A TOP doctor has blamed a "dysfunctional" culture at NHS Highland for a crisis in medical recruitment and retention engulfing its rural hospitals.

Dr Gordon Caldwell, a consultant physician who was the clinical lead at Lorn and Islands hospital in Oban until he resigned last summer, said there "still seems to be a lot of fear" among staff more than four years on from a bullying scandal that cost the health board nearly £3 million in settlements.

Dr Caldwell - who joined NHS Highland in 2018 - said an exodus of senior consultants from Oban and Fort William over the past 18 months is down to management "undermining us, bullying us, and blaming us for problems that were due to a lack of leadership".

READ MORE: One in seven consultant posts empty in NHS Highland

The 66-year-old, who is internationally regarded for his expertise in medical education, became so concerned about the impact on junior doctor training in Oban that he whistleblew to NHS Education for Scotland (NES) while on sick leave for stress after finding his own internal complaints rebuffed.

A resulting inspection report, published in May last year, said NES had "serious concerns about the training environment" at Lorn and Islands hospital, including around the "safety of care".

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Trainees told inspectors that they felt "ill-equipped to make decisions" and feared there was "significant potential for harm" due to staffing shortages.

A follow-up inspection in November last year said improvements had been made but warned that "there remains a fragility of senior cover and a heavy dependence upon locum consultants".

Dr Caldwell, who spent 15 years as a director of medical education for an NHS trust in England, said the May inspection report was the "most damning" he had seen in his career.

"I knew that junior doctors were not adequately supervised, but [NHS Highland] were saying everything is fine."

TIMELINE: How bullying claims engulfed NHS Highland - and the fallout

The Herald: Lorn and Islands Hospital, Oban Lorn and Islands Hospital, Oban (Image: freelancer)

He said he wanted to speak out about his own experience in a bid to "turn things around" for the region.

Dr Caldwell said: "For a rural hospital, it just seems really tragic what's happened.

"I came here in 2018. Oban was a lovely hospital then, with really strong team working, and it's just been destroyed - whether by dysfunction or deliberately.

"I think it's probably dysfunction, but if it's deliberate then they are trying to close consultant-led services on the west coast and now they've got a perfect argument because locums are costing so much and they can't recruit.

"There still seems to be a lot of fear within NHS Highland and Argyll & Bute.

"Management would deny that and say there's been a big cultural change, but I didn't feel any cultural change."

READ MORE: Sturrock Review into NHS Highland bullying allegations finds that many 'suffered serious harm and trauma'

The latest workforce statistics show that one in seven consultant posts (14.5 per cent) in NHS Highland were vacant by December 2022.

That is the highest rate of any of the mainland boards and more than double the national average of 6.5%.

The vacancy rate has also crept up steadily from 2.5% in December 2012, versus a much smaller shift from 3.2% for Scotland as a whole.

The Herald: Medical and dental consultant vacancy rates in NHS Highland, December 2012 to December 2022Medical and dental consultant vacancy rates in NHS Highland, December 2012 to December 2022 (Image: Turas)

Dr Caldwell, who lives in Ballachulish, left in September 2022.

Another consultant colleague had already retired five years early in December 2021, with a long-term locum doctor quitting in summer 2022, leaving Oban with just one permanent consultant physician instead of the expected four.

Meanwhile, the Belford hospital in Fort William has just one permanent consultant physician who is due to retire in May following a string of departures, including one consultant who left in early 2022 and another at the end of 2022.

Dr Caldwell said he was particularly alarmed after a senior executive at the health board approached him in early 2019 and "asked me to go to Fort William and find enough evidence to get two of the consultants sacked".

He said: "He wanted them out of Fort William and a new start because he thought they were the problem.

"He thought the standardised mortality ratio in Fort William was high, but you can't apply it to a small hospital. He couldn't understand that.

"I went there in March 2019 and found them to be very good consultants, really committed to their patients and to the hospital, but it was a very poorly supported hospital.

"So I filed my report saying exactly that: they were excellent, but the hospital was poorly supported."

The Herald:

READ MORE: NHS Highland whistleblowers blast 'culture of fear and intimidation' silencing concerns over patient safety 

Nonetheless, all three Fort William consultants were referred to the GMC - the doctors' regulatory body - which ultimately concluded there was no case to answer.

One of the doctors involved went on to be awarded substantial compensation as part of the health board's 'healing process', instigated in the wake of the damning 2019 Sturrock Review into bullying allegations.

Dr Caldwell said: "We could have had thriving hospitals, but instead people living in the west coast of Scotland are getting a very poor service."

NHS Highland said the Belford is "fully staffed" in terms of surgeons and anaesthetists, with four each, and confirmed that it has one consultant physician in post. 

Two vacancies for consultant physicians are "out to advert and being covered by two long-term locums". 

It said the Lorn & Islands hospital has the full complement of three anaesthetists, and two full-time consulant surgeons - though one "is on long-term sick and will retire in May". 

There is one permanent consultant physician and two long-term locums. 

A spokesman said: "Dr Caldwell left NHS Highland in September 2022 after a period of absence and was last working for us in November 2021.  

"We cannot comment on individual employment cases and neither can we make comment about incidents that he describes that happened over three years ago, however any complaints or concerns raised by our consultants or other colleagues within Oban or Fort William have been fully investigated and addressed some time ago."

He said NHS Highland is "fully invested in supporting and recruiting to the full establishment of our consultant body", adding: "The recruitment issues that we do face as an organisation are shared by other health boards and we are actively looking into using more innovative methods of marketing and promoting NHS Highland as an attractive place to work, such as the recent Aim High Aim Highland campaign. 

"Available and affordable accommodation in these areas is also a key challenge faced in these popular areas for tourism."