Swinney condemns ‘utterly unacceptable’ health board culture exposed in review

Scotland’s First Minister has condemned the culture at the country’s largest health board as “utterly unacceptable”.

John Swinney was pressed during First Minister’s Questions on a review that found a “serious breakdown” in relationships among staff and management at NHS Greater Glasgow and Clyde (NHSGGC) is likely having a detrimental effect on patient care.

The Healthcare Improvement Scotland (HIS) report found emergency doctors at Scotland’s biggest hospital, the Queen Elizabeth University Hospital (QEUH) in Glasgow, were subject to “disrespectful behaviours, poor teamwork and incivility” by management.

Mr Swinney told MSPs on Thursday that the behaviour highlighted in the report, and its impact on patients, must be addressed by the health board leadership.

He said: “Let me use this platform to make it abundantly clear to every health board in the country that the culture that is referred to by HIS is completely and utterly unacceptable.”

He said that in general, Scotland has a “formidable record” on improving patient safety.

“However, the quality and strength of that patient safety programme will be undermined if there is not a culture of acceptance of the need to tackle the behaviour that the HIS report highlights,” he said.

The probe looked at emergency departments (EDs) in three hospitals at NHSGGC, which serves a population of 1.2 million people and employs 44,000 staff – QEUH, the Royal Alexandra Hospital in Paisley and Glasgow Royal Infirmary.

The agency carried out the review after concerns were raised by a group of ED clinicians at the QEUH that patient care was being compromised and that their concerns were not being listened to.

The report also warned of an “unacceptable normalisation” of corridor care at the health board, and of “ambulance stacking” as a solution for ED overcrowding at QEUH.

Scottish Labour leader Anas Sarwar described the report as “devastating”.

Speaking during FMQs, he added: “I have been raising concerns for years with successive SNP health secretaries and first ministers, but here we are again.

“This is just the latest report after 29 doctors raised concerns almost two years ago, and it exposes serious issues around the culture of NHS Greater Glasgow and Clyde.

“But it follows the same pattern: patient safety compromised, staff ignored, bullied and silenced, and when they blow the whistle the management deny their claims, intimidate them and attempt a cover-up.

“Staff describe the working environment as brutal and inhumane, they talk of moral distress, of being haunted by some patient experiences leading to harm, and they say it is a constant battle to keep patients and staff safe and that there is no support from management.”

The HIS report was also raised by Scottish Conservative leader Russell Findlay, who said similar situations are happening in emergency departments “across Scotland” and he highlighted the review found patient safety is being “seriously compromised”.

Responding, the First Minister said: “Patient safety is an absolutely fundamental pre-requisite of our healthcare system and the report from HIS was designed to address the legitimate concerns raised by representatives of the staff in the emergency departments of NHS Greater Glasgow and Clyde.

“I expect the board to implement and address the findings of the HIS report.

“Indeed, I’m confident that the board will do so.

“There’s been an entire change of leadership in NHS Greater Glasgow and Clyde with a new chair, new chief executive, new medical director in place in the board, taking forward, as the chief executive of the health board has made clear publicly, at pace and at scale the reforms necessary.”

Mr Swinney added he “understands” the concern about access to A&E, but he assured worried Scots there have been improvements in recent weeks to waiting times.

Mr Findlay said the majority of those surveyed in three hospitals under the board’s management reported “patients rarely receive care that is appropriate or timely”, as he asked the First Minister when the Government will “take the necessary and decisive action” to meet the national recommendations in the report, which include defining new standards and introducing guidance on the quality of patient care.

The recommendations, the First Minister said, are “urgent priorities”.

In the HIS report, staff described examples of “significantly poor professional behaviours”, instances of alleged bullying, and “a lack of respect that has the potential to lead to patient harm”.

The review also described the level of stress and distress among staff at all levels in the three EDs as “palpable”, and said many staff described working in a “relentless and unforgiving environment that exceeded reasonable limits for prolonged periods”.

Robbie Pearson, chief executive of HIS, said: “This report is one of the most far-reaching and comprehensive reviews we’ve undertaken, in terms of the breadth of evidence we’ve analysed, and the number of patients and staff that we engaged with.

“Moreover, we believe that the recommendations – including those that sit with our organisation to take forward – are the right ones to help deliver better patient care, both locally and at a national level, and supported by a positive culture where everyone works together to solve problems.”

An NHSGGC spokesperson said: “The emergency departments in NHSGGC, like those across Scotland, continue to be under pressure.

“While we aim to provide high-quality care for our patients, delays in the flow through and out of hospitals often result in patients waiting too long in emergency departments.

“Under these pressures, the working environment can also be difficult for our staff.

We take the report, and most importantly the views of our patients and staff, very seriously and want to assure our patients and staff of our commitment to improve

“We have received the report from Healthcare Improvement Scotland which raises these issues and outlines a range of recommendations to improve both the local NHSGGC system and indeed A&E services across Scotland.

“We take the report, and most importantly the views of our patients and staff, very seriously and want to assure our patients and staff of our commitment to improve.

“In the two months since NHSGGC chief executive Professor (Jann) Gardner joined the organisation, she has been out meeting staff and hearing about our successes and challenges.

“Along with medical director Dr Scott Davidson and nurse director Professor Angela Wallace, Professor Gardner has pledged to listen to staff and to work collaboratively and respectfully to tackle the challenges we face and to build trust between staff of all levels.

“In addition, she has launched ambitious plans for whole-system transformation at scale and pace to address the pressures in our hospitals, create capacity to treat more patients who are waiting for treatment and to support more people to be treated from the comfort of their own home.

“Ensuring that our staff feel valued and respected is essential for our future success and this will sit at the heart of our work.

“Whilst this is being progressed, there may be further short-term measures that can be introduced to improve the patients and staff experience within our emergency departments. The chief executive, along with colleagues, will meet staff early next week to begin a supportive dialogue on this.

“We will build the recommendations from the HIS ED review into these discussions.”