Health: Jeane Freeman has spent the year fighting fires
It has been a baptism by fire for the Scottish Health Secretary, with Jeane Freeman’s portfolio suffering the year from hell shortly after she took over from Shona Robison.
Patients at a Glasgow hospital dying after contracting infections from pigeon droppings, a waste scandal that saw human body parts stacked up outside Scottish hospitals, drug deaths in Scotland reaching the highest ever level and bullying within the NHS.
And then there’s Freeman’s greatest archnemesis: the failed opening of Edinburgh’s new children’s hospital.
September 2018 started off on the wrong foot, when Freeman had to apologise to 1,800 Scottish women. The women, aged 50 to 70, were not invited to critical breast cancer screenings, after missed appointments were discovered during a review of the breast screening programme.
The following month, news broke that private contractor Healthcare Environment Services (HES), based in Lanarkshire and Dundee, was unable to dispose of hundreds of tonnes of hospital waste, including human body parts.
HES was stripped of its NHS contracts in Scotland and England, the Environment Agency launched a criminal investigation, and the company ceased trading in December 2018.
The issue resurfaced again in January when “bags of clinical waste” were found backed up at hospitals and GP surgeries. Freeman made £1.4m contingency arrangements to transport Scottish clinical waste to England for incineration. Since May 2019 hospital waste disposal has been carried out in Wales, attracting criticism from Scottish Tories MSP Graham Simpson: “People will see this decision and wonder why Scotland under the SNP isn’t capable of disposing of its own medical waste.”
Meanwhile, NHS Scotland Director General of Health and Social Care Paul Gray stepped down after five years, with NHS Tayside and Grampian chief executive Malcolm Wright taking over permanently in June.
In October, an Audit Scotland annual assessment of Scottish NHS board finances found no health board had met key national targets and they were all “struggling to break even”. It said NHS Scotland’s performance was in a downward spiral as its model was not financially sustainable.
The spending watchdog found NHS Highland and NHS Ayrshire and Arran faced “significant financial challenges” despite having received ‘brokerage’ loans from the Scottish Government.
Freeman announced that from 2019/20 NHS boards would have their debts to the government written off, giving them three years to balance their books before a new medium-term financial framework was put in place.
A review of NHS Tayside was announced in April after it emerged 14 women, who later died from breast cancer, were given lower doses of chemotherapy than anywhere else in Scotland. An interim report on Tayside, released in May, also found its mental health services had “failed patients and families”. This followed Tayside being placed under special measures and its leadership replaced in early 2018.
In early 2019 hospital infections rose to the top of Freeman’s agenda, after two Queen Elizabeth University Hospital patients – including a 10-year-old boy – died after contracting fungal infections caused by a build-up of pigeon droppings. Following the deaths, Freeman ordered a review into the construction, design and maintenance of the Glasgow hospital.
The infection issue persisted in March, when NHS Lothian wrote to 186 heart operation patients, warning that they may have picked up an infection during surgery.
Bullying within the NHS became another headache for Freeman, after high-profile reports of harassment and bullying at NHS Highland led to 100 doctors signing a letter condemning the working culture. An independent review was commissioned, chaired by John Sturrock QC, which found widespread bullying and harassment of NHS Highland staff, led by a “dysfunctional” senior management. The Royal College of Physicians said tackling bullying required a “major cultural shift” in the NHS.
One of the darkest shadows cast over Freeman’s portfolio was the failed opening of Edinburgh’s Royal Hospital for Children and Young People, which cost more than £150m to build and was postponed indefinitely in July 2019 after last-minute inspections found safety concerns in its ventilation systems. An additional £11.6m has been paid to building contractors to fix a range of problems, under a settlement agreement.
Scottish Liberal Democrat health spokesperson Alex Cole-Hamilton accused Freeman of being “asleep at the wheel” and described the situation as “a shambles”: “This should be a thriving centre of excellence for children’s healthcare. Instead, hundreds of beds are gathering dust and we don’t know for how long it will be a ghost hospital.”
Union official Tam Waterson called for Freeman’s resignation over the debacle, saying the hospital would have to be torn down and rebuilt due to drainage issues, but the health secretary dug her heels in, saying: “The timetable of work I set out in July, when issues with the ventilation in critical care came to light, remains on track.”
Hospital waiting times continued to lag, with data in June 2019 revealing there were 1,442 people delayed from being discharged from hospitals in Scotland, six more than June 2018.
In April, Freeman announced £70m for NHS Scotland to tackle areas where people were waiting too long for treatment, part of a £850m Waiting Times Improvement Plan. Three months later, she announced a further £32m would be invested into reducing waiting times.
However, the health portfolio’s biggest challenge to date may be Scotland’s drug death crisis. In July, news that death from drugs in Scotland had reached its “highest ever level” echoed across the country. Data showed there were 1,187 drug-related deaths in 2018 – a 27 per cent increase on 2017.
The reactions from opposition parties flowed thick and fast. Scottish Labour called on SNP ministers to “declare a public health emergency” over the deaths, while the Scottish Greens urged the Scottish Government to adopt an “evidence-based approach” by permitting supervised drug consumption facilities. The Scottish Tories accused the SNP of “pinning their hopes on consumption rooms, because they know it’s something the UK Government does not agree with”.
Public health minister Joe FitzPatrick told the UK Scottish Affairs Committee he needed help persuading the UK Government to “act now” by implementing a range of public health-focused responses to the crisis, including introducing safe consumption facilities, or devolving the power to the Scottish Government. FitzPatrick has since written to the Home Office to ask for an “urgent” meeting, and a Drug Deaths Taskforce was started this summer to investigate underlying causes of the crisis and make policy recommendations.
But despite a long list of issues, Freeman has delivered a few wins in the last year.
In response to the Sturrock bullying review, Freeman put together an advisory body to “support open and honest workplace cultures and to deliver improved behaviours among leaders and managers”.
A dedicated ‘whistleblowing champion’ will be recruited to every Scottish health board by the end of 2019 and a law allowing the Scottish Public Services Ombudsman to take on the role of Independent National Whistleblowing Officer for NHS Scotland will be introduced by mid-2020.
Alcohol sales dropped by three per cent last year – the lowest level since 1994 – after the minimum unit pricing policy was introduced, which NHS public health intelligence adviser Lucie Giles said showed “encouraging early indicators”. And the opt-out organ donation bill will come into effect next year, after it was backed by MSPs in June.
However, with such a busy first year in the job, Freeman has had little time to focus on the bigger issues in health – potentially leaving long-term planning on the back burner.