 The final item of business is members' business debate on motion 146.3, in the name of Edward Mountain, on the investigation into bullying claims at NHS Highland. This debate will be concluded without any questions being put, and I would ask those who wish to speak in the debate to press the request-to-speak buttons now. I call on Edward Mountain to open the debate for around seven minutes, please. I am, in fact, saddened that we are having this debate this afternoon, firstly because we shouldn't need to be having it, and secondly, it should have been dealt with when I first called on the First Minister to hold an independent inquiry into this issue in September. I would like to thank those members of the chamber and of opposing parties who have signed this motion that was in my name, particularly David Stewart, Rhoda Grant, Monica Lennon, Liam MacArthur, Alex Cole-Hamilton and John Finnie. Although no SNP MSP has supported the motion, I am confident that they believe, like I do, that there should be zero tolerance when it comes to bullying. I would like to welcome, before I go into the substance of my debate, those who have come from the Highlands to listen to this debate, who are up there in the gallery. I would like to thank them for all the work that they have done to bring this to the attention of the Parliament. I would also like to welcome those who are following this on BBC Live. There is a huge interest in this matter. When I became elected in 2016, it was apparent to me that there were significant issues within NHS Ireland, not just with waiting times and poor financial performance, but there was something else, something that I couldn't quite put my finger on, something that frankly made me feel very uncomfortable. I believe, Presiding Officer, that the way in which an organisation treats those that they work with paints a good picture of the way they treat those that work for them. In 2016, the deep division between patients in Cathness and Sky and NHS Ireland warned me that something was seriously amiss. Those protesters felt ignored and that NHS Ireland had shown them an unbelievable level of arrogance, which is perhaps why over a thousand of them took to the streets in Cathness on a wet and windy afternoon in October of that year. My concern grew further when doctors and nurses across the Highlands started to contact me informing me of issues and passing on correspondence from NHS Ireland. A trickle became a flood. Issues that should have been addressed with senior management, but they felt that they were unable to do so because of the response that they received. That attitude manifested itself at board level. The huge turnover of non-executive board members in the last five years should have been a flag to the then health sector tree, but it wasn't. What should have been an even bigger deafening klaxon to that sector tree was when the non-executive board passed the following motion on 28 August 2017. I read that motion. We feel that the culture and leadership of the organisation is a risk to our stated values and objective. That is from the board of NHS Ireland. That motion was passed to the chair of NHS Ireland, who subsequently denied he knew about it, and it was also passed to the Scottish Government. The result was a Government's review, which condemned the executive management of NHS Ireland. I am going to quote one paragraph of the report produced by John Brown, and it is as follows. If you want to look it up, it is paragraph 430. The chair should consider externally facilitated support such as mediation to provide a safe and insecure environment for board members to meet with him and the chief executive to discuss recent concerns and for an agreed way forward to be found. One has to ask what exactly was going on in the boardroom that made it an unsafe and insecure environment, while perhaps exactly what was going on elsewhere in NHS Ireland. On Friday, a meeting organised by the GMB and whistleblowers was set up to discuss bullying. We heard stories about what was going on, and I want to quote just one, just one of the 100 plus that had been reported. I quote, and this is from a lady. Each time it got worse and worse, crying and begging my husband before a shift not to make me go in, and crying when I returned home. My bullying in the workplace got so bad that it affected my mental health. It was so bad that it not only affected me in the work but also in my home life and my life with my kids. This is from a healthcare professional doing her job. She is not the only one. I have heard of other harrowing cases who have contacted me directly. I have been so concerned that, on one occasion, I contacted the office of the chief executive of NHS Scotland to seek help as NHS Ireland remained uncommunitive. It does not stop there. There are patients across the Highland who feel let down, unable to raise the issues that they want to because of the unpleasant reaction to the fact that some have received when they have the temerity to complain. Everything that I have seen and heard has convinced me that there is a bullying culture in NHS Ireland, and it cannot be written off as gossip that the chair of the board tried to do on 27 July this year. To me, it is evident at every level, from the boardroom to the floor of the wards. You see it in the way that NHS Highlands work with their own, with their patients and with those who dare to question the service provision or management. On the latter point, I will just make this point. Trust me, I know. On Friday, the cabinet secretary announced an independent review into bullying in NHS Ireland, which I welcome, but I am afraid that that is just the start. The review will need to look back to identify where the culture of bullying emanated from. John Starrett will need to speak to the staff and patients and board members, and that will take time. I hope that, during the course of this debate, the cabinet secretary can confirm who will be allowed to contribute to the review, that the review will look back for at least 10 years, that the review will cover what I will term as the coercion of staff by the projection of authority, which I believe goes on the whole time. When it comes to reporting, I hope that the cabinet secretary will confirm to me what early 2019 means, because time is sadly a luxury we don't have. We have to address this issue that is festering and I have told has been around for over 10 years. We need to do it, cabinet secretary, for the staff, the patients and the victims in NHS Ireland. Bullying has no place in any of our institutions, and particularly not NHS Ireland. We move to the open debate. The speeches of around four minutes, please. I call Gail Ross to be followed by David Stewart. Bullying, discrimination, intimidation, victimisation, abuse, harassment. We teach our children from a young age that this behaviour is not acceptable in nursery and school, it's not acceptable in college and university, it's not acceptable in the workplace and it should not be acceptable full stop. When the news broke in the press that four clinicians had come forward to say that scores of health workers had been or felt they had been bullied at various NHS Highland establishments across the Highlands, there was quite rightly a condemnation of such behaviour. I am not going to go into the detail of the allegations, because for me that is something for the investigation to explore. What I will say is that any member of staff at NHS Highland that feels they have been bullied no matter what shape that takes must feel supported to come forward. I have met with staff locally, Government officials and spoke to the Cabinet Secretary about that. On 15 November, I asked the Government about an independent investigation, and the answer from the Cabinet Secretary was as follows. The scale and scope of the allegations of bullying and the timespan of those in NHS Highland is such that I need to understand the issues that appear to have led to a culture where those concerns cannot be raised or resolved satisfactorily by the board. To ensure all the issues can be raised and heard by those involved, I have commissioned an externally led independent review. This review will consider all the circumstances that have led to the allegations and make recommendations. My officials continue to hold discussions with NHS Highland staff and their representatives, and we will finalise the scope of the investigation during the week beginning on 19 November and look to announce who will lead the independent investigation as soon as possible thereafter. On 23 November, I asked who will be leading the review and what the scope of the review will be. The Cabinet Secretary answered that I have asked John Sturrick QC to lead the independent review to explore the underlying issues and concerns that have led to allegations of bullying and harassment within NHS Highland. The review will include conversations with affected individuals, including current and former staff, representatives, board members and health board management. The scope of the review will be to create a safe space for an individual and or collective concerns to be raised and discussed confidentially and with an independent and impartial third party. To understand what, if any cultural issues have led to any bullying or harassment and a culture where such allegations apparently cannot be raised and responded to locally, and to identify proposals and recommendations for ways forward, which help will ensure that the culture within NHS Highland in future is open and transparent and perceived by all concerned in this way. The review will commence with initial meetings taking place before Christmas. A review report with proposals and recommendations for ways forward will be provided to the Scottish Government in early 2019. Separate to this independent review, the chief executive of NHS Scotland, Paul Gray, has today written to NHS Highland to offer an increased level of support to help them to recover their financial position and strengthen internal governance. That will raise Highland to stage 4 in the board escalation framework. Additional support will take the form of a support team led by a transformation director who will assist the board in planning and delivering the improvement initiatives that are necessary to restore the board to financial balance. I believe that it is important to get that on the official record. The Government is taking that seriously and has answered calls for an independent investigation. The board is being given extra guidance and assistance, but I will end with two pleas. First, a plea to NHS Highland to commit to listen and act on the evidence received. Secondly, a plea to all NHS staff that are considering coming forward with any information about anyone. Please feel safe and supported to do so, because you are on the front line and the backbone of our NHS. We appreciate everything that you do, and we need you to be healthy and happy so that we can be too. David Stewart, followed by John Finnie. I congratulate Edwin Mountain for securing this evening's debate and all his campaign work around bullying within NHS Highland. I also warmly welcome to the gallery NHS Highland staff, past and present. As with Edward Mountain, on Friday I attended an important but emotionally challenging event organised by the GMB doctors and whistleblowers on bullying. Over 60 people attended and over 140 statements from victims have already been taken. One account of the bullying particularly struck me and I quote, You raise a bullying in a harassment case and yet every step of the way you are on trial. Your character is attacked, you are then subjected to mockery and someone even writes that you are schizophrenic in their statement. Every step is a way, you are treated like you have done something wrong. You start to doubt yourself and even your own character. You are isolated, you cannot talk to anyone about it but you know everyone knows. Your manager tells you that it is your fault and in fact it is you and you should lose your job, your MMC licence and your liberty. Suddenly you are very afraid of what has just happened here. You go off sick and you are. You are beside yourself, how could this have happened? You go from being bullied and trying to report it to suddenly you are the problem. Your family do not know what to do. You are seeing the doctors every few days. You think about taking your own life. Your family and partners stay with you. They are scared to leave you alone. They do not talk about it even now. The staff that I met before and after the Bava event had all worked for NHS Highland at some stage in their careers. In addition, as with Edward Mountain, I spoke to several former board non-executives over the last year and also received many phone calls and emails from concerned staff in administration, front-line nursing and GP practices. It seemed to me that there was an underlying toxic culture of bullying. That clearly was having an effect on staff morale and emotional health. The wider issue to me was the possible effect that this was having on the credibility of NHS Highland and its ability to recruit and retain staff. It is also difficult to measure the effect that it has had on patients but surely has had an impact. For that reason, I welcome the cabinet secretary's written answer on Friday, which, with perfect timing, coincided with the bullying conference that I am colleagues were attending. Like Edward Mountain, I had also been calling for an independent QC-led review and I welcome the terms of the review to include current and formal staff. Could the cabinet secretary or the minister in their closing speeches confirm whether there is any time limit in respect to formal staff in terms of when they left? What about patients? If they have witnessed or experienced bullying among NHS staff, will that be considered by the Starwick review? Will the findings be published in full and will the health and sport committee have a role in the proceedings? I also asked the cabinet secretary about the role of ACAS. I contacted them and the chief executive and sharps it to me and I quote, we would be pleased to meet all or any of the representative bodies, ideally face to face, while an investigation is not within our remit. We can conciliate in any dispute and carry out work to improve employment relations. I am also struck by history repeating itself. The Francis review, led by Sir Robert Francis QC, examined bullying in the NHS in England. Its recommendation stressed early support for whistleblowers, cultural change, prevention of isolation and containment, and legal protection for whistleblowers. Members will know that the independent national whistleblowing officer will be subject to a super-affirmative SSI in the spring of 2019, which will be held by the health and sport committee of which I am a member. This is an important recommendation, notwithstanding recommendations in the Starwick review. I will provide new principles, standards and procedures to protect and enhance the role of whistleblowers. In conclusion, Presiding Officer, this has been a timely debate, and everyone has the right to be treated with dignity and respect at work. Bulling and harassment are unacceptable and are a violation of human and legal rights. Let us look to the new year and the conclusion of the review for a new dawn where staff in NHS Highlands started fresh in safety and security as respected, dedicated professionals, free from the dark cloud of bullying. As is the convention on these occasions, I thank my colleague Edward Mountain for securing the debate. The member will know full well that I have not always agreed with his pronouncements in relation to NHS Highlands, and that is certainly the case tonight. I think that there has been a conflation of ideas. I would like to restrict myself to the wording of the motion, which I think is important. Who is not going to condemn bullying in any shape or form? I will also condemn the people who have stood in silence and watched that happen, and the institutional arrangements have allowed that to happen. As the motion says, I also welcome the independent review, and I commend John Sturrick. John Sturrick is often referred to a man of the highest calibre who has a history of understanding the meaning of words and listening, and that is the important thing. The other word from the motion that I would like to comment on is the word promptly. I think that what is very important is that we get this matter understood and resolved, and that should take the time that it takes. I like others, like the two members who have already spoken. Indeed, along with Ian Blackford, one of the MPs for the area, I attended Friday's meeting. I have to say that it was very harrowing to hear some of the statements. I commend the people who have come forward. Now, we are all given a very large folder, and that has contained a lot of harrowing information. I hope that information will be made available to Mr Sturrick. The dignity that you can show anyone in a workplace is very important. In a previous career, I was involved as a police federation official just across the road, and we discussed the introduction of a quality and fairness programme. The police is quite a challenging environment, given the rank structure there. It would certainly seem that it has embraced the philosophy of equality and fairness better than across the road, but the key to that is dignity. You can have all the processes in the world, and I do not doubt that Mr Sturrick will unearth that there is a great wealth of policies sitting and gathering dust on a shelf. It is my personal experience that it will not go into case work other than to say that, having dealt with a particular case, it is apparent that the timescales, often the case with employment disputes, went right out the window. That sends a very clear message to someone. If someone is too busy to deal with your issue, if someone is going to be in holiday, if someone has left the organisation, I want to understand the value, for instance, of any exit interviews that have taken place, because people have talked about the loss of people, and David Stewart has talked about the potential of recruiting and retaining staff. It is important. We need to understand the systems that are already in place and those that should be in place to address concerns. I also want to pick out—I was very grateful for the cabinet secretary's response to my colleague Gail Ross's question. I thought that it was comprehensive. The timing was the timing. If someone says that they are going to create a safe space for people to come forward, I am very happy to commend that, and the confidentiality that is ensured with that process. There is no doubt that Mr Stewart is an independent and impartial third party. I made a suggestion to NHS Highland earlier on this process. That was, again, back from my days when there was an instance of bullying in the then Northern Constabulary. I, using health and safety legislation as a health and safety rep, called on the expertise of the Institute of Occupational Medicine to come in and examine the workplace. That was a suggestion that was noted but not taken up by NHS Highland. I think that it is fair to record that there have been issues over a period. I think that probably what I am keenest to come out of this is that we have a safe working environment for people, but that we are not this big black cloud hanging over the NHS in the Highlands. The majority of people that I speak to know nothing of bullying, what they know of, is the quality of care that they have, and the very high standard of care that they have. I would not want anything that we do or say to impact on that. I think that it is fair to say that the NHS Highland is a caring organisation. People would have imagined that care would have transferred to the wellbeing of their staff. Hopefully, that is the case in the future. I look forward to Mr Stewart's work, and I am sure that we will be discussing it again in the future. The last of the open debate contributions is from Donald Cameron. Thank you, Deputy Presiding Officer. I would like to begin by thanking my colleague Edward Mountain for not only bringing his motion forward to be discussed this evening, but also for his dogged persistence in raising the profile of this issue and in campaigning for the staff who are at the centre of this debate. I know that I speak for many across this chamber when I say that we all appreciate everything that our NHS staff do, but nobody should fear their place of work. The allegations that have surfaced and continue to surfaced are deeply alarming. The simple fact is that, according to one clinician, the number of victims in NHS Highland who have been caught up in this particular issue could reach the thousands. That fact alone is extremely concerning. This issue is one that requires political consensus, and I do not want to use this time either to point fingers or to use it as a political football. I welcome to the fact that an independent review was announced by the cabinet secretary despite the fact that it has taken some time to get to this point. In particular, I welcome the appointment of John Sturrick QC to lead it. I happen to know him fairly well many years ago. He was one of the people who trained me as an advocate, and I can attest to the fact that he will bring a robust, rigorous and measured approach to this review. He also has a hugely impressive track record in mediation, and I am sure that his stewardship of the review will ensure that those who brought this issue to light and those who have since come forward with their experiences can rest assured that no stone will be left unturned in the review. It is critically important that we do not turn this issue into a witch hunt or seek to prejudge the review and the allegations that have been made, but it is clear from the sheer number of complaints that have been raised that there are serious questions to be asked. I share the concerns of others that the initial response to claims from the management of NHS Highland did appear to lack any awareness of the extent to which those problems existed. At the end of October, NHS Highland stated that it was unanimous as a board that there is no systemic culture of bullying. I find that last statement very difficult to reconcile with the facts that we now know, because what has happened since that statement and what continues to happen is that a number of clinicals and medical professionals have come forward to tell their stories that they have been too frightened to disclose. They deserve to be commended for their courage in speaking out. One of the worst stories that I read in the media was the example of one employee, former employee, who contemplated suicide as a result of his experience. That story should haunt us all. The fact that someone felt so badly let down that he considered entering his own life is a stark reminder of the human cost of the situation. I am pleased now that the NHS Highland Chair, David Alston, has welcomed the review. It is clear that there are many questions that need to be both asked and answered. I hope that the review is as extensive as possible. As John Finnie has just said, it reports promptly, albeit with due regard to the evidence. I am sure that it will. It is clear that we need to avoid rushing to prejudge its outcome, but what is obvious, it seems to me, is that there has been a very serious breakdown in communication between the NHS management in NHS Highland and its wider staff. It seems that many people have felt that they cannot disclose issues for fear of retribution, and there is a deep, deep problem, it seems. I sincerely hope that the review will go some of the way towards rectifying that situation and that any recommendations will be looked at more broadly across the wider NHS in Scotland. If we do not care for NHS staff, if we do not care for our carers, then we are in serious trouble. I hope that this day marks a turning point, not just for health provision in the Highlands but across Scotland, too. I now call on Jane Freeman to respond to the debate for around seven minutes, please, cabinet secretary. Thank you, Presiding Officer. I am grateful for this opportunity to set out what the Government's position is on this matter and what we have done. I think that it is clear, as has been said across the chamber, that it is a sentiment that I would share with all the members, which is to condemn bullying and harassment in any shape or form. The bottom line is that bullying and harassment is an abuse of power, and an abuse of power is something that offends me personally and deeply. I am concerned and was concerned about the recent allegations that amounted to, as they emerged, a bullying culture within NHS Highland. That is why I acted to ensure that the serious issues that were raised could be properly dealt with. I am mindful that, as those allegations emerged, there was clearly, although we had offered the board assistance in listening properly to what those allegations might be way back in September, what was clear was that there was a need for an independent review to be undertaken so that people could feel that what was being looked at and the conclusions that might be reached had a degree of credibility. What I want to understand from that review is why there are still so many staff who feel that they cannot raise concerns about what is an issue that is important to them and is therefore a valid issue. That tells me that there is something that we need to tackle. If there is anyone in our health service who feels bullied or harassed, we need to address it. What is clear is that, although we have policies and procedures, it is still the case that, underneath that, people feel unable either to speak up or if they do speak up, they feel that they are being closed down and those policies and procedures are not working. That is partly why, in addition to the independent review, I will take the time to answer the questions that have been raised by members in their contribution, but that is also why I have raised, as my ministerial colleagues have, in every review that we are undertaking of every health board, questions around those matters, particularly with area partnership forums, to begin to understand, even in boards where we do not have the situation that we face in NHS Highland. That is the case for the majority of our boards. It is still the case that we may have situations where staff feel about 15 per cent, I think, from the most recent survey, that, in some way, they are being bullied and harassed, but those issues are not surfacing. We need to understand what it is that is preventing that. In that regard, our staff side, our combination of trade unions, RCN, BMA and others, are one of the ways in which we can harness some of that work. In terms of NHS Highland, as members already know, on 23 November, I announced at John Sturrock a QC, and Mr Cameron is absolutely correct, a QC of some standing, some significant respect in this area and, indeed, a highly respected mediator has agreed to conduct that independent review into the allegations of a bullying culture at NHS Highland. The review will explore what the underlying issues are and will include conversations with any affected individuals, including current and former staff, their representatives, board members and management, and, indeed, including patients if patients wish to come forward. My officials have had a number of conversations with key stakeholders, and that has helped to shape some of the scope of the review that we discussed and agreed to with Mr Sturrock. Given that Mr Sturrock is carrying out the investigation, how and how safely can people divulge information to him? He has to have an understanding of what is happening, but, at the same time, if there are people perpetrating that behaviour, that has to be dealt with. I wonder how that interacts and what control people will have over where their report and what happens with the information that they give. If they are afraid to speak out, they might be willing to speak to Mr Sturrock, but they will not pursue anything else if that is a fear. That comes down the line. I am grateful for that question, because it is a very important question. There are two sets of issues that we need to deal with. The first is for Mr Sturrock, and he has already begun work by contacting a number of individuals and making his presence more publicly known. For him to understand all the issues and to hear from all the people who want to come forward and speak to him about their own personal experience or instances that they have witnessed, so that he can begin to form his view through that safe space for the concerns to be raised and discussed confidentially and to form his view in terms of the overall culture. What is the prevailing culture? Why are those matters being raised in the way they are? Why do people not feel that they are able to pursue those? Alongside that, he will have to identify individual specific instances that need to follow a different process if the individual wishes them to do that. In any bullying culture, there are those who are bullied and those who are bullied, and we need to be able to address both in that. That is why, in answer to another question that Mr Mountain raised about how early in 2019 we are talking about, I have said to Mr Sturrock that I am looking for at least interim recommendations in early 2019, but until he begins his work, we cannot be absolutely certain exactly how long it will take him in its totality. We need to see what the volume of individuals he should be listening to and taking account of are, especially if it is past as well as present. However, I need to know and have some degree of pace around this so that, if he has interim recommendations, we have those in early 2019. In response to Mr Sturrock, yes, they will be public. I would expect the Health and Sport Committee in the Parliament to want to discuss those and, indeed, to want to discover from me what I intend to do about them, and to pick up some of Ms Grant's issues around individual cases and how those individual cases, if the individual wants to pursue it, might be addressed. Until he has begun the work, then that is not something that we particularly know. I am conscious of time if I can cover a couple of other areas of what was asked. Mr Stewart mentioned ACAS, Mr Swinney also mentioned the source of other—not Mr Swinney—Mr Finnie. I am sorry to have done that to you, if you want to be responsible for education. I am sure that he will share it with you. What Mr Finnie asked was about other areas of expertise, and that is for Mr Stewart to determine where else he might want to seek other areas of expertise to help inform the work that he is doing. Obviously, as a Government, we will continue to support him in that. I am conscious of time, so let me just finish by reaffirming that I take that matter very seriously. I am looking for those interim recommendations in part in answer to Mr Cameron's point about where are the lessons here to be learned for our health service as a whole? Abuse of power in any form, by any individual, in any organisation is utterly unacceptable and in our health service above all, which is compassionate, caring and highly professional in NHS Highland as it is elsewhere. Our staff deserve to be treated in the manner that we expect them to treat our patients. Thank you very much.