Poor leadership and working culture in NHS, warn health bodies

A series of high-profile and serious failures of care in Scotland have demonstrated that poor leadership and working culture alongside staff shortages and low morale have contributed to systemic failings in the NHS, according to a new report by the Academy of Medical Royal Colleges & Faculties in Scotland.

High profile inquiries at NHS Lanarkshire hospitals, Vale of Leven Hospital and Aberdeen Royal Infirmary found serious failings in NHS management between December 2013 and 2014.

The Scottish Academy, which is made up of all the Medical Royal Colleges and Faculties in Scotland, set up a working group to investigate common themes in the reports, alongside the well-known Francis report into serious failings in care in Mid Staffordshire in England and some other investigations.

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Professor Alan Paterson, director of the centre for professional legal studies at Strathclyde University, chaired the working group.

There is little evidence of “tackling the underlying systemic failings”, he warned.

These include poor leadership at all levels, inappropriate targets, staff shortages leading to inexperienced staff in important positions, poor staff morale and communication with patients, bullying and inhibitions to whistleblowing.

The report also suggests there are limitations with the external assessments into the cases themselves, questioning the methodologies and systems of following up recommendations.

The Academy makes 20 recommendations to tackle the “deep rooted and systemic” failings.

“This includes recognising and acknowledging the commonality between the events in Mid Staffordshire and the incidents in Scotland. Opportunities to learn and prevent recurrence have been missed and this must change for the sake of patients,” said Paterson.

The primary indicator of performance for the NHS, the report recommends, should be quality of care, and this should influence patient experience and the decisions of health boards.

NHS Boards must also take serious action to improve the working culture in the NHS, the Academy says, while the Scottish Government should help foster a working culture free from bullying with minimum safe staffing levels.

Professor Derek Bell, President of the Royal College of Physicians of Edinburgh, said staff must have time to care and be supported to raise concerns.

“We have a collective responsibility; doctors, patients, all NHS staff and managers must work together to ensure that our NHS is the best it can be and break this cycle of failings in patient care," he said.

NHS Healthcare Improvement Scotland is currently consulting on a new, comprehensive approach to reviewing the quality of care.

The Scottish Government's clinical director of healthcare Jason Leitch responded to the report by saying improvement work following the inquiries at Lanarkshire, Vale of Leven and Aberdeen were ongoing, and the NHS was "constantly striving to improve healthcare in Scotland". Read his full response here.