Meeting of the Parliament

Meeting date: Thursday, May 9, 2019

Official Report 1031KB pdf

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NHS Highland (Sturrock Review)

The next item of business is a statement by Jeane Freeman on the Scottish Government’s response to the Sturrock review. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:30  

I am grateful for the opportunity to update members on the findings of the fully independent review that I commissioned, which was led by John Sturrock QC, into allegations of a culture of bullying and harassment in NHS Highland. The report of the independent review has been published in full today, alongside the immediate response from the Scottish Government.

I offer my sincere thanks to John Sturrock for his significant personal commitment to the undertaking, which is demonstrated by the review’s thoroughness and by the substantive, detailed and thoughtful report that he has delivered. In its conclusions and recommendations, his report focuses on repairing relationships and on the practical steps and leadership that are needed to restore trust and build a truly exemplary workplace culture in NHS Highland. Mr Sturrock has provided evidence for his conclusions from all those he heard from, and I sincerely thank everyone who engaged with the review—especially those who shared their own, often very difficult, personal experiences.

I commissioned the review in November, as I was greatly concerned that a group of staff in NHS Highland felt that they had no option but to raise their concerns publicly. It was clear to me that, despite the steps, interventions and support up to that point, serious concerns remained, which it was essential to hear. I was also keen to ensure that NHS Highland staff had the opportunity to access a safe space in which individual and collective concerns could be raised and that that was provided through a review with a perspective that was independent of the Government and the board. Through listening and understanding, that impartial perspective was to focus on proposals that would secure and promote an open, transparent and inclusive workplace culture.

I believe passionately in the NHS Scotland values of care and compassion, dignity and respect, openness, honesty, responsibility, quality and teamwork. I know that staff in NHS Highland believe passionately in those values, too. Our collective belief in those values is critical to our capacity to deliver the safe and effective person-centred care that people deserve, but belief in the values must be evidenced by behaviours that reflect the values. NHS Highland has many caring, supportive, diligent and highly skilled staff, but this extensive review has identified a number of significant cultural issues that have contributed to actual and perceived behaviours in NHS Highland that have not always reflected the values. That can neither be acceptable nor be allowed to continue.

We now need to engage constructively with the review’s findings, conclusions and recommendations. We must also reflect that, as John Sturrock points out, the experience of a number of staff who work in NHS Highland is not that of a bullying culture, and they have equally legitimate concerns that need to be heard and taken account of. Whatever else we might do, it is absolutely right to put staff in NHS Highland at the centre of the engagement and dialogue. That is the only way to secure the sustainable restoration of trust and shared purpose that is essential to a positive working culture. I have therefore made it clear to the board that I require it and the wider leadership of NHS Highland to consider the report carefully and actively engage with staff at every level to consider the conclusions and recommendations and how they can be positively applied.

The review considered matters in Highland, but it is clear to me that it raises important issues that require serious reflection across the health service. What the review articulates about how we work to build supportive workplace cultures that engender and encourage behaviour that reflects our national health service values is absolutely of general application. This is not just an opportunity for NHS Highland; it is an opportunity for all of us in NHS Scotland.

I am well aware that concerns about bullying and a desire to secure a positive culture are shared across our health service. As a result, I intend to bring together the leadership of our boards, including staff and union representatives, our royal colleges and professional and regulatory bodies to examine how, collectively, we can take forward measures to support and promote an open and honest working environment for all our staff. In particular, I will ask the collective leadership what more we need to do to effectively deliver the behavioural and attitudinal improvement in leadership and management that sits at the heart of the Sturrock review.

We will commence that important work in the summer by hosting a summit on wellbeing, engagement and employee experience in NHS Scotland. I am delighted that John Sturrock has agreed to join us for that first meeting. There are other steps that I intend us to take. The review highlights the opportunity to improve the relationship between boards and the Government. It highlights the dilemma, which is not always satisfactorily resolved, about when to support and when to intervene and the need to move with some pace on the improvements that have already been identified in “A Blueprint for Good Governance”, which was published earlier this year, and it aims to further strengthen health boards’ vital scrutiny and assurance work. That includes enhancing the recruitment, training and development of board members and ensuring that there is greater consistency in that regard across NHS Scotland.

I have also reflected on how we can ensure that all NHS Scotland staff, across all boards and irrespective of their role, have faith in the systems that we put in place to allow them to speak up, raise concerns or put forward ideas and be confident that they will be listened to and respected without anxiety about negative consequences. In part, that involves the work that is already under way to improve our workforce policies to ensure a people-centred focus that is consistent in its policy and application across the NHS.

As members know, on 30 April 2019, we introduced legislation to Parliament to allow the Scottish Public Services Ombudsman to take on the role of independent national whistleblowing officer for NHS Scotland. The SPSO will have the authority to investigate how whistleblowing cases have been handled, make recommendations and lay reports before the Scottish Parliament, in order to enhance public confidence in and scrutiny of the system.

We will now proceed with recruiting new non-executive whistleblowing champions to every health board, so that we will have them in post by the end of this year. The whistleblowing champions will provide assurance that boards are complying with NHS Scotland’s policies on whistleblowing. They will also have the authority to escalate concerns directly to me when they feel that issues have not been appropriately addressed at board level. In the coming weeks, I will again visit NHS Highland to hear for myself how it is progressing the work from the review.

I appreciate that this is a substantive report and an important piece of work, and I understand that members will wish to take time to reflect on its contents and on what I have said today. I also understand that members will be keen to hear about the progress that we make and, in particular, about the outcome of the work that I will lead with colleagues across our national health service, royal colleges and professional bodies on our collaborative leadership to promote a culture that reflects our NHS values. The concern and determination to take this opportunity to set the right course for our NHS is shared across the chamber, and the work to do that should be a shared endeavour. Following the summer recess, I will update the Health and Sport Committee and will be happy to discuss our progress with it at that time, if it would find that helpful. I am, of course, also happy to keep party spokespeople updated and to discuss all these matters with them.

I am committed to doing all that we can to ensure that everyone in NHS Scotland feels valued, safe and supported. That matters greatly to every person who works in our NHS, and it matters greatly to every patient we serve.

I commend this statement to Parliament.

The cabinet secretary will now take questions on the issues raised in her statement. I will allow around 20 minutes for that.

I thank the cabinet secretary for advance sight of her statement. More important, I thank John Sturrock for his detailed report.

It was only the Scottish Government and casual observers who did not recognise that there was a serious problem in NHS Highland. John Brown’s review, “Corporate Governance in NHS Highland”, which was published in May 2018, proved that. In September 2018, when four senior clinicians made allegations of bullying and I asked the First Minister for an independent inquiry, the Government was still dithering.

Finally, when we got an inquiry—and a very substantive one, too—we learned that there was “fear and intimidation” and that some staff have

“suffered significant and serious harm”.

According to the report, it appears that the Scottish Government knew about the dysfunctional nature of NHS Highland in autumn 2017 and yet did nothing about it, waiting to see whether others would do something. In my 40 years of professional experience, I have never read such a damning report on management.

In the cabinet secretary’s statement, I did not once hear the word “sorry”. I welcome her belated actions, but if we are to move forward, we need to resolve the issues of the past, through healing.

Let me give the cabinet secretary the opportunity, on behalf of the Scottish Government, to start off the process of rebuilding our health service by apologising to the staff, patients and people of the Highlands for this situation, which is attributable purely to poor executive management—that is my view, and it is backed up by Mr Sturrock. Will she apologise?

I have already apologised to NHS staff in the Highlands and will do so again. I am more than happy to do that.

In addition to expecting the apology, NHS staff in the Highlands and across our health service will judge us by how we respond to this positive and substantive report, which does not shirk from highlighting failings but argues strongly that the approach that should now be taken must be restorative and healing and must aim to move things forward.

In that regard, we all need to be careful about the language that we use. I do not accept that the Scottish Government did not recognise the problem or that it dithered, and I certainly do not accept that the Government did nothing about the problem. From as early as 2017, senior officials from the Scottish Government were working with NHS Highland—with the board and others—to try to improve governance and relationships.

As Mr Sturrock highlighted, and as I said in my statement, there is a dilemma for any Government—not just this one—about when to provide support, help and encouragement and when to draw a line and say, “That’s not working; we now need to intervene,” which is what we did. With hindsight, there might be a case for saying that we should have done that earlier or that we should not have done it when we did it. The fact is that we are where we are. We have a substantive report and our job, collectively, is to work out exactly how we take things forward, not just in NHS Highland but across our health service.

I thank the cabinet secretary for advance sight of her statement and acknowledge her initiative in asking John Sturrock QC to review the claims of bullying in NHS Highland.

NHS Highland is my home board. I have dealt with the board for more than 20 years and in two Parliaments. I have dealt with everyone from chief executives and board members to cleaners and patients. However, no amount of experience could have prepared me for the GMB-organised event in autumn last year. More than 60 people attended, and they spoke with one voice on the toxic culture of bullying in the organisation.

What new system can be put in place for all those who lost jobs, left jobs and suffered mental health problems, whose experience we must never forget? What assessment has the cabinet secretary made of the effect of the bullying on NHS Highland’s credibility and ability to recruit and retain staff?

Let us look to the future and the implementation of the review recommendations, so that staff in NHS Highland and beyond can start afresh in safety and security as respected, dedicated professionals, free from the dark cloud of bullying.

I am grateful to Mr Stewart for his comments and questions. I absolutely recognise his long history of positive engagement and strong interest in these matters. I completely understand how unprepared he would have been for the meeting that the GMB convened. The Scottish Government and Mr Sturrock were also unprepared, hence the lengthening of the time that the review has taken to allow for the number of people who wanted to give evidence to Mr Sturrock about their personal experience.

Mr Sturrock’s review makes the point about providing support for those who have experienced bullying or harassment, and whose emotional or mental health has suffered as a consequence. The board is actively considering how it might do that and will actively consider what other steps it needs to take. As well as reflecting the evidence and the views that were expressed to him, a central thrust of John Sturrock’s report was to recognise that the only way to move forward is to heal first, and to heal by moving forward. He is clear about that in his report and NHS Highland absolutely understands that; it is quoted today as saying that it must embrace all the recommendations of the report and act. It has begun that work, as well as work to consider how it will engage directly with staff. I was keen that this be a report not just for the chamber but for NHS Highland. It therefore needs to engage with its staff to understand whether they want more than is in the report.

It is impossible to have a scientific view on the impact of the review on recruitment and retention. However, concern about that was raised by those who had not themselves experienced bullying and harassment, and we need to consider what we do about that, too.

I ask for shorter questions—and indeed answers, cabinet secretary—so that we get through all the questions.

What commitments has NHS Highland made on implementing the recommendations of the review, and will a timeline for implementation be established?

NHS Highland is committed to ensuring that the recommendations are implemented and it will host a suite of engagements with all its staff. It will set out a specific timeline in the coming days.

As I said, I will visit the board soon. In addition, as John Sturrock recommends, I will undertake a full review of the progress that has been made 12 months on from the publication of the report.

Clearly, there is lot of learning for the wider NHS from the Sturrock review. What we read in today’s report points towards the systemic and institutionalised bullying at NHS Highland being just the tip of the iceberg. The cabinet secretary said that she wants to be judged on how we respond. Will she commit to bringing a full debate on the report before Parliament, in Government time, at the earliest opportunity?

I am happy to make that commitment in addition to the commitments that I have made to update the Health and Sport Committee and to have discussions with party spokespeople. We need time to reflect on what is a 176-page report, and to know a bit more about how NHS Highland is responding to it. However, in the wider debate—because it is a shared endeavour—I am happy to commit to that.

I pay tribute to the GMB for bringing this serious issue to our attention. The little of the report that I have read in the time allowed is horrific. Similar concerns have been expressed by other health boards in Lothian, Tayside, the Borders, Ayrshire and Arran and Greater Glasgow and Clyde. If it is the case that this is the culture of the NHS in Scotland, and that it is fed by staff shortages and cuts that put enormous pressure on everyone in it, what will the cabinet secretary do to tackle it and to ensure that the NHS is adequately resourced to allow staff to work in an open and collaborative fashion?

The questions are getting a wee bit long.

I do not accept that a significant proportion of the difficulty is the result of the financial resourcing of boards, and the Sturrock report does not justify that. What it talks about is the quality of relationships. We can have as many policies as we want, but if the relationships inside a board or any organisation are not positive, healthy, open relationships, policies will not resolve things.

I have set out what I intend to do in the immediate term and am open to other practical propositions, but the key thing is to hear from our royal colleges, regulatory bodies, staff side representatives, including our unions, of course, and the leadership of our health boards across Scotland about what more they believe that they can collectively contribute to creating a positive workplace culture.

I thank the cabinet secretary—first for commissioning the work, and secondly for early sight of the report. I also thank Mr Sturrock for his detailed work, which I have not, I have to be honest, digested in detail. I have, however, seen the recommendation in respect of Argyll and Bute that there be a separate review, to be undertaken—which is important—by an outside person. Is the cabinet secretary able to outline a timeline for that?

I am glad that Mr Finnie has pointed out the separate review that is recommended by Mr Sturrock. I have asked the board of NHS Highland to consider what advice it might want to give me on that. My senior officials are also considering how we can take that forward, and who might lead the independent review. I will be happy to update John Finnie once we have concluded.

The report states that senior people in the Scottish Government were aware of the issues for a considerable period of time, which ought to have signalled the seriousness of matters. What changes to processes will the cabinet secretary now instruct, so that future warning signs that are escalated to her Government will be dealt with from the outset?

I am not convinced that changes to processes can resolve that matter. Senior officials in the Scottish Government health directorate pay close attention to how our boards operate in terms of governance, scrutiny and so on. We have a number of other ways of gathering information, including the chairs’ regular meetings with me, and the chief executives’ regular meetings.

The question goes back to the dilemma about when a Government should move from supporting people to fulfil their responsibilities as leaders in a local board, to intervening directly when that does not appear to be working. The Government needs to reflect on that, while accepting that there is a judgement to be made every time. We need to see whether there is more that we can do to improve the consistency with which we make those judgements, so that people understand the basis on which we might intervene. We need to do that more than we need to look at the escalation framework, which currently has NHS Highland on level 4.

I am aware that the Scottish Government is currently in the process of appointing a national whistleblowing officer. Can the cabinet secretary outline how the national whistleblowing officer will work with whistleblowing champions across health boards to ensure that a collaborative approach is taken to promoting best practice?

I referred to the independent national whistleblowing officer in my statement, and the legislation to allow the Scottish Public Services Ombudsman to take on that role is currently before Parliament. Prior to the role going live, there will be a six-month training and implementation period. We expect it to go live in summer 2020, by which time the non-executive whistleblowing champions will be in post. We intend that they will be in post by the end of this calendar year. It will then be for the independent national whistleblowing officer and the non-executive board champions to come to an agreement about when they will escalate any matter to me, and when board champions will escalate matters to the independent whistleblowing champion.

The final point that I will make is that whistleblowing is a reflection of a culture that is not working. The key issue is what more we need to do to get the workplace culture to work, while we have proper whistleblowing policies in place.

, too, want to ask about Argyll and Bute, specifically. Paragraph 27.29 of the report states that Mr Sturrock was

“concerned to hear from a number of sources about particular problems in some of the island communities and of a management culture located in Lochgilphead and Oban”.

He ends that chapter by saying:

“I am persuaded that a specific review of management practices in Argyll and Bute is necessary and, because the nature of some of the allegations implicate management at a very senior level, consideration should be given to this being conducted by someone from outside”.

What is the cabinet secretary’s response to that?

As I have said, I completely accept that recommendation. I will give active consideration to how we might engage that review very quickly. I will hear from NHS Highland—which is, of course, under new leadership—about what advice it might want to offer me, and then I will determine who, independently, will conduct that review.

I call David Torrance to ask a quick question. He will be followed by Lewis Macdonald.

Will the cabinet secretary outline how lines of communication between clinical and senior staff can be improved to ensure that all NHS staff feel supported at work?

There is, in all our boards, a clear governance arrangement that should allow, through the medical director and the chief executive, constant communication between clinical leaders and others. Nonetheless, effective communication is a key feature in the report. In addition to looking at the arrangements and processes that exist in our boards, as I outlined earlier, talking to the royal colleges will provide me with additional advice that they want to give about how the members whom they represent think communication can be improved in individual boards, or generally across the health service.

I look forward to the cabinet secretary coming, as she has said she will, to the Health and Sport Committee to address the issues. In the meantime, I ask her to reflect further on the recommendation that the committee made last year—that an independent investigative and reporting line for NHS whistleblowers might well assist with the new structures that she puts in place.

I am happy to reflect on that suggestion to see what more it might add to the whistleblowing line that exists, and to respond directly to the committee on that.

I call Clare Adamson to ask a quick last question.

The cabinet secretary will be aware that a survey across NHS Scotland in 2017 showed that 85 per cent of staff reported that they had not experienced bullying and harassment by colleagues. Every experience of bullying and harassment should be of concern, and is completely unacceptable. In the light of the recommendations, will the cabinet secretary outline how those who have experienced bullying or harassment at work will be supported in coming forward with their experiences?

I did not really recognise that as a quick question.

We already have policies in place, but the Sturrock review has identified for us the importance of the work that we are undertaking to ensure that we have a once-for-Scotland approach to a number of our workplace policies, including on bullying and harassment. We have to ensure that not just the policy but its application is consistent across all our health boards. That gives us the opportunity to consider organisational cultures in all the boards and to identify with staff—for example, through the partnership forums, which involve staff and union representatives—what more can be done in each board to ensure that the policies are implemented in a way that is speedy and open, allows staff to come forward and be listened to with respect, and is safe, in that there is no negative impact on them simply because they have raised their voices.

That concludes questions on the Scottish Government’s response to the Sturrock review. I apologise to Fulton MacGregor for being unable to take his question.