IN a series of leaked reports passed to The Herald on Sunday, startling new details about the problems at Glasgow’s flagship hospital campus have been revealed.

Ventilation reports, minutes of meetings about bone marrow transplant facilities and health watchdog documents detail a catalogue of issues across both the Queen Elizabeth University Hospital (QEUH) and Royal Hospital for Children (RHC), dating back to 2015.

The cache of documents includes a report by independent consultants Innovated Design Solutions that looks at how to improve the ventilation and air quality in the RHC. The report suggests problems in the ventilation system in other parts of the hospitals.

A report by Health Protection Scotland was also passed to The Herald on Sunday, expressing concerns about plans to address problems with bone marrow transplant units, and minutes of a meeting with health chiefs about issues with the children’s bone marrow units just months after they opened.

Today we can reveal the contents of the documents for the first time.

Wards

Both the cancer ward in the RHC and the adult bone marrow transplant ward at the QEUH are described as having not been built for their purpose.

Private contractor Innovated Design Solutions concluded in its investigation into ward 2A: “We anticipate the original accommodation design was not intended for use by patients with immune response impairment/deficiency. On the contrary, the existing ventilation strategy would appear only likely to promote the risks associated with uncontrolled ingress of infectious aerosols into patient areas.”

On the adult bone marrow unit, Health Protection Scotland reports from October 2017 state: “The decision to transfer the care of bone marrow transplant patients from the Beatson oncology unit to the QEUH was made in June 2013. Construction of the QEUH was well established at this point and therefore the new unit was not purpose built.”

Ventilation

The size of the device which takes air in and out of the hospital was selected incorrectly, according to the Innovated Design Solutions report. The document explains that the devices are only able to take in 100% of the air needed when filters inside the ventilation system are clean. As soon as filters start to get dirty, the amount of air the system can take in falls, reducing the number of times air can be circulated through the hospital. The report indicates the devices would need to be able to take in 125% of the air required to account for dirty filters.

The report explains: “Air handling units [AHUs] fans were not sized or selected to afford a spare 25% capacity, as suggested by record documentation.

“Whilst technical literature would suggest there is 125% capacity available in AHUs, the manufacturer has advised that fans/motors were selected based on 100% duty with clean air filters (ie all AHUs).

“We would emphasise the probability of these issues/inadequacies being applicable to other air handling equipment installed within the A&C [adult and children’s] hospital.”

The number of times air is circulated around wards is vital to patient safety. Patients with severely restricted immune systems should be in rooms with 10 air changes per hour, while people with more robust immune systems should have six air changes per hour. The ventilation report reveals that there were only three air changes per hour in the children’s cancer ward, describing this as “significantly lower than would normally be expected”.

The report states: “It should also be noted that current air change rates are not in accordance with recommendations defined within either [Scottish or UK guidelines on hospital ventilation].

“Whilst we were unable to locate documentation defining system design criteria, [UK guidelines on hospital ventilation] were available in 2007. If there was an agreed deviation from recommendations defined within guidance documents, available at the time of design, we would expect this to be clarified within the Health and Safety File documentation.”

Energy-saving devices

Thermal wheels, which help to capture heat and save energy from ventilation systems, are common in large buildings but scientists have begun questioning their use in hospitals as they carry a risk of contamination. The devices are widely used in both the QEUH and RHC, as well as in the nearby Imaging Centre for Excellence and the learning and teaching facility on the campus.

Investigators said they “Consider this to identify a potential risk associated with cross-contamination” and added: “We recommend this be further investigated and level of associated risk considered against the use of facilities. We anticipate the majority of AHUs installed within the building are also equipped with thermal wheels ie Critical Care, General Theatres, Theatre Recovery, Endoscopy, Ultra CT Suite, Nuclear Medicine. Again, we recommend this be further investigated.”

Record keeping

Several anomalies were picked up by investigators at the private consultancy firm in terms of the records held for the RHC. During their investigations into ward 2A, they found “evident anomalies” with records such as those for the size of air handling units which did not match those installed.

They said there was no record about why the number of air changes in the bedrooms was lower than the required amount and added: “We were unable to locate any details… pertaining to an agreed deviation from recommended guidance.”

The device which supplies air into bedrooms was also noted as being incorrect in the records, with investigators finding the devices were “incorrectly identified within record documentation, albeit functionality is very similar”. The sizes of pipes which carry air into the hospital were recorded differently on two separate drawings – one stated they were 7550x600mm and another said they were 600x500mm.

Drawings of ventilation systems on other floors were also found to be inaccurate.

Bone marrow units

NHS Greater Glasgow and Clyde (NHSGGC) medical director Jennifer Armstrong, Grant Archibald, the then-head of acute services, and Billy Hunter, head of facilities, as well as five other senior colleagues held a meeting in September 2015 to discuss apparent problems with the children’s bone marrow transplant suites.

The minutes of this meeting state they “acknowledged clinical frustration about progress and the need to plan for patients currently waiting transplant”.

They also state that “two suites have been sealed (which should safely last one year) to avoid air penetration from a source outwith the air handling unit” and add “Brookfield [contractor] could retrofit air handling unit modifications … at an approximate cost of £35k per room”.

NHSGGC confirmed that upgrades were made to four of the suites, which had been used for bone marrow transplant patients, while four of the other suites were used to accommodate other children with cancer and were not upgraded.

Health Protection Scotland documents raise concerns about plans to fix the adult bone marrow transplant suites in the QEUH, which had been emptied of patients several months after the hospital opened.

The document states: “The decision to transfer the care of bone marrow transplant patients from the Beatson oncology unit to the QEUH was made in June 2013. Construction of the QEUH was well established at this point and therefore the new unit was not purpose built.

“Whilst NHSGGC has continued to work towards recommendations, it is noted that the solution proposed does not meet guidance, nor does it seek to address all the recommendations … As a result, HFS cannot comment on the effectiveness of the measures intended to be put in place.”

Bone marrow transplant patients have now returned to the QEUH, following work undertaken in 2017, according to NHSGGC.

Expert's opinion

Christopher Shaw, director of the Medical Architecture design practice, said: “These are new buildings and there are errors. How it happened is a consequence of the complexity and unique nature of the projects and the mismatch of control systems to those projects.

“In a building of this type there are hundreds of thousands of components. These are brought together by specification, design and construction through tens of thousands of controlling documents and databases. It’s then assembled through thousands of contracts and warranties.

“It’s a one-off product. The complexity should be mitigated by guidance and standards. Those can be managed and maintained where there is a rolling programme of projects to recycle knowledge from mistakes and introduce evolutionary improvements.

“However, change in the procurement process has pushed ‘risk’ to the contractor and since the banking crisis there has been a broken pipeline of work. Both of these have undermined that status and effectiveness of performance specification.”

Shaw added that while he was not an engineer, and had no in-depth knowledge of the Glasgow hospitals specifically, he believed “the issues identified are likely to be generic and occur elsewhere”.

He added: “They are undoubtedly serious and, in the case of an oncology unit, I would say critical. These faults will need to be corrected.”