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

6. Adequacy of the Review

Extent of Response

6.1. Overall, as noted above, a total of 340 people engaged with the review. They have come from a broad cross-section of the staff employed by or associated with NHSH, from most departments, services and occupations, mostly current and some former. To give me some context, I spoke to a few outside observers also.

6.2. Geographically, the respondents came from across the region covered by NHSH, including Argyll and Bute. As can be seen in the graphics below, they span support staff, doctors and nurses, GPs, senior and middle management, board level, allied health professionals and others.

6.3. In total, again as noted above, my colleagues and I engaged with 282 of these respondents directly and in written form. Altogether, approximately 40 days were allocated to meeting and information gathering, together with substantial support and administrative time. Writing up the report has taken many additional days.

Publicity for the Review

6.4. An "all-user" email was circulated by NHSH publicising the review and advising of a dedicated email address to which to write to make contact with the review. Other interested parties were also informed by Scottish Government and they circulated details. People who wished to do so made contact with me using the email address. I responded personally by email to nearly every person who made contact with the review.

6.5. One group who may, at least to some extent, have been missed may be those employees who do not use or have access to email as they may not have received communication about the review. I refer to this in my proposals.

6.6. I am aware that there was a view in some quarters that more could have been done to publicise the review and that there was a danger of selection bias in that only those with a grievance to express would respond. However, after the first two or three weeks, it became clear that the response was significantly greater than anticipated and with a very broad range of views, as will be obvious later in the report.

Limitations

6.7. The response was such that, in the time and with the resources available, I could not meet with all those who had responded and who wished to meet, even with help from my colleagues. Therefore, I agreed with the Cabinet Secretary that I would write to those who had made contact after the initial communications and advise them that I would endeavour to provide an initial report in February. If individuals wished to comment on that, or if they still wished to meet and be heard by someone in private after its completion, provision could be made for a possible further stage of the review.

6.8. While the timescale has changed, it is very important that this is not lost sight of. Many NHSH employees have commented on promises being made and then not kept. This should not happen with this report, which I accept is much fuller than anticipated at an earlier stage. There may be others who I did not meet, seek out or hear from who may wish to comment on the report when they see its terms.

6.9. A number of those to whom that particular message was sent have made written submissions to me instead, often at my request. Throughout, people have been understanding of the potential (and actual) enormity of the task in the planned timescale and have sought to accommodate my requests for assistance in managing the volume of material. I am very grateful to everyone for their thoughtfulness.

MSPs

6.10. At their request, I also met with two local MSPs. I was aware that local politicians need to take care in how they characterise situations like these. There is an understandable frustration and a need and indeed duty to draw attention to perceived wrongs. However, where patient confidence is so important and matters so fragile, a degree of discernment and balance will always be necessary.

6.11. As one respondent put it, "political grandstanding by MSPs or others and resolving disputes through the media" is not conducive to a long-term solution. I hope discernment will continue to be applied in the aftermath of this report.

Criteria for Meetings

6.12. I am aware that concern has also been expressed about the criteria I applied when arranging to meet people. To be honest, I undertook to meet many of those who got in touch at an early stage before the size of the project became clear. I felt it fair to honour my commitment to them whenever I could and to fit in as many others as possible in the timescale. There were certain people with whom it seemed particularly important to meet. There was a judgment to exercise and also a certain randomness in the process which, paradoxically, has achieved a very wide spread of views and minimised the bias that trying to identify set criteria could have built in. In any event, as I make clear later, provision should still be made for those who feel that they still wish to be heard.

Spread of Views

6.13. As noted above, concern was expressed that, given my remit and its wording, I would only hear one point of view and that the other side of the story would not be heard. However, I am able to say that those coming forward in response offered a wide range of views, from those who wished to say that they are not aware of bullying in NHSH at all to those who provided details of their own and others' experiences of bullying behaviour, both individually and collectively.

6.14. One of the challenges is that experience was often mixed and, indeed, sometimes contradictory. As one respondent observed: "It is possible to have two co-existing experiences". Another commentator said: "It slightly shocks me how thin the dividing line can be between one person's experience of someone as a robust manager who gets things done and another person's experience of them as a bully."

6.15. There is much to wrestle with. In some ways, ambiguity can be useful: "...in the intersection between [multiple] perspectives, real insight can be gleaned".^[9] It is hoped that real insights will be gleaned in this report.

6.16. Others speak of the "coincidence of opposites." The theologian Richard Rohr once said that holding contradictions and resolving them in ourselves and in our organisations are "the only real agents of transformation, reconciliation, and newness". In any event, the fact remains that there is no one perspective on any of this. There is a variety of viewpoints.

Reasonable Cross-Section

6.17. While the number of respondents to the review is low relative to the overall number of employees in NHSH, I have taken the view that they represent a reasonable cross-section of the workforce.

6.18. Given the volume of information I have received, I am comfortable that I can form views which have general applicability. In any event, there should be an opportunity for those who disagree with my conclusions to do so. Others can decide whether, in an organisation of approximately 10,000 employees, the information here is sufficiently relevant and important to warrant action. I have formed the view that it is.