By Caroline Gardner, Auditor General for Scotland
We’ve all felt it – that sense that the culture’s not quite right in an organisation. It can be hard to pin down, but the tell-tale signs are well-known: poor communication, top-down management, disengaged staff, a lack of trust, and bad behaviours like bullying going unchallenged by senior leaders. All too soon it can turn into ‘the way we do things around here.’
Scotland’s public services haven’t been immune. The early years of the Scottish Police Authority were marked by poor governance and difficult relationships, a legacy which is only now being overcome. And the recent Sturrock report into bullying and harassment at NHS Highland found that hundreds of people had experienced inappropriate behaviour.
The leaders of our health and care system are working in an environment of extreme pressure and great complexity, but that doesn’t mean culture change is unachievable.
Sir David Dalton, former chief executive at Salford Royal NHS Foundation Trust, made a point of spending half his time on the shop floor, listening to staff and patients. His aim was to create a culture that supports consistently high standards of care, with deep staff involvement. It worked; over 90% of patients rated their care as excellent.
The NHS in Scotland has a similar aim, with health and social care integration promoted as the way to transform our healthcare services. But that’s not the reality of the job for board chief executives and other leaders, and it’s not what they’re held accountable for. Too many healthcare leaders are consumed by the pressure to hit performance and financial targets, focusing on firefighting rather than leadership.
Part of the problem is the high rate of turnover of chief executives and other senior managers. It takes time to build relationships and trust; Sir David Dalton was in his job at Salford for 18 years. The average time at the helm for Scotland’s healthcare leaders is about two years. It’s in everyone’s interests to end that churn, but the opposite appears to be happening.
In 2018/19 five of the 22 NHS boards saw a change in chief executive. We’re seeing increasing numbers of vacancies, and it’s getting harder to fill jobs as a blame culture makes leadership roles less attractive.
As Auditor General I understand the need for accountability when things go wrong, but failures are rarely down to a single individual. Public failures too often lead to sackings or resignations as a substitute for understanding the causes of the problem, which are often complex and beyond the powers of any one person to fix or prevent. That’s a hard truth in a world where public sector failings reflect directly on politicians who are themselves under pressure to act. But the leadership pool in Scotland is small, and we need to grow it rather than shrink it further.
Project Lift, the new NHS and social care approach to leadership development, is a positive step. But it will take time to grow the next generation of leaders and in the short term they would benefit from seeing our current leaders backed and given the space to lead. The Scottish Government can help to make that happen by providing more support.
Accountability matters, but it needs to exist alongside collaboration, understanding, kindness and compassion – for staff as well as those they care for. The alternative is to continue on the leadership merry-go-round of recent years, and the stop-start, short-term organisational culture that breeds. And that’s no alternative at all.