Patients ‘put at risk by toxic culture at hospital A&E’

Patient safety has been put at risk by a toxic culture of mismanagement and bullying at Forth Valley Royal Hospital’s accident and emergency department, frontline health workers have warned.

Staff had alleged that the health board’s management “colluded in and condoned” unacceptable levels of “bullying and harassment”, triggering a culture and governance review of NHS Forth Valley.

Nurses and doctors told the independent review – as reported in the Daily Record – that they were “battle-weary”.

Many senior staff had resigned, leaving shifts in A&E over-reliant on junior staff who were unsupervised and lacked proper training.

Problems in the department – including a suspiciously low number of reports of mistakes and near misses – dated back years but had been exacerbated by the pandemic, according to the review.

The review by former NHS executives interviewed 35 nurses, two doctors and six of the A&E team who had left the hospital.

NHS Forth Valley has refused to publish the report which is believed to contain 45 recommendations for the health board and has only been shared with staff involved in the review.

According to reports, the confidential report highlighted a culture “that made staff fearful of being publicly humiliated by managers” and an “irretrievable breakdown of necessary working relationships” between frontline staff and nursing leadership and management.

Nurses also told of high levels of anxiety, mental health problems and fears over patient safety due to bullying and staff and skill shortages.

One junior staff member said inexperienced recruits were not properly inducted and there was no “formal teaching”, according to the Daily Record.

They added: “You just pray you are not going to be asked to undertake a procedure you have not been trained in.”

A poster dedicated to nurses on a wall in ward A31 at Forth Valley Royal Hospital in Larbert. PA Media

Another said a junior nurse was ordered to stand at the entrance of A&E when the department had become overstretched to “stream” patients, often redirecting them to minor injury wards or the pharmacy without a proper clinical assessment.

The report said: “Staff told us the focus on waiting times could often be at the expense of safety and quality in the emergency department.”

The hospital has only met a government target of 95% of A&E patients being seen within four hours three times in more than four years.

The most recent monthly waiting time figures show 78.5% were admitted, transferred or discharged within the target time during May.

NHS Forth Valley said it has established a committee to implement the report’s recommendations – including improvements to staff engagement, relationships leadership and a review of staffing.

The health board’s chief executive, Cathie Cowan, said: “We have a duty to ensure the health and wellbeing of local staff as well as the patients they look after.

“It is important that any concerns raised by staff or their representatives are taken very seriously and fully explored in a fair and open way.

“That is why as soon as these concerns were raised, I asked a team of experienced external healthcare professionals to carry out an independent review of the culture and governance arrangements within our emergency department.

“I would like to personally thank all of the staff who participated in the review process for sharing their experiences, providing feedback and in many cases, putting forward their own ideas and suggestions for improvements.”

Senior Royal College of Nursing officer Bob McGlashan said: “RCN members came to us with a number of very serious concerns, including unsafe practices and a culture of intimidation in the emergency department at Forth Valley Royal Hospital.

“We wrote to the health board about these issues in November 2020 and they rightly acted quickly to set up an independent review.

“Staff across the NHS and social care are working under incredible pressure at the moment and it is completely unacceptable for anyone to be subject to bullying or any other form of intimidation.

“We look forward to working with our members and NHS Forth Valley to implement these recommendations in full to ensure nursing staff feel safe and are able to provide high-quality patient care.”