Meeting of the Parliament

Meeting date: Tuesday, May 16, 2023

Official Report 1001KB pdf

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Urgent Question

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NHS Grampian (Baird and ANCHOR Units)

To ask the Scottish Government what its response is to reports that NHS Grampian was warned about, and failed to address, “significant” issues on the Baird and ANCHOR—Aberdeen and north centre for haematology, oncology and radiotherapy—units almost three years before announcing delays.

National health service boards are responsible for the commissioning and day-to-day management of their capital projects. Previous experience found that the nature and complexity of those projects meant that an additional layer of external assurance was needed to ensure that the specialist requirements of such healthcare facilities and their sites are fully addressed. That is why we created NHS Scotland Assure in June 2021 to provide critical oversight for projects being carried out by local health boards.

The report that is being referred to today was conducted by NHS Scotland Assure and demonstrates the value of it having a greater role in such projects. A crucial element of any large capital project is on-going review and refinement of the agreed design, in particular the mechanical, electrical and infection prevention and control aspects. Those are now all independently reviewed by NHS Scotland Assure for projects that are carried out by local health boards.

What will hugely concern the people of the north-east is that this situation was warned about three years ago and patients are paying the price. Despite members of the Scottish Parliament requesting details of the assessment from 2020 that there were problems, it has taken a freedom of information request to drag that information out today. When was the Scottish Government first made aware that there might be issues with the ventilation systems? I am not asking about the report, just about Government awareness. What action was taken by the Scottish Government following that awareness?

I can only refer to the report that I am aware of, which is the report that was carried out by NHS Scotland Assure, which was established by the Scottish Government to undertake the type of key review work that is necessary for complex NHS facilities of that nature. It is now the responsibility of the local NHS board, which is now carrying out the project and ensuring that the report’s recommendations are effectively implemented.

The other aspect that I can assure members about is that no new NHS facility will open until it has completed the final checks for which NHS Scotland Assure is responsible. That is to make sure that once the facility is open, it complies with all the necessary standards that are set and that it meets the required level of patient safety.

I assure the member that we are determined to make sure that NHS Grampian learns lessons from this situation and that it implements the recommendations in the NHS Scotland Assure report.

The cabinet secretary, of course, avoided the question of precisely when he became aware. I suspect that is because he is basically admitting that he has not been made aware, which is an extraordinary admission of a lack of involvement and interest on the part of this Government, especially given that this is far from the first hospital project to be beset by infection control problems—one thinks immediately of the Queen Elizabeth in Glasgow and the Edinburgh sick kids. I appreciate that the cabinet secretary is new in post, but his two predecessors presided over what are now four projects that had patient safety problems, overran in time and bust their budgets. What consequences will former ministers face for their incompetence? Precisely what steps will the Scottish Government take to understand the causes of and learn lessons from those failures?

Given the length of time that he has been in the Parliament, I am somewhat surprised at Mr Kerr’s lack of knowledge of how NHS capital projects are carried out. Local health boards are responsible for the delivery of NHS capital projects. If the member was listening to my answer, which I suspect that he was not, he will have heard that we set up NHS Scotland Assure back in June 2021 specifically to address issues around complex health projects being delivered effectively. That is exactly what it is there to do and its report demonstrates the effectiveness of that process, which is why NHS Grampian is responsible for carrying out its recommendations.

It is concerning that we have another hospital with serious health and safety issues. An inquiry is currently investigating the construction of Scottish hospitals including the Scottish Government’s flagship hospital, the Queen Elizabeth university hospital.

Patients and staff will rightly be outraged by the latest development in NHS Grampian. What discussions, if any, have been had with trade union colleagues to ensure that the workforce has confidence in the safety of the hospital that it will be expected to work in?

Carol Mochan raises an important issue. However, let us deal with the way in which the matter is dealt with at the local level.

The NHS board is responsible for taking forward and delivering the capital project. In June 2021, because of experience with some other capital projects that were being taken forward by boards, including at the Queen Elizabeth university hospital and the sick kids hospital in Edinburgh, we created NHS Scotland Assure, which has the responsibility for providing the final level of oversight of how an NHS board takes forward a project. Its review of the NHS Grampian project identified a number of areas in which actions now need to be taken in order to address the issues that it highlighted around infection control measures and ventilation aspects. It is now for NHS Grampian to ensure that those actions are implemented.

There is a final process that that project will have to go through before it can start to receive patients, which allows NHS Scotland Assure to check that the recommendations have been implemented. In effect, that assures it that the actions that it has recommended have been implemented to make the environment safe for staff and patients. People can have that level of assurance right from day 1, including Carol Mochan’s colleagues in the trade unions.

NHS Scotland Assure was established by the Scottish Government to improve the quality and management of healthcare construction and refurbishment projects across NHS Scotland. How can it be used to ensure that we have the wide range of skills and expertise—not least expertise in ventilation engineering—required for the construction of those particularly complex structures?

Healthcare establishments are complex capital projects that require a significant level of specialist technology to be deployed within them for a whole variety of reasons, particularly in clinical settings, from theatres to intensive care units. They all require specialist equipment and ventilation and other infection control measures to be implemented.

We set up NHS Scotland Assure to provide us with confidence that boards, in delivering projects, are implementing the right measures in order to ensure that the buildings comply with the standards and guidance that have already been set out for healthcare establishments. NHS Scotland Assure provides expertise to all boards in order to give them the confidence that they need that the buildings meet the required standards. It is there to support all our health boards throughout the country in delivering their capital projects. It is extremely important that, when a local health board is taking forward a capital project, NHS Scotland Assure’s recommendations are fully and effectively implemented before the building can be opened to staff and patients.

In the sick kids hospital example, the issue was that a standard of four cycles an hour was applied to four bedrooms rather than 10, and the fact that those four bedrooms had critical care beds was overlooked. It sounds like a similar mistake was made in this instance.

As the cabinet secretary has said, NHS Scotland Assure has picked up a mistake, but a mistake was made nonetheless. Is there an issue with the way in which standards are held or with the way in which those standards are implemented in the design and planning of hospitals, such as the Aberdeen one?

Daniel Johnson raises an important point. There are a couple of factors. One is that the project predates some of the changes to guidance recommendations that have been implemented since we learned lessons from Edinburgh and Glasgow. There is a crossover between those projects and the application of the new standards. Obviously, there is also the creation and implementation of NHS Scotland Assure, which started in June 2021.

I have already flagged up through my office the need for us to ensure that, at the very outset, when NHS boards are taking forward projects, they are very clear about the process and the standards that they are expected to meet. That is what I am looking for. Of course, sometimes those might be revised during the course of a major capital project, such as the one in NHS Grampian, but it is important that boards are alive to those and respond to them immediately rather than waiting for the implementation of the key review process from NHS Scotland Assure. I have asked for assurance that all boards that are taking forward capital projects are aware of those. Equally, it is reassuring that the NHS Scotland Assure process identified the issue and has been allowed to flush it out at a stage that allows the board to take the rest of the action to address those concerns.