Hospitals and services

When you become pregnant, your first contact is with a midwife, who records details of your medical history and assesses how healthy you are. The midwife will find out if your pregnancy is progressing smoothly.

If there are no problems with either your health or that of your unborn baby, you will be able to receive all your care at the Inverclyde CMU all the way through to giving birth. You will be able to do this even if this is your first baby.

If you’re expecting twins (or even more babies!), you will receive all your care from midwives up until the time you are due but – purely as a precaution – you will be asked to give birth in a consultant-led unit, usually the one at the Royal Alexandra Hospital.

If there are any concerns whatsoever about your health, or that of your baby, you will receive your care jointly between the local midwives and consultants at the Royal Alexandra Hospital. You will give birth at the Royal Alexandra Hospital.

However, for most mums this is just a precaution as most births go absolutely smoothly and good planning by staff will mean there is little to worry about.

At 12 weeks you will be offered an ultrasound scan and this will allow midwives to estimate when your baby is due.

During your pregnancy you will be invited to attend a series of workshop sessions which are designed to help you prepare for birth and getting ready to be a mum. These will cover subjects like:

• Relaxation techniques
• Parenting skills
• Breastfeeding

We don’t forget about your partner or birth supporter either – they can come to workshop sessions too and find out how they can help you during the birth and beyond.

A blood test is offered at 15 – 16 weeks into the pregnancy in order to screen for any problems. Four or five weeks later, this is followed by a second ultrasound scan, which is intended to provide a more detailed look at the baby – by this time you will be starting to feel the baby’s first movements.

At 24 weeks you will have an ante-natal appointment with your midwife, during which she will check the baby’s growth and listen to his or her heartbeat. If you are a first-time mum, you will have another appointment with the midwife at 32 weeks.

At 34 weeks, you are getting close to the time of the birth. You will be offered more blood tests to find out if you need extra iron and you will be given a chance to look around the CMU’s birthing suite. At 38 weeks first-time mums will have another appointment with their midwife.

When the time comes to give birth to your baby, it is important that you feel relaxed in your surroundings.

Inverclyde CMU’s birthing suite, along with the rest of the unit, was completely refurbished and is state of the art.

In particular, we have installed a new birthing pool, which you can use to help you stay comfortable during labour and give birth in if you choose. We also provide birth mats, birthing balls and birthing stools. You can bring in your own CDs, or choose from a selection we provide, and have the lights dimmed in order make the birth as peaceful and private as possible.

It is these kinds of things that can help you in controlling pain. Before giving birth, your midwife will have spent some time discussing this with you and will help you to overcome your worries and fears.

Massage, relaxing music, breathing techniques and the birthing pool can make all the difference – but if these are not enough, you can have Entonox (gas and air) and, if appropriate, the drug pethidine to help make contractions less pain. Like every drug, this has drawbacks and these will have been explained to you by your midwife.

Newsletters

Issue 1 – Winter 2020 (PDF)

Wednesday, 26th February, 2020

NHS Greater Glasgow and Clyde has served a summons on Multiplex, Capita Property and Infrastructure Ltd and Currie and Brown UK Limited for losses and damages incurred due to a number of technical issues within the Queen Elizabeth University Hospital and the Royal Hospital for Children.

Given the public interest in the hospitals and legal proceedings, the summons is being published today (26 February 2020).

The summons sets out where the requirements of NHSGGC were not met in either design, commissioning or building stages in eleven specific areas.

The legal action is being taken following a review commissioned by NHSGGC to consider how these technical issues arose and any further actions required.

Specific issues have also been the subject of a further external review. An independent review by Health Protection Scotland (HPS) into the water supply confirmed contamination of the water system in 2018.

The independent review by HPS, which was commissioned by NHSGGC, was established to investigate a number of probable linked cases of infection associated with the water supply.

HPS agreed with the measures proposed by NHSGGC to address the water system issues – and these actions have been taken.

The report and the remedial work carried out by NHSGGC have been shared with families, the public and other stakeholders.

Jane Grant, Chief Executive, said:  “We would assure patients and their families that patient safety is paramount and that patient care at the two hospitals is of a high standard.

“Our staff strive at all times to provide high quality care and I would like to thank them for their continued professionalism and dedication during this time.

“Whilst we are now taking legal action on a number of design and installation issues, it is important to stress that the hospitals continue to provide safe and effective care.

“A significant amount of work has already taken place including the remedial action on the water supply and the ventilation.

“We know that patients, families and staff have been caused concern as the issues have emerged and I am sorry for any distress caused.

“As the matters are now the subject of court proceedings, we are not in a position to comment further.” 

ENDS

Summons

• QEUH Finalised Summons – 22nd January 202

Precis

• Note regarding proceedings raised against MPX

Background

The current estimation of damages and losses is approximately £73m, which include the costs incurred to date and an estimate of future anticipated costs.

It should be noted that because this sum is an estimate it may be subject to change.

In total, the summons covers eleven technical issues.  Action taken to address the issues is as follows:

Issue 1: Water System – Action Taken

When issues with the water system were identified in Wards 2A and 2B at the RHC in March 2018, steps were taken to investigate and put in place improvements and control measures including fitting point of use filters on water outlets.

When bacteria were subsequently identified in the drains of these wards in June 2018, drain cleaning was initiated in high risk areas.

In mid-September, we made the decision to transfer the patients to Ward 6A of the neighbouring QEUH.  This allowed our technical staff to carry out more detailed examinations of the overall environment of the two wards. 

We subsequently installed a continuous Chlorine Dioxide dosing plant in RHC (December 2018) and QEUH (March 2019) and installed further point of use filters in all clinical areas where the haemato-oncology patients are likely to attend.  These solutions were endorsed by Health Protection Scotland and Health Facilities Scotland. 

We continue to monitor water hygiene closely.  The water is ‘potable’ meaning it conforms to drinking water standards.

Issue 2, 3 and 4: Ventilation – Action Taken

Work was carried out on the adult BMT unit in 2017 to improve the air quality and provide HEPA filtration to all patient bedrooms and ancillary areas.  We continue to monitor the air quality in this unit. 

Seven negative pressure rooms have been upgraded and this was complete by May 2019.

The ventilation system in Ward 2A and 2B of the RHC is currently being upgraded to provide optimal, state of the art facilities for all our young haemato-oncology patients. This work will conclude in summer 2020.

Issue 5: Plant and building service capacity

Further design investigation required.

Issue 6: Toughened glazing – Action Taken

A protective canopy is being installed, and is currently under construction, to mitigate the risk of the impact of fractured glass.

Issue 7: Doors – Action Taken

The door frames are not as required in the contract and replacement and repairs are having to be carried out more often than expected.  However, it must be stressed that fire safety has not been compromised as this does not affect the integrity or functionality of the doors.

Issue 8: Heating system

The energy plant continues not to achieve the required efficiency.

Issue 9: Atrium roof – Action Taken

The section of the roof that was damaged has since been replaced.

Issue 10: Internal fabric moisture ingress – Action Taken

Previous media reports have covered the issues relating to the design and materials used in the construction of the en-suite bathrooms.  A programme of repair or replacement is underway.

Issue 11: Pneumatic transport system – Action Taken

The hospitals continue to operate with alternative transportation and portering arrangements as a backup.

The Oversight Board (OB) for Queen Elizabeth University Hospital (QEUH) and the Royal Hospital for Children (RHC), NHSGGC (hereinafter, “the Oversight Board”) is convened at the direction of the Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland, further to his letter of 22 November 2019 to the Chairman and Chief Executive of NHSGGC. These terms of reference have been set by the Director General, further to consultation with the members of the OB.

The  purpose of the OB is to support NHSGGC in determining what steps are necessary to ensure the delivery of and increase public confidence in safe, accessible, high-quality, person-centred care at the QEUH and RHC, and to advise the Director General that such steps have been taken. In particular, the OB will seek to:

• ensure appropriate governance is in place in relation to infection prevention, management and control;
• strengthen practice to mitigate avoidable harms, particularly with respect to infection prevention, management and control;
• improve how families with children being cared for or monitored by the haemato-oncology service have received relevant information and been engaged with;
• confirm that relevant environments at the QEUH and RHC are and continue to be safe;
• oversee and consider recommendations for action further to the review of relevant cases, including cases of infection;
• provide oversight on connected issues that emerge;
• consider the lessons learned that could be shared across NHS Scotland; and
• provide advice to the Director General about potential de-escalation of the NHSGGC Board from Stage 4.

In light of the on-going issues around the systems, processes and governance in relation to infection prevention, management and control at the QEUH and RHC and the associated communication and public engagement issues, the Director General for Health & Social Care and Chief Executive of NHS Scotland has concluded that further action is necessary to support the Board to ensure appropriate governance is in place to increase public confidence in these matters and therefore that for this specific issue the Board will be escalated to Stage 4 of the Performance Framework. This stage is defined as ‘significant risks to delivery, quality, financial performance or safety; senior level external transformational support required’

The OB will agree a programme of work to pursue the objectives described above. In this, it will establish sub-groups with necessary experts and other participants. The remit of the sub-groups will be set by the chair of the Oversight Board, in consultation with Board members. The Board will receive reports and consider recommendations from the sub-groups.

In line with the NHS Scotland escalation process, NHSGGC will work with the OB to construct required plans and to take responsibility for delivery. The NHSGGC Chief Executive as Accountable Officer continues to be responsible for matters of resource allocation connected to delivering actions agreed by the OB.

The OB will take a values-based approach in line with the Scottish Government’s overarching National Performance Framework (NPF) and the values of NHS Scotland.

The NPF values inform the behaviours people in Scotland should see in everyday life, forming part of our commitment to improving individual and collective wellbeing, and will inform the behaviours of the OB individually and collectively:

• to treat all our people with kindness, dignity and compassion;
• to respect the rule of law; and
• to act in an open and transparent way.

The values of NHS Scotland are:

• care and compassion;
• dignity and respect;
• openness, honesty and responsibility; and
• quality and teamwork.

The OB Members will endeavour to adopt the NPF and NHS Scotland values in their delivery of their work and in their interaction with all stakeholders.

The OB’s work will also be informed by engagement work undertaken with other stakeholder groups, in particular family members/patient representatives and also NHSGGC staff.

The OB is focused on improvement. OB members, and sub-group members, will ensure a lessons-learned approach underpins their work in order that learning is captured and shared locally and nationally.

The Oversight Board (OB) will meet weekly for the first four weeks and thereafter meet fortnightly. Video-conferencing and tele-conferencing will be provided. 

Full administrative support will be provided by officials from CNOD. The circulation list for meeting details, agendas, papers, and action notes will comprise OB members, their PAs and relevant CNOD staff. The Chairman and Chief Executive of NHS Greater Glasgow and Clyde will also receive copies of the papers.

View minutes from the meetings below

• Oversight Board Minutes 27th November 2019
• Oversight Board Minutes 3rd December 2019
• Oversight Board Minutes 13th December 2019
• Oversight Board Minutes 19th December 2019
• Oversight Board Minute 9th January 2020
• Oversight Board Minutes 23rd January 2020
• Oversight Board Minutes 6th February 2020

The objectives for the Oversight OB are to:

• improve the provision of responses, information and support to patients and their families
• if identified, support any improvements in the delivery of effective clinical governance and assurance within the Directorates identified
• provide specific support for infection prevention and control, if required
• provide specific support for communications and engagement
• oversee progress on the refurbishment of Wards 2A/B and any related estates and facilities issues as they pertain to haemato-oncology services.

Matters that are not related to the issues that gave rise to escalation are assumed not to be in scope, unless OB work establishes a significant link to the issues set out above.

In order to meet these objectives, the OB will retrospectively assess issues around the systems, processes and governance in relation to infection prevention, management and control at the QEUH and RHC and the associated communication and public engagement; having identified these issues, produce a gap analysis and work with NHSGGC to seek assurance that they have already been resolved or that action is being taken to resolve them; compare systems, processes and governance with national standards, and make recommendations for improvement and how to share lessons learned across NHS Scotland.

The issues will be assessed with regards to the information available at the particular point in time and relevant standards that were extant at that point in time. Consideration will also be given to any subsequent information or knowledge gained from further investigations and the lessons learned reported.

The OB will be chaired by the Chief Nursing Officer, Professor Fiona McQueen, and will report to the Director General for Health and Social Care.

• Professor Fiona McQueen (Chair), Chief Nursing Officer, CNOD, Scottish Government
• Keith Morris (Deputy Chair), Medical Advisor, CNOD, Scottish Government
• Professor Hazel Borland, Executive Director of Nursing, Midwifery and Allied Health Professionals & Healthcare Associated Infection Executive Lead, NHS Ayrshire and Arran
• Professor Craig White, Divisional Clinical Lead, Healthcare Quality and Improvement Directorate, Scottish Government
• Dr Andrew Murray, Medical Director, NHS Forth Valley and Co-chair of Managed Service Network for Children & Young People with Cancer (MSN CYPC)
• Professor John Cuddihy, Families representative
• Lesley Shepherd, Professional Advisor, CNOD, Scottish Government
• Alan Morrison, Health Finance Directorate, Scottish Government
• Sandra Aitkenhead, CNOD, Scottish Government (secondee)
• Greig Chalmers, Interim Deputy Director, Queen Elizabeth University Hospital Support, CNOD, Scottish Government
• Calum Henderson, Secretariat, Queen Elizabeth University Hospital Support Unit, CNOD, Scottish Government

The Co-chair of Area Partnership Forum and the Chair of the Area Clinical Forum will be in attendance at the meetings. In addition to these members, other attendees may be present at meetings based on agenda items, as observers: senior executives and Board Members from NHSGGC including, Medical Director, Nurse Director, Director of Estates and Facilities, Director of Communications, Board Chair and Chief Executive; and representatives from HPS, HFS, HIS, HEI and HSE.

The OB recognises that a broad range of stakeholder groups have an interest in their work, and will seek to ensure their views are represented and considered. These stakeholders include:

• Patients, service users and their families
• The general public
• The Scottish Parliament
• Scottish Government, particularly the Health and Social Care Management Board
• The Board of NHSGGC and the senior leadership team of NHSGGC
• The staff of NHSGGC and Trade Unions.

Special focus will be given to patients of the haemato-oncology service and their families, as highlighted by their direct involvement in the Communications & Engagement sub-group.

On 22 November we escalated NHS Greater Glasgow and Clyde to Stage 4 for infection prevention and control and engagement and information with patients and families.

Level 4 brings direct oversight and engagement from Scottish Government to the operation of Queen Elizabeth University Hospital and Royal Hospital for Children. We have set up an Oversight Board, reporting to the CEO of NHS Scotland and to me and chaired by Professor Fiona McQueen, our Chief Nursing Officer. The Oversight Board will:

• Ensure improvements to the systems, processes and governance in relation to infection prevention, management and control;
• Ensure improvements to the associated communication and public engagement issues;
• Ensure improvement to appropriate governance processes at the Board; and
• Ensure the rebuilding of public confidence and strengthen the approaches that are in place to mitigate avoidable harms.

Working to the Oversight Board we have 3 groups – on infection prevention and control led by Irene Barkby, the Executive Lead for Healthcare Associated Infections from NHS Lanarkshire; on communication and engagement, led by Professor Craig White who has been working directly with families since October following my meetings with some of the families. Family representatives are also part of this group.

The third group will consider any technical issues required.

Professor White has also now written to 400 parents of children seen by the Paediatric Haemato-Oncology Service to hear directly from them on their experience of communication and engagement with the board and this statement today, and any future statements together with updates on the progress of the Oversight Board, will be made available to them.

An essential and early part of the Oversight Board’s work is to understand the levels of infection and review all the available information from all sources on case numbers. This work is complex, it needs to be reviewed and, of course, validated.

On 26th November Health Protection Scotland published its review of datasets for the years 2013-19. The report confirmed a higher number of certain infections in 2017, 2018 and 2019, but concluded that the current levels of infection are returning to normal. For the most recent months of October and November 2019 the level of Gram-negative bloodstream infections has been below the current average.

We also instructed NHSGGC to provide the total number of patients with positive Gram-negative blood samples within the Paediatric Haemato-Oncology unit since the Royal Hospital for Children opened in 2015. The focus has been on infections which are associated with water and the environment, particularly those associated with environmental organisms – in Wards 2A and 2B in the Royal Hospital Children, and Ward 6A in the Queen Elizabeth Hospital.

This data will be subject to an expert led case by case review to consider the decisions taken on healthcare acquired or community acquired infection designation, reporting, action taken and information shared and with whom.

Anas Sarwar previously brought to the chamber’s attention a number of locally-commissioned reports by Glasgow’s health Board. I want to thank Mr Sarwar for bringing these reports to my attention. Two of the reports were by a private company – called DMA – in 2015 and 2017. I can confirm that these were commissioned by the Board but were not provided to the Scottish Government at the time of their commencement or their completion.

The Health Protection Scotland review we commissioned into the water contamination incident in 2018 reflected the understanding of the issues and the Board produced ‘a detailed action plan addressing all points identified’.

The Board’s action plan was published in February 2019 and the actions taken include installation of a chemical dosing plant to treat the water systems and reduce the risk of possible contamination.

I expect the Oversight Board to fully consider all locally-commissioned reports as part of its work. We need to understand what has been reported and what action has been taken.

Some of this work may take some time to be completed, but I am adamant that we need to move forward with action now.

I recently met with a number of NHS Greater Glasgow and Clyde clinicians who have raised concerns. Our NHS should be celebrated and its staff work hard to care for the people of Scotland each and every day. Their service is remarkable.

I found their insights to be incredibly helpful in shaping the actions we are now taking. I want to thank them not only for making their concerns known, for persisting in following their professional responsibilities but also to thank them for accepting my invitation to continue to work with us to consider the evidence we have, the decisions taken and the steps needed to resolve the outstanding issues.

In addition, we will be writing to each of the individual families, setting out the arrangements that will be put in place to review individual cases and how families who wish to be involved in these reviews can do so.

Concern has been raised about the use of antibiotic prophylaxis and anti-fungal drugs with this patient cohort. The Oversight Board tasked one of its members – Dr Andrew Murray, the co-chair of the Managed Clinical Network for Children’s Cancer Services Scotland – to meet with a multi-disciplinary team of senior clinicians for a clinician-led review of the use of these medicines on 6 December.

The frontline team has confirmed to Dr Murray that the use of antibiotic prophylaxis is being tailored to the needs of each individual patient and that families will be fully informed on their use and why.

Ordinarily, the clinical lead on infection prevention and control matters is a Board’s medical director with the support of others, such as the estates department. However, as a result of considering all of these issues I have outlined today I think that we can only begin to restore trust by taking significant additional steps.

That’s why I have asked Professor Marion Bain, former Medical Director of NHS National Services Scotland, to take over the responsibility for the systems and processes for infection prevention and control within NHS Greater Glasgow and Clyde.

We will also have a senior clinician in infection control and prevention, external to NHS Scotland, who will provide an independent expert assessment of the actions we are taking.

They will also review the infection data and help to validate it. They will report to the Oversight Board and provide an external assurance that the actions that are being taken are effective and appropriate.

This morning, I again met with the Board of NHS Greater Glasgow and Clyde. The Board is in no doubt how seriously this Government takes these issues and the safety of care, the importance of transparency and rigour in these matters, and the actions I require from them to restore and rebuild confidence.

Andrew Moore, the Head of Excellence in Care from Healthcare Improvement Scotland as well as Angela O’Neill, the Deputy Nurse Director in NHS Greater Glasgow and Clyde have been appointed to ensure the actions identified by the Oversight Board are actually fully implemented.

Lastly, members will also be aware of my decision to announce a statutory public inquiry to examine issues at the QEUH and the Royal Hospital for Children and Young People in Edinburgh to ensure that all lessons are learnt to stop this happening again. I have appointed the Right Honourable Lord Brodie QC PC as Chair. Terms of reference are being set and will be shared with the families in the New Year.

Families deserve confidence in their services and deserve answers. I have outlined a significant level of intervention within the operation of the QEUH to ensure these issues are dealt with thoroughly and quickly.

I will keep parliament updated on the progress of the Oversight Board and their findings. I know, like me, it’s the overriding concern of all members of this chamber that where our NHS falls short of the expectations we have for it that we move robustly to address them.