Edinburgh Sick Kids: The unusable hospital that is finally open

NHS Lothian says Edinburgh's new Sick Kids hospital is one of the "best-designed healthcare facilities in the world" but its full opening is the end point of a saga stretching back years.

It was more than 160 years ago when Edinburgh surgeon John Smith began a campaign to create Scotland's first dedicated children's hospital.

His public fundraiser, kickstarted by an emotional and eloquent letter to The Scotsman newspaper, resulted in a specialist medical centre being opened in 1860 - just a year on from that letter being penned.

The hospital initially struggled to keep up with demand in a city where the average death rate of children under the age of five was one in 13.

Several moves followed before it settled in an imposing red sandstone building next to The Meadows park, in what was to be its home for the next 126 years.

• Millions paid out for unused Sick Children's Hospital in Edinburgh

• Spreadsheet error led to Edinburgh hospital opening delay

• Repayments for delayed Edinburgh children's hospital to increase

Receiving more than 50,000 patients through its doors every year, most people in Edinburgh have, or will know someone with, a Sick Kids story.

It is why the closure of the old site and the move to the new facility was a big deal.

The move has the feel of a football team locating to a new out-of-town stadium. The cherished but tired setting in the city centre swapped for a spacious and state-of-the-art facility on the outskirts.

The issues surrounding the opening of the new Royal Hospital for Children and Young People in Edinburgh will be examined by a public inquiry

Stepping alone into the airy and colourful atrium of the new hospital is a world away from the cramped and chaotic feel of the old building.

But to get to this stage has been a long time coming.

A decade of drama

Edinburgh is no stranger to construction sagas involving public money, so it is perhaps not surprising the backstory to the Sick Kids is complicated.

The original business case for a new children's hospital next to the Edinburgh Royal Infirmary (ERI) in the Little France area of the city was approved in 2008.

Possibly cognisant of the troublesome £1bn Public Finance Initiative (PFI) deal to build the neighbouring ERI, NHS Lothian wanted to pay for the new facility straight from public purse.

Staff were ready to leave the old Sick Kids hospital but the move was postponed after last-minute safety checks

More than £1m was spent on developing this plan until 2010 when, amidst a wider squeeze on public spending, it was announced the new hospital would now be funded under the Non-Profit Distributing (NPD) system, the Scottish government's version of PFI.

A deal signed in 2015 then saw private consortium IHSL appointed to design, build, finance and maintain the hospital.

The facility was to cost about £150m to build, but its full price tag over the following 25 years, including maintenance and facilities management fees, would come to £432m.

The old Sick Kids was sold for housing to a private developer and after a few bumps along the road - not least a fallout between NHS Lothian and IHSL that nearly went to court - the removal vans were booked for July, 2019.

The last minute problem

As NHS staff were making the final arrangements for the move to Little France, 50 miles along the M8 in Glasgow a band of senior health board officials, civil servants and IHSL managers were locked in a day long crisis meeting.

Last minute inspections had found safety concerns over the hospital's ventilation systems and the meeting saw Health Secretary Jeane Freeman presented with a number of options before she decided to postpone the opening to get the problems fixed.

The issue for the health secretary - and the public purse - was that under the terms of the NPD contract, repayments - which average about £1.4m a month - had already started because NHS Lothian had taken possession of the site from IHSL because it had been signed off as ready by independent assessors.

A political row followed and a series of independent reviews pointed to a "collective failure from the parties involved" to not spot that parts of the hospital failed to comply with ventilation guidelines designed to control infections.

An NHS Lothian-commissioned review found a "human error" in a 2012 spreadsheet with the specifications for air flow in critical care rooms had set in motion a series of events that delayed the opening.

The hospital opened to outpatients in July 2019 and the repairs to the ventilation system were made.

Ms Freeman has previously said the cost of this remedial work and delays in opening the hospital campus is estimated to be £28m, but the final bill is likely to be bigger, including higher NPD repayments.

The new hospital includes a £5m art and therapeutic design programme

The issues surrounding the delayed opening of the Sick Kids are now being examined by a public inquiry.

By the time of the inquiry's first hearing on 22 June, the new hospital should have bedded in and the benefit of the leap in quality of facilities should have been apparent to the "little creatures" and families written about in Dr Smith's Scotsman newspaper letter.

Highlighting the horror he had seen in 1850s Scotland, the surgeon said: "The whisperings of distress lisped out by those unfortunate little creatures too feeble to attract attention."