Meeting of the Parliament

Meeting date: Wednesday, September 11, 2019

Official Report 1073KB pdf

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Royal Hospital for Children and Young People

The next item of business is a statement by Jeane Freeman on the Royal hospital for children and young people. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:37  

I am grateful for the opportunity to update Parliament on the Royal hospital for children and young people and the department of clinical neurosciences.

Before I do, I put on record my sincere thanks to all the staff for their forbearance in difficult circumstances. I am genuinely sorry that, despite the considerable work that they put into planning the move to the new hospital, that move cannot yet be realised. I am acutely aware that, for many, the halt created significant personal challenges to important domestic arrangements. This morning, I met the chair and the employee director of NHS Lothian, and I have again written to all staff who are involved, to update them on the current situation, which I am setting out to the chamber.

Let me also record my thanks to the patients and their families for their forbearance and patience. The safest possible care for the children is my overriding priority, and I am sorry for any impact that the current situation has had on them.

Today, I will write to the Auditor General for Scotland, whom I have kept fully informed to date. I assure Parliament that we will, of course, fully co-operate with any further scrutiny that Audit Scotland or the committees of this Parliament might choose to undertake.

Following my decision to halt the opening of the new facilities in July, I commissioned two reports: one from KPMG and the other from NHS National Services Scotland. KPMG was asked to consider issues of governance and to establish the facts that led to the decision to delay the move. NSS was asked to examine the whole site and to advise me on relevant compliance issues. I am publishing both reports today.

The NSS report provides a detailed assessment of key buildings and identifies issues that require to be resolved to ensure safety prior to occupation. Although the report is technical, I will highlight several areas. In addition to the issue that was previously identified in critical care, remedial action is required on the quality of ventilation work in a number of areas, with specific issues identified in haematology and oncology. Independent testing identified no widespread contamination of the water systems, but NSS has recommended remedial and precautionary actions as well as system-wide disinfection prior to occupation. It has also recommended monitoring of the drainage system and has concluded that elements of plumbing require monitoring and routine disinfection, although that is considered to be low risk.

NHS Lothian has accepted all the recommendations, and its action plan has been published today. Phase 2 of NSS’s review is to assess fire, medical gases and electrical safety. Although that work is still in progress, there is no indication that findings in those areas will create a further delay beyond that which I will set out. It is clear that significant work is to be undertaken to ensure that the site is fully compliant. The work that has been done over the past weeks to identify and plan the remediation of all the outstanding issues allows me now to give a clearer indication of a realistic timeline for moving into the new hospital.

The additional work that NSS recommends can be undertaken in parallel to the work to resolve the ventilation issue in critical care. The key consideration in determining when the move to the new facilities can take place is the time that is needed to rectify the critical care ventilation system. That work includes designing, procuring and installing the solution for that system and then rigorously testing and validating it. That work will, I regret to say, take time. In the interests of patient safety, I will not authorise a move to the new site until that work has been completed, tested and found to be fully compliant.

The work will be carried out as quickly as possible, but, to ensure that it is done properly and to give maximum certainty to staff and patients, I have concluded that children’s services will remain on their current site until next autumn. The department of clinical neurosciences is unaffected by the issue in critical care. However, the additional work that is required to rectify the other issues at the children’s hospital may impact on the DCN clinical pathway. I am, though, mindful of the challenges that are faced in the current DCN location, and I have asked that the work on the children’s hospital be phased to allow the DCN to migrate earlier. My current expectation is that the DCN will be able to move next spring.

The KPMG report on governance sets out a clear picture of human error and confusion over interpretation of standards and guidance, as well as missed opportunities to spot and rectify that error, despite clear references to the requirement to adhere to relevant technical guidance. Members can read the report in full. In short, the main problem stems from a key document—the environmental matrix. The document, which was first produced by NHS Lothian in late 2012, was inconsistent with the guidance but was referred to throughout the project.

I want to make it clear that I hold the principle of accountability in and of our health boards to be vital. This publicly funded project of strategic importance has not been delivered by NHS Lothian in compliance with the standards and guidance. That is unacceptable. There are clear issues about accountability in the board to be considered now, which must be done carefully and with due process. I will advise Parliament of the outcome of that work in due course.

NHS Lothian is at level 3 of our performance escalation framework. However, given the issues with the new hospital and the number and level of issues that need to be rectified, the Scottish Government health and social care management board has escalated NHS Lothian to stage 4 for the project.

That means that, in relation to the project, we have assessed that there are significant risks to delivery, quality, financial performance and safety, as well as that senior-level external support is required. A senior programme director will be appointed, who will report directly to the Scottish Government.

All of this—the delay, the additional work that is needed at the new hospital and the additional work that is needed to ensure that the existing sites can continue to operate well—comes at an additional cost. Given that NHS Lothian had taken possession of the site, the unitary payment of £1.35 million per month must be made even though the facilities are not yet open. However, those payments were already budgeted for and so, strictly speaking, that is not an additional cost. The additional costs arise from the work that is needed to replace the critical care ventilation system, the other remedial work that NSS has identified and work in respect of the continued operation and improvement of the current sites. The costs will continue to be refined and I will keep Parliament updated, but I can advise members that the current estimate of additional costs for the works is £16 million.

As I said, this is a publicly funded project of strategic importance that has not been delivered in compliance with the standards and guidance that are in place for the safety of patients and staff. The delay that we now face will be borne by NHS staff in Lothian and by patients and their families, and the additional cost will be borne by the health portfolio.

NHS boards in Scotland have delivered many major infrastructure projects on time, on budget and in compliance. However, we cannot have a repetition of the problems that we see today. That would not be right for the public purse and it would not be good enough for patients or staff. Therefore, in line with the programme for government, we will move swiftly to establish a new national body for reducing and effectively managing risks in the healthcare built environment. The new body will have oversight of the design, planning, construction and maintenance of major NHS infrastructure developments, not least in order to ensure effective infection prevention and control and compliance with standards and guidance.

The NSS and KPMG reports are detailed, and I appreciate that members will not have had time to read them fully before this statement. I have therefore arranged to meet Opposition party spokespeople tomorrow, to answer any questions that they have. I have also written to the convener of the Health and Sport Committee, and I am, of course, happy to provide his committee with additional information or to attend the committee to answer questions.

As I have set out, my overriding priority is patient safety, and I know that that priority is shared by members across the chamber. The children and families who depend on these hospital services should receive them in the safest way possible. No one would choose the current situation, but we will resolve it and deliver the safe migration of service to the new Royal hospital for children and young people and department of clinical neurosciences.

The cabinet secretary will now take questions on the issues raised in the statement. I intend to allow around 20 minutes for the questions, after which we must move on to the next item of business. I repeat the usual mantra and ask members to try, once we have had the questions from front-bench members, to keep their questions short.

I thank the cabinet secretary for providing an advance copy of her statement.

It takes a pretty cynical Government to try to bury bad news by sneaking out two major reports at the very time that Parliament is asked to hold ministers to account. Today’s statement raises more questions than it answers. The cabinet secretary expects us to believe that human error and confusion and the failure of an environmental matrix mean that no Scottish National Party ministers are responsible for the seven years of delay on the project. Reading between the lines of the statement, it looks as though the cabinet secretary intends to hang NHS management out to dry for the problem. The cabinet secretary has been in her job for a year now, and her predecessor held the position for four years, while all the delays and problems were happening. What responsibility will SNP ministers take for the findings of the reports?

I find all of that deeply disappointing. Let me be clear: I am sneaking nothing out. On 4 July, when I halted the move to the new hospital site, I said that patient safety was my priority. It was my priority then and it remains so now. I also said at that point and subsequently that I would publish the reports as soon as they were available, and I have done that. [Interruption.] Please do not to mutter at me from the sidelines, Mr Briggs.

I have offered a meeting with party spokespeople tomorrow precisely because I appreciate that the reports are technical and that members are seeing them only today and will need time to review them. We will meet tomorrow, when I am sure that there will be plenty of opportunities for members to ask further questions.

I do not expect Mr Briggs to believe anything. The KPMG report is clear in what it says, as is the NSS report. I am acting on those reports, and Mr Briggs will know—because he will have made great effort to understand his brief—that responsibility for infrastructure build currently rests with boards, so boards are responsible for the build and compliance. I have said clearly—and the programme for government said this last week—that we now need to move to a situation in which we hold more closely expertise in and responsibility for compliance. We are addressing those issues.

If Mr Briggs would care to listen to what I have said, I think that he would agree that the approach that I took on 4 July and that I have taken ever since—I will, absolutely, take it from now on—is exactly right for patient safety, our NHS staff and the public purse.

I thank the cabinet secretary for advance sight of her statement.

This project is a disaster. The statement throws up more questions than answers, so we now need a debate that should be timetabled in Government time. The KPMG report on governance highlights human error, confusion over the application of standards and guidance, and missed opportunities to rectify mistakes, but we still do not have a clear picture of where responsibility lies. Are we to believe that no one is responsible? I think not. Does the cabinet secretary fully agree with the reports? Does she believe that the investigations are adequate? We know from the reports that there was regular and extensive dialogue between NHS Lothian and the Scottish Government. Who from the Government sat on the project board and where are they now? The role of NHS Lothian has been referenced many times in the statement but, ultimately, the buck stops with the health secretary and this Government. On the principle of accountability, we need a full-blown public inquiry. Does the cabinet secretary agree? Yes or no?

My straightforward answer is the one that I have given before: no, I do not agree. I do not see what difference a public inquiry would make to the work that we have already undertaken. The focus should be on remedying the situation and moving patients and staff safely to the new site. I do not see why we would distract them from all that into a public inquiry, when we have the reports and when I am here to be accountable for what boards are doing.

I said in my statement that there is more work to do with the board, because I firmly believe in the accountability of NHS boards, both in boards and to Government and the wider public. There is more work to do and I will update Parliament on that. Ms Lennon says that she has many questions. I look forward to hearing some of them tomorrow at the meeting—I am sure that she will be there—when we can begin to answer her questions once she has had the opportunity to read the report in full.

The focus must be on two things: how to ensure that that new site, a major facility of strategic importance, is safe and that patients and staff can move there safely. I am absolutely focused on that. In relation to how do we understand why this happened—not just what happened, but why—I have taken account of that in my statement and I have updated Parliament on what we will do in terms of infrastructure projects across the wider NHS, some of which have been delivered recently on time, on budget and in compliance.

I remind members who want to ask a question to press their request-to-speak button.

Our children and young people clearly deserve more than the senior managers of NHS Lothian have been delivering. The cabinet secretary announced today the escalation to level 4. Does she agree that the board’s senior management should reflect on the current situation, work constructively with any programme manager who is put in place by the Government to deliver the new hospital and get their finger out and get performance back on track?

It is important to be clear that the escalation to level 4 is for this project. The board is already at level 3 in relation to other matters around performance. Of course, Ms Constance is right to say that the board should be focused on its performance across a range of issues. With the additional support that we have given it, the board is focused on that and is already making progress in those areas.

The point about the escalation to level 4 is that it represents recognition of the importance of this area of work and of the need to provide an external project director, with whom I am confident that the board and senior management will work closely to deliver what we need done.

Ms Constance mentioned the need for reflection. I know from speaking to the chair of the board this morning and from other conversations that the members of the senior team in NHS Lothian are reflecting on how we have got to the present situation. We will continue to have those discussions with them and, as I said in my statement, I will update Parliament on the outcome of that.

When I asked you on 27 June whether you felt that it would be safe to open the new sick kids hospital, you responded by saying that you had had all the reassurances that you had tasked NHS Lothian to give you.

My question is simple. What scrutiny did you put in place? What lessons had you learned from the failure of the Queen Elizabeth hospital? What reassurances did you receive that those lessons had been learned? What has happened seems to stem from the tender process.

Members must not use the second person. The term “you” is the second person, Ms Ballantyne. I have let it go by, but I want people to remember to say “the member” or whatever instead of using “you”.

I gave the answer that I gave on 27 June precisely because I had had assurances from NHS Lothian that all the compliance issues had been met and that the lessons that at that point had come from the Queen Elizabeth university hospital had been learned. I was advised on 2 July that the ventilation system in critical care was not compliant with national standards and guidance, and I acted on 4 July in that regard. The answer that I gave Ms Ballantyne was based on the information that I had been given by NHS Lothian at that time.

Patient safety was and remains paramount. What steps does NHS Lothian plan to take for the existing sites to ensure that they are as effective and safe as possible for all patients?

We asked NHS Lothian to produce an additional plan on mitigation for the existing site at Sciennes and the department of clinical neurosciences site at the Western general, and to give us an estimate of the costs. That is contained within the overall estimate. It includes additional expenditure to do with an increase in the maintenance levels.

With regard to the DCN, active work is under way to look at a modular unit. There might be other alternatives that might be more suitable from a clinical point of view, one of which was raised with me this morning. The DCN site is the most critical area. I am very keen that, with the involvement of the clinicians concerned, we identify what can be done to manage the safety of that site until we can move to the new site at the Royal hospital.

As far as Sciennes is concerned, the other area that is being actively considered is the location of out-patients, with a view to increasing the footprint of accident and emergency on the existing Sciennes site.

Further to that point, the Sciennes site is in my constituency. In her statement, the cabinet secretary mentioned the cost of remedial action on the new site, but what is the total cost of keeping the old site open, which was not programmed? Equipment that was due to be replaced will have to be provided, maintenance will have to be carried out on a building that is well past its sell-by date and contracts that were cancelled have had to be renewed. What is the cost of keeping the old site open?

The total estimated cost of maintaining the existing sites, which includes an element of dual running, is between £6 million and £7 million. That includes some of the factors that I have mentioned, such as the interim modular solution, and equipment including neuroradiology equipment, as well as additional investment in the current Sciennes site and in the DCN. As the plan is developed, I am happy to provide the member with the details so that he can be assured that all the issues that he believes need to be taken into account are being taken into account.

Can the cabinet secretary expand on the role of the new national body that is being set up to ensure that all future NHS building projects are protected against problems with water, ventilation and drainage systems?

As I mentioned, we will move swiftly to establish that national body. Its objective is to better manage and reduce the risk in terms of the healthcare built environment. Its final function will, of course, be informed by the independent review of the Queen Elizabeth hospital that is being undertaken. The body will have oversight of the design, planning, construction and maintenance of major NHS Scotland infrastructure developments. It will hold expertise in those areas, including in microbiology, and, critically, it will have a clear understanding of the interrelationship between the built environment and effective prevention and control. It will also have a compliance function. Work is under way at this point to bring that body together. Again, I will ensure that Parliament is updated as we make progress in that regard.

The cabinet secretary states that the additional cost of this shocking case will be borne by the health portfolio—so, ultimately, by the people of Scotland. Those who support private finance initiatives claim that the risk is always borne by the private sector, and this is yet another case that reveals that to be false. Does the cabinet secretary agree that her Government’s non-profit-distributing model, just like the private finance initiative before it, means that it is the public who pick up the cost when things go wrong?

There is nothing in either of the reports that I commissioned to suggest that the funding model holds any responsibility for the situation that we are facing and the need to halt the migration to the new site in the interests of patient safety. What I am keen to do—this is why I said that the additional cost would be paid by the health portfolio overall—is to ensure that front-line patient-facing services are not asked to bear any of that additional cost. Within the overall health portfolio, we will manage that additional cost without an impact on patient services.

I restate my call for a full public inquiry into this matter.

The KPMG report tells us that this disastrous outcome was baked into the hospital build from day 1 because of a flawed reference to an environmental matrix in the tender document. What oversight did the Government have of that tender?

If the most optimistic expectation is that the staff and patients will have to wait another year for the new sick kids hospital to open, what is the worst-case scenario for how long the delay will be?

I will deal with the question about the timeline first. I have consciously ensured that the timeline that I have given Parliament today—autumn for the full children’s services and spring for the DCN—can be relied on. If it is possible for the necessary work to be undertaken more quickly, services will move sooner than that. However, that is the timeline that it is right and proper for me to confidently give this Parliament.

Mr Cole-Hamilton is right to say that the KPMG report identifies a flaw in the 2012 environmental matrix document, which meant that it gave the wrong specification for critical care ventilation. However, the report also points out that subsequent guidance and documents gave the right specification and that mistakes were made and opportunities were missed to spot those and correct matters.

Mr Cole-Hamilton asks about Government oversight. In terms of the current relationship between NHS boards and infrastructure projects, Government oversight is primarily around finance and timelines; it is not in the area of these specifications. That is one of the reasons why we will establish that new national body. In my view, that gap and deficiency needs to be rectified and Government needs to have greater oversight in terms of design and compliance and the interrelationship between the build and effective prevention and control.

I welcome the publication of the reports. Will the cabinet secretary join me in acknowledging the contribution of all the staff who, in very difficult circumstances, have continued to provide high-quality clinical services at both the children’s hospital and the department of clinical neuroscience?

I am grateful to Ms Harper for that question—I absolutely will acknowledge that contribution. In July, along with the chief medical officer and the chief executive of NHS Scotland, I visited both the Sciennes site and the DCN in the Western general. I had the opportunity to speak to different groups of staff and explain my decision to halt the move, as well as to hear what they believed needed to be done, part of which has informed the work that will go into additional investment into those sites to see them through the coming period.

Despite the undoubted disappointment of the staff in the circumstances—they were ready to move to a site to which they had anticipated moving for some time and they had made their own arrangements to accommodate that—I was struck and impressed by how quickly they were moving to be able to continue to deliver high-quality care professionally. I wrote to them then and I have written to them again today. I also intend to visit those sites again this month to talk through with staff what I have laid out in Parliament and what the reports say, and to answer any questions. I have also offered to meet the partnership forum of NHS Lothian, which—as members know—is made up of the unions and representatives of staff from across the health board.

Three more members wish to ask questions. I want to get you all in, but you must make your questions short.

The cabinet secretary confirmed in her statement that the payment of £1.35 million per month will continue and that a further £16 million of additional costs will be incurred. Will she clarify the detail of those additional costs and whether any of them will be recovered for the public purse?

As I said, the additional costs cover the costs of maintaining existing sites—which I outlined for Mr Johnson—project team costs and the costs of the work that needs to be done to remedy the new site; that is, the costs of upgrading the ventilation system in critical care and fixing the ventilation and other matters, which the NSS report identifies, elsewhere on that site. I am happy to provide Gordon Lindhurst with the detail of that if he would find that helpful.

On whether any of it is recoverable, the KPMG report did not express an opinion on the accountability of individuals or organisations. Given that the board holds the various contracts, it will wish to consider that with its legal advisers. We will continue to have discussions with it on that.

Will the cabinet secretary confirm how many procedures and operations have been cancelled as a result of the most recent delays? Will she also release the programme of meetings that she and her officials had with NHS Lothian, the project team and Integrated Health Solutions Lothian—the project and the delays have gone on for years—so that parents and NHS staff can see for themselves the failings in governance that have plagued this vital and much-needed set of hospital facilities?

That was not really a short question; however, never mind.

Before I answer that question, it is important to note that the KPMG report confirmed that NHS Lothian’s governance processes were exactly as they should have been. I am happy to issue the list that Ms Boyack requested if she sends me a note—I did not write everything down—saying what specifically she wants to look at.

From memory, I think that just under 4,000 patients had to be notified of a change in location for their appointment and procedures. NHS Lothian staff worked remarkably well to ensure that that happened, both by telephone and follow-ups in writing.

My understanding is that no appointments were cancelled, although some might have had to be rearranged. In addition, we put in place a helpline, which remains in place. This month, the number of calls has declined significantly—there were seven in the most recent week—but that helpline will remain in place until we are sure that it is no longer needed.

Initially, staff were located at the new site in order to ensure that anyone who turned up there would be assisted to get to Sciennes or the DCN quickly for their appointment in those places.

At the close of her statement, the cabinet secretary was clear about something that it is worth repeating. Will she confirm that, although no one would choose the situation, the Government will resolve it and deliver the safe migration of services, and the children’s hospital will open?

I absolutely confirm that. Patient safety first and last is my priority.

I thank members. We got through all the questions.