‘Purist’ approach to infection control poses risk to patient safety, probe told

A former senior manager at a Glasgow hospital at the centre of infection concerns has told a public inquiry that adopting a “purist” approach to infection control could have posed a greater risk to patient safety.

Dr David Stewart, who was deputy medical director at Queen Elizabeth University Hospital (QEUH) until his retirement in 2019, faced questions at the Scottish Hospitals Inquiry on Thursday morning about his response to serious concerns raised by infection control doctors (ICDs) about the safety of the new facility.

Concerns were raised about the flagship hospital even before it opened in 2015, including around the ventilation and water systems, and “flaws” in the design, build and functioning of wards intended for bone marrow transplant patients.

Dr Stewart told the inquiry these issues had not been part of his remit, but that in 2015 he was asked by medical director Dr Jennifer Armstrong to investigate what were described as “cultural” problems within the ICD team.

These arose, the inquiry heard, in the context of ICDs attempting to raise concerns about the new hospital and came to a head when one IC doctor attempted to resign after feeling management was failing to take her concerns seriously.

The inquiry was shown a copy of the resulting report from October 2015, which was compiled on the back of interviews with nine members of staff.

One of the report’s finding stated: “Whilst it it clear that concern for patient safety is the primary motivator for ICDs when arriving at decisions, there appears on occasion to be a lack of appreciation by some ICDs of the need to risk-assess decisions from an organisation/political perspective.”

When asked what he had meant by the term “political”, Dr Stewart immediately disowned the word, insisting that “I’m not sure why ‘political’ is there, because what I’m describing is not about reputational risk at all”.

He told the inquiry he was talking about the potential risk to patients posed by a “purist” approach to infection control.

“If a situation arises, there might be a, we could use the word, purist infection control solution or opinion, but that needs to be translated into the real world,” he said.

“If there were an infection outbreak in a ward, from a purely infection control point of view, the best thing might be to close that ward, stop any further admissions, until the issue is dealt with.

“That’s fine but healthcare is a series of interconnected moving parts, and you can’t look at any decision in isolation.”

He added: “If you shut a ward, what effect will that have on A&E waiting times? What effect will that have on ambulances outside the hospital? What effect will that have on patients being nursed in corridors?

“What the bigger picture here? And taking that whole context, what is the bigger risks to patients?”

Counsel to the inquiry Fred Mackintosh KC also challenged Dr Stewart on his handling of the concerns that ICDs Dr Christine Peters and Dr Teresa Inkster raised in detail with him on three occasions in 2015.

The inquiry heard that Dr Stewart passed each of these to the medical director as they were her responsibility and that she had assured him they were being addressed.

Mr Mackintosh put it to Dr Stewart that simply acting as a “gopher” and passing the concerns up the chain may be “in some sense an abrogation of your responsibility as a clinician”.

Referring to one email Dr Stewart sent to the ICDs that indicated he was not engaging with their concerns, Mr Mackintosh said: “You’re not a gopher, you’re the deputy medical director.

“So, I’m putting to you that in some way that email is you effectively not stepping up when someone needed to and taking this seriously.”

Dr Stewart replied that the concerns were not his responsibility, adding that he was “not sure what I could have done”.

“These issues are brought to me. They’re not something that I’ve chosen not to deal with. They’re something I cannot deal with. They’re not something that fall within my ambit of responsibility at all, nor had I any authority in this matter,” he said.

“I bring them to the medical director, there’s comings and goings, I have conversations with her, I pass out all the information I got.

“At the end of the day, I think that’s all I can do.”

In the afternoon session Dr Chris Deighan, who was one of two deputy medical directors who succeeded Dr Stewart, was asked about specific concerns raised by Dr Inkster in her letter resigning from chair of the hospital’s Incident Management Team.

In one of the concerns Dr Inkster alleged the hospital breached its “duty of candour” to the families of two children who became infected by bacteria linked to the hospital’s water system.

Dr Inkster reported that efforts were made to prevent her from telling the families that the infections were linked, leading her to claim that “the obligation to tell the truth and communicate freely with parents and patients is being undermined”.

Dr Deighan, who undertook an investigation into the incident, told the inquiry that in his view it was the product of “cock-up rather than conspiracy”.

He continued: “This was just poor communication, delayed communication.

“Often in healthcare we delay communication because we want to get the communication perfect, or because we want all that information to be available.”

The inquiry is currently investigating the construction of the QEUH campus, which includes the Royal Hospital for Children.

It was launched in the wake of deaths linked to infections, including that of 10-year-old Milly Main.

The inquiry continues.