The unreported? Talking-up the new Southern General Hospital, Glasgow
countering media negativity and re-building public confidence
Now that the independent review of the new Southern General Hospital (aka South Glasgow Hospital) has been published and has rebutted certain prevalent media and opposition politicians’ scares, it’s timely to amplify what the review tells us that’s positive.
Complying with guidance
The report seeks in the following way to acknowledge the benefit of hindsight whilst conducting a forensic, after-the-fact review: “While establishing the infrastructure to support the QEUH Project NHS GG&C complied with available guidance. This included setting up arrangements for expert input and governance. The problems identified by this Review and other scrutiny processes however, call into question the suitability and adequacy of the guidance available at the time. The creation of the National Centre for Reducing Risk in the Healthcare Built Environment and its involvement in future capital projects should help to minimise or avoid similar challenge.”
Moreover the authors of the report provide some perspective when making their reference to prior guidance: “Some of the problems that they have encountered are rare if not unique but they can, nonetheless, help others in the future.”
And overall the review states, almost for the avoidance of doubt it seems: “Building the QEUH/RHC (Royal Hospital for Children) complex has been a major achievement.”
After rebuttal the re-building of public confidence
The authors of the review seem mindful of the damaging nature of some aspects of the public discourse and seek to put the record straight: “The QEUH and RHC combined now have in place the modern safety features and systems that we would expect of a hospital of this type. The general population of patients, staff and visitors can have confidence that the QEUH and RHC offers a setting for high quality healthcare.”
Achievements in infection control
The review makes mention of NHS Scotland’s notable track record in tackling hospital acquired infection (HAI): “The NHS GG&C Board, and Scotland in general, has made important strides in responding to lessons learned, policy and practice changes, with the net effect of sustained reduction in HAI incidence. Hospitals are not, and never will be, risk-free environments but patient safety has improved steadily and significantly over time.”
It adds: “… it is worth reflecting that, in the intervening 18 years since the Watt Group report, the incidence of HAI has fallen steadily and then stayed low across NHSScotland; systems and practices now in place have achieved sustained improvements in health risk for HAI.”
(The Watt Group report investigated an outbreak of salmonella at the Victoria Infirmary, Glasgow, between December 2001 and January 2002.)
On hospital practices
The review findings include positive mention in a number of places of hospital practices. The last phrase in the following quote should cause certain members of the corporate media, BBC Scotland and some opposition politicians to ‘reflect’ – but will it?
“One aspect of the hospital and its size is that there are few comparators for the hospital, and so experience of the scale of the challenge is unusual, ..… It is little wonder that strains showed, although the quality of healthcare for patients in the face of waves of new events did not waver.”
“The conduct of these investigations complied with guidance as set out in the manual, and was by and large impressive. The response to the events of 2018 that led to the closure of Ward 2A & 2B was particularly so, ….”
“The installation of chlorine dioxide dosing to the entire hospital’s water supply without interruption of the clinical service over the autumn and winter of 2018-19 stands out as an operation of sizeable ambition and without precedent – those engineers and managers who carried out the task deserve credit.”
The review acknowledges that in certain challenging situations not all ‘experts’ agree.
“The Review heard polarised views expressed by groups of microbiologists and clinicians, backed by evidence on either side. One group portrayed the cluster of gram negative infections as representing significant clinical risk borne of a likely external influence, probably from an environmental source or sources, and possibly linked to problems with the building such as the lower than expected number of air changes per hour (ACH).”
But: “The other group believed that the gram-negative contaminants causing a variety of serious infections were inevitable but clinically manageable consequences of the standard hospital environment and patient population in question; any external factors were multiple and possibly unalterable, and the risks were acceptable.”
It adds: “Incident management was proficient … ”
“The general profile of infection control in terms of recorded incidence of key infections and outbreaks in the QEUH hospital complex was as good as, or better than other comparable data, both in other hospitals and compared with the hospitals that QEUH/RHC replaced and also when compared with other hospitals across Scotland.”
On staff relations during challenging times the review finds:
“.. document initiated the whistleblower process. Management action from that point was steady, systemic and methodical; they acted in good faith, even though some elements may have been delayed.”
“… we found no evidence of institutionalised bullying in NHS GG&C.”
More broadly: “We find a mixed picture on communications. The communications between clinicians and patients and their families have been, by and large, of high quality. Transmission of sensitive clinical information from hospital to headquarters was sound.”
Despite the emphasis above on positives, this review is far from a whitewash. It make negative criticisms around how a highly complex design and build project was conducted whilst emphasising the relevance of its findings to future learning of benefit to all who may embark on similarly challenging projects.
“… the Review is an investigation into alleged deficiencies in a system which allowed clinical risks in treatment and care to arise which may have caused harm to numbers of patients. It is likely that a large number of individuals had a part to play in this, none of whom individually could have prevented the totality of what occurred. In the course of analysing what happened and why, it will be necessary to consider what could have been done better by individuals and organisations. This is an essential part of identifying the lessons to be drawn.”
It adds: “Certain aspects of the design, build, commissioning and maintenance of the QEUH have posed challenges in creating the optimal conditions for IP&C (infection prevention and control) and have increased the risk of Healthcare Associated Infection”.
However, there is no way of getting away from this conclusion:
“An independent review has concluded that the design, build, commissioning and maintenance of Multiplex’s Queen Elizabeth University Hospital Glasgow (QEUH) was not linked to avoidable deaths there.”
And: “The review found that the hospital “offers a setting for high-quality healthcare for patients, staff and visitors and there is no clear evidence linking failures in its design, build, commissioning and maintenance to the avoidable deaths”.