Horrendous behaviour was ‘tolerated for many years’ at a department in the University Hospital of Wales
05:29, 15 Jan 2026Updated 16:47, 17 Jan 2026
General view of University Hospital of Wales, Cardiff(Image: WalesOnline)
A nasty voicemail rant that accidentally revealed what bosses thought of a sick employee. A supervisor who feared a colleague had poisoned their drink bottle. A “savage” workplace with a trend of staff being signed off due to feeling “unsafe”.
Those are among the many alarming revelations from a report into failings at Wales’ biggest hospital. The document – which focuses on the HSDU (hospital sterilisation and decontamination unit) at Cardiff’s University Hospital of Wales – paints a stunning picture of bullying, violence, sabotage and weak leadership.
“There has been systemic failure at all levels of the organisation for over 10 years,” concludes the report, which was finalised in August 2024 but you are only now reading about for the first time. You would not know of it at all if not for whistle-blowers coming forward to WalesOnline.
Why did Cardiff and Vale university health board hide the unit’s comprehensive service review from the public? After all, last year there was a similarly damning review of another department at the same hospital – its operating theatres – and the health board did release that report at a press conference.
The difference in that case was WalesOnline had already found out about the operating theatres investigation before its completion and had reported extensively on it. At the press conference, the health board’s chief operating officer Paul Bostock claimed: “The fact we’re having this conversation today is to demonstrate we want full transparency.” But his claim is undermined by the concealment of the HSDU report.
We can now reveal the findings of the report, leaked to us by hospital sources who have also shared their own insights into the unit’s woes, and who have no faith they will be addressed. The report has several themes in common with our other recent stories on the health board, including an abject failure to deal with bullying and toleration of unacceptable, potentially criminal behaviour. It is an organisation that has faced a near-constant stream of scandals over the last year or so.
Five staff were subject to disciplinary action as a result of the HSDU report. Two then resigned, two were redeployed outside the unit, and one was sacked.
Plaid Cymru and Tory politicians described the report as “shocking” and called for action from the Welsh Government. The health board insisted it has since strengthened “leadership oversight, management arrangements and team culture”.
‘It was dreadful’
The HSDU, which is a unit focused on sterilising medical equipment, has a “long history of cultural issues”, according to the leaked report.
It states a previous review took place in 2016 but failed to end the “bullying, harassment, inappropriate behaviour and poor management which creates a toxic working environment”.
The health board appointed two senior figures from other departments to carry out the 2024 investigation. They interviewed 68 people, mostly one-to-one.
The investigators learned the unit was divided into two “cliques” who did not “trust each other”. They found the culture was “not safe” and that there were staff who felt unable to “speak up freely”.
Certain people refused to speak to others, which led to issues with work not being handed over. The tensions were so severe that some staff “resorted to using signs” for communication with those they didn’t want to speak with, the report found.
“There were examples of people behaving in both a violent and aggressive manner, for example people losing their temper, throwing trays, shouting, getting in people’s physical space and hitting trolleys,” the report states.
But only a “small number” of these incidents were managed formally, according to the report, which found “systemic poor behaviours were tolerated for many years”.
Sources told us there was shock in the unit when an employee kept his job after an alleged unprovoked assault on a supervisor. “It was dreadful,” said a witness. “We were signing out for the day when he dragged the supervisor from one side of the corridor to the other and pinned him to the wall.
“Other staff pulled him away then he walked down the corridor kicking all the trolleys. The supervisor looked drained, like a ghost.”
Because the supervisor would shortly be starting a job in another health board, management reportedly decided they could “draw a line under” the incident. This appalled some colleagues who felt unsafe working with the culprit.
The same employee allegedly came up with insulting names for colleagues and wrote these on his locker above a slang word for male genitalia. Photos of the locker show one of the names was “shurken head” – allegedly a misspelling of “shrunken head”, aimed at a staff member’s appearance.
Another of the names was “[Colleague’s name] Covid”, which he allegedly coined to make fun of an employee who he felt had let the team down by staying home after a positive covid test.
He allegedly took aim at this colleague in a social media post: “Don’t be a w***er who just phones there [sic] boss and books a test with no symptoms. Just to have time of work!!! Have you no shame???”
Sources said the culprit remained in post despite complaints from those targeted. One of them decided to leave the unit and, on his final day, was subjected to more mockery from his tormentor.
The day before his departure, the culprit had posted an image of a clown on social media, with the caption: “Tomorrow is a good day.” The next day he brought cupcakes into the tea room, each topped with an image of a clown on rice paper.
In another social media post, he shared an image of actor Pedro Pascal looking exasperated, captioned: “When you walk into work and see that you’re on shift with all the coworkers you can’t stand.”
Some staff ‘thrived on targeting colleagues’
In a room where surgical tools are washed, one employee allegedly dropped his trousers and flashed a young female colleague. Although a disciplinary investigation upheld the allegation it was “put down as a work prank” and he kept his job, a whistleblower told WalesOnline.
That incident was not mentioned in the report, though it did highlight patterns of “coercive behaviour”. A few staff seemed to “thrive on targeting individuals, often people who were seen to be more vulnerable or a threat”, and this would continue until the victims either left or changed their shift pattern, the investigation found.
A “significant” number of staff reported bullying and harassment. In some cases they were signed off work due to feeling unsafe. “Many described not feeling able to do their job properly for fear of what might be said or done, including [by] the supervisors and managers,” the report reads.
One employee told WalesOnline they confidentially reported bullying to a manager, only for the alleged bully to be told who had made the complaint.
Another worker, a trainee technician, reported a colleague for bullying and later quit as her complaint had not been dealt with. We have seen the young woman’s resignation letter, stating: “Due to the ongoing issues within the department and myself struggling with the general atmosphere I feel it’s better to remove myself from added stress and anxiety.”
When two candidates scored the same in interviews for a supervisor role, they were both given a six-month trial with another interview to take place afterwards. But the candidates, who were from different cliques, found it “very difficult to have a fair trial as members of the opposite clique have made it difficult for them to perform”, the investigation found.
An alleged attempted poisoning and a voicemail calamity
The report cites a police callout in 2020 over an allegation of a staff member’s drink bottle being “tampered with” while in the staff room fridge. The owner of the bottle had smelled what they suspected to be Surgistain – an acid solution for removing rust – in the bottle.
Sources said the health board never tested the bottle because of the cost. Police reportedly also decided against a test because there was no injury. (The bottle had not been drunk from after the potential tampering.)
The report noted the matter had been reported to police “as there was a feeling that the management would not deal with it”. Although police found “no evidence of criminal intent”, the report pointed out that a band-five manager had believed the bottle “smelt like Surgistain”.
In 2022 there was a voicemail incident that left all parties mortified. The report states: “This incident involved unit managers and supervisors inadvertently leaving an inappropriate message on a member of the team’s answerphone.”
WalesOnline has heard the voicemail. There is nothing remarkable about the beginning of the message, in which a boss asks a technician why they are not in work that day – although we understand the technician had already left a message explaining she was unwell.
The boss then says goodbye but continues talking, not realising the voicemail is still recording. She begins ranting about the technician to a colleague, who joins in. “They should stop f***ing paying her,” they say, before turning their attention to another employee who had been off work, calling him a “liar” and “full of s***”.
The report states an investigator was appointed from outside the unit but “the member of staff affected by this incident found it very frustrating and upsetting that the outcome of the investigation was not shared”.
It goes on: “This incident remains unresolved for the staff member. Letters of apology were written but it is unclear whether these were passed on.”
Another factor behind the atmosphere of distrust was a suspected sabotage in 2021, which was not covered in the report but was revealed by WalesOnline last year.
One of the holes in the tray wraps in the HSDU unit(Image: )
Over a fortnight, more than 30 trays of surgical tools had to be sent back for re-sterilisation because of holes in the wrapping. As a manager told staff at the time, it looked like the tray wraps had been “intentionally damaged by pushing a pen through them”.
Police were called in but a culprit was never identified. One employee was puzzled not to have been questioned on the matter, and was not aware of any colleagues being asked about it either. “It wasn’t properly investigated,” they told us. “Senior management were quick to dismiss it.”
They suspected the culprit of picking their moment for maximum disruption. “It’s really important to understand they targeted the weekend, when these trays would have been needed for emergencies,” said the source.
Paperwork from when staff reported the tray piercings, which nearly led to an operation being cancelled(Image: )
The “massively disruptive” sabotage almost led to an emergency operation being cancelled, they added. “It’s evil. It was definitely discussed in the team: ‘What kind of people are working in this health board who would do such a vile thing?'”
The health board said the police involvement “had the desired outcome as damage to the trays ceased”.
‘A handshake in the office’
Even when there was behaviour that warranted disciplinary action, the health board tended more towards “respect and resolution processes”, the report states.
“There have been very few examples of where poor behaviour has been managed through any formal process,” it adds.
In many cases the outcome was a mediation “not conducted by people with formal mediation skills”. Management often tried to resolve matters through “a handshake in the office”, the report found.
There were times when temporary redeployment was offered but would only be “taken up for short periods or not at all, despite serious allegations of attempted harm”, it states.
There was also “aggressive and threatening” behaviour from staff towards managers, yet the report found no evidence of this behaviour being challenged even informally. Some people in the unit told the investigators “no one is ever managed or brought to task”.
Much of the trade union reps’ time was spent supporting HSDU staff. Reps described the unit as “savage” and “unforgiving”, according to the report.
Senior leadership did not prioritise fixing the culture. “The executive’s focus was on the quality and safety issues related to the aging estate of HSDU and the air handling unit that is at its end of life,” the report states.
It also highlighted that some staff in pay band two were doing “the exact same work” as band three colleagues.
A health board in crisis
One of the most troubling findings of the report was that staff felt “powerless”. There were “multiple opportunities where concerns have been raised to the executive [and other senior figures] where people have failed to act,” it states.
A whistleblower told us: “The health board claims to be transparent but when the public are only finding out all these things from staff members coming forward, I think that’s quite alarming.”
They have no faith in the health board turning around the HSDU, where they claim toxicity and aggressive behaviour have persisted since the review.
The report bore similarities to other scandals at the health board, such as when operating theatre staff felt unable to speak up about their toxic workplace. Last year’s scathing report into that department found illicit drug use, racism, bullying and staff sabotaging each other.
In November we revealed almost 300 doctors had sent a letter fiercely criticising how the health board was being run. They said morale was at an “all-time low” in University Hospital of Wales amid chronic sewage leaks, various “risks to patient safety”, and a “firefighting” culture focused on “short-term fixes”.
Whistleblowers have frequently spoken to us about the horrendous conditions at the pigeon-infested hospital. In September we reported on the tragic case of Gareth Idris Johnson, a much-loved 41-year-old dad-of-three who died after the hospital’s maintenance problems led to him being moved to a different unit following an operation. The coroner warned there was a risk of more deaths if the hospital did not address those issues.
We also revealed the health board failed to act when an electroconvulsive therapy clinic manager bullied colleagues for years, as well as a separate bullying crisis in the cardiac physiology department and allegations of unauthorised visitors being invited in to watch operations.
In July the Welsh Government did escalate the health board to a ‘level four’ targeted intervention due to “serious concerns relating to governance, culture, quality and safety and operational pressures” – falling short of level five, which would mean placing it in special measures. It remains at level four.
Reacting to the leaked report, Plaid Cymru health spokesman Mabon ap Gwynfor said: “I would like to pay tribute to all those brave individuals who have come forward to highlight the shocking behaviour and culture within University Hospital of Wales.
“Being the second such report in a short period, it is clear that no lessons are being learnt because of the shortcomings in the NHS governance structures.”
The MS called for the Welsh Government to “urgently” reform the NHS to strengthen governance structures.
Tory MS for South Wales Central, Andrew RT Davies, recently spoke in the Senedd about our reporting on the health board’s failings, demanding that health secretary Jeremy Miles “get into that health board and sort it out”.
In response to the report he said: “While Plaid Cymru separatists and Labour spent £120million on 36 more Senedd members, they diverted resources away from local hospitals. These shocking revelations are the latest in a series of governance failings at UHW, putting patients’ safety at risk.”
What the health board says
We asked the health board if it had put in place the report’s recommendations, which included a cultural action plan, an interim “experienced operational manager”, a review of pay progression, and disciplinary action against some staff.
A health board spokesman responded: “Over the past two years we have robustly, fairly and in line with established HR processes tackled a significant number of cultural issues raised by colleagues past and present. It is important that colleagues are treated fairly but robustly within a confidential HR process.
“In August 2024 a thorough review into cultural issues at HSDU was completed and shared with appropriate and relevant people, including the board and staff side representatives and associates for oversight and review. We acknowledge not everyone will like or ever accept the outcome of very often difficult, sensitive, and emotive processes.
“As a health board, we are satisfied that we have dealt with the very challenging and in this instance historical allegations robustly, fairly, equitably and with compassion. Colleagues’ recollection and accounts of events change over time and those investigating have to make a judgment based upon the evidence of all individuals concerned.
“The review examined a range of cultural and behavioural issues within the service and resulted in clear recommendations and actions. Subsequently five members of staff were subject to disciplinary action, two of which later resigned, two were redeployed into roles outside of HSDU, and one member of staff was dismissed. The health board has taken the review and the actions extremely seriously.
“Since the review concluded, leadership oversight, management arrangements and team culture have been strengthened. Colleagues report improved ways of working and a more positive team environment. While individual experiences can vary, this reflects the current position within the service. The findings and subsequent progress were formally presented to the health board’s ‘people and culture’ committee in September 2024, and a further update was received by the committee in March 2025.”
A spokesman for the Welsh Government said it is working with the health board to agree “appropriate intervention support”.
He added: “We have been clear with the health board about their need to improve the culture and leadership, particularly addressing concerns raised in the recent internal reviews.”
If you would like to contact us about an issue we should be investigating, email us at conor.gogarty@walesonline.co.uk