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

3. NHS Highland

A Place of Work

3.1. It has been an enormous privilege to conduct this review. NHSH is a central and vital part of the Highland community. It extends from Caithness to Campbeltown, from Kingussie to Portree and from Nairn to Tobermory. But, interestingly, not to Elgin or Stornoway, Kirkwall or Perth! It has its central focal point at Raigmore in Inverness. It is a large, diverse, complex and sometimes fragile organisation. NHSH is and has been for many a great place to work. The following observations by some of the respondents to the review emphasise this point.

"I am immensely proud to work for the NHS and NHS Highland, I love my job and I think that the majority of people working within the NHS go above and beyond every day when they are at work."

"My over-riding impression is that staff are trying their very hardest to provide the best standard of care for their patients."

"My experience of working as a nurse in NHS Highland is a very positive one... Where ever I go and whoever I interact or work with I am filled with a great sense of pride to see such great staff delivering really excellent care."

"Raigmore is the nicest, friendliest hospital I have ever worked in."

"Generally speaking, it sometimes feels like the organisation is under siege. One of the things that keeps me going is how many good things one can see in the organisation. Being able to see that there are positive things happening."

The People who Work in NHSH

3.2. There are thousands of well-motivated, caring and supportive people providing excellent caring services to thousands of patients in the area served by NHSH, often sacrificially and well beyond the call of duty. I have met many very fine, high quality professional people, trying – and doing – their best in their jobs, which they love, in often really difficult circumstances. The public's expectations of them (and of the NHS as a whole) are huge. We must acknowledge that fact and its effects.

3.3. I have admired the professionalism and humanity of individuals whose primary role is either to provide care for others in the community at times of stress and pain or to support colleagues who do so. I am struck by the essential goodness of those employed by NHSH and also by the adverse impact on many of them of the allegations which have been made, including on those for whom the allegations came as a shock.

3.4. This has been a very hard time for many employees of NHSH and those connected with NHSH. It may be that focus on the primacy of patient care and safety in recent years, through quality and performance initiatives, has not been matched in all situations by care for those delivering the services. The two are of course inseparable.

3.5. Overall, I am sure that NHSH staff wish to do well for and to support each other and the patients and others they seek to serve. This can and should be the foundation going forward. Patients and others in the NHSH community need to be reassured that the day to day work of the organisation is designed and able to do the very best it can for all concerned.

Pressures and Priorities

3.6. I am aware that there are other pressures and priorities too, not least financially. The organisation is under huge financial pressure. While that is so, it seems really important that the people side is given full consideration. While cost constraints are a part of life in a publicly funded organisation, ultimately people must be the priority. Indeed "People are the Priority" might be a useful slogan for the year ahead. I am told that prioritising people is a central tenet of the Nursing and Midwifery Council Code.^[1]

3.7. Financial targets will only work well if people are thriving. Human dignity is an infinite resource; public finance is not. Indeed, perhaps the only way to optimise the use of limited fiscal resources is to draw upon and acknowledge the deep well of goodwill that exists in the NHSH workforce. That goodwill has been seriously tested in recent years for a number of those working in NHSH. Ironically the damage to, and waste of, human resources surely adds to the financial cost.

3.8. If people, and achieving their full potential, become the priority, the converse is also likely to be true. Real compassion in and towards the workforce is an investment, an example perhaps of preventative spend.

3.9. The value of all this coming to the surface, as it now has, must be that it creates an opportunity to learn, to try to do things differently in the years ahead and to turn a crisis into a better future. At some point, a line will need to be drawn under the past and I hope that this report will play a modest part in enabling that to be done. There is a great opportunity now to create an open, safe and inclusive organisation in all of its component parts, perhaps even to be a leading exemplar to other organisations.

A Word about Patients

3.10. I am aware that it was hoped that allegations of bullying against patients would also be included in this review. However, given the time constraints, it was agreed at an early stage that these would not be included. Purely for the record, we received very few such allegations, even from the outset.

3.11. Everyone is agreed that patient safety is paramount. Patient safety is not something I can cover in detail in this report. However, a number of concerns have been expressed to me about the consequences for patients of unhappiness and poor relationships among staff and it seems inevitable, given the extent of dysfunctioning upon which I report below, that there will be issues to address, of which I was given some examples.

3.12. On the other hand, and in keeping with my earlier comments, the vast majority of patient care is likely to be of a very high standard. In so far as this whole situation has caused concerns for patients and their communities, confidence needs to be restored. I hope that this report, and the actions following it, will play a part in helping to do so.