Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, June 16, 2020

Official Report 907KB pdf

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Topical Question Time

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Queen Elizabeth University Hospital (Review)

To ask the Scottish Government what its response is to the review into the Queen Elizabeth university hospital. (S5T-02267)

As members know, I commissioned the independent review in January 2019, with the remit to establish whether the design, build, commissioning and maintenance of the Queen Elizabeth university hospital and the Royal hospital for children have had an adverse impact on the risk of healthcare associated infection, and whether there is wider learning for NHS Scotland.

I have welcomed the report that was published yesterday, its important findings and recommendations, and the contribution that it will make to the public inquiry. I will respond fully to its findings and recommendations in due course.

In thanking Dr Fraser and Dr Montgomery for their considerable work, I record again my sincere thanks to the whistleblowers for their courage and persistence in the face of the difficulties that were placed in their way.

I recognise that for some of the families who have been affected the report does not provide all the answers that they rightly ask for, but I hope that the report, the outcome of the independent case review that is under way, and our response to both will assure them of the extreme seriousness with which I take their concerns.

I welcome that response from the cabinet secretary. It is a small step in the right direction although, sadly, it leaves many big unanswered questions.

As the health secretary said, the report is one of several pieces of work. It is crucial that any process takes with it the families who have been affected. That is not helped by there being clear inconsistencies. On one hand, the co-authors say that the review was not about looking at individual cases, and that they therefore did not speak to families, but, on the other hand, the report makes judgments on individual cases. That is not acceptable. Its success or failure will depend on getting answers from Milly Main’s parents and all the parents who have been affected. Will the cabinet secretary give a firm commitment that families will be at the heart of the next stages—namely, the clinical case review and the public inquiry?

I am very happy to give Mr Sarwar that assurance. As he probably knows, following my meeting with a number of the families involved, we undertook a number of actions, one of which was to place a very senior clinical member of my team in Queen Elizabeth university hospital as direct liaison between the board and the families, to ensure that when the families had questions on any matter, they were speedily given full answers. He continues to do that work.

Families have been involved in the work of the oversight board and its design, and have assisted in developing how the independent case review will go forward. Individual families in specific cases that will be independently reviewed are aware of that, and have the option to be alongside the case review while it happens—or not, depending on how they want to engage. They will certainly be involved and will have the findings of the case review fully reported to them in person, and will have as many opportunities as they need to return with further questions.

Finally, the remit of the public inquiry was considered by the families involved in order to ensure that it would achieve what they hoped that it would achieve. Members of Parliament were also given the opportunity to comment through their parties’ health spokespersons.

The remit is now finalised. I will speak to Lord Brodie later this week. I hope, following that, to be able to update members on when the public inquiry will begin. Lord Brodie has been keen from the outset to understand how he can best engage with the families; I understand that he intends to appoint a family liaison officer to the inquiry, in order to ensure that that happens.

The authors of the review accept that their report was about the future, not the past. However, the past matters, especially to those who have lost a child, because there are indisputable facts. The Queen Elizabeth university hospital was built with design flaws. The independent water-quality report at the time of opening found that there was high risk of infection. That was not actioned at the time, and there were infections in children. Milly Main died from Stenotrophomonas infection; that is written on her death certificate.

There is a culture problem, and there was an attempt by the leadership of the health board to ridicule and silence whistleblowers. Does the cabinet secretary accept that the public inquiry must look at those issues and provide answers? Will she publicly support Milly’s parents’ demands for a fatal accident inquiry, so that they can try and get justice and answers on their daughter’s death?

I completely agree with Anas Sarwar that the past matters. It is often unanswered questions about the past to which many families desperately require answers. I completely concur, and I believe that the public inquiry will work very hard to address that. It needs to look at the past in order to provide answers and the lessons that we need to learn for future infrastructure building in our national health service.

The independent case review—with independent experts in their field looking case by case—is also looking at the past. I hope that all the families, who have been contacted, choose a way of engaging with the case review that best meets their needs. As I said, they have a range of reviews.

I understand that Ms Darroch’s case—Milly’s case—has been reported to the procurator fiscal. Cases need to go through due process, in which—as I know Anas Sarwar understands—it would not be appropriate for me to intervene. We need to let that happen, we need to let the public inquiry begin, and we need to see how Milly’s mum feels as a consequence of the review of her daughter’s case. We will then see whether we need to take further steps.

I note that seven members would like to ask a question; I am not sure that we will get them all in. Nonetheless, I ask for succinct questions and answers.

I have two questions. First, on 28 January, the cabinet secretary told me that the 80 families who had been identified would have, at the very least, a face-to-face talk through with regard to their specific case. Has that happened?

One of the points in yesterday’s report was that the impact and benefits of single rooms should be reviewed and that any future design around that should be considered. Will the Scottish Government now review single-room occupancy in hospitals?

With respect to the face-to-face talk through, part of the work of the independent case note review has been delayed—as Miles Briggs might expect, it is taking longer because of Covid-19. The independent reviewers are working through different ways in which they can have that face-to-face talk through, the commitment to which remains. They have undertaken some of that, and it will take longer. It is now anticipated that the initial report will be available in the autumn. However, that may not be the complete report; it depends on how they can meet the commitment to the face-to-face talk through in circumstances in which we are still dealing with Covid-19.

In relation to single rooms, I note from an initial reading of the report—I am sure that I will read it again more than once—that the specific point that was picked up was in relation to the maintenance of, in particular, hand wash basins and the water supply in single rooms in which, inevitably, the water flow was not as great as in a four-bedded bay in which the water was used more often. There was a maintenance issue that was not picked up and addressed at the outset. That is part of what we need to consider as we progress, because we know that single rooms also play an important role in effective infection prevention and control, notwithstanding the points that the report makes in that regard.

What role will the national body that was announced in the programme for government to strengthen infection prevention and control have in ensuring that we have a wide range of skills and the expertise that is required for the construction of these particularly complex structures?

The national body that has been announced and on which progress is being made—albeit more slowly than we would have anticipated before Covid-19—will have a critical role. Notwithstanding Mr Sarwar’s comments about where he would have liked this independent review to have gone and his concerns around it—which I hope that we will discuss later—there are clear lessons in it.

The national body will consider the lessons, such as those about single rooms, maintenance schedules and the kind of maintenance that should be done, and the design at the outset, which should allow for a better balance between energy efficiency and the right air flow, particularly for groups of patients who are immunosuppressed.

The design of a building such as the Queen Elizabeth university hospital needs to be capable of being flexed depending on the particular needs and vulnerabilities of different patient cohorts. That has to be a key lesson even of this review, far less what the public inquiry will teach us.

One of the review’s findings is that

“Some of the difficulties encountered with water and ventilation systems were the result of ambiguity concerning the status and interpretation of guidance”.

The independent review of the Government arrangements for the Royal hospital for children and young people likewise found that the issue with ventilation in critical care stemmed from “confusion” over interpretation of standards and guidance.

Why do such critical errors in the building of our hospitals keep being made, and what assurance can the cabinet secretary give that clear guidance will be produced in the future, and that it will be followed?

There is an argument that the guidance is clear. The instances to which Ms Johnstone refers relate to local interpretations of the guidance. Part of the point of the national centre’s role in signing off design and build, and in providing guidance, is that we will remove the opportunity for local interpretation of guidance. We will have clear national guidance and a single interpretation of it, which will remove some of the areas of perceived ambiguity that arise due to local interpretation. In one place, there will be a body of experience and expertise that moves from one infrastructure project to another with a degree of consistency and skill that we do not get if we leave matters up to each individual board.

The failure of mechanical ventilation to change over the air in critical care elements of the new sick kids hospital in Edinburgh is the reason why the move to the new building was halted and why remedial changes to the building are having to be effected at a cost of many millions of pounds. Given that the same problem has been identified in the QEUH, what remedial work is required to ensure adequate air flow in that hospital?

The remedial work in the Queen Elizabeth campus has already begun. It involves internal construction work; therefore, as in other areas, progress has slowed due to the response to the pandemic. Even in the first phase of easing restrictions in the construction industry, work has not been possible because of where it will take place—wards 2A and 2B in the children’s hospital.

Considerable initial work has been done, but it has not yet been completed to ensure the ventilation flows and the air changes that are needed across wards 2A and 2B. Initially, the intention was simply to deal with one ward, but the decision has rightly been made that work should be done across both wards. As Alex Cole-Hamilton might remember, patients and families were decanted from the area to wards 6A and 6B in order to allow the work to happen. The work is under way, although I do not yet have the final timeline for when it will be completed, due to reasons of construction supply as well as construction work. As soon as I have the final timeline, I will make sure that members know it. The work will have to be signed off by all the regulatory bodies before I agree that children can move back into the area.

What assurance can the cabinet secretary give that the terms of the public inquiry will allow proper scrutiny of the decisions that were taken by the Government and successive ministers in respect of the QEUH and the Royal hospital for sick children in Edinburgh?

Notwithstanding the cabinet secretary’s comments about family engagement, some families are feeling quite upset and let down by the process so far, and they feel that there has been a cover-up. What is her response to those families?

There has certainly been no attempt by me to cover up anything in that regard.

We have taken a number of steps to ensure that families are heard and that when they have shared concerns, those concerns are addressed. That is Professor White’s daily role and has been for a number of weeks. Where there are individual family issues around a child’s case, such as how the case has been managed and whether there was an impact on the management or treatment of the child, and for those tragic cases in which a child died as a consequence of the environmental issues, we have also taken steps to ensure that the independent case review has a clear determination to work with a level of family engagement that the families determine themselves.

As I already said, Lord Brodie has been clear from the outset that he wants to personally hear from families directly about their concerns and issues. As I also said, the draft remit, which he was content with, was circulated for comment to families who are engaged with and affected by issues at the children’s hospital at the Queen Elizabeth university hospital, and those comments were incorporated into the final remit that we will publish.

A great deal of work has gone on to ensure that that all happens. How Lord Brodie conducts his inquiry is of course entirely for him. It is a statutory inquiry with a number of significant powers. He was thoughtful before agreeing to chair the inquiry, because he is determined to get to the bottom of a number of issues that he has already identified as needing to be drilled down into. That includes the role in decision making of Government, and he will consider and conclude whether that has been appropriate or whether mistakes have been made and failures have occurred. I am certain that he will pursue his public inquiry without fear or favour and in the manner that he thinks is correct. I cannot tell him how to do it, and I would not dream of doing so. He will get on and do it.

On whether there is more that we can do to address questions that families still have, I remain, as always, open to meet, speak to and hear from individual families about their concerns and to see whether there is anything more that I can do to address them.

I apologise to Neil Findlay and Daniel Johnson, but we have to move on to the next question.

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Schools (Part-time Learning Model)

To ask the Scottish Government whether it will provide further clarity to comments by the Deputy First Minister that schools could adopt a part-time learning model for the whole of the next academic year. (S5T-02270)

I indicated on Sunday that we do not want the blended learning model to go on for a moment longer than is required for public health reasons and that we want young people to be back having face-to-face learning for 100 per cent of the school week as soon as it is safe to do so.

Ensuring that our children and young people have the highest-quality education is of critical importance. To that end, our regular three-weekly reviews of the coronavirus regulations will include specific consideration of the evidence and data relating to transmission in schools and among young people. Where that suggests that specific safety restrictions can be lifted or eased without putting pupils or teachers at undue risk, we will take that course of action.

My inbox is full on this matter, as I suspect is the case for other members. Parents around Scotland were justifiably concerned and angry this weekend. They are concerned about how they can possibly return to work with their children being educated only part time and they are angry that no one in the Government can give them clear answers to fundamental questions about their children’s education next year.

Instead, we have had mixed messages, confusion and a chronic lack of leadership. On Sunday morning, the cabinet secretary told broadcasters that part-time schooling could last all next year, only to be undermined by the First Minister a few short hours later.

On behalf of parents, and to help the cabinet secretary clear up any confusion on the matter, I have a simple question. Knowing that we cannot rely on a vaccine for the virus being available any time soon, by what date does he believe that schools will return to normal?

As I made clear in my first answer, I want schools to return to normal as quickly as it is safe for that to happen. The Government is working with its local authority partners through an agreed framework, which has been discussed and agreed with the teaching professional associations and representatives of the parental community, to ensure that we have a workable approach to sustain the learning of children and young people, part of which will happen in school and part of which will happen at home, supported by a range of digital learning support that is available just now and will be strengthened as we approach the resumption of the school term in August.

As I said in my earlier answer, we will bring to an end blended learning when it is safe to do so.

I acknowledge that this is a challenging period for parents. However, I too have had communication from many parents about the importance of ensuring that our schools are safe places for children and young people. I am sure that members will understand the importance that I have to attach to ensuring that our schools are safe places for the education of children.

The cabinet secretary is saying, in essence, that he cannot give a date. However, the First Minister was able to say yesterday that the blended model will

“not ... last a year or anything like it”.

What exactly does that mean?

Parents and pupils need more detail, but we are getting two competing messages from the Government’s two most senior ministers.

Since the education secretary does not know whether, or when, schools will fully reopen, perhaps he can answer some questions to which he should know the answer. How much additional classroom capacity could schools deliver if social distancing was reduced to 1m? How many additional teachers have been recruited since March to deal with his plans for blended learning? Will he guarantee to members that children will be able, next academic year, to access the same breadth of subjects as was available to them this year?

The blended learning model is the product of an agreement between the Scottish Government, local authorities, the teaching professional associations and parents. It has been worked on for some weeks since the lockdown began, to ensure that we had an agreed framework that could be deployed locally to maximise the impact and effect of education on young people.

On school occupancy, answers vary around the country, as Mr Greene will know. As I explained to the Education and Skills Committee on Friday, some schools operate significantly below full occupancy and, in many cases, will be able to deliver almost a full timetable for children and young people. At the other end of the spectrum are schools that have much more significant rolls, which may be close to capacity, or even, in some circumstances, over capacity. They have to manage very carefully the accommodation that is available to them.

The strategic framework put in place the facility for, and the requirement on, local authorities to maximise available accommodation and staff resources. That is what we expect of local authorities, and it will vary because of the options that are available around the country. In the plans that come forward from local authorities, we will be looking for detail on how they are maximising the use of accommodation and the recruitment of staff.

The General Teaching Council for Scotland is contacting registered teachers who are not currently teaching, to assess their availability to support the expansion of learning models around the country.

The Scottish Government produced a detailed route map for the reopening of economic and social life. It is not perfect, but at least it is a timetabled plan towards normality for every part of Scotland. Why on earth, therefore, was there no route map for a return to full-time school for every pupil in Scotland—as is, after all, their right?

Mr Gray has obviously not been reading carefully enough, because that is precisely what the strategic framework does. It underpins the importance of restoring full-time education for young people, at the earliest possible opportunity, when it is safe for us to do that for staff and pupils. If Mr Gray is prepared to be cavalier with the safety of staff and pupils, he is welcome to that view, but it is not one that I share.

The cost of providing blended education will be different for each local authority, and we do not yet know how long the approach will last. Can the cabinet secretary provide a best estimate of the educational and financial impact for each month in which blended learning remains in place in Scotland? Will local authorities be permitted to end blended learning and return to normal when they consider it appropriate to do so?

The assessment of financial issues will flow from the development of local authority plans to deliver the blended learning approach around the country. That commitment was given in the strategic framework that the Government published in May and the issue will be the subject of detailed discussion as we assess and consider the plans that individual local authorities put forward. Mr Gibson is correct to say that plans will vary from area to area across the country.

The mammoth effort to get our health service ready for the virus and to protect our businesses from the virus has not been replicated in the context of young people’s education.

If the Scottish Government is asking parents to return to work, the Scottish Government has an obligation to make provision for full-time childcare. If school hours are cut in half, childminder provision is cut back and grandparents are not allowed to look after kids, who exactly is going to look after them?

Mr Rennie does a disservice to the educators the length and breadth of the country who have done a significant amount of work to deliver learning in the extremely challenging circumstances that we currently face. If Mr Rennie will not pay tribute to the teachers who are delivering that education, I am very pleased to do so, to make sure that teachers understand that the Government appreciates and values the contribution that they are making in difficult and challenging circumstances.

The route map that the Government set out indicates clearly the relationship between the resumption of economic and work activity and the resumption of school activity in the country: they must go hand in hand. That is the design of the route map, and further details on that will be shared with the Parliament by the First Minister on Thursday.

Bruce Adamson, Children and Young People’s Commissioner Scotland, said:

“We know the home based learning that they have been doing just doesn’t work. It is no substitute whatsoever for a real-life, school-based education.”

He went on to say that the proposals for blended learning are

“heavily based on home learning”,

which is

“going to have a real impact on children’s right to education. So we need to do much better.”

Does the cabinet secretary need to do much better?

As I indicated in my earlier answers, the Government has formulated a framework for the resumption of full-time schooling, in partnership with our local authority colleagues, the professional associations and parents, to make sure that we resume learning as early as we can do.

I have accepted publicly—I did so in front of the Education and Skills Committee on Friday—that blended learning is not as good a model as the education delivery model that we had in place before Covid.

We have to resume full-time education as early as we possibly can do. However, I have to deal with the reality that the scientific and clinical advice to me just now does not enable us to restore full-time learning in schools. We will do that at the earliest possible opportunity. I am sure that the Parliament understands the importance of our listening to and following carefully the scientific and clinical advice that is available to us, because the safety of children and staff must be paramount in the decisions that we take.

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Protests (Glasgow)

To ask the Scottish Government what its response is to the violent scenes that took place in George Square, Glasgow, at the weekend. (S5T-02272)

I was completely appalled by the shameful scenes that took place in George Square last Sunday, first because there is never any excuse for violence or intimidation, and secondly because our police officers have been on the front line in keeping us safe during this pandemic, and for them to have to face the disorder that we witnessed on Sunday is simply unacceptable.

The scenes were very much in stark contrast to the peaceful Black Lives Matter demonstrations that took place in Scotland the week before.

I remind everyone that we continue to be in a crisis situation and that mass gatherings of people put at risk the lives our citizens and front-line public service workers. The First Minister and I have been crystal clear in supporting everyone’s right to protest, but we have called on those who wish to do so to consider alternative ways to protest, such as through social media and digital means.

The minister will be aware of Tommy Ga-Ken Wan, a Scottish-Chinese gentleman who is a photographer in Glasgow. He was racially abused and punched on the head. According to Tommy, the police threatened him with action if he did not leave. A staff member for The Herald, who was also there, said:

“Went along to #GeorgeSquare today—folk patrolling the perimeter threatening people who are taking photos ... After being approached by a few men I deleted most of my pictures”.

Can the cabinet secretary outline what action the police can and should take in such circumstances and why no action was taken on Sunday against those thugs?

I was deeply moved by Tommy Ga-Ken Wan’s comments and the story of the disgraceful incident that he had to face. As someone who has also publicly faced racist abuse, I know how hurtful it can be. I read his account in the Glasgow Times this morning. I was deeply moved by it and ashamed that we live in a country where someone has to suffer that racial abuse. I offer solidarity to Tommy during this difficult time.

Over the years, including before I was justice secretary but particularly during my time in this role, I have spoken about hate crime to Police Scotland’s most senior police officers—chief constables, deputy chief constables and assistant chief constables. There is zero tolerance for hate crime in any form.

With regard to the specific incident that Sandra White raised and the disappointment that Tommy expressed in his story, the chief constable is accountable for police operations. Therefore, if Sandra White has not already done so, she should write to the chief constable, who will undoubtedly respond. If Tommy is equally unhappy with Police Scotland’s actions in regard to this particular incident, he can also make a formal complaint about it. If he is not satisfied with the response to his complaint to Police Scotland, he can make a complaint to the Police Investigations and Review Commissioner in relation to the handling of that complaint. There are avenues to take that forward.

I have written to the police, but I have not yet received a reply. I have already spoken to Tommy—I would not put forward anything that he had not agreed to—and I have offered to speak to him again.

Those people were thugs. I witnessed police officers, helicopters, mounted police and police motorbikes and vans, and the whole square was closed down to ordinary people walking about.

Although the people were thugs and their actions were criminal, there is more to it. That intolerance comes from people’s ignorance of the history of slavery and colonisation. I ask that this subject be taught in our schools, as part of our school curriculum. A good place to start would be the television programme, “Slavery: Scotland’s Hidden Shame”, which is presented by David Hayman. I ask the cabinet secretary to speak to the Cabinet Secretary for Education and Skills, because the events stem from ignorance about what happened all those years ago.

I agree with Sandra White’s characterisation that the individuals involved were thugs—there is no getting away from that. In my opening remarks, I specifically made the point that the scenes in Glasgow on Sunday were in stark contrast to the Black Lives Matter protests in Scotland the previous weekend.

With regard to Sandra White’s substantial point, the Deputy First Minister and I have had that conversation. He can give her more details, but the curriculum for excellence allows the opportunity for the slave trade and Scotland’s role in it to be taught in our schools. If there is something further that we can and should do in that regard, the Deputy First Minister would be happy for me to say that we could actively explore that.

What I would say is that, for all the negatives—there are many of them—that have been raised by the Black Lives Matter movement, there is a silver lining, in that we have been forced as a nation to confront that part of our past in a way that I do not think has happened in my lifetime. I suppose that the message that I would send is that we should not waste that opportunity and we should ensure that we educate not just ourselves but future generations on the role that Scotland played in the slave trade.

I apologise to James Kelly and Patrick Harvie, who have been waiting patiently to ask a supplementary question. We have run out of time.