Royal Hospital for Children

Some children have to take a mainly liquid diet, or are already on tube feeds and may suffer from vomiting, reflux or just discomfort preventing adequate weight gain. In these children we may change the type of feed given, reduce the volume and /or prescribe treatment to

• Control reflux
• Improve gastric emptying
• Stimulate appetite
•  Refer to the complex feeding team in Paediatric Gastroenterology 

High Energy Milk and Drinks

In practice these drinks and special milks are only really suitable for children who really cannot eat (or learn to eat) solid food.

There are a wide range of these products on the market, but while they sound as if they should helpful for increasing weight gain, there is little evidence that they are effective and we have seen many instances in our clinic where they have suppressed appetite for other foods and in some cases even slowed weight gain.    

If these products are started it is important to monitor their effect over time. If they do not result in increased weight gain or have only a short term effect, they should be stopped and other strategies adopted. 

If you are worried about feeding problems and issues such as food refusal or picky variable eating, the Help my child won’t eat leaflet may provide the answer to some of the issues that are worrying you.

Your health visitor (for preschool children) or your GP (for school age children) can usually offer helpful advice and support. If need be they may refer you on to:

• Dietitian – to assess whether their diet is good enough and give you advice on managing their eating behaviour
• Parenting support such as triple P, for support in managing their behaviour in general
• Paediatrician to investigate worries about their growth or possible nutrient deficiencies
• Speech therapist to investigate how they chew and swallow.

If these people are worried and you live in the Greater Glasgow health board area , they may refer on to us, but we do not accept referrals straight from primary care.

Almost all families encounter feeding issues such as food refusal, picky eating and other problems at some stage. In order to cope with these it is important to understand what influences a child’s feeding behaviour for better or worse

The key factors that put a child off eating are:

• Not Being Hungry – help by avoiding snacking before meals and high energy drinks, offer small portions, leave at least 2 hours between meals or snacks
• Unhappiness or Stress – Help by trying to make mealtimes happy, keep meals short, praise food eaten and let child self feed.
• Short Term Illness – Help by waiting for it to pass, they will eat again when better.

Useful Resources

• My child still won’t eat leaflet
• Stop any high energy drinks  (link to Weaning from high energy milk and drinks)
• The two hour rule for severe food refusal
• The role of treats and snack

The team has been in existence for 18 years, with various staff all working only part time in the clinic.  We hold weekly clinics – currently mainly via attend anywhere. Seven year ago we were shortlisted for the BMJ child health team of the year.

The current team:

• Consultant paediatrician (Charlotte Wright)
• Clinical psychologist (Emily Fraser)
• Paediatric dietitian (Jen Bain)
• Assistant psychologist (Collette Moore)
• Specialist paediatric registrars

We also work with speech therapists, other dieticians and members of other specialist teams and are helped immensely by admin support.

• Full dietary and nutritional assessments
• Tube weaning
• Consideration of need for tube feeding
• Observed or video’d meals
• Kitchen clinics
• Kitchen therapy sessions

Anonymous patient story

“When we arrived at the Feeding Clinic team run by Prof Wright, we had already tried different approaches to get our son weaned from tube feeding, including contact with the Graz feeding clinic in Austria and rapid cessation of tube feeds, but none of them had worked for us.

Our son was non-verbal with a complex medical history (born prematurely, oxygen dependant for several years, tracheostomy, gastrostomy and ASD),  so we knew it was going to be a challenge .We did not know at the time where the journey would take us, but as a Mum, I recognised the need to try, to give our son the best chance of  a more positive longer term outcome. 

Yes, it was about weaning our son from tube feeding, or at least reducing complete dependency, but it was also about the social occasions that we take for granted when families come together and enjoy a meal together.  Christmas 2019 was a milestone as it was the first time, our son then aged 14 had eaten a full Christmas dinner!
The journey to get there has been long, (5 years) with ups and downs, but consistent throughout has been the huge support from Prof Wright and her team at Glasgow University Hospital.

What I learned along the way was to manage my own behaviours, keeping the environment calm, not be anxious. Recognising at the beginning not to set unrealistic expectations, that there was no rule book, for e.g. always having meals at the table (that did come, but much later) and accepting that minute steps over time, aggregated to key milestones.”

First steps

“We started by “desensitizing”. Our son, because of his medical history had an aversion to anything around his mouth, but I did recognise that he was most relaxed when  watching television or on the computer, so I took those opportunities to just gently touch the side of his mouth with a soft flexi-spoon (nothing on it) every evening or when we could  , but at least 5 x to start with, so he knew there was an end.  Eventually we tried with yoghurt, literally with a dot of yoghurt on the spoon but then he would tolerate no more. Always the same process, the same coloured soft flexi-spoon, he would first look at it, then smell and then taste.

This coincided with the first reduction in tube feed, which was the removal of daytime feeding. This was a big step for us. When I look back now, it is amazing that I too was dependant on those tube feeds, almost as a security blanket to ensure our son was well nourished. It was the motivation to keep going, so I started to put a finger tip of egg yolk on the flexi-spoon and again encouraged our son to lick at least 5 x.

Then one evening, I sensed that he wanted to try some more, so I increased the amount of egg yolk. Over several weeks, we progressed to scrambled egg (runny to start with so it was easy to swallow. This was all done while our son was watching computer! He was relaxed.  This went on for weeks, until gradually he was having more scrambled egg. By the time we had our next clinic we were already adding some cheese to the egg and our son was tolerating that. But I also knew that living on eggs alone was probably not going to be a life long choice.”

Extending the food range

“For the next several months, I tried extending the food choices, we tried yoghurt (without success), we had some success with jelly and then over time I tried adding different things, so mashed beans to scrambled egg, crumbled cake into the jelly. I also tried mashed avocado with varying degrees of success and then there were various other foods that we tried without success.  Some days we had great successes, like a full scrambled egg eaten, other days he simply was not interested or became agitated. Those days were not easy, they were hard, but we just kept going as “tomorrow might be a better day” and usually they were.”

Reducing reliance on tube feeds

“At the same time, his tube feeds were very gradually being reduced between clinic appointments. What’s maybe interesting to note, is that as our son’s oral intake of food increased, he became less tolerant of the tube feed being connected at night time, so I usually waited until he was asleep.

To start with, the tube feed reductions were small so mentally it felt manageable. Our son was not losing weight, but he was not gaining any weight either. It was the motivation to try and increase calorie intake, to get ready for the inevitable next steps of more feed reductions. There were some clinic appointments where we felt not ready for a feed reduction so gentle persuasion from the feeding team with an outline of a plan was enough to keep going.

As our son was now quite familiar with eating scrambled egg we did at some point move away from feeding at the computer to “incentivising”. It was just a natural progression to incentivise computer time after eating, it worked for us. But any time we were attempting to introduce a new type of food, I would just offer a tiny amount while he was still on the computer and usually had to try  this 15-20x before that food type was accepted.”

Widening Food textures – learning oral skills

Early on in the process, I recognised that texture as well as the taste of food was important for our son, so it was always about taking a small step (mashed potato, and then gradually extending with blended casserole for e.g.). , I used to blend boiled carrot, chicken with lentil, into a very easy to swallow smooth paste.

We even tried haggis and neaps at one point, all blended and eventually adding potatoes. Gradually, as the tube feeds continued to decrease, our son was eating more of food that was blended, easy to swallow format. We used to take some in a food flask if we were going out for the day and this went on for months as they became his diet staples. I also noticed a change in his eating skills, from licking his lips, to using the front part of his mouth to chew and then swallow.

Those small steps of gradually accepting smooth, blended, soft wet foods, took several months and a few years! The process is long and slow, but necessary to continue to create a positive environment and to give our son the time to learn those basic skills of seeing, smelling, tasting and eventually being comfortable to swallow. These are steps that come naturally to babies as they wean, but they were skills that our son had to learn for himself and be confident with. As he was non-verbal , I did use sign language to encourage swallowing and eating, so we added communication to the mix.

Working with school

In the early stages of the programme, I did not inform our son’s school, mainly because I just felt we were building a good way of working at home, and was nervous about a “bad experience” if someone tried to be too enthusiastic at school however well intended.

So, it was several months into the programme, before I finally felt confident to notify the school and for the them to also support us.

Our son has progressed from always having potato & tuna for lunch to choosing his own lunch from the school menu and he has several school favourites (sausages & mash, baked potato with cheese!)

Real progress at last

Signs that things were progressing was when he took the initiative himself to open the fridge door or cupboard looking for food! And then there were the experiences of “forgetting “to pack a blender while on holiday! And realising that actually he was ok to take fork mashed food -another milestone achieved!

Gradually we built up a menu of different foods he would like, eventually eliminating the tube feeds. We have had to be creative finding medicines in liquid format, that are easy to add to foods almost unnoticed, as these could no longer go down his tube.

It took several months later before we finally felt confident enough for the gastrostomy tube to be removed, the final milestone of our journey.  It remains a process of trying different things, with surprises along the way like chicken curry, Chinese stir fry, fish without the chips. He has never liked chocolate or yoghurts – I can live with that!

It has been a long journey, but with a very successful outcome. We are very grateful to Prof Wright and her team, for their unwavering support and encouragement. And finally, to our son for having the courage to try.

Some children are started on high energy milk and drinks (e.g. pediasure, fortini, infatrini) in order to increase weight gain.  These may be effective in the early months, but if they are continued they all too often spoil the appetite, without increasing overall intake. 

Some children may be taking almost all their diet from these drinks, while others just take them as a supplement to their solid diet.  After careful assessment we would most commonly aim to reduce and stop these drinks, which usually results in improved  appetite, reduced food refusal and no change in weight gain or growth. 

In early research we found that tube weaning resulted in weight loss but no slowing of growth.

We have shown that tube fed children had similar appetite patterns (satiation) to healthy children. 

We found that stopping sip feeds did not result in weight loss and in some  children weight gain increased.

We have also described our underpinning philosophy, how the clinic operates and its cost effectiveness.

We also see some children or young people where there are major worries about slow weight gain or underweight and /or their ability to eat effectively and safely.

In many cases, after a detailed assessment of growth and nutritional status, we have been able to offer reassurance  that growth levels are acceptable, given the child’s underlying condition, but in other cases we may advise that tube feeding is needed.

Many children eat a quite limited diet and most of these children grow and develop normally, even with apparently inadequate diets. However, if there is concern about this, we would usually recommend a multivitamin supplement suitable for the child’s age and current diet and we may be able to offer some behavioural work to encourage relevant dietary diversity.

Many of these children have other features of Autism Spectrum Disorder and behavioural work may need to be undertaken by their local community team.

Very occasionally children eat such a limited diet that they become severely deficient in one of the key nutrients they need, most commonly Iron, but also sometimes vitamin D (Rickets) and rarely vitamin C (Scurvy).

Call: 0141 452 4450

Location: Level 2. Follow the signs to Atrium, Take Lift/Stair to Level 2, Exit Lift/Stair at Level 2, Walk along the corridor and Turn Left. Ward 2A is straight ahead

Find your way here from the main entrance (PDF map)

Call: 0141 452 4475

Location: Level 2. Follow the signs to Atrium, Take Lift/Stair to Level 2, Exit Lift/Stair at Level2, Ward 2B is on your left.

Find your way here from the main entrance (PDF map)

This project has involved an £8.9 million investment in significant upgrade work, including replacement of the ventilation systems, and once open the ward will provide the highest-quality environment that is fully suited to the needs of our young patients and their families.

A considerable amount of work throughout the ward has been carried out, including a full refurbishment of all ensuites to provide a safe, high-quality environment for everyone.

We would like to give special thanks for the tremendous fund-raising efforts of former patients Molly Cuddihy and Sara Millar, who have raised hundreds of thousands of pounds for the hospital and enabled the creation of a new, purpose-built chill-out area for children aged 8-12 years, to go alongside spaces for younger children and teenagers, which has been supported by The Teenage Cancer Trust (TCT).

Ward 2A has a parents’ kitchen and that also been included in the renovation. It is a light, comfortable space which allows parents to store and prepare food, make a cup of tea, or just take five minutes to chat with others.
Single bedrooms will have built-in, fold-down beds which will help parents have more comfortable overnight stays.

Ward 2A is the inpatient part of the ward and it comprises 24 patient rooms, play and social areas for all age groups, and a parent kitchen and sitting area.

Ward 2B is the Schiehallion day care unit and houses five treatment rooms and two, four-bed bay areas. Most of the treatment given to your child or young person will be in the shared bed bays.

The bright, colourful ‘Schiehallion’ logo at the door greets those arriving and inside the decor has been created with young people in mind. We’re aware that any stay in hospital can be a daunting experience for children, so we’ve tried to make the surroundings as welcoming as possible.

As with all other paediatric services, the new ward will provide holistic care, looking after our patients’ mental wellbeing as well as their physical needs.

Schiehallion Ward is supported by a Health Play Assistant and a Health Play Support Worker. Our dedicated Play Team are here to interact with all our babies, children and young people, providing daily normalising play activities that are free from any aspect of medical intervention, as well as developmental play for our children that are in hospital for a long time. In addition, we have two Health Play Specialists who will work with children and young people to understand aspects of their clinical care through the use of play and role play, as well as provide specific distraction during treatments and procedures.

In every room, we have installed new iPads complete with a new entertainment system that allows them access to TV, films, games and other interactive services.

Children and young people have played an important role in making sure that the offering on the iPads is not only age-appropriate, but also what our young patients need and want. Our Play Team recently surveyed more than 70 young people to gauge their opinion on the service we provide, and the results have helped shape our TV and digital service throughout the RHC.

Ward 2A provides play and socialising spaces for all our patients, no matter what their age.

Alongside the new facilities a new menu will be offered to patients in Schiehallion.

Meals are tasty, nutritious and varied, with vegetarian options and soft easy to chew choices available. A vegan menu is available on request and a range of special diets, including low potassium/ no added salt, low fibre/low residue, food allergies and texture modified, as well as Kosher and Halal are catered for.

In addition, for some of our young patients on Ward 2A, we know how important it is that they can have something to eat whenever they feel able, and to help cater for that there will now be an out-of-hours snack menu until 10pm each evening, offering a range of favourite items including burgers, chicken nuggets and toasties.

As is the case throughout the hospital, our water meets all national standards and is safe to drink.

In addition, as is the case in all areas of the hospital, the water undergoes a process of filtration and regular dosing with Chlorine Dioxide.

Where our most vulnerable patients are cared for, such as Ward 2A/2B, you’ll see additional filters on the taps. This is an extra level of protection for patients and is part of a rigorous system of care and regular maintenance for our taps, as well as the water system as a whole.

There are 11 separate ventilation systems serving the ward, all of which are finely balanced to provide exactly the environment that every child needs. Every system has a back-up, meaning that ventilation will remain uninterrupted if there is an issue with a unit, or if maintenance work is required. The air coming into Ward 2A is filtered using HEPA (high efficiency particulate air) filtration, and bedrooms achieve 10 air changes per hour to ensure continuous fresh air.

In addition, the system now uses a ‘pressure cascade’, which provides another layer of protection by ensuring that air will always flow away from vulnerable patients, out into the corridors and ultimately out of the ward.

All this means that the ventilation system is helping us to provide the highest-quality environment for all patients.

Our key priority is the care and wellbeing of our patients and, through the extensive work we have carried out, we are confident that we now have the highest-quality and safest environment in which to look after them.

We have put in place the best safeguards we can, and the ward will be monitored closely by our infection control experts and estates teams. This means that, as is the case in all wards across our hospitals, if any issues arise we will be able to put in measures quickly to ensure the safety of patients.

The extensive work we have done within Ward 2A/2B and the highly sophisticated systems we have put in place, alongside our continued commitment to infection prevention and control, mean we are in the best possible position to keep our young patients safe.

We are continually monitoring the unit, more than any other hospital in the UK, to provide rigorous assurance of the ongoing safety of the hospital environment.

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.