The Queen Elizabeth University Hospital Independent Review has examined the design, construction, commissioning and maintenance of the Queen Elizabeth University Hospital (QEUH) and Royal Hospital for Children (RHC) to address problems. In parallel, a public inquiry is being conducted.
The review has confirmed shortcomings in the water and ventilation systems as well as in the level of independent scrutiny during the work.
However, it concluded that there is no clear evidence linking failures in design, build, commissioning and maintenance to avoidable deaths.
Chairs Dr Andrew Fraser and Dr Brian Montgomery were asked to investigate if the management and execution of the project had adversely impacted on the risk of healthcare associated infection at the NHS Greater Glasgow and Clyde (NHS GG&C) flagship hospital.
The review has concluded the hospitals offer 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 avoidable deaths.
However, the report also details findings, which are focused on potentially vulnerable groups of patients.
- NHS GG&C has put in place, and is still working on, improvements to the wards where these vulnerable patients are managed. This includes replacement of water, drainage and ventilation systems in order to minimise the risk of infection to patients who will receive their cancer treatment there.
- The QEUH project would have benefited from greater external expertise and greater uptake of internally available expertise to support decision making on the water and air ventilation systems at key points in the design, build and commissioning phases.
- The design of the hospital did not effectively reconcile conflicting aims of energy efficiency and meeting guidance standards for air quality.
- Some of the difficulties encountered with water and ventilation systems were the result of ambiguity concerning the status and interpretation of guidance.
- The level of independent scrutiny and assurance throughout the design, build and commissioning phases was not sufficient.
- Governance of the project during design, build, commissioning and maintenance did not adequately take account of the scale and complexity, and specialist nature of the building project.
- The effectiveness of Infection Prevention and Control (IP&C) advice was undermined by problems within the NHS GG&C IP&C leadership team and internal relationships with the wider IP&C and microbiology cohorts.
- There were deficiencies in the quality and availability of management and technical information relating to the QEUH project, especially relating to the build and commissioning stages. This constrained the Review and continues to hamper effective running of the QEUH/RHC building.
Fraser said: “While the hospital provides a safe healthcare environment for patients, staff and visitors, as the review progressed our findings caused us to focus on those clinical places caring for children and adults with cancers including leukaemias.
“These specific groups have been exposed to risk that could have been lower if the correct design, build and commissioning had taken place.”
There are a total of 63 recommendations in the report.
Three specific areas for future research have also been identified by the review in relation to supporting similar future projects:
- air quality in clinical environments;
- water quality in clinical environments;
- rare microorganisms and their clinical significance.
Montgomery said: “Our focus was on delivering a clinically-focused, forward-looking report that sought both to understand the origins of the situation in Glasgow but more importantly to assess the current state of the hospital and identify learning applicable to future capital projects.
“We found a complex story with a variety of perspectives and views. Undoubtedly and with hindsight, the Health Board, groups within it, and the Design and Build Contractor could have reached different decisions and produced results that would have reduced infection risk.
“We have tried to concentrate on learning from the experience in a way that will avoid repetition of mistakes and enhance future projects.”
During the course of the review, over 100 hours of interviews were conducted with medical staff within in NHS, contractors and some of the patients and families who have been affected. Around 3,000 documents and reports have also been scrutinised over two phases.
The first phase of the Review process considered issues of infection prevention and control at the hospital and the second phase examined the QEUH and RHC buildings with advice being provided by technical expert Billy Hare, a professor in construction management at Glasgow Caledonian University.