Over the last few weeks I’ve been pushing for an update from the Scottish Government on the investigation into the management culture at NHS Lothian.
The investigation followed the serious concerns raised in the report on waiting time management in NHS Lothian which uncovered allegations of the suppression of information and an oppressive management style.
The Cabinet Secretary, Nicola Sturgeon, confirmed that she had received initial findings and, the following day, sent me a copy of the final report which revealed deeply disturbing findings.
The report noted that the management style at NHS Lothian contributed to a situation where information on poor performance is not passed up the management structure, where positive gloss is put on reports and where staff are pressurised to find solutions without support.
This management culture is clearly at odds with the stated values the health board seeks to promote – the so called ‘Lothian Way’ – which places patients first and foremost while giving a central importance to staff motivation and organisational reputation.
It appears to be the case that this culture has existed for some time and to the extent that the behaviour came to be viewed as ‘normal’ by staff. The situation has reportedly been exacerbated by the unwillingness of staff to use whistle blowing policies due to lack of confidence in their effectiveness and fear of reprisals in their work life. I am concerned that despite the clear evidence of bullying behaviour, this situation did not come to light earlier.
At a time when health board budgets are under increasing pressure and staff numbers are being cut it appears that the situation reached a breaking point with press reports about patients being offered appointments at English hospitals. This sparked off the whole investigation which has led to this point.
But its deeply concerning that staff did not feel confident to raise these problems and it was patients who blew the whistle.
I am pleased that the Scottish Government is now working with Audit Scotland to look at this matter following Labour’s calls for a Scotland-wide investigation. I also welcome the Scottish Government’s continuing work with NHS Lothian to develop a sustainable plan to ensure patients are seen and treated within waiting time guarantees.
The results of these investigations have highlighted the need for action at NHS Lothian – both to reassess its procedures in terms of waiting time reporting and to reassert its commitment to the ‘Lothian Way’.
However I was deeply disappointed that beyond saying that the evidence in the report was “beyond the pale” the Cabinet Secretary did not take the opportunity of yesterday’s debate in Parliament to address the lessons set out in the report.
I believe there are serious issues of accountability and governance which have not been addressed at Scottish Government level. Given the big pressures caused by staff reductions, and the current tight funding regime it will be an immense challenge for NHS Lothian to meet its statutory waiting times targets. Our debate highlighted that patients deserve better and transparency on waiting times.
And the staff of our NHS do a tremendous job, but they need more than warm words – they need action and a positive working environment, not a workplace where they are stressed out, covering for the lack of resources. I think the time has come for a Whistle blowers hotline so that staff are protected when they have concerns to report.