Staff tell of immense pressure to build Scotland's 'trophy' hospitals

One senior employee in the health board’s management team said they would be “unsurprised” if NHS Lothian had experienced similar pressures, leading to mistakes being made with the Royal Hospital for Children and Young people which has had its opening postponed indefinitely.

SNP Health Secretary: I can't guarantee Edinburgh's Sick Kids hospital will open next year

And an architect who worked on designs for the Edinburgh hospital told how he saw "a decision making process which repeatedly placed need to meet deadlines ahead of patient safety."

Robert Menzies said he witnessed problems with the initial design which needed time to resolve but 'the decision was made to get it out to the bidders and leave it up to them to fix these mistakes.'

A senior NHSGGC employee said: “The amount of pressure we were under to deliver these projects to target, to specifications, on time, everything, was immense. It was coming from the Government who were coming under pressure about waiting times, capacity issues in the current estate.

“They were desperate to get these new facilities opened. Things which maybe should have been looked over by infection control, health and safety or other specialists were not, in my opinion. Some key people who should have been involved, and who were at the beginning, were not by the end."

A submission to the Scottish Parliament's health and sport committee earlier this year from staff said: "It appears that the design brief for a new hospital is ‘innovation’. The design brief for another is ‘energy efficiency’.

"Quite simply, the design brief for any hospital needs to be ‘patient safety’ whether or not there is an ornamental pond or multiple restaurants"

The children's hospital in Edinburgh was due to open last month before being halted by cabinet secretary for health and sport, Jeane Freeman, citing problems with ventilation.

Problems with drainage and flooding have also emerged, as well as a payment of £11.6m made earlier this year to contractors HIS Lothian Ltd to fix "drainage issues, heater batteries and void fire detectors”.

NHS Lothian, which is now also paying a £1.4m management fee every month until the facility opens, was advised it would be less risky to pay the contractor to resolve the problems than take them to court.

READ MORE: SNP MSPs accused of trying to "weaponise" blue water school row

The first business case for the Edinburgh hospital - which includes a cinema and £5m of therapeutic artwork - was submitted in 2008 but delayed due to a lack of cash. It was revived in 2010 and the project awarded to a private consortium.

Mr Menzies said clinicians came under pressure to sign off a revised blueprint in 2012 that the architects were unhappy with because delays were turning it into a political hot potato.

He said: "The anticipation was that [those bidding to build the hospital] would do what was needed to address any issues but the approach adopted by the project managers was that the reference design was what was required to be built.

"I have 40 years in healthcare architecture and I can't think of an occasion where the reference design has been adopted as the final design."

He said the decision arose out of problems encountered when building the Glasgow hospital, which he also worked on, when the bidders strayed too far from the initial plan.

"The message from the Glasgow team to the Edinburgh one, who were about a year behind, was to make sure the reference design isn't changed. The reference design was not developed enough and yet we were telling builder 'that's the design you have to work on in order to win the bid.'"

He said his firm joined one of the bid teams and tried to change the layout of four long and narrow interview rooms. There were no cost implications and they were told it worked better, he said, but that it was 'non-compliant.'

"It was this rigid adherence to the reference design that was suffocating any attempt to remedy problems," he added.

"We needed to halt the process and work out how we were going to sort out these problems but that's where it started to unravel. It was rushed out to the bidders, there was political pressure with the need to replace the old building, deadlines were looming."

In Glasgow, issues with ventilation at the QEUH are being investigated after a 10-year-old boy died from fungus linked to pigeon droppings. Patients in both the RHC and QEUH have also been struck down with water-borne pathogens.

A new suite of brain surgery theatres costing £7m were scheduled to open in 2018 at the Imaging Centre for Excellence, on the QEUH campus, but are still lying empty after failing safety tests surrounding ventilation.

Another source at NHSGGC, who did not want to be named for fear of losing their job, said the focus for the new builds was “more about innovation, energy efficiency and environmental benefits.”

They explained: “As the process went on, [there was] more focus on getting the stuff done on time, and creating flashy facilities that look incredible.

“There is absolutely no point in having hospitals applauded for their design and aesthetic when they don't seem to be able to function as a hospital in the most basic sense – to keep people safe and make things easy to deliver the best care possible.”

Glasgow QEUH: Two more children with cancer struck down by rare bugs at super hospital

A senior NHSGGC employee added that similar pressures are being applied to the Golden Jubilee hospital and four other health boards currently developing new elective procedure centres.

The centres are supposed to make to easier to get treatment for cataracts, knee and hip replacements and are to be spread across four health boards as well as the Golden Jubilee.

In September, Freeman wrote to the chief executives of boards carrying out the projects, chastising them for falling behind schedule.

She wrote: “I am aware of the current status of each of the individual projects and I am disappointed at the level of progress made to date and the significant slippage in the timescales of the expected deliverable dates that were agreed three years ago.

“As such I will be focussing on increasing the pace of work required to deliver these centres within the original agreed timescale.”

Sources claim both the government and the former head of NHSGGC were intent on leaving a legacy, adding to the pressures to get the Glasgow facilities completed.

Scottish Liberal Democrat health spokesman Alex Cole-Hamilton MSP said: “It’s shocking to hear some of the professionals involved in the commissioning stages felt excluded from critical planning because of time constraints.

“Ultimately if the public is pouring millions and millions into these big builds they want efficient facilities to be the end result. People would be stunned to think health and safety has played second fiddle to deadlines.

“The safety of patients should be the driving force behind these flagship projects, not political pressure.”

Monica Lennon, Labour's health spokeswoman said: "“Everyone involved should remember these are healthcare projects, not vanity projects.

“Mistakes can make the difference between life and death, so no one should be treating our hospitals as “trophy pieces.”

“Unfair pressure risks poor decision-making and we simply cannot take chances with patient safety. The ambition to create showpiece hospitals should not be compromising the basic principles of healthcare and our precious NHS. SNP Ministers should be making sure that there is enough resource available to upgrade and renew our hospital estate and that this is supported by exemplary project management.”

An NHSGGC spokeswoman said:"The project to design, construct and commission the Queen Elizabeth University Hospital and the Royal Hospital for Children was delivered within a robust governance framework.

"This included independent technical support and monitoring of progress by an external government gateway review process.

"As with any major build project, the timescales for the project were set and agreed at the outset. It was delivered in line with the agreed programme – taking more than four years to build and delivered one month ahead of schedule.

"From project conception to completion there was a multi-disciplinary clinical and non-clinical project team representing the NHS in the client construction partner process.

"Appropriate regulatory bodies were content with the compliance of the project to national standards and certified it fit and ready for use."

The Scottish Government added: "Decisions on building schedules for the new Queen Elizabeth University Hospital and Edinburgh Children’s Hospital were – quite rightly - entirely for NHS Greater Glasgow and NHS Lothian to take in conjunction with their contractors."