Hospital board apologises after damning report

editorial image

NHS Lothian has been reacting to a hard-hitting report which put the spotlight on shortcomings at the health board in regard to waiting times and a culture of bullying in the workplace.

The report was published by the Academy of Medical Royal Colleges and had been specially commissioned by the Scottish Government into its reporting of A&E waiting times against the 4 Hour Emergency Access Standard.

It investigated circumstances where waiting times of more than four hours were not being correctly recorded as breaches of the standard.

The board has accepted all of the observations and recommendations of the report.

It now says that improvement actions to meet the recommedations are already progressing in line with NHS Lothian’s own internal review procedure which was approved at a public meeting of NHS Lothian Board back in February.

Jim Crombie, Interim Chief Executive of NHS Lothian, said: “We have recognised from the outset that mistakes were made and accept the findings of this review.

“It’s clear not all was as it should have been. Staff have also come under intense pressure and for these failings I’m really sorry.

“Since the publication of our own review last November we have already taken a number of steps to rectify the reporting errors including significant staff training to ensure correct recording of 4 Hour breaches. We are confident the measures we have already put in place have removed any ambiguity over the correct procedures.

“We welcome today’s finding, which accords with our own, that staff had not amended breach times to deliberately falsify performance but instead that confusion had led to these mistakes. Our staff do an incredible job in difficult circumstances. I am proud of them and note the review team found a number of examples of excellence in team working and inclusion.

“However, we also share the Scottish Academy’s concern about bullying behaviour as reported by staff at many levels during the review, while recognising that there was no evidence of bullying and harassment at Board Level. In the face of intense and sustained pressure working relationships can sometimes be fraught and plainly we have not been doing enough to support our front line staff. We are working to identify practical ways to reduce pressure right across the system and undertaking a programme to develop our leaders. As part of that work we will, through all mechanisms, ensure that it is absolutely clear that NHS Lothian does not tolerate bullying behaviour.

“We are also clear that the job of ensuring patients travel swiftly and safely through the system does not rest with just one team or department. It is a ‘whole system’ responsibility. Focussed on patient safety, we are therefore also working with our partner organisations to ensure patients get the right treatment in the right place at the right time and to reduce delays in patient discharge which have a significant impact throughout the hospital system.

Today’s review recommends we strengthen governance and leadership and we are already immersed in that work”.

The report was published by Scottish Government following a review of practices on three sites of the Royal Infirmary of Edinburgh, the Western General Hospital and St John’s Hospital after concerns were raised.

Brian Houston, Chairman of NHS Lothian, said: “The review is not about assigning blame and true change is more than just re-writing protocols and procedures. We have to re-focus our own mindsets. If something has gone wrong in the way in which staff are working with each other or in the pressures they feel from day to day, then it is up to us in the board of NHS Lothian to fix it.”

Meanwhile Miles Briggs, Scottish Conservative Shadow Health Secretary, said: “This is a truly damning report into the culture of NHS Lothian which found a total lack of robust management with staff often afraid to raise concerns for fear of reprisals. Put simply that must change and never be able to occur again.

“When it was revealed that waiting times figures had been misreported at hospitals across Lothian I called for an urgent review.

“Bullying and harassment are completely unacceptable anywhere and especially so in an environment where patients’ lives are at stake.

“Staff and patients at NHS Lothian have the right to feel safe and respected and it is now vital that we see a genuine change in the culture at NHS Lothian not just warm words.

“I will be seeking a urgent meeting with NHS Lothian to discuss how the recommendations will be implemented and what monitoring will be put in place to make sure we never see a repeat of this unacceptable situation in the future.”

Meanwhile MSP Neil Findlay said: “This report is shocking. People across Lothian have been raising these issues for years - manipulating waiting times, bullying and harassment of staff, poor communications from Senior managers, the repeated boarding out of patients and a failure in Governance all impacting on patient care. We have had previous reports about these issues within NHS Lothian and little seems to get done.

“We now have evidence that targets are being prioritised over patient care with staff subjected to a culture of bullying. We cannot allow our most valuable public institution to be subjected to this.

“We need root and branch reform of NHS Lothian so that we can get an accurate understanding of waiting times, understaffing issues resolved, patient care prioritised and an end to bullying of the workforce, we can’t just keep papering over the cracks.”