A health board at the centre of an inquiry into the safety of its flagship hospital has been accused of trying to dodge scrutiny by redefining how it will carry out investigations into near misses and incidents where patients have come to harm.

Health chiefs at NHS Greater Glasgow and Clyde have signed off on a new process that will see several safety incidents previously investigated under the terms of a Serious Adverse Event Review (SAER) categorised instead as "Rapid Reviews".

Events classed as Rapid Reviews rather than SAERs will not be automatically flagged to board members, nor notified to Healthcare Improvement Scotland (HIS) as is the case for Category One SAERs where blunders have resulted in death or severe injury.

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It will be up to managers to decide which incidents to treat as Rapid Reviews, but these are mostly expected to cover events currently considered Category Two or Three under the SAER framework.

According to HIS guidance published in 2019, a Category Two serious adverse event is something which results in "temporary harm" such as prolonged treatment or the need to suspend a particular service.

Category Three incidents are considered "near misses" where there was potential for harm, but no harm occurred.

HIS stresses that "a severe or tragic outcome" should not be the "only determining factor" when deciding the level of review required, adding that "near miss events with no adverse outcome and complex lower severity adverse events (Category Three) can also warrant high level review if there is potential for learning".

NHS GGC's new system will take effect from January 1 after being endorsed by the board's clinical governance committee.

The shake-up has been led by deputy medical director Colin McKay and Paula Spaven, the director of clinical governance.

However, the Herald understands that a number of senior clinicians have raised concerns about the changes, but that their criticisms were never communicated to board members.

The Queen Elizabeth University Hospital and Royal Hospital for Children campus is currently at the centre of the Scottish Hospitals Inquiry (Image: newsquest) An expert group was formed in October to evaluate how to "streamline" the process amid concerns that investigations were taking too long to complete, including well over a year in many cases.

NHS GGC said its new approach will enable it to prioritise resources to the most complex cases, and that the changes are "in line with" the 2019 HIS Adverse Event Framework.

However, the Herald has seen communications from healthcare professionals consulted about the redesign who are alarmed by the changes.

They write: "Rather than try and work out the reasons why its taking so long and tackle the blockages in the system, their [Mr McKay and Ms Spaven] idea is to do less of them [SAERS] by filtering a large chunk down another process.

"They have cobbled together a report format they’re calling Rapid Review that asks the same questions as a SAE report but it isn’t called a SAE and so it won’t be reported as such...There’s no clue how they can make it rapid either when it’s the same thing under a different name.

"They won’t have any of the scrutiny the board gives to SAE reports.

"It is going to be left to the discretion of directorate managers to decide which incidents are labelled SAERs and which go through this new process and they are only obliged to tell the board which incidents they have commissioned as SAEs so there is going to be a huge organisational blindspot here.

"[The worry is] big areas of risk such as patients being harmed following avoidable falls...Perhaps if we crack problems like this at an organisational level there will be fewer SAEs needed but instead, they are just being delegated down the chain to a level where there is no scope to affect change."

Serious Adverse Event Reviews (SAERs) are currentlySerious Adverse Event Reviews (SAERs) are currently labelled category One, Two, or Three depending on severity, but NHS GGC will replace many of these investigations with a 'Rapid Review' process instead(Image: PA) They go on to say that they were "flabbergasted" during a meeting on November 22 to discover that "wholesale change to such a safety critical process" had been signed off by the Clinical Governance Committee with effect from January 1.

They added: "None of the risks of the proposals have been presented to the board, nor have the concerns raised thus far by our group.

"Key people such as the medical director of mental health was not present at all. We were all left feeling ambushed, that it was a fait accompli."

In addition to the introduction of Rapid Reviews, further changes to the SAER process will see the groups of senior clinicians who are currently tasked with independently checking the SAER reports on behalf of the board, before they are signed off, disbanded and replaced by local management teams.

This was criticised by clinicians as "marking their own homework".

They added: "This is going to have implications for how they review the most serious incidents like baby deaths, suicides and child protection cases. It is such a backward step."

NHS GGC said the role of quality assurance by independent clinicians "will be kept under review".

It comes as families involved in the Scottish Hospitals Inquiry said they have been shocked by evidence which they say demonstrates a "clear lack of transparency" by NHS GGC in relation to problems at the Queen Elizabeth University Hospital in Glasgow and its adjacent Royal Hospital for Children. 

Scottish Labour's Jackie Baillie said NHS GGC must 'learn lessons from past mistakes'Scottish Labour's Jackie Baillie said NHS GGC must 'learn lessons from past mistakes' (Image: PA) They have called on the inquiry - which is probing whether issues with the buildings' water and ventilation systems led to a string of unusual, sometimes fatal, infections - to publish an interim report on the hospitals' safety.

Scottish Labour's health spokeswoman, Jackie Baillie, said: "At a time when the public inquiry into the safety of two Glasgow hospitals is still ongoing, it is all the more pressing that Glasgow's Health Board learns the lessons of past mistakes.

"While there is always a balance to be struck, there must be transparency and it's essential that reviews remain independent, thorough and command the confidence of staff.

"NHS Greater Glasgow and Clyde must be transparent about its processes so that patients can enter hospital feeling assured that they are in the most trusted of hands."

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In a statement, NHS GGC said: "We are committed to being open, honest, and supportive towards those affected by adverse events and aim to ensure consistent, high-quality, and timely reviews with shared learning, managed throughout the event rather than retrospectively.

"Following a review of SAERs, we are adopting a new approach which is in line with other NHS Scotland Boards and the current Health Improvement Scotland Adverse Event framework.

"This will categorise adverse event reviews by scale, scope, complexity, and learning opportunities.

"This will enable us to respond more efficiently to incidents to help ensure patients and families are informed as early as possible, while also streamlining cases to allow us to dedicate resources to investigate the most complex cases.

"As part of the evaluation, the role of quality assurance by independent clinicians will be kept under review, while Adverse Event Oversight Groups will also be established within sectors, directorates, and partnerships to manage and oversee all adverse events within their services.

"NHSGGC works in line with the Healthcare Improvement Scotland Adverse Event Framework which was published in 2019 and will notify category one events as required and continuously evaluate its approach to managing adverse events."