Chartered Institute of Building Magazine of the Chartered Institute of Building


‘No link’ between Multiplex hospitals and deaths

16 June 2020

There was no link between failures in the construction of two Multiplex hospitals in Scotland and unavoidable deaths, an independent review has found.

The Queen Elizabeth University Hospital Independent Review has published a report into the design, build, commissioning and maintenance of the Queen Elizabeth University Hospital (QEUH) and Royal Hospital for Children (RHC).

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.

But the review concluded that the hospitals offer “a setting for high quality healthcare for patients, staff and visitors” and there was “no clear evidence” linking failures in their design, build commissioning and maintenance to avoidable deaths.

After examining documents, listening to witnesses, and discussion with experts, the report’s authors said: “The QEUH and RHC combined have in place the modern safety features and systems that we would expect of a hospital of this type. The general population of patients, staff and visitors can have confidence that the QEUH/RHC offers a setting for high quality healthcare.”

Report identifies failings

However, the report also detailed a series of problems with the hospitals:

  • Improvements to the wards where vulnerable patients are managed are underway, including the 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”;
  • 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”. The report said this “constrained” the review and “continues to hamper effective running of the QEUH/RHC building”.

Dr 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”.

“The series of problems and influences that we have identified through the phases of the QEUH project has disrupted treatment for defined groups of patients, meant additional workload for Infection Prevention and Control teams, many clinical groups and hospital management, and diverted resources and attention from the running of this large and complex facility”.

Recommendations to feed into public inquiry

The report has made a total of 63 recommendations relating to air quality in clinical environments, water quality in clinical environments, and rare microorganisms and their clinical significance.

Dr 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.”

In November last year, the Scottish health secretary, Jeane Freeman announced a public inquiry into problems at the QEUH, to be headed by high-ranking Scottish judge Lord Brodie.

Both Dr Montgomery and Dr Fraser have attended meetings with Lord Brodie, who will lead the public inquiry, and the report makes a number of recommendations for areas of further investigation by the inquiry.

A spokesperson for Multiplex said: “The independent review published today has established no sound evidential basis for asserting that avoidable deaths have resulted from failures in the design, build, commissioning or maintenance of the QEUH and RHC.  As the authors of this extensive review have outlined this is a complex story with a variety of perspectives and views. Our team will now go through their detailed findings and recommendations to properly consider issues they have raised in relation to the design and build of hospital before making any further comment.”

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