The latest dossier of claims obtained by Labour MSP Anas Sarwar also claims the warnings were escalated to Scottish Government level before Milly’s death in August 2017. It is still unclear exactly when SNP ministers first became aware of the problems at the Queen Elizabeth University Hospital and adjoining Royal Hospital for Children.

A month after Milly’s death another assessment found the water was not safe and that there was a high risk of infection.

Mr Sarwar said: “At each of these stages the warnings were ignored and appropriate action was not taken. It led to the death of a child. If this happened in the private sector there wouldn’t be a public inquiry, there would be a criminal investigation.

“The First Minister, Health Sec­retary and Health Board officials must detail who knew what and when. This is unforgiveable. This can’t wait for a public inquiry that could take years, we need full transparency and accountability now.

“I will not rest until Milly’s parents and the parents of all the children affected, get the answers and justice they deserve.”

It was announced yesterday that Court of Session judge Lord Brodie will chair the public inquiry, which will also look at the delayed Royal Hospital for Children in Edinburgh.

Mr Sarwar unveiled the “damning” new evidence during First Minister’s Questions at Holyrood yesterday, calling for “full transparency and accountability” from the administration.

Miss Sturgeon said: “The Scottish Government is determined to get the answers that Milly’s parents and parents of any children who were treated at the Queen Elizabeth want and deserve.”

The scandal emerged when a whistleblower contacted Mr Sarwar to say a doctor-led review had been covered up by the health board.

It found one “water infection episode” had occurred in 2015, 10 in 2016 and 26 in 2017. Twenty- three such episodes in 2018 were made public, while there have been a further 15 this year.

On Wednesday, a review by Health Protection Scotland found child cancer patients were at risk during 16 separate infection spikes at the hospital.

According to the new information from whistleblowers, debris in a water tank which was first spotted in 2015 was still there two years later. The first report by contractors DMA Canyon found “high risks”, a lack of management structure and problems with water temperature control.

Five of the plant rooms, where water enters the building, were deemed “high risk”. In March 2017, hospital staff alerted management about possible infections in cancer ward 2A, according to Mr Sarwar’s dossier.

In August that year infection-control doctors requested testing for Stenotrophomas, the bacteria listed on Milly’s death certificate later that month. It was claimed these concerns were sent to Health Protection Scotland and the Scottish Government.

Two months later, an updated risk assessment by DMA Canyon found “high- risk” problems including ones from 2015.

The report highlighted: “DMA were advised during the initial occupation phase that the filter system was bypassed due to issues with the pumps and filter set and this may have introduced contamination, debris (and potentially bacteria) into the system.

“As the tanks have not been cleaned since this time any material or contamination then present could potentially have been flushed into the system and have colonised parts of the system.”

In 2018, a number of infections were detected in patients. Wards 2A and B in the children’s hospital were closed and patients transferred to wards in the Queen Elizabeth hospital.

Gaps in legionella control were identified by DMA Canyon in a third report. It noted: “We would describe the legionella management on site as being high risk until remedial actions highlighted within the legionella risk assessment and within this gap analysis are implemented.”

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