1 Tuesday, 28 February 2012
2 (10.00 am)
3 MS ELIZABETH SLOAN RAWLE (continued)
4 Examination by MR MACAULAY (continued)
5 MR MACAULAY: Good morning, Mrs Rawle. A number of points
6 I want to pick up with you before I move on to the
7 outstanding questions. The first is this: yesterday,
8 I think you mentioned that Elaine Burt may have been
9 your head of nursing in the latter part of 2007. My
10 understanding is Mrs Burt did not join
11 NHS Greater Glasgow and Clyde until March 2008. So
12 I think that name was a mistake.
13 A. Yes.
14 Q. Was it Ellen Hudson?
15 A. It was Ellen Hudson. I had completely forgotten about
16 Ellen Hudson. We went from Mrs MacGillivray to
17 Ellen Hudson for a very short period of time. She then
18 left, and then Elaine Burt came at that point.
19 Q. My understanding is Ellen Hudson was head of nursing
20 from about September 2007 until February 2008. Would
21 that be right?
22 A. That would be right.
23 Q. Since I didn't manage to do it very successfully
24 yesterday, can I put the organisational chart on the
25 document viewer for you?
1
1 If we focus on the box on the bottom right of
2 the document, we are now looking at the organisational
3 chart for the rehabilitation and assessment directorate.
4 Can we see that your name has actually been highlighted
5 as the clinical service manager, and you were reporting
6 to Beth Culshaw; is that right?
7 A. Yes, that's correct.
8 Q. Can we see, looking to the chart, that Beth Culshaw
9 would report to the director, who was Anne Harkness?
10 A. Yes.
11 Q. If we move up to the top of the document, towards the
12 top right, can we see to the very far right, if we just
13 focus in on that, Anne Harkness, we can see her name to
14 the far right, she reported ultimately to
15 Robert Calderwood; is that right?
16 A. That's correct, but I believe at the time it was to
17 Mr Divers.
18 Q. To Mr Divers, yes. Looking to some of the evidence you
19 gave yesterday --
20 MR KINROY: My Lord, I wonder if we want a process number
21 into the transcript for this chart?
22 MR MACAULAY: Yes. The process number I gave yesterday is,
23 and we needn't put it on the screen because it is
24 difficult to make out, GGC02700001.
25 Just to go back to one or two of the points you made
2
1 yesterday, before you took up the position you had as
2 clinical manager, you were the rehab manager for Argyll
3 and Clyde; is that right?
4 A. Not for Argyll and Clyde; for the Vale of Leven
5 Hospital.
6 Q. For the Vale of Leven?
7 A. Yes.
8 Q. Remind me, when did you take up the position, then, of
9 clinical manager?
10 A. Sorry?
11 Q. When did you take up the post of clinical manager?
12 A. 2006.
13 Q. Did you require to receive any training or extra support
14 for this new post?
15 A. There was some financial training, to do with the
16 budgets, because obviously I had already held part of
17 the budget, so it was the additional staff for the
18 physiotherapists, the occupational therapists, it was
19 taking on more managerial roles. I didn't actually
20 receive any further training. If I had any issues that
21 I didn't understand, I would speak to Mrs Culshaw.
22 Q. I think certainly when the walkaround or walkabout took
23 place after it was realised there was a problem, there
24 was, in particular, a focus on the poor quality of
25 the fabrics and the flooring, et cetera, of
3
1 the Vale of Leven Hospital. Do you remember that?
2 A. Yes.
3 Q. I take it that, in any event, you would have been aware
4 of the condition of the hospital --
5 A. Absolutely.
6 Q. -- before the walkaround?
7 A. Absolutely.
8 Q. You had raised concerns about the condition of
9 the hospital in the past?
10 A. Yes.
11 Q. Did you see the condition of the hospital in any way as
12 increasing the risk of infection?
13 A. No.
14 Q. Coming back to the position of the contingency bed that
15 could be added to bay 16 of ward F, and we had some
16 discussion about that yesterday, did you, yourself, see
17 whether or not adding a fourth bed might be an infection
18 control risk?
19 A. No, I didn't particularly ask the question, because
20 I assumed, because there was a bedhead there and that
21 had been the position within that bay for so long, that
22 it was four-bedded, there couldn't possibly have been
23 a problem. The reason I took out that fourth bed was
24 purely because of equipment.
25 It was the smallest -- probably the smallest bay in
4
1 all of the bays that I actually managed. There was
2 obviously a problem if the nurses had to take in
3 a wheelchair and move a patient around, and one of
4 the locum consultants we'd had and Sister Shepherd came
5 to me and said could there be any possibility of taking
6 a bed out. This was before we went actually into the
7 RAD, I believe, and I spoke with the manager -- I can't
8 remember who that would be at the time -- my manager,
9 because obviously it made a change in the configuration
10 of the bed numbers within the hospital, and it was
11 agreed that it was clinically the best thing to do to
12 take out that bed.
13 Q. The other point I want to raise with you in a similar
14 vein is in relation to cohorting. I think, again, this
15 was mentioned yesterday. Did you understand that some
16 cohorting did take place, particularly in ward F?
17 A. Yes, I did -- I knew -- that was, as I say, when alarm
18 bells started to ring with me, when I realised there was
19 cohorting. I hadn't realised patients with C. difficile
20 had been cohorted in the hospital before.
21 Q. What did you understand by "cohorting" then at that
22 time?
23 A. Patients with the same infection in the same area,
24 nursed in the same area.
25 Q. Would that area be a bay?
5
1 A. A bay, yes.
2 Q. You mentioned a moment ago that the bed space could be
3 used for equipment storage; is that right?
4 A. No.
5 Q. Was the bed space in bay 16 being used for equipment
6 storage at any point?
7 A. No, it just meant there was more turning room. Because
8 we'd taken the bed out and we went back to three beds at
9 that time, there was more turning space. There was more
10 turning space for the physio to work with the patient.
11 They went off ward for their physiotherapy, but if the
12 physiotherapist came to take the patient, there was just
13 more room to manoeuvre.
14 Q. When you were, then, performing your role as the
15 clinical manager and you were off duty, did you hand
16 over to someone else?
17 A. Yes, there was always a senior manager on call for
18 Clyde. I took part in that rotation.
19 Q. Can you mention some names, as to who would step in for
20 you?
21 A. It was just the senior management team. It would be --
22 it could be Beth Culshaw, Roseanne McDonald,
23 Catriona Glen, Melanie McColgan. We had a rotational
24 group of senior managers who went on call for Clyde.
25 Q. So when you were on leave, for example, would it be one
6
1 of the senior managers who would cover for you?
2 A. No, they would only cover for me -- Mrs Culshaw would
3 then cover for me, if there was an issue when I was on
4 leave, but the rotation only covered out of hours, ie,
5 in the evening and overnight and at the weekends.
6 Q. Can I move on to questions, then, I have been asked to
7 put to you, and can I begin now by putting questions to
8 you on behalf of patients and families. Do you follow
9 that?
10 A. Yes.
11 Q. As you have told us, you were a senior manager at the
12 Vale of Leven Hospital during the relevant period, which
13 is January 2007 to June 2008. In what ways during that
14 period did you actively manage infection control issues
15 in respect of the wards for which you had managerial
16 responsibility?
17 A. I didn't actively manage infection control. I ensured
18 that all of my wards had the infection control manual
19 and that the nurses were trained. We had link nurses.
20 I didn't actively manage infection control. I knew that
21 we had isolation rooms that we could -- I think probably
22 the best way to say it, I knew that we could meet all
23 the requirements in the infection control manual.
24 Q. Did you make any positive contribution to the prevention
25 and early detection of hospital-acquired infection, and,
7
1 in particular, C. diff infection in the
2 Vale of Leven Hospital?
3 A. I think in the prevention I was certainly aware that the
4 nurses had the manual and were following the manual.
5 I think, as far as the detection was concerned, that was
6 not really my role.
7 Q. How did you satisfy yourself that the nurses were
8 following the manual?
9 A. Because any issues with infection control that were not
10 being kept -- the infection control nurses would come
11 and see me if there were any issues. I remember one of
12 them coming to tell me that someone wasn't wearing an
13 apron correctly. They knew where I was. I was easily
14 accessible. I believe they were following the manual.
15 Q. As a manager, then, who was based on site, were you not
16 better placed than frontline staff to monitor and keep
17 under review, at least for the wards for which you were
18 the manager?
19 A. I think if I had been actually working within the wards
20 I may have been more aware. I was dependent on the
21 information passed to me. I don't think that being on
22 site makes a great deal of difference. For example, my
23 replacement is not on site now. There is not someone in
24 my position on site at the moment.
25 Q. Was it your responsibility to put in place reporting
8
1 systems to enable you to keep under review, for example,
2 the incidence of infectious diseases such as
3 C. difficile?
4 A. I don't think it was my responsibility to put in the
5 systems.
6 Q. Whose responsibility was it?
7 A. The infection control team.
8 Q. When you say "the team", is there any particular
9 individual you would identify, then?
10 A. It would have to be the team leader, Mr MacAulay.
11 Q. Is that --
12 A. It would have to be the team leader.
13 Q. Who was that at the relevant time?
14 A. Well, I believe now it was Dr Biggs.
15 Q. She was the infection control doctor?
16 A. I believe she was.
17 Q. But there was also an infection control manager; is that
18 right?
19 A. In the Vale of Leven?
20 Q. No, no, in the infection control setup.
21 A. A nurse manager? A nurse specialist?
22 Q. Can I put it another way around: did you know if there
23 was an infection control manager at the time?
24 A. No. The most senior person within the Vale of Leven was
25 Jean Murray.
9
1 Q. If we go back, just to digress, to the organisational
2 chart that we see on the screen, and we move to the
3 left, and perhaps just make that a little bit bigger, we
4 are focusing here on the Clyde acute directorate, where
5 we see that Deborah den Herder was the director; is that
6 right?
7 A. Yes.
8 Q. If we look in the box above that, can we see there is
9 reference there to infection control manager Tom Walsh?
10 A. Yes.
11 Q. Did you know if Mr Walsh had any responsibility for
12 infection control from the perspective of
13 the Vale of Leven Hospital?
14 A. I didn't realise he had it from -- obviously latterly,
15 when the C. diff problem was identified, we had a lot
16 more to do with Mr Walsh at that time, but at the time,
17 I can't remember thinking there was an infection control
18 manager.
19 Q. If, during the relevant period, Mrs Rawle, there were
20 sufficient cases of C. diff infection at the
21 Vale of Leven to satisfy the definition of an outbreak,
22 was that something that ought to have been brought to
23 the attention of all, or, at any rate, some, of
24 the groups of which you were a member?
25 A. Yes.
10
1 Q. Would it not have been common sense for you, as the
2 senior manager on site for wards 14, 15 and F, to have
3 put in place a requirement for regular infection control
4 reports from that source?
5 A. In hindsight, yes.
6 Q. During the relevant period, did you receive
7 environmental and hand hygiene audit results?
8 A. Yes, environmental and hand hygiene, yes.
9 Q. By whom were such audits done?
10 A. The environmental were done by -- well,
11 Mrs Catriona Sweeney was the hospital manager and
12 facilities and catering. They were done by some of her
13 team.
14 Q. And the hand hygiene audits?