New report uncovers management failures at NHS Lothian

St Johns Hospital, Livingston. Picture: Ian GeorgesonSt Johns Hospital, Livingston. Picture: Ian Georgeson
St Johns Hospital, Livingston. Picture: Ian Georgeson

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A bombshell new report into Lothians hospitals following allegations by a whistleblower that A & E waiting times were being falsely recorded has uncovered a litany of failures.

Health Secretary Shona Robison ordered the independent report after allegations were raised in October 2017 that emergency waiting times were being falsely recorded at St John’s Hospital in Livingston.

A report by the Academy of Royal Colleges into emergency care at St John’s, The Edinburgh Royal Infirmary, and the Western General has now revealed a catalogue of failures including, incidences of bullying and harassment that has driven some staff to tears, a lack of medical leadership and a poor governance structure.

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The probe has made several recommendations including a full review of the governance of NHS Lothian, the adoption of a more transparent culture allowing staff to report concerns without fear of repercussions, and the adoption of a zero tolerance bullying policy

NHS Lothian board today said it accepts all of the observations and recommendations of the report.

A spokesman said improvement actions to meet the report’s observations and recommendations are already progressing.

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.

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“Since the publication of our own review last November we have already taken a number of steps to rectify the reporting errors including significant staff training to ensure correct recording of 4 Hour breaches. We are confident the measures we have already put in place have removed any ambiguity over the correct procedures.

“We welcome today’s finding, which accords with our own, that staff had not amended breach times to deliberately falsify performance but instead that confusion had led to these mistakes. 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 that 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.

“We are working to identify practical ways to reduce pressure right across the system and undertaking a programme to develop our leaders. As part of that work we will, through all mechanisms, ensure that it is absolutely clear that NHS Lothian does not tolerate bullying behaviour.

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“We are also clear that the job of ensuring patients travel swiftly and safely through the system does not rest with just one team or department. It is a ‘whole system’ responsibility. Focussed on patient safety, we are therefore also working with our partner organisations to ensure patients get the right treatment in the right place at the right time and to reduce delays in patient discharge which have a significant impact throughout the hospital system.

Today’s review recommends we strengthen governance and leadership and we are already immersed in that work”.

The report was published by Scottish Government following a review of practices on three sites of the Royal Infirmary of Edinburgh, the Western General Hospital and St John’s Hospital after concerns were raised.

Brian Houston, Chairman of NHS Lothian, said: “The review is not about assigning blame and true change is more than just re-writing protocols and procedures. We have to re-focus our own mindsets. If something has gone wrong in the way in which staff are working with each other or in the pressures they feel from day to day, then it is up to us in the board of NHS Lothian to fix it.”