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Professor John Robertson OBA

BBC Scotland return today with an extended piece on the re-convened public inquiry into ‘safety and wellbeing issues‘ at two Scottish hospitals, the Queen Elizabeth University Hospital in Glasgow and Royal Hospital for Children in Edinburgh.

I’ll deal only with the former here. The BBC text is presented as quotes with my rebuttals below them in plain text:

In the coming weeks it will examine contentious new evidence from Glasgow’s health board about the risk of infection from the water and ventilation systems

This is a long-running practice where any case made by the Scottish Government or one of its agencies is described as ‘controversial‘ or ‘contentious.’ Why so? There is no quote in the full text attributing the word to an expert, indeed anyone. It’s just Lisa Summers deeming it so just as once she described Oncology in NHS Tayside as ‘dysfunctional‘ though no one other than her had ever said it. It’s ‘new‘ evidence in a 218 page report.

But a series of infection outbreaks and concerns around the water and ventilation systems began to emerge three years later – and a number of patients died including 10-year-old Milly Main. The report found a “series of problems” with the design and build of the hospital, but no clear evidence to link those failures to any “avoidable deaths”. However, that investigation did not consider child cancer patients.

See that lazy, casual but also sneaky linking of the deaths to infection outbreaks and the cancer ward?  As early as 2019, Greater Glasgow and Clyde Health Board had commissioned an independent expert report and this had found that there was ‘no evidence of a single point of exposure [in the building] causing the blood stream infection‘, implying that the bacteria could have been brought into the wards by visitors, and that infection rates in QEUH’s child cancer wards were no different from those in NHS Grampian and Lothian equivalents (p54).¹

The announcement followed [….] a series of of infection outbreaks – and at least four deaths – at the QEUH.

Again the dishonest tagging on of deaths to the infection outbreaks and the insertion of ‘at least four‘ when it was only four ? There’s quite a lot to say about this:

First, infections after surgery are more likely due to bacteria already on your skin than from microbes in the hospital. 

Most health care-associated infections are caused by previously harmless bacteria that patients already had on their bodies before they even entered the hospital.²

Most infections in hospitalized patients are endogenous, meaning they are caused by bacteria that have already colonized the patient’s digestive tract prior to infection. Nosocomial [brought in by patients, relatives] infections more than double the mortality and morbidity risk for hospitalized patients, resulting in an estimated 20,000 deaths a year³

Second, there was no statistically meaningful mortality spike

As in the Lucy Letby case, we see the dangers of widespread ignorance of statistical significance among, of course, patients and journos, but also among some experts in medical fields. An increase in mortality in the QEUH child cancer wards was detected by investigators in 2019⁴ but crucially this report’s key comment below was not reported:

It is not possible to determine whether changes in episodes are confounded by changes in the patient population and their underlying medical conditions.⁵

Third, the spike/blip may be as much the result of more children coming in already infected as of more becoming infected after being admitted.

As early as 2019, Greater Glasgow and Clyde Health Board had commissioned an independent expert report and this had found that there was ‘no evidence of a single point of exposure [in the building] causing the blood stream infection‘, implying that the bacteria could have been brought into the wards by visitors, and that infection rates in QEUH’s child cancer wards were no different from those in NHS Grampian and Lothian equivalents (p54).⁶

A BBC Scotland investigation in June 2020 also spoke to senior doctors at the QEUH campus who said their attempts to raise concerns about risks to patient safety were not taken seriously.

They spoke to two. The link to the BBC Disclosure report has been disabled. One whistle-blower, a Dr Inkster had a memory lapse or did she just want to tell a different story to suit BBC Scotland and Scottish Labour? In the 2021 study she lead, they found the organism thought to be a risk factor was in other hospitals too and it was always in the outlets thus crucially not in the feed to the wards.⁷

The inquiry also heard how a doctor told a mum her son would be safer at home getting cancer treatment than at the QEUH campus. Other evidence included a mother, whose son was being treated for cancer on a children’s ward, likening the hospital environment to “a third world country”.

This is shameful, shoddy and unprofessional. Pickens and Summers are operating here at sub-tabloid-level presenting gossip and rumour which is deeply offensive to the staff. QEUH is proven to be one of the safest hospitals in Scotland and safer than most in other parts of the UK.^{8, 9} More than two thirds, around 80 hospitals in England, had a worse ratio than QEUH¹⁰. Journalism is about choices of sources. Back in the day, BBC Scotland would not have touched this stuff and today BBC England, Wales and Northern Ireland, still would not.

One expert said she had never experienced a “more seriously toxic atmosphere” than the one she found among infection prevention and control staff at the QEUH. A former infection control nurse also told the inquiry that staff at the children’s hospital felt “extreme anxiety” that child cancer patients were unsafe. And a senior doctor gave evidence that she was “appalled” at the state of child cancer wards when the new £870m hospital opened in 2015.

Little better, the above is anecdotal, based on single sources of uncertain motive. Still shoddy. Still shameful. Still offensive to the 40 000 staff in NHS Glasgow and Greater Clyde.

This section of the inquiry will consider new evidence from NHS Greater Glasgow and Clyde (NHS GGC), submitted in a 218-page report claiming the Queen Elizabeth University Hospital campus had no excess infections since 2015. The findings of the report were in conflict with a previous independent review of cases, which connected the deaths of at least two child cancer patients in part to infection linked to the hospital environment.

This is just nonsense. Connecting the deaths of at least two child cancer patients in part to infection linked to the hospital environment is both utterly weak as evidence and does not, in any way, contradict statistics revealing no excess infections in a population of many hundreds.

It finishes with:

What have some of the affected families said?

I have four children. To lose a child must be the most awful thing and the slightest suggestion that their death was unavoidable must consume your live but that does not make you an expert witness. Indeed, such is the intensity of your pain, you should not be prominent in the mediated discourse for fear of distorting it badly with your burning passion and perhaps paranoia. In the past, you would not have and BBC Scotland or the Labour Party would not be grooming you.

I’ll finish there. Pickens and Summers need to take some time to reflect on what they are doing here before it’s too late for their own mental health.

Sources:

1. https://www.gov.scot/binaries/content/documents/govscot/publications/corporate-report/2021/03/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report/documents/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report/govscot%3Adocument/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report.pdf
2. https://theconversation.com/infections-after-surgery-are-more-likely-due-to-bacteria-already-on-your-skin-than-from-microbes-in-the-hospital-new-research-227435
3. https://www.ncbi.nlm.nih.gov/books/NBK2632/#:~:text=Most%20infections%20in%20hospitalized%20patients,digestive%20tract%20prior%20to%20infection.&text=The%20majority%20(60%20percent)%20of,evidence%2Dbased%20practices%20are%20presented.
4. https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2902/documents/2_review-of-nhsggc-paediatric-haemato-oncology-data.pdf
5. https://www.epsu.org/article/uk-hospital-cleaning-brought-house-scotland-wales-n-ireland
6. https://www.gov.scot/binaries/content/documents/govscot/publications/corporate-report/2021/03/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report/documents/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report/govscot%3Adocument/queen-elizabeth-university-hospital-nhs-greater-glasgow-clyde-oversight-board-final-report.pdf
7. https://www.nss.nhs.scot/media/4038/nhs-scotland-assure-research-qa-cupriavidus.pdf
8. https://www.publichealthscotland.scot/publications/hospital-standardised-mortality-ratios/hospital-standardised-mortality-ratios-july-2023-to-june-2024
9. https://digital.nhs.uk/data-and-information/publications/statistical/shmi/2024-05#highlights
10. https://digital.nhs.uk/data-and-information/publications/statistical/shmi/2024-05#highlights