Scottish health board review findings 'completely unacceptable', says John Swinney

The findings of a review into Scotland’s largest health board are “completely and utterly unacceptable”, First Minister John Swinney has said.

A probe by Healthcare Improvement Scotland found a “serious breakdown” in relationships among staff and management at NHS Greater Glasgow and Clyde (NHSGGC) was likely having a detrimental effect on patient care.

The agency looked at emergency departments (ED) in three hospitals in the health board, which serves a population of 1.2 million people and employs 44,000 staff.

The Queen Elizabeth University Hospital in Glasgow | PA

It carried out the review after concerns were raised by a group of ED clinicians at the Queen Elizabeth University Hospital (QEUH) in Glasgow that patient care was being compromised and their concerns were not being listened to.

Speaking during First Minister’s Questions on Thursday, Mr Swinney said: “Let me use this platform to make it abundantly clear to every health board in the country that the culture that is referred to by Healthcare Improvement Scotland is completely and utterly unacceptable.”

He said there was a new leadership team in place that was committed to addressing the issues raised in the report.

Scottish Labour leader Anas Sarwar said the findings were “devastating”, adding: “After years of warnings and hollow claims of lessons learned, why is this SNP Government allowing this rotten and at times fatal culture to continue?”

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The First Minister said: “Mr Sarwar has my assurance that in my communication and that of the Health Secretary [Neil Gray] to health boards, the contents of that report are unacceptable and they must be addressed by health boards around the country.”

Scottish Tory leader Russell Findlay warned similar situations were happening in emergency departments “across Scotland”.

The review, which examined EDs at the Royal Alexandra Hospital in Paisley, Glasgow Royal Infirmary and QEUH, found a culture of “disrespectful behaviours, poor teamwork and incivility” was having a negative impact on staff morale and wellbeing, as well as likely having a detrimental impact on patient care.

It warned of an “unacceptable normalisation” of so-called corridor care and of “ambulance stacking” as a solution for ED overcrowding at QEUH.

Review co-chair Dr Pamela Johnston said: “It was clear that every member of staff we spoke to at all levels of the organisation was committed to delivering high quality and safe care, and shared the ambition to improve the current situation for patients.

“However, when staff do not feel valued and respected, goodwill is eroded. To resolve this complex problem, NHSGGC needs to take a whole-system approach across urgent and unscheduled care.

“This strategy needs to start with everyone working collaboratively and respectfully to address the issues before them.”

The review team spoke with patients and staff, and said the latter had highlighted a number of matters of “serious concern”.

Staff at QEUH, they said, described examples of “significantly poor professional behaviours”, instances of alleged bullying, and “a lack of respect that has the potential to lead to patient harm”.

The review also described the level of stress and distress among staff at all levels in the three EDs as “palpable”, and said many staff described working in a “relentless and unforgiving environment that exceeded reasonable limits for prolonged periods”.

The report did, however, note the majority of patients that responded to a survey carried out for the review reported a “largely positive” experience of care.

Robbie Pearson, chief executive of Healthcare Improvement Scotland, said: “This report is one of the most far-reaching and comprehensive reviews we’ve undertaken, in terms of the breadth of evidence we’ve analysed, and the number of patients and staff that we engaged with.

“Moreover, we believe that the recommendations, including those that sit with our organisation to take forward, are the right ones to help deliver better patient care, both locally and at a national level, and supported by a positive culture where everyone works together to solve problems.”

The report, which runs to more than 180 pages, makes 30 recommendations for improving the situation at the health board, along with a further 11 recommendations for the Scottish Government and national agencies.

An NHSGGC spokesperson said: “The emergency departments in NHSGGC, like those across Scotland, continue to be under pressure.

“While we aim to provide high-quality care for our patients, delays in the flow through and out of hospitals often result in patients waiting too long in emergency departments. Under these pressures, the working environment can also be difficult for our staff.

“We have received the report from Healthcare Improvement Scotland which raises these issues and outlines a range of recommendations to improve both the local NHSGGC system and indeed A&E services across Scotland.

“We take the report, and most importantly the views of our patients and staff, very seriously and want to assure our patients and staff of our commitment to improve.

“In the two months since NHSGGC chief executive Professor (Jann) Gardner joined the organisation, she has been out meeting staff and hearing about our successes and challenges.

“Along with medical director Dr Scott Davidson and nurse director Prof Angela Wallace, Prof Gardner has pledged to listen to staff and to work collaboratively and respectfully to tackle the challenges we face and to build trust between staff of all levels.

“In addition, she has launched ambitious plans for whole-system transformation at scale and pace to address the pressures in our hospitals, create capacity to treat more patients who are waiting for treatment and to support more people to be treated from the comfort of their own home.

“Ensuring that our staff feel valued and respected is essential for our future success and this will sit at the heart of our work.

“Whilst this is being progressed, there may be further short-term measures that can be introduced to improve the patients and staff experience within our emergency departments. The chief executive, along with colleagues, will meet staff early next week to begin a supportive dialogue on this.”