A DAMNING report into bullying in NHS Highland said many staff suffered "serious harm and trauma" as a result, driving them to quit their jobs or retire.
John Sturrock QC said it was possible that "many hundreds" of stuff had been the victims of inappropriate behaviour, although he stressed that "it is not possible to conclude conclusively that there is or is not a bullying culture in [NHS Highland]".
Analysis: From 'inappropriate' use of suspensions to how tight-budgets and targets drive bullying
The specialist mediation lawyer was commissioned by the Scottish Government to carry out an independent review after a group of senior clinicians wrote to the Herald in September last year alleging that the health board was blighted by a "culture of fear and intimidation" stemming from senior executives.
Read more: 'Culture of bullying and intimidation at NHS Highland must change'
Mr Sturrock said he had been contacted by 340 current and former staff members, and gathered evidence face to face and in writing from 282 witnesses.
The majority - 66 per cent - "wished to report experiences of what they described as bullying, in many instances significant, harmful and multi-layered".
In his report he writes: "While it is not possible to conclude conclusively that there is or is not a bullying culture in NHSH, it may be possible to conclude that the majority of employees of NHSH have not experienced bullying as such.
"Having said that, extrapolating from the evidence available to this review, it seems equally possible that many hundreds have experienced behaviour which is inappropriate.
"That seems far too many.
"The number of individual cases in which people have experienced inappropriate behaviour which falls within the broad definitions of bullying and harassment described earlier is a matter of the utmost concern.
"Many appear to have suffered significant and serious harm and trauma, feel angry and a sense of injustice and want to have their story heard.
"A number of those against whom bullying allegations have been made are also, or have been, the subject of inappropriate behaviour themselves.
"Many people have been afraid to take steps to address issues internally or to speak out, currently and over a period of many years. Many feel that no really effective, safe mechanism to do so has existed.
"A significant number of employees, at all levels of seniority, have resigned, moved to other jobs or retired as a direct result of their experiences in NHSH and inability to achieve a satisfactory resolution, some to their financial detriment."
Read more: Highland medics say culture of fear is silencing concerns over patient care
He added that the testimonies he had heard painted a picture of employees who did not feel valued, respected or supported in carrying out very stressful work, and "not listened to regarding patient safety concerns, with decisions made behind closed doors".
He added: "They feel sidelined, criticised, victimised, undermined and ostracised for raising matters of concern. Many described a culture of fear and of protecting the organisation when issues are raised.
"The senior leadership of NHSH has seemed to many, though not all, to have been characterised over some years by what has been described as an autocratic, intimidating, closed, suppressing, defensive and centralising style, where challenge was not welcome and people felt unsupported."
Read more: Six former non-executive directors back independent probe into NHS Highland
Since the Herald broke the story, a number of senior executives have stepped down.
NHS Highland's former chief executive, Elaine Mead, left her role as planned in December. Chairman David Alston medical director Dr Rod Harvey also stepped down in March.
Labour MSP for the Highlands, David Stewart, said: "In my 20 years of experience of dealing with NHS Highland as an MSP and MP, I have never before encountered such a toxic culture of bullying than that which has been experienced by the staff.
“The Sturrock Review validates the claims of those who have spoken out.
“The Health Secretary must ensure there is support all of those who have lost their jobs or experienced mental health problems as a result of their experience. They must not be forgotten.”
Edward Mountain, Conservative MSP for the Highlands said he was alarmed that the report indicated the Scottish Government "knew about the dysfunctional nature of NHS Highland in Autumn 2017 and yet did nothing".
Health Secretary Jeane Freeman, in a statement to the Scottish Parliament, said the report provided "important learning and reflection here for other NHS Scotland health boards and for the Scottish Government".
Ms Freeman said she would be convening a Short-Life Working Group in the summer with representation from NHS boards, trade union representatives, the Royal Colleges and the professional and regulatory bodies "to examine how we collectively take forward measures that support open and honest workplace cultures".
She added: "In particular, I will be tasking this group to look specifically at what more we need to do to effectively deliver the behavioural and attitudinal approach to leadership and management that is at the heart of the Sturrock Review.
"Meantime, I will also be writing to all health boards in Scotland to consider the Review and look again at the effectiveness of their own internal systems, leadership and governance."
In a statement, NHS Highland - which is being overseen by a new executive team, led by Iain Stewart - said it "welcomed" the report.
The statement added: "This report contains a number of important conclusions and recommendations which the Board will review in detail.
"NHS Highland will not tolerate unacceptable behaviour under any circumstances and is committed to ensuring that lessons will be learned and all staff will be treated in a fair and respectful way."
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