NHS Highland's medical director personally raised the alarm that senior staff at Raigmore Hospital in Inverness were being bullied by health board bosses in 2012 - despite expressing surprise recently when clinicians hit out about a deep-rooted culture of fear and intimidation.
Former non-executive director at NHS Highland, Mike Evans, said he was approached by Dr Rod Harvey - now the board's medical director - six years ago.
At the time, Mr Evans was chair of the Raigmore Governance Committee and Dr Harvey, a consultant physician and endocrinologist, was the associate medical director at Raigmore Hospital.
Read more: NHS Highland medics slam 'culture of fear and intimidation'
Mr Evans, a chartered accountant who stepped down after nearly seven years on the board in April 2017, said: "Rod suggested to me that there was inappropriate bullying going on with regard to senior members of Raigmore executive team by the chief executive's office.
"Not specifically the chief executive, but [directors within] the chief executive's office.
"It's no secret that that point in time was round about when the financial pressures on NHS Highland were coming to the fore and Raigmore was and is, as a large part of the expenditure, a large part of that financial pressure."
Mr Evans said Dr Harvey - who was not personally being victimised - declined to lodge an official complaint after Mr Evans raised the issue with then-NHS Highland chair Garry Coutts. However, a senior member of the Raigmore team quit soon after.
However, he said he had felt compelled to speak out now after Dr Harvey - who was appointed medical director in 2014 - said he "did not recognise" claims of a bullying culture at NHS Highland after four senior clinicians penned a letter to the Herald in September describing a "culture of fear and intimidation" and "practice of suppressing criticism, which emanates from the very top of the organisation".
Read more: Highland medics - 'Practice of suppressing criticism emanates from the very top'
The medics - Dr Eileen Anderson, chair of the Area Medical Committee; Dr Lorien Cameron-Ross, vice chair of Area Medical Committee; and GP staff representatives Dr Jonathan Ball and Dr Iain Kennedy - warned this was adversely affecting both staff and patient care.
Mr Evans said: "What I was surprised at [after the clinicians' letter] was Rod Harvey, who has come out and said that NHS Highland weren't unaware of anything, when he was the person who brought it to me."
Mr Evans stressed that he "believes incredibly" in the good work that NHS Highland do for patients and that he never uncovered concrete evidence of bullying during his tenure.
However, he said he shared clinicians' fears that criticism was stifled, in particular in the wake of a one-on-one meeting with chief executive Elaine Mead in 2012 to address the issues raised by Dr Harvey.
He said: "It was an unusual meeting that I had reservations about, and I have to say I considered resigning myself following that meeting because I didn't think it was entirely appropriate.
"That accords in my mind with some of the observations that have been made by others about being 'put in a room with someone' and persuaded that there is no bullying going on. I can remember going home to my wife and saying 'you know, I'm not sure I want to be on this board'."
Read more: Report reveals 'extremely murky goings-on' at NHS Highland
Dr Harvey confirmed he had expressed concerns about "inappropriate bullying behaviours" to Mr Evans, but said this was during a "chance meeting" and he "did not seek him out for that purpose".
Dr Harvey denied using the term 'chief executive's office' in conversation with Mr Evans, adding: "At no point did I ever consider raising an official complaint. I had a perfectly civil conversation with [Mr Coutts] and subsequently the chief executive following which I considered the matter satisfactorily resolved."
He added: "I have always been clear in my statements that it would be naïve to believe that in an organisation of the size of NHS Highland that no bullying episodes occur, but when they do they should be robustly addressed either formally or informally.
"I would stand by my view that I do not recognise a systematic culture of bullying throughout the organisation."
Mr Evans is one of three former NHS Highland non-executive directors to speak to the Herald amid the bullying row now engulfing the health board.
Sarah Wedgwood left NHS Highland in March 2017 for health reasons after nearly seven years on the board, including four years as vice-chair. She also served as its first ‘whistleblowers’ champion’ and as a result said she was "not at all" surprised by claims of a bullying culture.
She said: "While I was in post, numerous senior personnel [came] to me but significantly they didn't want it taken any further.
"They wanted my advice and a listening ear and that in itself demonstrated to me - given the number - a lack of trust and feelings of fear that were palpable and lack of faith in the system. They thought they wouldn't be heard without reprisals, so that's why they weren't prepared to raise it."
The key role of non-executive directors on a health board is to scrutinise the recommendations of NHS executives to ensure that major service changes or spending decisions are in the best interests of patients and staff.
Ms Wedgwood, who has spent her career working in the public health sector, including serving as director of policy for the Care Commission and as a senior health advisor to the Scottish Government, said she felt unable to carry out her role properly at NHS Highland.
She said: "There was insufficient evidence given to us to do our job. So for instance, when you were getting a serious policy change you ought to be given the project plans, risk assessment, outcomes, costed appropriately, and that request was met with resistance and we were told to 'trust'. Well, trust can only go so far."
Myra Duncan resigned in May 2017 after nearly five years as a board member. She was one of six to quit in the space of a year between 2017 and 2018, and says she left after feeling prevented from holding executives to account.
She said: "There was just a lack of transparency. Recommendations came to the board, however there was no audit trail of how that recommendation had been arrived at."
She added: "You'd get a recommendation and you'd challenge and ask questions, which you have to, but it felt that you didn't ever get the right information that you were asking for.
"My view was that the board wasn't being allowed to hold executives to account. I personally didn't feel that I was being encouraged or supported to do that."
In recent months, NHS Highland has reversed a controversial decision to close the cardiac rehabilitation 'Heartbeat Centre' in Raigmore Hospital in Inverness and use facility instead as a day hospital for older people. An external review also halted NHS Highland's plan to cut the number of inpatient beds at Portree Hospital on Skye.
Since the clinicians' letter, dozens of other NHS Highland staff have also approached trade union GMB to share their own experiences. They include a retired director, dentist, surgeons, clerical staff, cleaners, nurses and a department head.
In a letter to Health Secretary Jeanne Freeman dated October 8, GMB regional officer Liz Gordon said the number who had come forward "runs counter to claims by [NHS Highland chair] David Alston that these allegations relate to a small group of disgruntled clinicians".
David Alston, chair of NHS Highland, said: “We take this extremely seriously, not least because we fully recognise the current situation has resulted in an unsettling and upsetting time for all.
"This damaging set of allegations has cast a very dark shadow over the reputation of the Board. Therefore it is in nobody’s interest for this not to be tackled urgently, respectfully and comprehensively."
Mr Alston also said he was "very surprised" by Mr Evans' comments, adding: "He at no time raised any outstanding concerns or new concerns relating to bullying with me informally or formally.
"In the absence of any further information it is not possible to comment further.
"More generally I would reiterate that NHS Highland does not tolerate bullying and harassment behaviours. The board takes such allegations extremely seriously and any complaints made will be fully investigated through appropriate procedures."
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