20. Some Broad Management Issues
20.1. As one considers further the details of what is happening in a management context, the following extensive observations come from someone working as a departmental secretary. I repeat them here as this summarises many views I have heard and raises issues about job creation and protection, appropriate placing, redeployment, funding, overstaffing and bullying:
"The main management tone is generally divide and conquer, belittle and undermine your staff so that they are too scared to trust anyone with their issues. You are made to feel that you are the only one with an issue.
There has been a huge explosion in management, so much so that the people who end up in the managerial posts are often staff who don't know how to manage/don't know the job as they have come from outwith the NHS or are staff that another directorate is trying to offload (because as we know in the NHS if you are not fit for a job they create another one for you and move you along, more than likely with a pay rise to sweeten the deal). This means that once you are in a post and you can't cope with it or are just bad at it you can be redeployed or indeed request redeployment into any position that is equal in pay-band or below, you will be on a protected salary. This also means that someone who was bullied in one department can redeploy to a higher band as a line manager and then become the perpetrator and keep the higher banding.
Jobs appear to be created out of thin air, to the curiosity of lower banded staff who have to struggle on due to lack of money to get the staff that are needed on the lower pay grades, only to discover that staff have been taken on elsewhere either in management roles that have no problem getting funding or on the back of Government funding, the problem with this is that when the funding runs out what do you do with the staff? They can't go back to the job they had as it has been backfilled. They are redeployed more often than not into a position that has been created, quite often managerial and not in the discipline they are trained for.
If you count in all the "time saving departments" and their managers, there is a vast amount of overstaffing. Every manager is managing on a dog eat dog basis and protecting themselves and a job that either they are incapable of doing and should have gone from long ago should not even have as it was a created post as they couldn't be sacked.
There is a mentality of protect their job at all costs and this is where the bullying comes in. It is their way or the highway. There is no listening to staff who are in post and try to make things easier for everyone. I am sure that a lot of the pressure is coming from higher up than my administrator and service manager and sideways from the peer groups who are also trying to cover themselves, which is where the link to the board and what has already been made public is."
Bullying in NHS Highland is in the managerial DNA, there is constant pressure on bands 4 and below to get targets met, targets that are actually not of our making and can only be solved by paying consultants or other hospitals to treat the patients. These are actually to the benefit of the managers as they are paid bonuses for getting them met.
At the end of the day it is the patients that suffer the consequence of this. NHS Scotland needs a roots and branches clearout of managers and the money saved diverted to where it is needed.. patient care."
There is much to consider and review just in these few paragraphs.
Appointment and Recruitment
20.2. I have been told repeatedly that there are significant deficits in the appointment, promotion, support for and training of managers at many levels, resulting in many unhappy relationships (for managers and those being managed), poor communication and unsatisfactory decision-making, which is likely to be costly in both staffing and financial terms. It is also likely to be the source of inappropriate behaviours which are experienced as bullying.
20.3. Recruitment to management is a recurring issue. This view from a mental health practitioner reflects the views of many who engaged with the review:
"Generally, I feel that management is poor in some areas, with people being recruited/promoted into posts that they do not have the skills for. This has a direct effect on the service delivery to our patients but also to staff morale and sickness levels within services. It is difficult to recruit to some of the more remote and rural areas. Staff development is not a priority. This is one of the factors that affect our ability to recruit and retain people within NHS Highland."
20.4. The issues pertaining to appointment processes to senior positions arose on a number of occasions: According to a senior consultant:
"A number of senior medical posts within NHS Highland do not appear to be advertised to relevant staff. There is evidence that some of these posts may be created to favour key individuals in favour with senior management; those individuals are appointed to them without open competition. Together with the release of research monies this behaviour looks like patronage, and may be expected to buy favour or silence opposition."
20.5. As we have seen earlier in this report, favouritism is an issue of concern. This from a nurse:
"The lack of equal support for [Clinical Nurse Specialists] is profound. There is definitely a culture of apportioning blame, and career progression blocking for the least favourite staff.
It worries me, as I can see that junior staff nurses, or even senior staff nurses do not want to enter into specialist roles as there is too much responsibility put on these CNSs with little or no recognition. The lack of forward planning and future workforce planning to invest in staff is debilitating to the service, and I believe that there is a complete lack of awareness, from those who could make these changes, that changes need to be made."
20.6. If nothing else, the perception of favouritism is harmful. Another nurse referred to staff and friends of a Service Manager being "given upgrades irrespective of their ability and privileges (office space, desks, equipment), whilst the Senior Nurse was informed that there was no money for the promised upgrade and the Nursing budget was also threatened in relation to the number of posts and overall workforce".
Promotion and Training
20.7. As noted above, the promotion process for managers was raised on numerous occasions: it seems that management training for those who are promoted is perceived to be inadequate and that this, understandably, could lead to mis-handling of difficult employment issues. Another related concern is the promotion to manager of people without relevant experience in or understanding of the discipline they are being asked to manage. The "grow our own" policy was the subject of criticism.
20.8. The following comments capture the concerns expressed by a number of respondents:
"Throughout NHSH it is common practice for staff to be promoted into supervisory/managerial positions with absolutely no grounding in people skills, managing people skills, etc. It seems that once one reaches a certain banding, perhaps Band 7, they become autonomous and non-accountable. For example, sending out totally inappropriate letters to staff."
"How do applicants get an interview for a post they aren't fit to do? It horrifies me that a Band 6 gets promoted to a Band 8A. How can we be sure that it is safe to employ these people if they haven't got the knowledge and understanding. That's a concern."
"Let's be honest for what skills we are looking for in our managers and if it is line management, then recruit them for that."
""Growing our own" and advertising lower grade posts so that higher up staff get promoted does not work if those promoted are not competent"
"..a lot of service managers are promoted into posts that they don't have the skills to do that work. They fall into dictatorial techniques. It doesn't lead to getting the workforce on board. When I was recruiting new people, I was being pressurised to move people up the scale and advertise for the lower post. "Grow our own". That's great but doesn't matter if they're not ready to do the job. Need new people in post with different thinking."
"There is a theme of "growing our own" in NHSH – they get slotted into posts they are not ready for and don't have the experience for. They need more management training and beyond their specific qualifications. Nurses go into managing roles, but they don't have the management training."
Lack of Diversity
20.9. One manager offered this view which is self-explanatory:
"There is very little diversity in the senior managers, mostly white, middle class, 50-60s and in last job before retirement. They have old fashioned, dictatorial management styles and do not listen, know what's happening on the ground, trust staff or know how to engage them in decisions."
Friendship and Family Ties
20.10. As anticipated in the chapter on causes which may be particular to NHSH, I am told that many managers are friendly with colleagues (often people they manage) outside of work and that this can get in the way of holding colleagues to account for their behaviour. Training about how to manage multiple roles and relationships (and confidentiality) appears lacking. There are also criticisms of conflicts arising when family members are employed in sensitive positions, as characterised here:
"NHS Highland is a small environment with many staff being related to senior staff, which resulted in other staff being afraid of repercussions if they spoke up about inappropriate behaviour."