Update on Royal Hospital for Children and Young People

A timeline for the phased move of services to the new Royal Hospital for Children and Young People (RHCYP) has been announced.

Health Secretary Jeane Freeman expects the Department of Clinical Neurosciences (DCN) to move in spring 2020, with the rest of the Children’s Hospital migrating to the new site in autumn next year.

The decision follows the findings of two reports commissioned by the Health Secretary in July to ensure patient safety across the site.

An independent review of the governance arrangements for RHCYP by KPMG has found that the main issue with ventilation in critical care stemmed from an error in a document produced by NHS Lothian at the tender stage in 2012. This was despite the requirement to also adhere to relevant technical guidance.

The KPMG report attributes this to human error and confusion over interpretation of standards and guidance. It also concludes that opportunities to spot and rectify that error were missed.

Ms Freeman said:

“I would like to acknowledge the contribution of staff who have continued to provide high quality clinical services. We are all very grateful for their dedication and professionalism in what have been very difficult and disappointing circumstances.

“I also want to thank the patients and families affected for their patience. The safest possible care of their children is my overriding priority and I am sorry for any impact the current situation has had on them.

“I am of course bitterly disappointed that a mistake made in 2012 was not picked up earlier. This is a publicly funded project of strategic importance, which has not been delivered by NHS Lothian in compliance with the standards and guidance. The delay we now face will be borne by NHS Lothian staff, by patients and their families and the additional cost will be to the public purse.

“My overriding priority is that the children and families who depend on these hospital services can receive them in the safest way possible. The current situation is not one anyone would chose – but it is one I am determined to resolve.”

Ms Freeman also asked NHS National Services Scotland (NSS) to undertake a detailed assessment of compliance of all building systems which could impact on patients and staff at the new site.

This has identified a range of issues which need to be resolved prior to occupation of the building, including ventilation and water systems. The NSS report makes a number of recommendations which NHS Lothian have accepted and the Scottish Government will publish an action plan from the board along with both reports.

Due to the scale of the challenge relating to the delivery of the new hospital, NHS Lothian has been escalated to level 4 in the NHS Board Performance Framework for this specific issue. The Scottish Government will put in place a Senior Programme Director who will take responsibility for day to day delivery of the RHCYP from now until the site is fully occupied. 

As announced in Programme for Government, a new national body will also be created. This will have oversight for the design, planning, construction and maintenance of major NHS Scotland infrastructure developments.

Background:

KPMG report

NHS NSS report

NHS Lothian Action Plan

Main findings of the NSS report which need to be resolved prior to occupation of the building: 

• in ventilation - in addition to the issue previously identified in critical care - remedial action is required on the quality of work in a number of areas, with specific issues identified in Haematology / Oncology
• independent testing identified no widespread contamination of the water systems, but NSS has recommended some remedial and precautionary actions, as well as system-wide disinfection prior to occupation
• NSS recommend active monitoring for drainage and plumbing, however both these areas are considered low risk

The new national body as announced in Programme for Government will provide advice and challenge to all capital investment projects currently in development, including the Elective Centre Programme, the Monklands Replacement Project, the Baird and Anchor in Aberdeen and various primary health and social care centres across the country (Chapter 3, p109)

NHS Board Performance Escalation Framework

Board	Current Stage	Date Escalated/De-Escalated	Primary Factors
NHS Tayside	4	Stage 4 February 2019	Financial position and financial management; governance and leadership
NHS Highland	4	Stage 4 November 2018	Financial position and financial management; governance, leadership and culture
NHS Borders	4	Stage 4 November 2018	Financial position and management; leadership
NHS Ayrshire & Arran	3	Stage 3 July 2018	Financial position and management
NHS Lothian*	3	Stage 3 July 2019	Performance and management

  *NHS Lothian remain at level 3 but have been escalated to level 4 as of September 2019 specifically for delivery of RHCYP programme