NHS staff have reported low morale and bullying are widespread in the service despite record levels of investment.
A snapshot of opinion among the Scottish workforce revealed the majority do not feel involved in decisions that affect them and would not recommend the NHS as an employer.
Nearly one in five staff had experienced bullying or harassment - mostly at the hands of colleagues and senior managers - but were unlikely to report it out of fear of repercussions or the belief that nothing would be done about it, it was found.
The survey, based on nearly 50,000 responses across medical and non-medical staff, was written in May last year but has not been publicly released by the Scottish Executive. It has now come to light after a concerned paramedic, who acquired it through Freedom of Information legislation, passed it on to nationalist MSP Christine Grahame.
It showed staff felt they made good use of their experience and skills at a personal level and the majority were satisfied with their work. But they were less positive about their employers: only 42% said they felt proud to work for their health board, with many citing poor communication with managers and senior colleagues.
There was particular disenchantment with the way in which health boards are managing the process of change in the NHS, with staff citing this as a key factor in their appraisal of the service. Dissatisfaction with pay and staffing levels was also reported by nearly half of respondents.
Shona Robison, the SNP's health spokeswoman, accused the executive of covering up the bad news by not publishing the survey last year. She added: "The Health Minister is ducking his responsibilities by not publishing this report and that is sending out a poor message to senior managers about their responsibilities."
However, the executive said the survey had been made widely available to staff within the NHS and was being used as the basis for action by health boards.
Andy Kerr, Health Minister, said he wanted to see "clear progress" by boards in addressing the issues raised in the report through implementing local action plans.
He said: "These plans form a key part of the discussions I hold with board chairs and chief executives during the public annual reviews process, where I expect to see clear progress made in tackling the challenges highlighted by the survey."
Unions yesterday called for a high-profile campaign to tackle the culture of bullying in the NHS and to improve communication between senior managers and frontline healthcare workers.
Nanette Milne, the Conservative's health spokeswoman, said she was not surprised by the survey results, given the pressure being put on health boards by the executive. "I have no doubt that the NHS is totally controlled from the centre, with huge pressure being put on health boards and senior managers to meet this target-driven culture. I think this filters down and leads to poor staff morale." The Royal College of Nursing (RCN) warned that problems with workplace bullying and harassment were leading people to leave the NHS. Colin Poolman, professional officer with the RCN, said: "There has been a lot of work done but what these figures make clear is that we have not made a significant enough difference. There is a high percentage of employees who report being bullied and harassed by colleagues, managers and the public." The British Medical Association (BMA) also warned of "change fatigue" within the NHS and called for a period of stability in the service. A spokeswoman added: "It can be particularly demoralising when change is imposed as a result of political target- setting and is not driven by clinical need. "Again, the BMA has called for change to be driven by clinical need and for clinicians to be involved in these decisions."
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