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

34. Specific Proposals: Present Support

Individual Support

34.1. Support is needed for individual employees in NHSH (at all levels), who have experienced inappropriate behaviour and who have suffered distress, harm and other loss. This should include providing safe spaces for many current and outstanding physical, emotional and psychological issues to be addressed fairly urgently.

34.2. This will include some people with whom I have met and others with whom there was not time to meet. Some responded to the review, others may not have spoken up at all. It is likely that there are quieter voices still to be heard. It is not enough to assume that, because people have not spoken out, there might not be a need to be pro-active now.

34.3. This support should be provided by facilitators who have a variety of skills, including trauma recognition, pastoral care and other counselling and complaint handling skills. The extent of this is not easy to measure and I acknowledge could take many months and will need to be well resourced. The number of those who may need help could be in the hundreds. A specific time limit should be set for completion of this task so that a sense of closure can be achieved.

34.4. A number of NHSH employees have "bystander" guilt or shame. They now regret not acting when they could see things occurring which were inappropriate. These people may also need support and understanding as they work through the cycle of denial, blame, confusion, acceptance and moving on. Specific recognition of this experience may be an important step.

34.5. In all of these, clarity around purpose and objectives is essential in order to avoid creating unrealistic expectations.

Listening is Key

34.6. Linked to this, as noted above, there are a number of people who approached the review with whom there was not adequate time to meet. Some of these respondents may be satisfied that the contents of this report address their concerns. However, others may still wish to be heard and offer views, whatever the rights and wrongs of what they have experienced or perceived.

34.7. A simple private listening exercise may be all that is required along the lines of the meetings I have already conducted in this review. This should be offered, again within a limited time period of say three months, if resources can be made available within that timescale.

34.8. For completeness, an invitation to participate in such an exercise should be extended to those employees who may not have received information about the review and to any others who may still wish to come forward. This needs to be well communicated and widely disseminated and, to manage expectations, there should be clarity at the outset about what the expected objectives, outputs and timescale are intended to be.

34.9. I am privy to a significant amount of information about specific instances of inappropriate behaviour in specific departments in NHSH. The steps above should ensure that a mechanism is offered to those who have contacted me and still wish to take matters forward to be able to contact a confidential resource with these concerns.

Independent Process

34.10. It is likely that these initiatives will result in a need to address some specific complaints, disciplinary matters and grievances, many of which appear to remain outstanding and/or unresolved. The cooperation of the unions, especially the GMB, will be important in this. A strategy to resolve the many outstanding cases as speedily as possible should be devised, within a set timescale so that people and the organisation can move on.

34.11. It is for discussion whether this support should be provided on a basis independent of NHSH. Certainly, as a number of issues pertain to the perceived inadequacy or lack of impartiality of internal support, it is likely that there will be much more confidence in external provision at least until NHSH internal procedures are credible and can meet this need and there is renewed confidence in governance and leadership. Indeed, I understand that NHSH HR department would welcome outside help from a dedicated team to help address current and outstanding individual cases.

Safe Spaces

34.12. Many of the issues currently being or which could potentially be addressed through conventional grievance and other procedures may be amenable to, and more effectively resolved by, facilitated conversations and mediation. In all of this, thought should therefore be given to designing a process to engage a number of independent facilitators and mediators who could assist with the backlog.

34.13. Separately, there is a clear need for safe and independent spaces for people, including those characterised as "victim(s)" and "perpetrator(s)", to be supported in trying to break the cycle of accusation and counter-accusation. I am mindful that providing support and compassion for those who have been viewed as perpetrators will be the most difficult aspect for many people; nevertheless, it will be necessary if healing is to occur. And, of course, these terms are not easy to apply and may be interchangeable in some contexts.

34.14. As part of this, steps should be taken, wherever possible, to rehabilitate, retrain and reintegrate staff who have been the subject of, or accused of, bullying. Where this is not possible, steps should be taken to make necessary staffing changes. Careful and wise oversight will be essential, especially in cases where there has been, or is, a diagnosis of trauma. Returning to a place where trauma has been experienced can, I am advised, be counter-productive. Trauma specialists should be asked to provide guidance.

34.15. To an extent, there is an element of truth and reconciliation and restorative justice in these proposals. This needs to be done for the longer-term health not just of NHSH but of individuals and communities.

Meetings and Workshops

34.16. Well facilitated meetings in local areas with specific groups may be useful as a way forward and to address current concerns. However, it is important to bear in mind that many issues arise within such groups. Thus, a mix of individual meetings and group sessions may be necessary. This would apply to specific departments and disciplines and to some geographic areas.

34.17. In particular, an initiative to identify, contact and support clinical departments and other practices and departments which have been particularly affected by inappropriate behaviours in recent times is necessary. In each case, steps should be taken to listen to all points of view, including the most junior staff, managers, clinicians and the quieter voices in a safe environment. A series of workshops and private meetings is likely to be the most effective combination for this.

Financial Matters

34.18. A number of people appear to have suffered some financial loss as a result of (alleged) inappropriate handling of their situations and are in financial difficulty as a result. Whether these claims are fully justified is beyond the scope of this report but many have a feeling of helplessness and hopelessness. Many feel let down by or inadequately supported by HR or other representatives, including on occasions trade unions and professional bodies. It is for consideration whether some form of independent review panel might be established for a limited period to bring closure for these individuals.