The catalogue of problems at the Queen Elizabeth University Hospital site could cost as much as £50m to repair, the Herald on Sunday can reveal.

The staggering cost of repairing the four-year-old facility and associated buildings was raised earlier this year among senior staff at NHS Greater Glasgow and Clyde (NHSGGC), following a number of high-profile infections at the the £842m super hospital.

Today, we can also reveal a number of other issues at the scandal-hit site including ventilation systems not of the correct size, safety alarm failures, chronic infighting among staff and a lack of input from infection control teams on the project before it even opened.

NHSGGC has already admitted it will cost £2.75m to sort out problems with the water system and ventilation at the new hospital, however a report released on Friday by Healthcare Improvement Scotland revealed there are more than 300 outstanding repairs to be done - without any plan to complete them.

It is understood the health board's estates and facilities manager told the corporate management team in January that it could cost as much as £50m to rectify the issues at the site.

NHSGGC refused to officially give a figure for the repairs, but admitted problems with older buildings on the campus do require a "significant investment".

A source close to NHS senior management told the Herald on Sunday: “ Early figures quoted to bring the critical areas up to speed are £50m, plus the disruption of closing down areas. The corporate management team were told this earlier in the year, when the issues across the estate were brought up.”

Two other senior sources also said they were informed of the staggering costs involved.

Problems already identified by auditors at Health Facilities Scotland are believed to include the size of the ventilation ducts, which may not be large enough to fit certain air filters needed for a hospital the size of the QEUH, and alarm systems supposed to detect failures with ventilation and contamination which did not function at all.

Special isolation rooms which are essential to stop the spread of infections are also missing from the facility - an issue now being probed by the Health and Safety Executive.

Infighting between infection control teams and the health board's facilities and estates team is rife, according to various senior NHS sources, who say that staff who previously raised concerns about the state of the new hospital were ignored.

One senior health source told the Herald on Sunday: "Concerns about the ventilation and water were raised as far back as 2015, and these weren't listened to. It was as if they didn't want to know.

"In 2017 various microbiologists also raised concerns in a report and they were ignored too. People are being bullied and right now it is clear that the board and directors at NHSGGC are trying desperately to find someone to blame."

Healthcare Improvement Scotland inspectors picked up on the problems in their report last week, citing "challenges in the working relationships between senior staff" which they say must be resolved.

Trade union BMA Scotland also raised concerns about treatment of an employee who reported the bird droppings issue in December, although no official complaint was made.

It has also emerged that the board's infection control manager has been shifted to a project manager job following the bird faeces discovery, and will now be involved in the independent inquiry and internal investigations into the outbreak - a move critics say will stop an impartial investigation taking place.

One source close to the investigation said: "It is ludicrous that someone linked so closely to infection control would now be managing the investigation into infection problems. How can it be independent and balanced if this is the case?"

Hugh Pennington, professor of bacteriology at Aberdeen University, said the fault lies with the health board management and warned there will be further outbreaks if issues are not resolved quickly;

He said: "Clearly the management is not on top of these issues. There are communication problems between infection control and other areas. These are all management issues.

"While the infection rate is no higher than anybody else's the problem really is that if the issues carry on - some of them seem to have been there for 2 or 3 years - sooner or later they will have a higher number of outbreaks and infections.

"Prevention is the name of the game here. It was very disappointing to see this in a hospital that has only been running for a short period.

"If it was an old building that was going to be pulled down, you might say 'that explains it;'. This is a new hospital with problems with routine maintenance, routine cleaning, people raising problems and nothing being done."

Dr Lewis Morrison, Chair of BMA Scotland said: “While it would be wrong to jump to conclusions around individual infection outbreaks, there now seems little doubt that there are serious issues to address at the QEUH hospital site. The report from Healthcare Improvement Scotland makes that absolutely clear.

“For a report to find that a parts of the site are in such a poor state of repair that they therefore cannot be effectively cleaned would seem completely unacceptable in a modern NHS. That there are at least 300 outstanding maintenance jobs without evidence of a plan to complete these, suggest the scale of the challenge of rectifying the situation.

“A further theme that comes through is shortages of staff – including infection control doctors, who play a crucial role with the assessment and mitigation of infection risks presented by the built environment. Without the right staff in place, it is hard to see how real improvements can be made. Equally, there would also appear to be issues with senior management acting on concerns of the clinical staff who are in place – for example in estates meetings. The board must act urgently, as they have set out in their action plan is response to the report, to deal with these critical issues and make improvements across the board.

“But it would also be wrong to suggest these are isolated problems. Our NHS is under resourced and understaffed as we have been warning for some time. Therefore it is no surprise that building maintenance is suffering, with a resulting negative effect on cleanliness. And if this is the case at one of the most modern facilities in Scotland, then it is hard to believe that there are not similar issues at some of the more dated buildings in use.

“Finally, it is welcome that there is a review into the design and building of the QEUH, and we hope there maybe lessons for the NHS as a result. For example, and without pre-empting results of the review, an increased and more effective role for infection control experts in the design and building of NHS facilities is an area where real improvements can potentially be made.”

A report into water contamination issues at the hospital site revealed there was "no documented evidence of NHSGGC Infection Prevention and Control Team involvement in the commissioning or handover process of the project" although infection control and prevention nurses had been seconded to work on the project team.

The lack of involvement by infection control in new medical projects was raised by BMA Scotland in submissions to the Scottish Government earlier this year, where they said:" It is an uncommon event for an infection control team to oversee a major build

– although they are often consulted as the project progresses. However, there may not always be enough time and experience to optimally deliver this input despite expert knowledge clearly being needed.

"Added to this, the NHS experts and the builder’s experts often don’t agree on points of design and how this may relate to infection risk."

NHS Greater Glasgow and Clyde didn't respond to specific enquiries regarding safety alarm failures or ducting being the wrong size.

A spokeswoman said that the special HEPA filters required in some areas of the hospital were "not generally required throughout hospitals, but only in Bone Marrow Transplant units" and added: "The Bone Marrow Transplant unit in the QEUH has been fitted with HEPA filters. There are no current issues with the ventilation system and the ducting for the general wards within in adult hospital and the children’s hospital.

"There is however work currently underway to upgrade the haemato-oncology ward in the Royal Hospital for Children to the latest specification while patients are temporarily relocated to another ward in the QEUH. We have previously announced that this work is being carried out."

On staff concerns about the site problems being ignored, the spokeswoman said: "We believe that all concerns have been addressed", and added they were "unaware" of any concerns discussed about staff treatment by BMA Scotland.

On the upgrade costing £50m, she said: "We do not know where you have obtained the £50m figure but can confirm that some of the older buildings on the QEUH campus do require significant capital investment but not the two new hospitals.

"There will always be significant numbers of repair requests ongoing at any one time in any hospital, but a campus as large as the QEUH will have proportionately more. To clarify the 300 outstanding repair requests are routine repairs like a broken blind, broken door handle, broken hinge etc and do not represent a significant investment."

The Health and Safety Executive said: "HSE is currently investigating the circumstances surrounding the outbreak of Cryptococcus infection at Queen Elizabeth University Hospital.

“Initial enquiries commenced on 24 January 2019 but it is not possible at this stage to provide a date for completion of the investigation.

“Our investigation will examine the range of control measures in place to reduce and mitigate the risks of such infections. This will, as a matter of course, include the adequacy of ventilation systems but we cannot comment further on the detail of this ongoing investigation.”

Health Facilities Scotland did not respond to our request for comment.

The Scottish Government refused to address specific issues highlighted by the Herald on Sunday, but re-iterated the statement made by Cabinet Secretary Jeane Freeman following the HIS report released on Friday.

Ms Freeman said: "Patients and the public deserve to have complete confidence in the cleanliness of Scottish hospitals and the quality of NHS services. I am clear that Scotland’s hospitals should be clean and safe, and that we have a strong record on infection control and prevention. However, this report highlights a number of areas where immediate action is required, and we will work with the board to ensure these are addressed as soon as possible.

“The findings of this report will of course feed into the independent review into the design, commissioning, construction, handover and maintenance of Glasgow’s Queen Elizabeth Hospital."