The next item of business is a statement by Neil Gray on the Scottish hospitals inquiry’s report on the Royal hospital for children and young people and the department of clinical neurosciences in Edinburgh. As the cabinet secretary will take questions at the end of his statement, there should be no interruptions or interventions.
14:53
I am pleased to receive, and I welcome, the interim report from the Scottish hospitals inquiry on the Royal hospital for children and young people and the department of clinical neurosciences, both in Edinburgh.
The inquiry’s overarching aim is to consider the planning, design, construction, commissioning and, where appropriate, maintenance of the Queen Elizabeth university hospital campus in Glasgow and the Royal hospital for children and young people and the department of clinical neurosciences in Edinburgh.
I extend my thanks to Lord Brodie and his team for their hard work and dedication in producing the interim report, and I am grateful for the progress that the inquiry has made thus far. I am also deeply grateful to the many witnesses, especially parents, patients and their families, who have fully committed to the inquiry process and have provided the necessary evidence, reflecting their own experiences and that of their children. It has allowed the inquiry to produce the findings contained in the report and the 11 specific recommendations. I also extend my thanks to the staff at the Royal hospital for children and young people and the department of clinical neurosciences in Edinburgh for their continued hard work and dedication.
On 4 July 2019, the then Cabinet Secretary for Health and Sport announced that the opening of the new Royal hospital for children and young people and the department of clinical neurosciences in Edinburgh would be postponed due to serious concerns about patient safety and wellbeing. A public inquiry was announced on 17 September 2019, with Lord Brodie appointed as chair soon thereafter, and the inquiry’s setting-up date was 3 August 2020.
The inquiry’s purpose is to determine how vital issues relating to the built environment of the hospitals, such as water supply, drainage, ventilation and other key building systems, gave rise to concerns about patient safety and welfare; how they occurred; and what steps were taken and can be taken to prevent them from being repeated in future projects. The Scottish hospitals inquiry chaired by Lord Brodie is, rightly, independent of the Scottish Government.
As we consider the interim report, the work of the inquiry continues so that parents, patients and families, and all those affected, have the answers that they deserve, and so that when lessons are identified, we take steps to implement the necessary improvements to ensure that we maintain the highest standards of patient safety throughout.
All of us, whether for ourselves or through our families and friends, will have interactions with the national health service in Scotland, and there is nothing more important to me than ensuring that Scotland’s NHS is safe and effective and that all patients receive the high standard of care that we would all expect in fit-for-purpose buildings.
Turning to the interim report findings, I note that the remit of the Scottish hospitals inquiry requires it to determine
“how issues relating to adequacy of ventilation, water contamination and other matters adversely impacting on patient safety and care occurred; if these issues could have been prevented; the impacts of these issues on patients and their families; and whether the buildings provide a suitable environment for the delivery of safe, effective person-centred care.”
The remit further requires the inquiry
“to make recommendations to ensure that any past mistakes are not repeated in future NHS infrastructure projects.”
Without a doubt, patient safety is of the utmost importance, and the findings in the interim report will significantly contribute towards ensuring that lessons can be learned.
The evidence before the inquiry and the interim report make it clear that safety is not a binary issue. There is a sliding scale of risk from safe to unsafe, which can be influenced by many factors that the Scottish Government and senior health board leaders must consider. Although it is right for the Scottish Government to take the time to reflect on the report’s findings and recommendations before responding more fully, l want to take the opportunity today to talk briefly about some of those findings.
A full response from the Scottish Government to the interim report will be provided in the coming months, but the report confirms that the decision taken by the then cabinet secretary to postpone the opening of the hospital was the right one. That decision understood the risks associated with the introduction of patients into a facility that had not met the required safety standards. Only through that direct intervention by the then cabinet secretary were we able to act and deliver the necessary changes to the built environment.
The issue that led to the decision to delay related principally to the design of the ventilation system of the paediatric critical care department of the new hospital. The significant remedial works that were carried out to the ventilation system to remedy the non-compliance involved extensive work to replace the system in the relevant areas. The results of independent testing and the expert evidence heard by the inquiry indicate that the remedial works have been successful.
The inquiry has stated that the environment of the Royal hospital for children and young people and department of clinical neurosciences in Edinburgh is
“suitable ... for the delivery of safe, effective person-centred care”,
and that it has been since the facilities opened in March 2021. No evidence is available to the inquiry that indicates any contrary position, and I am confident that that will provide assurance to patients, parents and families who are accessing the hospital’s vital services.
However, it is clear from the inquiry report that communications fell below the standard that we would expect. The interim report talks in detail about some of the difficulties faced by parents, patients and families. The impact of unclear or poor communication on the wellbeing of parents, patients and their families during a very difficult, emotional and uncertain period in their lives is not to be underestimated, and the interim report sets out that
“Health boards must ensure that in the event of any adverse situation that could affect the wellbeing of patients and their families, there is a communication strategy in place to liaise with this crucially important group.”
It also says:
“The Scottish Government should ensure that this liaison is supported in any overarching communication strategy it may wish to introduce.”
To those who rely on the hospital, and those who should have been able to rely on information about what was happening, I make the commitment that the Scottish Government will improve, and I will work with the health boards to ensure that we all learn lessons that put parents, patients and families at the heart of the decisions that are taken and their impacts.
The report also raises concerns about a number of instances where a governance process or aspects of operational management were ineffectively implemented. I expect health board managers to address those concerns appropriately, with support from relevant national health service bodies, such as NHS Scotland assure, to ensure that their governance processes are robust, open, transparent and fit for purpose.
We continue to make improvements to policy and practices, alongside our NHS partners, including the establishment of NHS Scotland assure to provide a co-ordinated approach to the improvement of risk management in new buildings and infrastructure projects across the Scottish NHS. NHS Scotland assure provides assurance that the healthcare built environment is safe and fit for purpose, and it has improved support to health boards on technical matters. Its work also includes a programme of learning intended to enable health boards to assist NHS Scotland assure in better supporting those boards that are about to go through the same process.
NHS National Services Scotland is also in the early stages of developing and improving the existing standard contract for major capital projects, which will have clearer roles and responsibilities for those involved in the process to support governance, assurance and risk management.
We have introduced a national infrastructure board to provide strategic leadership and expertise in driving forward a national strategy for infrastructure change. The board will ensure that infrastructure continues to support health and care service needs, will seek opportunities for doing better and will provide national oversight of the continued safe and effective operation of the retained estate.
NHS National Services Scotland has also updated the Scottish health technical memorandum guidance on ventilation to include the role of design supervision given to the ventilation safety group. That multidisciplinary group, which includes authorising engineers, expert technical consultants and clinicians, is responsible for overseeing the management of the ventilation systems of a healthcare provider and is expected to assess all aspects of ventilation safety and resilience that are required for the safe development and on-going operation of healthcare premises.
Improvements have been made, but I recognise that Lord Brodie and the inquiry team have rightly drawn attention to areas that require further focus and improvement. The Scottish Government is committed to working with the health boards and other NHS bodies to consider and address each of the 11 recommendations made in the interim report.
I stress that the interim report does not represent the conclusion of the inquiry’s work, and that its investigations into the Queen Elizabeth university hospital and the Royal hospital for children in Glasgow continue. We recognise the progress that has been made by the inquiry in relation to this report, and that further hearings are planned to run throughout 2025.
We must continue to fully scrutinise what has happened in the past in order to maintain public confidence in our healthcare provision and to ensure that vital learning is applied, so that we can prevent similar circumstances from occurring again.
I will continue to update the Parliament as the work progresses.
The cabinet secretary will now take questions on the issues arising in his statement. I intend to allow around 20 minutes for questions, after which we will need to move to the next item of business. Members who wish to ask a question should press their request-to-speak button.
I declare an interest, as a practising general practitioner.
The hospitals were given the go-ahead in 2012 and were initially scheduled to open in 2019. However, catastrophic ventilation system failures were found, and the hospitals eventually opened some two years later than planned, which caused more than 2,000 appointments to be disrupted. The inquiry’s findings are deeply concerning. From catastrophic ventilation design flaws to a complete failure of communication with patients and families, this is a stark example of utter incompetence.
The Scottish National Party Government has form when it comes to secrecy, brushing problems under the carpet and poor financial oversight. I say to the cabinet secretary that the hospital is a children’s hospital for the children of Scotland. Patients suffered and families had to watch their children suffering and, as always, not one manager or board member was sacked or held accountable. Senior NHS staff members have sauntered off into the sunset with their fat-cat pensions.
Given the serious failings that were highlighted in the inquiry, including ventilation design flaws and communication breakdowns, will the Scottish Government take full responsibility for the mismanagement of the project, and can the cabinet secretary say what specific actions will be taken to hold accountable those who are responsible?
It is critically important that we have processes that are transparent, and that we learn lessons where issues have arisen, as Sandesh Gulhane has set out. That is why I am responding today to the interim report of a public inquiry that was established under this Government to see what lessons needed to be learned from the issues that he has raised.
There are areas where we can already see improvement. The implementation of NHS Scotland assure in all stages of our health infrastructure capital project will ensure that we are able to learn lessons from what happened previously.
Of course, it is an interim report, so there will be further work to be considered. We will respond in due course to the inquiry on its interim findings and, of course, we will seek to implement them and make sure that improvements happen in commissioning of our health infrastructure.
I thank the cabinet secretary for his statement and Lord Brodie for the interim report.
However, the cabinet secretary will recognise that this is just one half of the story. In the case of the Edinburgh sick kids hospital, unfortunate though the delay and the uncertainty were for families, thankfully no child lost their life. I believe that Jeane Freeman was right to put patient safety first.
In contrast, the Queen Elizabeth university hospital—Nicola Sturgeon’s flagship hospital—was rushed through when it clearly was not safe, and children died as a consequence.
We await the findings of Lord Brodie’s final report, but what lessons have been learned to avoid taking such a reckless approach again, as appears to have happened with the Queen Elizabeth university hospital?
I appreciate Jackie Baillie’s comments on the issues around the hospitals in Edinburgh and Jeane Freeman’s decision. I agree with her that Jeane Freeman took the right decision, which is borne out in the interim report’s findings.
I caution Jackie Baillie about arriving at conclusions on the Glasgow side of the inquiry. That inquiry is on-going and much evidence is still to be led in it. I certainly cannot prejudge, or seek to cut across in any way, the work of a public inquiry.
On Jackie Baillie’s question about lessons being learned, I have already mentioned, in my statement and in my response to Sandesh Gulhane, the implementation of NHS Scotland assure. That service is about ensuring that, at every stage of the commissioning of a health infrastructure programme, we have assurance on the safety and practicality of health projects. I believe that that is giving us much greater assurance of the safety that Jackie Baillie is looking for.
I welcome the Scottish Government’s commitment to learning lessons. Although I appreciate that time will be required to fully consider the recommendations, can the cabinet secretary advise how he will look to improve communication in the future?
I remind members of my entry in the register of members’ interests: I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
I thank Clare Haughey for her question. Obviously, it is critically important to me, as it is to the public, that NHS boards acknowledge not only that their services exist to treat patients, but that patients and their families should always be given clear information about those services and their care. Where boards fail in that duty, we need to ensure that that is rectified.
We regularly meet our NHS boards’ communications teams to provide leadership, to collaborate and to agree common approaches to communicating information among NHS health boards and across NHS Scotland.
We will continue to listen carefully to patients and families who are involved in the inquiry, and to others further afield. I will work with the health boards to ensure that we all learn lessons and put them at the heart of the decisions that are taken on patients and their families.
I remember the period well, because I served as shadow health secretary. I agree with Jackie Baillie about the actions that Jeane Freeman took and with the establishment of NHS Scotland assure, which we, on the Conservative benches, called for.
I pay tribute to the whistleblowers who have raised many of the concerns. I also record my concern about some of the evidence that has been taken in private during the public inquiry. Patient safety must be paramount.
How will the communication strategy that the cabinet secretary referred to provide the independence that is required for transparency? Too often, health boards go into lockdown when there is a problem. We need to ensure that, when concerns are raised, they are taken to the top—to the cabinet secretary’s desk. What work will be taken forward to make the process truly independent?
There are a number of issues in Miles Briggs’s question, for which I am grateful, and I am grateful to him for his recognition of the role that whistleblowers play.
I have been absolutely clear—as, I believe, my predecessors were—on the culture that I expect within the health service around supporting people who come forward with concerns before the matter gets to the point of whistleblower status. There are very clear processes and protocols in place to support whistleblowers who come forward with their concerns, and I have a very clear expectation of how those are handled, both regarding the seriousness that is applied in ensuring that systems are safe, and regarding transparency in the public communications that Mr Briggs mentioned. As I have set out, we are working with our boards to ensure that that can be realised.
Page iv of the report clearly sets out that it is “an interim report” that does not represent the conclusion of the inquiry, the investigations of which into the Queen Elizabeth university hospital will continue. Does the cabinet secretary agree that the on-going work of the inquiry is of the utmost importance, so that families and patients can get the answers that they deserve?
Yes, I absolutely agree with Rona Mackay. Inquiries are set up by ministers to examine matters of public concern about a particular event or set of events. They operate independently of Scottish ministers, and they have a crucial role in scrutinising the past to inform lessons for the future. While the Scottish Government considers the interim report, the work of the inquiry continues, so that patients, families and all those who have been affected will have the answers that they deserve. We need to respect that process.
I am incredibly grateful to all the participants, for the work of Lord Brodie and the inquiry team and for the time, effort and energy that have gone into the inquiry from so many dedicated people. The findings in the interim report will contribute significantly to ensuring that lessons can be learned, so that we can take steps to implement the necessary improvements to maintain the highest standards of patient safety across the health service.
What lessons will be learned from the experience at the sick kids hospital? The cabinet secretary said that the impact of unclear or poor communication on the wellbeing of parents, patients and their families during a difficult, emotional and uncertain period in their lives is not to be underestimated. I am thinking, in particular, about the design of the new eye pavilion in Lothian. It has been approved, but the existing eye pavilion is shut and it will be years before it is replaced.
What lessons will need to be learned on patient support and communications, and then on the design of the new hospital, so that it is built on time and is safe for patients, staff and families from the day that it is ready?
That is critical. The experience of the necessary closure of the eye pavilion is an example of where there has been better communication, both through the Government and through the health board, to patients and to MSPs. I was involved in the site visit to the eye pavilion with Sarah Boyack and others so that there was transparency as to the necessity of that decision having to be taken.
It is not just me saying that we should not underestimate the impact that poor communication can have on patients and their families; that is what the interim inquiry report says. We must take that seriously. Where there are improvements to be made, we will continue to look at them, including by learning lessons from live cases such as the one that Sarah Boyack raises.
It is welcome that the Scottish Government acted quickly and established NHS Scotland assure to improve how we manage risk in the healthcare built environment across Scotland. Can the cabinet secretary expand on how NHS Scotland assure works with boards to provide a co-ordinated approach to risk management across the NHS estate, as set out in his statement?
NHS Scotland assure plays a critical role in ensuring the safety and effectiveness of new built-environment facilities in Scotland. The principal way in which that is achieved is through a key-stage assurance review—KSAR—which occurs at every stage in the capital investment process, from business case development all the way through to the construction and commissioning of the new building. I therefore believe that lessons have been learned around the design process that was of concern in the case of the Edinburgh hospitals.
By focusing on crucial areas such as infection prevention and control, water safety, ventilation, electrical systems and medical gases, the KSAR process provides independent assurance that healthcare building projects are being delivered in line with relevant standards and that they minimise risk to patients, families, staff and visitors.
What mechanisms are in place to track and report on the implementation of the inquiry’s recommendations and any further recommendations that it may bring as the inquiry progresses? How will patients and the public be kept informed of the progress of that implementation?
We will respond formally to the inquiry’s 11 recommendations in due course. In that response, we will set out some of the progress that will already have been made against some of the recommendations—some of that will be wrapped up in the work of NHS Scotland assure. As Lorna Slater asked for, we will be able to track progress against the recommendations and anything else that comes in from the remainder of the inquiry in relation to the sites in Edinburgh and in Glasgow.
Lord Brodie’s interim report provides us with an important opportunity to reflect on the lessons learned. I am pleased that we now have a clearer understanding of what happened at the Royal hospital for children and young people. At the time, many of my constituents were deeply concerned by the delays and confusion relating to the opening of that new facility in Edinburgh. For those who were affected, all that was unnecessary and added an extra layer of stress at already difficult times.
As the cabinet secretary will be aware, a number of hospitals will require renewal and replacement in the coming years, including the Belford hospital in Fort William and the Gilbert Bain hospital in Shetland. Looking towards those projects, will the cabinet secretary outline what lessons have been learned from the Scottish hospitals inquiry, so that we do not find ourselves in a similar position further down the line?
There are two elements to Alex Cole-Hamilton’s question. First, he makes the point that the feeling at the time was that the delays were unnecessary. The interim findings demonstrate that the delays were necessary and that it was the right decision to delay the opening of the hospital. The difficulties experienced at that time due to the poor communications may have led to the feeling that the delays were unnecessary, and I recognise Alex Cole-Hamilton’s reflections on that.
The second point is about our confidence in new hospitals. Alex Cole-Hamilton named some projects. I have an interest in a hospital project that my constituents will want to have confidence in, which is the new Monklands hospital in my constituency. I believe that the process that we have established through NHS Scotland assure, without waiting for the conclusion of the inquiries, gives me, Parliament and the public greater assurance that lessons have been learned from the Edinburgh and Glasgow situations and that we can ensure that buildings will come forward in a timeous, safe and effective way.
In his statement, the cabinet secretary mentioned the national infrastructure board. Will he provide more information on how the board provides national oversight and supports health and care service needs?
The NHS Scotland national infrastructure board plays a vital role in guiding the strategic development and investment in NHS Scotland’s infrastructure, ensuring that it can effectively support the delivery of healthcare services. A key function of the board is to provide advice and direction on long-term whole-system strategic planning for NHS Scotland’s infrastructure. The board considers how best to ensure that current infrastructure remains safe, resilient and fit for purpose. It also looks ahead, 20 to 30 years hence, to anticipate future needs and helps to shape NHS Scotland’s future infrastructure investment programme.
The cabinet secretary’s statement highlighted that the report raises concerns that there were a number of instances in which the governance process or aspects of operational management were ineffectively implemented. We now know that that resulted in 1,586 appointments in paediatrics being affected. It is very worrying that children experienced a reduction in care due to operational management inadequacies. What work has been done to assess the impact of that issue on the children in regard to their treatment at the time and since then?
Roz McCall makes a fair point. I will need to come back to her on the impact of the delay in opening, which was some time ago now. As I said in response to Alex Cole-Hamilton and in my statement, I believe that the delay was necessary, but it will have had an impact on the children and their families. I recognise that, so I will endeavour to respond more formally to Roz McCall’s question.
The cabinet secretary talked about the significant remedial works that were required and the fact that the inquiry’s remit required it to make recommendations to ensure that any past mistakes are not repeated in future NHS infrastructure projects.
The cabinet secretary has spoken about this at some length in response to other members. Is there anything more that he would like to say about how the Scottish Government plans to ensure that lessons are learned, particularly with regard to NHS Lothian and my constituents, and about how it will keep Parliament informed about the inquiry and the implementation of its recommendations?
I think that I have set out where the process can be improved to avoid such issues arising in the first place. The process involving the infrastructure board and NHS Scotland assure improves that position. We are obviously interacting with boards, including NHS Lothian, to make sure that the recommendations are understood and the lessons about communications and process are learned so that the issues that Ben Macpherson has raised in relation to infrastructure and the impact on his constituents can be properly addressed, and so that we have a better process in future for the people whom he represents.
Air ais
Portfolio Question TimeAir adhart
Health and Social Care Innovation