'Serious breakdown' in relationships hit patient care

Staff have been raising concerns over patient safety at the Queen Elizabeth University Hospital in Glasgow since 2021

Emergency doctors at Scotland's biggest hospital were subject to "disrespectful behaviours, poor teamwork and incivility" by their bosses, a review has found.

The Healthcare Improvement Scotland (HIS) report found a "serious breakdown" in relationships between managers and A&E consultants at Glasgow's Queen Elizabeth University Hospital (QEUH) was likely to have had a detrimental impact on patient care.

The review also called for the "normalisation" of treating patients in corridors and extended waits for ambulances outside A&Es across Scotland to be stopped.

NHS Greater Glasgow and Clyde said a transformation programme was working "at pace and scale" to improve care at the hospital.

The NHS watchdog HIS was first contacted by 29 A&E doctors working at QEUH in 2023. They claimed safety was being "seriously compromised".

This included evidence of what they said was treatment delays, inadequate staffing levels and patients being left unassessed in unsuitable waiting areas.

HIS was forced to apologise to the medics for not properly investigating their concerns and then last year it launched a review of three NHS GGC emergency departments, including the QEUH.

The review found overcrowding and poor patient flow in the three A&Es, along with concerns about insufficient management support for frontline staff.

It also said there was a lack of compassionate, respectful and positive leadership at all levels of NHS GGC.

Dr Pamela Johnston, a former medical director at NHS Tayside, co-led the review into the QEUH

The review was led by Dr Pamela Johnston, a former medical director at NHS Tayside, and Prof Hazel Borland, a former nurse director and deputy chief executive at NHS Ayrshire and Arran.

In their report they pointed out that the urgent and unscheduled care system across the entire health service was under pressure and "struggling to meet demand".

They said this could only be changed by a national intervention.

Dr Johnston said: "When staff do not feel valued and respected, goodwill is eroded.

"To resolve this complex problem NHS Greater Glasgow and Clyde needs to take a whole system approach across urgent and unscheduled care.

"This strategy needs to start with everyone working collaboratively and respectfully to address the issues before them."

A statement issued by the 29 doctors who complained to HIS in 2023 thanked the review team for its detailed report. It added: "Concerns over the safety and humanitarian care of emergency patients has been the driving motivation for bringing these issues into the public domain."

The HIS review covered the emergency departments at the QEUH, Glasgow Royal Infirmary and the Royal Alexandra Hospital in Paisley

The HIS review covered the emergency departments at the QEUH, Glasgow Royal Infirmary and the Royal Alexandra Hospital in Paisley.

It involved interviews and surveys with staff and patients, and reviewing a wealth of material including shift handover notes from A&E departments.

The report says the level of stress and distress among staff at all levels in the three emergency departments was "palpable".

Some staff said the working environment in the QEUH was "brutal" and "inhumane", while one staff member described being "haunted" by some patient care experiences that had led to harm.

The HIS report said bosses at NHS GGC "must demonstrate recognition of the low morale, poor wellbeing and moral distress among staff and take actions to address these".

It suggested the use of external mediators to re-build relationships.

'Normalising' corridor care

The report has made 30 recommendations for NHS GGC covering improvements to processes and culture.

It also makes a further 11 Scotland-wide recommendations.

The report says treating patients in corridors and the stacking of ambulances outside A&Es "has become a normalised solution for emergency department crowding" in NHS GGC emergency departments.

The authors state this problem is not unique to NHS GGC but that "it cannot and should not be tolerated".

They called for urgent work across Scotland to eliminate the "unacceptable use of non-standard care areas, given the risks to patients and the impact on staff".

The review also suggested that the tools used by NHS bosses to work out appropriate staffing levels in emergency departments were "not sufficiently robust".

Prof Jann Gardner said the problems in the report were partly caused by increased strain on the system

There have been concerns raised about patient safety standards in the emergency department at the QEUH a number of times in recent years.

In 2022, BBC Scotland revealed how A&E doctors had urged NHS Greater Glasgow and Clyde to declare a major incident at the hospital amid fears the department would be overwhelmed.

Another request for a major incident to be declared was put forward in December last year amidst overcrowding concerns, but this was turned down.

Major incidents are declared when there is a serious threat to the health of the community and might include measures such as non-urgent procedures being cancelled or ambulances being diverted.

Prof Jann Gardner, the new chief executive of NHS Greater Glasgow and Clyde, said the problems identified by the report were, in part, a result of increased strain on the whole system.

She told BBC Scotland News: "The pressures of our front door are a real challenge for us.

"We need to build a culture where people feel that they are valued and listened to, and where our patients feel like they'll be cared for well and their experience will be positive, and right now all of those components are not there."

Prof Gardner took over the role in February, after the departure of the former chief executive Jane Grant.

She said it was not for her to respond to Ms Grant's role in the health board's past problems.

Prof Gardner added: "Wherever there is pressure in a system relationships become strained, but clearly the voices of our staff are telling us that something needs to move on.

"It's a complex system and I think there are a myriad of issues that will have led to how people feel today, and I don't want to diminish either the relationship issues that people have raised or the system issues of working in a pressurised environment."

The health board boss confirmed she had started a transformation programme "at pace and scale".

Prof Gardner said: "We are improving care - we have improved significantly our ambulance stacking and we are reducing corridor care but it does remain a problem.

"I'm absolutely committed to listening to the voices of our staff and to building forward with them the solutions that we need to put in place.

"Today is not what we want and I hope that I've been sending out that message from day one."