Meeting of the Parliament

Meeting date: Tuesday, January 22, 2019

Official Report 1180KB pdf

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Topical Question Time

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Cryptococcus Infection (Queen Elizabeth University Hospital)

To ask the Scottish Government what its response is to reports that two patients have died at the Queen Elizabeth university hospital after contracting a fungal infection, and what advice has been issued to national health service boards on that matter. (S5T-01442)

I will go through some clear, factual points in response to that question, which I am sure members would appreciate.

In November, the bacteria Cryptococcus was identified in one patient. That patient was discharged for palliative care and, sadly, subsequently died in late December, but Cryptococcus was not a contributory factor in their death. [Jeane Freeman has corrected this contribution. See end of report.] In December, the post-mortem of a child who had passed away confirmed that Cryptococcus was present and was a contributory factor in the child’s death. I know that I speak for the whole Parliament when I say that our thoughts and sympathies go to both families.

The identification of two cases acts as the trigger for additional infection control measures by a board. Those measures were undertaken; they include the provision of prophylactic antifungal medication to the relevant group of vulnerable patients, the provision of additional high-efficiency particulate air—HEPA—filter machines to ensure clean and clear air, and air monitoring.

When I visited the Queen Elizabeth university hospital this morning, I had detailed briefings and the opportunity to speak directly with the medical director, the senior nurse, senior board members and a family. From that, from the external advice that NHS Greater Glasgow and Clyde has sought, including advice from Health Protection Scotland, and from the clinical advice that is available directly to me, I am confident that the board has taken all the steps that it should to ensure and maintain patient safety. To provide further independent assurance, I have asked the Healthcare Environment Inspectorate to review the incident fully and recommend any further steps that should be taken.

I, too, extend our sympathies to the families of the patients who died. We have now learned that the infection was a contributory factor in the case of the child who sadly died, which people will be shocked and upset to hear.

The cabinet secretary said that she is confident in NHS Greater Glasgow and Clyde, but she must recognise that, over the weekend, there was a complete lack of clarity from the health board in response to legitimate media inquiries. We also had no update from the Scottish Government at a worrying time.

We have had further information about the outbreak that occurred back in November, but it is not clear when the Scottish Government was first made aware of the situation. Perhaps the cabinet secretary will confirm that. We learned yesterday that an out-patient and his wife wrote last March to the previous cabinet secretary about the pigeon infestations, but the Government has said that it cannot find that letter.

This is a serious public health concern. Sadly, two people who contracted the infection are dead. The public need to have full confidence that the Government has a grip on the situation.

Was the cabinet secretary made aware of the issue at the Queen Elizabeth when she took over as health secretary last year? If she was not, when exactly was she first notified and what did she do when she was?

I will be clear on a number of matters. I said that I am confident that the board has taken all the steps that it should to ensure and maintain patient safety in the light of the incident.

Monica Lennon queried why there was no update from the Government. I hope that I am making it clear to members that I treat such matters exceptionally seriously, but I want to work on the basis of factual information. That is why I have come to give factual information today.

The Government was first informed of the Cryptococcus infection in two patients on 21 December. That was the right time for the Government to be informed, because it was the post-mortem following the child’s death that identified the second case. As I said, a second case is the trigger for additional infection control action. We were rightly informed and kept up to date.

To make progress and understand the factual situation, we must first be sure about patient safety, and we must then be sure about and take time to identify the source and the manner of the spread of the bacteria. That takes time, because plates have to be cooked—if members will forgive me, I cannot think of another word—

Incubated.

I thank my minister for that helpful comment. Plates must be incubated to ensure that the right form of Cryptococcus is identified, so that the right steps are taken and so on.

As for the letter, not just the current Scottish Government but all previous Governments have always had a robust system for recording all communication to ministers and cabinet secretaries, whether it comes in writing, by email or via social media. Over the past few days, we have undertaken a thorough search of the MACCS—ministerial and corporate correspondence system—using a number of different ways of spelling people’s names and different keywords, and have found no record of that letter. In addition, Ms Robison’s constituency office undertook a search of its system and found no record. Although the letter predates my appointment as cabinet secretary, my constituency office also undertook such a search. Although we have found no record of the letter, we have made it clear that, if its authors wish to advise us of what they said, I will be very happy to deal with the matter seriously and to respond directly to them. However, in the absence of that information, I cannot do so.

I think that the people of Scotland will find it absolutely extraordinary that, in a modern hospital—the country’s flagship super-hospital, no less—an infection from pigeons can kill patients. The health board has struggled to get its facts straight over the weekend, the Evening Times has reported that concerns had been known about for two years and two people are dead, yet we do not know what our health secretaries have been doing. This is the latest in a catalogue of public health concerns not just at the Queen Elizabeth university hospital but in NHS Greater Glasgow and Clyde. Two cancer wards at the Royal hospital for sick children were closed over an outbreak of bacteria, and the temporary closure of the Cowlairs facility led to more than 1,000 operations being cancelled. The public are right to be concerned about patient safety. If this unthinkable and deadly infection can happen at the flagship Queen Elizabeth university hospital, what is to prevent it from happening at other hospitals?

Will the cabinet secretary comment further on what steps she is taking to support the families of the deceased and what she is doing to prevent this from ever happening again at any other hospital?

Let us be clear, because it is very important that we deal in factual and accurate information. I understand that the concerns that were raised two years ago were very different from the concerns about this case, which has led to one patient dying as a consequence of Cryptococcus infection. The concerns of two years ago were acted on by the board, which implemented a number of additional anti-bird measures including spikes and the use of hawks. Those concerns were dealt with at that time, and this is a new instance.

In investigating the source of the infection, the hospital’s and the board’s estates staff, including the director of estates, traced it to one plant room on the 12th floor, at the top of the building. There, invisible to the naked eye, was a very small break in the wall through which pigeons had entered, and their excrement was found in the plant room. I emphasise that the break was found only by means of smoke detection because, as I have said, it was invisible to the naked eye. Staff continue to work on how bacteria from that excrement were able to enter a closed ventilation system, and they will continue to update us on that.

Nevertheless, Ms Lennon is right in saying that concern has been expressed—by the board and by me, but, much more importantly, by the people of Glasgow and more widely—about what appear to be a number of instances of the fabric of the Queen Elizabeth university hospital being less than satisfactory. Therefore, in the discussion that I had this morning, I agreed that a review should take place, with external expert advice. That review will look at the building’s design, the commissioning of the work and the construction, handover and maintenance of the building to identify where issues were raised that should have been addressed and where current maintenance programmes should perhaps be more robust or frequent—or whatever the review’s recommendation might be.

Independent expert advice will be sought for the review, and, in addition, such advice will be provided to me on the progress of the review and its recommendations. By the end of this week, I intend to make available to members and to publish the review’s remit and details of the expert advice that will be sought in the various technical areas in which it is required. It is right that we should consider whether, in its totality, the fabric of the Queen Elizabeth university hospital is as fit for purpose as we require it to be and that, if there are lessons to be learned, we should take those and apply them across the rest of our health system in Scotland, particularly where we have the commissioning of new build.

We have had a series of quite lengthy questions and correspondingly detailed answers. At least five members would like to ask further questions. If members can be brief, we will be able to get through some of those, at least.

I very much welcome the cabinet secretary’s statement and, in particular, the review, which I hope will also look at the issues around the closure of the children’s cancer wards at the Royal hospital for sick children. It is very welcome, too, to hear that the proper procedures appear to have been carried out.

However, a great deal of anxiety has been created unnecessarily as a result of the way in which external communications have been handled by NHS Greater Glasgow and Clyde. If the information had been made available more timeously, I am sure that much of the anxiety that has been created in recent days could have been avoided. Will the cabinet secretary make sure that the health board learns lessons on the need, in such circumstances, for effective and timeous communications and transparency as part and parcel of the strategy for handling such outbreaks?

I absolutely accept Mr Neil’s point. In answer to Ms Lennon, I should have said that the board immediately had conversations with the families of the two individuals who died, and there is on-going communication between clinical staff and the families affected in the areas of the hospital concerned right now.

This morning, I took the opportunity to discuss external and internal communications with NHS Greater Glasgow and Clyde, and I understand that there will be—and I expect to see—a number of improvements in those areas in addition to other improvements that the board has made. However, we must understand that, in order to be sure of one’s facts, one cannot always work exactly to the timetable of the news cycle. There will be times when I or a health board cannot answer questions from our friends in the media at the precise point at which they are asked.

That said, it is fair to say that improvements have been sought on external communications, and I am confident that improvements will be made.

I, too, express my sympathy to the families involved, and I thank the cabinet secretary for her answers to the previous questions.

What other concerns—if any—have been raised with the cabinet secretary with regard to the major problems at the Queen Elizabeth university hospital? Will she ensure that there is full transparency when it comes to the publication of the review?

We know that a number of issues have arisen at the Queen Elizabeth university hospital, including with water hygiene, external cladding, the ventilation system and glazing failures. As I explained, the most recent incident involved ingress into the plant room and the ventilation system. I expect the review to cover all those areas and others, such as the impacts on access to healthcare. As part of the review, external advice will be taken, because some of what will be discussed will certainly be beyond my expertise in its technicality.

The review’s recommendations will be made public and I will present our response to the recommendations to the chamber. By the end of this week, I hope to be able to make public to all members the review’s remit, the nature of the external advice that will be sought and of the additional independent advice that will be provided to me, and an idea of timescale, although we must wait to find out what the experts tell us. I undertake to keep the Parliament updated, to make public the review’s recommendations and to respond to those recommendations in the chamber.

Given the series of events that have taken place at the Queen Elizabeth university hospital, I welcome the review that the cabinet secretary has announced today. Can she give a guarantee that it will be a genuinely independent review—that is, that the people who were involved in commissioning, doing the work on and delivering the hospital will not be part of investigating what has gone wrong there?

Also, will the review commit to look at the history of the reports from the consultant microbiologists at the hospital, who, I believe, have been raising concerns about the safety and security of the hospital for a number of years?

Yes—I can give that commitment. Obviously, individuals who have been involved at various steps along the way will provide information to the review, and perhaps comment and opinion. We will need to discuss with those who will be charged with the review exactly how they want to undertake it, but it will have that very important independence and expert advice available to it.

Can the health secretary advise on the current hospital-acquired infection rate for NHS Greater Glasgow and Clyde and how it compares with the rest of Scotland?

Since 2007, there has been an 85 per cent fall in cases of Clostridium difficile infection in over-65-year-olds and a 94 per cent fall in levels of MRSA, in line with the national average. The national point prevalence survey record shows that the Queen Elizabeth university hospital has an overall rate of hospital-acquired infection of 4 per cent; in comparison, the rate for Scotland is 4.9 per cent. We should not ignore the successful track record of our patient safety programme.

However, the hospital deals with very sick individuals in a very acute circumstance, and in those circumstances—in this hospital and elsewhere—infection arises. The key is to understand what we need to do to improve patient safety and get to the source of that infection.

I have been advised today that there has been a fungal infection that is not connected to the one that we are discussing. Further information has been given to me and more information is to come. Again, I am very happy to keep the Parliament updated on that. It affects two patients, both of whom are being treated. The source of that infection is being pursued and additional safety measures have been put in place, including air sampling and enhanced cleaning. As I said, that is unrelated to the infection caused by pigeon excrement but, as I explained, I will come back and update members on that in due course.

I apologise to James Kelly. We do not have any more time for questions on that subject.

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Brexit Withdrawal Agreement

To ask the Scottish Government what its response is to the Prime Minister’s latest statement on how she plans to proceed with the Brexit withdrawal agreement. (S5T-01449)

First, it is clear from yesterday’s statement that the Prime Minister has simply not taken on board the crushing scale of the 230-vote defeat in the House of Commons. Yesterday, the Prime Minister could have ruled out no deal. She did not do so. She could have called for an extension of article 50. She did not do so. Instead, still failing to understand the European Union’s position, she intends to return for further negotiations, armed with plan A.

Given the Prime Minister’s approach to engagement with the Scottish Government to date, her offer of an enhanced role for the devolved Administrations lacks credibility. Indeed, this morning, the United Kingdom Government cancelled the meeting of the joint ministerial committee (European Union negotiations), which was due to take place on Thursday. That decision flies in the face of the Prime Minister’s rhetoric.

However, the Scottish Government will continue to do everything that we can to protect Scotland’s interests, and the First Minister is due to meet the Prime Minister in the coming days. The Prime Minister should now focus on securing an extension to article 50, during which arrangements can be made for a second referendum that includes the option to remain within the EU.

Finally, I congratulate the 3 million campaign and the members of this Parliament who voted in December to call on the UK Government to scrap the settled status fee—all members, of course, except the Conservatives. The UK Government should never have introduced it in the first place, but the U-turn is welcome. However, that does not change the fact that EU citizens should not have to apply to retain rights that they already have.

Last week, the First Minister wrote to the Prime Minister, calling for a meeting of the JMC and for

“Urgent and meaningful discussions ... to agree a way forward which can command a majority in the House of Commons, and”—

this is crucial—

“which has the confidence and support of the devolved administrations.”

The cabinet secretary has just given us the information about the JMC. In light of that, what does the Scottish Government think is the best way forward in resolving the current impasse?

The JMC(EN) is not meeting on Thursday, and I understand that the JMC (Plenary) is not meeting over the next few days, although I understand that the First Minister of Wales will also meet the Prime Minister.

It is important that there is some consensus on the way forward, but in the absence of consensus in Parliament, the best resolution would be a second EU referendum.

In her statement yesterday, the Prime Minister referred to improved discussions and consultation with the Westminster Parliament and the devolved Governments, but she also made clear that that is simply about setting future negotiating terms in relation to her current deal, which was rejected by 230 votes. Her offer of talks, as set out in her statement, is just about implementing the political declaration that sets out the framework for the future relationship between the EU and the UK; it is not about changing the terms of the political declaration in a future arrangement.

It is important that there is greater engagement, but it has to be meaningful engagement that tries to address what could command a majority position. That is why the debates that will take place in Westminster over the next week are important; there will be opportunities for members there to put forward different suggestions.

The cabinet secretary mentioned the scrapping of the UK’s proposed EU settled status fee. Does she agree that the disgraceful policy should never have been in place to begin with and that no citizen should be expected to pay to secure rights that they already have and are entitled to because they have made their home in the United Kingdom?

I welcome the scrapping of the settled status fee; the pay-to-stay approach was never appropriate in the first place. The anxiety about the application system that so many EU citizens have faced and continue to face is of real concern in a country in which we need to ensure that we can attract people from the EU and beyond to help in our workplaces and in our universities, care sector and health sector.

This is a very serious point. The UK should address people’s concerns about the application system. There are many questions about the pilot, which was launched yesterday. What kind of message is being sent to people if they are being asked to apply for something that they already have?

I think that this Parliament—even members on the Conservative benches—can come together on that. If we want to address Scotland’s real issues with population and migration, this Parliament can make a difference if we come together. We—Ben Macpherson, in particular—made a difference in the discussions and arguments about scrapping the fee, and we can do more in this area if we come together as a Parliament and work together to put forward common-sense proposals.

The cabinet secretary does not want a no-deal Brexit. I am with her on that. What detailed, concrete, positive proposals for a deal to resolve the crisis has the cabinet secretary’s party brought to the discussions with the Prime Minister in the past week?

The member is aware that we have spent the past two and a quarter years arguing for a compromise position of single market membership and customs union membership.

We are starting to see an opportunity for other parties to come to that position, but the clock is ticking. That is why we have to stop the clock. Unless we rule out no deal, it remains the default position. We have to ensure that there is the opportunity to remain, because if we scrap freedom of movement, whether we do so under the Prime Minister’s deal or no deal, that will be catastrophic for Scotland.

To date, we have been diligent and patient in putting forward our proposals, and our First Minister will again engage with the Prime Minister. However, we are now at the very last minute. The UK Government has spent 15 months trying to get a resolution to the risk of a hard border between Ireland and Northern Ireland. After 15 months and no progress, and with the EU standing full square behind the Irish position, what makes the Prime Minister think that she will get movement in the next few weeks?

The clock is ticking. We need to stop the clock and ensure that there are opportunities for a common-sense proposal, because the consequences are very dire indeed.