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Bullied NHS staff’s ‘tears of frustration’ at dysfunctional hospital

A review of Aberdeen Royal Infirmary has raised concerns over leadership, governance, culture and inappropriate staff behaviour – including bullying – at NHS Grampian’s flagship hospital.

The report from Healthcare Improvement Scotland (HIS) said these failings are “impacting on the quality of care at Aberdeen Royal Infirmary and have the potential to have a more serious impact if not urgently addressed by NHS Grampian”.

The review also included an unannounced inspection of the care of older people at Aberdeen Royal Infirmary and Woodend Hospital, which found poor care and a lack of visible and effective leadership.

The report details a culture that varies from department to department in Aberdeen Royal Infirmary, many of which have staff who suffer from low morale, are disengaged from management and work under a forceful style of management that some staff “perceive to be bullying”. Some departments also provide poor supervision and education for doctors in training.

It also comments on “very poor relations” between some senior medical staff and management at all levels. The report says that this is in part due to poor management visibility, communication and engagement with medical staff, but is also a result of the unprofessional behaviour of some medical staff which has not been resolved.

Some of the unprofessional behaviour that had not been addressed includes open and aggressive criticism of the work of other staff and poor communication between co-workers. The report says there was also a belief amongst some senior medical staff that hospital policies did not apply to them.

HIS calls one of the surgical units “significantly dysfunctional”, saying there are serious allegations about the performance and behaviour of individual consultants that need to be resolved.

The watchdog also said there are serious issues with staffing, with medical staffing in the emergency department needing “urgent attention to maintain safety”. The report also says there is a serious nurse shortage at the hospital.

Dr Angus Cameron, chair of the review team and medical director at NHS Dumfries and Galloway, told The Scotsman the issues raised by the report are serious and described it as “sobering reading”.

He said: “I think the key message is we spoke to a lot of staff, over 500, and I was impressed by how emotional the discussion was.

“We found people in tears with their frustration at not being able to make Aberdeen Royal Infirmary work more effectively and that was because there was a lack of leadership, a lack of learning from when things had gone wrong and there was some completely unacceptable behaviour by senior medical staff that has gone unaddressed for too long.

“This is very de-motivating for other staff, we heard of consultants being highly unprofessional – intimidating and bullying other staff members – and a feeling of constant conflict amongst some of the senior doctors.

“I would stress it was only some, there is a silent majority of consultants up there who are highly professional and good people but if they are intimidated and over-ruled by a small number of consultants, you have a totally unworkable atmosphere.”

He added: “We’ve discussed with NHS Grampian what their actions [to address bullying] are going to be and we understand that they have formed a plan which will address all of the abnormal, unreasonable behaviours as well as addressing the weaknesses in management and improving the staffing levels.”

Addressing the report in Holyrood, the Scottish health secretary, Shona Robison, said: “The picture painted by Dr Cameron’s team is a worrying one.

“It describes a climate of mistrust between clinicians and senior managers in several specialities, unprofessional behaviour by a number of consultants which impacted on morale and the effectiveness of the service, and which went largely unchallenged, and a failure to respond effectively to concerns about staffing pressures and vacancies.

“There is also evidence that managers were distant, trainees were inadequately supported, complaints were poorly handled and that systems of governance and performance management were weak, muddled or indeed absent.”

She added: “Make no mistake, these things are unacceptable in the NHS in Scotland and they will be resolved.

“Let me also send a clear message that no matter who you are or at what level you work in the NHS, these behaviours highlighted in the HIS review will not be tolerated in our National Health Service.”

Responding to the report NHS Grampian released a statement in which it said the organisation has accepted all the recommendations in the reviews by HIS.

The new interim chief executive of NHS Grampian, Malcolm Wright, said: “These reports highlight issues with leadership and management, culture and behaviour, accountability and governance within NHS Grampian. We take these reports extremely seriously and we accept the recommendations that the reports make.”

He added: "We believe that our staff are amongst the best working in NHS Scotland and as a Board we are committed to doing all that we can to support them. We take our role as a teaching hospital seriously and we will ensure that this support is extended to all staff and to trainees in all disciplines."

(Image: Aberdeen Royal Infirmary c. Bill Harrison and licensed for reuse under this Creative Commons Licence.)

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