
The Scottish Government, which ordered the report, said the intimidating culture was “originating from the top level”.
As the report was released, NHS Lothian confirmed that James Barbour, the chief executive who presided over the era of the bullying culture and who retired days before the report’s interim findings were delivered, stepped down with a full pension and will not face any disciplinary proceedings or financial penalties.
After 35 years with the NHS, where his finishing salary was £170,767, he is expected to receive a lump sum of £220,000 on top of an annual pension of £75,000, though it is understood no enhancements or bonuses will be paid.
NHS Lothian would not say whether he would have faced disciplinary action had he still been a member of staff.
As the report was published, patient groups called for some of Mr Barbour’s payout to be clawed back.
The investigation was ordered by Health Secretary Nicola Sturgeon after a previous probe into the manipulation of waiting times at the health board heard allegations of bullying and an oppressive management culture.
Both studies were carried out by PricewaterhouseCoopers, with David J Bowles & Associates joining the team for the bullying study.
Ms Sturgeon said today that she was “shocked but not surprised” by the report and confident that interim chief executive Tim Davison was steering the health board into a new era.
Asked whether she had demanded that Mr Barbour stand down, she would only comment: “He took the decision that he was retiring and that was his decision to take and that’s that.”
The study, which was based on one-to-one interviews and focus groups, acknowledged that the bullying culture did not extend to all areas, but made it clear that the issues went right to the top.
In describing the way that organisations work, it said: “There will be an over-arching culture which is predominantly created and shaped by the chief executive and the senior leadership team, in this case the Executive Management Team (EMT),” it said.
One member of staff who was interviewed said: “There is a blame culture, particularly for senior managers, and I see it cascade and leak out to the lower graded staff.”
Another referred to “a macho culture that has lasted for some time” while a third said the culture was “shocking . . . an atmosphere of fear”.
The report also said staff talking about meetings at the health board “describe a high degree of tension in the room waiting to see who will get ‘a good kicking’ with others with their ‘heads down looking at their feet’.”
In describing the health board’s leadership style, the report said “a number of instances of bullying, intimidation and inappropriate behaviours were alleged, both first and second hand. This depicts an organisation where being bullied, whilst not representing the daily experiences of the majority of staff, is common at certain levels . . . staff feel intimidated and anecdotes of bullying behaviour are common”.
It said staff were either afraid to raise the issue of bullying for fear of repercussions, had become so used to the situation that they thought it was normal, or felt that complaining was pointless.
Margaret Watt, chairwoman of the Scotland Patients Association, said that Mr Barbour should pay the price of presiding over such an unhealthy workplace.
She said: “I asked a long time ago that he should have gone. It’s OK for these guys to be head of these health boards but they should get themselves out of their offices and into hospitals and introduce themselves to patients.
“We should be looking at these pensions. It’s totally immoral. What we’re saying is ‘you didn’t do very well, but here’s your golden handshake, here’s your pension’.
“Here’s a man that hasn’t dealt with the system appropriately, or given our patients and staff respect and dignity, and we’re giving him a golden handshake.”
Lothians MSP Sarah Boyack said: “What I would want to know is who agreed that the chief executive could leave during this inquiry. Was he interviewed? Did he have views on this issue? The report refers to a culture of management and talks about the importance of the chief executive, but isn’t specific about how many people are involved in this culture. It leaves a lot of questions unanswered.”
Tom Waterson, Lothian branch chairman for Unison, said: “I think the most important thing is how we move on and how we alter the culture that’s been embedded within NHS Lothian. There needs to be some sort of an amnesty where people can come forward and say ‘if my behaviour’s caused angst, I’d like to change it’.”
On Mr Barbour’s role in the bullying culture, Mr Waterson said: “The culture that existed over the past few years was directed from the top.”
But he defended the pension payout, which NHS Lothian says is protected by law.
“He wasn’t given any extra, it wasn’t a ‘golden cheerio’, it was what he was entitled to because of the money that he’s paid in over the years. I can understand that might stick in people’s throats, but that’s what he was entitled to,” he said.
Speaking after the report was published, Ms Sturgeon said: “I’m shocked at it although, given the [previous] PwC report, I’m not surprised that that’s what the report found.
“There’s no place anywhere in the NHS for management practices like those described in the report.”
The investigation said the worst problems were in areas where there was pressure to hit high-profile targets.
The study made a raft of recommendations, which will be discussed at a meeting next week. They include training for senior and middle managers on the difference between bullying and firm management, and the setting up of an independent phoneline for staff to seek advice on whistleblowing.
It was recommended that the “Dignity at Work” policy should be reviewed, that exit interviews should be held with departing staff, and the staff survey should be reappraised.
NHS Lothian chairman Dr Charles Winstanley said: “Our focus is now on implementing the recommendations and ensuring that NHS Lothian never finds itself in this position again. We intend to establish a steering group to oversee the progress of the recommendations.”
Tim Davison, interim chief executive of NHS Lothian, added: “I will ensure that the relationship between management and the workforce is open and transparent, and that we work in an inclusive and engaging environment where staff feel free to voice concerns.
“I am certain that we can use this report as a way of ensuring NHS Lothian moves forward with confidence and ambition.”