Bullying and Harassment in the National Health Service

– in the Scottish Parliament on 10 September 2019.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The final item of business is a members’ business debate on motion S5M-17240, in the name of Edward Mountain, on bullying and harassment in the national health service. The debate will be concluded without any question being put.

Motion debated,

That the Parliament, in light of John Sturrock QC’s report into allegations of bullying and harassment at NHS Highland, commends the courage of all those who have spoken out in this regard and also those who do so throughout NHS Scotland, and notes calls on the Scottish Government to protect and support all those who speak out against bullying and harassment and to ensure that the whistleblowing process is robust and easily accessible.

Photo of Edward Mountain Edward Mountain Conservative

I thank those members who supported the motion in my name, including David Stewart, Rhoda Grant and Neil Findlay from Labour, Mike Rumbles from the Liberal Democrats and John Finnie from the Greens. I am, however, sad that no member of the Scottish National Party signed the motion.

I welcome all those who have travelled from the Highlands to listen to the debate. Some of those who are sitting in the public gallery are members of the whistleblowing group, and I would like to thank them for everything that they have done.

Only last week, an MSP asked me whether I really believed that bullying is an issue. The simple answer is yes—not physical bullying but psychological bullying, which is often worse. Some suffered in silence and some resigned, but until the whistleblowers spoke out, they had nowhere to turn.

I have received requests for help from not only victims but parents who were worried about their children, and wives and husbands who were worried about their partners. I have heard many heartbreaking stories about why people could not face the next day at work because of bullying. One person was not sure that they could face life at all. After 12 years in the Army, I am not faint hearted, but to be rung on a Friday night by a parent distraught about their child, a national health service employee who was contemplating suicide, was not easy.

That was just the tip of the iceberg. Once the whistle was blown, 140 bullying victim testimonies were collated by the GMB trade union, shedding light on the deeply harrowing experiences of a wide variety of NHS Highland staff. Despite my calls and those of many others, the Scottish Government dithered about whether to launch an investigation. When it did so, and John Sturrock QC published his report, the report confirmed what many knew already: there was indeed “fear and intimidation” of staff, many of whom had

“suffered significant and serious harm”.

In my years of professional experience, I have never read such a damning report. In the weeks and months since the report was published, many NHS Highland employees have contacted me. Most were relieved that the culture of bullying had finally been recognised. However, some felt that the report did not deal with their situation. Those are the ones I call the managed out—they were managed out of their jobs by bullying, and they feel that the Sturrock report has not addressed their mistreatment. They should not feel marginalised as part of the process, and I call on the Scottish Government to fully investigate their situation.

It is clear that the Sturrock report, rather than being the last step, is the first step towards changing the culture of NHS Highland. I welcome the reconciliatory approach that has been taken by the new chair and chief executive of NHS Highland. They are driving forward a new culture of respect, and the health board is slowly rebuilding.

However, NHS Highland is not alone in needing to change. In the wake of the Sturrock report, the Scottish Government must also change how it operates. In October last year, the Cabinet Secretary for Health and Sport announced that she would appoint a whistleblowing champion for each health board. I welcome that action, but it has taken until the summer of this year for applications to open. That is too long.

We know what happens when there is not a robust system. As one non-executive director stated in the Sturrock report:

“The issue of a bullying culture was first raised with the auditors, Audit Chair and Board Chair in late 2016.”

They went on to say that the Scottish Government

“knew about it” but

“Nothing was done.”

In fact, the Government seemed to be blind to the warning signals. Perhaps the biggest red flag was in 2017, when four non-executive members of the NHS Highland board resigned.

When some of the board’s non-executive directors expressed a lack of confidence in the chair and the chief executive, it became clear that something was being done to prop up a failing management team. In response to the non-executives’ claims, the executive members of the board wrote to their colleagues stating their unreserved support for the chair and the chief executive. Not only does that show the dysfunction of the board back in 2017, but it raises serious questions about why the Scottish Government was not watching. Why did it have to take four senior clinicians to exhaust every avenue before their only option was to blow the whistle? Many people are asking why, if the Scottish Government knew about the bullying, it did nothing. Many staff members, both former and current, would like an answer to that question. I believe that they deserve it, which is why I support the whistleblowers’ calls for a further investigation to be launched into why no action was taken in 2016 and to find out what was going on in the board.

Too many loyal and hardworking NHS staff have been mistreated and had their careers ruined as a result of being bullied in NHS Highland. I welcome the Sturrock report, but we need to be clear that the report is just the beginning of a process and not the end. I support the actions of the new chair and chief executive in following through on Sturrock’s recommendations, but Sturrock’s report did not answer every concern. As I mentioned, NHS Highland cannot move on until former employees who were managed out have had their mistreatment addressed.

We still need to have the full and frank debate on the Sturrock report that the cabinet secretary promised in this session of Parliament. We need to make sure that this appalling and sorry state of affairs never, ever happens again. I finish with a plea: let us have that debate, which would be part of the healing process, and let us ensure that whistleblowers are appointed to every board as soon as possible.

The Deputy Presiding Officer:

We now move to the open debate, with speeches of four minutes.

Photo of Emma Harper Emma Harper Scottish National Party

I read John Sturrock’s report, which is great and contains a lot of information. I recommend that employees who work for any health board look at it, because it includes good guidance.

I thank Edward Mountain for bringing the motion to the chamber. It is an extremely important subject, which has raised many questions and statements—and rightly so.

I, too, commend the courage—as noted in the motion—of the NHS Highland employees who spoke out to inform John Sturrock QC in his inquiry into cultural issues related to allegations of bullying and harassment in NHS Highland. It is difficult to come forward to raise complaints and concerns about one’s place of work and to challenge the behaviours of peers and managers. People do so, I hope, with the intention of obtaining better outcomes for all.

As we have heard already, bullying damages lives. It is important to state the quotation from Maya Angelou that John Sturrock’s review includes:

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

The emotional stress that bullying inflicts can lead to poor work performance and absenteeism, and it can even force people to leave their jobs, as we have heard. Conversely, dignity at work has profoundly energising effects on employees, their feelings of integrity, self-respect and pride and their motivation.

Much has been done across NHS Scotland to tackle bullying and harassment in the workplace and to promote the standards of behaviour that are acceptable and expected in each organisation. It is important to note that dignity at work in NHS Scotland extends beyond a workplace that is free of bullying and relates also to a working environment where one feels dignified, doing valuable work in a supportive environment for fair reward. Being valued, listened to and treated with respect are just some of the things that are experienced in a dignified workplace. Bullying and harassment are not new, and are not just focused in NHS Scotland.

Members are aware that I have been a nurse for 30 years and was previously employed in the USA, NHS England and NHS Dumfries and Galloway. I have experienced harassment, which is called “horizontal hostility” or “lateral violence” in the USA. It is not necessarily physical, as Edward Mountain said; it is also psychological.

In my case, while working in the operating room in Los Angeles, on more than one occasion, specialist laparoscopic surgical instruments unusually “disappeared” from their specific labelled, organised storage place—we knew that we should be tracking those items. Then they miraculously reappeared after a particular individual came to the rescue in order to curry favour with the surgeon. My video imaging equipment would be rewired over the weekend, which affected the patients’ safety. That direct sabotage put patients at risk.

We know that promoting dignity at work and a good, civilised work environment matters, because it reduces errors and stress and fosters excellence.

What are the solutions? What can be done to support and promote in the workplace a culture in which morale is good and staff are empowered and motivated and achieve great work?

In preparing for the debate, I noted five main items that can be addressed. I cannot deal with them all now, but during my research, I found that Professor Beverly Alimo-Metcalfe has looked at what we need to do to support leadership. I ask the cabinet secretary what measurement statistics we are using to look at the effectiveness of an individual leader in developing a positive culture across their teams, and how we measure sensitivity to the change that is required.

The transformational change that we are seeing with health and social care integration across all our health boards—whether in Scotland or England, or even in the USA—really needs to be looked at. What are NHS Education for Scotland, Healthcare Improvement Scotland and organisational development leaders doing to collaborate across the health system, so that we can have a civilised work environment in which we reduce errors and stress and foster excellence?

I look forward to supporting the cabinet secretary and to hearing her response.

Photo of Miles Briggs Miles Briggs Conservative

I congratulate my friend and colleague Edward Mountain on securing this important debate and pay tribute to the excellent work that he has done in continuing to speak out for NHS Highland staff who have experienced bullying and harassment. I know, from having met and spoken with some members of NHS Highland in the past weeks and months, that they greatly appreciate the work that he has done.

I thank NHS Highland’s new management team, which hosted me on a visit to Raigmore hospital in April. We had the opportunity to have an open and frank discussion about the real challenges that that team faces in trying to move the organisation forward. That is vital for any organisation. NHS Highland needs to move forward from issues in the past. Real learning can be taken forward in any organisation only if it moves forward to ensure that such things never happen again.

I echo and support the sentiments in the motion, which commends all staff across NHS Scotland who have come forward and spoken out about bullying and harassment in their workplace. Their bravery can help not only their fellow NHS colleagues but patients in our health service.

As Emma Harper rightly stated, we will get the best out of our NHS staff in any workplace only when they feel truly valued and respected. Much progress still needs to be made nationally to help to achieve that, and I know that people in NHS Highland are acutely aware of that.

I look forward to the Government holding a full parliamentary debate on the Sturrock report. The cabinet secretary pledged that to me in her statement on 9 May, and I have recently followed that up with her in writing.

The Scottish Conservatives welcome the Sturrock report and its important recommendations, many of which we believe can be applied widely across all NHS boards. The report found significant and alarming evidence of bullying and harassment in NHS Highland. Many staff suffered serious harm and trauma to the extent—this has been outlined—that they were forced to quit their jobs or retire early, and that has added to well-known staffing challenges in many specialties.

We remain deeply concerned that it took ministers so long to take any action to intervene, although they knew about the dysfunctional management and the nature of the complaints in NHS Highland from at least the autumn of 2017.

The Scottish Conservatives back a zero-tolerance approach to bullying and harassment in the NHS. We have called for better processes for NHS whistleblowers for more than a decade and have repeatedly said that the Scottish Government needs to help to build a genuine culture of openness in our NHS in which our NHS staff feel able to raise concerns and suggest improvements without fear.

We should acknowledge that the whistleblower helpline has been a welcome improvement, but there is much more that we can do. I am pleased that the Parliament’s Health and Sport Committee recently looked carefully at proposals for the Scottish Public Services Ombudsman’s new role as the independent national whistleblowing officer. We recently published our report on that.

It is vital that we get the system right, that the new national standards for NHS services ensure that all organisations receive and investigate any whistleblowing concerns, and that those standards are robust and transparent.

In its written submission to the committee’s inquiry on a new national whistleblowing officer, the British Medical Association stated:

“We consistently hear from our members that they fear raising concerns or ‘whistleblowing’ for the possible impact they believe it could have on their career or their relationship with colleagues. Many also believe that they won’t be listened to or it won’t make a difference.

This is simply not acceptable.”

That has to change. The BMA is right, and its comments indicate just how far we still need to go to have a system that truly enjoys the confidence of NHS staff across Scotland, protects their confidentiality, and offers them real assurance that their concerns will be properly investigated and addressed.

To conclude, I very much welcome the debate and the spirit in which it has been brought to the chamber. We need to focus on bringing support to our NHS staff and ensuring that they receive the full support of the Parliament and the minister. Our NHS staff work incredibly hard day in, day out. They look after all of us. In turn, we need to ensure that the best possible systems are in place to respond to any concerns that they have.

I look forward to a longer debate on the Sturrock report in the future. The Scottish Conservatives will continue to back our NHS workforce to ensure that we have an accessible, transparent and effective whistleblowing process.

Photo of David Stewart David Stewart Labour

I congratulate Edward Mountain on securing the debate and on his excellent and well-researched speech. It is welcome that the debate follows on from the issue having been raised at last week’s meeting of the Health and Sport Committee.

I, too, congratulate the NHS Highland whistleblowers who are in the public gallery on their tenacity in pushing forward their important campaign.

The debate is timely. Everyone has a right to be treated with dignity and respect at work. Bullying and harassment are unacceptable and a violation of human and legal rights. Let us be clear: bullying is not acceptable anywhere, at any time, in society; it is an abuse of power.

Earlier this year, it was revealed that the number of NHS staff who contacted a whistleblowing hotline in Scotland had more than doubled in six months. It is imperative that the Scottish Government discovers why the NHS in Scotland has become such a fertile ground for inappropriate behaviour, and why some senior staff refuse to listen to the concerns of those who work on the front line.

It had always seemed to me that there was an underlying toxic culture of bullying in NHS Highland and that that was clearly having an effect on staff morale and emotional health. The wider issue is the possible effect that that has had on the credibility of NHS Highland and on the ability to recruit and retain staff. It is difficult to measure the effect on patients, but there will surely have been an impact.

Like Edward Mountain, I strongly supported the cabinet secretary’s appointment of John Sturrock QC to carry out the independent review. I have worked with Mr Sturrock in the past and hold him in high regard. Although Mr Sturrock said that there were multiple possible causes of bullying and harassment in the NHS, he touched on the role of increased pressure to perform and to meet targets as a factor in the overall equation.

Like others, I recognise that NHS Highland has experienced a change in leadership since the bullying saga first began. I, too, welcome the appointment of Iain Stewart as the chief executive, and of interim chair Professor Boyd Robertson, whom I know well from his days at Sabhal Mòr Ostaig. However, it is vital that NHS Highland moves quickly to explain what it plans to do by way of reparation for all the previous victims of bullying and harassment, both in terms of psychological support and compensation.

My case bag has been full, as those of other MSPs in the chamber will have been, of details of victims. Some victims who have contacted me have had their careers ruined, some have lost out financially and many have suffered mental health issues. One victim told me:

“I never ever wanted to leave but I felt forced into it and I had no-one to speak for me ... I have lost the job I loved, lost my earnings and also years of pensions. Finances have been dreadfully difficult for me since I left.”

Another victim, who was highlighted by the GMB, doctors and whistleblowers last year, said that raising a bullying and harassment case meant that

“every step of the way you were on trial”.

We have to learn from others elsewhere. The freedom to speak up review, which was led by Sir Robert Francis QC, examined bullying in the NHS in England. Its recommendations stressed that what was needed was early support for whistleblowers, a cultural change, the prevention of isolation and containment, and legal protection for whistleblowers.

As we all know, next year, the Scottish Government plans to create the independent national whistleblowing officer, whose new role and functions will be undertaken by the Scottish Public Services Ombudsman. The aim is to ensure that everyone who delivers NHS services in Scotland is able to speak out and to raise concerns when they see harm or wrongdoing that puts patient safety at risk or when they are aware of other forms of wrongdoing.

The Scottish Government has the opportunity to build a national culture in the health service in which there is openness and trust, and creating a truly independent whistleblowing officer will be an important first step. The message from all sides of the chamber in the debate has been that there is no place for bullying in the Scottish health service. We need to reclaim the workforce. Knowing what is right does not mean much unless we do what is right.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I thank Edward Mountain for giving us this opportunity to have a short debate. He asked when the Government will use its time for a debate on the topic. We will do that—I will return to that point.

Edward Mountain’s motion calls on the Parliament to commend

“the courage of ... those who have spoken out” in NHS Highland and

“those who do so throughout NHS Scotland” today. I am sure that we all support that call.

As I have done previously, I personally thank those in NHS Highland who spoke out, including those who are in the public gallery. Their courage is much to be commended. Speaking out is never an easy thing to do. I also apologise to them and to others for the fact that they were bullied and suffered hurt and harm in NHS Highland and elsewhere.

As members know, we commissioned the Sturrock review. I thank all those who contributed to the review and who took the time to explain their experience and their story to John Sturrock. Again, that was not an easy thing to do, but their input has fully informed his report. It has also had an impact on the thinking in Government and, more widely, across the chamber.

What have we, as a Government, done since John Sturrock’s report was published? We have asked all boards to consider the report’s recommendations, to look at how the report impacts on their policy and practice and to report to us on where they consider that improvements are needed. All of that is being looked at. Before the end of this year, Joe FitzPatrick and I will conduct a mid-year review with all the boards. We will look at their responses against what we are being told by the partnership forum and others about how a particular board operates.

Edward Mountain referred to non-executive whistleblowing champions. We have had 139 applications for those roles, and the champions will be in post by the end of the year.

As members know, the national whistleblowing officer, which is now part of the Scottish Public Services Ombudsman’s office, will fully begin their role next year.

I think that I have mentioned our “once for Scotland” approach when talking about our policies on whistleblowing. If that is used a lot, that means that the policies and the culture are not working. Yes, we need the whistleblowing bit to be right, but we need the policies and the culture to be right.

I have discovered that what are essentially good policies on staff support, culture, openness and the raising of concerns are not being applied consistently between our boards or, indeed, even in our boards, so we are undertaking work to tackle that.

I am sure that members will recall that, in my statement in May, I talked not just about what John Sturrock had said about NHS Highland but about what lessons there are for the whole of our national health service.

Photo of David Stewart David Stewart Labour

I understand that there will be investigation, post-Sturrock, into Argyle and Bute. Will the cabinet secretary say a little bit more about that?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

NHS Highland, with the staff in Argyle and Bute, has identified, on the basis of the Sturrock report, exactly what needs to be looked at, and it is in the process of identifying who will lead that review. The review should be short—given the scale and size of the issue, it does not need to be as long as John Sturrock’s review was. I hope to have all the detail of that review very soon, and I will make sure that David Stewart and other members have that information.

We knew that the Sturrock report would include lessons for bodies across the health service. Consequently, as members know, I convene a ministerial group that brings together the leadership across our NHS, including the leadership of boards, royal colleges, regulatory bodies and trade unions. The group has been widened to include the whole health and social care system, so local authorities are involved, too.

We met on 31 July, and we will next meet on 28 October. In between times, some of the work that is under way includes looking at Emma Harper’s question about how something as intangible as positive culture is measured. We can produce measurements that would give us a bit of an indication about how an organisation is working, but how should we measure how people feel? That work is looking more widely to see whether there are lessons that we can learn elsewhere.

On NHS Highland, I am pleased to hear colleagues rightly offer their support for the new leadership team and the work that they have undertaken. They have spent the past weeks since the Sturrock report was published in discussions with individual members of staff, groups of staff and the board. I visited NHS Highland in June and had the opportunity to speak with the people who are in the public gallery today and others about their experience and what they expected and hoped for.

The board and senior leadership have come together to identify six key areas of improvement: hurting and healing; information; people processes; values and behaviours; resilience; and communications. In that context, they will consider the important point that Mr Mountain made about the people he referred to as the managed out—people who have left or have felt under a compunction to leave because of the culture that existed in NHS Highland—and the issue of what action might be appropriate in respect of them, on a case-by-case basis, because that is entirely an individual matter. I discussed the issue with colleagues when I was there in June. The approach has to be about what is right for each person as opposed to being a policy. The policy is that there should be work done in order to make restitution. What the restitution is should be decided by means of a discussion between the board and each individual to determine what works.

Having come up with the plan, the leadership team will now engage with all staff in NHS Highland, as I wanted them to. Colleagues will remember that John Sturrock pointed out that, although there was a body of staff who had experienced bullying and had been hurt and harmed by it, there was another body of staff who had not had that experience and felt that the organisation that they worked for had somehow been tarnished, and that there was a need to bring those two groups together and move forward. Therefore, going back to all the staff with the plan is important. Once that process has been completed, I will again speak to NHS Highland about what it will do next and will make sure that that meets my expectations.

I do not accept that ministers took too long to intervene. I do not have time to discuss the matter in detail today, but members will recall from previous parliamentary answers and my statement that I have set out a number of steps that Government officials, on the instruction of ministers before my appointment, undertook to support the board in a number of ways. However, in November, after a number of courageous individuals stepped forward and said that there was a culture of bullying in NHS Highland, I commissioned John Sturrock’s report.

With regard to a Government debate on the issue, it seems to me that the most sensible thing to do is to bring a debate to the chamber when we have had the next meeting of the ministerial group on workplace culture in the NHS and when NHS Highland has had that final set of discussions with its staff on the plan that it intends to undertake. At that point, we can have a debate about what we are proposing across the whole of our NHS, about what is being undertaken in NHS Highland and about whether there is more that colleagues in the chamber think that we should do.

I do not think that this is an issue in which our particular party affiliations divide us at all, and I do not think that it should be that kind of issue. I think that it is an issue on which we can constructively and positively work together for the benefit and the sake of the staff in our NHS, who work hard every day to do the best job that they can.

Meeting closed at 17:38.