Delay to new hospital was due to ‘failure of governance’ – Freeman

Ms Freeman said it came as a “bolt from the blue” when she was made aware of concerns around the new Royal Hospital for Children and Young People in Edinburgh on July 2 2019, days before it was due to open on July 9.

She halted the move from the existing site after final compliance checks revealed the ventilation system in the critical care department of the new building did not meet the necessary standards.

Ms Freeman told the Scottish Hospitals Inquiry she decided the new hospital could not open as planned because she was not confident that it would be a safe environment to put patients and staff into.

She also had concerns about whether other aspects of the new Royal Hospital for Children and Young People/Department of Clinical Neurosciences (RHCYP/DCN) building would be up to standard given that the ventilation issue had been discovered at such a late stage.

Checks had found that the ventilation system was only delivering four air changes per hour in the critical care rooms, well below the 10 changes per hour set out in guidance.

John MacGregor KC, senior counsel to the inquiry, referred to a report by auditors Grant Thornton, commissioned by NHS Lothian, which described what happened as a “collective failure”.

The report found that an “environmental matrix” spreadsheet in 2012 wrongly stated the air change rate in critical care rooms should be four changes per hour, rather than 10, and that the mistake was missed from the outset.

Mr MacGregor asked Ms Freeman whether she agreed that it was a “collective failure” over the course of the whole project.

She replied: “In part. I don’t think it’s fair to pinpoint the blame on any one individual. I think it is a failure of governance and that means either the right people weren’t in the room when governance was being practised or the right questions were not being asked or pursued.

“You can ask the right question but if you just then sit back and accept whatever answer is given that’s not really governance either.

“So in that sense I think there are a series of failures but they are for me primarily around governance.”

In her written statement to the inquiry Ms Freeman said that after the issues emerged in early July there was a suggestion from NHS Lothian (NHSL) that they could migrate some of the departments from the existing hospital to the new building on July 9 2019 as planned but that she did not agree.

She wrote: “Putting to one side the fact that I was furious about this situation, not least because this was the first that I was hearing of it, I do not believe there was any point at which I thought there was a safe and credible option other than not migrating patients over to the new hospital on July 9 2019.”

Giving evidence to the inquiry on Tuesday, Ms Freeman also said there was “no option that is risk free” when deciding whether or not to migrate patients from the old hospital to the new one but that at least the risks were known at the former.

She said: “We know what the risks are there and we know how to mitigate and manage those and we have the data and information to support that.

“That’s on the one hand and on the other hand we have a new build, not yet open, that in one critical area we know is not meeting the standard which is a standard of best practice and therefore it cannot be considered to be safe.”

The new facility opened fully in March 2021.

The inquiry is considering the planning, design, construction, commissioning and, where appropriate, maintenance of both RHCYP/DCN and the Queen Elizabeth University Hospital Campus, Glasgow.

It was launched in the wake of deaths linked to infections at the Queen Elizabeth University Hospital Campus, including that of 10-year-old Milly Main.

Ms Freeman said she did not know if NHS warnings about a lack of research on ventilation, issued 12 years apart, were followed.

Documents from 2007 and 2019 from NHS National Services Scotland both referred to poor evidence about ventilation.

Ms Freeman was asked if she thought research on ventilation should be commissioned given the assessment in 2019 following issues with the Royal Hospital for Children and Young People in Edinburgh.

The report from 2007 also said “guidance needs more teeth”, warned “procurement processes are not fit for purpose”, described “the control of infection risk management” as “in its infancy”, and called for “research in the area of risk management prevention and control of infection”.

A report from 2019 said: “From an infection prevention and control perspective there is low-quality to no evidence from outbreak reports and current guidance to support minimum ventilation requirements.”

Mr MacGregor said: “If guidance equates with a basic law of safety for modern hospital facilities, why are we talking about guidance?”

Ms Freeman said: “It should be mandatory unless there’s evidence to make an exception in a particular circumstance. That would be my view. Whether or not the government currently is seeking to give guidance more teeth, I can’t comment.”

Asked if research should have been commissioned, Ms Freeman said it would have been “entirely reasonable” for it not to have been.

She added: “Of course this is September 2019, by January 2020 we were dealing with Covid. Even if that had been the intention, it would have been possible or entirely reasonable that it may not have been pursued, given the entirety of the NHS pivoted towards dealing with the pandemic.”

Mr MacGregor said: “If that research hasn’t been instigated, do you think it should be?”

Ms Freeman said: “Research doesn’t negate the request to adhere to what is considered to be best practice.”

The inquiry, before Lord Brodie, continues.