Meeting of the Parliament

Meeting date: Wednesday, November 20, 2019

Official Report 1118KB pdf

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Queen Elizabeth University Hospital

The next item of business is a ministerial statement by Jeane Freeman on Queen Elizabeth university hospital ward closures.

14:00  

I am grateful for the opportunity to provide members with an update on the position of the paediatric haemato-oncology wards at the Queen Elizabeth university hospital.

I start by offering my deepest sympathies to the families that are affected. To lose a loved one in any circumstances is hard, but I cannot begin to imagine the pain of losing a child in those circumstances, or the suffering and grief that will stay with the families for the rest of their lives. I also apologise to them for the fact that they feel they have not had their questions answered. They are absolutely right to ask and pursue their questions, and they are entitled to have them answered and to receive the support they need.

I take very seriously the concerns that have been highlighted to me about the deeply concerning issues that have been raised by a whistleblower. Our national health service—indeed, all our public services—can flourish and improve only when everyone working in it feels that they can confidently speak up. There is no room in our health service for anyone to criticise whistleblowers, publicly or otherwise, or to put them in fear for the safety of their jobs. Whistleblowing is not something that people who have dedicated their lives to healthcare do lightly. It takes courage and they should be thanked.

Much of our health service exemplifies that approach. It is right to thank all NHS Scotland staff who work every day to give the best quality of care to their patients. They deserve significant credit for helping to make our health service one of the safest in the world. Even so, however, things can go wrong and, when they do, I expect boards to respond professionally, transparently and speedily.

The whistleblower who came forward last week stated that an internal clinician-led review within NHS Greater Glasgow and Clyde had identified additional cases of infection among paediatric cancer patients, including a child who died in 2017. My officials are urgently seeking details of that review so that we can fully understand the findings and what action the board took in response.

Following my announcement on 17 September this year of a statutory public inquiry to examine issues at the Queen Elizabeth campus in Glasgow and the Royal hospital for children and young people in Edinburgh, I received correspondence from a bereaved parent concerning the death of their child in 2017. This was the first notification that I had received about that tragic death. I replied expressing my concern for them and my condolences for their sad loss. I advised them that a representative from the board would make personal contact with them to ensure that any questions and concerns were fully addressed. I understand that contact has now been made with the family and I am clear that I expect the board to do all that it can to support them and provide clear answers to their questions.

Over the course of last weekend, other families made contact with me. It would not be right for me to discuss the details of each case publicly and it would be entirely inappropriate for me to comment further on any case that is subject to an on-going Crown Office investigation. However, I want there to be no doubt that I am fully committed to ensuring that every family receives the answers that they are entitled to.

It is not a requirement for the Scottish Government to be notified of every patient death, and nor would that be appropriate. However, my clear expectation is that our NHS must support families by providing them with the accurate information that they need to understand what has happened and what is being done, and to do that in a clear, transparent and timely way.

I expect all NHS boards to ensure that communication and engagement with patients and families is centred on the needs of the patient and the family. I also expect boards to have considered whether the national adverse events framework or the organisational duty of candour procedure should be applied and to ensure that patients and families are genuinely involved in discussions about such decisions.

The issues over the past few days have concerned children who received treatment on the paediatric haemato-oncology ward—wards 2A and 2B—at the Royal hospital for children. Despite the correct mitigation measures being undertaken by the board in those wards, on-going surveillance did not give the board the confidence that it needed that all the organisms that had been identified had been eliminated. As such, in September 2018, those wards were closed for further work and upgrading. With the closure of wards 2A and 2B, the patient cohort has been temporarily moved to ward 6A at the Queen Elizabeth university hospital.

On 4 October, in response to a Government-initiated question, I updated members on the meetings that I had held with a number of families of paediatric cancer patients, and with some young patients themselves, who are currently being treated at the Queen Elizabeth university hospital, following concerns that they had raised with me around the safety of the ward, following reports of bloodstream infections among the paediatric haemato-oncology patients. I met them on 28 September and 1 October, and it seemed clear to me that the information sharing and communication from the board to those families had simply not been good enough.

As a result, I appointed Professor Craig White, reporting to me, to lead and direct the work that is required to make sure that the questions that the families have are clearly answered and, going forward, that their voices and views are clearly heard and paid attention to. Since appointment, Professor White has been in contact with the families, and remains so.

Recognising that they needed to significantly improve their relationships with the families involved, the chair and chief executive of the board wrote to all families who are in contact with the service, and they continue to meet personally every parent who has requested a meeting.

Clinical leads of the haemato-oncology service, and the infection control doctor on the incident management team, have been actively involved in investigations and decision making on actions that are being taken to ensure patient safety.

On the on-going safety of the environment in ward 6A, Health Protection Scotland has confirmed that it is content with the actions that are being taken by the board’s incident management team to investigate individual cases; that it has reviewed evidence of effective implementation of the actions that HPS recommended; and that it is assured that appropriate arrangements are in place for the on-going monitoring of infections, including the triggers that were agreed for detailed scrutiny of any further actions that are needed. In addition, I have asked that external clinical experts from the national managed service network for children and young people with cancer is invited to join the clinical management group that has been established to carry out on-going review of infections.

Over the weekend, calls were made for the board to be escalated. In NHS Scotland, we have a clear process that is consistent across all boards, and which is led by the NHS Scotland chief executive, to review levels of escalation for all boards. I have asked that the process of escalation be taken forward as quickly as possible. I will update Parliament on the outcome of that process as soon as it is concluded.

As members know, I announced a statutory public inquiry to examine these issues. I hope to be in a position to confirm the inquiry chair before the end of the year. I have a statutory obligation to consult the chair on the terms of reference, which I hope to be able to set out to the chamber early in the new year. In the meantime, the independent review that is being led by Dr Andrew Fraser and Dr Brian Montgomery is gathering evidence, with a view to publishing its findings in spring 2020.

I have outlined the steps that I have taken regarding the paediatric haemato-oncology ward at the Queen Elizabeth university hospital. However, I am acutely aware that the families of children who have received, and who are receiving, care need to have complete confidence that the care that is provided is of a high quality and in a safe environment. They, and the staff who deliver the care, also need to have confidence in the openness and transparency of information.

Families must have the right support and information to give them confidence that risks are monitored, that triggers for action are appropriate, that steps are taken both to prevent and limit infection spread, and that they are engaged and fully informed and treated with compassion and respect. The healthcare environment will never be risk free, but, given how devastating the impact of an infection can be for those who are most vulnerable, we must do all that we can to reduce that risk and support families. That is what I have been doing, and that is what I am committed to doing.

I thank the cabinet secretary for advance sight of her statement. I am sorry to say that, for the families, the statement will do very little to reassure or to answer the many and increasing questions about patients’ safety at the Queen Elizabeth university hospital campus. They believe that there has been a cover-up, and we need to get answers for the families.

I ask the cabinet secretary two simple questions. First, have all families been contacted and provided with the care and support that they might need? Secondly, Health Protection Scotland revealed in 2016 that a patient in ward 2A was identified as having a bloodstream infection. A further case was identified in 2017, and 23 additional cases were identified between 29 January and 26 September 2018. All of them were potentially linked to water contamination. Given the heightened concern about the risk of water infection to vulnerable, immunosuppressed patients during that period, what guidance and protocols were put in place and what sight of that did ministers have?

I am grateful to Mr Briggs for his questions. All families who have been in contact with me or with Professor White have been contacted, and Professor White is working directly with them. That includes the families whom I met in September and October.

The chair and the chief executive of the board have written to all the families who have had children treated over a period in either ward 2A or ward 2B or ward 6A to offer to meet them and to answer any questions that they might have. If families have responded, individual meetings have been held with patients, as I have said.

Professor White’s job is to ensure that, if families require additional support, that is made available to them. He continues to review and undertake that work and, as I have said, he reports directly to me.

I think that I partly covered HPS’s work on water infection in my statement. The board undertook a number of mitigation measures in wards 2A and 2B to identify the source of the infection and to prevent spread. However, its surveillance between January and September 2018 did not give it confidence that it had done everything to identify exactly the source of the organisms and that that environment was safe, and it closed the ward so that it could undertake further work. It has undertaken additional upgrading of wards 2A and 2B and has decanted patients to ward 6A, which is where current in-patients are.

If there are additional questions that need to be asked about that particular inquiry by HPS and the specific measures, I have all the information in front of me, and I would be very happy to ensure that Mr Briggs has the absolute details.

On the whistleblower’s revelation about the 2017 clinician-led inquiry, I have not seen that review. We have asked for that, and my officials are urgently seeking the detail of that so that we can consider what happened, what the board did in response, and whether that was sufficient.

In some ways, my statement was not intended to answer the specific questions that families have. That is why I met them, and that is why we have those contacts. Each family has different questions about their own child—about their current treatment and the environment that they are in, or about previous cases—and we need to treat them with respect and deal with them individually. No statement could cover that, and nor should it.

I thank the cabinet secretary for advance sight of her statement. However, heartbroken parents still need answers. The truth about water contamination and the multitude of scandals at the hospital must come out. That is why Scottish Labour fought for a public inquiry.

Milly Main’s mum deserves the truth about her daughter’s death, just as Victoria Freeman deserves the truth about her son, Mason, who also died unexpectedly at the hospital in 2017. Many other families fear a cover-up.

I am afraid to say that the cabinet secretary’s statement is underwhelming and that families deserve much, much better. A passing mention of possible escalation measures against the health board is weak and not good enough. It is not clear what exactly the Government is prepared to do. Does the cabinet secretary have complete confidence in the current leadership of NHS Greater Glasgow and Clyde? I cannot stress strongly enough that parents feel completely failed and the wider public is losing confidence. Where is the empathy and compassion for those families? Why should they place their trust in the health board and the cabinet secretary?

I think that they should place their trust in me because I am compassionate and I have empathy, and that is precisely why I met those families and have undertaken the work that I have done. Whether it is Ms Lennon or anyone else who says that I am careless or irresponsible on these matters, I refute that absolutely—it could not be further from the truth. It might suit Ms Lennon to make those points for other reasons, but they are not true and I refute them absolutely.

On Ms Lennon’s question—[Interruption]. Please do not shout at me; it does not help.

Families absolutely deserve answers. That is why I met them and appointed Professor White, and why he gave detailed answers to 71 questions that families asked. I checked with them that we had taken a clear and careful note of the 71 questions so that they were sure that we had not missed anything. Professor White provided detailed answers for them to every one of those questions, and he will continue to answer questions.

The public inquiry is, in part, how we get to the bottom of how these situations have arisen. That is why I initiated the inquiry that, as Ms Lennon said, she asked for.

I do not accept that my reference to escalation is weak. There is a proper process and Ms Lennon should understand that if we expect staff at whatever level in any organisation to treat those whom they serve with respect, we must treat them with respect in the first place. There is a proper process for escalation that is undertaken by the chief executive of NHS Scotland. That process is under way with respect to NHS Greater Glasgow and Clyde, and it needs to be fair and equitable across all boards. A decision will be taken and I will advise the chamber of that decision. That is the right way to do things. I will not be rushed into making wrong decisions simply to satisfy members in the chamber.

The whistleblower coming forward has enabled families to come forward too, to seek answers to questions that have long gone unanswered. However, lessons cannot be learned if staff feel unable to report issues confidently and in confidence. I want to understand what immediate action the cabinet secretary will take to ensure that there is the culture of openness and transparency that we all seek. It is essential that that replaces one in which lessons cannot be learned.

Ms Johnstone is quite right about the culture of an organisation and the importance of staff feeling not only confident and safe in raising issues but that they will not experience any adverse effects from having done so. In a private visit, I spent some time with a range of staff—clinical, domestic and estate—currently working in ward 6A in order to hear from them their concerns and what they needed in order to feel confident that the right actions were being taken to ensure that the environment in that ward is safe. That is why I mentioned the clinicians’ active engagement in the incident management team’s work. That is with respect to what we are doing in ward 6A, and Professor White reports to me that he continues to have that engagement with all those staff to ensure that they continue to feel that they can raise issues and are heard and that what they raise is then acted on.

On the wider question, as I am sure Ms Johnstone and others know, we are undertaking a range of actions. The Health and Sport Committee yesterday recommended that the Parliament approve the draft order to establish the independent national whistleblowing officer in the Scottish Public Services Ombudsman. The selection of the whistleblowing champions, who will report direct to me, is under way, and we will have appointed them by the end of this parliamentary term—that is, by Christmas. Of course, we also have the short-life group that I have convened with a range of royal colleges, trade unions, staff representative and others to look collectively at all the steps that we need to take to provide staff with wellbeing and mental health support and to promote that positive culture. I described that yesterday in the committee as a jigsaw of work that we need to piece together. Although there is no single thing that will resolve matters, I believe that to date, we have the right pieces in place, and we will take that work forward.

I am grateful to the cabinet secretary for early sight of her statement. Despite the public interest around the Queen Elizabeth university hospital and the high-profile scrutiny that it has received, an internal clinician-led review has taken place that even the cabinet secretary was not aware of. Does she now understand why the information gathered by that review was subsequently withheld?

I do not understand that. As I said, the Scottish Government was not advised of the clinician-led review. We undertake to obtain that information from the board and to look at the review that was undertaken by those clinicians in 2017, so that we can see what actions the board took. If we are unhappy or dissatisfied with any of that, we will take action in that regard.

At some point, if it is appropriate for the individuals involved, I also hope to be able to speak to the clinicians who led that review in order to understand personally from them what their experience was and what more we need to do to understand what obstacles and difficulties they came up against in carrying out that work. That is the situation as it stands.

As Mr Cole-Hamilton knows, there was HPS work in 2018. There are a number of matters that we need to get to the bottom of, and in the period since just under a week ago, when this was all revealed, we have been working actively and consistently to try to do that. As information is received, reviewed and compared with other information that we have, and as things become clear, I will continue to update members.

The front benchers for each of the parties have had a chance to ask expanded questions and the cabinet secretary has similarly addressed those. I would welcome it if the remaining nine members would not preface their questions with mini-speeches, but just ask a question. I hope that we will have concise questions and answers.

Alison Johnstone raised the issue of culture. At the Health and Sport Committee yesterday, we took evidence on the handling of whistleblower complaints. Will the cabinet secretary say how it is expected that that will help to change the culture within the NHS?

As I and other members have said, the important thing is that individuals who work in our health service feel confident and safe in raising issues of concern. The independent national whistleblowing officer is one of the measures that we are putting in place, with the Parliament’s approval, in order to provide that route for whistleblowers, and the Scottish Public Services Ombudsman helpfully said yesterday that, where she considers it to be appropriate, she will work alongside individuals to ensure that they have that confidence and feel safe in raising such issues. That is one step that it is important to take.

The non-executive whistleblowing champions, who will be appointed before Christmas and will report directly to me, will also have an active role, not just in checking whether policies are followed, although they will do that, but in engaging directly with staff and others where there are concerns and helping them to feel confident in raising those concerns, both within the board and, if the whistleblowing champion feels that they have not been addressed properly, directly with Government.

The tragic case of Milly Main in 2017 should have triggered an adverse event review. Adverse event reviews are designed to highlight major systemic issues such as those that, in this case, have only come to light two years later. What is the cabinet secretary doing to ensure that the adverse event review process is consistently applied across all health boards so that we can avoid such tragedies in future?

That is a really important issue. Mr Whittle will know that work was done not long ago that identified variation in the triggering of serious adverse event reviews across our health boards. We now have Healthcare Improvement Scotland actively working to identify the core triggers and, through its follow-up work, it will ensure that all boards work to the same process and triggers for an adverse event review. As that work is completed, I am happy to ensure that Mr Whittle receives an update. HIS will continue to monitor to ensure that the process is delivered; in addition, we have other means of monitoring to ensure that all boards apply the process in a consistent fashion.

The cabinet secretary mentioned that the process of special measures is not a feature of the NHS in Scotland. Will the cabinet secretary set out the process by which boards are moved up and down the escalation levels for support from and directive oversight by the Scottish Government?

The NHS board performance escalation framework has five stages. The designation of boards at stages 1 or 2 is managed by Scottish Government policy leads, while decisions to escalate boards to stages 3 or 4 are made by the Scottish Government’s health and social care management board, which is our most senior level of managers. Decisions to escalate boards to stage 5 are taken by the cabinet secretary in accordance with ministerial powers of intervention.

The escalation levels are consistently reviewed against board performance, and decisions can be made for boards to come down the escalation ladder. At each stage, there are various levels of Government support or direct intervention.

A child has died and there have been two years of cover-ups, bullying and intimidation by the health board. Milly Main’s parents and family have lost confidence in the health board, so we look to the cabinet secretary for support. Will she make a personal commitment today to notify all families of the 26 children affected of what happened in 2017? Will she make a personal commitment to ensure that the bullying and intimidation stops, and will she give a public guarantee that the jobs of the NHS staff who have bravely come forward will be protected and that they will not experience further intimidation?

I am grateful to Mr Sarwar for his reply to my letter, in which he offered to share information with me, as appropriate.

I make the commitment now—I did so in my statement, but I will repeat it—that I am determined that all the affected families receive answers to their questions. There is no more for me to say—I am committed to ensuring that. My personal commitment is to ensure that, for all the families that were affected by the review that the clinicians led—once we have seen and understood that work—or by subsequent events, we take steps to ensure that all their questions are answered fully, that they understand what happened that led to the death of their child and what has happened since, and that we do not have another round of families feeling that their questions have not been answered.

As I said in my statement, it is my commitment that any whistleblower who comes forward should have their role protected and should not experience adverse effects on their job as a consequence of raising issues that are of concern to them. Such people dedicate their lives to working for the health service and they do not come forward lightly. I take the issues that they raise very seriously. Mr Sarwar has that commitment from me.

On my commitment to end the bullying culture, I am sure that Mr Sarwar appreciates that no one individual can end a culture of bullying and intimidation. However, he has my commitment, as cabinet secretary, to lead our work to end that culture, which I will do in every possible way by working with boards, unions, staff representatives and all other relevant individuals.

It is my absolute commitment to bring an end to the culture of bullying and intimidation that we see in some of our health boards some of the time. It is important that we have some perspective—not all our health boards have such a culture all the time. However, Mr Sarwar has my commitment that, in this case, I will lead the work to ensure that we get to that point.

A new body to strengthen infection prevention and control, including in the built environment, was announced in the programme for government. How can it be used to ensure that we have the required wide range of skills and expertise—not least in ventilation engineering and construction of those particularly complex ventilation structures?

David Torrance is referring to our programme for government commitment to establishing a national centre of expertise to cover major infrastructure projects in the built environment. We are in the process of finalising the exact scope of that body. It will have a compliance function, among other things.

The intention is to bring together in one central place the expertise that is needed to design buildings, to negotiate contracts, to monitor delivery against contracts, to ensure that effective infection prevention and control measures are built into building designs, to look at on-going maintenance, and so on. We are currently considering the digital infrastructure, as part of that work. In the coming weeks, I hope that we will be able to set out the scope of that body to the chamber as well as the timeline towards its establishment.

Throughout the investigations, the NHS staff in the Queen Elizabeth university hospital have been on the front line, fully facing the issues resulting from the tragic circumstances. What is the cabinet secretary doing to ensure that staff receive the fullest support possible?

I am grateful to Mr Corry for his very important question. Staff are, of course, affected by what has happened. As I said in my statement, they need to have confidence that their working environment is safe and, therefore, to have full information on and involvement in it. The death of any patient also deeply affects staff who are involved. All such matters need to be addressed and thought about.

When I visited the staff in ward 6A, I talked to them about what they needed to help them to cope with what is a stressful job in any circumstances, and which is additionally stressful in the current circumstances. They advised me about some help that they could use, and about work that is already under way following discussions with them, including breakout times and additional support for their physical and mental wellbeing. I will continue to ensure not only that that support is delivered to the staff in ward 6A, but that the board looks to ensure that it is available across the whole estate.

Although the traditionally led public inquiry will be independent of the Scottish Government, can the cabinet secretary outline how individuals and families will be invited to feed into it once it is under way?

Of course the public inquiry is independent, and it has a statutory role, responsibilities, and powers. As I said earlier, under that process, I am required to consult, with the chair of the inquiry, on its remit. The chair will be in charge of how he or she wants to receive evidence, how to undertake the inquiry, and how to manage additional workstreams on other areas that might feed into the inquiry.

My expectation is that the inquiry will be able to create a space for families and others to put their views and to be heard. At the end of the day, however, it will be for the inquiry chair to make that decision.

The cabinet secretary told BBC Scotland on 18 November, and she implied it again today, that she did not know about the tragic death of three-year-old Mason until last weekend, when his mum wrote to her, and she took immediate action to get answers as a result of that correspondence.

However, I wrote to the cabinet secretary on 21 November 2018 about the circumstances of Mason’s tragic death and the fact that his mum had not received answers to a letter that she had sent to the Government. The cabinet secretary replied to my letter on 24 December 2018 and confirmed that correspondence had been received from Mason’s mum on 21 September 2018.

Why, therefore, did the cabinet secretary claim not to know about Mason’s death? Why did she fail to take action when she was informed about concerns more than a year ago?

I am glad that Mr Smyth has raised the issue. What I was asked on “Good Morning Scotland” was whether I knew about the death of Mason and the inquiry into that death. When I said no, I was answering the part of the question about the inquiry.

I did know about Mason’s death. As Mr Smyth has said, there was correspondence over a period of time, initially about medical negligence, and those issues were dealt with. There was also correspondence from Mason’s mum, who said that she had not had replies: we checked that, and replies had been sent.

I received correspondence from Mason’s mum over the weekend—specifically about her concern about whether infection had played a part in her son’s death. Those are the most recent steps that I have taken on that matter.

Can the cabinet secretary give an assurance that to ensure that lessons are learned across Scotland’s NHS, the Scottish Government will consider fully the findings of the report on Shrewsbury and Telford Hospital NHS Trust, material relating to which emerged yesterday?

I am grateful to Tom Arthur for that question. The situation to which he refers is tragic, and the sympathy of everyone in the chamber goes to all those who have been affected.

This morning, I asked officials to check the recommendations of that investigation against our current work in the services, and to ensure that all the recommendations are already covered by what we are doing.

I expect to receive advice on that from officials in the coming days. Again, I am happy to ensure that Tom Arthur and other members understand our response to the recommendations on delivery of maternity and children’s services.

I thank the cabinet secretary and members for their contributions.