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 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.”
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.
Scottish Labour health spokesperson Jackie Baillie and Health Secretary Michael Matheson.
Plans to replace a NHS Greater Glasgow and Clyde facility that manufactures radio-pharmaceutical medicines were found to have 31 significant or major risks, including “poor project governance”, in a report published last June.
Commenting on the BBC revelation that hundreds of problems with health board building projects have been found by NHS trouble-shooters, Scottish Labour health spokesperson Jackie Baillie said: “This new revelation goes to show the parlous condition of the NHS estate under the SNP.
“It is deeply concerning that so many vital projects have been delayed due to significant issues found by trouble-shooters.
“We know from the tragic events at the QEUH that building problems can have fatal results and we know from the Edinburgh Sick Children’s fiasco how long these delays can last.
“We cannot have patients being put in danger either through sub-standard building work or through long delays.
“It is clear that there has been a breakdown of ministerial oversight and that the Health Secretary and his predecessors have failed to act.
“Michael Matheson must act now to get these issues under control and to support health boards in ensuring that building projects are safe for patients.”
LibDem Alex Cole Hamilton and Health Board bosses Jane Grant and John Brown.
Responding to NHS Assure reports, released to the BBC under freedom of information laws, which identify hundreds of problems with health board building projects including issues with ventilation, fire hazards and infection control, Scottish Liberal Democrat leader and health spokesperson Alex Cole-Hamilton MSP expressed further concern about the situation.
He said: “This trouble-shooting scheme was set up because there were big problems with the new Glasgow super hospital and lengthy delays at the new Edinburgh Sick Children’s hospital. These revelations make clear that problems were not just confined to those two major projects.
“This SNP government has caused serious damage to Scotland’s NHS. Concerns like these lead to delays and backlogs, putting patients at further risk and leaving staff under more severe strain.
“It’s clear that successive ministers ignored the warning signs and allowed problems to come to a head. The Health Secretary must now move quickly to work with health boards to resolve outstanding issues and ensure that buildings are safe and fit for purpose.”
The “successive ministers” were Nicola Sturgeon, Shona Robison and Jeane Freeman and there have been repeated calls for the resignation of Health Board chairman John Brown and Chief Executive Jane Grant without any response from these officials.
‘I could not wait any longer’
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”.
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.”