 That concludes topical questions. The next item of business is an urgent question, and I call Liam Kerr. To ask the Scottish Government what its response is to reports that NHS Grampian was warned about and failed to address significant issues on the burden anchor units almost three years before announcing delays. Cabinet Secretary, Michael Matheson. NHS boards are responsible for the commissioning and day-to-day management of their capital projects. The previous experience has found that, due to the nature and complexity of these projects, an additional layer of external assurance was needed to ensure that the special requirements of these healthcare facilities and the sites are fully addressed. That's why we created NHS Assure in June 2021 to provide the critical oversight to projects being taken forward by local health boards. The report being referred to today was conducted by NHS Assure demonstrating the value of them having this greater role in these projects. Clearly, a crucial element of any large capital project is the on-going review and refinement of the agreed design, in particular the mechanical, electrical and infection prevention and control aspects. Those are now all independently reviewed by NHS Assure for such projects and taken forward by local health boards. Liam Kerr. I'm very grateful. What will hugely concern the people of the north-east is that this situation was warned about three years ago and patients are paying the price. Despite MSPs requesting details of the assessment from 2020 that there were problems, it has taken an FOI to drag that information out today. Cabinet Secretary, when was the Scottish Government first made aware that there may be issues with the ventilation systems? I'm not asking about the report, Cabinet Secretary, just awareness. What action was taken by the Scottish Government following that awareness? I can only make reference to the report that I'm aware of, which is the report that was carried out by NHS Assure to establish by the Scottish Government to undertake the type of key review work that is necessary for complex NHS facilities of this nature. It's now the responsibility of the local board who are taking forward this project to ensure that its recommendations are effectively implemented. The other aspect that I can give members assurance of as well is that new NHS facility will open until it has completed the final checks and that NHS Scotland is responsible for delivering. That's to make sure that once the facility is open that it complies with all the necessary standards that are set and to ensure that it will meet the level of patient safety requirements that are also required. I can assure the member that we are determined to make sure that NHS Grampian learns the lessons from this and that it will implement the recommendations that have been set out within the NHS Scotland Assure report. The cabinet secretary, of course, avoided the question of precisely when he became aware. I suspect that that's because what he's basically admitting is that he hasn't been made aware, which is an extraordinary admission of a lack of involvement and interest by this Government, especially given that this is far from the first hospital project to be beset by infection control problems. One thinks immediately of the Queen Elizabeth in Glasgow and the Edinburgh Sick Kids. I appreciate that this cabinet secretary is new in post, but his two predecessors presided over now four projects which had patient safety problems, overrun in time and bust their budgets. Cabinet secretary, what consequences will former ministers face for their incompetence and precisely what steps will the Scottish Government be taking to understand the causes of and learn lessons from these failures? I'm somewhat surprised that Mr Kerr's lack of knowledge on how NHS capital projects are taken forward and are taken forward by local health boards. They're responsible for the delivery of capital projects. We created back in June 2021 if the member was listening to my answer, which I suspect he possibly wasn't, but if he was listening to my answer, we set up NHS Assure back in June 2021 specifically to address issues of complex health projects being delivered effectively. That's exactly what it's there to do. Actually, this report demonstrates the effectiveness of that process, and that's why NHS Grampian are responsible for taking forward its recommendations. Harold Mawkin. It's concerning that once again we have another hospital with serious health and safety concerns. We currently have a Scottish hospital inquiry under way that is investigating the construction of hospitals, including the Scottish Government's flagship, Queen Elizabeth University hospital. Patients and staff will rightly be outraged by the latest development in NHS Grampian. Can I ask the cabinet secretary what discussions, if any, have been had with the trade union colleagues to ensure that workforce has confidence in the safety of the hospital that they will be expected to work in? The member raises an important issue. However, let's deal with the way in which this matter is dealt with at a local level. The NHS board is responsible for taking forward the capital project, delivering the project. We created, in June 2021, because of experience with some of the other capital projects being taken forward by boards, including at the Queen Elizabeth and also at the Sick Kids hospital here at Edinburgh, NHS Scotland Assure, which is the responsibility of providing that final level of oversight on how an NHS board takes forward a project. The review of the project by NHS Grampian has identified a number of areas where actions now need to be taken in order to address the issues that they have highlighted around infection control measures, ventilation, aspects, and it is now for NHS Grampian to ensure that those are implemented. There is a final process that that project will have to go through before it can start to receive patients, which allows NHS Scotland Assure to check that those recommendations have been implemented. So, by an effect, that assures them that the actions that are recommended have been implemented making the environment safe both for staff and also for patients. So, right from day one, people can have that level of assurance including her colleagues in the trade unions. David Torrance. Thank you, Presiding Officer. NHS Assure was established by the Scottish Government to improve the quality and management of healthcare construction and refurbishment projects across NHS Scotland. How can this be used moving forward to ensure that we are the wide range of skills and the expertise that is required for the construction of these particularly complex structures, not the least expertise in ventilating engineering? Cabinet Secretary. Hi, Presiding Officer. Healthcare establishments are complex capital projects that require a significant level of specialist technology to be deployed within them for a whole variety of reasons, particularly in clinical settings from theatres to ICU units, etc., where they all require specialist equipment and ventilation and other infection control measures being implemented. The reason why we set up NHS Assure is to provide us the level of confidence that boards in delivering these projects are implementing the right measures in order to make sure that the buildings comply with the standards and guidance that have already been set out for healthcare establishments. NHS Scotland Assure provides that expertise to all boards in order to give them the confidence that they need that these buildings meet the required standards. NHS Assure is there to support all other health boards across the country in delivering their capital projects. It is extremely important that when a local health board is taking forward a capital project, NHS Assure's recommendations are fully and effectively implemented before that building can be opened to staff and patients. Daniel Johnson. Thank you, Presiding Officer. In the example of the sick kids, the issue was that a standard of four cycles an hour was applied to four bedrooms rather than ten, with it being overlooked that those four bedrooms were critical care beds. It sounds like a similar mistake was made here. NHS Assure, as the cabinet secretary was pointing to, has picked up a mistake, but a mistake was made nonetheless. Is there an issue with the way that standards are held, or is there an issue with the way those standards are implemented in design and planning of hospitals such as the Aberdeen one in today's question? The member raises an important point. There are a couple of factors here. One is the project predates some of the changes to guidance and recommendations that have been implemented since we have learned lessons from both Edinburgh and also from Glasgow. There is a crossover between these projects and the application of those new standards. There is also the implementation or the creation of NHS Assure as well, which started from June 2021. What I am looking for and what I have already flagged up through my office is a need for us to ensure that, at the very outset, when NHS boards are taking forward projects, is that they are very clear about the process and the standards that they are expected to meet. Of course, sometimes they may be revised during the course of a major capital project such as the one in NHS Gampian, but it is important that they are alive to those and that they are responding to those immediately rather than waiting for the key review process from NHS Assure being implemented. There is an element here, and I have asked for assurance that all boards are aware of that, where they are taking forward capital projects. Equally, it is reassuring that the NHS Scotland Assure process has identified this issue and has been allowed to flush it out at a stage that allows a board to take the rest of the reaction not to address their concerns. That concludes the urgent question.