Meeting date: Wednesday, December 1, 2021
Meeting of the Parliament (Hybrid) 01 December 2021 [Draft]
Agenda: Portfolio Question Time, Queen Elizabeth University Hospital (Patient Safety), Ventilation in Schools, Point of Order, Scottish Land Commissioners, Business Motions, Parliamentary Bureau Motions, Decision Time, World AIDS Day 2021
- Portfolio Question Time
- Queen Elizabeth University Hospital (Patient Safety)
- Ventilation in Schools
- Point of Order
- Scottish Land Commissioners
- Business Motions
- Parliamentary Bureau Motions
- Decision Time
- World AIDS Day 2021
Queen Elizabeth University Hospital (Patient Safety)
I remind members of the Covid-related measures that are in place, and that face coverings should be worn when moving around the chamber and across the Holyrood campus.
The next item of business is a debate on motion S6M-02327, in the name of Anas Sarwar, on protecting patient safety at the Queen Elizabeth university hospital. I ask members who wish to speak in the debate to press their request-to-speak buttons now, and I call Anas Sarwar to speak to and move the motion.14:46
This morning, I met Kimberly Darroch, whose daughter Milly died four years ago, and Louise Slorance, whose husband died last year. They, like a number of families, are watching this debate.
Two years ago, I stood up in this Parliament and exposed the failures at the Queen Elizabeth university hospital in Glasgow. What has been uncovered in the two years since is a human tragedy on an unimaginable scale. It is beyond doubt the biggest scandal in the lifetime of this Parliament. Reaching where we are today has been possible only because of the bravery of senior clinicians who are willing to whistleblow. The response from the health board two years ago came from the same playbook that it is attempting to use now: cover-ups, spin, denials, bullying, silencing and calling into question the integrity of senior clinicians and families.
Let me start with a direct message to the front-line staff at the Queen Elizabeth university hospital. I thank you for everything that you are doing. I have every confidence in you and know that you are working day and night to do your best for your patients. I have no confidence in the leadership of your health board. You deserve leadership that does not try to silence you or bully you. Perhaps most of all, you deserve management that does not disgracefully attempt to spread the blame to staff, as we have seen this week. I know that they are letting you down, and this fight is as much for you as it is for patients and families.
I say this directly to the health board leadership. Listen to the words of Dr Christine Peters: “do not gaslight” the entire staff base at the Queen Elizabeth university hospital in order to protect your jobs at the top. Do not underestimate the resolve of the staff, patients and families. They cannot be silenced and they cannot be managed away. I have spoken to them and I have made them a promise—as a representative, but, more importantly, as a father. I will not stop, I will not go away and I will not rest until I get the answers and the justice that patients, families and the staff deserve.
Today, we are drawing a line in the sand. In the words of Kimberly Darroch and Louise Slorance, enough is enough.
Members of the Parliament have a choice of siding with patients, families and staff or with the health board’s failed leadership. For the sake of the dedicated national health service staff, the patients at the hospital and the grieving parents, and in memory of those who have lost their lives, I implore every member in the chamber to please send a message to the health board’s leadership that the Parliament has no confidence in them and to support escalating the board to the highest emergency level without delay.
This has been a two-year fight for justice. In that time, three water reports that flagged the risk as high have been ignored; staff have been bullied and silenced; patients have got infections; and more patients have died—in one case, a family found out the cause only because of the bravery of whistleblowers, and in another case, a family still do not know how their child died, because the health board has not contacted them.
We have had wards closed, an independent review, a case note review, a public inquiry and criminal investigations. Families still have to fight the system to get the truth and still have to tell their tragic stories in newspapers to get answers from the Government and the health board. People are still dying from preventable hospital-acquired infections.
In the two years, not a single person has been held to account, so I have direct questions for the health secretary. How many healthcare infection incident assessment tool red warnings has he received from the hospital since he became health secretary? When did he receive them? If the answer is none, why not? What questions have been asked about that? If the answer is that warnings have been received, how many have there been, when were they received and what action did the health secretary take? The crucial question is this: how many more deaths, how many more heartbroken families and how many more tragic stories will it take before the Government loses confidence in the health board’s leadership?
There is the chance today for everyone in the Parliament to show that we believe and stand by the NHS staff and to show that we support the patients and the parents who have lost loved ones and will seek justice for them. As I said at the start, Kimberly Darroch, Louise Slorance and many other families are watching the debate. They want to know what side members of the Parliament are on. I know which side I am on. The question for every member in the chamber is: what side are you on?
That the Parliament has no confidence in the leadership of NHS Greater Glasgow and Clyde, and believes that the Scottish Government must escalate the NHS board to Stage 5 of the performance escalation framework without delay.
I call the minister, Maree Todd, to speak to and move amendment S6M-02327.2. [Interruption.]
I will sum up. Do not worry—I will respond to questions. I will take interventions, too.
Excuse me—could we have less chatting from a sedentary position across the chamber? I have called the minister, who is on her feet to speak, so that is a huge discourtesy to her.14:53
My thoughts and condolences are with all families who have lost a loved one while they were in the health service’s care.
Various claims have been levelled against NHS Greater Glasgow and Clyde, and we have worked throughout to ensure that they have been investigated and, when necessary, acted on. When we consider individual claims, it is vital for specific consent to be given on an individual basis before comments are made. It would be totally inappropriate for me or any other member to discuss cases when such consent from the families who are involved was not explicit. Members may be aware of a letter from clinicians at the board who have stressed that point.
Serious claims have been made about Aspergillus in the Queen Elizabeth university hospital. That is why the health secretary has tasked Healthcare Improvement Scotland with undertaking a wider independent general review of Aspergillus in the QEUH to assess and determine whether there are broader concerns that require action. Any recommendations from that work will be implemented as quickly as is practicable.
As members will be aware, an independent review of the QEUH was commenced in March 2019 and was followed by the establishment of a statutory independent public inquiry, led by Lord Brodie QC, in September 2019. That public inquiry is now fully under way and I look forward to its conclusions and any recommendations being fully enacted.
Members will also be aware that NHS Greater Glasgow and Clyde was elevated to stage 4 of the NHS board performance escalation framework in November 2019. In order to provide independent scrutiny of the board, a QEUH oversight board was established at the same time, followed by a case note review in January 2020.
The investigations and reviews of recent years have led to a substantive programme of recommendations being implemented in the board and the hospital. That has meant that, of the actions for the board, 98 per cent of the independent review recommendations have been completed and 88 per cent of the oversight board’s recommendations have been completed—importantly, none of the small number of outstanding actions relates directly to patient safety. Further, 100 per cent of the actions in the case note review have been completed. An update on outstanding and continuing actions has been requested at the next meeting of the assurance group. We will work with the board to determine how progress against the recommendations can be shared more widely than current reporting mechanisms allow.
Scotland is the only country in the United Kingdom with a national reporting system for incidents and outbreaks. Funded by the Scottish Government, the evaluation of cost of nosocomial infection project team’s recent study identified Aspergillus as representing 0.68 per cent of all healthcare associated infection. Within Europe, it was estimated at the time of survey in 2016 that 6.5 per cent of patients who are treated in an acute care hospital have an HAI. In Scotland at that time, the overall point prevalence of HAI was 4.5 per cent of acute hospital patients.
In NHS Scotland more generally, the latest hospital standardised mortality ratio—HSMR—provides a measure of mortality adjusted to take account of some of the factors known to affect the underlying risk of death. The latest statistics show that QEUH is below the Scottish average for HSMR, as again has been observed in the letter from clinicians. [Interruption.]
The minister is in her last minute.
Immense progress has been made in Scotland since the world-leading Scottish patient safety programme was launched in 2008. Since then, the programme has influenced the safety of care in Scotland by delivering reductions in HSMR by 14 per cent; the cardiac arrest rate by 29 per cent; sepsis mortality by 21 per cent; neonatal mortality by 15 per cent; and paediatric ventilated associated pneumonia by 86 per cent.
Minister, you are approaching the end of your time.
Although the focus rightly and reasonably relates to the performance of the board against important recommendations and lessons that continue to be learned, there is a very important factor that appears to be too often omitted from the conversations. I note that senior clinicians, doctors and nurses have publicly expressed their anger when their integrity has been called into question without evidence to back up such serious allegations.
In conclusion, where there are concerns they will be investigated and acted upon. [Interruption.]
Excuse me, minister, please resume your seat.
Members will recall that, when I called the minister to speak, there was sedentary chattering going on and I had to interrupt her before she had even started. Let us allow the minister to conclude, and move on with the debate.
Our NHS staff are working incredibly hard and we will continue to do all we can to support them to provide the best care possible for the people of Scotland.
I move amendment S6M-02327.2, to leave out from “has no confidence” to end and insert:
“recognises the work of frontline NHS staff at the Queen Elizabeth University Hospital (QEUH), and across the health service, in the care that they have provided to patients and families throughout the COVID-19 pandemic; offers its condolences to all families who have lost a loved one while in the care of the health service; notes that NHS Greater Glasgow and Clyde was elevated to Stage 4 of the escalation framework in November 2019; further notes that the board has completed 91% of the 108 recommendations that followed the work of the QEUH Independent Review, the Oversight Board Report and the independent Case Note Review; welcomes that Healthcare Improvement Scotland is to review aspergillus infections at QEUH, and calls for any recommendations from this work to be implemented as quickly as practicable; recognises that the independent public inquiry, chaired by Lord Brodie, is underway, and looks forward to its conclusions and any recommendations being fully enacted.”14:59
My thoughts and condolences are with all the families who have been affected by this scandal. I thank front-line staff at the hospital; our criticisms are not of them. I hope that Parliament can agree that it is the direction and the leadership that they are receiving from the health board that need to be addressed.
When the Queen Elizabeth university hospital was first opened in July 2015, the First Minister described it as one of the
“best designed healthcare facilities in the world”.
The then health secretary described the hospital as “state-of-the-art” and said that it would “transform patient care.”
When families watch their loved ones go into hospital, they expect them to receive the world-leading healthcare for which our NHS is so highly respected. They do not expect an NHS hospital to be the cause of death of their loved ones.
It has been two years since whistleblowers first came forward to suggest that children, including 10-year-old Milly Main, had died as a result of contaminated water, yet we still do not have a complete picture of the extent of avoidable deaths at the Queen Elizabeth university hospital or the Royal hospital for children. Years later, we are still reliant on the bravery of the NHS staff who have come forward to tell the truth.
I thank Labour for lodging the motion and for bringing forward this crucial debate. I praise Anas Sarwar for being a persistent champion of the cause of the families, who deserve answers. They need to know how their loved ones were so tragically let down. The Scottish Conservatives will stand with Labour and its motion today.
The health board has utterly failed in its duties, and it is right that board members are removed as part of a systematic changing of the culture across NHS Greater Glasgow and Clyde towards openness and transparency.
However, Scottish National Party Government ministers must restore confidence by showing that they are doing everything that they can to treat the scandal of avoidable deaths with the urgency that it deserves. That means escalating the board to stage 5 of the performance escalation framework now.
Almost a week after First Minister’s question time, we have received a letter of apology and correction from the First Minister. Last week, in response to questions, she said that the health board was already at the highest level. At the end of First Minister’s question time, Jackie Baillie made a point of order, and I watched the First Minister roll her eyes when Jackie Baillie said that there was another level to go to. Six days later, the First Minister has written to Parliament to apologise for her mistake and say that the board could still move to stage 5. That is what we are demanding should happen today.
The health secretary and his predecessor must be held accountable for the actions that they have taken since they first learned of these appalling deaths. As Anas Sarwar did, I will ask the health secretary direct questions. What action has been taken to get a grip of the situation? What action has been taken to encourage openness and transparency? What action has been taken to ensure that the hospital is a safe environment for patients?
It is not good enough to hide behind a public inquiry as an excuse for inaction. It is not good enough to hold professionals accountable, but not the politicians who were elected to oversee the performance of our health service. That is why the Scottish Conservatives, in our amendment, are calling for a further independent inquiry to be held into
“the ministerial response to avoidable deaths at the Queen Elizabeth University Hospital.”
If Government ministers are confident that they have taken every possible action to promote transparency and to take emergency action to prevent further deaths, they will have no issue with backing our amendment.
This is not about scoring political points. Every member in the chamber must understand the anguish and heartbreak of the families who have lost loved ones in this appalling tragedy. I say this as a husband, a father and a son: families entrusted their husbands, wives, mothers, fathers, sons, daughters, brothers and sisters into the care of the health service and were let down.
A hospital is a place where patients are supposed to get better; it was, instead, the cause of their death, and it might still be causing deaths now. How can we deny families the simple request of knowing what went wrong, why this happened and what is being done to prevent it from ever happening again?
Mr Ross, could you conclude, please?
In today’s debate, we cannot give families those answers, but we can commit to finding them and to holding those responsible to account.
I move amendment S6M-02327.1, to insert at end:
“; recognises that ultimate responsibility lies with the Scottish Government, and therefore calls for a further independent inquiry into the ministerial response to avoidable deaths at the Queen Elizabeth University Hospital.”15:04
I rise for the Liberal Democrats to offer our support for the motion in the name of Anas Sarwar. I echo the condolences that have been offered to everyone who has been affected by the tragedies at the hospital.
It is rare that the leaders of all Opposition parties attend such a debate, but the topic that we are discussing is of such public importance, with feelings running deep in our society, that we have all been compelled to lead for our parties.
It is dismaying, then, that the First Minister has not found an hour in her diary to attend Parliament to address the problems at the hospital—a hospital that she commissioned and that serves patients in her own constituency, and one in which problems have gone unaddressed on her watch. I find that contemptible.
Three years ago, we learned about serious safety and cleanliness issues at the QEUH, ranging from grime-damaged facilities to contaminated supplies. At the time, I and others urged that the hospital be put under the closest of surveillance. Evidently, that did not happen. The hospital was opened in 2015 and its construction alone cost £842 million. As we have heard, it was heralded as a superhospital, built to provide the most excellent and efficient healthcare to those who need it.
Ever since its creation, the Queen Elizabeth university hospital has been troubled by problems embedded in the very fabric of the building. Similar problems put a stop to the opening of the new hospital for sick kids in Edinburgh, and millions of pounds and 18 months were spent on putting those problems right. The problems were caught just before the sick kids hospital came into operation, but the problems at QEUH emerged only one by one, in the years after it opened, and they emerged because they were allowed to have a catastrophic impact on patient health.
The failures in standards are shameful, and the fact that such failures have led to loss of life is unforgivable. We have already heard about Andrew Slorance, who was a father of five and a dedicated public servant. Milly Main was just 10 years old when she passed away in the paediatric hospital. Last week, we learned about two other deaths of children possibly linked to infections in that hospital. As the father of three young children, my stomach turns just thinking about that. When anybody uses the hospitals in our country, they entrust their own lives and the lives of the people they care about into the hands of others. No one should expect their life to be endangered—or even lost—not by the condition that they were seeking help for, but by the place of treatment.
Enough is enough. Now is the time for decisive action, which is why the Scottish Liberal Democrats support Scottish Labour’s motion. Those who are responsible must be held accountable, and the NHS board must be escalated to stage 5, accompanied by additional oversight and checks to prevent any further risk to life.
This is not a criticism of NHS staff—anyone who says otherwise is gaslighting those same staff. As Dr Christine Peters said on Twitter last night, the NHS staff working at the Queen Elizabeth university hospital have acted with the utmost compassion, bravery and self-sacrifice, aware that the fabric of the building in which they were operating was harming the patients whom they were trying to support. They deserve our utmost respect, but they, too, have been egregiously let down by mismanagement. It is only because of whistleblowers that we have some of the information that we do have.
As I mentioned, Dr Christine Peters took to social media last night to tell us about the reviews into the whistleblowing. The so-called independent review did not look at a culture of bullying in the health board. Those are the things that we need to uncover. Those are the things that deserve our attention.
We should be very clear about what has caused the scandal: failure of management and of leadership, both by Greater Glasgow and Clyde NHS Board and an SNP Government that has been complacent in presiding over one of the worst scandals in the history of devolution.
Although it will not make up for the grief, disappointment and anguish that has been created, the very least that this Government could do is prove that it cares by supporting the motion and acting swiftly.
We move to the open debate.15:08
At the heart of this issue are patients and their families who have suffered a serious injustice the like of which few of us can even fathom. On top of that, we have hard-working NHS staff whose reputations are being damaged by the failure of authorities to address a life-threatening problem for which no one has been held accountable.
The focus of everything that I am about to say is concern for the welfare and professionalism of both of those groups. That is, after all, our primary responsibility as elected representatives of the people, and I hope that that will be central to any reporting surrounding the story.
Week after week in this chamber, we naturally end up focusing a great deal of time on incompetence and poor governance, but, for me and for Scottish Labour, the central concern should always be the effects on people’s everyday lives.
In this case, at the Queen Elizabeth university hospital, we can see as plain as day that the lives of the people affected have been a secondary consideration. Waterborne infections at the hospital, the extent of which we still do not fully understand, have been a factor in the deaths of a number of people, including children. That is a number of families who will be spending Christmas, and every Christmas after that, without the people closest to them. I am concerned that that is not being fully understood by the Government. Those deaths may have been totally avoidable, yet no one has been properly held to account. That is gross negligence and someone has to answer for it.
We are now at a point where senior clinicians feel that they have no choice but to speak out, despite a culture of bullying that we hear exists within the health board. Having worked in the NHS, I find that truly shocking. I know for a fact that clinicians would take that step only if they felt that all avenues of appeal and justice had been exhausted. I applaud the staff for speaking out and encourage the Government to listen to their pleas, not to the claims of the health board’s senior management.
There are a few simple questions that must be answered. Why are the leaders of the health board still in post? Why are the members of the oversight board still in post? Why have emergency powers not been used to take control of the hospital and get a grip of the situation? Those are basic things that the public demand of a Government, and they are not being done, for reasons that I cannot grasp. Given the justified scrutiny of all Governments’ handling of public health during Covid, it seems to me that we cannot for a second allow public trust in our NHS to be damaged. Why, then, is Scottish Labour forced to call for a change at the top of NHS Greater Glasgow and Clyde while the Government sits on its hands?
Let us be clear: it gives none of us any pleasure to say that the senior management of NHS Greater Glasgow and Clyde has failed and should step down, but it should take responsibility for the situation and step down immediately. If it will not do so, it should be removed and we should move to stage 5 of the performance escalation framework without delay. That is what my party is calling for. It is right and it is honest. In all honesty, it is the very least that should be done.
We need to decide whether we are on the side of the families, who are righteously furious, and the amazing staff, who are being kept quiet, or whether the primary interest of the out-of-touch managers in the Government is in laundering their reputations. Those who have presided over the mess cannot be allowed to stay in control. The motion must be supported by every member in the chamber.15:13
I offer my condolences to all families who have lost a loved one while in the care of the health service. Like everyone, I recognise the work of front-line NHS staff at the Queen Elizabeth university hospital and staff who have been working across the health service during the pandemic and before it.
I will focus on two key fundamentals in the debate. The first is that the staff of our health service deserve the assurance that, if they have concerns about the care of patients, they will be listened to and supported. It is important to mention the letter that 23 clinicians wrote to the First Minister, which says:
“We have been, and remain, fully committed to being completely open and transparent in all that we do and we are dismayed that the integrity of our staff has been repeatedly called into question. ... Do we ever wilfully withhold information from them? Absolutely not.”
More importantly, the families of people who have been treated at the Queen Elizabeth university hospital campus deserve to have answers to their questions and as safe an environment as possible for the care of their children.
Will the member give way?
I am short of time. I know that Mr Hoy is up next, but I have only four minutes and I am aware of the short time for the debate.
The Scottish Government has consistently taken the action that is necessary to ensure greater transparency and learning from the issues that have occurred at the hospital. The cabinet secretary established an independent review group to look at the building’s design, construction, commissioning, handover and on-going maintenance and at how all those matters contributed to infection control.
As we heard, the Scottish Government established an oversight board after Greater Glasgow and Clyde NHS Board was escalated to stage 4 on NHS Scotland’s performance framework.
An independent public inquiry is currently under way into the Queen Elizabeth university hospital and, of course, the Royal hospital for children and young people in Edinburgh. The important point to remember is that it is already under way.
The independent case note review, led by Professor Mike Stevens, looked back at clinical cases to determine whether a link to infections associated with the Queen Elizabeth university hospital existed. Its report was published in 2021.
The Scottish Government has consistently listened to expert recommendations and will continue to assess and monitor arrangements with NHS Greater Glasgow and Clyde. A significant amount of work is already under way to address infection in hospitals and reduce the incidence of infection, as we heard from Maree Todd.
We talked about why Greater Glasgow and Clyde NHS Board was escalated to stage 4. The public inquiry will ensure that the issues raised are fully investigated.
The concerns about Aspergillus infections have been mentioned. The Cabinet Secretary for Health and Social Care has asked Healthcare Improvement Scotland to carry out a wider review. Any necessary action will be taken as a result of those strands of work.
The public inquiry comes back to the crux of the matter. It is chaired by Lord Brodie. It is entirely independent and its conduct, procedures and lines of inquiry are a matter for the chair, not the Government. The inquiry is a critical next step in seeking to understand the issues that affected both the Queen Elizabeth and the Royal in Edinburgh.
Will Paul McLennan give way?
I am sorry, but I have only one minute left.
The inquiry’s terms of reference are comprehensive and include considering the physical, emotional and other effects on patients and their families of the issues identified. It would be wrong to pre-empt its outcomes and it is incumbent on all of us to allow it to do its work. That is not to play down anything that members have raised, but the public inquiry exists for that reason.
That balanced and proportionate approach addresses the two main points that I raised at the start of my speech: the staff of our health service deserve the assurance that, should they have concerns about the care of patients, they will be listened to and supported, and the families of those who have been treated at the Queen Elizabeth university hospital campus deserve to have answers to their questions and as safe an environment as possible for the care of their children.15:17
The issues that we are debating could not be more serious. They are matters of life and death within our NHS—an institution in which people should feel safe and secure, in which they rightly expect to have their lives saved, not wasted, and from which they should expect the highest levels of clinical care and the highest standards of hygiene, cleanliness and infection control. Instead, we are debating a hospital that failed, a health board that failed and a Government that has failed.
It is more than two years since we first learned that contaminated water led to the death of Milly Main, but new tragic cases are still only now being made public. Families of the individuals who were infected reveal a culture of secrecy and cover-up among the senior hospital staff. I am in do doubt that the board of NHS Greater Glasgow and Clyde should be held accountable and responsible, but let us not overlook the simple fact that the buck stops elsewhere.
The Scottish National Party planned, delivered and ran the hospital. The Government must take full responsibility for the situation. That is why my colleague Douglas Ross is right to call for a second independent public inquiry into the actions of the SNP Government. Yes, the board should go, but the ultimate responsibility lies with SNP ministers’ repeated failure to get to grips with the tragic situation. The Parliament and the country need to fully understand what action ministers have taken since they first became aware of the issues.
We support the Labour motion and propose our own amendment, but we should be careful what we wish for. Escalating the hospital and the health board to stage 5 would mean transferring the operational control of the health board to Scottish ministers, and, on the basis of past, present and, to be frank, today’s performance, that will not inspire confidence among patients.
However, the debate goes far wider than the tragic deaths and illness experienced at the Queen Elizabeth university hospital: it is, sadly, about the culture of this Government—its moral code and moral compass. We know that a fish rots from the head down. We know how this Government operates when it comes to transparency. We know how this culture has permeated some public institutions. There is a corrosive culture of secrecy, questions unanswered, seats left unfilled—like the First Minister’s today—and responsibility dodged. There is diversion and distraction—“It wisnae me,” “Look the other way,” “Nothing to see here.”
Will the member take an intervention?
No, I will press on—I am in my final minute.
For the families of those who have died, for the relatives of Andrew Slorance, for Milly Main, for Gail Armstrong and for the others who have died or contracted serious infections, we need answers. People have died. Children have died. Parents are grieving. Families are asking why. Why, minister?
By voting the right way tonight, we will move closer to getting them the answers and, ultimately, the justice that they deserve, and we will move closer to holding those responsible to account. The minister, this Government and Scottish National Party members can give their voice to transparency and accountability. They can say that they have no confidence in NHS Greater Glasgow and Clyde, or they can run the very real risk of this country losing confidence in this Government and its ministers.15:21
I, too, offer my condolences to the families and loved ones who have lost children and relatives at the Royal hospital for children and young people and the Queen Elizabeth university hospital. Too many have been lost over the past few years.
I want to put on record that, although I do not agree with Anas Sarwar’s conclusions, he is right to make Government and health boards feel uncomfortable, given what has happened over the past few years.
At the core of this afternoon’s debate is the Opposition’s clear suggestion that NHS Greater Glasgow and Clyde should immediately be escalated to stage 5 of the performance escalation framework. That would, in effect, subject the board to direct ministerial control.
I do not think that that suggestion acknowledges the complexity of the situation or the on-going work that is taking place. I think that it suggests—unintentionally, I am sure—that escalation would be a solution to the most serious issues that the Queen Elizabeth university hospital and the Royal hospital for children and young people have faced. It is unclear to me how doing so would make a substantial difference at this time. The suggestion also ignores substantial progress that appears to have been made.
None of the politicians here is an expert on healthcare.
Will the member give way?
I am sorry, but I do not have time—this is a very short debate.
Robust independent expert review of the most serious concerns is required. Clear recommendations need to be made and implemented as speedily and fully as possible. It is my understanding that that is precisely what is happening.
It is important that the minister confirmed today that, following the work of the Queen Elizabeth university hospital independent review, the oversight board report and the independent case note review, NHS Greater Glasgow and Clyde has completed 91 per cent of the 108 recommendations that have been made. I think that that is highly relevant when determining whether the escalation status should be raised to stage 5. Had such progress not been made, the arguments of some members in this place would be far stronger.
That said, it would be helpful if the cabinet secretary could, in his closing remarks, address how elected representatives in this place can follow the progress that NHS Greater Glasgow and Clyde is making on the recommendations on an on-going basis. How will NHS Greater Glasgow and Clyde report on its compliance with the many and varied recommendations that have been made, in a way that enables members of this Parliament and others to take a material view on how substantial that progress is? What on-going monitoring and reassurance work are in place to ensure that recommendations are complied with, embedded into practice and complied with in the long term? We must ensure that vital improvements are sustained.
I have a couple more comments to make. I listened with interest to the response when there was some uncertainty about using hospital standardised mortality ratios to say whether there is an on-going significant problem at the Queen Elizabeth university hospital. It is factual to say that, at the moment, the figure is below average, which should give us some confidence. However, I think that it would be helpful if members had a clearer understanding of how hospital standardised mortality ratios work, to see whether that reassurance can be extended across this place.
It is important to acknowledge that some senior clinicians have raised concerns about the nature of the political debate on this issue. In closing, I will say that all parties in this place have to change their relationship with one another and we have to change the way in which we debate these issues, because it can be corrosive. We have to find ways—although maybe not this afternoon, Mr Sarwar—to come together on healthcare and these most serious of issues.15:25
My thoughts are with everyone who has been affected by infection outbreaks at the Queen Elizabeth university hospital and with anyone who has lost a loved one. I cannot imagine the pain that has been experienced by the families of people who have caught infections in a place where they were supposed to be safe and cared for.
Those people deserve answers, which is why it is right that a public inquiry has been established and is under way. It is, of course, essential that we do not wait for the findings of the inquiry to be published and that action is taken now to prevent further infection outbreaks. As we have heard, Healthcare Improvement Scotland is carrying out a wider review of Aspergillus infections at Queen Elizabeth university hospital, and the board is implementing the recommendations of the independent review, the oversight board report and the independent case note review. That essential work must continue at pace, and I am sure that we will all monitor progress closely.
It is important that any findings and decisions are communicated on an on-going basis to patients, families and staff. I would be grateful if the cabinet secretary would confirm that people are being kept up to date.
The independent review found that
“Patients, staff and visitors who are vulnerable due to immuno-suppression, or who are in proximity to patients with certain highly infectious communicable diseases, have been exposed to risk that could have been lower if the correct design, build and commissioning had taken place.”
It is of deep concern that we cannot seem to get the basics right when constructing new, state-of-the-art hospitals in Scotland. We have seen that at both the Queen Elizabeth university hospital and the Royal hospital for children and young people in Edinburgh. I sincerely hope that the public inquiry will clearly set out the steps that we need to take to avoid such failures in the future.
There has been a devastating human cost behind those failures, and we have a responsibility, when debating these sensitive matters, to get the tone right. We risk causing more harm than good if we are not careful about the language that we use. Senior clinicians at NHS Greater Glasgow and Clyde have raised concerns about the way in which the issues have been portrayed. They feel that their integrity is being questioned and that that is undermining patients’ confidence in them and the services that they provide.
As I said, those who are responsible for failures must be held to account, but the attacks on clinicians will not help us to do that. I am concerned about damaged patient trust and lower staff morale at a time when people are under severe stress. We need to establish what has gone wrong and how it can be prevented in the future, while also rebuilding trust between clinicians and patients, whose faith in services will understandably have been shaken.
Practical steps are being taken to improve patient safety, but we cannot ignore the emotional toll, so mental health support must be made available to patients, families and staff who have been affected. [Interruption.] I would welcome any comments from the cabinet secretary about what support is being provided.
Excuse me, Ms Mackay. Could we not have chatting across benches, please? Let the speaker who has the floor make their contribution. Please resume, Ms Mackay.
I close by focusing on concerns that have been raised about confidentiality. The Greater Glasgow and Clyde clinicians have expressed their disappointment in the discussion in Parliament of individual patients without the prior knowledge of the families concerned. That will no doubt add to the distress of family members who have already experienced a devastating loss, and I urge anyone who raises cases in Parliament to ensure that proper consent has been sought.
We talk about transparency and the need to have open communication with patients and their families. That applies to us as MSPs, too. No one should have to hear details about their loved one’s case broadcast in Parliament, and I hope that members will reflect on that.15:29
The gravity of this debate cannot be ignored. It is shocking that we have reached this point and that Scottish Labour has had to bring the motion to Parliament today. Surely all of us across the chamber must agree that no family should have to experience a battle to know what happened to their loved one when they died in one of our hospitals. No family should have to fight for the answers and no family should have to relive their loss every day because of a lack of closure and a lack of accountability. We must also agree that nobody who works in our NHS should ever feel that they cannot speak out and be heard on such serious issues.
However, after years of secrecy, denial and cover-up, not a single person has been held accountable for the catastrophic errors and infection scandal at the Queen Elizabeth university hospital. Since 2015, the issues have been raised time and again. There have been reports on contaminated water, deadly flaws in the building’s fabric, serious patient infections and death, the bullying of staff and the silencing of whistleblowers, but no one in the senior management or board leadership has been held to account.
Let us be absolutely clear once again that this is not about the doctors, nurses and care assistants who work day in and day out in the hospital treating sick patients—they have worked tirelessly, especially throughout the pandemic, and they rightly deserve our deep gratitude. This is about those in positions of leadership. We stand with the courageous staff and whistleblowers who have revealed the scale of infections at the hospital, in the face of denial and intimidation from the leadership. We stand with the families who have described their ordeal and their feeling that nobody in power is listening to them.
Two weeks ago, at First Minister’s question time, I raised the case of the Smith family from Greenock. Theresa and Matthew Smith’s baby daughter Sophia died at just 12 days old of an infection that was contracted at the Queen Elizabeth, despite initially responding well to treatment for breathing problems. I spoke to Theresa today. Her child is not just a statistic. She spoke to me about the unimaginable pain of being unable to find any closure or to properly grieve the loss of her child, because she does not know why she died. She said to me:
“How can you accept what you do not know?”
Theresa asked me to speak of Sophia today, to say her name in this place and to say that her life was worth the world to those who loved her for those short 12 days and who still love her today. The family want all of us in positions of power in this place to listen. They want us to listen when they tell us about the tortuous journey to try to get answers. They want us to listen to the fact that, for four years, they have felt locked in a battle, with phone calls, emails and letters stonewalled, when all they want to do is find some peace. They want us to listen to the fact that they feel constrained and silenced in the public inquiry.
The Government regularly cites that inquiry in response to calls for action on the issue. Last week, Theresa’s evidence to it was ruled too contentious to be made public, after legal applications by the Government and the health board. The legal experts have said that such orders should be used only as a very last resort, or there is a risk to public confidence in the inquiry. The First Minister told us in the chamber that she
“will not tolerate cover-ups or secrecy on the part of any health board.”—[Official Report, 18 November 2021; c 15.]
However, in this case, her officials acted to ensure that evidence was heard in secret. That cannot be how the inquiry is conducted, given how families have been treated.
It is clear that, for families such as the Smiths, trust is completely broken. They have little faith in the process, so we must act. This is about leadership and confidence in leadership. Crucially, it is about the trust of grieving families and the basic decency of ensuring that they can grieve in some peace. To begin to even think about a process of restoring trust, we must support the motion in Anas Sarwar’s name.15:34
I will speak in support of Douglas Ross’s amendment but, before I do so, I draw attention to my entry in the register of members’ interests.
I reaffirm my support for the principles that are outlined in the Labour motion. However, issues with patient safety in the Queen Elizabeth university hospital go beyond some of the heartbreaking tragedies that Labour members have outlined. I want to speak further about the burdens that front-line staff face, which may contribute significantly to the on-going problems with the UK’s second-largest acute hospital.
Behind the scenes, unnecessary pressures are often placed on staff. I say to Ms Mackay that no one in the chamber blames clinicians. I want to talk about the staff who are directly involved in delivering patient care in a fast-paced clinical environment. Through unyielding, arduous, management-driven controls and processes or unbalanced procurement and budget control processes, those staff find themselves in distressing situations that distract their attention from delivering safe patient care. Those processes mean that staff are too often challenged by frustrated senior colleagues because equipment is not available for them to use.
The outcome of that may be that the patient’s procedure is cancelled. Why? Because loan paperwork has not been completed days in advance of the planned procedure. Why? Because the one and only device in the department had been opened, sometimes in error, for a previous planned procedure. Scheduled procedures have clashed because there is only one piece of equipment for the entire department, or it has not been returned in time from sterile services due to tight turnarounds from cases the day before.
Perioperative staff and those in theatre are at the front line and face such hellish but completely unavoidable challenges daily, and sometimes even multiple times a day. I assure members that the frustration that is felt by the entire multidisciplinary team when that happens is palpable. I know that that such issues are not unique to NHS Greater Glasgow and Clyde. Staff should not have to face those issues when balanced, sensible and cost economic solutions are available to managers to approve.
We say with one breath and in one debate that we want to support staff’s health and wellbeing and then go on to thank them profusely for their heroic efforts. However, as I have said before, we need to do more than offer them our thanks and gratitude. Why do we not look to remove some of the completely unnecessary pressures in their day-to-day jobs and allow them to focus on their patients?
We are calling for a second independent public inquiry into the ministerial response to avoidable deaths at the Queen Elizabeth university hospital. A comprehensive independent inquiry would identify all the areas that cause risk to patients in the hospital and would accelerate the implementation of preventative and mitigating actions. The SNP planned, delivered and ran the hospital and today we have heard that percentages are more important to it than patients. It must take full responsibility for this disgraceful situation.15:37
Debates such as this are always difficult, because most of us are parents, mothers or husbands. It is painful to talk about loss and I have no doubt that it is painful to hear your loss being discussed in public.
The people served by NHS Greater Glasgow and Clyde deserve to have confidence in their health board and in their hospitals. I guess that I speak in my role as convener of the Health, Social Care and Sport Committee, which is relevant to the scrutiny of the operation of our hospitals. The cases that have been mentioned in the debate are heartbreaking and any allegations made by staff or families must be taken extremely seriously and investigated fully.
I think that we all agree that answers must be given. We know that NHS Greater Glasgow and Clyde is currently at the highest level of escalation and will remain there while all the issues are thoroughly investigated, and we know that the independent statutory public inquiry is under way—
Will the member give way?
I am afraid that I do not have time.
The inquiry must be allowed to conclude and report. Further concerns about Aspergillus infections in the Queen Elizabeth hospital have been highlighted recently in the press and in the chamber. Last week, accusations were made that the Government was “hiding behind process” and Opposition members called for the board to be sacked wholesale and without delay.
As I said, the cases are extremely upsetting and the emotion is warranted and understandable, but in relation to people being held to account, all members know how important robust investigative processes are. They are crucial in three regards: to get to the truth of what has happened, to identify what must be done as a consequence and, where necessary, to provide any evidence of failure on the part of individuals. I agree with Bob Doris that if we throw out or curtail those processes, we are lost.
I am most concerned about political rhetoric when it comes to the death of anyone. In the chamber, we have a duty to be careful in what we say and how we say it. People who have lost their lives have been mentioned here over weeks and months, and I hope that every family has given their consent for that to happen. Families are watching, and we must remember to ensure that they agree to the public mention of their loved ones’ cases.
I am also concerned about what high-profile political exchanges can do to patient trust. Members have mentioned this morning’s reports of a letter from senior clinicians at the Queen Elizabeth university hospital who wrote to the First Minister and the cabinet secretary to express their disappointment and frustration about the way that the press and the Scottish Parliament portray their hospital colleagues and their treatment of patients. Some of today’s rhetoric, particularly from the Conservative benches—saying that “the SNP is running the hospital” or talking about how a fish rots—does not do us any favour when we talk about people’s loved ones.
Only with robust investigation will we get answers to what has happened. That pathway is crucial to ensure that any problem that has been discovered gets resolved. We must allow the investigation to happen for the sake of the patients, their families and the staff of the Queen Elizabeth university hospital, or any hospital where issues are reported, and have similarly robust systems in place for staff and patients to report without fear or favour.
We move to closing speeches.15:41
I declare an interest as a practising NHS doctor.
Glasgow’s Queen Elizabeth university hospital is at the heart of arguably the greatest disgrace, not just of the SNP’s time in government but of Scotland’s entire devolution era. It has been marred by scandals since its opening in 2015 and the hospital management has failed in its duty on a number of fronts, particularly on transparency.
A damning investigation into the water supply found widespread contamination. Children died after being infected with bacteria. That tragedy is now subject to a criminal investigation, so it is no wonder that we should now have little faith in the leadership—I stress that word—of NHS Greater Glasgow and Clyde.
We understand why Scottish Labour is calling for special measures to move the health board from stage 4—which is not, as Gillian Martin and the First Minister have said, the highest level—to stage 5, which is the highest level. Bob Doris asked what that move would achieve. The answer is accountability and stopping bullying, secrecy and cover-up culture—unless Bob Doris feels that the Government would not be able to achieve that.
Although grave concerns exist over the management of the institution, we believe—I believe—that patients and their families can trust the front-line clinical staff who deal with them.
It is important that we understand that the continued criticism of the hospital impacts the mental health of doctors and nurses and the morale of all staff, which is another reason why we must act now and deal with this crisis. Let us not have more of the same defensive posturing and dithering from an SNP Government that is now in its sixth year of presiding over the Queen Elizabeth university hospital scandal, as staff morale plummets.
We need to consider carefully what the people we represent want and what the patients and their families expect. First and foremost, they want assurance that, if they or their children need to be admitted to the SNP’s flagship hospital, they will be safe. We need to prioritise that safety, and see an independent, specialist infection control assessment of the hospital conducted every year and, given the history, for at least the next five years. The Queen Elizabeth scandal is like a cancer; we need to treat and monitor it and ensure that we do so carefully until it is in complete remission.
That point brings us to accountability, of which there is no sign from anyone, including the SNP-Green Government. Special measures without delay are a must. In tandem with those, we call for a full inquiry to ascertain, not what caused patients to fall ill and die, but who has been responsible for making the decisions during this crisis. The public demands transparency, not cover-up. The accountability trail is important and, wherever it leads, justice must be done.
Sue Webber is telling us about front-line staff who daily face hellish yet avoidable challenges. Douglas Ross calls for an independent inquiry to be held into the ministerial response, which is important because no one can escape responsibility and accountability, including those at the very top.
I echo Carol Mochan in saying that we clinicians would only ever speak out like this when there is no other choice. Bullying is unacceptable, so why is it allowed on the SNP-Green watch? The integrity of NHS clinicians has never been called into question by anyone in Opposition, as said by Maree Todd and Gillian Mackay. I stand here commending the front-line staff who are saving lives day in, day out, despite being let down by senior management day in, day out.
The Scottish Conservatives’ thrust in today’s debate is quite straightforward. We are simply addressing two fundamental questions that so many Scottish families ask. First, is my hospital now safe? Secondly, who is responsible? Our amendment is measured and reasonable. We should be able to count on the Government’s support if it puts patients first.15:46
First, as everyone else has done, I extend my condolences to the loved ones of those who have been affected by the issues that members have raised today. Let me say at the outset that I do not for one second begrudge Anas Sarwar, Paul O’Kane or any other member raising constituents’ cases. Nor, indeed, do I begrudge members of the public coming to them to raise those cases. Nobody in Government begrudges their having raised those cases. In fact, it is incumbent upon people to raise such cases when consent has been acquired.
However, I take exception to the line that is being taken of, “Whose side are you on?” Each and every single one of my colleagues on the back benches and in the Government—I include myself—are on the same side. It is the side that Douglas Ross, Anas Sarwar and Alex Cole-Hamilton are on. Each and every one of us wants the best and safest patient experience for members of the public. We are all on the same side.
When we have disagreements, they should absolutely be debated, but I would not question the intention of any member of this Parliament, regardless of the party to which they belong.
Will the cabinet secretary take an intervention?
I will not, because I only have four minutes.—[Interruption.]
Members may heckle me from the sidelines if they want, but it is really important—
Excuse me, cabinet secretary.
Members cannot really heckle from the sideline. That is a matter for me; I am the ref. Could members please just listen to the cabinet secretary? Thank you.
I want to draw attention to some of the concerns that clinicians have raised and which have been derided in the chamber. I will tell members what the clinicians have to say. I will read a couple of excerpts from the letter that the clinicians sent to me and the First Minister. They did not send it to Jane Grant, the chief executive of the health board, or to John Brown, the chair of the health board. The 23 clinicians—doctors and nurses—wrote to me. They are people whom we applauded and called heroes, and for whom we demanded a pay rise and granted a pay rise to. Those men and women are the heroes—not the management, not politicians and not Government ministers.
I will quote directly what they have said so that I am not accused of misquoting. They have said:
“We have been, and remain, fully committed to being completely open and transparent in all that we do and we are dismayed that the integrity of our staff has been repeatedly called into question.”
They also said:
“This unfounded criticism of our clinical teams and staff as well as the safety of our hospitals, is also hugely detrimental to staff morale at a time when so much is being asked of them.”
They went on to say:
“this sustained criticism of our staff is undoubtedly causing them distress and worry.”
Those are not my words; they are the words of the doctors and nurses, so let us not dismiss them. Please, let us not dismiss their concerns.
My second point is about consent. I do not begrudge Anas Sarwar’s having raised the cases of Milly Main and Louise Slorance as he has done, and continues to do, with great effect. We have a responsibility to answer those questions. In the case of Andrew Slorance, whom I knew well from my various ministerial roles, we have ensured not only that a case review is taking place but that there will be an external review. NHS Lothian will provide that, as external assurance. Seven clinicians will be involved in it.
On top of that, on the wider issue of Aspergillus in the Queen Elizabeth university hospital, I have instructed our national improvement agency, Healthcare Improvement Scotland, to look at that.
On the questions that Anas Sarwar asked, I will write to him in detail and will put the reply in the Scottish Parliament information centre.
You do not know the answer. How many red notices have there been?
I do know how many red notices there have been, although my understanding is that there have been three. I will write to Mr Sarwar in detail to address a number of the questions that he asked. I will also provide detail on what we have done nationally.
Could you bring your remarks to a close, please?
I will end my remarks by saying that we have taken action. There have been seven reviews. The recommendations have not sat on a shelf; 98 per cent of them have been implemented, as have 88 per cent of the oversight board’s recommendations.
Of course improvements, where they can be made, must be made. Huge improvements have been made. I ask members to seriously consider, when they raise cases in the chamber—
Cabinet secretary, please conclude.
—that they do so with the consent of the families involved. I guarantee members that, whenever cases are raised, they will not be dismissed but will be taken seriously by the Government.
I ask members to back my amendment to the motion.15:51
For the families who have watched today’s proceedings in Parliament, this debate will have been a deeply upsetting experience. It will have brought back memories of loved ones, but it will also have brought back anger towards those who covered up the truth from them. We owe those families answers and we owe them action. It is incumbent on all of us here to demonstrate that Parliament will not stand by when NHS staff are being bullied and blamed, and that we will not stand by when patients are being failed and lied to.
Far too often during my time in Parliament, I have had to raise the heartbreaking impact of infection outbreaks in our hospitals on the families and friends who have been left behind. From the deaths following the C diff outbreak at the Vale of Leven hospital to the tragedy that continues to this day at the Queen Elizabeth university hospital, each one of those deaths was avoidable. While we cannot bring back those who have been taken too soon, we can help to deliver some justice for their families, and we can try to stop it happening again. That is our responsibility today.
Today, we must tell the leadership at NHS Greater Glasgow and Clyde that Parliament has no confidence in it and that enough is enough. We must tell the leaders of that board that we will not tolerate their bullying, their cover-ups, their disgusting attempts to blame courageous NHS staff and—yes—their lies. The clinicians and nurses at the hospital are heroes. They have been working in absolutely impossible conditions in a building that is not fit for purpose. Please do not forget that it was clinicians who exposed the scandal at the Queen Elizabeth university hospital in the first place. They are the ones, along with their patients, who are being failed by health board senior managers. How dare the health board and the Scottish Government use those hard-working staff as a human shield for their failures?
The cabinet secretary quoted a letter. The clinicians in question are senior managers; they are appointed by the chief executive. They are not the clinicians who are saying that there is something terribly wrong. Why does the Government not listen to the clinicians who are saying that there is a problem?
It is beyond doubt that the hospital leadership has failed, but the Government, too, faces a question of leadership. I say to every SNP and Green MSP in the chamber today, to the health secretary, who so recently expressed his confidence in the board of NHS Greater Glasgow and Clyde, and to the First Minister herself, that you have a choice to make today; you can choose to side with NHS staff and patients or you can choose to continue the culture of cover-up and secrecy at the very top of the board.
From start to finish, this scandal has happened under Nicola Sturgeon’s watch. She was health secretary when the hospital was commissioned, and she was First Minister when it was opened and all the warnings about water contamination were ignored. She was First Minister when Anas Sarwar first told Parliament about the infections at the hospital two years ago, and she was First Minister when it emerged that a family had not been contacted following the death of their child, who had contracted an infection. She was First Minister when Louise Slorance pleaded with her to prevent what happened to Andrew Slorance from happening to others and she is the First Minister today, when we have the opportunity to take immediate action by using the Government’s emergency powers to escalate the NHS board to the highest level of the performance framework.
Therefore, I say this: no more hiding behind process, no more blaming of staff and no more waiting for the findings of a public inquiry to come at least three years down the line. Families cannot wait that long and the country cannot wait that long. There are still patients dying in the hospital after contracting infections.
So, for the sake of the staff who are 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 public confidence in our NHS, we can and we must take action today. I call on members to support the motion.
That concludes the debate on protecting patient safety at the Queen Elizabeth university hospital.
Before the next item of business, I will allow a short pause for front-bench teams to safely change their seats. I remind members that Covid-related measures are in place and that face coverings should be worn when moving around the chamber and across the Holyrood campus.