Damning report finds bullying in NHS Lothian

It found evidence of bullying and harassment, lack of leadership and a failure always to prioritise patient safety and quality of care.

The independent report was ordered by Health Secretary Shona Robison after allegations were raised in October 2017 that emergency waiting times were doctored at St John’s Hospital in Livingston.

Its publication yesterday coincided with Ms Robison’s resignation as part of a Cabinet reshuffle following a catalogue of problems including missed targets and a financial scandal at NHS Tayside.

The report on NHS Lothian by the Academy of Royal Colleges looked at the emergency departments at St John’s, Edinburgh Royal Infirmary and the Western General.

It said staff at all levels felt there was “limited focus” on emergency care from the board.

On St John’s it said: “We found evidence of bullying and harassment of some individuals and observed styles inconsistent with good working relationships with several staff who were openly distressed. Medical leadership felt almost non existent and, at best, disjointed.

“We heard several examples of when staff were left ‘in tears’ by the behaviour of others.”

At the Infirmary, the report said medical leadership was “fragmented”.

“Some staff felt they were treated badly and unsupported when raising concerns and stated they would be wary about doing so again.

The culture at the Western General was described as “more positive”. But the report said: “Concern was expressed about the future of WGH with a feeling that the WGH site is less important than the other sites.”

NHS Lothian had carried out its own internal report after concerns were raised about under-reporting of A&E waiting times. It concluded staff acted with the best of intentions in developing local guidance on recording waits because national guidance was vague and ambiguous.

It said staff were under “intense pressure” beyond that of working in a busy department, but said none of those interviewed felt bullied or harassed.

But the independent report said the national guidelines were clear and it disagreed with the finding on bullying.

The report comes six years after former NHS Lothian chief executive Professor James Barbour OBE abruptly retired after evidence of waiting time manipulation surfaced. A report at the time on bullying within NHS Lothian described an “undermining, intimidating, demeaning, threatening and hostile working environment”.

Yesterday’s report said: “NHS Lothian has had a previous review into its culture and, despite action being taken, we felt that this had not yet been fully embedded at all levels of the organisation.”

The report highlighted daily tele-conferences between the three sites. “It appears to be a review of activity of the sites and capacity although the true purpose felt unclear and was unclear to most staff. The tone and approach by the chair was perceived as aggressive on occasions and some staff described feeling intimidated and worried about attending the telephone conference.”

The report also criticised a management group known as the access and governance committee which it said had missed an opportunity to detect the mis-reporting of waiting times.

In its recommendations, the report said: “The issue of bullying and harassment requires urgent action.”

It urged NHS Lothian to “develop a more transparent culture that enables staff at all levels to report concerns without fear of repercussions”.

And it said: “A review of the leadership requirements on all three sites should be undertaken aimed at strengthening the overall general and clinical management.”

Lothian MSP and Tory health spokesman Miles Briggs said he would be seeking an urgent meeting with NHS Lothian to discuss how the recommendations will be implemented.

He said: “This is a truly damning report into the culture of NHS Lothian which found a total lack of robust management with staff often afraid to raise concerns for fear of reprisals. Put simply that must change and never be able to occur again.”

Tom Waterson, of health union Unison, said the report raised many concerns.

“We want to ensure there is full support for staff and lessons will be learned. We cannot have the same type of situation we had in previous years.”

But he said he did not think bullying was on the same scale as before. “A lot of it is because of the pressure that comes from government on waiting times. That’s passed down the line and someone gets it in the neck. We need a proper review into whether waiting time  targets are needed for everything.”

Lothian Labour MSP Kezia Dugdale said it was “extremely concerning” that the report had found a culture of bullying and harassment.

“These findings are alarming and need to be at the very top of the in-tray for the new Health Secretary. Urgent action must be taken to restore public confidence and ensure that our dedicated NHS staff can do their jobs.”

Jim Crombie, interim chief executive of NHS Lothian, said: “We have recognised from the outset that mistakes were made and accept the findings of this review. It’s clear not all was as it should have been. Staff have also come under intense pressure and for these failings I’m really sorry.

“Our staff do an incredible job in difficult circumstances. I am proud of them and note the review team found a number of examples of excellence in team working and inclusion.

“However, we also share the Scottish Academy’s concern about bullying behaviour, as reported by staff at many levels during the review, while recognising there was no evidence of bullying and harassment at board level.

“In the face of intense and sustained pressure working relationships can sometimes be fraught and plainly we have not been doing enough to support our front line staff.”