In light of recent NHS scandals, the findings of the report by the Academy of Medical Royal Colleges and Faculties in Scotland might come as no great surprise, but they are shocking all the same.

Sickening might be a better word, since the failures of care at Aberdeen Royal Infirmary, Vale of Leven, and NHS Lanarkshire indicate a culture that is not just deeply unhealthy but, for those patients at the receiving end of the problems identified, potentially life-threatening.

Much has been said about the malfunctioning of clinical and management staff in cases such as Mid Staffordshire and the above-named institutions, all four of which have come under the report's scrutiny. This overview, however, is not a rehash of each case, but an attempt to gather the threads from these situations, to see what wider lessons can be learned. The result is a dismaying picture of dysfunction, with blame firmly placed on a systematic breakdown in communication between managers and clinical staff. Lack of leadership is the report's refrain. Of many chilling comments, among the most stark is that each crisis has been distinguished by "a loss of basic compassion and the prioritisation of inappropriate targets over patient care". Overemphasis on targets created a climate in which "if it could not be measured and was not monitored it became unimportant". This loss of focus on the NHS's fundamental role resulted in "patients being treated inhumanely and without dignity".

Such scenarios are more the stuff of regimes where life is held cheaply than of what is purported to be the finest health service in the world. That the report should strenuously recommend that "quality of care must become the primary influence on patient experience ... and the primary indicator of performance" is such a statement of the obvious one can barely understand how these health boards badly lost their way. The answer appears to lie in tensions between medical staff and management, whose objectives are in conflict. The resultant bullying, a word used repeatedly in this succinct document, partly explains what it calls "learned helplessness". This is a condition in which ward staff feel that individual effort or complaint make no difference to the care patients receive. Resigned to low and inadequate standards, and fearful of repercussions should they speak out, they keep their heads down and their mouths shut.

The report offers various directives for improvement, among them regulated minimum levels of staffing. But most pressing of all, the root that needs to be healed if the entire tree is not to blow down is the need to eradicate suspicion and hostility between clinical staff and managers. Any improvements that do not begin by repairing this rift will be skin deep. At a time when demands on the NHS are steadily increasing, and budgets under pressure as never before, resources - be it of time or energy, money or morale - must not be wasted on such counterproductive and potentially hazardous friction. Every effort and every penny should be directed to the frontline of treatment and services for patients. Otherwise, anything that diverts attention from this core duty and responsibility is potentially a prescription for disaster.