Meeting of the Parliament

Meeting date: Tuesday, January 28, 2020

Official Report 928KB pdf

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Queen Elizabeth University Hospital Oversight Board

The next item of business is a statement by the Cabinet Secretary for Health and Sport, Jeane Freeman, giving an update on the Queen Elizabeth university hospital oversight board. The cabinet secretary will take questions following her statement. I encourage all members who wish to ask a question to press their request-to-speak buttons.

The people who are served by NHS Greater Glasgow and Clyde deserve to have confidence that their local health board is improving its performance. The staff of our health service deserve the assurance that, should they have concerns about care of patients, they will be listened to and supported.

The families of children who have been treated at the Queen Elizabeth hospital campus deserve to have answers to their questions, and they deserve as safe an environment as possible for the care of their children. The actions that I have taken in recent times in NHS Greater Glasgow and Clyde aim to deliver in respect of their concerns.

Last week, I escalated the health board to level 4 for all aspects of its performance. That action included bringing in an operational turnaround director who is working directly to resolve issues in a number of areas, including out-of-hours services and waiting times.

However, today I will focus on actions that have been taken since I updated Parliament in December about the health board’s escalation to level 4 for infection control and for family engagement around the Queen Elizabeth university hospital.

Scotland’s chief nurse, Professor Fiona McQueen, chairs the oversight board that has identified the steps that are needed. The first is a review of the care of children who had bloodstream infections from 2015 to date. The second step is improvement in the quality of governance of infection prevention and control. The third is the establishment of a technical group to ensure that associated building, water and ventilation works are being progressed, and the fourth is to sustain far better communication and engagement with patients and families.

My clear priority is to ensure that families are given the answers that they need about their children’s time in the hospital—in particular, about infections that might have caused harm or, in the worst cases, been the cause of death. A review of patients is looking at relevant cases in the paediatric haemato-oncology ward since the hospital opened in 2015.

Since December, a team of Scottish experts from outside NHS Greater Glasgow and Clyde has been assembled to undertake the review. It is led by Professor Marion Bain, whom I have appointed to take over responsibility for infection prevention and control at the hospital.

To ensure rigour and robustness, the case reviews will utilise two approaches. One is an epidemiological review that is validated by microbiologists and epidemiologists and uses international infection definitions to identify Gram-negative infections in the selected group. The epidemiology review will define the frequency of infections and their distribution by person, place, and time. Health Protection Scotland will lead that part of the work.

The paediatric trigger tool review is an internationally validated approach that will help clinicians to understand the effects that infection might have had on children, and will help in assessment of the wider quality of care. Infection prevention and control measures, and their use and effectiveness, will also be assessed in relation to the outputs of the case reviews.

Dr Peter Lachman is a paediatrician and chief executive of the International Society for Quality in Health Care, and is one of the authors of the paediatric trigger tool, has provided us with guidance on its use for this purpose, and on the augmentation that is required for patients.

Because the review will cover a significant time and a number of cases and complexities, a segmented approach will be taken. The first group of case reviews will concentrate on patients who received care in 2017. I think that that is appropriate, given the long period of worry and distress that their families have endured. The first set of reviews will be completed during February. The review team considers that it is likely that there will be about 80 cases to be examined overall, but they will continue to keep that assessment under review.

The whole approach—use of the trigger tool and the other steps that I have outlined—will be discussed with the parent representatives who are working with us. The review must also answer the questions that are posed by parents. Professor Craig White will liaise with parents to ensure that that happens, and that they are kept informed of progress. As the review of each case is completed, families will be offered an individual face-to-face report by one of the reviewing clinicians.

I consider it imperative to the restoration of confidence that no-one in the process is marking their own homework—not NHS Greater Glasgow and Clyde, and not NHS Scotland. All must be subject to expert and independent external scrutiny; the work of the review team will be advised and subjected to scrutiny by experts from outside Scotland. Professor Mike Stevens, who is an emeritus professor of haemato-oncology from the University of Bristol, and Gaynor Evans, who is clinical lead for the Gram-negative bloodstream infection programme at NHS Improvement England, will advise the review team and report directly to the chief nursing officer.

Parliament will recall that, in 2018, NHS Greater Glasgow and Clyde considered it necessary to close wards 2A and 2B at the Royal hospital for children, and to relocate patients to ward 6A in the Queen Elizabeth hospital. The move was worrying and unsettling for children and their families, and the length of time has been longer than expected. Changes have been made in ward 6A to make space available for parents to have a rest and some time to themselves. Extra measures have been taken to enhance air filtering, alongside thorough and regular cleaning. Additional steps have been taken to bring to ward 6A aspects of the play and therapeutic environment of wards 2A and 2B.

Welcome though those enhancements are, it is obviously necessary that children return to the wards that were specifically designed for them. Wards 2A and 2B are being refurbished to make good the problems that were identified in 2018, and to bring the wards up to the highest standards. I am informed by NHS Greater Glasgow and Clyde that its plan now is that work will be completed this summer. Progress towards reopening is being monitored by the oversight board’s technical subgroup, and by Professor McQueen. Patients will move back to wards 2A and 2B when they are fully ready and meet all required standards.

Professor Marion Bain is now in post, and is leading the case review that I have described. Working with the staff who have raised concerns, and making sure that their insight and experience are woven into the on-going work of infection prevention and control in NHS Greater Glasgow and Clyde, she is reviewing all aspects of working practice and governance, including how the board assesses, reports and manages incidents and outbreaks.

The policies of NHS Greater Glasgow and Clyde are being considered, as is the detail of spikes in infection that were experienced in the hospital, and how the board responded, both in its operations and corporately. I expect the oversight board to receive a report from the subgroup about those matters by the Easter recess. Alongside that, the chief nursing officer has instructed a peer review of how the infection prevention and control team approaches and escalates infection incidents. That review will report during February to Professor Bain.

Professor Craig White is following up on the feedback that has been received from parents through surveys and individual meetings, and which is informing the work of the communications group of the oversight board. I am grateful to the parent representatives who are working with us on that.

NHS Greater Glasgow and Clyde’s website now has an improved section that offers answers to general questions that parents have asked about the hospital and the safety and care of their children.

We will ensure that families are involved in preparations to reopen wards 2A and 2B, with answers to their questions, and taking into account ideas that they might have for the operation of the wards.

Lastly, I want to update Parliament on progress on establishment of the public inquiry that I announced in September last year. The drafting of the remit and terms of reference are at an advanced stage, and are being considered by Lord Brodie. Lord Brodie and I are committed to ensuring that the inquiry addresses the concerns of patients and families, and to offering them an opportunity to comment on the terms of reference before they are finalised. I expect that the remit and the terms of reference will be shared with families during February. I will meet thereafter with party spokespeople, as I have committed to doing.

In the month since I escalated Greater Glasgow and Clyde NHS to level 4, significant work has been under way to address the legitimate concerns that have been raised by members on behalf of families and staff. The work is on-going, under the scrutiny of external experts. It is detailed and will take time, but families, children and staff deserve to see it being done properly and thoroughly. I will update Parliament further as progress is made.

I thank the cabinet secretary for the advance copy of her statement. The last time that we had a statement, I asked how many cases had been identified. Today, the cabinet secretary said that it is likely that about 80 cases will be examined. Has the cabinet secretary personally instructed Professor McQueen to make contact with those families? Secondly, looking at wider issues in the health board and given the concerns that were raised regarding the Vale of Leven, Queen Elizabeth and Gartnavel hospitals—we know many of them—why has it taken until now for the cabinet secretary to act?

I am grateful to Mr Briggs for his questions. Regarding contact with families, the first thing that is being done is that representatives of families are being talked though the approach to the review of cases so that they understand why it is a twin approach. They are being talked through the process that will then be involved, and why the first segment of cases out of the 80 have been identified as the first to be looked at. That information will be shared widely with all the families. Professor White will ensure that that happens, as well as making sure that families have a copy of the statement that I have made today, as he did in December.

Families will then be asked individually how they want to be involved. At the very least, they will have a face-to-face talk-through of the result of their own specific case with a member of the clinical team that has undertaken the review. Families may wish to have other involvement. They may wish to look at the information that is being reviewed. They may have additions that they want to make to that information. The approach will be bespoke for each family and for what they want. In some instances the patients themselves may be involved, because we are not talking only about young children but about young adults.

I do not understand Mr Briggs’s second question about why it has taken so long to act. We have acted appropriately at the right time in terms of infection prevention and control. Members will know from my previous statements about my engagement with the families and my involvement very early on, from the time of my appointment, in terms of the streptococcus infection and the action that was taken then.

Greater Glasgow and Clyde NHS has not responded to those actions and to that support as I would expect it to do. That is why, in terms of infection prevention and control, it has not only been elevated to level 4, which is a serious level for a board to be at; prior to that elevation I also instructed the independent review, which should report in the spring, and the public inquiry into some of the wider and deeper issues around infrastructure build. That inquiry will report on the Queen Elizabeth university hospital and the Royal hospital for children in Glasgow and on the new NHS Lothian Royal hospital for sick children at Little France.

I think that we have taken the appropriate steps, allowing boards to exercise the responsibility that they have for the job that they are there to do, but acting where they are not taking that responsibility as seriously, or as effectively, as I require them to.

I encourage you to give slightly more concise answers, cabinet secretary, as we still have 12 members who want to ask questions.

I thank the cabinet secretary for advance sight of her statement. This remains a worrying time for many families and patients. We welcome many of the actions that have been outlined and agree that no one who is involved in this scandal should be marking their own homework. However, it appears that that has been the case for too long. Families and staff whistleblowers have feared a cover-up of the many complaints, crises and tragedies that have plagued the Queen Elizabeth university hospital since it opened in 2015. It is only now, in 2020, that we are beginning to see serious action being taken. Along the way, the public has lost confidence in NHS Greater Glasgow and Clyde. Although the health secretary has invited people to join or help the board, no one has been asked to leave. That feels quite incredible.

Can the cabinet secretary say, hand on heart, that she has complete confidence in the current leadership team, including the chief executive, and, if so, why?

I agree with the comments that Monica Lennon has made, and I am grateful to her for making them. This has been an unnecessarily worrying time for families and staff. That is also why, in addition to the steps that I have outlined, we have actively sought to engage directly with families in order to hear what they have to say and to make good use of those senior microbiologist clinicians with significant expertise who stepped forward to work with us through this process. I am grateful to them for that, and their resilience and strength should be commended.

On the point about no one being asked to leave, I should be clear that NHS Greater Glasgow and Clyde is now at level 4, and I have not ruled out level 5. However, I think that it is important to give the board the opportunity to work under our direction to improve its processes. It is important that we are the ones who are looking at that and are not asking it to do that. It is important that, if anything has been covered up, ignored or missed, or if any wrong decisions have been taken, there is an external view—a view that is external to us—that looks at all of that in order to uncover the truth of the matter on these infection issues, as well as anything else that might arise in the public inquiry.

It is now up to NHS Greater Glasgow and Clyde to respond appropriately and to meet the requirements of it that I have set out clearly. Level 5 is a serious step. As I said, I have not ruled it out, but I am giving NHS Greater Glasgow and Clyde one last chance to respond appropriately and show that it understands not only what it needs to do now, but what it needs to do in a way that is sustainable in the long term.

The cabinet secretary said that the paediatric trigger tool review will also help to assess wider quality of care. Could she elaborate on the scope of that review and on what steps are being taken to ensure that actions, finding and decisions are communicated on an on-going basis to patients, families, health service staff and the wider community that relies on the hospital?

On that last point about communicating the progress on an on-going basis, that is largely being led by Professor White, but he is being informed in that work by the parent representatives and others who are working with them.

I am due to visit the Queen Elizabeth university Hospital and the Royal hospital shortly after the February recess. At that point, I will take the opportunity not only to meet relevant staff but, if at all possible, to meet the area partnership forum which, as Alison Johnstone knows, covers all the unions that are involved on that campus, so that I can ensure that they feel that they are properly engaged and fully informed.

On the question of the wider quality of care, when the trigger tool is used, we look at how infections are identified; how the connections are made or not made; whether what was done was appropriate in terms of time, place and person; whether that was done to the standard that we and the external experts would expect; and what happened with the care in relation to the use of antibiotics, prophylaxis and so on.

None of that is, in any sense, to question what the clinicians who are involved in the care of these children have been doing; they provide the highest quality of care, as is widely recognised by many people, including me. Rather, it is about considering whether the proper management of infection incidents, and the connections that are then made and the steps taken, have a wider impact on other care decisions that clinicians might make.

I am grateful for early sight of the statement.

I want to ask about wider problems in the health board, which I think underpin the problems at the Queen Elizabeth. I am grateful that the cabinet secretary has appointed an operational turnaround director. In view of the board’s size and the unprecedented nature of the problems that beset it, what qualities has she sought in recruiting for that post? How long will the post be in place? How can we be assured that, when the operational turnaround director leaves, we will not slide back into the problems of the past?

The operational turnaround director is Calum Campbell, the chief executive of NHS Lanarkshire, and he is focused on improving NHS Greater Glasgow and Clyde’s delivery of scheduled, unscheduled and out-of-hours care. He will also be able to consider—and advise us and the board on—additional cultural issues in the board in relation to the pace of change and engagement with clinicians and staff, with an absolute focus on delivering high-quality services for patients.

NHS Greater Glasgow and Clyde’s performance in these matters is not what we require it to be, which is why we not only escalated the board to level 4 but brought in the turnaround director, who is reporting directly to Government on these matters.

The member asked how long that person will be there. They arrived on site on Monday, and we will need to take a little time for their additional assessment—oversight of which is led by our chief operating officer, John Connaghan—of what more needs to be done to improve the delivery of services. That will give me a better idea of how long the turnaround director will need to be there before we see the improvements that we need.

Those improvements must be sustainable, as Mr Cole-Hamilton rightly said. There is no point in someone going in, fixing the problem and then walking away only for it all to fall over again. Improvement needs to be sustainable, which is why Mr Campbell’s assessment of the sustainability of capability and capacity inside the board will be helpful. We will take a view and a decision on how long his involvement might be necessary once we have more information in that regard. I will be happy to inform Mr Cole-Hamilton as I reach that view.

I stress again that I am looking for succinct questions and succinct answers.

I thank the cabinet secretary for her statement. I was pleased to hear the commitment to improving communication with families. Can she assure members that the parents of affected children will be fully involved in the review of their own children’s cases, to ensure that the insight that they can offer is fully utilised?

Yes, I can. Parents will be involved as fully as they wish to be. We accept that some families will want to be more involved than others, which is why I said that there should be a bespoke solution for each family, so that each family can determine their level of involvement in their case review and the extent to which they want to contribute additional information for consideration.

While this Government has been fixated on what flag is flying outside, kids have been shifted from one contaminated ward to another and parents have been left in the dark. Wards 2A and 2B were supposed to open soon; now we hear that it will be summer before the work is completed. Can the cabinet secretary guarantee that the wards will open this year?

Let me be really clear to the Parliament: I am not fixated on flags; I am fixated on improving the performance of our national health service and, most important, on ensuring that, in this instance, families and staff are treated with the respect that they deserve and are involved as fully as possible. I think that all the steps that I have set out indicate how serious I am about that.

The board’s assessment is that wards 2A and 2B will be ready to open in the summer. That is why I said in my statement that the oversight board will, indeed, oversee that, to make sure of all the work that needs to be done—so that the wards can open not only safely but to the standard that we require—and that the families will be involved in and assured of it all. I am sure that Ms Wells remembers that I have appointed Professor Bain and others to make that direct work a reality for the families and the children who are involved.

What role will the additional expertise that is being brought in play in ensuring that the measures that have been put in place to date are satisfactory?

We have additional expertise from Health Protection Scotland and from Professor Marion Bain, who has now taken lead responsibility for healthcare-acquired infection prevention and control from Dr Jennifer Armstrong, the medical director at NHS Greater Glasgow and Clyde. Also, as I have said, Professor Mike Stevens from the University of Bristol and Gaynor Evans of NHS Improvement in England are providing additional scrutiny of the work that the Government is commissioning and how that work is being done, particularly around case reviews, the involvement of families and the lessons that need to be applied in terms of overall infection prevention and control. Finally, the peer review that the chief nursing officer has commissioned on how the infection control team works will be a matter of considerable importance, and we should have that report next month.

This is a step in the right direction. Greater oversight of management is welcome, but we still have not got to the heart of the problem. The cabinet secretary says “if” there is a cover-up, but there is no “if” about it. The health board leadership has lost the trust of patients, parents and the public. Statements are still being issued by the health board that are simply untrue and deliberately misleading, despite the oversight board having been implemented by the Government. Managers are more interested in saving their skins than in doing the right thing. The cabinet secretary has said that they have one more chance. How many last chances do they need? What will it take for her to lose confidence in the leadership of that failing health board?

In one respect, I agree with Mr Sarwar. What I have outlined today is not the heart of the problem, which is partly why we have the independent review and the public inquiry. Those all layer in to find out exactly what has gone wrong with that hospital in its physical build and environment and then in how it is operated and how staff are engaged and involved. I know that Mr Sarwar understands that, but it is worth making the point about the layers that are involved.

A lot of what he asks is similar to what Ms Lennon said, and I completely understand why he is asking. The allegation that statements that have been issued by the board are untrue is specifically being looked at today by Professor Bain in her meetings with the senior clinicians, who are very experienced microbiologists in the particular areas of water and ventilation. If the statements are untrue, not only will they be corrected but we will pursue directly with the chief executive and the chair of the board why statements that are not factually correct are being issued.

I have been really clear—I have certainly made it clear to the board—that this is the final chance to respond appropriately to this level of escalation and direct Government involvement in direction. Either the board will respond to that or we will go to the next stage. I hope very much that the board will respond and show itself willing to accept where it has got it wrong, learn how to get it right and take all the steps that are needed to provide assurance to Mr Sarwar, to me and, most important, to patients in Greater Glasgow and Clyde. We will see whether it does that, but we will not lie still for long, waiting to be assured of that.

I thank the cabinet secretary for her explanation of the communication with the families so far. Can she provide information on the on-going support that is being provided to the families to reassure them that the unit at the Queen Elizabeth university hospital is safe and infection free?

That is being done in a number of ways. Information is now on the NHS Greater Glasgow and Clyde website. Professor White also secures information in response to questions that individual families might have, in an on-going and iterative process. I think I made the point that 71 questions arose from the meeting that I had with a number of families, but further questions have arisen subsequently, and Professor White is engaged with them all. There is also a group, which Professor White leads and which has family representatives on it, whose role is to report to the oversight board. In its scrutiny, it is very clear about the quality of that engagement and information.

There is more for us to do in that regard, but we have fully responded to what families have asked us to do to date. However, quite rightly and reasonably, they might require more from us. As I have touched on, there are also individual cases in which very specific work is being carried out.

I am afraid that there is not enough time to hear from any more members, so I must apologise to Brian Whittle, Daniel Johnson, John Mason and Tom Arthur.