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Chamber and committees

Meeting date: Tuesday, December 10, 2019

Meeting of the Parliament 10 December 2019

Agenda: Time for Reflection, Topical Question Time, Queen Elizabeth University Hospital Oversight Board, Education (Performance), Human Rights Defenders, Code of Conduct for Members of the Scottish Parliament, Decision Time, Miscarriage


Contents


Queen Elizabeth University Hospital Oversight Board

The next item of business is a statement by the Cabinet Secretary for Health and Sport, Jeane Freeman, on an update on the Queen Elizabeth university hospital oversight board. The cabinet secretary will take questions at the end.

14:24  

Families deserve to have confidence that the places where they take their children to be cared for are as safe as they possibly can be. That means that their engagement with their health board must be open, honest and rooted in evidence.

That is even more important in the tragic circumstances where a child’s life is lost. It is, in my view, simply cruel for the grief of a parent to be compounded by a lack of clear answers. So I again offer my sincere apologies, to the parents affected for their loss, and to all the parents affected by the circumstances that we are discussing for the additional burden of worry, uncertainty and anxiety that they have faced.

I will set out the action and the steps that we are taking to give parents, families and patients the answers that they legitimately seek and to step by step ensure that we are working on evidenced data to put in place all the required infection prevention and control measures, and, by doing so, secure the confidence of clinical teams, patients and families. All that immediate work is set against the backdrop of both the independent review that I commissioned in January and the wider statutory public inquiry that I announced in September.

On 22 November we escalated NHS Greater Glasgow and Clyde to stage 4, for infection prevention and control, and for engagement and information with patients and families. Stage 4 brings direct oversight and engagement from the Scottish Government to the operation of the Queen Elizabeth university hospital campus and the Royal hospital for children.

We have set up an oversight board that is reporting to the chief executive officer of NHS Scotland and to me, and that is chaired by Professor Fiona McQueen, our chief nursing officer. The oversight board will ensure improvements to the systems, processes and governance in relation to infection prevention, management and control; improvements to the associated communication and public engagement issues; improvement to appropriate governance processes at the board; and the rebuilding of public confidence. It will also strengthen the approaches that are in place to mitigate avoidable harms.

We have three groups working to the oversight board. One is on infection prevention and control and is led by Irene Barkby, the executive lead for healthcare-associated infections at NHS Lanarkshire. The second is on communication and engagement, and is led by Professor Craig White who has been working directly with families since October, following my meetings with some of the families. Family representatives are also part of that group. The third group will consider any technical issues.

Professor White has now written to 400 parents of children seen by the paediatric haemato-oncology service to hear directly from them about their experience of communication and engagement with the board. My statement today, and any future statements that I might make, together with updates on the progress of the oversight board, will be made available to them.

An essential and early part of the oversight board’s work is to understand the levels of infection and to review all the available information from all sources on case numbers. That work is complex: it needs to be reviewed and, of course, validated.

On 26 November, Health Protection Scotland published its review of data sets for 2013 to 2019. The report confirmed a higher number of certain infections in 2017, 2018 and 2019, but concluded that the current levels of infection are returning to normal. For the most recent months of October and November 2019, the level of Gram-negative bloodstream infections has been below the current average.

We also instructed NHS Greater Glasgow and Clyde to provide the total number of patients with positive Gram-negative blood samples within the paediatric haemato-oncology unit since the Royal hospital for children opened in 2015. The focus has been on infections associated with water and the environment, particularly those associated with environmental organisms, in wards 2A and 2B in the RHC and ward 6A in the Queen Elizabeth. That data will be subject to an expert-led, case-by-case review to consider the decisions taken on healthcare-acquired or community-acquired infection designation, on reporting, on action taken and on information shared and with whom.

Anas Sarwar previously brought to the chamber’s attention a number of reports commissioned locally by Glasgow’s health board. I want to thank Mr Sarwar for bringing those reports to my attention. Two of the reports were by a private company called DMA, in 2015 and 2017. I can confirm that the reports were commissioned by the board, but were not provided to the Scottish Government at the time of their commissioning or of their completion.

The Health Protection Scotland review that we commissioned into the water contamination incident in 2018 reflected the understanding of the issues and the board produced

“a detailed action plan addressing ALL points identified”.

The board’s action plan was published in February 2019, and the actions that have been taken include installation of a chemical dosing plant to treat the water systems and to reduce the risk of possible contamination.

I expect the oversight board to fully consider all locally commissioned reports as part of its work. We need to understand what has been reported and what action has been taken. Some of that work might take some time to be completed, but I am adamant that we need to move forward with that action and other steps now.

Recently, I met a number of NHS Greater Glasgow and Clyde microbiology clinicians who have raised concerns. Our national health service should be celebrated, and its staff work hard to care for the people of Scotland each and every day. Their service is remarkable. I found the insights from the clinicians very helpful in shaping the actions that we are now taking. I thank them not only for making their concerns known and for persisting in following their professional responsibilities, but for accepting my invitation to work with us in considering the evidence that we have, the decisions that have been taken and the steps that are needed to resolve the outstanding issues.

In addition, we will write to each of the individual families, setting out the arrangements that will be put in place to review individual cases, and how families who wish to be involved in such reviews can be.

Concerns have been raised about the use of antibiotic prophylaxis and antifungal drugs with that patient cohort. The oversight board tasked one of its members—Dr Andrew Murray, who is the co-chair of the managed clinical network for children’s cancer services in Scotland—to meet with a multidisciplinary team of senior clinicians, on 6 December, for a clinician-led review of the use of those medicines. The front-line team has confirmed to Dr Murray that the use of antibiotic prophylaxis is being tailored to the needs of each individual patient and that families will be fully informed on its use and why it is being used.

Ordinarily, the clinical lead for healthcare-acquired infection is a board’s medical director, who is supported by others, such as those in the estates department. However, as a result of considering all the issues that I have outlined today, I think that we can begin to restore trust only by taking significant additional steps. That is why I have asked Professor Marion Bain, who is the former medical director of NHS National Services Scotland, to take over that responsibility within NHS Greater Glasgow and Clyde. A senior clinician in infection control and prevention will be reviewing the infection data and helping to validate it. They will be external to NHS Scotland and will provide an independent expert assessment of the actions that we are taking, to ensure that they are effective and appropriate.

This morning, I met the full board of NHS Greater Glasgow and Clyde. The board is in no doubt about how seriously the Government takes the safety of care and the importance of transparency and rigour in these matters. It also knows the actions that I require from the board in order to restore and rebuild confidence. Andrew Moore, who is the head of excellence in care from Healthcare Improvement Scotland, and Angela O’Neill, who is the deputy nurse director in NHS Greater Glasgow and Clyde, have been appointed to ensure that the actions that the oversight board identify are fully implemented.

I will keep Parliament informed of the progress of the oversight board and its findings. I know that Parliament’s overriding concern—it is mine, too—is that, when our NHS falls short of the expectations that we have for it, we move robustly to address those issues. Most important of all, patients and their families must have confidence not only in the high quality of care that they receive from our national health service, but in the safety of the environment in which they receive it.

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

The cabinet secretary says that families deserve to have confidence in their services and that they deserve answers. I agree. The problem is, though, that families have lost confidence in NHS Greater Glasgow and Clyde and in the Scottish National Party Government. Sadly, nothing in today’s statement suggests that the Government is in control of the crisis at the hospital.

I want to ask the cabinet secretary two specific questions. First, can she confirm that all required blood tests for patients at the hospital have been undertaken since it opened? Secondly, given that she has now had almost a month to find out what is going on, will she outline how many children ministers believe to have been infected?

On the first part of Mr Briggs’s question, I assume that he is referring to blood tests of children in the paediatric haemato-oncology unit, rather than the entire hospital. Those blood tests are taken as part of those children’s treatment and are part of their regular monitoring. The clinicians initiate those tests and engage in them. I do not think that in anything we have discussed today, with respect to the Royal hospital for children, or indeed ward 6A in the Queen Elizabeth university hospital, there has been significant—if any—questioning of clinical care. Those blood tests continue in order to monitor the effectiveness of clinical treatment and ensure that, where an infection is suspected, it can be identified whether there is one and, if there is, what it might be.

In terms of the numbers, I was trying to explain in my statement that we now have a significant body of reports: those that have been locally commissioned, some of which we were unaware of; reports of our own that we have commissioned from HPS; and information that has come from microbiology clinicians, who have been referred to as whistleblowers.

What we have to focus on, and what the oversight board is engaged in, is bringing all of that data together and looking, case by case, at every single infection that has been identified. We then need to take an expert-led view as to whether the designation that was given to an infection—whether it was hospital or community-acquired—is a designation that our experts agree with. We need to identify the number of organisms involved and the number of patients then affected, and whether a patient’s infection was a contributory factor in any subsequent death.

As I have clearly said, all of that work—which I have described in detail—takes time. That is why I have committed to coming back to the chamber with an update in January, to keep both the chamber and families up to date. I want to be sure that when I stand here and when I give that information to families as well as to members, I am confident that I know exactly how many organisms we are talking about, which were environmental and which were waterborne, how many patients were affected, and in how many subsequent deaths a patient’s infection was a factor. At the same time, we will look to see what NHS Greater Glasgow and Clyde has been doing and whether we need it to do more to mitigate infection and ensure its prevention.

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

We know that children have died in this flagship hospital when warning signs were not acted on. Infection outbreaks remain unexplained and parents continue to worry that their children are at risk. Many of them say that they lost trust in the health board long ago, that they still do not feel fully informed and that they are not reassured by the on-going high levels of prophylaxis use.

Can the cabinet secretary confirm whether the most recent reported child death is linked to a hospital-acquired infection, and whether it has been reported to the Crown Office? Has Milly Main’s death been reported to the Crown Office? On the wider issue of trust, staff whistleblowers and families have acted with courage in the public interest, whereas it seems that the board has acted to protect itself. Why will the cabinet secretary not exercise her powers and escalate the board to level 5?

The cabinet secretary is adding people to the board, but why will she not move anyone aside? If that was the right action in NHS Tayside over finance issues, why is it not the right one in Glasgow, when the safety of children and other patients is at stake?

Ms Lennon asked a number of questions. I will attempt to go through them all.

I will start at the end. I am not adding people to the health board; I am bringing in external expertise to the work of Government, in order to undertake the work that I outlined in my statement and in my response to Mr Briggs, because the board is now at level 4. I am not looking for assurance from NHS Greater Glasgow and Clyde. I am looking for all the evidence from all the reports and ensuring that not only do we bring in those external experts, who are reporting to me, but that they go through that evidence forensically and reach their own conclusions.

Where those conclusions differ from the conclusions that NHS Greater Glasgow and Clyde reach, we will pursue that. However, I am also bringing in external expertise from outside Scotland to validate the actions that we are taking in terms of level 4 and the oversight board.

With respect to Milly Main, my understanding is that that case was not reported to the Crown Office and Procurator Fiscal Service. I understand the concern that has been raised around that, particularly by the family but also from Ms Lennon. I have asked the board to have an early discussion with Milly Main’s parents in order to conclude whether they are content that that case be reported to the Crown Office. Among others, the case of Milly Main is particularly distressing in that her mother discovered only when reading the death certificate that infection played a part in her child’s death. The reporting of cases to the COPFS is undertaken by doctors or boards and not by Government ministers, but it should certainly not be done without consulting the families concerned, so that is what I have asked the board to do.

It is difficult to answer Monica Lennon’s question about the most recent case, because I am not sure whether she is referring to the case in the paediatric intensive care unit. However, I am happy to provide an answer to Ms Lennon outside the chamber if she can give me more direct information on what particular case she is referring to. I am very happy to do that, but I do not want to give her an answer if we are talking about different cases. As Ms Lennon knows—I appreciate that she has not done this—we are not in the business of naming individual patients or families here, unless that information is already in the public domain.

I thank the cabinet secretary for the advance sight of her statement. With regard to the public inquiry, I welcome the fact that the terms of reference are being set and that they will be shared with families in the new year. We have to be certain that the remit is appropriate, robust and wide ranging. The cabinet secretary rightly speaks of the need to rebuild public confidence. Given that need and the great public interest in the matter, what steps will the cabinet secretary take to consult Parliament before finalising the terms of reference?

As I have said, I will return to Parliament once the terms of reference have been agreed between me and Lord Brodie. In advance of that, we will consult the families on the terms of reference. I am keen that we get on and agree the terms of reference and get the public inquiry started. Consulting Parliament would probably prolong the process. However, following taking the families’ views, I am happy to discuss the draft terms of reference, before they are finalised, with the relevant party spokespeople on health and sport and take their views. I hope that that would be satisfactory to members.

I am grateful for the early sight of the cabinet secretary’s statement. Although it is very concerning that escalation to level 4 has been necessary and that level 5 might also be necessary, I hope that the steps outlined in the statement will ensure that no patients or families need endure further distress. The cabinet secretary said that the oversight board will ensure improvements to communications. Is she concerned about communication between the health board and the Scottish Government up to this point? Does she have any further understanding as to why the reports identified by Anas Sarwar were not shared with the Government when they were completed? What action has she taken to ensure that that kind of failure to communicate does not happen again?

I believe that we have seen improvements in communication between the board and the families since Professor White took up the role that I asked him to take up in October. Mr Cole-Hamilton will recall that when I met the group of families that I did meet, which is of course not all the families engaged in this area, we ended up with 71 detailed questions, all of which have now had detailed answers. Professor White took forward that piece of work with the board. I therefore think that we are seeing improvements, but involving representatives of the families in the work of the oversight board on information exchange and engagement is a critical part of ensuring that we continue to see improvement.

I want to see that way of working embedded in the board, so that it will not need external expertise and guidance in order for it to be done but will become business as usual. That will be a significant culture change, but it is very necessary.

Following my meeting with it today, the full board of Greater Glasgow and Clyde is very clear on my expectations of it, with regard to communicating information to the Government. In terms of level 4, the board’s job is to provide the Government, through the oversight board, with all the information that we need. It should provide it in a timely fashion, in full, and we should not have to spend time going back and forward looking for different bits and pieces. I am confident that the board understands that and that that will now be the manner of work. Of course, if there are any glitches, I am sure that Mr Cole-Hamilton knows that he can rely on me to act on them in a timely way.

It is surely beyond doubt now that health boards must ensure that they foster a culture whereby staff feel that they can raise concerns. What steps has the Scottish Government taken to support such developments on the part of health boards?

Ms Ewing is absolutely right, and I am sure that she will be aware, from her interest in this issue and the chamber’s previous discussions, of the approval by Parliament of the necessary steps to establish the independent national whistleblowing officer in the office of the Scottish Public Services Ombudsman. The Health and Sport Committee has taken evidence from the ombudsman’s office on how it will carry out the work. I have made previous statements that, by Christmas recess, we will have appointed the individual board whistleblowing champions and there is a review on a once-for-Scotland basis of all our relevant human resources and other policies to ensure that they are consistent across all boards.

However, members know—I have said this before and I know that we agree on it—that having whistleblowing policies is fine, but they do not necessarily, in and of themselves, ensure that staff in any organisation, not least one as large as our national health service, feel safe, empowered and welcome when they raise issues of concern. That is a huge cultural piece of work that we are actively engaged in, through the short-life ministerial group, with a range of stakeholders from regulatory bodies to NHS boards to representatives of unions and others, and it will take some time for us to be confident that we have secured the level of cultural change that we need inside the NHS for that to be the case. We will build into our annual ministerially led reviews and mid-year reviews of our health boards key questions and discussions in order to ensure that we can keep tabs on the improvements that we are looking to see with regard to the cultural issues that lie underneath Ms Ewing’s question.

A few weeks ago, I highlighted the case of Sam, a 13-year-old who was tragically diagnosed with leukaemia. Sam was unable to be treated at ward 6A at the Queen Elizabeth university hospital and he was sent to Edinburgh, where he got the last available bed. Wards 2A and 2B in the Royal hospital for children have been closed since September 2018. Is the cabinet secretary confident that those two wards will reopen in March 2020, ensuring that no more patients and their families, like Sam’s, have to go elsewhere for vital treatment?

I am grateful to Ms Wells for that question and, of course, I take this opportunity, through her, to express my sympathies to Sam’s family. Ward 6A in the Queen Elizabeth, to which wards 2A and 2B were decanted, has now opened to new admissions, which is a positive step. That was done as a consequence of incident management team meetings that involved clinicians and others who were involved in ward 6A, so that they were comfortable that that was the right thing to do. With regard to wards 2A and 2B, my understanding is that the board is on track, but we are currently in discussions with it and are being updated on exactly what work needs to be done and whether further work or validation needs to be undertaken so that we can give a final timeline for the reopening of wards 2A and 2B.

It is welcome that an external senior figure will take over infection control in Glasgow. What steps have been taken to examine past cases so that the events that have been described are not repeated?

I have instructed the oversight board, supported by all those whom I mentioned earlier, to carry out a full review of all relevant cases. They will go back to 2015 and work their way through all those cases in detail. All the steps that I have set out will be considered, as well as the broader clinical context of each case, so that there is a thorough investigation into whether each infection case was healthcare associated and whether there was any associated mortality in them. I know that members will understand why that review is complex. It will take some time, but it needs to be done in that detailed, forensic, case-by-case way. That will start from 2015.

A child who lost their life is at the heart of this case. The cabinet secretary has said that the independent water report that was done in the week that the superhospital—which cost over £800 million and was built at the heart of Nicola Sturgeon’s former constituency—opened was not shared with the Government. That is simply unforgivable. The water supply was deemed to be not safe and high risk. In those circumstances, the hospital should never have been allowed to open.

Will the cabinet secretary launch an urgent investigation into how that was allowed to happen and ensure that heads roll? I do not doubt her sincerity on the issue, which is why I welcome the appointment and implementation of the oversight board. However, patients, parents and the public have lost faith in the leadership of the health board. The people on it must be moved aside to allow a genuinely independent investigation to happen. The longer they walk the crime scene, the more chance they will have of compromising the investigation and the more chance there will be of our failing before we have even begun.

I agree with Mr Sarwar that the non-sharing of the reports with the Government and, I understand, the non-sharing of those reports with the board in 2015 are entirely unacceptable and that, from looking at those reports, action should have been taken before patients and others moved into particular areas of the hospital. Staff were concerned with particularly vulnerable groups of patients. The rest of us manage such infections, and we probably do not even notice that we have them because our immune systems work healthily and well. However, the organisms are particularly dangerous and threatening for that vulnerable cohort of patients.

I do not disagree with the sentiment that Mr Sarwar has expressed. We have taken steps in giving the clinical lead on healthcare-acquired infection to a medical director whom we are bringing in, and to ensure that we have independent expertise, for example. It should be remembered that those steps are in the context of the independent review that I commissioned, which is due to report in the spring of next year, and the public inquiry, which will go further behind some of the issues that Mr Sarwar has raised about the overall design, construction, build and maintenance of the hospital and how it contributes to effective infection prevention and control, or otherwise. I want answers to those questions, as well.

Can the cabinet secretary provide an assurance that the families of children who were treated in the cancer ward, including one of my constituents, will have the opportunity to engage fully with the oversight board to highlight concerns that they have had and that their concerns will be listened to and acted on to ensure that lessons can be learned for the future?

Yes, I can. Professor White is already engaging with families. He has written to all 400 families who have a connection with that particular haemato-oncology service, which is currently located in ward 6A, asking them for any questions that they have. Professor White has also asked for their views on their experience of receiving information, asking questions and receiving answers and what more they think can be done. As I have said, two representatives from families are actively engaged in the oversight board’s work on improving communication, engagement and information exchange. As I have also said, we will consult families on the remit of the public inquiry and if anything more comes from families on their active engagement, I will be very happy to look at that. Of course, all the families who are involved will be consulted in that case-by-case review on how they want to be involved. If they want to be fully involved, of course they will be.

Apologies to Emma Harper, John Mason, Brian Whittle and David Stewart. I am afraid that we have run out of time.