Meeting of the Parliament

Meeting date: Tuesday, November 27, 2018

Official Report 881KB pdf

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NHS Highland (Bullying)

The final item of business is a members’ business debate on motion S5M-14643, in the name of Edward Mountain, on the investigation into bullying claims at NHS Highland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament condemns bullying in any shape or form; welcomes the independent external investigation to examine the claims of bullying in the workplace at NHS Highland, which was announced by the Cabinet Secretary for Health and Sport on 2 November 2018, and notes the calls on the Scottish Government to ensure that the matter is resolved fully and promptly.

17:05  

I am saddened that we are having the debate—first, because we should not need it, and secondly, because the issue should have been dealt with in September when I first called on the First Minister to hold an independent inquiry. I thank members from opposing parties who signed the motion that is in my name—particularly David Stewart, Rhoda Grant, Monica Lennon, Liam McArthur, Alex Cole-Hamilton and John Finnie. No Scottish National Party MSP supported it, but I am confident that SNP members believe, as I do, that there should be zero tolerance of bullying.

I welcome those who have come from the Highlands to listen to the debate—they are up in the public gallery—and I thank them for all the work that they have done to bring the matter to the Parliament’s attention. I also welcome those who are following the debate live on the BBC. There is huge interest in the matter.

When I was elected in 2016, it was apparent that there were significant issues in NHS Highland—not just waiting times and poor financial performance but something else. I could not quite put my finger on it, but something made me feel uncomfortable, to be frank.

The way in which an organisation treats those it works with paints a good picture of the way in which it treats those who work for it. In 2016, the deep division between patients in Caithness and Skye and NHS Highland warned me that something was seriously amiss. The protesters felt ignored and felt that NHS Highland had shown them unbelievable arrogance, which is perhaps why more than 1,000 of them took to the streets in Caithness on a wet and windy afternoon in October 2017.

My concern grew further when doctors and nurses across the Highlands started to inform me of issues and pass on correspondence from NHS Highland. A trickle became a flood. The issues should have been addressed with senior management, but people felt unable to do that because of the response that they expected to receive. That attitude manifested itself at board level. The huge turnover of non-executive board members in the past five years should have been a flag to previous health secretaries, but it was not.

An even bigger, deafening klaxon should have sounded for the then health secretary when the non-executive board members passed a motion on 28 August 2017 that said:

“We feel the culture and leadership of the organisation is a risk to our stated values and objectives”.

That came from NHS Highland’s board. The motion was passed on to NHS Highland’s chair, who subsequently denied that he knew about it, and to the Scottish Government. The result was a governance review, which condemned NHS Highland’s executive management. I will quote from one paragraph of the review report, which John Brown produced—if members want to look it up, it is paragraph 4.30. It says:

“The Chair should consider externally facilitated support, such as mediation, to provide a safe and secure environment for Board members to meet with him and the Chief Executive to discuss recent concerns and for an agreed way forward to be found.”

One has to ask—what exactly was going on in the boardroom that made it an unsafe and insecure environment? Perhaps exactly what was going on elsewhere in NHS Highland.

On Friday, there was a meeting to discuss bullying, organised by the GMB and the whistleblowers. We heard stories of what was going on. I want to quote one—just one of the 100 plus that have been reported. This is from a lady:

“Each time it got worse and worse, crying and begging my husband before a shift not to make me go in, and crying when I returned home. My bullying in the work place got so bad that it affected my mental health. It was so bad that it affected not only me in work but my home life and my life with my kids.”

This is from a healthcare professional doing her job, and she is not the only one. I have heard about other harrowing cases from people who have contacted me directly. I have been so concerned that on one occasion, I contacted the office of the chief executive of NHS Scotland to seek help, as NHS Highland remained uncommunicative.

It does not stop there. There are patients across the Highlands who feel let down and unable to raise the issues they want to raise because of the unpleasant reaction that some have received when they have had the temerity to complain.

Everything that I have seen and heard has convinced me that there is a bullying culture in NHS Highland and it cannot be written off as gossip, as the chair of the board tried to do on 27 July this year. To me, it is evident at every level, from the boardroom to the floor of the wards. I see it in the way that NHS Highland works with its own staff, with its patients, and with those who dare to question service provision or management. On the latter point, I will just say: trust me, I know.

On Friday, the cabinet secretary announced an independent review into bullying in NHS Highland, which I welcome, but I am afraid that that is just the start. The review will need to look back to identify where the culture of bullying emanated from. John Sturrock will need to speak to staff, patients and board members, which will take time.

I hope that, during the course of this debate, the cabinet secretary can confirm who will be allowed to contribute to the review; that the review will look back at least 10 years; and that the review will cover what I would term the coercion of staff by the projection of authority, which I believe goes on the whole time.

When it comes to reporting, I hope that the cabinet secretary will confirm to me what “early 2019” means, because, sadly, time is a luxury we do not have. We have to address this issue that is festering and which I am told has been around for over 10 years. We need to do it for the sake of the staff, the patients and the victims in NHS Highland. Bullying has no place in any of our institutions and particularly not in NHS Highland.

17:12  

Bullying, discrimination, intimidation, victimisation, abuse and harassment: we teach our children from a young age that that behaviour is not acceptable in nursery or in school. It is not acceptable in college or university. It is not acceptable in the workplace. It should not be acceptable, full stop.

When the news broke in the press that four clinicians had come forward to say that scores of health workers had been or felt that they had been bullied at various NHS Highland establishments across the region, there was quite rightly condemnation of bullying.

I will not go into the detail of the allegations because, for me, that is something for the investigation to explore. I will say that any member of staff at NHS Highland who feels that they have been bullied, no matter what shape that bullying took, must feel supported to come forward.

I have met staff locally, I have met Government officials, and I have spoken to the cabinet secretary about this. On 15 November, I asked the Government about an independent investigation. The answer from the cabinet secretary was as follows:

“The scale and scope of the allegations of bullying and the timespan of these in NHS Highland is such that I need to understand the issues that appear to have led to a culture where these concerns cannot be raised with or resolved satisfactorily by the Board. To ensure all the issues can be raised and heard by those involved I have commissioned an externally led independent review. This review will consider all the circumstances that have led to the allegations and make recommendations. My officials continue to hold discussions with NHS Highland staff and their representatives and we will finalise the scope of the investigation during the week beginning 19 November 2018 and look to announce who will lead the independent investigation as soon as possible thereafter.”—[Written Answers, 16 November 2018; S5W-19967.]

On 23 November, I asked who will be leading the review and what its scope will be. The cabinet secretary answered:

“I have asked John Sturrock QC to lead this independent review to explore the underlying issues and concerns that have led to allegations of bullying and harassment within NHS Highland. The review will include conversations with affected individuals, including current and former staff, their representatives, Board members and Health Board Management.

The scope of the review will be to:

• Create a safe space for individual and/or collective concerns to be raised and discussed confidentially with an independent and impartial third party.

• To understand what, if any cultural issues have led to any bullying, or harassment, and a culture where such allegations apparently cannot be raised and responded to locally.

• To identify proposals and recommendations for ways forward which help to ensure the culture within NHS Highland in the future is open and transparent and perceived by all concerned in this way.

The review will commence with initial meetings taking place before Christmas. A review report with proposals and recommendations for ways forward will be provided to the Scottish Government in early 2019.

Separate to this independent review, the Chief Executive of NHS Scotland Paul Gray has today written to NHS Highland to offer an increased level of support to help them recover their financial position and strengthen internal governance.

This will raise Highland to Stage 4 in the Board Escalation Framework. Additional support will take the form of a support team, led by a transformation director, who will assist the Board in planning and delivering the improvement initiatives necessary to restore the Board to financial balance.”—[Written Answers, 23 November 2018; S5W-20143.]

It is important to put that on the record. The Government is taking the matter seriously and it has answered calls for an independent investigation. The board is being given extra guidance and assistance.

I will end with two pleas. The first is a plea to NHS Highland to commit to listen and act on the evidence that is received. The second is a plea to all NHS Highland staff who are considering coming forward with any information about anyone: please feel safe and supported in doing so. You are the front line and the backbone of our NHS. We appreciate everything that you do and we need you to be healthy and happy so that we can be too.

17:17  

I congratulate Edward Mountain on securing the debate and on all his campaign work around bullying within NHS Highland. I also warmly welcome NHS Highland staff, past and present, to the gallery.

On Friday, along with Edward Mountain, I attended an important but emotionally challenging event that was organised by the GMB, doctors and whistleblowers on bullying. More than 60 people attended and more than 140 statements from victims have been taken.

One account of the bullying in particular struck me:

“You raise a bullying and harassment case and yet every step of the way you are on trial. Your character is attacked, you are then subjected to mockery and someone even writes that you are ‘schizophrenic’ in their statement ...

Every step of the way you are treated like you have done something wrong. You start to doubt yourself and even your own character. You are isolated ... you cannot talk to anyone about it, but you know everyone knows ...

Your manager tells you it is your fault and in fact it is you, and you could lose your job, your NMC licence and your liberty. Suddenly you are very afraid. What just happened here? ...

You go off sick, and you are. You are beside yourself, how could this happen? You go from being bullied and trying to report it to suddenly you are the problem. ... Your family don't know what to do. You are seeing the doctors every few days, you think about taking your own life. Your family and partner stay with you, they are scared to leave you alone. They don’t talk about it, even now.”

The staff I met before and after the event all worked for NHS Highland at some stage in their careers. I have also spoken to several former non-executives over the last year, as has Edward Mountain, and have received many phone calls and emails from concerned staff in administration, front-line nursing and general practices.

It seemed to me that there was an underlying toxic culture of bullying that was clearly having an effect on staff morale and emotional health. The wider issue is the possible effect that that has had on the credibility of NHS Highland and its ability to recruit and retain staff. It is also difficult to measure the effect on patients, but there will surely have been an impact. For those reasons, I welcome the cabinet secretary’s written answer on Friday, which, with perfect timing, coincided with the bullying conference that my colleagues and I attended.

Like Edward Mountain, I had been calling for an independent Queen’s counsel-led review. I welcome that the terms of the review include current and former staff. Would the cabinet secretary confirm in her closing speech whether there will be any time limit for former staff in terms of when they left? What about patients? If they have witnessed or experienced bullying among NHS staff, will that be considered by the Sturrock review? Will the review findings be published in full? Will the Health and Sport Committee have a role in the proceedings?

I also ask the cabinet secretary about the role of the Advisory, Conciliation and Arbitration Service. I contacted them and the chief executive Anne Sharp said:

“We would be pleased to meet any or all of the representative bodies, ideally face to face. While the investigation is not within our remit, we can conciliate in any dispute and carry out work to improve employment relations.”

I am also struck by history repeating itself. The freedom to speak up review led by Sir Robert Francis QC examined bullying in the NHS in England. Its recommendations stressed early support for whistleblowers, cultural change, prevention of isolation and containment, and legal protection for whistleblowers.

Members will know that provisions on the independent national whistleblowing officer for the NHS will be subject to the super-affirmative procedure in the spring of 2019, and will be considered by the Health and Sport Committee, of which I am a member. That is an important development, notwithstanding the recommendations of the Sturrock review. It will provide new principles, standards and procedures to protect and enhance the role of whistleblowers.

This has been a timely debate. Everyone has a right to be treated with dignity and respect at work. Bullying and harassment are unacceptable and are a violation of human and legal rights. Let us look to the new year and the conclusion of the review for a new dawn in which staff in NHS Highland start afresh in safety and security, as respected, dedicated professionals, free from the dark cloud of bullying.

17:22  

As is the convention on such occasions, I thank my colleague Edward Mountain for securing the debate. The member will know full well that I have not always agreed with his pronouncements on NHS Highland. That is certainly the case tonight; there has been conflation of matters. I will therefore restrict myself to the wording of the motion, which is important.

Who would not condemn

“bullying in any shape or form”?

I also condemn those who stood in silence and watched it happen, and the institutional arrangements that allowed it to happen. As the motion suggests, I welcome the independent review. I commend John Sturrock—Jock Sturrock, as he is often called. He is a man of the highest calibre, who has a history of understanding the meaning of words and listening, which is important.

The other word from the motion that I want to comment on is “promptly”. It is important that we see the matter being understood and resolved. That should take whatever time it takes. As Gail Ross, David Stewart and Ian Blackford—one of the MPs for the area—did, I attended the meeting on Friday. It was harrowing to hear some of the statements. I commend the people who have come forward. We were all given a large folder that contains a lot of harrowing information. I am sure that that information will be made available to Mr Sturrock.

The dignity that can be shown to people in the workplace is important. In a previous career, I was a Scottish Police Federation official, literally just across the road from the Parliament. We discussed the introduction of an equality and fairness programme. The police force is a challenging environment, given its structure of ranks, but it seems to have embraced the philosophy of equality and fairness. Key to that philosophy is dignity.

There can be all the processes in the world—I do not doubt that Mr Sturrock will unearth a great wealth of policies that are gathering dust on a shelf—but it is my experience, in particular from dealing with one particular case, that timescales in employment disputes often go right out the window.

When someone is too busy to deal with a person’s issue, that sends a clear message to them, as does someone being on holiday or having left the organisation. I want people to appreciate the value of exit interviews, for example. Members have spoken about the loss of staff; David Stewart talked about recruiting staff and retaining staff, which are important. We need to understand the systems that are already in place and those that should be in place in order that we can address concerns.

I was grateful for the cabinet secretary’s response to my colleague Gail Ross’s question; it was comprehensive. The timing was the timing—whenever it takes place, if someone says that they are going to create a safe space for people to come forward, I am very happy to commend that and the confidentiality that is ensured by the process. There is no doubt that Mr Sturrock is an independent and impartial third party.

I sought earlier in the process to make to NHS Highland a suggestion that went back to an incidence of bullying from my days in the then Northern Constabulary. I used health and safety legislation; as a health and safety rep, I called on the expertise of the Institute of Occupational Medicine to come in and examine the workplace. That suggestion was noted, but not taken up by NHS Highland. It is fair to record that there have been issues over a period.

I am keenest that what will come out of the review is a safe working environment with no big black cloud hanging over NHS Highland. The majority of people to whom I speak know nothing of bullying. What they know of is the quality of care—its very high standard. I do not want anything that we do or say to impact on that. NHS Highland is a caring organisation; people might imagine that that care extends to the wellbeing of its staff. I hope that that will be the case in the future.

I look forward to Mr Sturrock’s work, and I am sure that we will discuss this matter again.

17:26  

I thank my colleague Edward Mountain for lodging the motion and for his dogged persistence in raising the profile of the issue and campaigning for the staff who are at the centre of the matter. I speak for many members across the chamber when I say that we all appreciate everything that our NHS staff do, but nobody should fear their place of work. The allegations that have surfaced, and those which continue to surface, are deeply alarming. The simple fact, according to one clinician, is that the number of victims in NHS Highland who have been caught up could reach 1,000. That fact alone is extremely concerning.

The issue requires political consensus, so I do not want to use this time to point fingers or to use it as a political football. I welcome the fact that an independent review has been announced by the cabinet secretary, despite the fact that it has taken some time to get to this point. In particular, I welcome the appointment of John Sturrock QC to lead it. I happen to know him fairly well. Many years ago, he was one of the people who trained me as an advocate, so I can attest to the fact that he will bring a robust, rigorous and measured approach to the review. He also has a hugely impressive track record in mediation, so I am sure that his stewardship of the review will ensure that people who have brought the issue to light—and, indeed, those who have since come forward with their experiences—can rest assured that no stone will be left unturned.

It is critical that we do not turn the issue into a witch hunt, or seek to prejudge the review and the allegations that have been made—although it is clear from the number of complaints that there are serious questions to be answered. I share with others the concern that the initial response to the claims from the NHS Highland management appeared to lack awareness of the extent to which problems existed. At the end of October, NHS Highland stated that it was “unanimous as a board” that there was no “systemic culture of bullying”.

I find that last statement to be very difficult to reconcile with the facts that we now know. Since that statement, clinical and medical professionals have continued to come forward to tell their stories, which they had previously been too frightened to disclose. They deserve to be commended for their courage in speaking out. One of the worst stories that I read in the media was about a former employee who had contemplated suicide as a result of his experience. That story should haunt us all—the fact that someone felt so badly let down that he considered ending his life is a stark illustration of the human cost of the situation. I am pleased that NHS Highland’s chair, David Alston, has now welcomed the review.

It is clear that many questions need to be asked and answered, so I hope that the review will be as extensive as possible and that—as John Finnie said—it reports promptly, albeit with due regard to the evidence. I am sure that it will.

It is clear that we need to avoid rushing to prejudge the outcome of the review, but it is also obvious that there has been a serious breakdown in communication between the management of NHS Highland and the wider staff. It seems that many people have felt that they cannot disclose issues for fear of retribution. There is a deep, deep problem.

I sincerely hope that the review will go some way towards rectifying the situation, and that recommendations will be considered more broadly across the NHS in Scotland. If we do not care for NHS staff—if we do not care for our carers—we are in serious trouble. I hope that this day marks a turning point for health provision not only in the Highlands, but across Scotland.

17:35  

I am grateful for the opportunity to set out the Scottish Government’s position on the matter and to say what we have done.

As members across the chamber have said, we must condemn bullying and harassment in any shape or form. I share that sentiment with all the members who have spoken. The bottom line is that bullying and harassment are an abuse of power, and abuse of power is something that offends me personally and deeply. I was, therefore, concerned by the recent allegations that suggested that there is what amounts to a bullying culture in NHS Highland, and that is why I acted to ensure that the serious issues that were raised could be properly dealt with.

As the allegations emerged, way back in September, we offered the board assistance in listening properly to what those allegations might be. However, I was, of course, mindful that it was clear that there was a need for an independent review to be undertaken so that people could feel that the process and the conclusions that may be reached would have a degree of credibility.

I want the review to help me to understand why there are many staff who feel that they cannot raise concerns about an issue that is important to them and is therefore a valid one. That tells me that there is something that we need to tackle. If anyone in our health service feels bullied or harassed, we need to address that. It is clear that, although we have policies and procedures, some people still feel unable to speak up. Further, those who speak up feel that they are being closed down and that those policies and procedures are not working.

That is partly why, in addition to the independent review—I will take the time to answer questions that have been raised about it by members today—my ministerial colleagues and I have raised questions around such matters in every annual review that we undertake with every health board, particularly in relation to area partnership forums. We want to begin to understand what is happening because, even in boards where we do not face the situation that has arisen in NHS Highland—which is to say the majority of our boards—we might still have situations where staff feel that they are being bullied or harassed. According to the most recent survey, around 15 per cent of staff in our NHS feel that way, but the issues are not surfacing. We need to understand what is preventing that, and one way of doing so would be to harness the combination of bodies involved on the staff side—the trade unions, the Royal College of Nursing, the British Medical Association and others.

As members know, on 23 November, I announced that John Sturrock, a QC of some standing who is a highly respected mediator—Donald Cameron is absolutely correct in that regard—has agreed to conduct the independent review into the allegations of a bullying culture in NHS Highland. The review will explore the underlying issues and will include conversations with any affected individuals, including current and former staff, their representatives, board members, management and patients, if patients wish to come forward. My senior officials have had a number of conversations with key stakeholders, which has helped to shape some of the scope of the review that we agreed with Mr Sturrock.

How safely can people divulge information to Mr Sturrock, who is carrying out the investigation? He has to have an understanding of what is happening, and if people are perpetrating that behaviour, it must be dealt with. How will those things interact, and what control will people have over where they report and what happens with the information that they give? If they are afraid to speak out, they might be willing to speak to Mr Sturrock, but might not want anything to be pursued, although such information might still come down the line.

I am grateful for that important question. There are two sets of issues that we need to deal with. Mr Sturrock has already begun his work by contacting a number of individuals and making his presence known more publicly, so that he can come to understand all the issues and hear from all the people who want to come forward and speak to him, in a safe space where concerns can be raised and discussed confidentially, about their own personal experiences or incidents that they have witnessed. He can then begin to form his view of the overall prevailing culture, why matters are being raised in this way and why people feel that they are not able to pursue them. Alongside that, he will have to identify specific individual instances that will need to follow a different process, if the individual so wishes.

In any bullying culture, there are those who are bullied and those who bully. We need to address both. That is why—in answer to Mr Mountain’s question about how early in 2019 we are talking about—I have said to Mr Sturrock that I am looking for at least interim recommendations in early 2019. However, until he begins his work, we cannot be absolutely certain exactly how long the review will take in total. We need to see how many individuals he should be listening to and taking account of, especially if we are talking about the past as well as the present. I need to know that, but still have some pace around the review. Therefore, if Mr Sturrock has interim recommendations, we will have them in early 2019.

My response to Mr Stewart’s question is that the recommendations will be public and I would expect the Health and Sport Committee to want to discuss them and to discover from me what I intend to do about them. Ms Grant asked about how individual cases might be addressed, should the individuals want to pursue them. Until Mr Sturrock has begun his work, we will not know that.

I am conscious of the time, Presiding Officer, but I will just cover a few other areas that members asked about. Mr Stewart mentioned ACAS, and Mr Swinney mentioned—not Mr Swinney; I mean Mr Finnie. I am sorry to have done that to Mr Finnie. If he wants to be responsible for education, I am sure that Mr Swinney will share it with him. Mr Finnie asked about other areas of expertise, and it is for Mr Sturrock to determine where he might want to source other expertise from to inform the work that he is doing. The Government will continue to support him in that.

As I am conscious of the time, I conclude by reaffirming that I take the matter very seriously indeed. I will be looking for interim recommendations—that partly answers Mr Cameron’s point about the lessons that we can learn from the situation for the health service as a whole. Abuse of power, in any form, by any individual, in any organisation, is utterly unacceptable. Above all, our health service is compassionate, caring and highly professional. In NHS Highland as well as elsewhere, our staff deserve to be treated in the manner in which we expect them to treat their patients.

Meeting closed at 17:39.