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BREEAM ‘took precedence’ over NHS guidelines at tragic Glasgow hospital

Queen Elizabeth University Hospital IBI
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Elements of a Glasgow’s flagship Queen Elizabeth University Hospital (QEUH) were designed to meet environmental goals ahead of medical guidelines, a government-commissioned report has found

An independent review led by doctors Andrew Fraser and Brian Montgomery concluded that targets under the BREEAM sustainability benchmarking scheme were, in some cases, put above NHS design standards.

The £842 million project was originally designed by healthcare giant Nightingale Associates before the firm was bought out by Canadian-owned IBI Group in 2010.

It opened in 2015 but was hit by a catalogue of issues with its water supplies, heating system and windows. In early 2019 the Scottish Government linked a child’s death at the hospital to the cryptococcus bacteria, found in soil and bird faeces.

The independent report this week declared that no evidence had been found to confirm that failures in design or construction of the hospital were responsible for avoidable deaths. It added that the hospital currently had in place ‘the modern safety features and systems that we would expect of a hospital of this type’.

However, in a 227-page document, the review team set out a number of findings and more than 60 recommendations for future hospital development.

‘The energy target within BREEAM appears to have been a significant influence in the decision to specify sealed windows, chilled beams, and minimise overall capacity for the mechanical ventilation system,’ said the report.

‘However, achieving the high rate of air changes recommended for critical areas requires plant which consumes greater energy […] the balance shifted toward achieving the BREEAM Excellent target instead of air change rates that met NHS guidance standards.’

The report added that uncertainty about whether NHS design standards on air changes were mandatory or just recommendations had contributed to BREEAM ’taking precedence’.

‘The net effect is that the margin of safety in terms of hospital air quality impacting on routine infection prevention is likely to be slim,’ it warned.

The review team found that patients, staff and visitors who were vulnerable due to immuno-suppression, or were in proximity to patients with certain highly infectious diseases, had been exposed to risk ‘that could have been lower if the correct design, build and commissioning had taken place’.

The level of independent scrutiny and assurance throughout the design, build and commissioning phases was insufficient, found the report. Governance of the project during these stages did not adequately take account of the scale, complexity and specialist nature of the project.

Dr Fraser said: ‘As the review progressed, our findings caused us to focus on those clinical places caring for children and adults with cancers including Leukaemias. These specific groups have been exposed to risk that could have been lower if the correct design, build and commissioning had taken place.’

Dr Montgomery added: ‘Undoubtedly, with hindsight, the health board, groups within it, and the design and build contractor could have reached different decisions and produced results that would have reduced infection risk.’

Chief executive of NHS Greater Glasgow and Clyde Jane Grant conceded that the report highlighted ‘several areas of learning’ for the organisation.

’We remain fully committed to applying the learning from this experience,’ she said. ’We also remain focused on remedying any ongoing consequences of decisions and actions taken when designing, building and commissioning the hospital and in its maintenance.’

A spokesperson for Multiplex said: ’As the authors of this extensive review have outlined, this is a complex story with a variety of perspectives and views. Our team will now go through their detailed findings and recommendations to properly consider issues they have raised in relation to the design and build of hospital before making any further comment.’

IBI Group said that ahead of a public inquiry, it was not appropriate for the company to comment on the report.

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Readers' comments (2)

  • This is a very large and complex hospital, with the design and construction processes in the hands of experts (presumably) - so whatever happened to quality management?

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  • There are numerous ways to achieve energy reduction in a building of that complexity, so the strategy should not have prioritised a methodology that clearly compromised the building brief. Some BREEAM teams focus on ticking boxes rather than improving the building performance, and some clients insist on BREEAM targets that may be unachievable considering the overall brief. Proper and thorough energy modelling (higher level than what is strictly required for BREEAM but what is now recommended by BREEAM), in the hands of a competent strategic team, should have identified other ways to achieve the desired energy results with no loss of quality.

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