John Swinney says a ‘lot has to change’ at NHS Grampian after damning report

John Swinney has told NHS Grampian bosses a “lot has to change” as he insisted it was “reprehensible” that some operations on children had continued after paediatric surgeries were halted over safety concerns.

While the First Minister accepted there had been “no negative consequences” as a result of this, he insisted it was “unacceptable” that the operations took place when surgeries had been stopped for “for proper patient safety reasons”.

Mr Swinney spoke out after a damning report from Healthcare Improvement Scotland (HIS) “identified serious weaknesses in all aspects of leadership and management of the medical workforce across the acute sector of NHS Grampian”.

The review, which was instigated by NHS’s Grampian’s chief executive, highlighted “serious concerns” after a patient died during surgery as a result of complications.

HIS said a review of what happened made a “major omission” by “not meaningfully examining” the actions, clinical decision-making, and operative techniques of the surgeons involved.

This was said to be a “concerning and unjustifiable failure of governance and a missed opportunity to improve patient safety”.

The HIS report also revealed that although NHS Grampian temporarily suspended paediatric surgery at Dr Gray’s Hospital in Elgin on July 9, this was not “fully enacted”.

While surgery was suspended because of concerns over the ability to provide “safe and effective care for critically unwell paediatric patients”, NHS Grampian later notified HIS that paediatric dental and ENT surgery had, in fact, continued until August 6.

Speaking about that, Mr Swinney said: “It was crystal clear that the requirements to end the surgery for children at Dr Gray’s was not followed by NHS Grampian and that is reprehensible.”

Mr Swinney added that he and Health Secretary Angela Constance want to see “dramatic changes” from NHS Grampian “to address the legitimate concerns”.

But the First Minister refused to back a call from Scottish Labour leader Michael Marra for the board there to be sacked.

Raising the issue at First Minister’s Questions at Holyrood, Mr Marra said: “The First Minister is right to condemn this in the strongest possible terms, children were put at risk and the board also failed to properly investigate why a patient had died on the operating table.”

The Scottish Labour leader added: “I see absolutely no reason whatsoever that the board of NHS Grampian should remain in place. The First Minister should call for them to go and to go now.”

Mr Swinney, however, insisted changes had already being made to the leadership team at the health board – pointing out it was the new chief executive there, Laura Skaife-Knight, who had called in HIS in May to carry out the “diagnostic review” .

The First Minister added that a “large proportion of the board” at NHS Grampian had also been replaced, telling MSPs there had been changes made today to the senior leadership team “which are necessary in my view as a consequence of this report”.

Insisting the Government was taking concerns “incredibly seriously”, Mr Swinney vowed to “leave no stone unturned” to ensure patient safety.

His comments came after HIS raised concerns over a lack of workforce plans, poor recruitment controls and “significant concerns” about how doctors are managed, adding that these failures are impacting patient care and patient safety.

Ms Skaife-Knight acknowledged it had “identified serious failings within NHS Grampian” as she apologised to patients.

The NHS Grampian chief executive said: “As a board we own and accept the findings, we apologise to our patients, families and communities for letting them down and we commit to putting things right.”

Health Secretary Angela Constance has already made clear that she expects “decisive and urgent action” from NHS Grampian.

Ms Constance said: “The findings of this report are extremely serious and will be deeply concerning for patients, families, local communities and staff across Grampian.

“It identifies significant failings in leadership, governance, accountability and organisational culture.”

Simon Watson, the medical director at HIS, said the findings of the report “will make difficult reading for NHS Grampian’s leadership and will understandably raise concerns among patients, the public and staff”.

Speaking about the report, he said: “It provides a clear diagnosis of significant problems in key aspects of clinical governance.

“We found weaknesses in clinical governance systems, leadership and organisational oversight. These are essential for an organisation to provide assurance to patients, staff and the public about the safety and quality of care they provide.”

Ms Skaife-Knight accepted that “the report makes for very tough reading” adding that it “describes features of our leadership, governance and culture which are unacceptable and which cannot continue”.

The NHS Grampian chief executive confirmed “immediate changes” had been made to medical leadership at the health board, with an interim medical director due to start on Monday November 16.

But she said: “Most concerning are the unacceptable delays in investigating and implementing learning from incidents involving patient care which can prevent us from making the changes necessary to keep patients safe.”

Adding that the “findings will cause concern to our local community” she said a dedicated phone line has been set up on 08085 202030 “for anyone who has specific concerns and wants to speak to us”, with this available from 8am to 6pm on weekdays from today.

She also stressed: “Our focus is now about responding at pace to the feedback and making the improvements needed that are now long overdue.”