AN INDEPENDENT review has criticised a culture of "bullying and harassment" at hospitals where A&E waiting times were under-reported.

The report into NHS Lothian carried out by senior clinicians said they had heard of "several examples" where staff in emergency departments came under pressure to fudge waiting times performance by "[prioritising] patients about to breach the four hour standard rather than a patient with a greater clinical priority".

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The report added that "several examples were cited where staff felt they were asked to take actions that they felt were not right for patients but often felt unable to challenge this for fear of the consequences or their concerns were dismissed".

The A&E target is for 95 per cent of patients to be seen, treated and either admitted or discharged within four hours.

The Scottish Academy of Medical Royal Colleges carried out the review after a whistleblower at St John's hospital in Livingston raised concerns in October about doctoring of patients' waiting times to meet the four-hour target to process A&E patients.

It emerged in December that emergency waiting times at every acute hospital run by NHS Lothian had been under-reported.

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Professor Derek Bell, chair of the Scottish Academy, was commissioned by the Scottish Government to conduct an external review into the allegations made by the whistleblower.

The review stated: "There is clear evidence that breach recording was not in line with expected practice since 2012 and puts the validity of unscheduled care data into question for several years.

"There was no evidence that staff amended breach times to deliberately falsify performance. However, we felt that there is a fine line between falsification and confusion, when pressure is applied to 'meet' the four hour standard."

Reviewers said the "apparent lack of a clear and robust governance structure" had "contributed significantly" to this.

Investigators found some staff felt "admonished and blamed" rather than supported when raising concerns and disputed the findings of NHS Lothian's own internal probe, which claimed there was no evidence bullying and harassment.

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The review stated: "We observed some inappropriate behaviour with several examples that were consistent with bullying and harassment."

NHS Lothian has accepted all of the recommendations.

Jim Crombie, NHS Lothian interim chief executive, said: "We have recognised from the outset that mistakes were made and accept the findings of this review.

"It's clear not all was as it should have been. Staff have also come under intense pressure and for these failings I'm really sorry.

"Since the publication of our own review last November we have already taken a number of steps to rectify the reporting errors including significant staff training to ensure correct recording of four-hour breaches."