Response to Cllr Kenneth MacLean's letter

NHS Western Isles has been made aware of a letter circulated by Cllr Kenneth MacLean, which was not shared with us by Cllr MacLean.

The NHS Board welcomes and encourages the raising of legitimate and evidenced concerns about healthcare. However, Cllr MacLean’s letter presents a number of unfortunate inaccuracies, speculation, unsupported damaging allegations and incomplete accounts that risk causing unnecessary alarm. 

NHS Western Isles fully complies with all statutory Duty of Candour requirements, and our reporting is independently audited and publicly available. The number of cases we report reflects actual clinical criteria, not speculation or population comparisons. Annual Duty of Candour reports for 2020-21 (bearing in mind this was during a worldwide pandemic) and 2021-22 were both developed and were presented at an NHS Western Isles Board meeting in November 2022. 

We cannot discuss individual patient cases in the public domain and at the point of this response we have not had the opportunity to identify Cllr MacLean's descriptions of patient care. However we can confirm that all significant adverse events are investigated through established clinical governance processes.

Whilst we fully acknowledge that, despite best efforts, things can occasionally go wrong in healthcare, NHS Western Isles staff work tirelessly with dedication and professionalism to provide the highest standard of patient care. When concerns do arise, we are committed to ensuring they are thoroughly investigated, that patients receive appropriate feedback and apologies, and that learning from every case is embedded to improve future care. 

We encourage any family, or individual, who believes they have a complaint about the care received, or outstanding questions, to contact us directly so that we can address their concerns in full, taking into account all of the facts. If individuals remain unsatisfied with the complaints process, we make it clear their right to appeal any decisions to the independent Scottish Public Services Ombudsman. 

With regard to accusations about the organisational culture of NHS Western Isles, we strongly dispute these allegations. NHS Western Isles is very proud of the services delivered and supported across the Western Isles by our staff who act all times with the patients at heart. 

Independent staff surveys show a supportive working environment, and all concerns from staff are handled through established, transparent processes.

We have robust mechanisms for staff wellbeing and support (which are being continually reviewed and strengthened through an organisational Wellbeing Group) and we take allegations of bullying extremely seriously. Anonymous reporting, whistleblowing channels, and external escalation routes are all in place.

Contrary to the allegations, recent independent staff surveys have shown both high levels of pride in working for NHS Western Isles and positive experiences of teamwork and support. No such cultural concerns as alleged by Cllr MacLean were suggested in any way. 

Our focus remains firmly on delivering safe, compassionate, and high‑quality care to the people of the Western Isles. 

Like all Health Boards, in particular island Boards, we face increasing recruitment challenges in some areas, but we are encouraged that we continue to attract committed professionals from across Scotland and beyond, and we have a diverse, skilled and dedicated workforce we are extremely proud of.  Unfortunately unsubstantiated, damaging miscommunications can have the impact of adversely damaging  recruitment campaigns and, as a result, impacting negatively on local healthcare services, such as those in the area represented by Cllr MacLean. 

We welcome scrutiny and operate within a system that already includes regular external audits, national oversight bodies, Scottish Government reporting, independent and professional regulation, announced and unannounced Inspections by Healthcare Improvement Scotland, and an annual public accountability review. 

If further reviews are requested by Government, we will of course cooperate fully and are more than willing to provide any evidence requested. However, the claims in this letter do not reflect the evidence, the reality of clinical practice, dedication, commitment and professionalism of all our staff and the experience of the vast majority of patients. 

NHS Western Isles remains unequivocally committed to patient safety, high‑quality, person‑centred care, continuous learning and improvement, and full transparency. We take our responsibilities seriously and Health Boards as organisations are fully accountable for the care we provide. 

Public statements that appear to prioritise publicity and which contain misinformation undermine constructive relationships, misrepresent the reality of our work, and create unnecessary alarm within the community. Such behaviour is counterproductive and does not support our shared aim to continuously improve care across the Western Isles.

Further background:

FULL DETAILS OF ADVERSE EVENTS PROCESS

All adverse events are reported and investigated via Inphase (previously Datix) adverse event reporting system, following initial reporting of an adverse event or near miss, the handler for the record will assess the reporting form to consider the organisation’s response to the event and level of investigation required.

A briefing note for a potential Significant Adverse Event Review must be completed for all Major and Extreme risk rated adverse events but must be considered for all events depending on the individual circumstances. The level of the review for adverse events will be dependent on the event in terms of its complexity and potential for learning. 

Information, communications and outcomes are centrally recorded and stored on the Inphase reporting system, so that an audit trail is evident. The decision to proceed, or not, to a significant adverse event review must be clearly documented. The risk management team, Nurse and Medicsl Directors  meet fortnightly and consider any submitted SAER briefing notes and whether a SAER should be commissioned or not.

 If a SAER is commissioned, this would trigger duty of candour, a chair for the review would be appointed and they would make contact with the individual or  family to discuss the review and answer any questions they may have. They would be the point of contact for the family and would also meet once the review is completed to discuss and share the report and any learning. 

Reports are scrutinised by the Clinical Governance Committee for assurance. It gives an additional level of scrutiny and an opportunity to capture any further learning. 

NHS WESTERN ISLES CULTURE

NHS Western Isles has implemented a varied approach to ensure staff feel empowered to raise concerns and engage in open dialogue. Some of these are outlined below:

Comprehensive Whistleblowing Procedures:  All staff ae encouraged to speak up and use whistleblowing procedures.  We have introduced mandatory staff training in whistleblowing, developed by the Independent National Whistleblowing Officer, so that staff know that they can raise concerns safely. This training has been delivered to Senior Managers, Line Managers and Staff.  We also participate in the annual ‘Speak Up’ campaign which encourages staff to raise concerns and have had a Board level Non Executive Whistleblowing Champion since 2021 (with the current champion based in Uist). 

Civility and Professionalism: Civility Awareness Training has been delivered to a number of teams and to the Board to educate on the impact of incivility and promote a supportive workplace environment. This also helped to create confidence in staff to undertake an informal and early resolution approach to issues that may arise at departmental level.

Conflict Resolution and Mediation: NHS Western Isles is committed to addressing issues before they escalate.  We have trained mediators who help provide early resolution support to staff.

Confidential Support Structures: We have a range of confidential supports available to staff including Confidential Contacts, Mental Health Contacts and an Employee Assistance Programme which provides confidential counselling 24/7 for staff and their families.

Targeted Campaigns: The Board regularly communicates to staff about maintaining dignity and respect.  A recent example is Respect in the Workplace communications, explicitly encouraging active listening, professional courtesy and compassionate peer support.

Listening to staff experience: The Chief Executive hosts staff open meetings and the Chief Executive and Employee Director offer confidential Exit Interviews to all staff who are moving in from the organisation. 

The impact of these initiatives is primarily evidenced through the low number of bullying and harassment claims from staff that require formal investigation, and by the significant growth in staff participation in the iMatter Staff Survey. In 2025, NHS Western Isles achieved a 70% response rate, an 8% increase from the previous year and the highest rate among all Geographic Boards in Scotland. NHS Western Isles were commended in the National Report for the considerable increase in response rate, reflecting a measurable shift in staff willingness to provide feedback.  The Staff Survey provides valuable feedback which we use to develop action plans with the aim of continuously improving staff experience.

All the above is scrutinised through regular reporting to the Board’s Staff Governance Committee and through valued partnership working with our Staff Side colleagues.

In relation to comments specifically about Barra Medical Practice, NHS Western Isles took over direct running of the Practice when the remaining independent partner left.  This meant there was initially a reliance on regular returning Locums in the first year but through an extensive recruitment campaign we now have two employed GPs who have greatly contributed to the leadership and development of NHS services on Barra, along with existing dedicated practice, dental and nursing staff.

The previous dentist on Barra was dismissed due to serious concerns, some of which were admitted at an employment tribunal, about his practice.  These concerns have been referred to the General Dental Council.