Cultural issues related to allegations of bullying and harassment in NHS Highland: independent review report

9. Navigating the Substance of the Report

Symptoms, Diagnoses and Remedies

9.1. My approach to the substance of this review is to describe what I have heard and read and to try to identify the circumstances which have led to the allegations of bullying and harassment, and to add my observations about these. This includes what, in terms of my remit, I "understand to be the cultural issues, if any, which have led to any bullying or harassment and [to a situation] where such allegations apparently cannot be raised and responded to locally."

9.2. Thus, simplistically, I am dealing with symptoms and diagnosis in this report (noting that things will often be more complex and multi-faceted). These refer both to events in the past over several years and to current circumstances. I am conscious of the exhortation not to "overwrite" or "underwrite" in such a report. Given the quality and substantial nature of so much of what I have heard, if I have erred it will be to overwrite. I do so in an attempt to ensure that, wherever possible, people feel that they have been properly acknowledged and enabled to move on – and also to give the Board and management a clear indication of what people in NHSH are saying.

9.3. This is an organisation with an £800 million budget funded by the taxpayer. The current situation merits serious analysis. The review has received an enormous amount of information, all of which will be destroyed soon for reasons of confidentiality. This report, therefore, is a distillation, a summary and what will soon be the only record of what I have been told.

9.4. I also seek to "identify proposals and recommendations for ways forward which will help to ensure the culture within NHS Highland in the future is open and transparent and perceived by all concerned in this way".

9.5. Thus, I seek to suggest possible remedies. As I have mentioned, these include both the restorative (seeking to address past and present issues) and the preventative (looking to the future and avoiding continuation or repetition of problems). These proposals are however merely signposts for others to follow in what needs to be an organisation-wide collaborative project of renewal.

Themes and Topics

9.6. Inevitably, what I have heard and read has caused me to consider the terms of my remit. I have taken the view that it would be helpful to take a broad rather than narrow interpretation of my remit, when I have heard and read so much which could help the organisation to learn and move forward.

9.7. Thus, to take words referred to in connection with remit, I "will consider all the circumstances that have led to the allegations and make recommendations".

9.8. This leads me to address matters in this report according to themes and topics, following I hope some sort of logical order. I have quoted liberally from my meetings and from written submissions as these speak more eloquently than any words of mine. However, as agreed with respondents, remarks have been used in a way which is non-attributable unless I have specific agreement to the contrary. Where I have been concerned about any possible risk of attribution, I have sought to check with the authors. If any have slipped through the net, I apologise. I have endeavoured to correct typographical errors but have not corrected grammar, except where necessary to make sense of the words used.

9.9. I am aware that extracting excerpts from longer submissions may deprive words of their context and I acknowledge that this may occasionally be a cause for concern. I have done my best to try to understand and place contributions in their wider context. I take full responsibility for the way in which this report is presented.

A Note of Caution

9.10. Finally, again, I need to reinforce the important point that matters are complex and not amenable to binary, simplistic analysis. There are many sides to most stories. I was presented with many contradictions and inconsistencies. Care needs to be taken in reaching overall conclusions and making apparently universal statements. I am conscious that I shall have slipped into doing so myself on occasions where the circumstances are probably more nuanced. My report should be read with all that in mind.

9.11. I start with some general observations about bullying and culture before moving on to the symptoms experienced in NHSH.