Patient safety

Scathing government review into NHS region blasts bullying and blame culture

A government-backed review into a major Scottish region has uncovered a culture of bullying and harassment where concerns raised were discouraged, with staff made to feel they had been “blamed rather than supported.”

The review into NHS Lothian, a region which serves around 800,000 people, including all major services for Edinburgh, found that a lack of structured and robust management led to confusion and poor focus on patient safety experience.

Ordered by the Scottish Government, the scathing review blasts the leadership team at NHS Lothian, highlighting a breakdown in trust between medical and nursing staff in the A&E department, with senior management’s attempts to resolve the issue proving “unsuccessful or detrimental.”

Following a whistleblowing letter sent into NHS Lothian – raising concerns regarding the validity of the region recording of breaches of emergency care at the St John’s Hospital site – news broke in December that waiting times of under four hours at every acute hospital ran by the area had been under-reported.

Chair of the Scottish Academy of Medical Royal Colleges Professor Derek Bell was subsequently asked to lead the review, which, through a series of interviews with board members and a range of other staff and stakeholders, found that the situation required “urgent action” on practice and management in the area.

The review team found that patient safety and quality of care was “not always prioritised as it should be,” adding that patient flow was not owned by everyone and largely left to nursing teams to manage.

‘Confusion and lack of focus on patient safety’

“The site leadership teams were variable in terms of experience and skills, including the roles and responsibility of the management and clinical leads. This may have contributed to a lack of consistency in senior leadership roles across the sites leading to confusion and a lack of focus on patient safety and experience,” the report added.

“This was particularly evident within the medical leadership.”

Management at the organisation was heavily criticised, including meetings involving the discussion and reflection of operational issues that were found to be “frequently deprioritised, cancelled or had poor attendance.” Staff described internal communications at NHS Lothian as variable, with limited opportunities to give views on new developments.

But despite the acute care failings, there was “clear commitment” from all staff to improve care for patients in the emergency department.

Amongst its recommendations, the review team called on board members to clarify the governance structure and supporting framework, with high-quality, safe care for patients as the key objective.

The inclusion of site leadership teams with visible support of good governance practice was another key area to be focused on in the future, the review team noted. In addition, a more transparent culture within NHS Lothian allowing staff to air concerns and the adoption of a team-based approach to the management of the four-hour standard were also a number of recommendations made to the Scottish Government.

Jim Crombie, interim chief executive at NHS Lothian, accepted the findings of the report and apologised for staff members who have come under intense pressures for the failings of the board.

He added: “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.”

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