Poor management leads to 'serious failings' at the NHS in Scotland

13 July 2015 -


A lack of leadership and poor working culture are two of the ‘deep-rooted and systemic’ problems identified in a highly critical report of NHS care in Scotland.

Matt Scott

The NHS in Scotland has been slammed for poor leadership and an inappropriate working culture that have led to systemic failings in NHS care north of the border.

A report from the Academy of Medical Royal Colleges in Scotland found six key issues that contributed to ‘serious failings’ at NHS facilities across Scotland:

  • Poor leadership at all levels resulting in a defective culture, a disconnect between clinical staff and management, inappropriate targets and poor accountability mechanisms;
  • Staff shortages, inappropriate skill mixes on teams, inappropriate use of inexperienced staff or failure to supervise;
  • Poor staff morale and motivation;
  • Poor dealings with patients;
  • Inadequate complaints handling; and
  • Limitations of external assessments.

Professor Alan Paterson, chair of the Scottish Academy Short Life Working Group on Hospital Reports and director at the Centre for Professional Legal Studies, Strathclyde University, said the management problems in the Scottish NHS were ‘deep-rooted’ and action was needed to rectify the problems so failures were not repeated.

“It is clear that serious failings in team working between clinical staff and NHS management played a significant role in the failings in care identified,” he said. “These failings are deep-rooted and systemic. They must not be ignored if we are to learn from them and to prevent repetition.

“It is also clear that a combination of factors led to some appalling failings in care, a loss of basic compassion and the prioritisation of inappropriate targets over patient care. In addition, leadership and accountability were all too often sadly lacking and bullying endemic.”

The report made 20 recommendations for rectifying the problems it highlighted as a result of its review of NHS care across the country. These included improving the management capabilities through better communication and aligning targets and performance measures with good clinical outcomes.

6 Ways to Fix the Scottish NHS

  • Emphasising the importance of good communication comes with good leadership. A supportive, listening environment must be created to produce a culture which instils confidence in staff, patients and relatives and in which innovation is encouraged;
  • Quality of care must become the primary influence on patient experience and NHS Boards, a routinely discussed and acted upon agenda item at Board level and the primary indicator of performance;
  • Action needs to be taken by NHS Boards to improve the working culture within the NHS and in particular to address the ‘learned helplessness’ that can be experienced by staff when poor standards of care are condoned and perpetuated due to a combination of organisational and external pressures and a sense that this cannot be changed at an individual level;
  • The Scottish Government should work together with the Scottish Academy, the General Medical Council and other stakeholders to foster a work culture in the NHS which is free from bullying;
  • The Scottish Government and NHS Boards should work together to develop minimum, safe staffing levels for all professions in hospital settings, providing the required skills mix and under appropriate supervision, so as to ensure that all patients receive safe and high quality care delivered by appropriately trained and experienced professional staff; 
  • Failings should not be viewed as isolated, localised incidents and reported on without reference to failings in other parts of Scotland and throughout the UK. It is clear such an approach has led to missed opportunities to learn valuable lessons from other parts of the NHS. When Inquiry or Review reports are published and are of national significance, all Boards should be required to demonstrate their compliance with the recommendations.

Ian Ritchie, chair of the Academy of Medical Royal Colleges & Faculties in Scotland, and president of the Royal College of Surgeons of Edinburgh, said that teams must work together under effective leadership if the recommendations were to be successful in fixing the problems with the Scottish NHS.

“This cannot be done by any one group,” he said. “Clinical staff and management must work more effectively together as teams. They must also be supported in doing so by ending the focus on inappropriate targets and making quality of care our over-riding priority.”

The report was published by a Working Group that was setup to review three reports on serious failings in care and management at NHS Lanarkshire, the Vale of Leven Hospital and Aberdeen Royal Infirmary. The Working Group also looked into a similar report into serious failings at Mid Staffordshire in England.

Paterson said that, while these reports had led to some mitigative action, this time steps must be taken to address the underlying issues within NHS leadership teams, and not just treat the symptoms.

“While there have been responses to the individual published reports of inquiries and reviews into failings in care, there is little evidence to suggest that we are tackling the underlying systemic failings which exist,” he said. “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.”

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