Kennedy, who has personal experience as a whistleblower, said the “fear and blame” he helped expose at NHS Highland eight years ago has not gone away.
The Highland GP said that despite years of inquiries, new whistleblowing procedures and promises of change, doctors raising concerns about patient safety can still find themselves bullied, marginalised or with their careers under threat.
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He claimed health boards remain preoccupied with balancing their books, staying out of the headlines and avoiding friction with ministers.
“I have little doubt that the majority of health boards, if not all of them, focus on probably two or three things,” he told The Herald, “One is balancing the books. Two is keeping off the radar of the Scottish Government, so keeping out of the media, and three, keeping the Scottish Government sweet. I think that’s the reality.”
Dr Iain Kennedy spoke exclusively to The Herald before he steps down as the chair of BMA Scotland. (Image: Newsquest)
Kennedy said his time working closely with the NHS, including as a non-executive director, had allowed him to see what happens “behind the curtain”.
“It’s very clear that in Scotland we still have a situation where health board reputation management and protecting the government comes ahead of patient safety and comes ahead of doctor well-being,” he said.
For Kennedy, the issue is deeply personal.
On September 26, 2018, he and three other senior NHS Highland clinicians took the extraordinary step of writing to The Herald to expose what they believed was a long-standing culture of bullying within the health board.
Their intervention triggered a major public reckoning, with the subsequent independent Sturrock review recording The Herald letter as the whistleblowing event which brought the crisis into public view.
Kennedy has previously described the personal cost, saying he felt bullied, threatened and isolated before going public and later suffered complex post-traumatic stress disorder.
The Sturrock review heard from hundreds of staff, with many describing bullying and fear of speaking out.
Eight years later, Kennedy had hoped to look back on the scandal as a turning point.
“I’d like to be sitting here saying that the work that we did has improved things,” he said.
“But sadly we know, particularly from doctors who have recently whistleblowed about hospitals in Glasgow and patient safety concerns, that the fear and blame continues, and that those doctors who speak up about patient safety or wrongdoing suffer detriment.”
Kennedy said the response can become intensely personal.
“They’re either bullied, or they have threats of being referred to the GMC, or they’re thwarted in their careers, or they’re labelled as cranks or as ill,” he said.
“The characters are challenged rather than a focus on the issues that they’ve raised.”
Asked whether the situation had deteriorated since 2018, Kennedy said he did not believe it had.
“I don’t think it’s worsened, but I think it stayed the same,” he said,“One good thing is people speak about it now. It’s no longer hidden, so there is an acknowledgement that the culture is not right in the NHS. But it’s stayed the same, and that is extremely disappointing.
“I suppose I feel some responsibility there that what we did didn’t quite have the impact that we hoped it would.”
His concerns echo previous Herald reporting. In 2021, an NHS Greater Glasgow and Clyde review found 60% of staff involved in whistleblowing cases said the experience had negatively affected their mental health, with some requiring counselling or medication. A quarter said they would not raise concerns such as unsafe clinical practice again after what they had experienced.
Kennedy has also studied the issue himself. Research conducted as part of an MBA at Warwick Business School found widespread concern among doctors about speaking out, including fears of bullying, marginalisation and career damage.
In March, Scotland’s Independent National Whistleblowing Officer fully upheld a complaint over staffing and workload at the maternity unit at the Queen Elizabeth University Hospital, including concerns over staffing levels and the health board’s handling of the whistleblowing case. New national guidance intended to make speaking up “simpler, clearer and easier to navigate” was subsequently published in July following recommendations from a review of emergency departments in NHS Greater Glasgow and Clyde.
Dr Kennedy said doctors still contact him “regularly” from across Scotland asking what they should do when they believe something is wrong.
His advice is to follow official procedures, involve colleagues and seek trade union support.
But his own experience taught him another lesson: if the system does not listen, do not be frightened of going beyond it.
“Ultimately, I still say to them, don’t be shy about speaking to your local MSP, and if need be, use the media.”
He credits the press with forcing action in the Highlands back in 2018.
“It was ultimately our use of the media, The Herald, other broadsheets, the TV and radio that actually put the pressure on the government to intervene,” he said, “The free press in Scotland has been crucial and will remain crucial to the NHS reforms that are required.”
Kennedy argues that formal processes alone cannot repair the culture.
Responsibility, he said, ultimately reaches Holyrood.
“It has to start from those in power,” he said. “It has to be led by the First Minister, by the Cabinet Secretary for Health, and in the chamber at Holyrood.
“So we need more openness about the current performance of the NHS and what the patient experiences, and a real focus on that, rather than fear, blame and cover-up.”
Kennedy’s concerns as he leaves the BMA chair extend beyond the treatment of doctors. He fears the NHS itself is drifting away from the principle on which it was built.
“My biggest concern about the NHS in Scotland is that we appear to have lost its founding principle – that the NHS is free at the point of delivery,” he said, “When patients need the NHS, many are finding it’s not there for them.”
He pointed to difficulties accessing general practice, pressure at A&E and hospital waiting times.
Increasingly, he said, those who can find the money are responding by paying.
BMA polling last year found 29% of Scots surveyed said they or someone in their household had used private medical care in the previous two years.
Among those who had done so, 64% cited NHS waiting lists being too long, while 43% of all respondents said they had become more likely to use private care.
Kennedy sees the consequences in his own consulting room.
“Sadly, and I think we should be ashamed in Scotland, it has now become normalised that people are having to go private,” he said, “Very worryingly, I’m seeing more and more patients that seem to accept it as inevitable that if they’re to get the healthcare that they need, they’re going to have to go private.
“I’ve had cases this week where patients have told me that they’ve gone private and they’ve shown me the results of their operation, or they’re asking me for help to go private.”
Kennedy questioned whether political reluctance to confront the growth in private treatment was helping postpone difficult decisions.
“Part of me thinks that there’s a deliberate silence on the matter because it helps the government avoid doing what it needs to do, which is reform the NHS,” he said, “It’s absolutely clear that we need to have NHS reform.”
For Kennedy, the first task is workforce planning.
He argues Scotland has failed to match the doctors it trains and employs with the needs of different communities, leaving some doctors struggling to progress while GP practices and hospitals elsewhere struggle to fill posts.
Remote and rural areas are bearing a particularly heavy price.
Kennedy, who works in Inverness and rural Highland practices, said his own group had advertised for a GP without receiving a single applicant.
“We haven’t matched the medical workforce towards the needs of the whole population across the whole country,” he said.
“Not just the cities, but the remote and rural areas as well.”
Kennedy points to additional investment in general practice and improvements on contracts and pay among the successes of his tenure.
But asked whether the new money was enough to stabilise general practice, he did not hesitate.
“No, it’s not enough.”
For years, he said, governments have promised to shift more healthcare away from hospitals and closer to people’s homes.
He argues the money has too often moved in the opposite direction.
“We need to see some genuine shifting of the balance of care,” he said.
“Not all talk, but no action.”
Kennedy will remain involved with the BMA after leaving the chair and plans to spend more time working in his Highland practices.
For all his warnings about an NHS under extraordinary strain, he has not lost faith in medicine.
Asked whether he would still tell a young person to become a doctor, he said: “Absolutely. It’s an exciting career.
“We have the privilege of being very highly respected and trusted by the population, and that relationship between the doctor and the patient is a very special relationship.
“I’m optimistic that things will improve.”
There was, however, one final qualification.
“That does depend on the government listening and doing the right thing.”
Responding to Dr Kennedy’s claims, Health Secretary Angela Constance rejected his characterisation of the relationship between ministers and NHS boards and insisted patient safety remained a central priority.
Ms Constance said: “This is simply untrue – the Scottish Government works very closely with NHS boards to deliver on our shared priorities for patients. Central to this is patient safety and ensuring our hard-working NHS workforce is supported to deliver high-quality care.
“The evidence is clear that our NHS has turned a corner and this is thanks to the dedication of NHS staff and the significant investment made by this government, including a record £22.5 billion in health and social care this year.
“I take a zero-tolerance approach to bullying and harassment and I expect all boards and their employees to act in line with NHS values. Employees should be able to raise any concerns safely and we will continue to ensure support for whistleblowing is in place across every board. We will also continue to invest in NHS staff wellbeing, to ensure they can continue to deliver the best care.”