Has the NHS forgotten about those who deliver care?

In my speech to the ARM this year, sadly I had to say that bullying and harassment within NHS Scotland had dominated the last 12 months. These problems aren’t by any means new or recent, but have only now fully come to light. What is new is a growing demand for change and a groundswell of opinion from both organisations and individuals that the toxic environment far too many of us work in must now be transformed into a more positive workplace, for the good of staff and indeed patients.

This seachange in attitude was kickstarted when four brave doctors in NHS Highland went public on years of issues there. Their speaking out  took a lot of courage and we should be grateful to them for making a stand and showing that bullying is not welcome in NHS Scotland.

Following an FOI to all health boards requested by BMA Scotland, we discovered that about 800 cases of bullying have been raised across the NHS in Scotland over the last five years. Those numbers indicate there is a significant problem, but it seems very likely many cases go unreported, and hence the true scale is hard to know. Nonetheless those cases are a powerful illustration of the impact of bullying and harrassment on individuals and the NHS and ultimately patients..

The NHS Highland review, led by John Sturrock QC, made for stark reading and prompted the Cabinet Secretary for Health, Jeane Freeman, to convene a short life working group to address the problems identified.

The group met for the first time this week. One of the questions it has answer is why the NHS in Scotland has become such a fertile breeding ground for wholly inappropriate behaviours? My message was firstly that the NHS has become more about delivering on numbers and seems to have firstly forgotten that its about teams of people delivering care to individual patients , not meeting targets, and that secondly we have created a culture where feedback has become synonymous with criticism and blame rather than a vehicle for improvement and thanking hard pressed staff for doing their very best. I have made it clear we must ensure good care is recognised, but equally when teams know they haven’t delivered the best, that they have time and space to discuss why without fear of blame. The group has an opportunity to build on the momentum for change, and on the clear desire and need so many are expressing that our NHS needs to be a more positive place to work.

There were many encouraging signs at the first meeting of the group. To get representatives from practically every part of the health service and from a huge range of professional associations together during what is traditionally a holiday period emphasises that we all recognise how important this is. What’s clear is that another reiteration of or new raft of policies galore is not what is going to deliver a better NHS workplace. Changes in attitude, a focus on much more visible senior leadership and training those leaders, feedback that means something and that includes praise not just criticism, time to reflect on how our teams are doing and crucially resources to back that up will all be needed. And many spoke of the huge resource, staffing and target driven pressures in our NHS and that that must be acknowledged. There was an outbreak of violent consensus which I found genuinely refreshing. But we have been here before and it’s delivering on all this that really matters.

With the first meeting of the SLWG under our belts, and with the next meeting due in October, we can’t lose impetus and I hope we can now start to provoke a genuine revolution in the culture of NHS Scotland. It’s time to move beyond fact finding and apologies and this opportunity must not be squandered. Healthcare workers in Scotland must be able to go to work unafraid. We have to put an end to the blame driven and bullying culture in our NHS.

My message remains clear: value us, through actions, not just words. If we can work in a system where we are genuinely listened to, in well-staffed supportive services, and be properly paid without threat of financial penalty, then Scotland will be a place where doctors want to train and – crucially – stay. That is the thread that must run through whatever comes from the SLWG. I’ll keep on making that case on behalf of doctors, and we’ll keep you posted.

Lewis Morrison, BMA Scotland Chair

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