NHS chiefs slammed for culture of bullying

• Review shows management style created a “threatening and hostile working environment for some staff”

• The report also highlighted concerns surrounding a strong sense of a “blame culture”

Staff at NHS Lothian described a culture of fear and gave a number of examples of how they were intimidated and bullied by managers.

Health experts welcomed the investigation and demanded other boards be scrutinised to ensure the problems are not endemic across the NHS in Scotland.

View the report in full (PDF)

The health board, Scotland’s second biggest, has been ordered to radically overhaul its management style and ensure the report’s recommendations are put in place as soon as possible.

The independent study was ordered after it emerged board staff had doctored official figures to avoid missing government targets.

The chief executive, Professor James Barbour, retired from his £195,000-a-year post last month after more than a decade.

The 48-page report said “a number of instances of bullying, intimidation and inappropriate behaviours were alleged, both first and second-hand”.

It said: “This depicts an organisation where being bullied, whilst not representing the daily experiences of the majority of staff, is common at certain levels.

“The corollary is that staff feel intimidated and anecdotes of bullying behaviour are common, with the Lothian Way often being referred to as ‘the bullying way’.

“This has pervaded the culture of the organisation so that staff feel undervalued and they have little faith that the organisation will handle them in a fair manner, should they need to raise an issue about bullying by a senior manager.”

Health secretary Nicola Sturgeon, who ordered the report, said there was “no place” for such a management style and has demanded the board takes on a new and improved strategic direction.

She said: “I want to be clear that there is no place in any part of the NHS for a management style or culture of this type and it will not be tolerated.

“It will be important now for the board to embrace a new strategic direction and work to embed an inclusive, supportive, open and transparent culture throughout the organisation.”

The government has ordered the board to produce an action plan to bring improvements in waiting time information reporting, governance and culture.

NHS Lothian chairman Dr Charles Winstanley vowed to improve the way the health board worked.

He said: “This has been a difficult time for NHS Lothian, but this review was necessary and has provided us with a clear way forward.

“Our focus is now on implementing the recommendations and ensuring NHS Lothian never finds itself in this position again.”

He revealed a steering group made up of trade union representatives and non-executive board members would be set up to oversee the progress of the recommendations.

The report said “significant pressure to deliver faster access to services” in a “challenging financial environment contributed to an extremely disturbing picture” at NHS Lothian.

It went on: “We heard repeatedly from staff that all they were doing was managing targets with an emphasis on quick fixes.

“We identified allegedly unacceptable pressures being placed on staff which led to finding tactical paper-adjustment solutions to waiting lists rather than addressing the root causes. There is an almost total concentration on targets and the tasks required to achieve them, with less emphasis on people management and the softer skills which develop and engaged workforce.”

One worker told how managers bullied and shouted at staff, giving them “relentless pressure”. Staff working across the board described a long-standing “macho culture” and an “atmosphere of fear”.

A member of staff said: “There is a blame culture, particularly for senior managers, and I see it cascade and leak out to the lower graded staff”.

Another said: “Those of us with mortgages and career aspiration had better be afraid. If you don’t reach your targets, you can collect your P45”.

Tim Davison, acting NHS Lothian chief executive, attempted to reassure staff, the public and politicians by saying it would strive to address all areas of concern. He said: “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.“

Labour said it had written to independent public watchdog Audit Scotland demanding an investigation into the management culture at all health boards.

The party’s health spokeswoman Jackie Baillie MSP blamed unrealistic government targets for some of the issues highlighted in the report and warned similar practices could be going on across the country.

She said: “It is clear NHS Lothian was under huge pressure as a result of SNP budget cuts and an aggressively target-driven culture. NHS Lothian might be the health board that has been found out, but the pressures on all health boards are the same. I fear this is just the tip of the iceberg.”

Liberal Democrat health spokeswoman Alison McInnes said she was disappointed NHS staff continued to be subjected to workplace bullying.

NHS Lothian employs 28,000 staff, including 15,000 nurses and midwives and 2,700 medical staff. In March, when news of the mis-reporting of waiting times broke, Prof Barbour claimed bullying and harassment had “never been tolerated in NHS Lothian”.