Edinburgh's new Sick Kids hospital: Inquiry report criticises NHS Lothian on lack of clarity over ventilation needs

The Royal Hospital for Children and Young People (RHCYP) and Department of Clinical Neurosciences in Edinburgh were due to open in July 2019 but a delay was announced just hours before.

Eventually opening in March 2021 with the delay believed to have cost almost £17 million, the hospital became a subject of the Scottish Hospitals Inquiry - alongside parts of the Queen Elizabeth University Hospital campus in Glasgow .

Picture: Scott Louden

Lord Brodie, chairman of the inquiry, published 11 recommendations on Monday as part of his interim report, where he criticised NHS Lothian's handling of the design of the RHCYP and accused it of leaving patients and families "in the dark" on the delay.

Ahead of the opening of the site, issues with the pressure differentials and air change rates - which can help to protect from airborne diseases - in the ventilation of the paediatric critical care department were found, the inquiry reported.

Lord Brodie said: "On the basis of the evidence that I have heard, I have concluded that in a project for the construction or refurbishment of a healthcare facility, it is the health board, as the prospective provider of that healthcare, in consultation with relevant stakeholders and clinical and technical advisers, that is best-placed to identify what it requires from the ventilation system.

"This includes the precise output parameters that the ventilation system must meet.

"Accordingly, determining the output parameters of a ventilation system should not be left to the judgment of the project company and its subcontractors during the design phase.

"The design should address how previously determined parameters are to be achieved, not what should be achieved.

Scottish Hospitals Inquiry chairman Lord Brodie has published his interim report on Edinburgh’s new Sick Kids hospital

"In relation to this project, it is my conclusion that NHS Lothian did not present its requirements for the output specifications of the ventilation system with sufficient clarity and precision."

Instead, the board relied on the contractor's interpretation of NHS guidance for ventilation systems, the inquiry found, and provided a document described as an "environmental matrix" which set specifications for the ventilation system.

The matrix contained an "undetected error" in relation to critical care rooms, the inquiry said.

Jim Crombie , the deputy chief executive of NHS Lothian, said: "Lord Brodie has identified our failure to provide a clear design brief at the outset as critical to events as well as weaknesses in governance and understanding between contractual partners.

"We are sorry for these failures and also deeply regret that opportunities were missed by all parties over the course of the project to detect and rectify errors in the design of the ventilation regime.

"The report acknowledges the changes that have been put in place in NHS Lothian and the new guidance introduced since 2019 to ensure that lessons are learned and similar events can be prevented in the future.

As well as the design of the buildings, the inquiry also criticised NHS Lothian's handling of communications with patients and their families around the delay.

"The decision not to open the hospital as planned had a significant impact on patients and their families, who were shocked, scared and deeply disappointed that long-promised new facilities were not to be available for the treatment, in some cases, of children suffering from very serious conditions," Lord Brodie said.

"Patients and their families were left in the dark as to the reasons why the hospital did not open as planned.

"Communication with patients and families was unsatisfactory in this regard. I have seen this to have been important.

"There is a group of young patients who are very seriously ill and spend a significant portion of their time, sometimes much of their lives, in hospital.

"They are supported by family members or guardians. The hospital becomes, for them, their second home.

"The impact of unclear or poor communication on the wellbeing of patients and their families during what may already be a very difficult, emotional and uncertain period in their lives is significant."

Mr Crombie responded: "Patient safety was always our driving force in commissioning a first-class hospital building so we know that the discovery of a ventilation problem just days before it was due to open caused shock and significant concern for our patients, their families and our staff.

"We once again reiterate our sincere and unreserved apology to them all for the resulting delay to the transfer of patient services to the new facility.

"I am particularly sorry that patients and their families were let down at a time when they were already worried and vulnerable."

The final report of the inquiry, which will focus on the Glasgow hospital, is expected next year.