A ‘politically driven…target culture’ cascaded from senior management contributed to inappropriate behaviour at NHS Highland, a report has said.

A total of 184 staff have now received payments totalling nearly £2.5m from a scheme set up to help victims of bullying and harassment.

An independent panel set up to assess cases of bullying and workplace harassment said staff should be given the ‘necessary skills and resources’ to meet targets, and management should ensure their ‘transactional nature is not to the detriment of relationships’.

In its third set of recommendations to the board, the Independent Review Panel (IRP) said the term “cronyism” had often been used to describe the way appointments were made.

It also raised new concerns about clinical leadership for services in remote and rural areas, as well as the support offered to new staff moving to the region from elsewhere in Scotland and the UK.

And on targets, it said staff needed to be given the 'necessary skills and resources' to meet them.

The scale of bullying at NHS Highland was laid bare in an independent review published in 2019.

As part of its response to the Sturrock report, the health board set up a ‘healing process’ overseen by an independent body.

That panel has now heard testimony from 226 current and former staff, with 213 being passed along for review by the remuneration committee.

One of the first victims to go through the process described the compensation he was offered as “shocking” and warned many could end up “bitterly disappointed” by the “broken” system.

The panel says NHS Highland could ‘lead the way’ in providing basic mental health first aid training for all staff as part of its ‘healing process’.

It suggests supporting the transition of staff from outwith the area to live and work in the Highlands should be a key focus, which the panel says the Scottish government should be involved in directly.

There are 57 active participants still to complete the healing process.

The IRP is expected to hear all remaining cases by March 2022, when a final findings report will be produced for the board.

Its most recent report said: ‘We are also very conscious that improving the culture in NHS Highland to the extent that is necessary will take time, but we note the leadership which is being given to this by the Chair, Chief Executive, executive team and other non-executive board members.

‘Recently, a number of participants we have met have commented on this positive leadership and commitment to change at the top of the organisation but that it is taking time to filter through to staff on the frontline. The testimonies we have heard to date indicate that bullying and harassment was occurring at all levels in the organisation.’

In a report to the board, culture advisor Emma Pickard said work was underway to improve the on-boarding of new recruits to NHS Highland, as well as to review leadership in remote areas.

‘NHS Highland has little scope to change the national approach to target design and delivery; although it has been acknowledged that senior leaders can change the way that targets are communicated / cascaded and how staff are supported to respond,’ Ms Pickard added.

Read more: Highland bullying victims question ‘healing process’; Highland healing process deadline pushed back; HSCP to re-run chief officer recruitment process

Sign up to our bulletin for key health & social care updates straight to your inbox.