The people served by NHS Greater Glasgow and Clyde deserve to have confidence that their local health board is improving its performance.
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 children who have been treated at the Queen Elizabeth Hospital campus deserve to have answers to their questions, and as safe an environment as possible for the care of their children.
The actions I have taken in recent times in NHS Greater Glasgow and Clyde aim to deliver on these concerns.
Escalation to Level 4
Last week I escalated the board to level 4 for all aspects of it performance. This includes bringing in an operational turnaround director working directly to resolve issues in a number of areas, including out of hours services and waiting times.
But today I will focus on actions taken since I updated Parliament in December in relation to the board’s increase to level 4 for infection control and family engagement around the QEUH.
Chief Nurse Prof Fiona McQueen is chairing an oversight board that has identified the steps needed.
- First, a review of the care of children who had blood stream infections from 2015 to date;
- Second, improving the quality of governance of infection prevention and control;
- Third, establishing a technical group to ensure associated building works, water and ventilation are being progressed; and,
- Fourth, sustaining far better communication and engagement with patients and families.
Case review – numbers, approach, timescale
I have a clear priority to make sure families are given the answers they need about their children’s time in the hospital. Particularly about infections that may have caused harm, or – in the worst cases – may have been the cause of death.
A review of patients is looking at relevant cases in the paediatric haemato-oncology ward since the hospital opened in 2015.
Since December, a team of Scottish experts from outside GGC has been assembled to undertake the review, led by Prof Marion Bain, who I have appointed to take over responsibility for infection prevention and control.
To ensure rigour and robustness the case reviews will utilise two approaches:
An epidemiological review which is validated by microbiologists and epidemiologists and uses international infection definitions to identify gram negative infections in the selected group. The epidemiology review will define the frequency of infections and their distribution by person, place, and time. Health Protection Scotland will lead this part of the review; and,
The Paediatric Trigger Tool Review - an internationally-validated approach that will help clinicians understand the effect infection may have had on children and will also help assess wider quality of care.
Infection prevention and control measures, their use and effectiveness will also be assessed in relation to the outputs of the case reviews.
Dr Peter Lachman, Paediatrician and Chief Executive of The International Society for Quality in Health Care, and one of the authors of the Paediatric Trigger Tool, has provided guidance on the use of the Tool for this purpose and the augmentation required for these patients.
As this review covers a significant time period and a number of cases and complexities, a segmented approach will be taken.
The first group of reviews will concentrate on patients who received care in 2017. I think that’s only appropriate given the long period of worry and distress that these families have endured.
The first set of reviews will be completed during February. The review team considers that there are likely to be around 80 cases to be examined, but they will continue to keep this assessment under review.
This whole approach will be discussed with the parent representatives working with us. The review must also answer questions posed by parents - and Prof Craig White will liaise with parents to ensure that this happens and they are kept informed of progress.
As reviews are completed families will be offered an individual, face to face report, by one of the reviewing clinicians.
I consider it imperative to the restoration of confidence that no one in this process will be in the business of ‘marking their own homework’. Not NHS Greater Glasgow and Clyde, not NHS Scotland. All must be subject to expert, independent and external scrutiny.
The work of the review team will be advised and subject to scrutiny by experts from outside Scotland.
Prof Mike Stevens, Emeritus Professor of Haemato-oncology from the University of Bristol; and, Gaynor Evans, Clinical Lead for the Gram-negative Bloodstream Infection Programme at NHS Improvement England, will advise the review team and report directly to the Chief Nursing Officer.
Wards 2A and 2B – timetable for reopening
Presiding Officer, the Parliament will recall that in 2018 NHSGGC considered it necessary to close wards 2A and 2B at the Children’s Hospital, and relocate patients to ward 6A in the Queen Elizabeth.
This move was both worrying and unsettling for children and their families and the length of time has been longer than expected.
Changes have been made in ward 6A to make available space for parents to have a rest and some time to themselves, extra measures have been taken to enhance air filtering, alongside thorough and regular cleaning and additional steps taken to bring aspects play and therapeutic environment of 2A/2B to 6A.
Welcome those these enhancements are, what is obviously necessary is for children to return to wards specifically designed for them.
Wards 2A and 2B are being refurbished, to make good the problems identified in 2018 and to bring them up to the highest standards.
I am informed by GGC that their plan now is for work to be completed in the summer of this year and progress towards reopening is being monitored by the Oversight Board’s technical sub group.
Patients will move back to 2A and 2B when these wards are fully ready and meet all required standards.
Infection prevention and control
Presiding Officer, Prof Marion Bain is now in post in GGC. Prof Bain is leading the case review that I have described already.
Working with the staff who have raised concerns, and making sure their insight and experience is woven into the ongoing work of infection prevention and control in GGC, she is reviewing, all aspects of working practice and governance, including how the Board assesses, reports and manages incidents and outbreaks.
The policies of GGC are being considered, but so too is the detail of spikes in infection experienced in the hospital, and how the Board responded both in its operations and corporately.
I expect the Oversight Board to receive a report from the sub group about these matters by the time of the Easter recess.
Alongside this, the Chief Nursing Officer has instructed a peer review of how the Infection Prevention and Control team approach and escalate infection incidents.
This will report during February to Prof Bain.
Communication with families
Prof Craig White is following up on feedback received from parents through surveys and meetings, and this is informing the work of the communications sub group of the Oversight Board and I am grateful to the parent representatives who are working with us on this.
GGC’s website now has an improved section offering answers to questions that parents have asked about the hospital and the safety and care of their children.
We will ensure that families are involved in preparations to reopen wards 2A and 2B, with the questions they have answered, and taking into account ideas that they have for the operation of the wards.
Lastly, Presiding Officer, I want to update the Chamber on progress with the establishment of the Public Inquiry, which I announced in September last year.
The remit and terms of reference are at an advanced stage of drafting and are being considered by Lord Brodie.
Lord Brodie and I are committed to ensuring that the Inquiry addresses the concerns of patients and families and to offering them an opportunity to comment on the terms of reference before they are finalised. I expect that the remit and the terms of reference will be shared with families during February and thereafter I will meet with party spokespeople as I have committed to do.
Presiding Officer, significant work is under way to address the legitimate concerns that have been raised by members on behalf of families and staff.
The work is ongoing under the scrutiny of external experts, it is detailed and will take time. But families and children and staff deserve it to be done properly and thoroughly. I will update Parliament further as progress is made.
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