NHS Lothian slammed over safety & bullying

26 June 2018, 15:33 | Updated: 26 June 2018, 15:35

NHS

NHS Lothian has a culture of bullying and harassment, failed to accurately record breaches of a waiting time target and does not always properly prioritise patient safety, a review has found.

The Academy of Medical Royal Colleges carried out the review after a whistleblower raised concerns on October about doctoring of patients' waiting times to meet the four-hour target to process A&E patients.

Reviewers found: "Patient safety and quality of care is not always prioritised as it should be, particularly at times of high activity."

The report agrees with the health board's internal review over recording of breaches of the four-hour target.

The Colleges report states: "There is clear evidence that breach recording was not in line with expected practice since 2012 and puts the validity of unscheduled care data into question for several years.

"There was no evidence that staff amended breach times to deliberately falsify performance. However, we felt that there is a fine line between falsification and confusion, when pressure is applied to 'meet' the four hour standard."

Reviewers said the "apparent lack of a clear and robust governance structure" had "contributed significantly" to this.

They criticised the health board's internal review for failing to highlight the role of a governance committee in missing an opportunity to detect the mis-reporting of breaches and did not agree with its finding there is no bullying and harassment.

Investigators found some staff felt "admonished and blamed" rather than supported when raising concerns and others reported feeling bullied, harassed and intimidated.

Among a string of recommendations, the report recommends the health board takes urgent action on bullying and harassment, improves governance, ensures a focus on patient care and develops a team approach to the four-hour standard with clear responsibilities.

NHS Lothian has accepted all of the observations and recommendations in the report and said improvement is already underway.

Jim Crombie, NHS Lothian interim chief executive, 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 four-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."

He said he shared concerns about bullying behaviour, adding "plainly we have not been doing enough to support our front line staff" and practical solutions are being sought.

He said: "As part of that work we will, through all mechanisms, ensure that it is absolutely clear that NHS Lothian does not tolerate bullying behaviour."

Mr Crombie pledged a focus on patient safety.

A Scottish Government spokeswoman it asked Professor Derek Bell to lead the review immediately after serious allegations were reported last November.

She added: "We welcome the fact NHS Lothian takes full responsibility for the findings and has taken swift action to put immediate steps in place to ensure this doesn't happen again.

"Every member of staff has a right to dignity at work - bullying and harassment in any form is not acceptable and NHS Lothian is taking action to strengthen non-executive and executive governance."