Queen Elizabeth University Hospital Investigation and Response to Infections

Presiding Officer,

I am grateful for the opportunity to provide members with an update on the position of the paediatric haemato-oncology wards at the Queen Elizabeth University Hospital.

I want to start by offering my deepest sympathies to the families affected. To lose a loved one in any circumstances is hard - but I cannot begin to imagine the pain of losing a child in these circumstances - or the suffering and grief that will stay with them for the rest of their lives.

I also want to apologise to them that they feel they have not had their questions answered.

They are absolutely right to ask and pursue their questions, and they are entitled to have them answered and to receive the support they need.

I take very seriously the concerns highlighted to me about the deeply concerning issues which have been raised by a whistle-blower.

Our NHS – indeed all our public services – can only flourish and improve when everyone working in it feels they can confidently speak up.

There is no room in our Health Service for anyone to criticise whistle-blowers, publicly or otherwise - or to put them in fear for the safety of their jobs.

We need to recognise that whistle-blowing is not something people who have dedicated their lives to health care, do lightly. It takes courage and they should be thanked. 

Much of our health service exemplifies this approach and it is right to thank all NHS Scotland staff who work every day to give the best quality of care to their patients - they deserve significant credit for helping to make our health service one of the safest in the world.

But even so, things can go wrong and when they do, I expect Boards to respond professionally, transparently and speedily.

As you know, the whistle-blower who came forward last week stated that an internal clinician-led review within NHS Greater Glasgow and Clyde (NHSGGC) had identified additional cases of infection amongst paediatric cancer patients – including a child who died in 2017. My officials are urgently seeking full details of this review so we can fully understand the findings and what action the board took in response.

This is a serious matter and I want to set out clearly my understanding of the facts and the actions I have taken.

Following my announcement of a statutory public inquiry on 17 September this year to examine issues at the Queen Elizabeth campus in Glasgow and the Royal Hospital for Children and Young People (RHCYP) in Edinburgh, I received correspondence from a bereaved parent concerning the death of their child in 2017. This was the first notification I received about this tragic death.

I replied expressing my concern for them and my condolences for their incredibly sad loss. I advised them a representative from the board would make personal contact with them to ensure any questions and concerns were fully addressed.

I understand that contact has now been made with the family and I am clear that I expect the Board to do all that they can to support them and provide clear answers to their questions.

Over the course of last weekend, other families have made contact with me. It would not be right for me to discuss the details of each case publicly and it would be entirely inappropriate for me to comment further on any case which is subject to an ongoing Crown Office investigation.

However, I want there to be no doubt that I am fully committed to ensuring that every family receives the answers they are entitled to.

It is not a requirement – nor would it be appropriate - for the Scottish Government to be notified of every patient death. But my clear expectation is that our NHS must support families by providing them with the accurate information they need to understand what has happened, and what is being done. And to do that in a clear, transparent and timely way.

I expect all NHS Boards to ensure that communication and engagement with patients and families is centred on their needs. I also expect Boards to have considered whether the national adverse events framework or the organisational duty of candour procedure - introduced through new legislation by this Government last year - should be applied. And that patients and families are genuinely involved in discussions about such decisions.

The issues raised over the past few days have concerned children who received treatment on the paediatric haemato-oncology ward, Ward 2A/2B, at the Royal Hospital for Children (RHC), QEUH.

Despite the correct infection mitigation measures undertaken by NHSGGC in Ward 2A/B, ongoing surveillance did not give the Board confidence that all organisms that had been identified, had been eliminated. So in September 2018 these wards were closed for further work and upgrading.

With the closure of Ward 2A/2B, the paediatric haemato-oncology patient cohort has been temporarily moved to Ward 6A at the QEUH.

On 4 October, I updated Members in response to a Government Initiated Question on the meetings I had with a number of families of paediatric cancer patients, and some young patients themselves, who are currently being treated at the Queen Elizabeth University Hospital - following concerns they raised with me around the safety of the ward following reports of bloodstream infections among the paediatric haemato-oncology patients. We met on 28 September and 1 October and it seemed clear to me that information sharing and communication from the Board to these families had simply not been good enough.

As a result, I appointed Professor Craig White, reporting to me, to lead and direct the work required to make sure that the questions the families had were clearly answered and going forward their voices and views could be clearly heard and paid attention to. Since appointment, Professor White has been in contact with the families and remains so.

Recognising that they needed to significantly improve their relationships with families involved, the Chair and Chief Executive have written to all families in contact with the paediatric haemato-oncology service and continue to meet personally with every parent who has requested a meeting.  

Clinical leads of the haemato-oncology service and the Infection Control Doctor on the Incident Management Team have been actively involved in investigations and decision-making on actions being taken to ensure patient safety.

And with respect to the ongoing safety of the environment in ward 6A, Health Protection Scotland (HPS) have confirmed they are content with the actions taken by the Board’s Incident Management Team (IMT) to investigate individual cases, that they have reviewed evidence of effective implementation of the actions that HPS have recommended and are assured that appropriate arrangements are in place for ongoing monitoring of infections, including the triggers agreed for detailed scrutiny of any further actions needed.

In addition I have asked that external clinical experts from the National Managed Service Network for Children and Young People with Cancer are invited to join the Clinical Management Group that has been established to carry out ongoing review of infections.

Over the weekend calls have been made for the Board to be escalated. In NHS Scotland we have a clear process that is consistent across all Boards and is led by the NHS Scotland Chief Executive to review levels of escalation for all Boards. I have asked that this process of escalation be taken forward as quickly as is possible. I will update parliament on the outcome of that process as soon as it is concluded.

As members know, I have announced a statutory public inquiry to examine these issues and I hope to be in a position to confirm the Inquiry Chair before the end of this year. I have a statutory obligation to consult the chair on the terms of reference, and I hope to set these out early in the New Year.

In the meantime, the Independent Review led by Doctor Andrew Fraser and Doctor Brian Montgomery is gathering evidence, with a view to publishing its findings in spring 2020.

In conclusion, Presiding Officer, I have outlined the steps I have taken regarding the paediatric haemato-oncology ward at the Queen Elizabeth University Hospital.

But I am acutely aware that the families of children who have and are receiving care need to have complete confidence that the care provided is of a high quality and in a safe environment. They, and the staff who deliver their care, also need to have confidence in openness and transparency of information.

Families must have the right support and information to give them confidence that risks are monitored, that triggers for action are appropriate, steps are taken to both prevent and limit infection spread and they are engaged and informed fully and with compassion and respect.

Sadly the healthcare environment will never be risk free, but given how devastating the impact of an infection can be for the most vulnerable we must do all we can to reduce that risk and support families. That is what I am committed to doing.