1. Executive Summary
A decision was taken on 2 July 2019 to delay moving to the new Royal Hospital for Children and Young People & Department of Clinical Neurosciences (RHCYP & DCN) on 9 July 2019. This followed an inspection of the facility, which raised concerns regarding the ventilation arrangements for critical care beds (intensive care and high dependency) and other areas of the hospital. NHS National Services Scotland (NSS) received a commission from Scottish Government to undertake an external series of checks, led by Health Facilities Scotland (HFS) and Health Protection Scotland (HPS), to ensure that the relevant technical specifications and guidance applicable to the new hospital have been followed and are being implemented.
The objectives of the review in relation to RHCYP & DCN were:
- To provide a report by September 2019 to Scottish Government on whether the relevant technical specifications and guidance applicable to the RHCYP & DCN are being followed and implemented.
- Where relevant technical specifications and guidance have not been followed, identify necessary remedial actions.
Given the specific focus on the control of Healthcare Associated Infections (HAI), the review concentrated on a system wide approach for ventilation, water and drainage systems. The process involved site visits, sample inspections and a targeted review of available documentation.
NHS Lothian informed the reviewers at the start of the process that elements of the Critical Care ventilation system required redesign and modification to ensure compliance with guidance. Additionally, Haematology / Oncology is also being reviewed as a result of changing clinical needs, and specific risks were identified. NSS provided advice relating to the design instruction for elements of the Critical Care ventilation system and similar advice will be provided in relation to Haematology / Oncology.
The review commenced on the 9th July 2019 with this final report published in September 2019 for consideration by the established RHCYP & DCN Oversight Board.
1.2 Summary of findings
The findings have been collated based on information provided by NHS Lothian and on-site reviews of the RHCYP & DCN. Expert advice was sought within the key focus areas of ventilation, water and drainage and plumbing systems and their overarching management and assurance processes relating to these systems. The following table outlines the status of key findings:
|Review||Summary Assessment||No. of Issues per priority|
|1 (H)||2||3||4||5 (L)|
|Management & Assurance||Omissions identified in key roles within the management structure, ease of access to information and prioritisation of building system alarms.||-||-||1||2||-|
Remedial action is required within both general and theatre ventilation systems.
Critical Care redesign was already being considered separately by the Board.
Haematology / Oncology is also being reviewed as a result of changing clinical need and specific risks were identified.
Risk assessments are underway as part of the ward by ward risk assessments being done locally, requested as part of the review.
|Water Systems||Independent testing identified no widespread contamination of the water systems, however, remedial action is required on a number of water system areas as well as system wide disinfection prior to occupation.||-||1||2||1||-|
|Drainage & Plumbing||The drainage system has multiple redundancies in place; active monitoring is required. Elements of plumbing require inspection and appropriate remedial action taken.||-||-||-||1||-|
The following definitions were used to categorise the findings:
|1||Significant – Concerns requiring immediate attention, no adherence with guidance|
|2||Major – Absence of key controls, major deviations from guidance|
|3||Moderate – Not all control procedures working effectively, elements of noncompliance with guidance|
|4||Minor – Minor control procedures lacking or improvement identified based on emerging practice|
|5||Observation and improvement activity|
Overall remedial action is required to be undertaken within the ventilation and water systems prior to occupation. Following acceptance of this report, the review team are ready to assist the NHS Lothian team in developing a programme of activity and remedial actions.