NHS board did not consider hospital-acquired infections to be unintentional, inquiry told

A psychologist who worked with families of child cancer patients at a scandal-hit super hospital told an inquiry that NHS management “did not consider healthcare-acquired infections to be unintentional and unexpected”.

Professor Craig White, associate director of NHS Scotland’s chief operating officer and associate director of Healthcare Quality and Improvement, worked on the Scottish Government’s duty to franchise health legislation in relation to “unexpected or unintended incidents” in 2018.

He trained in the social and psychological impact of cancer in 1998 and worked with families of child cancer patients at the Royal Hospital for Children in Glasgow after being called into the role by then Scottish health secretary Jeanne Freeman in October 2019 until June 2021 .

Professor White gave evidence on Thursday to the Scottish Hospitals Inquiry, which was set up to examine infections on the Queen Elizabeth University Hospital (QEUH) campus, which includes the Royal Hospital for Children, and whether the built environment contributed.

He told the inquest his role was to “ensure that the voices of affected families were heard and that they were provided with information”, but said he was met with “distrust” from relatives.

He said he was tasked with working with executives from NHS Greater Glasgow and Clyde (NHSGGC), initially to get answers to 71 questions about water and ventilation.

Professor White said that in 2020 he discovered that the NHSGGC changed its duty of candour policy and added three concepts that did not exist in the law, which was designed to address incidents that could have resulted in harm.

He said the legislation “sets out the obligations of the responsible person, but only if the procedure is activated” – but the inquiry’s chairman, Lord Brodie, said there was “a discrepancy between the legislation and NHSGGC policy” that made it more difficult activation due to additional requirements.

Prof White said: “The policy included reference to ‘patient safety incident’, which is not in Scottish legislation and appears to have reference to ‘avoidability of harm’ and ‘causality’, neither of which are described in the legislation.”

Lord Brodie said: “GGC policy has introduced perhaps three obstacles as a precondition for activation that are not found in the legislation. What you discovered in early 2020 was that, since April 2018, the GGC had been imposing, by virtue of its policy, a greater hurdle on whether it was obliged to take the steps specified in the legislation.”

Professor White said he challenged the changes as families suffered “psychological harm” due to hospital-acquired infections – which he said were not perceived by the NHSGGC as “unexpected” due to the risks to cancer patients.

Giving evidence, Prof White said: “What the subgroup learned was that the organizational duty of candor was not activated, there was discussion as to why not, the information was that the legislation sets out ‘unintentional or unexpected incidents’. The legislation does not define these terms, they are what the person responsible – GGC – must interpret.

“They did not consider healthcare-acquired infections as ‘unintentional and unexpected’, as it is known that children with cancer are immunocompromised and can develop infections.

“My challenge to colleagues was questions like ‘is it expected that a mother of a child who vomited due to cancer treatment would not be able to clean her child because the water is turned off?’.

“The subgroup discussed ‘unintentional/unexpected’ – because the organizational duty of candor includes increased treatment or psychological harm.

“By this time I had already visited some families in their homes. I was saying ‘there are some families who are extremely distraught and distressed, how do you explain the psychological damage?’.

“It’s not just the infection, you also have things like increased treatment or psychological damage.”

Craig Connal KC, senior counsel to the inquiry, said: “The position remains, as you have been told – the council’s approach had obstacles which did not reflect the terms of the statute.

“In many respects the main obstacle is that causation – incident A caused harm B – was part of the council’s system, when legislation says ‘the incident appears to have resulted or may result’.”

Prof White said: “It doesn’t say ‘establish causality’. The intentions behind this legislation were to make it clear to relevant people and staff what they can expect in terms of feedback, support and the end of the process, so that this is publicly disclosed annually.”

The investigation continues in Edinburgh.