Bullying In NHS Highland Proves To Be Expensive

28th September 2021

NHS Highland will today 28 September 2021 discuss the latest report on the bullying situation now that compensation payments are well underway. The recommendations flow from the Sturrock report published 9 May 2019.

Cultural issues related to allegations of bullying and harassment in NHS Highland independent review report.

NHS Highland
Meeting: NHS Highland Board
Meeting date: 28 September 2021
Title: Healing Process Update Report
Responsible Executive: Fiona Hogg, Director of People & Culture
Report Author: Fiona Hogg, Director of People & Culture.

1 Purpose
This is presented to the Committee for:
 Discussion
This report relates to a:
 NHS Board Strategy
This aligns to the following NHS Scotland quality ambitions:
 Safe
 Effective
 Person Centred

2 Report summary
2.1 Situation
The NHS Highland Healing Process was developed by NHS Highland in close partnership with colleagues, trade union representatives within Highland and Argyll and Bute and whistle blowers to help people who have suffered from historical bullying and harassment up to and including 31st December 2019 whilst working within Highland and Argyll and Bute.

The options available to participants include a 1:1 discussion by experienced independent facilitators, access to Psychological Therapies provided by Validium, and access to anIndependent Review Panel (IRP) hearing. The IRP then make recommendations to the Board for approval, based on the request of the participant and their assessment of the case in line with the guidance.

This can include apologies, organisational learnings, financial payments, referral to internal processes, redeployment or re-engagement or no further action.

The NHS Highland Healing Process opened for registration in late May 2020 and closed to new registrants on the 31st March 2021.
The Healing Process was one of the steps NHS Highland have taken to address the issues raised in the Sturrock Report. Other actions to support current colleagues and address cultural issues include the introduction of a 24/7 Employee Assistance
Programme in May 2020 and the 24/7 Independent Speak Up Guardian Service in August 2020. We have an ongoing Culture Programme Plan, with progress reported to the NHS Highland Board at each meeting.

2.2 Background
A progress update on the uptake of the Healing Process was submitted to the Board in May 2021. A further update is now provided, including the current and anticipated costs of the process.
2.3 Assessment

Participation
At the time of the May 2021 report, we had 309 active participants. A further 16 people have chosen to withdraw from the process since then and we now have 293 active participants.

Progress of cases
We have 177 cases which have completed through the process to date and have received their outcome. We have a further 9 cases who have completed their panel and are in the post panel review process. Of the remaining 107 cases still to go to panel, 57 are booked onto a panel and 50 are still working through the pre panel preparation process with support.

Estimated Conclusion of the Healing Process
At present, panels are scheduled to complete at the end of March 2022. It is currently expected that it will take until the end of June 2022 to complete all the necessary processing, reviews and reporting following the final panels.

Psychological Therapies
As part of the Healing Process, Validium have been engaged to provide psychological therapies to participants. To date, 205 participants have been referred to the service and 143 participants have had therapy authorised which is chargeable. Existing employees have access to some therapy under the Employee Assistance Programme, a separate contract with Validium, so where the recommended treatment is available through this route, no additional charges are required. Validium report on outcomes of therapy where recovery or progress can be assessed, on
an anonymised basis. These reports show a high proportion of cases achieving recovery or making substantial progress. Anecdotal feedback has also been received both directly and indirectly from participants on the value of this support.

Apologies
All participants who request an apology and for whom the Independent Review Panel recommend this is appropriate receive an apology. To date, the Chief Executive has provided 85 written apologies to participants. A further 10 participants requested an
apology; however, the Independent Review Panel did not recommend this as appropriate or did not believe it would aid their healing, having listened to their experience.

Organisational Learning
Organisational Learning from all cases heard by the Independent Review Panel has been collated. The first two reports were presented to the NHS Highland Board in March 2021 and some actions were identified, where the issues had not already been addressed.

Further reports will be produced as additional themes or learning emerge. Actions identified to address the issues from the Organisational Learning Reports are being tracked as part of the Culture Programme Plan and will be regularly reported on via the
Culture Oversight Group, Staff Governance Committee and NHS Highland Board.

Other outcomes
The Independent Review Panel has also recommended the organisation consider redeployment options in 3 cases. These have been taken forward into discussions with the participant and the Director of People & Culture to understand if any additional support
is appropriate and can be offered.

It has also recommended referral to other internal processes are considered in 5 cases. Again, these have been taken forward with participants as appropriate, by the Director of People & Culture. Due to the unique nature of the Healing Process, the Independent
Review Panel have only access to the participants' experience. The recommendation is that NHS Highland review and consider the situation, using all available information, to understand if any additional actions or review are needed and to take these forward as appropriate.

Costs
We can update on the most recent position with regards to the Healing Process payments and costs. There are two sets of costs involved, the costs of the Financial Payments, and the set up and ongoing running costs of the Healing Process. These are treated slightly differently in accounting terms.

Financial Payments
Up to 9 August 2021, 177 Independent Review Panel outcomes have been approved by the NHS Highland Remuneration Committee, which includes 150 recommendations for financial payment and 27 with no payment requested or recommended. All panel recommendations have been accepted to date. Those 150 financial payment recommendations total £2.063m.

There are 5 Bands of payments and the payments approved to date are as follows:
Level Range Number of cases
Level 1 £500- £5,000 46
Level 2 £5,000 - £15,000 61
Level 3 £15,000 - £30,000 35
Level 4 £30,000 - £60,000 6
Level 5 £60,000 - £95,000 2

As noted in the annual accounts, we have accounted for current and future liabilities of £4.2 million for the financial payments, of which £2.063m has already been approved as above. Based on the payments to date and cases remaining, our current modelling
suggests the total cost of the payments would be in the region of £3.415m, so the funding provided by the Scottish Government should be sufficient to cover this. The reduction in costs expected is due to regular revision of the average payments following each
remuneration committee and a reduction in the number of participants as some people have withdrawn.

All payments recommended by the Independent Review Panel have been approved by the Remuneration Committee.

Healing Process running costs
As noted in the 2020/2021 annual accounts, £1.1 million was spent on setting up and running the Healing Process in that financial year, which was funded by Scottish Government. This includes the scheme design and set up as well as the cost of running and administering the panels and the wider healing process and providing the various outcomes, including psychological therapies. It also includes the costs of setting up and running the website.
It is expected that costs for this financial year will be in the region of £1.282m and this funding has also been provided by Scottish Government to NHS Highland.

We have contracts with key suppliers and individuals to deliver the Healing Process, in line with the process that was agreed and appropriate contracts and, where applicable, tender waivers are in place and updated as required. Costs are invoiced monthly based on activity carried out, except for the Psychological Therapies, which are noted below.

As part of these costs, NHS Highland has to date approved £340,545 of treatment and support for psychological therapies for the Healing Process, provided by Validium, which are invoiced on treatment completion. £178,440 has been invoiced to date.
It is likely that some of the final costs will be incurred in financial year 2022/3, although these will be limited as the panels are due to end in March 2022. Costs in 2022/3 will be mainly be concerned with final administration and reporting.

Healing Process Internal Audit
NHS Highland commissioned Azets, our Internal Auditors, to carry out a review of the set up and running of the Healing Process. The completed report was received by the NHS Highland Audit Committee on 7 September 2021. The audit found that the controls around the design and set up of the Healing Process, the
communication of the process, engagement with suppliers and governance arrangements have been well designed. A recommendation that a specific information asset register
and protocol around the record retention timescales should be set up is being taken forward. The report noted the complexity of setting up and operating such a bespoke and confidential process, whilst maintaining all relevant governance standards and reported
confidence in those interviewed in the reliability of the Healing Process.

2.3.1 Quality/ Patient Care
The Healing Process supports colleagues who have experienced harm, and the process will benefit the quality of services and care in enabling their continued employment.


2.3.2 Workforce
The Healing Process supports colleagues to address past harm and aids healing.

2.3.3 Financial
Financial implications are set out in the paper. The costs of the Healing Process have been supported by Scottish Government.

2.3.4 Risk Assessment/Management
The risks associated with the process are documented and mitigated and an internal audit report has been completed to review the process.

2.3.5 Equality and Diversity, including health inequalities
The Healing Process has been designed to ensure it is fully inclusive of all.

2.3.6 Other impacts
None.

2.3.7 Communication, involvement, engagement and consultation
We continue to engage with a range of stakeholders on this topic, including Partnership, Whistleblowers, the External Culture Advisor, Whistleblowing Non-Executive Director, the Culture Oversight Group and Staff Governance Committee.

2.3.8 Route to the Meeting
The content has been reviewed by the Executive Directors Group on 20th September

2021.
2.4 Recommendation Discussion - Examine and consider the implications of the Healing Process update
report.

Board papers for the meeting can be found HERE

A number of other papers address the issues under other headings such as culture and healing.