Terms of Reference
Since opening in 2015 the Queen Elizabeth University Hospital (QEUH) in Glasgow has experienced problems with rare microorganisms. A small number of patients have contracted severe infections and several rare microbiological contaminants with the potential to cause serious infections have also been identified. These have been linked to issues with water quality and ventilation systems and have been the subject of reviews undertaken by the Healthcare Environment Inspectorate and Health Protection Scotland.
To address concerns about patient safety the Cabinet Secretary for Health and Sport set up an Independent Review (“the Review”) to look at the buildings’ “design, commissioning and construction, handover and ongoing maintenance and how these matters contribute to effective infection control.” The Review’s recommendations will be made public and the Scottish Government will inform the Parliament of its response to the Review recommendations.
“To establish whether the design, build, commissioning and maintenance of the Queen Elizabeth University Hospital and Royal Hospital for Children has had an adverse impact on the risk of Healthcare Associated Infection and whether there is wider learning for NHS Scotland.”
Terms of Reference
There is public and professional concern that the built environment at the Queen Elizabeth University Hospital (QEUH) and Royal Hospital for Children (RHC) is compromising best practice in infection prevention and control and increasing the risk of Healthcare Associated Infection.
Dr Andrew Fraser and Dr Brian Montgomery have been appointed by the Cabinet Secretary for Health and Sport to co-Chair the Review to investigate these concerns, make recommendations and highlight learning for NHS Scotland. The Review has specifically been tasked to undertake a clinically-focussed approach which examines the built environment with particular reference to the design, build, commissioning and maintenance of QEUH/RHC.
The Review, which is non-statutory, will be conducted according to the principles laid out in Professor Alison Britton’s report, “An Investigative Review into the process of establishing, managing and supporting Independent Reviews in Scotland.”
Scope of the Review
The review will examine:
- The new QEUH and RHC buildings on the greater QEUH campus site;
- The governance processes in place to oversee the project as it moved through the phases of design, build, commissioning and maintenance with particular regard to issues relating to infection prevention and control;
- The extent to which decision makers took account of infection prevention and control issues at each phase;
- The overall design of QEUH/RHC with particular reference to site selection, the safety of water systems, drainage systems and ventilation systems – general and specialised;
- Whether at all stages of design, build, commissioning and maintenance, the built environment complied with relevant legislation, standards, recommendations and guidance relating to infection prevention and control that applied at that time;
- If changes to the specification occurred, whether issues relating to infection prevention and control were considered and addressed appropriately;
- Whether the hospital has been utilised in a way that differs from the original design intentions and whether this has compromised the delivery of optimal conditions for infection prevention and control.
Out of Scope
- Other buildings on the campus, including the retained estate that predates the QEUH/RHC;
- The clinical management of individual patients or specific groups of patients;
- Aspects of the design, build, commissioning and maintenance of QEUH/RHC which do not impact directly on infection prevention and control;
- Issues relating to the concerns at QEUH/RHC which have already been satisfactorily addressed and implemented, or are going to be addressed by one or more of the concomitant reviews, inspections or inquiries.
- Extensive preliminary work undertaken to establish the processes, structures, support and governance required to ensure a robust Review;
- Selection of key advisers, sourcing specialist advice and developing secretariat function and team;
- Agreeing the remit, drawing up preliminary Terms of Reference and inviting feedback on these;
- Visits to various hospitals and specific sites;
- Developing protocols and methods of working;
- Information gathering including collation of key documentation;
- Analysis of documentation, including correspondence and transactions surrounding the specification and placing of the contract to construct the QEUH/RHC as well as relevant developments and decisions that altered the design and build throughout the construction period;
- Analysis of documentation of decisions, taking into account testing and monitoring data around the time of commissioning the new hospital elements, as and when it opened to patients;
- Analysis of post-construction surveys of the QEUH/RHC and in particular those surveys intended to test and/or quality assure systems within the buildings;
- Assessment of existing evidence, legislation, standards, guidance relating to the building of clinical facilities with particular regard to infection prevention and control.
The Review will invite written communications from:
- Patients and families with experience of care delivered in QEUH/RHC where there are concerns in relation to infection prevention and control;
- Stakeholders with involvement in and/or experience of the design, build, commissioning and maintenance of QEUH/RHC;
- Staff (clinical, estates, domestic, management) working within QEUH/RHC with particular reference to the impact of the built environment on the delivery of best practice in infection prevention and control;
- External stakeholders (members of the wider public and their representatives);
- Individuals or groups with concerns relating to the built environment and its impact on infection prevention and control.
There will follow a period of familiarisation with documentation, building a chronology of events and identifying emerging issues. As part of this process, the Review team will establish a list of relevant witnesses and issue invitations to interview.
The Review team will arrange interviews, and transcribe proceedings.
In the closing phase, the Review will select preliminary findings/recommendations, and thereafter proceed to prepare and submit its final report.