Meeting of the Parliament

Meeting date: Tuesday, March 10, 2020

Official Report 1009KB pdf

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Topical Question Time

The next item of business is topical question time. There is one question today.

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Royal Hospital for Children and Young People

To ask the Scottish Government what its response is to the concerns raised by the former chair of NHS Lothian regarding the new Royal hospital for children and young people. (S5T-02062)

My short response is that I fundamentally disagree with Brian Houston’s reported assertions and accusations.

The events leading to my decision to halt the transfer are set out in the independent assessment of governance arrangements for the project, which was published last autumn. On Thursday 4 July 2019, I took the decision that, because patient safety could not be guaranteed if the hospital were to open the following week, I would instruct a complete halt to the transfer until I could be assured that patient safety in every area of that hospital, including the department of clinical neuroscience, met national standards. For the benefit of members, I advise that, at that stage, NHS Lothian’s preference was to attempt to rephase occupation over the following weeks and months, including having the DCN move in as planned and ambulatory paediatric services move in later in the summer of 2019. The subsequent investigations on the issues to be rectified have demonstrated that such an option would not have been feasible or safe

As a former national board chair myself, I did not take that decision lightly. The safety of patients—not least that of children—cannot be left to chance. The subsequent support for delivering the project, which was provided by the Scottish Government as a result of escalating the board to level 4 for the work, has put Mary Morgan in to oversee the final delivery of the project to the standard required and within the timeline set.

I will, of course, continue to keep Parliament advised on when the hospital will open to serve the people of Lothian.

In an interview in the Edinburgh Evening News, the former chairman of NHS Lothian’s board paints a worrying picture in his description of a “toxic” culture, presided over by the cabinet secretary, in which the board has been treated with utter “contempt”. His account raises a fundamental question of trust. It says:

“to come out and say she was overruling NHS Lothian was a lie.”

I ask the cabinet secretary whether Mr Houston’s version of events is correct. Will she say whether she actually overruled NHS Lothian?

Let me repeat part of what I said in my first answer. On 3 July, the chief executive of NHS Lothian sent the Scottish Government’s director general of health an email that considered four potential options. NHS Lothian considered that option 4—rephasing the timing of the move into the building to allow a phased occupation over the next few weeks and months—was the best one. I did not consider that it was the best option; I instructed a halt. I think that that is clear.

It is also clear that, from my dealings with boards across the country and my actions in the chamber, I am the least likely person to preside over a toxic atmosphere. I refute that accusation absolutely.

Everything that the cabinet secretary has outlined suggests that a dysfunctional relationship exists between Scottish National Party Government ministers, our health boards and the Government’s advisers. In the same interview, Mr Houston says that the cabinet secretary threatened that if he did not resign she would fire him. I ask her to say whether that is the case.

Let me be clear. I do not accept that there is a dysfunctional relationship between the Scottish Government and national health service boards, or between any NHS directorate staff and NHS boards. I do not believe that Mr Houston’s reported assertions and accusations, which I have clearly said that I refute—I have provided evidence to back up my position—in any way indicate substantive evidence for Mr Briggs’s assertion.

I stress that, on 4 July, I took the decision to halt the move. Mr Houston next met me on 18 July. At no point in the intervening period did he—the chair of a major NHS board—feel that it was incumbent upon him to contact me, as the cabinet secretary, to discuss what might have gone wrong or what should be done next and where the board should be involved. Nonetheless, the director general of NHS Scotland was in contact with the chief executive and such matters were discussed, as they continually are between the director general, our national clinical director, our chief medical officer and our various directors in the NHS. Indeed, tomorrow, I will attend a meeting of the NHS chief executives, just as I regularly attend meetings of the NHS chairs.

I do not accept that there is a dysfunctional relationship in any respect. I accept that it is my job to challenge and support boards to ensure that we get the best performance for the investment. In relation to whether I said to Mr Houston that I would sack him, I point out that Mr Houston resigned. I have powers under the National Health Service (Scotland) Act 1978 to dismiss chairs, but I did not use those powers in this instance.

The dominant issue of coronavirus presents a public health emergency, and we are about to hear from the cabinet secretary on that matter. We have all committed to work with the Scottish Government in the public interest, but it is clear that the issue around NHS Lothian and the resignation of Brian Houston is not going away, and we cannot have it swept under the carpet.

Will the cabinet secretary agree to publish all the emails and the minutes of the discussions to which she has referred, and anything else that would help to bring the matter to a close? If we do not get the answers that we need, will she commit to giving a ministerial statement next week, so that all members in the chamber can have more time to explore the issue in full?

I do not believe that, in any respect, I am attempting to sweep anything under the carpet. Indeed, it would have been my wish to publish the appraisal. Mr Houston has made it clear in his response that he disputes the appraisal and its conclusions, but the general data protection regulation prevents me from publishing it. GDPR is not something that I made up or can control; it exists, and it prevents me from publishing the appraisal. I am also prevented from doing so because of the critical relationship that I have with board chairs and chief executives, and the relationship that my director general has with those individuals.

I have set out clearly what happened on 3 July, what I did on 4 July and how it took Mr Houston until 18 July to have a conversation with me, which took place only because I visited the sick kids hospital in Edinburgh. I do not know what more Ms Lennon wants to pursue in relation to the matter, but I say clearly that the people who are keeping it alive are Labour and Conservative members. No one from NHS Lothian and no staff member who is involved in the two hospitals has raised any concerns whatsoever with me in that regard. That includes those in the area partnership forum, who represent the staff across all the unions and with whom we have been actively engaged.

I believe that we have acted properly and that I have acted properly. I have set out very clearly why Mr Houston’s accusations are wrong and why I will not publish his appraisal, on which he founds what he has said. If we are genuinely focused on having the right health service for Scotland and on addressing the challenge of coronavirus, this matter should now be ended by members of the Opposition, who simply want to make political capital out of it.

We have had a good exploration of the issue, but six more members would like to ask questions. I would like to get through them, so I ask for brief questions and brief answers, please.

As the MSP for the Almond Valley constituency, I very much appreciate the plain-speaking approach that the cabinet secretary takes in standing up for patients and staff. I recognise that she made the call to postpone NHS Lothian’s planned move in the interests of patient safety at a time when, as has now been publicly acknowledged, no decision had been taken by the board. Will she elaborate on what work is now under way to oversee the safe delivery of the new hospital?

The board was escalated to level 4 for the work in question. The Government has appointed the director Mary Morgan to work with the health board and to oversee all the work that needs to be done to ensure that the new hospital is safe and meets the standards, particularly with respect to ventilation, electrics and fire safety. We are moving along the timeline, which has not changed from when I first announced it. I am hopeful that we will shortly be able to announce the move of the DCN to its new facilities at the new site. We will then continue the work in order to be able to open the hospital in the autumn of this year.

It is our job to hold the cabinet secretary to account on behalf of our constituents, and we will do that whether she likes it or not.

GDPR does not prevent the cabinet secretary from publishing emails, letters, minutes and agendas from any meetings. Will she now publish them all?

Of course Mr Findlay holds me to account—he does that with regularity, and I welcome it every time. My point about GDPR related to the appraisal. However, if the member wants to see the email from the board that I quoted from—

I want to see all of it.

—and he wants to see other exchanges around that time, I am very happy to publish those and to make those available to members.

Excellent.

The cabinet secretary does not agree that the relationship between NHS Lothian and the Scottish Government is dysfunctional, but it certainly appears as though it has been damaged. What action does she intend to take to restore the essential trust that must exist between the health board and ministers? In the light of Mr Houston publicly expressing such serious concerns about the relationship, will she meet him, or others, to explore the concerns, so that we can avoid any future breakdown in that important relationship?

Mr Houston’s resignation came as a result of the appraisal that he received from the director general of the NHS in Scotland. Appraisals are standard practice. Like others in this chamber, I know that they can sometimes be uncomfortable. Clearly, Mr Houston found that to be the case and did not accept the conclusion of his appraisal.

I do not accept that the relationship between this Government, the health directorate, me, the DG or any of my senior officials and NHS Lothian is damaged on the sole basis of one individual’s resignation and their personal decision to go to the press and make a number of accusations and assertions, which I refute. Our relationship with NHS Lothian continues to be productive, supportive and, yes, at times, challenging. That is as it should be.

Has the opening date of the sick kids hospital been confirmed and agreed by NHS Lothian? I ask because we had a recent cross-party briefing from senior staff at which the date was not confirmed.

As I said earlier, the timeline that I set out to move the DCN into the new facilities in spring and for the hospital to open in autumn remains on track. Specific dates require to be finalised as we progress the work on the new ventilation upgrade and on other matters. As soon as we have a specific date for both those aspects, I will happily return to the chamber or advise members by email of that.

The cloud under which all this sits is the reality that a hospital lies empty at the cost of £1.4 million a month, with no patients. Communication has been at the heart of some of the problems that we have discussed today. What confidence does the cabinet secretary have that she is receiving accurate communication from NHS Lothian about the hospital that she can then impart with regularity to the Parliament?

The climate that surrounds the situation is not simply that we have a hospital lying empty. We had a hospital that was not safe. That is the fundamental point. It is my job as cabinet secretary to protect patient safety, and that is what I did.

On the provision of information, as I have said, we have Mary Morgan from the Scottish Government working with NHS Lothian. She reports to an oversight board that is chaired by our chief nursing officer, and information from the board about the progress that is being made in order to ensure that the timeline that I have outlined is met is regularly communicated to me.

The cabinet secretary did not deny threatening to dismiss Mr Houston. If she did threaten to dismiss him, will she confirm what grounds she had for issuing such an ultimatum?

Mr Houston chose to resign; I chose not to use my ministerial powers. As I have said, the situation arose from an appraisal. I also said that we all accept that appraisals can be uncomfortable, but that they are an important part of how we conduct our work with our chief executives and chairs—indeed, we expect our chairs to do them with non-executives.

If Mr Houston does not accept any accountability for the situation that NHS Lothian finds itself in—at level 3 for performance and other matters, despite having significant additional resources and support put into it; and at level 4 in relation to a hospital that had to have its moving-in phase halted, on the grounds of patient safety, days before that phase was due to start—then his idea of the role of chair is different from mine, which is what I acted in accordance with when I was the chair of a national board. That goes broadly for other chairs, too.

What I expect from our chairs is clear. They require our support and our challenge, but they also need to accept their accountability in relation to the performance of the board that they chair. That is the situation that we are in. Mr Houston did not accept that and he did not accept the conclusions of his appraisal. In a situation in which someone does not accept that more work could be done, it is difficult for us to continue to have a productive relationship. In those circumstances, Mr Houston chose to resign.