Meeting of the Parliament

Meeting date: Tuesday, March 12, 2019

Official Report 969KB pdf

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Topical Question Time

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Queen Elizabeth University Hospital

To ask the Scottish Government what its response is to reports that the Queen Elizabeth university hospital faces a repair bill of up to £50 million. (S5T-01544)

Reports that the hospital requires repairs of around £50 million are inaccurate and the board does not recognise that figure, as it has made clear in public statements.

The board is investing £2.75 million in a water treatment plant and upgrades to the haemato-oncology ward at the Royal hospital for children. No other significant investments are required in the two new hospitals.

However, the Queen Elizabeth university hospital is part of the wider Queen Elizabeth campus, which includes older buildings. As with all estates, maintenance is an on-going process and the board continues to work through the required maintenance in the older parts of the campus.

I appreciate that the £50 million is not an official figure, although it is understood to have been given by NHS Greater Glasgow and Clyde’s estates and facilities manager to the corporate management team in January. NHS Greater Glasgow and Clyde also admitted that the problems with older buildings on the campus that the cabinet secretary mentioned would require “significant investment”.

There is undoubtedly a growing list of problems at the Queen Elizabeth university hospital—we hear of new issues every week. Only last week, Healthcare Improvement Scotland’s report highlighted that there were more than 300 outstanding maintenance jobs, as well as the fact that there is currently no clear ventilation structure.

How much does the Scottish Government expect that it will cost to fix the infrastructure issues at the hospital? Can the cabinet secretary reassure patients in Glasgow that that will not have a knock-on effect on other services?

I repeat that the £50 million is not a figure that is recognised by the board. It is not recognised by the board because it is not an accurate figure. It does not apply to the two new hospitals—the Queen Elizabeth university hospital and the Royal hospital for children.

The campus has a number of older buildings, including the buildings of neurology and neurosciences, physical disability rehabilitation, clinical genetics and pathology. The board is working through what the maintenance requirements of those buildings are, as we would expect it to do, and where the priority should lie, according to which of those buildings provide patient care. Again, that is what we would expect it to do.

The 300 outstanding jobs range from basic, small-scale maintenance that should be part and parcel of a normal programme of on-going maintenance—I am talking about everything from fixing taps to replacing light bulbs—to jobs that are about ensuring infection prevention and control. The board has produced a detailed plan in response to the Healthcare Environment Inspectorate’s unannounced inspection, which I commissioned. I have made clear my view of the report on that inspection. It is important to put on the record here in Parliament that the inspection report made it clear that front-line staff were doing all that they possibly could to prevent infection and to control it where it arose, that they understood their role and that they were following all the right patient safety protocols. What was wrong was that, when staff raised issues, they were not properly heard and addressed.

At yesterday’s annual review of NHS Greater Glasgow and Clyde, we went through the detail of the board’s plan. We will continue to monitor closely what it is doing. When it produces what it believes to be its maintenance requirement for the older buildings, that will be part and parcel of the conversation that we have with the board, as is the case with the conversations that we have with other boards. The key factor with regard to whether the issue will affect other areas is whether the maintenance that is required is required for patient safety and patient care, in which case it will obviously be priority maintenance.

I have seen the cabinet secretary’s comments on the Healthcare Improvement Scotland report, and I appreciate what she said. However, the same HIS report also highlighted staff shortages for cleaners—we know that there is a 10 per cent vacancy rate for domestic staff—and for infection control doctors, who play a crucial role in assessing infection risks presented by the built environment. What urgent action is the Scottish Government taking to recruit cleaning staff so that this flagship hospital is fully resourced?

As part of the annual reviews, as I am sure Ms Wells knows, one of the groups that my ministerial colleagues and I meet is the area partnership forum, on which all the staff-side trade unions are represented, including the Royal College of Nursing. I also meet the area clinical forum, which brings together senior clinicians from across all the board’s areas of work. In meetings with both those forums yesterday, we discussed the inspection report.

It is clear that NHS Greater Glasgow and Clyde carries a higher than acceptable level of unfilled domestic posts. There is a much higher than acceptable level of sickness absence among domestic staff—it is not too hard to work out why that is the case—and among maintenance staff.

As the employer, NHS Greater Glasgow and Clyde has to take action to fill those posts, and it has had a clear message from me that I expect it to take that action and fill those posts. We will be monitoring that closely, as well as the board’s review of a decision that predates all this by some years to move to having a generic maintenance role as opposed to specific maintenance roles for plumbers, joiners and so on. The board is considering whether that generic role works for it and whether it hampers recruitment in ways that we would not otherwise expect. The board is engaged in all that activity; I have discussed it with the board and we will be monitoring it closely. Also, through the director-general for health and social care, we will be looking at all our other boards to assure ourselves that they do not have similar issues.

There are three more supplementaries. I would like succinct questions and answers.

If not £50 million, can the cabinet secretary say what repair bill figure the health board does recognise?

In response to the damning report on the Queen Elizabeth university hospital, Dr Lewis Morrison, the chair of the British Medical Association in Scotland, said:

“Without the right staff in place, it is hard to see how real improvements can be made.”

Does the cabinet secretary agree with Dr Morrison?

With staffing levels, building maintenance, cleanliness and infection control causing concern at Scotland’s flagship hospital, the cabinet secretary will know that people right across Scotland are worried about the rest of our hospitals. Should they be worried?

As I think I have already explained, I cannot give the exact figure for the repair bill to Ms Lennon because the health board is working through what is required for the older buildings, exactly how much that will cost and where the priority areas should lie. I am happy to make that figure available. The board will make it public once it has reached that final figure.

Of course I agree with Dr Morrison; it is self-evident that we need to have the right staff in place with the right skills mix in order to do the job that we require them to do. We have had discussions with the BMA. As I said to Ms Wells, the health board is working on that in the particular areas of maintenance and domestic staff, and we will be monitoring that closely.

Our interim director-general for health and chief executive of NHS Scotland, Malcolm Wright, who is a former NHS board chief executive, is working directly, along with our chief nursing officer for Scotland, with the chief executives of all our other health boards to ensure that in the specific areas highlighted by the inspection report, which I commissioned, we have answers from all the other boards on where they sit against those recommendations and against our expectations of them, including their statutory responsibilities.

What progress has been made in recent years on reducing hospital-acquired infections?

Since 2007, there has been an 88 per cent fall across Scotland in cases of Clostridium difficile in patients aged 65 and over and a 93 per cent fall in levels of MRSA.

Given that we are talking about NHS Greater Glasgow and Clyde, I point out that figures for it that were published on 8 January show that C diff infection rates have been reduced by 85 per cent and MRSA rates have been reduced by 94 per cent, which is in line with national figures. As we have made clear, notwithstanding the serious difficulties with infections in NHS Greater Glasgow and Clyde that have been recounted in the Parliament, and the very great seriousness with which I take them, the Queen Elizabeth hospital remains on a par with the rest of Scotland on infection rates. The rate is running at about 4 per cent overall, whereas the Scottish average is 4.2 per cent. [Jeane Freeman has corrected this contribution. See end of report.] It is important to set out that context of the discussion.

The much-needed new Edinburgh children’s hospital now has a completion date of July, but that comes seven years after the original scheduled date and with a £16 million bill over and above the £150 million budget to complete it. Does that issue, coupled with the issues at the Queen Elizabeth hospital, point to wider problems regarding hospital building and procurement in the national health service in Scotland?

That is a bit wide of the mark, so be brief, cabinet secretary.

It is indeed a wee bit wide of the mark, Presiding Officer, but I will do my best to answer it.

On the member’s principal question, I do not think that the issues point to wider problems. As he will know, and as we would expect NHS Lothian to do, the board ensured that some of the lessons from the issues at the Queen Elizabeth were addressed with the new sick kids hospital in advance of the board accepting the handover of that new build. I would absolutely expect the board to do that. It takes time for those matters to work through, which at least in part explains some of the additional length in the process. It is excellent news that the board will take over the hospital from July and that patients will be in it from then. I am happy to provide the member with additional information if he cares to ask me specific additional questions.