A leaked report has detailed how a group of surgeons in Scotland who cared for 3,000 patients in 2014 have developed a "destructive, toxic culture" beset by "forceful and aggressive behaviour" that has the potential to be a "recipe for serious patient safety issues" and multiple medical negligence claims.
The independent report, commissioned by the Vascular Unit at Edinburgh Royal Infirmary and carried out by two of the UK's pre-eminent vascular surgeons, says that if clinicians do not act quickly to change the culture in the unit, it risks facing closure and, presumably, creating a serious medical negligence claim burden for the NHS.
Some of the findings can only be viewed as damning. For example, the unit is said to, at times, operate under a "gang culture" where favouritism and a culture of personal criticism and recrimination undermine safe and efficient operation.
The April 2015 report, featured on the HeraldScotland website, says that "the care delivered by this Unit appears to be more based on surgeons, individual careers, and their dysfunctional relationships rather than on safe, patient-centred delivery as described in the Francis Reports, the Keogh Report and more recently the Morecambe Bay Report."
The report then goes on to outline how such recrimination and dysfunction may have had practical consequences, even suggesting that it may have been a factor in the death of a patient.
And although there are some words of praise for aspects of the unit, including its modern and extensive facilities, there are a number of other concerns, including serious questions about whether it is further undermined by a culture of bullying. This has, says the report, had inevitable consequences for junior doctors, with "the current toxic environment [being] not one that trainees should have to witness or endure".
The authors state: "Very significant, rapid changes need to take place as described in our report as we believe the current situation amounts to a recipe for serious patient safety issues. We fail to see how vascular surgery can continue in Edinburgh if these issues are not addressed."
"We will not tolerate bullying or harassment in the workplace and this approach is embedded in the values of NHS Lothian," said Dr David Farquharson, medical director for NHS Lothian.
He added, "We have also developed systems to improve the way we deal with poor individual performance at work and introduced a clearer system for escalating concerns about performance.
"The immediate actions, identified in the report, have been implemented and an expert steering group has been created to progress other recommendations as a matter of urgency."
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