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by Dr Iain Kennedy
21 September 2023
Associate Feature: We need a radical overhaul in NHS culture

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Associate Feature: We need a radical overhaul in NHS culture

Our NHS in Scotland is in a worrisome situation. From GP and consultant shortages to waiting times and unrealistic targets, to under resourced social care and staff everywhere feeling exhausted, demoralised and burnt out. This is the mere tip of the iceberg. And action is needed – urgently.

I truly do not envy the mammoth task our government has in trying to fix this – one solution does not fit all here, and fixing one area will not sort the rest out. A targeted, strategic plan of action is required – looking at each area of the NHS individually and considering its needs.

Culture, and the way doctors and healthcare workers are treated within our NHS, is a key aspect of what needs to change. There is a saying among doctors that “civility saves lives” – and it couldn’t be more accurate. Creating a culture that is free from fear or favour is a necessity. Doctors and other staff are well aware of the risks that currently come with whistleblowing – knowing that their concerns might not be listened to or treated seriously, and that it may well result in negative personal repercussions for them and their careers.

Just a few weeks ago it was reported that a group of senior A&E doctors in NHS Grampian had raised concerns about staffing shortages – putting patient care, as well as staff wellbeing, at risk – with nothing done by NHS management to mitigate the situation. These doctors felt so worried, and so ignored by those above them, that they felt that had to go to the media as their warnings were falling on deaf ears. As a former whistleblower myself I understand how brave the doctors in Grampian were to raise their heads above the parapet.

This shouldn’t be the case. There should never be fear of being penalised and targeted for raising concerns that have patient safety at their very heart. Earlier this year I highlighted figures from a snap survey of our BMA Scotland members that showed almost 50% of those doctors who responded would still not feel confident about raising concerns, despite some of the practical steps that have been taken to enable NHS staff in Scotland to speak up.

I have said it time and time again, and I will keep on saying it until we see tangible change – we need a real shift in culture in Scotland’s NHS that means doctors and their colleagues working in all the caring professions are listened to when they voice their concerns about anything related to patient and staff safety within our NHS.

And while I acknowledge that one fix isn’t going to solve all of the problems, culture is ingrained into almost every aspect of day-to-day life within the NHS, and a shift in culture can and will lead to behavioural change when it comes to issues like wellbeing, working conditions and – crucially – patient care. 

Right now, things are simply not good enough. Our patients are our number one priority, and all of Scotland’s doctors – indeed all of Scotland’s NHS workers – should feel free to speak up without fearing they are putting their career at risk.

The Scottish government must be accountable for promoting a culture that values doctors and other healthcare workers through proper acknowledgement of the issues facing us right now.  Scotland’s politicians must be open and honest about what the NHS can deliver within its current limitations and the government must deliver a workforce plan that is transparent about the number of medical vacancies in Scotland’s NHS and what they are going to do to improve recruitment and retention. Culture is crucial. Pay is crucial. Workload is crucial. There is no time to leave anything to chance.

This article is sponsored by British Medical Association

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