Queen Elizabeth University Hospital

– in the Scottish Parliament on 2nd December 2021.

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Photo of Anas Sarwar Anas Sarwar Labour

2. Yesterday, Kimberly Darroch, who lost her daughter Milly four years ago, and Louise Slorance, who lost her husband Andrew a year ago, said that “enough is enough” and that the Government needs to decide whose side it is on—the side of patients, families and staff or the side of a failed health board leadership. Shamefully, the Government chose the wrong side.

Photo of Anas Sarwar Anas Sarwar Labour

Exactly—it is not a game, Mr Gray.

Whenever there is a serious infection, an urgent alert is sent to the Cabinet Secretary for Health and Social Care. It is called a HIIAT red warning. In the closing seconds of his speech in yesterday’s debate, the health secretary said that he had received three HIIAT red notices from the Queen Elizabeth university hospital since becoming health secretary. After weeks of such questions being asked, can the First Minister tell us what infections those three red warnings were for, what date they were received and what action the Government took?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I will come back to that; I can certainly provide information on that. First, however, I want to address a number of issues. I apologise if I take a bit of time with this answer, because those issues are really important to patients and their families across the country. I absolutely understand the questions that Kimberly Darroch and Louise Slorance have and their determination to get answers. I want to get them the answers to their questions. If I was in their position, I would be doing the same, as the family member of somebody who had lost their life.

Anas Sarwar has raised a number of concerns about the Queen Elizabeth university hospital. I want to briefly go through those and, in the process of doing that, I will answer the question that he has asked.

First, on the suggestion that the hospital is somehow unsafe and that there is a higher risk of infection there than anywhere else, evidence does not bear that out. Whether that evidence is hospital standardised mortality ratios or published reporting of hospital-acquired infection, the Queen Elizabeth performs better than the national average and better than many other hospitals. In addition—this is an important point—Scotland as a whole has a lower prevalence of HAI than the European average.

Secondly, the suggestion that there is a systemic problem at the Queen Elizabeth that is causing infections has always been taken seriously. That is why the independent review was commissioned; it is why the case note review was commissioned; it is why the oversight board was established; and it is why there is now a public inquiry and, of course, criminal investigations into some of the cases in question. Anas Sarwar derides all that as process, but much of it is process that he demanded. More important, all that process has led to improvements on the ground.

We take all this seriously, but the very difficult fact is that, despite best efforts to minimise the risk, no hospital anywhere in the world can eradicate completely the risk of infection in very sick patients.

I cannot go into the detail of individual cases, but after last week’s First Minister’s question time, I asked NHS Greater Glasgow and Clyde to do an internal review. It has advised me that, based on the work that it has done so far, there is no child who had Aspergillus noted on their death certificate as a direct or contributory cause of death. We are not resting on that. Healthcare Improvement Scotland has been asked to carry out a wider review.

On the issue of the HIIAT assessments, it is important to recognise what those signify. I think that, last week, Anas Sarwar gave the impression that, when one of those notices comes to Government, that signifies a death in a hospital. In fact, it signifies two or more cases of infection that are linked in some way. Red and amber ones come to Government. From 25 November last year to 1 December this year, two red and one amber one came to the Government from the adult Queen Elizabeth hospital. The dates of those were 12 January this year, 7 May this year and 23 June this year. I do not have the information on what infections were involved, but I can get that and provide it.

The point that I want to end on goes to my first point about the suggestion that the Queen Elizabeth is somehow an unsafe hospital. In the same timeframe as those three alerts were made in relation to the Queen Elizabeth, 45 were notified across Scotland as a whole. I will give some context around that. The Queen Elizabeth represents more than 11 per cent of all adult acute beds in Scotland, but less than 7 per cent of the HIIAT notifications.

We take all these concerns very seriously, but it is also important that politicians do not come to the chamber and try to erode confidence in the quality of care that is provided by dedicated clinicians in the Queen Elizabeth hospital every single day.

Photo of Anas Sarwar Anas Sarwar Labour

It is worth noting that, yesterday, we had a debate in the Parliament in which the health secretary had the opportunity to bring those facts to the Parliament but did not. The First Minister did not bother turning up for the debate and did not even bother voting on the motion for the debate.

It is also important to note that, although we are talking about processes, we are looking for the accountability and responsibility that come with those processes. To this day, not a single person has been held accountable.

I am pleased that the First Minister referred to the need for the HIIAT warning not to be about deaths but, crucially, to be about infections.

The First Minister:

It always has been.

Photo of Anas Sarwar Anas Sarwar Labour

I agree with the First Minister, but she needs to understand what is happening in that health board. The First Minister is either not being told the truth, or she is hiding the truth. I prefer to believe the first. I think that the health board is not telling the First Minister the truth. That is really serious. Jeane Freeman recognised that during the previous parliamentary session. We are talking about infections, not deaths. When those infections happen, they should be notified so that the Government can take the necessary action.

Let me give an example. While the First Minister hides behind process, and behind a public inquiry that could take three more years, patients are still getting infections and lives are still being lost. In the Parliament, I have talked about cases of Aspergillus and Stenotrophomonas. Those cases should trigger HIIAT red warnings.

Yesterday, I spoke to a mother who recently and tragically lost her six-month-old baby. The child was in the intensive care unit at the children’s hospital on the Queen Elizabeth university hospital campus. The mother showed me the death certificate. Listed as a cause of death was Serratia, another deadly bacterium linked to water and to the hospital environment. What the First Minister has said indicates that that death did not trigger a HIIAT warning. Serratia is a deadly bacterium linked to water and the hospital environment. That mother asked me to raise her case today. In her words:

“I have no confidence in this health board. I have no confidence that action will be taken. It is inevitable it will happen again and other patients will be affected.”

Another child has died and another family is grieving. What will it take before action is taken?

The First Minister:

I will make three points and will make them very genuinely because they are such important issues. My deepest condolences are with the mother whom Anas Sarwar referred to.

Let me be clear. The HIIAT system is about the Government being alerted to cases of infection. When the system is not triggered, that does not mean that no action is taken on individual cases of infection. The reason why the HIIAT system triggers an alert to Government on the basis of two or more linked infections is because that is indicative not of individual and isolated cases of infection but of a potential infection outbreak that should trigger a higher level of response.

I come back to isolated cases of infection. I find this difficult to say because it is such a hard fact, particularly for the parent or relative of someone who has died of an infection, or of someone who has got an infection in hospital, even if that did not contribute to the person’s death. I know what that feels like. Many years ago, my grandmother got an infection in hospital before her death. The reality for every hospital across the world is that, despite the best efforts and the highest quality of care, it is not possible to prevent every case of infection in very sick patients with compromised immune systems. That is why the HIIAT system is in place. Of course, we review such systems all the time.

Secondly, I will talk about process. I am not hiding behind anything and I am certainly not hiding behind process. The processes that are in place are important. I repeat the point that I made earlier. Anas Sarwar called for many of those processes, including the public inquiry. We are not waiting for that to conclude before we do anything. Look at the recommendations of the independent review of the fabric and maintenance of the hospital, which was commissioned by the Government, or at the recommendations from the oversight board. In the first case, 98 per cent of those recommendations have been implemented, in the second 88 per cent. There has been significant investment in specialist ventilation and water systems in the affected wards. Action is being taken all the time.

I come back to the point that I made earlier. Every case of infection is serious. When we look at all the evidence, the Queen Elizabeth has a lower incidence of infection than many other hospitals, although it is a big hospital providing specialist care.

I know that I am taking time on this, but it is so important. Lastly, there has been a suggestion of a cover-up. That issue was raised and addressed in the letter that 23 senior clinicians wrote yesterday.

I know from my experience as health secretary, from my experience as First Minister and from my experience as a citizen and, at times, a user of the health service how seriously clinicians take their duty of candour and honesty to patients. The Government takes that so seriously that we changed the law to make the duty of candour a legal obligation. I have confidence in clinicians.

If the allegation is, as it appears to be, that health boards, or in this case the Greater Glasgow and Clyde health board is pressurising, bullying or telling clinicians not to be honest with patients, then my message—not to Anas Sarwar, but directly to every clinician across greater Glasgow and Clyde and across the country—is that, if they feel that they are in that position, they should raise that in any way that they see fit and they should come to me directly, because that is not and would not be acceptable.

These are serious issues. Let us treat them seriously, as this Government does, but let us not erode confidence in a hospital that is providing a high quality of care. Sending out photographs of mould without saying that they are from four and two years ago, that it has been rectified or that the report that included those photographs in the first instance made it clear that patient care was not affected—that is what Anas Sarwar did yesterday. I think that that crosses the line from raising legitimate issues to trying to undermine confidence in a hospital and in hard-working clinicians.

Photo of Anas Sarwar Anas Sarwar Labour

I listened to what the First Minister said and I will address a couple of those points, but first I say that she should listen to the words of Dr Christine Peters, who was one of the whistleblowers at the start of this crisis. What did Dr Christine Peters say? “Do not gaslight” the entire staff base of the Queen Elizabeth university hospital in order to protect the jobs of a few at the top. No one is questioning the confidence in the front-line staff. What we are questioning is the confidence in the leadership of the board. This fight is as much about the staff as it is about the families and the patients.

I accept that we cannot stop every single hospital-acquired infection, but what we know has happened at the

Queen Elizabeth university hospital shows that a grip needs to be taken on the situation. If it were me, I would be saying to the health board, “Every single time there is a serious infection, I want to know about it so that we can make sure that we are taking the necessary action and we do not make the same mistakes again.” I would not be trying to hide behind some process, which is exactly what is happening in this case.

Why is the First Minister not getting a grip on the health board, so that we know every single time there is a serious infection related to the water and the hospital environment and action can be taken? The problem here is not those who are asking the difficult questions, but those who are making the wrong decisions.

The First Minister says that moving the health board into stage 5 would be a step too far, but in 2018 she escalated NHS Tayside into emergency measures. She sacked the chief executive and the chair, and that was for financial mismanagement. In greater Glasgow and Clyde, children have died and are still dying, yet not a single person has been held accountable.

No more hiding behind process. No more blaming of staff. No more waiting for the findings of a public inquiry in the distant future. Families cannot wait that long. The First Minister made the wrong choice yesterday, and we have heard today that there are still patients dying in the hospital after contracting infections. I shared a new case today.

For the sake of the staff working tirelessly to save lives, for the sake of the families who have lost loved ones, for the sake of patients in Glasgow and across Scotland and for the sake of all those who have had to share their heartbreaking stories, will the First Minister please listen, act and do the right thing?

The First Minister:

I will try to cover all the points that were raised there under three broad headings, as briefly as possible. I am probably betraying my age here, but I am never entirely sure what gaslighting exactly means in practice. However, I am not blaming staff. Nobody is blaming staff. The letter that was written to me and the health secretary yesterday was from clinicians and clinical voices—the head of medicine, medical directors and people who are part of the clinical community.

The point is this—and this is not blaming staff; this is recognising a reality. When individual patients or their families are communicated with, it is not a health board that communicates with them; it is clinicians. I have the utmost confidence in the way in which clinicians do that and the seriousness with which they take the duty of candour and honesty to patients. The point that I am making, though, is that if any clinician considers that they are being pressurised into doing something different, bullied into doing something different or told to do something different, they should not hesitate to bring that directly to me or to the health secretary. We will not tolerate that.

The second point is about hiding behind process. Anas Sarwar called for the public inquiry and it is right and proper that that happened. There is a criminal investigation on-going into certain cases. The independent review and the oversight board were important pieces of process that led to many recommendations that have been implemented and to real investment in the water and ventilation systems at the hospital.

I come back to this point, which will lead me into my last point. In saying this, I am not minimising the seriousness of every infection, but the Queen Elizabeth hospital, in published statistics on infection and standardised mortality data, actually performs better than the national average. That shows that some of the actions that are being taken are working. Clinicians in that hospital deliver a high quality of care across a very complex range of treatments.

That takes me to my final point, which is on the “sack the board” cry. This is really serious—

Photo of Anas Sarwar Anas Sarwar Labour

There is a criminal investigation.

The First Minister:

There is a criminal investigation under way. [



Presiding Officer, Anas Sarwar is, from a sedentary position, asking me who has behaved criminally. That is what a criminal investigation is intended to find out: whether anybody has behaved criminally and, if so, who and in what way. That is a really irresponsible thing to shout across the chamber.

The final point is this. If I thought for a minute that simply removing the health board would change anything on the ground in the Queen Elizabeth, or that the health board was the problem and that improvements were not being made because they were being blocked by the health board, I would remove it without hesitation. However, removing a health board, given everything that I have said about the work that is being done, in the middle of a pandemic and a vaccination programme, would not be the responsible thing to do. The responsible thing for Government to do is to work with the health board to continue to make the improvements and continue to ensure that in the Queen Elizabeth hospital, and in every hospital across the country, high-quality care is provided. That is what we do every day.

Photo of Alison Johnstone Alison Johnstone Green

Before we move on to supplementary questions, I wish to make members aware that First Minister’s question time will continue until 12:55 approximately.