1. Introduction to the Report
1.1. On 23 November 2018, I was asked by the Cabinet Secretary for Health and Sport to undertake a fully independent external review into allegations of a bullying culture at NHS Highland.
1.2. The stated purpose of the review was to:
- Create a safe space for individual and/or collective concerns to be raised and discussed confidentially with an independent and impartial third party.
- Understand what, if any, cultural issues have led to any bullying, or harassment, and a culture where such allegations apparently cannot be raised and responded to locally.
- Identify proposals and recommendations for ways forward which help to ensure the culture within NHS Highland in the future is open and transparent and perceived by all concerned in this way.
1.3. The press release announcing my appointment included these words from me:
"My primary role, therefore, is to provide a safe and confidential place for people to be heard and to explore with them what the underlying issues might be."
1.4. In publicising the review, I added that I hoped to make recommendations and proposals with a view to helping to improve culture and behaviours both now and in the future and restore the trust between the management of NHS Highland, the clinical community, and local staff-side representatives, in order to build and maintain a culture of cooperation and respect.
1.5. I note also that following a meeting hosted by Shirley Rogers, Director of Healthcare Workforce and Strategic Change in the Scottish Government, with union representatives on 19th November 2018, a statement was made by the Scottish Government that an externally led independent review into the allegations of bullying at NHS Highland "will consider all the circumstances that have led to the allegations and make recommendations" (my emphasis).
1.6. The Cabinet Secretary expressed the hope in the Scottish Parliament on 27 November 2018 that I would at least present her with interim recommendations in early 2019. That guided my conduct of the review. I submitted interim findings and recommendations on 5 February 2019.
Review and Report
1.7. This full report was submitted in draft form on 27 March 2019. I am conscious that this means that the review was conducted in approximately eighteen weeks (which included the Christmas break). I am mindful that such a relatively short period of time places some restrictions on the scope of the review but hope that this report does sufficient justice to what I have heard and read in that time to enable others to build on it.
1.8. I have been able to revise the report to take account of representations made since the first draft and I am also aware that, since I gathered information in late 2018 and early 2019, matters have moved on with a number of changes at senior levels.
1.9. I should also record, as I expand on later, that the number of responses I received greatly exceeded what had been anticipated when I was appointed and this has impacted on the management of time and resources. Nearly all respondents had serious contributions to make and concerns to express, and the majority requested meetings with me.
1.10. Against that background, this report is designed to enable the Cabinet Secretary to reach conclusions about the matters I have explored in connection with NHS Highland and, if she wishes to do so, to act on my proposals and invite others to do so. It is also written with a wider audience in mind including those in NHS Highland who will need to take matters forward and all those interested in the circumstances which I have been asked to review.
1.11. This is by no means the final word. I fully appreciate that some of those with whom I met, and others with whom I have not met, will have views to express about the content of the report. That should be part of the continuing dialogue. I have sought to reflect what I have heard and how I have seen things. This report reflects a stage in a longer journey of consideration and discussion about these important issues.
1.12. To aid navigation through the report, it is presented in six broad sections:
(i) Introduction and Summary
(iii) What the Review was Told
1.13. Some readers may wish to skim through the Context section which contains a number of general observations not all of which, I acknowledge, will be of interest to every reader.
1.14. There are a number of chapters in each section. Inevitably topics and themes overlap and intersect.
1.15. For those who wish a quick overview, the Summary of the Report, which follows after this Introduction, provides that. Please do bear in mind, however, that the full explanation of, and context for, the points made there are found in the detail of the report. There is also a Quick Summary of Main Points and Proposals towards the end, in Chapter 37.
1.16. For ease, I refer in this report to NHS Highland as "NHSH".
1.17. I have some limited experience myself of what is called bullying. The two quotations on page 2 relate to my own life experience: at school in the early 1970s and some years ago as the founder of a small business. Bullying affects many of us in many ways.
1.18. I am grateful to my colleague Miriam Kennedy for all her hard work behind the scenes and to my colleagues Charlie Woods and Liz Rivers for bringing compassion, insight and wisdom to the process. Ainsley Francis also provided invaluable support in the presentation of this report.
1.19. However, my biggest thanks go to the 340 people who came forward, often reluctantly and with some trepidation, most of whom candidly shared their experiences and offered their views. While I have not been able to incorporate or reflect all that I heard, I hope they feel that this review does some justice to what they said.
1.20. We often wish that things had not happened in our time. But we have to deal with what we have been given. If challenges seem impossible and overwhelming, all we can do is look to the present and the future. We each have the choice to do something, to make our contribution, however small. In that way, our sense of powerlessness can be converted into empowerment.
1.21. It is often said that "little things can make a big difference." I hope that this report will empower many people in NHSH to choose to accept the challenge to make contributions, however small, to a better future for the organisation.