Health board in apology to staff over ‘workplace toxicity’ in women’s services

NHS Lothian has apologised to staff and pledged to take a zero-tolerance approach to “bullying and favouritism” following a review prompted by a whistle-blowing report after a maternal death.

An overall improvement plan began in August 2024 after a whistle-blowing report raised questions about patient safety and working culture within women’s services following the death, and a review has scheduled improvements for the next 18 months.

The death is the subject of a forthcoming significant adverse event review and the health board has pledged to address any recommendations from that, and said actions in relation to whistle-blowing concerns are already under way.

The latest review covered three sites including the Royal Infirmary of Edinburgh, St John’s Hospital in Livingston, West Lothian, and services in the community.

NHS Lothian commissioned a report to help strengthen its workplace culture, however staff feedback included claims of “workplace toxicity” including “antagonistic behaviours, harassment, micro-aggressions, bullying and perceptions of unfair treatment” in addition to “unrealistic expectations of staff and a lack of resources”.

In the review summary, NHS Lothian deputy chief executive Jim Crombie and director of people and culture Tom Power deemed some behaviours unacceptable and apologised.

A statement from both read: “On behalf of chief executive Caroline Hiscox, the NHS Lothian board and corporate management team, we fully recognise and apologise for the cultural difficulties and resulting poor staff experience many of you have described.

“This is not what we want for our colleagues, and we are genuinely sorry that this is how your workplace experience has been.

“Some of the behaviours described have no place in our or any other workplace, and we want to work with colleagues in women’s services to ensure they are not part of our culture moving forward.”

A summary of the report said: “There were marked perceptions of a disconnect between senior management and staff, which has led to further frustration and disengagement.

“Staff generally perceived leadership to be disengaged and unresponsive, with reports of favouritism, bullying, and a failure to address systemic concerns. Many staff narrated a ‘them versus us’ workplace culture.

“Data pointed to staff in midwifery experiencing more negative aspects of the workplace culture, including the excessive pressures for performance.

“The senior management team was perceived by many as critical and reprimanding, and at times, out of touch rather than supportive and engaging, leading to a culture of fear and frustration.”

It also cited “staffing shortages, excessive workloads, and complex patient care requirements” as considerations, and found “staff seeking more supportive, visible, and accountable leaders who understand frontline challenges” and wanted “a more positive and inclusive culture, free from bullying and favouritism”.

Within the next six to 12 months, the health board said it plans to “create a culture of psychological safety” so concerns can be raised “without fear”, including leadership training on “empathy, communication, and inclusive decision-making”.

This includes an anonymous grievance system, “zero-tolerance policies on bullying, favouritism, and workplace intimidation”, and regular psychological safety training for staff and leadership.

Mr Power apologised to staff who had been “let down” and said he recognises women’s services is often a vocation.

He said: “Our improvement plan prioritised patient safety and care to give us assurance that we were providing safe care to women and babies.

“In this latest round of work, we are focusing on our teams and our leadership to make sure staff feel supported at work, safe to raise concerns and able to thrive.

“We commissioned this independent research because we wanted to leave no stone unturned in our efforts to get a truly comprehensive picture of the experience of our teams in women’s services.

“I apologise to those who have been let down at work and reassure them that we are determined to support them better to do the job they love.

“During the focus sessions, many of our staff talked about their role in women’s services as being a ‘calling’, such is their level of dedication to providing care for women and babies.

“I would like to reassure women and their families, as the report make clear, that they and their babies will receive high-quality care from our committed and professional staff.”