Healthcare Improvement Scotland (HIS) was recently revealed to have shelved a critical draft report into older people’s care at Dundee’s Ninewells hospital, run by NHS Tayside.
* Inspectors reported that 35 patients had been waiting on trolleys and in wheelchairs, some for six hours, for a bed.
* HIS shelved the report 24 hours after its managers met NHS Tayside chief executive Gerry Marr, who is also on the board of HIS.
* SNP Minister Roseanna Cunningham warned Health Secretary Alex Neil more than two months ago that the allegations were “grave”.
* HIS chief executive Frances Elliot left her post days after the row over the draft was raised in Parliament.
* Two inspectors and a lay “public partner” behind the original report quit as a result of HIS’s handling of the episode.
Jenny Marra, a Labour MSP who has tried to get to the bottom of the watchdog’s report, said it was clear the findings had been “buried” and accused Neil of “sitting on his hands”.
Audit Scotland last week published a report into whether NHS boards manipulated waiting times to meet national targets.
Attention has now turned to HIS, set up in 2011 to ensure that hospitals run by health boards are safe and clean. However, its own performance is now being questioned.
In September 2012, HIS inspectors conducted an inspection of older people’s care at Ninewells, the largest hospital in Tayside. Four months later, the HIS eventually published a report that contained criticisms of the service.
On the hospital’s “acute medical assessment unit”, the report noted that “some” patients had waited on trolleys and in wheelchairs in the “unit corridor”.
However, the Sunday Herald can reveal that the draft report went much further, stating: “We later learned that there had been 35 patients waiting on trolleys and in wheelchairs in the corridor during Monday afternoon and evening. Patients had experienced long delays waiting for a bed. In some cases, this was over six hours. The last patient to be found a bed was at 4am on Tuesday morning.”
It also stated: “We also had a concern that staff responding to an emergency would be delayed by the lack of access.”
None of these sections appeared in the final report.
The inside story of HIS’s decision to shelve and then change the draft report can also be revealed.
After the initial inspection, HIS sent a copy of its findings to NHS Tayside in October, a routine procedure which gave the health board an opportunity to comment.
On October 29, HIS received NHS Tayside’s “error report”, which outlined the board’s concerns.
Three days later, two senior HIS staff who were not involved in the inspection on the day – Robbie Pearson and Ian Smith – met NHS Tayside CEO Gerry Marr to discuss the findings.
Marr also sits on the board of HIS – the watchdog that was investigating his organisation’s hospital, the only NHS chief executive who has a seat on the HIS board.
Twenty-four hours after the meeting, HIS decided to “defer” publication of the draft.
The decision was made by HIS chief executive Frances Elliot and two others, none of whom were part of the original inspection team.
On November 6, Smith emailed stakeholders that a decision had been made by HIS “not to publish” the report.
Two weeks later, Elliot elaborated on the decision in an email of her own. She said it would be “inappropriate” to publish the report “given the inaccuracies and potential imbalanced public perception that could arise” on the quality of the hospital’s care. She also said she had taken into account “the reputational risks regarding this report”.
However, on December 13, SNP Community Safety Minister Roseanna Cunningham contacted her Cabinet colleague, Health Secretary Alex Neil.
Writing in her capacity as a local MSP, she said the issues uncovered by the inspection were “grave”.
She added: “[W]hen the draft final report of the inspection team was passed to NHS Tayside for comment on factual matters, three members of the inspection team were taken off the case. HIS subsequently decided not to publish the report.”
By January, staff were unsure about what, if anything, would be published. It was then agreed that HIS would conduct a “follow-up” inspection of Ninewells.
On January 30, HIS finally released a version of the original report that omitted any reference to the 35 patients.
The watchdog’s handling of the Ninewells inspection has also had a damaging effect on morale.
Before the final report was published, two of the inspectors involved in the original probe handed in their notice.
It is understood they resigned after believing the episode had undermined their professional integrity.
A lay member of the Ninewells inspection team, Lynn Burns, resigned after the final report was published.
Marra said she intends to raise the Ninewells issue with First Minister Alex Salmond: “There is now no doubt that the report of the Ninewells inspection in September was buried because people in authority didn’t want its findings to come to light.
“A robust inspection regime protects patients. It also protects and gives backing to hard-working staff who are under pressure in our hospitals. The public can only have confidence in inspections if they are published on time and there has been no editing of the evidence that the inspectors have gathered.”
She added: “It is clear the Scottish Government knew over two months ago that the Ninewells report had been buried and knew about the inspectors’ resignations. The Cabinet Secretary for Health needs to explain why he didn’t take action to have the report published swiftly. He has been sitting on his hands and allowed this turmoil to develop in the Government’s health inspectorate, hoping it would never come to light.”
A spokesman for HIS said: “The chief executive of NHS Tayside and his team met with the director of scrutiny and assurance and the acting chief inspector for HIS to explain their concerns on November 1, 2012.
"This meeting was entirely appropriate and in line with HIS policies and procedures. The chief executive of NHS Tayside was not involved in any HIS internal discussions regarding the writing of the draft or final report.”
The spokesman said a “key part” of the meeting related to the draft report’s claim about 35 patients: “NHS Tayside pointed out that the original draft left the impression that there were 35 patients waiting in the corridor at the same time.
"The correct position is that the unit had 35 patients assessed over the afternoon and evening of September 24, 2012. As a consequence, we believed that the number 35 was not a meaningful number in relation to the care that was being delivered in the ward. This is the reason it was omitted from the final report.”
He added: “Similarly, the sentence ‘the last patient to be found a bed was at 4am on Tuesday morning’ would have left the impression that the patient had been waiting from the afternoon of September 24. The patient in question was actually admitted to a bed at 4.25am after coming through A&E at 2.30am.”
A spokesperson for NHS Tayside said Marr was not involved in making any decisions on the HIS report.
She said: “As chief executive of NHS Tayside, Mr Gerry Marr is the accountable officer for any inspections carried out by HIS on NHS Tayside premises and services.
“Therefore, it is absolutely appropriate that, just as happens in every other health board area, it is the chief executive who takes responsibility for raising factual inaccuracies contained in any draft report presented to the organisation.”
She said: “NHS Tayside frontline clinicians presented clinical evidence and patient data which raised significant factual inaccuracies relating to a specific section of the draft report.”
A spokesperson for the Scottish Government said: “HIS report independently and it would be inappropriate to interfere with their processes. The Health Secretary sought assurances from HIS that they were following appropriate due process in their current inspections and reporting.
“HIS informed the Scottish Government that it had a number of quality assurance issues with the draft report of the inspection into older people’s care which was carried out at Ninewells Hospital on September 24-26.”
