Contents
NHS Governance
Item 3 is an opportunity for members to discuss the main themes arising from the informal evidence session with NHS senior managers that we held last Tuesday. I invite comments on that session. Are there no comments? Members are not usually so shy and reticent.
12:00
The group that I spoke with was of the view that raising concerns was difficult—people did not want to speak out because it could be perceived negatively and might have a negative impact on any career progression and relationships with other colleagues. It did not feel as though there was an open culture in which issues could be discussed without an element of concern. That was the impression that I had from my group.
What was the rationale behind using that union in particular? Was it because it represents people at management level in healthcare?
Which union?
I think that everyone came from Managers in Partnership.
There were a few trade unions represented in that discussion.
Was MIP involved because it represents healthcare managers? I ask because its United Kingdom membership is 6,000, but in Scotland it has only about 500 members—at the last count—which is about 8 per cent of its membership. Given that, I am not sure how representative it is of healthcare managers more broadly.
I think that we approached the union because it is an organisation that has a collective voice, whereas we might have struggled to get individuals.
One of the things that struck me was that some of the people that I spoke to had a UK-wide remit and they spoke very positively about the NHS in Scotland in comparison with the rest of the UK. They also spoke about the privatisation of the NHS in England in particular and their concerns about the impact of privatisation on staffing there. They contrasted the two systems.
The group that I sat with were all Scotland-based staff members. They raised quite significant concerns about the culture that goes from ward level up through the system and the way in which it stifles innovation and prevents people from taking positive risks in developing services. There was an individual who, having raised a series of concerns, had experienced quite significant bullying and harassment in her role as a manager.
The overwhelming thing that the group wanted to contribute was about the pressure that they felt to deliver targets. They felt that the continuing pressure to deliver those targets can take over everything else. Some commonsense things that they would have liked to have brought in in their service area, ward, or area that they managed were put aside because of the overwhelming pressure to deliver the numbers. They saw that as a negative experience.
As we work on our report, it will be quite difficult to make those voices heard, particularly when people approach us as individuals or as MSPs to express concern about bullying and harassment—sometimes by senior advisers in the health service who report to ministers. We will have to consider how we can make those voices heard. In some cases, people are using us as their complaint system. I want to ensure that we get it right as a committee so that those voices are heard in our final piece of work.
To pick up on what you said, convener, some of the people I spoke to talked about the effects of stress. They said that when people are under pressure to make cuts, they revert to managerial styles that are not very effective. Although the people in my group had positive things to say about, for example, the patient safety programme and how excellent it is at empowering people at the coalface and delivering bottom-up change, they said that when people are under pressure they just revert to a top-down approach—“This is what you are going to do”—and bullying.
That definitely came across. I took screeds of notes, which I will pass on to the committee clerks. If other members have similar notes, they should send them on to the clerks so that we can capture some of the themes that came out of our discussions.
12:05 Meeting continued in private until 12:34.