1 Tuesday, 19 June 2012
2 (10.00 am)
3 MR MACAULAY: Good morning, my Lord. The next witness
4 I would like to call is Sandra McNamee.
5 MS SANDRA MCNAMEE (sworn)
6 Examination by MR MACAULAY
7 MR MACAULAY: Good morning, Ms McNamee. Are you
8 Sandra McNamee?
9 A. I am indeed, yes.
10 Q. What position do you hold at present?
11 A. I'm the assistant director of nursing for infection
12 control for NHS Greater Glasgow and Clyde.
13 Q. For how long have you held that particular post?
14 A. Since February 2002 -- sorry, February 2009.
15 Q. If I could ask you to slow down a little bit, so that
16 the transcriber can transcribe your evidence.
17 Can I go back in time a little bit, then? First of
18 all, did you train as a nurse and complete your training
19 in 1987?
20 A. I did.
21 Q. I think you also completed your midwifery training in
22 1990; is that correct?
23 A. That's correct.
24 Q. Did you practise as a nurse for some time after that?
25 A. I have practised as a nurse, since 1984, as a student
1
1 nurse, and then, as a practising nurse, continually
2 since 1987.
3 Q. Did you complete a BSc in Health Studies that you
4 obtained from Glasgow Caledonian University in 1994?
5 A. I did that when I was working full time, yes.
6 Q. When did you first take up a position in infection
7 control?
8 A. In 1994, in Glasgow Royal Infirmary.
9 Q. Did you obtain a qualification in infection control,
10 that being the Diploma in Infection Control Nursing at
11 Glasgow University?
12 A. I did, yes.
13 Q. In 1999, did you then go to work at Stobhill Hospital as
14 a senior nurse in infection control?
15 A. I did, yes.
16 Q. Did you complete a Masters degree in public health at
17 Glasgow University in 2001?
18 A. I did, yes.
19 Q. In 2002, did you move to West Glasgow Hospitals as
20 a senior nurse for infection control?
21 A. I did, yes.
22 Q. The position that you were in, in 2007 to 2008, the
23 period that the Inquiry is looking at, what position was
24 that?
25 A. I was the nurse consultant for infection control for
2
1 NHS Greater Glasgow and Clyde.
2 Q. When did you take up that particular post?
3 A. In November 2006.
4 Q. Then, as you have indicated, you took up your current
5 post as assistant director of nursing in infection
6 control in 2009; is that correct?
7 A. I did, indeed, yes.
8 Q. Can I just look at your statement, first of all, and
9 that's at WTS01000001. We have the first page of your
10 statement on the screen. If I can take you to
11 paragraph 6 on page 2, there you are setting out what
12 the acute infection control team consisted of in
13 2007/2008, is that right, in that paragraph?
14 A. Yes, that's correct.
15 Q. So there was Annette Rankin, whom we have heard from;
16 Isabel Ferguson, who was the general manager for
17 laboratory medicine (Glasgow); Marie Martin; and you
18 also mention Professor John Coia. What role did he
19 play?
20 A. I believe Professor Coia was the coordinating infection
21 control doctor for a period of time during those dates.
22 I believe Professor Williams was also the coordinating
23 infection control doctor, just for the Glasgow part of
24 Glasgow and Clyde at some point within those dates.
25 Q. We can ask him when we see him, but, so far as you're
3
1 aware, that role you think he had, did that cover the
2 Vale of Leven Hospital?
3 A. No, it wouldn't have done.
4 Q. Can I then look at your job description, Ms McNamee?
5 I will have that put on the screen. Is it, in fact, an
6 information pack for the post? It is GGC30330001. Can
7 we see this is described as being an information pack
8 for the post of nurse consultant in infection control?
9 Is this the information pack that would give us
10 information about your position as nurse consultant?
11 A. It would be, yes.
12 Q. So if we turn, then, to page 4 of the document, under
13 the heading "The job itself" towards the bottom is
14 a section 3. Are we told that:
15 "The nurse consultant in infection control will
16 provide strong strategic and clinical leadership across
17 NHS Greater Glasgow and Clyde.
18 "She will ensure the development of robust systems,
19 policies, procedures, professional guidance, consistent
20 standards and training strategies in line with current
21 national policy."
22 So we see a reference there to the development of
23 robust systems. Was that part of your remit?
24 A. It was, yes.
25 Q. Can you give us an understanding as to what that means?
4
1 A. It would be, really, any kind of -- as an example,
2 I suppose you could use the rollout of the statistical
3 process control charts. That was a system --
4 a surveillance system that I had worked with for
5 a number of years in north Glasgow and was a relatively
6 robust system for monitoring trends of infection. So
7 that would be an example of a system that would -- the
8 proposal was that that would be rolled out within the
9 ICP, so that would be a system.
10 Another example would be, I was tasked with linking
11 the educational strategy to the main educational
12 department within NHS Greater Glasgow and Clyde. So
13 I linked with professionals within learning and
14 education to ensure that the infection control elements
15 of training were included in the educational systems.
16 Q. What about reporting systems? So, for example, if
17 a particular hospital had a number of cases of
18 C. difficile, would that be something you would look at
19 to see that the reporting strategies were in place?
20 A. Not particularly. My role was to measure the board
21 against the performance, really, of other boards within
22 Scotland and then develop strategies to address any
23 issues that might be raised by our performance in terms
24 of all this national guidance and policies that came out
25 centrally.
5
1 Q. To what extent, then, in your role, would you need to
2 know how existing systems were working or not working,
3 as the case may be?
4 A. Well, we worked within the framework of the systems that
5 were in place at that time, so the outbreak policy was
6 a system of communicating information to the relevant
7 people within the board, but during this period there
8 was a lot of work going on within both acute and
9 partnership areas to try to standardise systems and
10 definitions in order that the data and the information
11 that was coming through was consistent.
12 There was a danger, if you were looking at different
13 systems that were in existence before the organisation
14 was put together, if you were comparing those, that they
15 wouldn't be equivalent, so you wouldn't be comparing the
16 right types of things.
17 Q. I was just wondering how you would develop robust
18 systems without knowing what you had in place?
19 A. Well, the surveillance system, as I said, that was
20 a system that worked within a large part of the board.
21 The plan was to roll it out. That would have been an
22 effective system for surveillance at local level.
23 Q. Did you know, as a matter of fact, prior to June 2008,
24 what surveillance systems they had in place in the
25 Vale of Leven Hospital?
6
1 A. No, I'm sorry, I didn't.
2 Q. If I could turn to page 5 of your job description, where
3 there is a discussion about your organisational
4 position, can we read there that the nurse consultant in
5 infection control will be managerially responsible to
6 the infection control manager:
7 "He/she will be professionally accountable to the
8 board's nurse director for the totality of professional
9 issues."
10 Do I take from this that your line manager was
11 Mr Walsh?
12 A. It was Dr Bill Anderson and then Mr Walsh.
13 MR KINROY: My Lord, I wonder if we could ask why the
14 witness did not know, as a matter of fact, prior
15 to June 2008, what surveillance systems they had in
16 place in the Vale of Leven Hospital? That might be
17 relevant to know.
18 LORD MACLEAN: Yes.
19 A. Because we had a quite distinct plan to standardise the
20 surveillance system and there was what I would consider
21 to be evidence that the existing surveillance systems
22 were working, I didn't have any reason to go in and
23 evaluate the surveillance systems individually at that
24 point in time.
25 MR MACAULAY: You said in that answer that there was what
7
1 you would consider to be evidence that the existing
2 surveillance systems were working. Are you including
3 the Vale of Leven in that comment?
4 A. Well, yes, because we had outbreaks declared in the
5 Royal Alexandra Hospital, in the intensive care unit at
6 Inverclyde. We had norovirus outbreaks declared and
7 managed within the Vale of Leven as well. So my
8 interpretation of that is that whatever surveillance was
9 in place was working at that time.
10 LORD MACLEAN: What do you mean "surveillance"?
11 A. I just mean the assessment and the management of
12 individual patients, and then an assessment, if you had
13 linked patients, as to whether or not they were linked
14 and the reporting of any information onwards to line
15 managers in order to facilitate ward closures or further
16 investigations.
17 LORD MACLEAN: Norovirus is obvious, isn't it?
18 A. Sorry, I ...
19 LORD MACLEAN: Norovirus is obvious, isn't it?
20 A. Norovirus is very obvious, yes, that's correct.
21 LORD MACLEAN: So do you really need a surveillance system?
22 A. You do still need somebody to go in and assess each of
23 the patients, because often you can be referred patients
24 with symptoms that may have other reasons for it and
25 they're not a classic picture of norovirus. The
8
1 decision to close a ward is a huge decision that has an
2 impact on other patients and other services, so we do
3 expect, even in the case of norovirus, infection control
4 nurses to go in and assess every individual patient
5 before they discuss that with the ICD and then make
6 a decision.
7 LORD MACLEAN: So it is down to the infection nurses?
8 A. They collect all the information, yes.
9 MR MACAULAY: Do I understand your position to be, then,
10 Ms McNamee, that you took comfort from the fact that
11 outbreaks were being declared in a number of the Clyde
12 hospitals in relation to the fact that surveillance
13 systems, therefore, must be working?
14 A. I took comfort that outbreaks were being declared and
15 managed appropriately in the Clyde hospitals.
16 Q. I come back to the point I raised with you, if you are
17 contemplating changing systems, as you have indicated
18 you were, would you not need to have some understanding
19 of the baseline systems that were already in place?
20 A. I wouldn't agree, no. I mean, we had a system that
21 worked well that I considered to be robust, it was
22 published in the literature, and that system, the plan
23 was for that system to be rolled out. So, really, what
24 was in place, as long as it appeared to be working at
25 the time -- I mean, this was a replacement. It wasn't
9
1 a new initiative. It was a replacement for the existing
2 surveillance systems. So there was -- well, there
3 appeared to be surveillance systems that were working
4 already in place.
5 LORD MACLEAN: What system was in operation at the
6 Vale of Leven?
7 A. I believe it was the T Card system.
8 LORD MACLEAN: Is that all?
9 A. I now know that they had an Access database. I knew
10 that after the OCT was convened in June 2008. But my
11 understanding is they were using a T Card system up to
12 that time.
13 MR MACAULAY: But they had a surveillance system, by that
14 I mean a database, whereby figures and, in particular,
15 in relation to C. diff, rates of C. difficile could be
16 produced; you're aware of that now?
17 A. That's correct. Yes, I'm aware of that now.
18 Q. If I could ask you to look at the organisational chart,
19 GGC02700001. Perhaps if you could look at a hard copy,
20 which I think you may have accessible to you there,
21 because what we have on the screen isn't particularly
22 good, first of all, can we see -- we read in the job
23 plan that you would be responsible to the infection
24 control manager, and then we read that he/she will be
25 professionally accountable to the board's nurse
10
1 director. Is that the infection control manager, or is
2 that you?
3 A. I apologise. Would you mind repeating that question?
4 Q. I am slightly confused about what is in your job
5 description. Can we just go back to that? It is
6 GGC30330005. It is the paragraph at the top, the second
7 sentence:
8 "He/she will be professionally accountable to the
9 board's nurse director for the totality of professional
10 issues."
11 Is that you being accountable to the nurse director
12 for professional issues?
13 A. Yes, for professional issues, yes.
14 Q. So if we go back to the organisational chart, then,
15 GGC02700001, and if you look at the hard copy you have
16 in front of you, can we see the box for the nurse
17 director, which is third from the left, is said to be
18 vacant, certainly at the time of this chart,
19 in November 2007?
20 Who were you professionally responsible to then in
21 the period we are looking at, from January 2007 through
22 to June 2008?
23 A. This is the acute services management structure, so
24 I would report to Rosslyn Crocket, who was the board
25 nurse director. This is the acute nurse director in
11
1 that vacant position.
2 Q. So you are not shown in this chart?
3 A. I am not, no. I wasn't part of the acute service
4 division at that time.
5 Q. We see Rosslyn Crocket. She is third from the right.
6 She is described as the director of women and children's
7 services?
8 A. But she was also the board nurse director.
9 MR KINROY: My Lord, it seems to me there may be some
10 confusion about the complex structure of the board.
11 I think it is complex myself, but, among other things,
12 the witness has said she was not part of the acute
13 service division, and there is an explanation for that.
14 Equally, there may be some confusion between an
15 employee being responsible to a line manager and being
16 responsible professionally to someone else. I am not
17 sure if that has ever been made fully clear, and it may
18 be the chance to do it now.
19 MR MACAULAY: Can I clarify that with you? First of all,
20 you weren't part of the acute directorate; is that
21 right?
22 A. That's correct.
23 Q. What were you part of?
24 A. The NHS board.
25 Q. In relation to professional responsibility, can you just
12
1 elaborate on what you mean by that, as opposed to
2 managerial responsibility?
3 A. The infection control manager set the agenda and my
4 objectives, and the objectives for our service as it
5 was. Nurses generally have a professional link to
6 someone who, if there was a professional issue, or
7 something that they were concerned about, they could go
8 to a senior nurse and discuss any kind of professional
9 issues.
10 If the infection control manager asked me to do
11 something that I felt professionally compromised by,
12 then I would go to the nurse director and discuss those
13 types of issues with her.
14 Q. If you go back, then, to the information pack for the
15 job, GGC30330005, we were looking at section 4, and if
16 we read on, we see:
17 "Crucial to the success of the post will be the
18 provision of professional leadership for all the
19 infection control nurses in NHS Greater Glasgow and
20 Clyde."
21 Would that include the infection control nurses for
22 the Vale of Leven?
23 A. Yes.
24 Q. How, then, did you achieve that professional leadership?
25 A. We had two subgroups from the board infection control
13
1 committee. The infection control policy subgroup, which
2 was comprised of infection control nurses, and we
3 drafted and reviewed the literature to put together the
4 policies, and also there was an infection control
5 educational subgroup, which I also chaired, and, again,
6 that was about reviewing the literature and providing
7 the right kind of educational materials.
8 So my leadership role was through interacting with
9 infection control nurses at these two subgroups.
10 Q. The final paragraph in section 5 is to this effect:
11 "The postholder will have a continuing clinical role
12 as a practising infection control nurse."
13 Looking to that, was that the position, did you
14 practise as an infection control nurse over this period?
15 A. If I had attended outbreak control meetings, that would
16 be me practising as a senior infection control nurse.
17 I didn't have very much experience when I went into post
18 in the partnership areas of the organisation, because at
19 that time the acute and partnership areas were split.
20 So I did spend a proportion of my time within
21 partnerships trying to get to know what the agenda was
22 for the infection control nurses that were dealing with
23 dental services, decontamination issues and health
24 centres, and things like that.
25 Q. It is perhaps my mistake, but I had read this as
14
1 indicating that, particularly in reference to there
2 being a clinical role as a practising infection control
3 nurse, you would have some hands-on involvement as an
4 infection control nurse, but you say that that wasn't
5 the position?
6 A. In practice, that wasn't the case.
7 Q. If we turn to page 7, there is a section that is headed
8 "Expert clinical practice". We read that you were to
9 use your highly specialised knowledge to:
10 "Provide expert nursing practice in relation to
11 direct and indirect patient care through direct
12 involvement with patient care activities."
13 What about that? Did you do that?
14 A. Again, I would suggest that that was, in the main, done
15 through giving expert advice during outbreaks,
16 particularly of infection. We did have -- during that
17 time, I would go and attend a meeting and be the link
18 between whatever part of the service was having the
19 outbreak and the board. However, I would go to that
20 meeting with the most up-to-date literature or the most
21 up-to-date types of practices that seemed to have had
22 some kind of impact in other areas that might be
23 experiencing the same kind of difficulties.
24 So a lot of my expert practice was via that type of
25 forum, or the development of the policies and the
15
1 application of the policies into practice.
2 Q. So when it talks about "through direct involvement with
3 patient care activities", we are not to understand that
4 to mean that, for example, you would go onto the ward to
5 advise infection control nurses in relation to
6 practices, and so on?
7 A. Infection control nurses don't give direct patient care
8 at any level.