By Andrew Picken
BBC Scotland News
Hundreds of problems with health board building projects have been found by NHS trouble-shooters, new data shows.
NHS Scotland Assure was set up in 2021 after a string of problems with hospitals in Edinburgh and Glasgow led to a public inquiry.
Assure’s role is to improve the quality, safety and running of NHS construction projects across Scotland.
In half of the 22 schemes it reviewed, the watchdog could not support them going forward without changes.
Of those projects it did not approve at the time of inspection, issues with ventilation, fire hazards and infection control were among the 314 “significant” or “major” issues spotted.
Without a satisfactory NHS Assure review, new facilities are not allowed to open to the public and a number of projects across Scotland – such as new hospital buildings in Aberdeen – have been delayed as a result.
The Scottish government said it wanted to ensure that new facilities were safe, and that the system was working “exactly as we expected”.
But one industry expert told BBC Scotland the data was concerning.
They said: “One of the major issues is that there is no feedback built into the system – a new hospital is constructed but there is no review after the construction to find out what works and what does not work.
“Thus, there is no systematic learning between one project and the next, most of the design teams and architects will have already left site so they are none the wiser.
“For many individuals a new hospital build is a once in a lifetime opportunity, as such most people will have received no training as to what is required.”
Billy Hare, a professor of construction management and deputy director of the BEAM Research Centre at Glasgow Caledonian University, said the Assure programme could be “slicker”.
He told BBC Scotland the ideal time for Assure to flag issues with projects would be at the early development or business case review stage, but said that if it came at the construction or handover stage it can lead to extra costs and delays.
Professor Hare also warned of communication issues between health boards and construction firms over specifications for buildings.
“Whilst it has been a problem in the past, I do believe that the inspections and the audits that NHS Scotland Assure have been implementing over the past year or so has been a real sea change,” he said.
“What I would expect is maybe in a year’s time they’ll realise the culture needs to change.”
Image source, NHS Highland
NHS Assure found 22 ‘significant’ or ‘major’ issues during a review of the Highland National Treatment Centre in December, 2022 and was not able to support the project at that time. The points were addressed by NHS Highland and the delayed centre opened in April.
NHS Scotland Assure’s team include microbiologists, infection control nurses, architects and engineers.
They carry out what are known as key stage assurance reviews at both the planning stage of projects and when building work is taking place.
Reports of all the Assure reviews to date were released to BBC Scotland under freedom of information laws. The projects it supported included plans for a new critical care unit in NHS Tayside and a replacement for Monklands Hospital in North Lanarkshire.
The projects where NHS Assure expressed concerns included a planned upgrade of the Western General Hospital in Edinburgh.
A review in October last year found 22 major issues and called for more detailed plans to be drawn up.
Plans to replace a NHS Greater Glasgow and Clyde facility that manufactures radiopharmaceutical medicines were found to have 31 significant or major risks, including “poor project governance”, in a report published last June.
‘I could not wait any longer’
Victor Morton, 65, went private for a knee replacement operation after being told he faced a two-year wait on the NHS
Delays to the NHS building projects that will increase capacity for operations ultimately mean some patients who are part of Scotland’s post-Covid treatment backlog will be on waiting lists for longer.
Former health worker Victor Morton, 65, was on the NHS Tayside waiting list for a knee replacement.
“It was having a big impact. At my first consultation in January 2021, I could walk a mile – but within three months of that I could not get round the block,” he explained.
When he was told that it could be two years before he got his operation, he decided he could not wait any longer – so he dipped into his savings and went private.
Part of NHS Tayside’s plan to deal with its waiting list backlog is to build a new National Treatment Centre at Perth Royal Infirmary.
An NHS Assure review of the project’s business case in February ruled it could not support it at this stage. A “lack of evidence to support the management, mitigation, and elimination of infections risks” was among the 30 major issues identified.
NHS Tayside says it has addressed two thirds of the actions in the review and is on track to complete the rest by the end of the summer. However, the project is behind schedule and without a target opening date.
Victor says the knee operation has given him “his life back” and he is back on the golf course and holidaying.
He added: “I feel privileged that I was able to do this. I know there are plenty out there that can’t.”
The Scottish government’s plans for National Treatment Centres (NTC) at 10 sites across Scotland and are meant to be delivering at least 40,000 additional procedures per year by 2026.
But NHS Assure has found issues with a number of them, including plans for a new modular-built orthopaedics centre at Forth Valley Royal Hospital.
A review in May, 2022 found 42 areas of significant or major concern even though construction was under way.
NHS Forth Valley said the NTC, which had been due to open in early 2023, will now open by the end of the year.
It added that the majority of the issues Assure found 14 months ago have been addressed and they “are confident that any outstanding issues will be resolved over the next few months”.
Image source, Getty Images
Well documented problems with the water and ventilation systems at the Queen Elizabeth University Hospital in Glasgow has resulted in much greater scrutiny of plans and construction of new healthcare buildings
Delayed NTCs have opened in Kirkcaldy and Inverness this year but both projects failed to get the support of NHS Assure experts during reviews that took place during the final months of their construction.
Dozens of significant and major issues were raised across both projects but were all addressed before opening.
A Scottish government spokesperson said it had established NHS Scotland Assure to improve how risk was managed.
In February, NHS boards were told that they would not be able to open any new facility without NHS Scotland Assure support.
“A crucial element of any large capital project is the ongoing review and refinement of the agreed design, in particular the mechanical, electrical and infection prevention compliance aspects,” said the spokesperson.
“Internal and external experts guide this process, which is independently reviewed by NHS Scotland Assure.
“We are ensuring that new facilities are safe and fit for purpose and the system is working exactly as we expected.”
