NHS a haven for bullies

Some of you will be aware that in recent months, Nicola Sturgeon was forced to face up to the fact that the NHS in Scotland was not working as it should.  NHS Lothian was found to have been fiddling waiting list figures.  This was not a 'victimless crime'.  People were being denied treatment they needed.  All in order to meet targets set by Nicola Sturgeon.

Part of the underlying cause in this mess is that the Cabinet Secretary for Health, Nicola Sturgeon, refuses to put in place robust central systems which give her instant access to audited performance data from NHS Boards on a range of critical areas of work.  For instance, Nicola could not tell you what the gender pay gap is just now across the NHS in Scotland.  She would have to write to all the NHS Boards and ask them to supply the information, then get one of her staff to put all 22 reports onto one spreadsheet and work out the answer.  But that issue is for another blog.

Back to the waiting list fiddling.  Back to the organised, institutional cheating of patients out of their right to being fairly treated, and not just in the medical sense, but also in the sense of basic human decency.  Back to our NHS, where the government has used up lots of Parliamentary time to push through a Patients Rights Act, which ensures in the fine print at the end of the Act that none of the 'rights' are enforceable in the courts.

In March 2012, PriceWaterhouseCoopers [PWC] presented a report to Scottish Government, 'Review of Aspects of Waiting Times Management at NHS Lothian'.  28 pages of dry, let's not scare the horses, comfortable and comforting jargon.  The verdict ?  In the words of the report - "In considering the multiple evidence sources, it is apparent that the management and processes for waiting times at NHS Lothian have been sub optimal."  I love that - sub-optimal.  The kind of language you can safely use in front of your granny.  Not sure the patients cheated out of their treatment would agree that phrasing was accurate.

In considering the multiple evidence sources, it is apparent that the management and processes for waiting times at NHS Lothian have been sub optimal 

Another report into the wider issues on the management culture at NHS Lothian was published in May 2012.  Translated ?  The PWC report found evidence of bullying and Nicola Sturgeon asked for another report into that.  This report was also written in that careful language one commonly encounters in the NHS.  It did manage to say - "Furthermore and more significantly the alleged inappropriate behaviours have endured and gone unchallenged or become accepted."  Translated ?  There was/is a bullying culture in NHS Lothian and one of the consequences was the fiddling of waiting times because the real picture was bad news senior managers did not want the Board to know about.

OK. Caught fiddling.  Caught bullying.  What does Nicola do ?  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."  She went on "I have now asked Dr Charles Winstanley [NHS Lothian Board Chairperson] to produce a single integrated action plan which will bring together the improvements required in waiting time information reporting, governance and culture.”

Translated ?  She asks the same Board members [appointed by her] who sat there while all this fiddling and bullying was going on under their noses to undertake the Augean stable cleaning.  Bit like asking Fred Goodwin and other 'sub-optimal' bankers to fix the banking crisis they created and guide us out of the recession.  Baffled, bewildered and bemused by her 'thinking', I asked the Cabinet Secretary why she was not considering her own position, given she had to take some responsibility for appointing a Board which had been unable to impose effective governance which would have avoided the fiddling and the bullying.  I also asked what she was doing to protect the staff who had been bullied and who were still being bullied.

The response I got was breathtaking in its attempt to do a Marie Antoinette [albeit with that Weegie accent and head-butting nod used by the Cabinet Secretary in interviews] over the issues.  Nicola said : "The results of the 2010 national staff survey indicated that less than 1.5% of NHS Lothian staff reported incidents of bullying or harassment. It would, therefore, have been difficult to conclude from the staff survey results that a culture of bullying existed. There is no indication from the 2010 national staff survey result that there is a wider culture of bullying across NHSScotland."   She had also decided, not unusually, to ignore most of my direct questions.  I have gone back to her along the following lines.

You say that there is no indication that there is a bullying culture in the NHS Scotland, citing the staff survey. Two things. Surveys are not the best tool with which to pick up bullying, as few NHS staff believe it is worth completing that or any other survey to ascertain staff experiences in this regard as they have no trust that their views will receive proper attention or action.  Your response concedes this very point on Lothian's results, and yet you now know that bullying exists in Lothian.

Secondly, the report on the bullying culture in NHS Lothian did put it into a context of how it compared to the rest of the NHS [as evidenced by the staff survey results] and found that there was no marked variation between NHS Lothian and the rest of the NHS.  It follows that if there is a bullying culture in NHS Lothian there is a strong likelihood that there is such a culture across the rest of the NHS.  You cannot concede on the one hand that the staff survey did not reveal the bullying found in NHS Lothian and then cite the same staff survey results as providing no indication that there is bullying across the rest of the NHS. 

Staff in the NHS will be filled with despair at this quality of analysis by the Cabinet Secretary.  Other than a flawed if not lazy analysis by the Cabinet Secretary, the response sets out in a lot of detail the many processes NHS Scotland has for tackling bullying.  Process itself will never change behaviours.  Glossy brochures, posters, leaflets and sound-bites will not change the culture of the NHS.  That apart, unless there is some kind of quality assurance around the various efforts being made to ‘tackle’ bullying, linked to monitoring over time of how staff perceive any change in bullying behaviours, it is all a waste of time and is on a par with much of the equalities work done in NHS Scotland where for example it still cannot provide robust data on whether BME or disabled people get access to the same quality of health services as non-BME and non-disabled people.  There are myriad processes across the NHS which suggest much activity on equality, but little or no evidence that any change is being made or discrimination is being eliminated.  So too is it with NHS Scotland’s limited value work on bullying.

Aside from that, my reading and re-reading of your response finds that you have ignored, avoided, or mislaid the core and direct questions I asked in my email of 15th May. This seems a tad discourteous, and I would courteously invite you to respond directly to these, and urgently.  These were :

Why have you as Cabinet Secretary, who has lead responsibility for creating the management culture in the NHS at the most senior levels, not accepted responsibility in any way for what has been uncovered and why have you not decided that your resignation would be the most appropriate and honourable action?

Given the Board members in NHS Lothian were all appointed by you, and that the governance arrangements at NHS Lothian failed to work in uncovering and dealing with the bullying culture, why is it that the Board is not being sacked and new, untainted, Board appointments being made?

Given the adverse impact on the patient experience as a result of the fiddling of waiting time guarantees, what confidence can and should patients have that the bullying culture has not also impacted on the quality of patient services in other parts of the NHS?

Given the report found no basis for believing that the bullying in NHS Lothian was unique to the NHS in Scotland, what radical and meaningful action is being taken to identify and eliminate bullying across the entire NHS?

And finally but no less importantly, why have you as Cabinet Secretary not required NHS Lothian to investigate the number of staff who have been dismissed or who have resigned from NHS Lothian employment as a direct result of the bullying culture and look at options for reinstatement of those staff or, at worst, appropriate levels of financial compensation being awarded to them?

The Cabinet Secretary needs to deal with the lives of those who have been bullied out of work in the NHS.  Ignoring it won't make it go away.  Ignoring it will mean that the culture uncovered will not change.  If you want to push the Cabinet Secretary into doing something real on bullying in our NHS, send her a tweet via this button.   Tweet to @NicolaSturgeon