– in the Scottish Parliament on 18th September 2019.
The next item of business is a debate on motion S5M-18902, in the name of Miles Briggs, on the mismanagement of national health service construction projects.
Patients, families and NHS staff need to have confidence that the hospital environment in which they are being cared for or working, is safe. The on-going concerns and issues at the Royal hospital for children and young people in Edinburgh and at the Queen Elizabeth university hospital in Glasgow have undermined public confidence. That should concern us all.
I pay tribute to all those who work in our NHS, as well as to the parents and families who have continued to speak out and seek answers from management and ministers over hospital safety concerns. I am sorry to say that, in many cases, their concerns and questions have been dismissed. We need to have a transparent and open NHS in Scotland, where those real concerns are listened to and acted upon. I am sorry to say that that has not been the case to date.
As a member of Parliament for Edinburgh and Lothian, I know just how desperately the communities that I represent here in the capital and across the east coast of Scotland need the new sick kids hospital. That is why we have seen such anger from families and NHS staff about what should have been a much celebrated and state-of-the-art new hospital being repeatedly delayed and not built to standard; a hospital that is now not due to open until next autumn—almost a decade since it was first promised.
It is not just at the sick kids hospital that we have seen on-going problems: Glasgow’s Queen Elizabeth hospital has suffered a catalogue of serious issues and, in Aberdeen, just this week, we saw a review announced into the cost and design of the new Baird family hospital and Anchor cancer centre. From Edinburgh to Glasgow to Aberdeen, across NHS Scotland, we have seen the mismanagement of major hospital infrastructure projects that have run over budget and behind schedule—and with serious patient safety concerns.
The Cabinet Secretary for Health and Sport and I are in agreement that patient safety must always come first. That is why I want to use the debate to ask the cabinet secretary about the here and now. I have received a number of communications from constituents and staff raising concerns with me regarding the condition of the department of clinical neurosciences at the Western general hospital and the old sick kids hospital here in Edinburgh. I have written to the cabinet secretary to raise those specific concerns with her directly, and I believe that it is important that we see ministers take action to reassure patients and to investigate the standards of both the medical equipment and the buildings that are being used at those NHS sites.
NHS Lothian has been escalated to level 4, with the Scottish Government now taking a directive role in the operation of the board and assessing risks around delivery, quality and safety. Therefore, given that the hospital is now expected to remain in use for the next year and potentially beyond, I seek assurance and clarity about patient safety and inspection of the DCN and the old sick kids hospital.
Given that Health Improvement Scotland last inspected the hospital in September 2018, will the cabinet secretary confirm today that she will instruct it to undertake an urgent inspection to investigate the concerns that I have highlighted to her?
I confirm that I will do exactly that. I look forward to receiving Mr Briggs’s letter on the concerns that have been raised.
On Monday, I will visit both the Sciennes and DCN sites with the chief medical officer and the chief executive of the NHS in order to meet groups of staff, who will have the opportunity to raise concerns. We will also address the concerns that Mr Briggs has raised.
I welcome that.
Presiding Officer, above all, throughout this period we must remember those who are at the heart of the problems that we have seen: they are the families of children who often have compromised immune systems. I have met families who have lost children.
I say to the cabinet secretary that patients, families and NHS staff are beyond angry. They have had enough and want to see real leadership so that those projects can be completed and the on-going safety issues addressed. I welcome the establishment of the new national body that was announced in the programme for government, which will have oversight of major infrastructure developments in the future. However, we need to see real progress now to get that organisation established and working and for its powers to be outlined and then made concrete. That is why, today, I have called on ministers to confirm within the next week that there are no further delays or issues with any other on-going projects and to publish the remit of the new national body by December.
I also welcome yesterday’s U-turn by the cabinet secretary in announcing a public inquiry. It is worth our reflecting that, just last week, she said:
“I do not see what difference a public inquiry would make”.—[
, 11 September 2019; c 33.]
I say to the cabinet secretary that it must make a difference. For the Scottish public to have confidence in that inquiry, we must look at all aspects of what has gone wrong over the past 12 years. The inquiry needs to consider the role that the Scottish Government has had in this sorry period and what early warnings might have been missed by ministers. That is why Scottish Conservatives cannot support the cabinet secretary’s amendment, which looks as though it would limit the scope of the inquiry before its work has even started.
The cabinet secretary should be in no doubt that this is her last chance to show that she has the leadership that is needed to turn this unacceptable situation around. Three major projects, in Scotland’s three largest cities, have been beset by problems. I am hugely disappointed and sorry that our great national health service in Scotland finds itself in such a situation. Let me make this clear to the cabinet secretary: Scottish Conservatives will never stop holding the Government to account for what we have seen. The SNP has been in sole charge of our health services for 12 years now. Its ministers are ultimately responsible, so they must take responsibility for these failures.
That the Parliament is deeply concerned with the ongoing mismanagement of key NHS hospital construction projects; notes the Scottish Government’s poor record on delivering hospital projects on time and on budget; further notes the ongoing problems which have led to the delay of the new Royal Hospital for Children and Young People in Edinburgh and the concerns expressed in relation to the Queen Elizabeth University Hospital in Glasgow; calls on Ministers to confirm within the next week that no further delays or issues with any other ongoing projects are expected, and asks for the remit of the new national body, which will have oversight of major infrastructure developments within the NHS, to be published by December 2019.
I am pleased to speak in the debate. I share the concerns that have been highlighted by members across the chamber about the on-going infrastructure issues at Queen Elizabeth university hospital campus in Glasgow and the delay in occupying the new Royal hospital for children and young people and the department of clinical neurosciences in Edinburgh. The safety and wellbeing of all patients and their families are my priorities and must be the primary considerations in all NHS construction projects.
Last week, I outlined how the reports that I commissioned from KPMG and NHS National Services Scotland on the Edinburgh project raised a number of issues that need to be resolved before patients can safely be cared for at the new site. On Monday, our senior programme director, Mary Morgan, began work on the plan that I set out, to deliver a safe and compliant site for the new Edinburgh children’s hospital and to ensure that the necessary work is undertaken at the current sites at Sciennes and the Western General to reinforce the safe delivery of services over the coming months. As I have said, next Monday, I will again meet groups of staff at both sites and will continue to ensure that the partnership forum remains up to date. The focus will remain on resolving the current issues and completing the work on the DCN by the spring of next year and the children’s hospital by next autumn. I will keep members updated on that as we make progress.
At the Queen Elizabeth, we continue to monitor the situation closely via Health Protection Scotland. We also monitor how NHS Greater Glasgow and Clyde is meeting our expectations for continual review of the control measures that are in place for infection prevention and will ensure that such review continues throughout the paediatric haemato-oncology patient pathway. I have spoken, on more than one occasion, to the chair of the board, and our chief nursing officer and her team continue to engage directly with its senior staff. Today, I have written to the families of patients in the oncology service at Glasgow’s children’s hospital who have contacted me, to make arrangements that suit them for the meeting or meetings that I will have with them so that I can hear their concerns directly. The work of the independent review continues, and members have recently been updated on progress as it moves from reviewing written evidence to hearing directly from key personnel.
As I said last week, there have been new infrastructure builds right across our NHS that have been delivered on time, on budget and in compliance. It is important to be clear about that in fairness to all those who have worked so hard to achieve those results.
However, over recent days, families of children who are receiving care at the Queen Elizabeth university hospital campus have made it clear that, notwithstanding the high quality of care that their children are receiving, they remain concerned about the safety of the building and they want the additional assurance that would be provided by a public inquiry. I said last week that we need to ensure that past problems and mistakes are not repeated, and we need to ensure that families, patients and the wider public are assured that we understand what has gone wrong and are taking the necessary steps to ensure that mistakes are not repeated. My amendment therefore sets out clearly that I will establish a public inquiry under the Inquiries Act 2005.
At this time, the Liberal Democrats are minded to support the Government’s amendment. However, given that Miles Briggs suggested that the amendment would limit the scope of the public inquiry, can the cabinet secretary confirm that the inquiry will be allowed to go where the evidence takes it?
Yes, I can confirm that, and I am coming to it.
The inquiry will be on a statutory basis, with all the powers that that brings. It will consider both the Queen Elizabeth university hospital campus and the Royal hospital for children and young people in Edinburgh, determine how deficiencies in ventilation and other key building systems occurred, determine who was involved and at what stage and make recommendations on the steps that we need to take to ensure that past mistakes are not repeated in future infrastructure projects.
I will return to the chamber to advise on who will lead the inquiry, its full remit and the timetable as soon as those details are finalised, but the inquiry remit will be informed by the views of the person who leads it and, given its statutory nature, I would expect that that individual will at least have a legal background.
I have lived through the tram inquiry here in Edinburgh, which is still to report. I appreciate that the cabinet secretary said that she will come back to the chamber with a timescale for the inquiry, but how long, roughly, does she think that it will take? When will we hear its recommendations?
It would not be sensible or possible for me to answer that question at this point.
I completely understand the need that the member has, which I also have, to hear what the inquiry has to say and what it finds, but it will be an independent inquiry on a statutory basis, and whoever chairs and leads it must have a key role in determining the full scope that it will have and how it will go about its work.
I expect the current independent review at the Queen Elizabeth university hospital and the reports from KPMG and NHS NSS that I published last week to provide important information to the inquiry, and its conclusions and recommendations will further inform the work of the new national body that we are moving to set up.
The new national body will have responsibility for oversight of the design, construction and maintenance of major infrastructure developments in NHS Scotland, ensuring the embedding of a focus on patient safety and a clear understanding of the interrelationship between building design and effective infection prevention and control.
My focus is threefold—to ensure that all the necessary steps are taken to ensure the safe delivery of the new hospital in Lothian and of care at the Queen Elizabeth campus; to establish a new body to oversee our coming infrastructure build, applying best practice in every aspect; and to provide the necessary independent assurance to patients, families and the public through the work of the statutory public inquiry.
I urge members to support my amendment. I move amendment S5M-18902.3, to leave out from “is deeply concerned” to “, and asks for” and insert:
“believes that patient safety should be the primary consideration in NHS construction projects; is deeply concerned with the ongoing problems which have led to the delay of the new Royal Hospital for Children and Young People (RHCYP) in Edinburgh and the concerns expressed in relation to the Queen Elizabeth University Hospital (QEUH) in Glasgow; notes the recent KPMG and NSS reports, which have identified the root of shortcomings in ventilation systems in key areas of the new RHCYP and identified a number of other areas to be rectified before the site opens; believes that, following concerns from affected parents, it would be the right step to increase confidence by establishing a public inquiry, under the Inquiries Act 2005 into the new RHCYP and the QEUH site to determine how vital issues relating to ventilation and other matters occurred, how mistakes were made and what steps can be taken to prevent them being repeated in future projects; further believes that the ongoing QEUH Independent Review, and the recent KPMG and NSS reports, will help inform the Inquiry; considers that ministers should update Parliament in the event that there are any significant delays to ongoing NHS projects; understands that construction inflation has been driven significantly in recent times by Brexit and its impact on sterling and on the attractiveness to potential skilled workers to come from the EU to work in Scotland; and welcomes that”.
I am grateful to Miles Briggs for lodging the motion for debate. Members on the Labour benches share his deep concerns about the mismanagement of NHS hospital construction projects and the consequences of that for patients and staff.
Scottish Labour has been campaigning loudly for an independent public inquiry into Scotland’s hospital crisis because we share the concerns of patients, their families and our hard-working NHS staff. In Edinburgh, the shiny new Royal hospital for children and young people is lying empty because it is not safe for patients, and in Glasgow the Queen Elizabeth university hospital has been rocked by one crisis after another. The Crown Office is investigating the deaths of patients who contracted infections at the hospital.
In Glasgow, the purpose-built royal children’s hospital campus is closed because of fears about water safety after children contracted infections. The adult ward, which was supposed to be a safe haven for those children, is now closed to new admissions because of the risk of infection. Children who have cancer are being “temporarily diverted” to use the language of NHS Greater Glasgow and Clyde. It is fine to use that expression if we are talking about cars being rerouted because of road works, but we are talking about toddlers and young people who have cancer, and I for one find that language rather insensitive. Some of those children face a 300-mile round trip to Grampian for cancer treatment. They are far from home and their families and friends.
The children’s hospital in Edinburgh and the Queen Elizabeth complex in Glasgow were built by the same contractor—Multiplex. Some of the problems that have been uncovered are similar, which is another reason why we have campaigned for a public inquiry.
Thankfully, the opening of the Edinburgh hospital was blocked in the nick of time. I am sure that we are all relieved about that; who knows what might have happened if children had moved across?
Children and young people in Lothian badly need the new hospital because, as we have heard in this chamber many times, the current building is old and not fit for purpose. They have waited for several years for the new building, which is already long overdue. Cabinet secretary, what investment will be made available to upgrade the current hospital and make it more comfortable for patients, especially in accident and emergency, which we know is just not fit for purpose? When will that work get under way?
The Queen Elizabeth in Glasgow is Scotland’s biggest hospital. When we add the hospital in Edinburgh to the Queen Elizabeth, we are talking about almost £1 billion of investment. However, in reality, because of the mistakes and missed opportunities that are being uncovered, it will all cost much more. We need to know how we have ended up with hospitals that are just not safe. It is shocking that deficiencies in the Edinburgh hospital’s ventilation system were identified only 100 hours before the facility was due to open. We are talking about a hospital for some of Scotland’s sickest children. Reports have been commissioned and they talk about human error, but the public needs to know who is responsible and how any of this could have happened.
In Glasgow, the problems at the flagship hospital and the purpose-built children’s hospital came to light only when patients had moved in and, tragically, some patients died after contracting infections. There will be plenty time to interrogate the pipes, the drains, the drawings and the contracts, but I want to talk about a patient.
Stevie-Jo Kirkpatrick from Dumfries is 15, has leukaemia, and has been a patient at the Queen Elizabeth for several years. I spoke to Annemarie, her mum, on the phone earlier today, and I know that the cabinet secretary has written to the family and others. Stevie-Jo was admitted to the adult ward at the Queen Elizabeth in November and she remained there until February. Because the children’s hospital next door is closed on safety grounds, her parents had no access to family facilities. During that four-month period, the family racked up a bill of £3,000 in travel, food and accommodation. There is no social space for teenagers in the adult ward, and Stevie-Jo is stuck in her room, isolated and anxious.
Annemarie told me:
“There are no facilities for us. Some days parents don’t eat because we are stuck in a room with our very sick children. There is nowhere to prepare a meal, not even a microwave. There is no peace and quiet if you just need 5 minutes to yourself. We just want answers and no one is telling us if our children are safe. That is why we need a public inquiry. It is long overdue.”
Today, Scottish Labour will support the Scottish Government’s amendment. We want to believe that the cabinet secretary is sincere and serious. We have to sort this out. It is a disgrace.
I move amendment S5M-18902.1, to insert at end
“; acknowledges the serious consequences that flawed construction can have for patient safety; recognises the impact that delays and uncertainty also have on patients and their families, and demands a fully independent public inquiry into the failings at the Queen Elizabeth University Hospital and Royal Hospital for Children and Young People.”
New state-of-the-art hospitals to look after Scotland’s people, young and old, should be a source of national pride, but sadly, here we are this afternoon debating the mismanagement of NHS construction projects. I thank the Conservatives for the opportunity to have this debate, because it is crystal clear that we cannot continue like this.
The impact on the health of patients who deserve and require the best of care is of huge concern, as are the demands that we are placing on those who work in our national health service. When we cannot get basics such as ventilation and drainage right—in our hospitals, of all places—something has gone quite horribly wrong. A local mum told me of her visit to the sick kids on the Sciennes site last month. A wall had been signed by staff who had thought that they were leaving the iconic, but exhausted, sick kids hospital behind. She spoke of going out the back to a tired little portakabin where staff and visitors could get a snack—“It just felt really sad. A little unloved. The portakabin was makeshift; I was surprised it was there in the first place and I can’t imagine what state it’ll be in if it has to serve that purpose for another year.”
It is not just about having to use portakabins for snacks. It is about the general hospital environment, and Monica Lennon made the point that we really need to understand what investment will occur so that the hospital is made safe, attractive and a place where people’s morale is uplifted for the time that they have to spend there.
There is a great human cost here: stress, additional travel, and working and being treated in an environment that does not meet current requirements and expectations. Staff have moved closer to where they thought their new place of work would be.
How much are we paying for all this? Audit Scotland tells us that the contractual issues alone will add an extra £90 million to the cost for NHS Lothian. Currently, my constituents and all those who use this highly regarded hospital are asking for answers. NHS Lothian took over the building in February this year from Integrated Health Solutions Lothian, which built it. Since then, we have been paying that private consortium £1.4 million a month for a hospital that cannot be used; that is not in the public interest.
We have two flagship hospitals—the Queen Elizabeth university hospital and the Royal hospital for children and young people—where at least part of the construction is simply not fit for purpose. The human costs are immense: uncertainty and unplanned travel for very sick children and their families, and staff working in buildings that are well past their sell-by date. Meanwhile, some offshore account benefits.
I welcome the fact that the cabinet secretary’s amendment today states that
“it would be the right step to increase confidence by establishing a public inquiry”.
Given that we now understand that no one knows how on earth matters at the sick kids progressed as far as they did—all the while with a building model that was not fit for purpose and would potentially endanger sick children—we need to get to the bottom of this.
I would be grateful if the cabinet secretary could confirm in closing what exactly we are paying that money for, every month. The original building costs for the sick kids were £150 million or so, yet we have been told that we could end up paying more than £430 million over the next 25 years. Is that value for money, when, at the end of it all, the public will still not own the building, which will belong to the bankers?
The cabinet secretary maintains that the Scottish Government’s public private partnership-lite, non-profit-distributing finance model plays no part in the construction fiasco, but I agree with the branch chair for the union Unison who said that the money should have been spent on patient care. We desperately need more money in our health service in Scotland, not less.
I hope that the cabinet secretary will ensure that the board and all those who are involved in trying to rectify this terrible situation as soon as possible will have the support that they require. I have sympathy with the creation of the new national body and I fully expect that we will be updated on its remit. I am slightly concerned by the fact that an individual seems to have so much control over what that remit will be, and I will be grateful if the cabinet secretary will expand on that issue.
I was the first parliamentarian to call for a public inquiry on these issues, so I am very grateful to hear that that will happen. I did that not because I wanted a stick with which to beat the Government, but to challenge the reality—or at least to address the reality—that we have a hospital in Edinburgh in which no children are being treated and which is costing taxpayers £1.4 million a month; patients from my constituency and others who expected to be moving but who are in the old hospital for sick children, a building that is well past its sell-by date; and a situation that was uncovered just 100 hours before the decamp was supposed to happen.
If—as the Government says and the KPMG report suggests—there was no specific error on the part of the Scottish Government, it will have nothing to fear from such a public inquiry. However, the inquiry will give us vital answers, so that infrastructure projects such as the hospital can go forward unencumbered by the risk of similar mistakes in the future.
I want to address three aspects, the first of which is tone. This morning, I met representatives of the British Medical Association, who made a direct appeal to me as an Opposition member. They said that I must remember that there are workers, clinicians and managers in the NHS who are involved in the project and who, right now, do not feel safe because of headlines about heads rolling. I am not looking for a scalp—if accountability is to be had, that will be for the future. In the meantime, I want answers.
The second aspect is about sequencing. Many of the people who will have to answer questions in the public inquiry are currently involved in the delivery of the new sick kids hospital and the changes that must be effected to that flawed building. I hope that the cabinet secretary will give us assurances that, in the conduct of the inquiry, those people will not be pulled off line, potentially making the delay even longer.
The final aspect is the policy response of the Government following the public inquiry. There might be many questions that affect the current operation of our territorial health boards, but the answer to none of them is central Government control. Although I support the creation of a central expert oversight group, the principle of local health board autonomy was hard won and we need to protect it.
It is important that the public inquiry delivers on all three of those aspects and that it answers questions about the waste of public money, how the flawed environmental matrix was allowed to influence the tender document and what the missed opportunities were to which the KPMG report refers. We must ensure that those opportunities are never missed in the future and that similar flaws in guidance documents on tenders do not lead to such a morass in the future. The lessons learned must be applied consistently across our 14 territorial health boards and we must resist the urge to take control because, with respect—I do not want to denigrate anyone or to change the tone that I have sought to establish in my remarks—the Government does not have the best record in delivering massive infrastructure projects. I point to a rather large example of that in my constituency, which might not yet be finished.
Nevertheless, I am grateful to the Scottish Government for listening to Opposition members in our unanimous calls for a public inquiry. The Liberal Democrats will support all the amendments that are before the chamber today. I go forward with the confidence that the cabinet secretary provided in her opening speech and her response to my intervention when she confirmed that the judge-led inquiry will go where the evidence takes it, there will be no precondition for what it is allowed to look at and, if it finds that the Government has anything to account for, the cabinet secretary will come to the chamber and recognise that.
Presiding Officer, who is to blame? Who will be the Government’s fall guy? When will the mess be sorted out? I have repeatedly been asked those questions as the fiasco of the Royal hospital for children and young people in Edinburgh has reverberated in the headlines.
Yesterday, we were told that there will be a public inquiry at the expense of the public purse, which came hot on the heels of the Cabinet Secretary for Health and Sport making it clear last Wednesday that she thought that a public inquiry would serve no purpose. If I were a cynic, I might think that the First Minister thought differently as she dealt with calls for heads to roll, or perhaps the cabinet secretary was advised that pointing to the forthcoming inquiry would buy her time and deflect questions.
In the inquiry, there will of course be questions asked; technical documents sifted and examined; and, no doubt, conclusions of mismanagement and miscommunication reached. However, the real questions might remain of who is ultimately responsible, whether political pressure was brought to bear to cut corners and speed up the build, and who should have realised that there was a problem and intervened to correct it. “Not I”, says the cabinet secretary. “I did not know—nobody told me that there were problems. My department was only responsible for funding it and checking that the budget was okay. I am as appalled as everyone else and I have acted quickly to resolve it.”
Meanwhile, as they unpack their boxes and face another year or more in a hospital that is no longer fit for purpose, the staff, parents and children who work at or depend on the hospital could be forgiven for thinking that the cabinet secretary’s interest and outrage is a little late. As they struggle with ageing or non-functioning equipment that they were not allowed to replace, because there was a newly equipped hospital on the horizon, they are right to ask why the Government is acting as though it has no responsibility for the fiasco.
When we read in the KPMG report that there were lots of meetings and exchanges of information, claims that the cabinet secretary and her Government were unaware of any potential problems look trite. The report says that the problem was human error—a misinterpretation of the standards at the outset of the tender. After the problems with the Queen Elizabeth university hospital in Glasgow, any competent Government would have immediately sought independent reassurance that the Edinburgh children’s hospital build would meet all the required standards, particularly as it was using the same basic design and the same contractor as the Glasgow build.
We have been told that lessons will be and have been learned. Surely, the key lesson to learn was at least to check, double check and triple check the specification of the ventilation systems and other key health and safety areas in any new build before signing it off.
The cabinet secretary says that she did not know that there were problems until 2 July. It was her job to know. In this chamber alone, she was asked time and again about the build. That should have heightened her nerves and ensured that she sought robust assurances.
The KPMG report identified that the key issue that led to the delay of the planned 9 July opening was the incorrect tender specification. As the contracting authority, should NHS Lothian not take responsibility for its tender document?
NHS Lothian also has a responsibility, but my point is that, in the light of the Queen Elizabeth university hospital debacle, the Government should have had heightened responses to any problems.
I am running out of time.
I am glad that the cabinet secretary made the decision not to open. In the circumstances, it was the right thing to do, and I welcome the proposition to create a robust, experienced board to lead on future builds. However, I echo some of the concerns that Alex Cole-Hamilton raised.
If the cabinet secretary did not know that the Edinburgh children’s hospital had design flaws until a few days before it was due to open, we and the electorate have to ask: was that incompetence? Did the cabinet secretary not bother to ask, check or ensure that the build was being done to the correct standards? Was it naivety and a failure to recognise risk? In the words that I hear so often in this chamber, was it a refusal to take lessons from anyone else? Either way, the cabinet secretary’s primary focus now seems to be finding someone to take the fall so that the Government can say that it has dealt with it.
As we do not have much time in the debate, I will get to the main points right away.
The safety of patients and their families is the most important part of the debate. We can all agree on that. However, some of the hyperbole that I have heard from Miles Briggs is concerning. The responsibility goes two ways. We should find out from the public inquiry that the health board has a responsibility for the situation—that is not passing on the blame to someone else. It was the main driver in the programme of delivering the building. We must take that into consideration.
I need to make progress, because we have only four minutes each.
I am pleased that the Scottish Government recognises the need to strengthen quality and control in the planning of healthcare buildings, since, as I have already said, the most important people are those who work at or depend on them. It is also important that that type of situation does not arise again. The fact that NHS Lothian has been escalated to level 4 on the escalation framework shows that the Scottish Government is looking to provide confidence. The action plan for the new hospital in Edinburgh will be delivered. There have also been on-going issues with the Queen Elizabeth hospital in the Greater Glasgow and Clyde NHS Board area. I welcome the fact that that board will also be part of the public inquiry.
The cabinet secretary is correct when she says that she listened to the parents of children in both areas about their concerns before she came to her decision on a public inquiry. It is about patient safety, which is paramount. That is why the Scottish Government announced in the programme for government that it will establish a new national body, which will have oversight of design, construction and maintenance of major infrastructure developments within the NHS. It is my opinion that the management of those projects by both health boards has not met the mark. They have been found wanting in those very important projects, but we need to ensure that that does not happen again. Perhaps the inquiry will tell us how to do that.
We are all rightly proud of our NHS and the work that is done by the people involved in it. I appreciate that the debate can become heated due to the passion that we all have for that key part of our society. However, although I have been involved in politics and the process for a long time and I know how passionate everyone can be, we should never, ever, politically weaponise the NHS.
The NHS is far too important for that type of petty politicking but, unfortunately, that is what some members of the Opposition have done in this chamber and—[
I would like to hear what Mr Adam has to say, and I would like to hear everybody else—
So, when we look at the situation and ask whether there have been issues with those projects, the answer is yes, there have been. Should we do something about it? Of course we should. Has the cabinet secretary taken on board the views expressed and taken action? Yes, she has.
I read recently that Miles Briggs believes that the NHS is becoming too politicised. I agree, and I offer him one piece of advice: stop it! Stop politicising our NHS. From these back benches, I have watched a cabinet secretary provide a plan to try to find a solution—a cabinet secretary who is willing to engage with anyone involved, including Opposition members—while at the same time I have not seen any Tory members ask about the responsibilities of senior members of the health board. I ask Tory MSPs to stop using our NHS as a way to promote themselves. Anyone would think that there was a Westminster election coming up. Oh, wait: there is.
That is the part of this debate that churns my stomach. We have a situation in both projects that should never have happened and we need to find out how it all came about. That is why the public inquiry is important, and the wishes of the families should be respected. I have family members and friends who work in the NHS and they are sick of their workplace being dragged through the political mire by Opposition parties.
I welcome the cabinet secretary’s plan on the issue and have confidence in her ability to sort it. Trying to solve a problem is difficult and it takes cool heads and thoughtful consideration. It is time for Opposition members to get away from their petty form of party politicking. We need to get on with solving the problem that is in front of us and continuing to deliver for the people of Scotland.
This debate is not about politics; it is not even about management decisions. Patients have died at the Queen Elizabeth university hospital because of infection control issues, including two babies who died because of pigeon-dropping infections, and members across the chamber would do well to remember that. That is what this debate is about; it is not about elections and not about politics.
We have seen a series of scandals at the Queen Elizabeth university hospital: ventilation issues, contaminated water, leaks, mould, fungal problems, falling panels, and sewage leaks at the main entrance and in the operating theatres. That has impacted on patients, with wards closed, patients and children dying, kids sent home, kids sent to hospices to get washed, and delayed chemotherapy; it has impacted on staff, who are overstretched and overworked, with some breaking down in tears because of the pressure put on them; and there has been an impact on the public, with confidence in that state-of-the-art hospital and our wider national health service shattered.
That is what this debate is about. There have been clear failures of leadership at both local and national level. I welcome the public inquiry, but I think that the public deserve certain reassurances. The inquiry must look at the first planning decisions, the building, procurement, construction, installation, commissioning, handover, maintenance, operational management and the organisational behaviour of the health board and NHS Scotland more widely.
I will focus on the health board for a moment. It had oversight of the project and signed it off. Why were infection control experts not at the heart of the project? How much money that could have been spent on patient care has been spent on remedial work?
Whistleblowers at the Queen Elizabeth university hospital have shared with me the worrying information that there has not been accuracy from the health board. For example, the health board has said that there were only 22 reported infections in ward 2A, whereas, in fact, there were 40 cases of infection. Moreover, when Health Protection Scotland investigated, it looked at only the 2017 cases and not the 2016 cases.
I also have worrying insight about whistleblowers having identified problems while the hospital was being built, after it was opened, and ever since. They were not listened to, and they were forced to whistleblow in September 2017. They were intimidated, bullied and silenced. That led to two infection control experts at the Queen Elizabeth university hospital resigning.
What is the role of ministers? I accept that many of the issues arose before the cabinet secretary came into post, but the Government was still her Government.
I have two criticisms of the cabinet secretary. First, when she, rightly, announced the review of the disasters at the Queen Elizabeth university hospital, why did it take six months for the review’s terms of reference to be set, to pick the appointees to control the review, and to start the investigation? Much could have been learned in that six months—it was six months lost.
Secondly, why did we not learn the Queen Elizabeth university hospital lessons for the children’s hospital in Edinburgh? The cabinet secretary says that she did not know about the issues until 2 July. If she had listened to the whistleblowers at the Queen Elizabeth university hospital, who had an interest in and an insight into what was happening in Edinburgh, she would have known well in advance. She should have bothered to read the evidence that went to the Health and Sport Committee in its inquiry in February. An anonymous submission from an infection control expert said:
“Inadequate ventilation systems have been installed in new build hospitals; these are not fit for purpose for the specialist patient groups they are intended for”.
If anyone had bothered to read the anonymous submissions from infection control experts in February and not waited until July, they would have known that. All of those issues must be looked into.
I realise that I am short of time, so I will close. It is important that the right people are involved in the inquiry. They cannot be people who were involved in the decision-making process for the building specification and the commissioning, people who were directly involved with addressing the problems and the issues, or people who are now dealing with the outbreaks and infections. The inquiry has to be genuinely independent; otherwise there will be accusations of whitewash by the health board and the Government.
First, let me debunk the notion that the SNP has difficulty delivering hospital projects. There was, for example, the £54.8 million acute mental health and North Ayrshire community hospital. We are told that Woodland View, which opened in 2016, serves up to 206 in-patients, centralises adult mental health and addiction in-patient services on one site, improves rehabilitation and re-enablement services, and provides additional out-patient and support services. Other examples are the £275.5 million Dumfries and Galloway hospital and the new £110 million emergency care centre in Aberdeen.
My thoughts are with the families who await the new Royal hospital for children and young people facility in Edinburgh, in which the SNP Government has invested £150 million, and which the cabinet secretary is rightly holding to the highest standards of patient safety, even if that means delay.
As patient safety is paramount, I support having a national body to oversee major NHS infrastructure developments; I welcome that constructive suggestion.
I would be happy to take an intervention if I could get the time back, Presiding Officer. I see that I cannot, so I apologise to Michelle Ballantyne for not taking it.
It was known at the outset that NHS Lothian would invest £80 million in enabling works to prepare the site. That was factored into the decision to proceed. Such costs were included in the full business case and in regular updates to the Scottish Government’s infrastructure investment plan.
Learning from previous experience is crucial. I welcome the fact that, back in January, the cabinet secretary commissioned an independent review of the QEUH building’s design, commissioning, construction, handover and on-going maintenance, and how they contribute to effective infection control. I also welcome the public inquiry into the two projects, which was announced yesterday.
Is it disappointing to have a one-year delay in delivering the Royal hospital for children and young people in Edinburgh and to go over budget on the £150 investment? Yes. Should questions be asked of the health board and contractor about why issues that were identified in 2012 were not communicated to ministers until earlier this year? Absolutely.
Should we put the inconvenience of the hospital opening in 2020 instead of 2019 in perspective when considering the magnitude of the project, the initial project cost and, again, patient safety? Obviously.
The Tories should get their own house in order. Only today, their Prime Minister—to whom they are slavishly devoted, unlike many of their more robust Westminster colleagues—was castigated on a visit to a London hospital by the father of a sick child, who said:
“There are not enough doctors, there are not enough nurses ... the NHS is being destroyed, and now you come here for a press opportunity.”
That is the situation after nine years of United Kingdom Tory Government.
Meanwhile, the backlog of repairs for English hospitals that are already open will cost a shocking £6 billion. As
The Independent reported, £3 billion of that money is required to address conditions that present “significant” risk to patients and staff. We are talking about a blocked toilet in Yorkshire that led to
“faeces coming through the floor” in the ultrasound department for weeks; a Midlands maternity unit in which a leaking roof led to equipment and electrical fittings being soaked, damaged and hazardous; and a labour ward that was
“too cold to safely care for babies.”
Because of their obsession with austerity, the Tories have deprived their health infrastructure of so much funding that some hospital buildings in England are literally falling apart, and the consequences affect us. Some 76 out of 170 hospital trusts—
—declared a “clinical service incident” in 2018-19 as a result of the
Dickensian infrastructure conditions. Instead of lecturing the health secretary, the Tories should tear into their own Government; they should not lecture the Scottish Government. The Conservatives should look in the mirror and let the SNP—the only party that is fit to govern—get on with it.
As for Labour, it disregarded 81 requests for a public inquiry into Mid Staffordshire NHS Foundation Trust for two years, despite 1,200 excess deaths having been caused.
The Scottish Government is working hard and doing its best. It is doing an excellent job relative to the other two parties, which would preside over ever-more disastrous conditions in our NHS, should they get into power.
It will not come as much of a surprise that I will focus on the Queen Elizabeth university hospital. In the past year, the hospital has been plagued with a catalogue of problems that show no sign of stopping.
Before I go any further, I put on record that my remarks are in no way a criticism of the amazing work that staff do day to day, caring for patients at the hospital and ensuring that their needs are met.
I stress that the SNP Government, which has now agreed to a public inquiry, needs to conduct that inquiry with the pace and urgency that it warrants.
Having opened in July 2015 and having cost nearly £850 million to build, the Queen Elizabeth was once hailed as a flagship hospital. Fast forward five years, and we see crisis after crisis, due in large part to the hospital’s construction history, design and fabric. Last year, a number of children in the adjoining Royal hospital for children were affected by bacteria in the water supply, which resulted in an incident management team being set up. Earlier in the year, it emerged, shockingly, that two patients had sadly died after contracting an infection that was caused by pigeon droppings at the hospital. In August, three children were struck down with infections while being treated for cancer. Only this weekend,
The Herald revealed a number of issues with the site, including concerns about a ventilation system, missing records or inaccurate record keeping and wards that were not fit for purpose. As a result, children are being forced to travel to Aberdeen for crucial care, including chemotherapy. That is the absolute tip of the iceberg for patients in Scotland.
It is hard to overestimate just how serious those issues are, as is demonstrated by the strength of feeling of parents who have spoken out on behalf of their children. I know, from constituents having raised their concerns directly with me, that patients are worried that they are putting themselves at risk. People are genuinely considering whether it is safe to walk through the hospital’s doors.
I appreciate that an independent review is under way and that, yesterday, the health secretary confirmed that a public inquiry will take place. However, patients are yet to see the sense of urgency that we would expect, given the circumstances, or the leadership that is required to fix the hospital’s systemic problems.
Over the summer, it was reported that the investigation into the hospital may not conclude for another 18 months. Today, many will be asking why it has taken so long for the health secretary to agree to a public inquiry. They will also be asking why it was only after hearing the heart-breaking stories of patients and their families that she agreed to do so, given that only last week she stated that she did not see what difference a public inquiry would make.
The public needs to see that the Government is committed to conducting the inquiry as soon as possible; they also want the lessons learned to be applied to all future hospital projects. Today, we have called for the remit of the new national body that will have oversight of major infrastructure developments in the NHS to be published no later than December. We cannot afford there to be any more issues relating to hospitals’ design and construction.
I reaffirm my support for my party’s motion. We need to hear from the health secretary not just what will happen in the next year or so but exactly what action will be taken in the coming days and weeks. Only by doing that will public confidence in our hospitals be restored.
I am pleased to have been called to speak in this afternoon’s debate. Given my constituency interest as the MSP for Cowdenbeath, I will focus my remarks in the brief time available on the issue of the new Royal hospital for children and young people.
I stress that of course patient safety must always be the paramount consideration in our national health service. Indeed, safe patient services are being delivered day in and day out at the existing Royal hospital for sick children, and it is widely recognised that children are receiving the best treatment from our excellent NHS staff.
It is very important that we stress for any anxious parents listening that, when talking about a delay in the opening of the new hospital premises, no child is being denied any care; rather, they are receiving the care that they need to the highest standard.
Turning to the decision to delay the opening of the Royal hospital for children and young people, I think it important to ensure that the facts are put on the record this afternoon in relation to the timing of the decision and the substantive reasons for it.
It could not be clearer from paragraph 2.2 on page 10 of the KPMG report that the issue of the ventilation problem
“was brought to the attention of the”
Lothian NHS Board
“on 1 July 2019”.
The report also says that there were four missed opportunities and that those issues were first looked into in July 2017.
I think that the member will find that that issue was in relation to whether the technical specification error should have been discovered. KPMG’s conclusion is quite clear, and I refer the member to that again.
The health secretary was advised of the matter on 2 July 2019 and therefore acted entirely properly and with all due speed in announcing on 4 July her decision to delay the opening of the new hospital. She acted timeously in setting in train the actions required to rectify the problem.
I turn to the substantive issues that are involved. It is, as I have said, also clear from the KPMG report that the problem leading to the decision to delay, which was intimated to Lothian NHS Board on 1 July 2019, involved an error in the tender specifications. Specifically, the environmental matrix that formed part of the tender documentation contained elements that were inconsistent with the Scottish health technical memorandum 03-01 as far as air change rates were concerned in some of the critical care areas of the new hospital.
That error was embedded in the tender documentation and was subsequently carried over into the implementation of the contract. That begs the question why the error was not picked up. As I said in my earlier intervention, it is difficult to see at this stage how ultimate responsibility could lie with anyone other than NHS Lothian—it is the contracting authority; that was its tender document.
The health secretary’s announcement of a statutory public inquiry is very welcome, because we must understand what happened with this building project and ensure that it does not happen again.
As I said at the outset, patient safety is the paramount consideration in all our hospitals; that should be the foremost consideration in each of our minds today. I hope that the public inquiry proceeds apace; I hope, too, that it does not impinge in any way on the speedy rectification of the technical issues that were identified at the Royal hospital for children and young people and the QEUH in Glasgow. In that regard, I commend the health secretary for listening to the views of the families affected and for acting decisively in response.
We need a new children’s hospital in Edinburgh. The sick kids hospital is a cherished institution in my constituency, but it has suffered from years of a make-do-and-mend approach, based on promises of a new building that have gone on for years, if not decades. Miles Briggs was absolutely right to say at the beginning of the debate that parents are angry. I am sorry if George Adam, who is no longer in his chair, thinks that that is a “petty” point. It is not a petty point; it is a personal point, because I am one of those parents. My daughter spent four months in the sick kids, and I know how compromised that building is and how badly a new one is needed. That is why we need an inquiry.
We should welcome the KPMG report, which is a useful document that tells us what happened. It shows that the contractor relied on a document that was supplied by the health board and which contained an error and that, subsequently, the health board regarded that document with a £16 million typo as not its document. The consequence was that rooms were built with substandard ventilation of four cycles per hour rather than 10. That was compounded by the fact that, either by oversight or by miscategorisation, it was not realised that those same rooms were four-bed rooms.
The question is, how did that happen? Could or should the issue have been spotted? The KPMG report is clear that there were four opportunities when it could have been spotted. In the official version—the one that we have just heard from Annabelle Ewing—the board did not know until June and the Scottish Government did not know until July, 100 hours before the new hospital was due to open. However, that is not true. The report states that, back in July 2017,
“it became clear that the Hospital would not be opening on time”,
as a result of three issues, including ventilation. That was two years before the decision was ultimately made.
I am afraid that I do not have time now, but I may give way after I have made this point.
What was known and when? In July 2017, a paper went to the programme board, on which the Scottish Government had a seat, following discussions with the clinical teams about the ventilation for those rooms. Through 2018, workshops were held with clinical teams. At the end of all that, in February this year, the agreed resolution was arrived at, with a cost of £12 million. Item 7 of that agreement specifically mentions ventilation in four-bed rooms, four of which were in critical care.
We now know what was known, but who knew it? The report states that the clinical management team included “a Director”, an “Associate Medical Director” and a “Nurse Director”. Ultimately, the agreement was signed by the board. The decision and discussions involved board members and the programme board, which included someone from the Scottish Government. The reality is that those groups knew that there were issues with ventilation and that those issues impacted four-bed rooms, but they failed to join the dots. What is more, the Scottish Government knew that, too, because it had a seat at the table. It is not good enough for the Scottish Government simply to say that it did not know, because it should have known. It is not good enough for the Scottish Government to say that it was not always in attendance at the meetings or that it was not an expert, because the information was there if the Government chose to interrogate it.
Even if we accept the Government’s points, it is clear that it missed at least three key opportunities. The issues at the Queen Elizabeth hospital were known about. Surely ventilation issues in a hospital that was built by the same contractor should have been a red flag. In the autumn before the new children’s hospital was due to open, when hot water was flooding into the basement, maybe ministers should have woken up and thought to ask questions about how the hospital was being constructed. Maybe at the point when an agreement was signed that specified that there were ventilation issues at a cost of £12 million, the Government should have sat up, taken responsibility and asked what was going on.
That is what needs to happen with the public inquiry. Ultimately, ministers need to take responsibility for the conclusions that the inquiry arrives at.
In closing, I will attempt to address some of the issues that have been raised.
Let me start with the public inquiry and whether it will be restricted in nature. I repeat that it is a statutory public inquiry, and the nature of such an inquiry is that the chair of the inquiry will have some say in its remit. Mr Sarwar helpfully set out the range of issues that the inquiry should cover. I take on board all those issues, which, of course, include the role of the Scottish Government and the relationship between national Government and our health boards up to now in terms of how infrastructure projects are taken forward.
I was asked about investment to upgrade the current sick kids hospital. Last week, I gave a total figure for the anticipated additional cost of the work to be done to rectify mistakes and correct issues on the new site and for maintenance and improvements on the existing sites, which I believe comes to just over £16 million—I think that we have issued that information to Mr Johnson. There is additional maintenance for both existing sites, at a cost of £2 million, and the cost of additional equipment and other matters for both sites runs to about £3.7 million. The other numbers relate to the work that needs to be done on the new site as well as to advice on technical and legal issues.
On the point about the ventilation issues in 2017, with which Mr Johnson finished his speech, that was part of the settlement agreement. It was an additional issue to the ventilation issue that came to my attention on 2 July and which caused me to halt the move. Of course, all those matters are—
Cabinet secretary, I am afraid that you are blaming Mr Johnson for what Mr Findlay is doing, but I do not think that either of them is happy.
I should have known that it was Mr Findlay. I will take an intervention from Mr Johnson.
Will the minister accept that the settlement agreement related to the four-bed rooms, four of which were in critical care?
Yes, that is my understanding, but it did not relate to the overall critical care unit. Mr Johnson and I can go back and forward on this; I am not trying to hide anything. I assure Ms Ballantyne that I am not looking for heads to roll—although I have a funny feeling that, given their comments, some members are looking for my head to roll.
Let me say clearly that all those issues will be examined in the public inquiry, the remit of which will cover the areas that Mr Sarwar set out, and that I will come back to the chamber with all the detail.
No, I cannot, I am sorry. I have only two minutes left.
On sequencing, Mr Cole-Hamilton and Ms Ewing expressed concern that the public inquiry should not throw off track the work that is necessary to get the new site ready in the timeframe that I gave last week. I will have clear oversight in that regard and I am assured that, although the establishment of the public inquiry will not be held up, the focus alongside that will be on ensuring that the work that needs to be done to secure a safe move to the new site is undertaken.
This is a small point about the Queen Elizabeth review: it is not entirely accurate to say that the two co-chairs of the review team spent six months doing nothing. During that six months, they were reviewing evidence and talking to people. They now move to the formal process of taking verbal evidence. They have been working to try to understand a range of complexities. Of course, what they do and what they conclude will inform the public inquiry.
Finally, I want to thank all the staff involved, not just at Queen Elizabeth but at the sick kids and the DCN in Edinburgh. As everyone has said, they deliver the highest possible quality of care, every single day, and it is entirely wrong that their work is diminished in any way by buildings that are not fit for purpose.
The public inquiry and our moves to change the relationships between what local health boards do, given their responsibilities, and what Government does, in creating the new national body, are entirely the right things to do. I will ensure that the Parliament and individual members are kept up to date with all the progress that we make on all this.
Why, whenever there is a crisis such as the continuing mismanagement of key NHS hospital construction projects, is it left to the Opposition to drag the Scottish Government into the chamber and force it to answer? It is never done in Government time. Avoidance and deflection seem to be the priority and, if you want any evidence of that, all you needed to do was to listen to how George Adam and Kenneth Gibson managed to humiliate their front bench. For Kenneth Gibson’s information, health is devolved, and it has been devolved to this Parliament for 20 years.
Making mistakes is part of life. Making the same mistakes, especially given the seriousness of the consequences in this case, is unforgivable. We had the crisis at the Queen Elizabeth and then the situation at the Edinburgh hospital for sick children, and they have been built by the same contractor. As has been asked several times in the chamber, who is accountable for that?
At the weekend, I spent some time speaking with a senior clinician from the Queen Elizabeth hospital, who suggested that problems are being covered up. He explained that there is a cancer patient who, while in remission, got the news that their cancer had returned and that they would need further treatment, only to find out that they could not have that treatment because they had fallen victim to the same infection that has affected so many others in that hospital.
As Miles Briggs asked, where does patient and staff confidence sit, cabinet secretary? While you dithered, public confidence went through the floor. Now, at long last, we have the announcement of a public inquiry.
We are talking about whistleblowing and a sea of clinicians being told to stay quiet.
Give me two seconds.
Given all the work that has been done on whistleblowing in the Parliament, and the fact that bullying has been raised over and over again, how can we ensure that there is an ability to share information and learn from those mistakes if people are told to stay quiet?
In what was a very good speech, Anas Sarwar suggested that, in a planning phase, especially in ventilation and water supply, infection control experts would surely be a prerequisite—apparently not. The same contractor that made mistakes in Glasgow made similar mistakes in the sick children’s hospital in Edinburgh.
No lessons have been learned. There is no opportunity to do so. We have to accept that there is a fundamental issue with public procurement in capital projects.
The member talked about looking at contractors and construction projects. Does he agree that we should look at the fact that the brand new £200 million hospital in Dumfries and Galloway was on time and in budget? Perhaps we should also consider that hospital, which was also a Scottish Government project.
Before I call members, I ask that you do not use the term “you”, please. I can use it, but you should not.
Five hospitals have been mentioned. I have to say that two out of five is not a good hit rate.
Jean Freemen inherited many of these problems, so it would be crass to lay the blame for those initial catastrophes at her feet. That responsibility has to lie with previous health secretaries, including Nicola Sturgeon. It was important to give the cabinet secretary the space to formulate a response. However, the responses—or lack thereof—are most definitely her responsibility. One could suggest that announcing an independent inquiry the day before the issue is due to be debated in Parliament is a cynical attempt to deflect criticism, especially given that members from across the chamber have been calling for an inquiry for quite some time.
Also, as Miles Briggs and others highlighted, the cabinet secretary dismissed a call for an inquiry just last week. If one was really cynical, one might even suggest that the Scottish Government was scrambling to avoid any bad publicity on a day such as this.
As the KPMG report highlighted, and as Daniel Johnson listed, there have been so many opportunities to intervene in the crises in the Queen Elizabeth hospital in Glasgow and in the Edinburgh sick children’s hospital. That restorative action never happened. How many times prior to today could the Scottish Government have stepped in on the sick children’s hospital in Edinburgh? Surely proper scrutiny by the Government would have recognised that there was such a serious issue.
Who is accountable? Somebody has to be. Michelle Ballantyne and Alex Cole-Hamilton asked whether the Scottish Government is prepared to accept whatever the public inquiry uncovers because it cannot be a ploy for the Scottish Government to buy time while it scrambles for answers. For the sake of patients and staff, I can assure you that we will not allow that to happen.