The next item of business is a statement by Shona Robison on the Scottish Government response to the Vale of Leven hospital inquiry. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.
14:31
I am here to present the Scottish Government’s response to Lord MacLean’s Vale of Leven hospital inquiry report. Before I do so, I again express the Government’s sorrow to the families of the 34 people who died at the Vale of Leven hospital as a result of the Clostridium difficile outbreak. We all agree that it was a terrible tragedy that should never happen again. I accept Lord MacLean’s findings that there were failings at the Vale of Leven that significantly contributed to patients being ill and families losing their loved ones.
I take the opportunity to again thank Lord MacLean and his team for producing such a comprehensive report. I also thank the patients and families for their perseverance in securing the inquiry and for their engagement with my officials as part of the implementation process.
Although the inquiry focused on the Vale of Leven hospital, it is clear that the recommendations have far-reaching implications up and down the country. That is why I accepted all 75 recommendations in Lord MacLean’s report and committed to taking the necessary steps to fully implement them.
I met the patients and families earlier today, and some of them are in the gallery. I thank them for taking the time to meet me. It is important that we collectively remember that what happened to them should not have happened, so I hope that our response and our commitment to continuing to improve go some way towards assuring them of how seriously I take the issue. Our response demonstrates that a lot of work has been done and that many improvements have been made in our national health service since the Vale of Leven outbreak, but more needs to be done, and those points are reflected in our response.
I am pleased that the response contains a foreword by the C Diff Justice Group. When I read it, it was a salient reminder to me, as it will be to all of us as we move forward, of why it is important that we implement Lord MacLean’s recommendations. It is only fit and proper to ensure that the serious nature of what happened at the Vale of Leven is reflected throughout our response.
The response reflects the fact that we do not take the tragedy lightly. The recommendations from Lord MacLean’s report have been grouped together, when they interlink, and addressed under three chapters, which are on oversight and leadership, preventing and controlling infection, and professional practice. The final chapter is about our next steps to ensure that the recommendations are fully implemented.
Lord MacLean’s report highlighted a number of failures, but it also acknowledged that the Scottish Government and the NHS have made improvements since the outbreak, particularly on infection prevention and control. Those improvements are highlighted in our response. For example, we have established the Healthcare Environment Inspectorate, which provides independent and rigorous scrutiny and an assurance system for our hospitals. In addition to HEI inspections, a number of measures, such as the work of the healthcare associated infection task force and the work of the Scottish patient safety programme, have contributed to significant reductions in surgical mortality and MRSA cases, and to lower C diff rates in over-65s than ever before.
The older people in acute hospitals inspections, which were introduced in February 2012, measure hospital performance against national standards, guidance and best practice. It is reassuring that a number of the key areas that are considered in the inspections relate to issues that Lord MacLean’s report highlighted: treating older people with compassion, dignity and respect; recognising dementia and cognitive impairment; preventing and managing falls; providing nutritional and hydration care; and preventing and managing pressure ulcers. Those are all basic things that we would expect for ourselves and our loved ones.
We want to improve patients’ experiences of health services, and this was enshrined in law through the Patient Rights (Scotland) Act 2011. The act provided for “The Charter of Patient Rights and Responsibilities” to ensure that patients’ rights are met and respected. The charter enabled the patient advice and support service to be established, which ensures that the public know that they can raise concerns, complain and feed back about the care that they have received so that we can continue to learn and improve.
The Government is committed to making necessary improvements that benefit patients across Scotland. Although I have highlighted some of the good work that is in place, there is still a journey ahead of us. I am very aware that more needs to and can be done to meet our ambition of having a world-class health service that is truly person centred, safe and effective.
In my statement in November, I said that a number of actions would take place following publication of Lord MacLean’s report. I am pleased to say that an implementation group and a reference group have been established, which include representation from patients and families, the British Medical Association, the Royal College of Nursing, public partners and the Health and Social Care Alliance Scotland.
I wrote to all national health service boards to ask that they assess themselves against the 65 recommendations for health boards. The initial summary of information showed that NHS boards were making good progress towards implementing the recommendations. The next stage is to quality assure the information and develop a process so that we know that the recommendations are being implemented.
I am committed to developing a national approach to assuring nursing and midwifery care. Initiatives such as the quality of care reviews that Healthcare Improvement Scotland is developing and our chief nursing officer’s care assurance system will deliver improvements for patients and staff.
The Government has introduced primary legislation on the duty of candour and on wilful neglect. We are also working with Healthcare Improvement Scotland to introduce secondary legislation that gives HIS powers to close wards to new admissions when that is deemed necessary.
I will now outline the steps that we will take over the coming months. Lord MacLean and his team are winding up the Vale of Leven hospital inquiry. That involves the inquiry team transferring files to National Records of Scotland, ensuring that all data protection and other legislative procedures are adhered to and finalising the financial aspects of the inquiry. Lord MacLean will publish the final costs shortly, once those processes are completed.
Although the inquiry is being wound up, the process is not at an end. A number of other actions will be taken to implement all the recommendations. Work is continuing with NHS boards, and the chief nursing officer has written again to them for an updated progress report on their original assessments. This time round, each board must ensure that its area partnership forum, area clinical forum and local people involvement network consider and agree to the response before it is returned. That is one of a number of actions that are under way to ensure that the recommendations are being implemented locally. I expect all boards’ responses to have been received by the end of August.
The implementation group is developing an action plan to take forward recommendations nationally. The plan will incorporate the recommendations that are not currently part of existing governance, scrutiny or improvement systems and will include the lead organisation that is responsible for each recommendation, the action that it will take and the timescale for completing it. The plan will also be considered and agreed to by the reference group.
I am pleased to inform colleagues that a dedicated page on the Vale of Leven hospital inquiry has been established on the Scottish Government website. It will be regularly updated as time goes on, and it will set out the progress against implementing all 75 recommendations. I will also send the Health and Sport Committee a short report on progress at the end of November.
I committed to publishing the initial responses of NHS boards that were provided in January 2015 once the analysis process had been completed. I assure the Parliament that those responses have been published on the Scottish Government’s website.
A crucial aspect of the implementation process is that patients and families continue to be involved until they feel that it is completed. I am delighted that they are represented on the implementation and reference groups and so are working with us on making care more person centred, safe and effective. I have received feedback that they are providing valuable input and support to the implementation process and to other key policy developments.
I look forward to working with the patients, families and other stakeholders to implement the national action plan developed by the implementation group. I will report on progress to Parliament at the end of November. I thank everyone involved in the inquiry and reiterate my commitment that we will learn the lessons from it. I present to Parliament the Scottish Government’s response to the Vale of Leven hospital inquiry report.
When our loved ones are admitted to hospital, we have trust in, and high expectations of, the care that they will receive. When their condition deteriorates as a result not of their medical condition but of infection and circumstances that they cannot control, that trust is broken.
That 34 people lost their lives because they contracted an infection in the very place they had turned to in the hope that they would get better is very serious and tragic. I associate myself with the cabinet secretary’s condolences to those families and express my deepest sympathies about what happened.
My colleague Jackie Baillie MSP cannot be with us today, but I am sure that the compassionate and tireless support that she has given the Vale of Leven families will be recognised across the chamber. Previously, she asked the Scottish Government about compensation for the families. Can the cabinet secretary please update the chamber on the arrangements for compensation?
During the period we are discussing, the rise of hospital-acquired infections such as C diff and MRSA undermined the confidence that we have in our NHS, and nowhere was that clearer than in the Vale of Leven hospital. I recognise that the situation has been treated as a matter of great seriousness by the NHS board and by the Scottish Government, and the inquiry by Lord MacLean, its conclusions and the Government’s response are welcome.
Lord MacLean has offered 75 recommendations, all of which have been accepted and many of which have been acted on, but he says that there is one major single lesson to be learned:
“that what happened at the”
Vale of Leven hospital
“to cause such personal suffering should never be allowed to happen again.”
I ask the cabinet secretary to give an assurance to the families of those who lost their lives that she is confident that practices are now in place in hospitals across Scotland that will prevent such a thing from ever happening again, as Lord MacLean said.
I thank Jenny Marra for her questions. I also recognise Jackie Baillie’s role, particularly in supporting the families and bringing many issues relating to the Vale of Leven tragedy to the chamber.
On compensation, a lot of progress has been made around the settlement of claims by NHS Greater Glasgow and Clyde. Obviously, the negotiation of compensation is a matter between NHS Greater Glasgow and Clyde and the families—or indeed their representatives. I can say to Jenny Marra that that is at an advanced stage.
Jenny Marra asked for an assurance that such a thing could never happen again. I can absolutely give that assurance. The particular circumstances that prevailed at the Vale of Leven have been well laid out in the inquiry and a lot has changed since then. We get notification of outbreaks now in a dramatically different way. For example, when outbreaks happen—and they still happen, as that is the nature of infections and we still have infections in our hospitals—they are a challenge. Infections are often brought in from the community, so we have to be vigilant.
However, this is about what we then do. The response is now rapid: the patients concerned are isolated, alerts go out and I am told when there is an outbreak, and the outbreak is very quickly brought under control. Those processes are very swift and effective, as they rightly should be, because, as I said, infections continue to be a challenge.
Those processes and alerts, and the ways in which infection control teams now work, were not in place at the Vale of Leven at the time. Therefore, I can assure Jenny Marra that the processes and procedures, including the swiftness with which infections and outbreaks are dealt with, are very different. Members can be assured that patient safety is at the forefront of that.
I thank the cabinet secretary for advance sight of her statement. I also thank her for correcting in her oral delivery some of the rather sloppy grammar that was evident in the draft. Even so, I found some of the paragraphs in the statement unhelpfully clumsy and in some cases impenetrable—and unnecessarily so. However, I associate myself with the sentiments that she expressed.
One of the Government’s responses to the recommendations on non-executive directors says:
“It is vital to ensure that non-executive board members are able to fully discharge their governance role. We will continue to work with NHS boards and others to ensure that non-executives have access to appropriate training and development materials. In doing this, we will build on the excellent work already underway within boards across Scotland.”
I would like to know what that actually means. The Government’s response identified “appropriate” training for non-executive board members. Is that training now mandatory or voluntary? There is a suggestion that if non-executive directors had been fully interrogating the systems that were in place, some of the deficiencies might have been highlighted. Given the sentiment expressed in the response, specifically how much time and resource do non-executive members have to give to the responsibility that arises from the recommendations?
A lot of work has gone into supporting and enhancing non-executive members’ skills and confidence. There are general and specific issues. Generally, non-execs play an important role in scrutinising and questioning the issues that they see in front of them and the issues that are brought to board meetings, for example. That is not just about infection control but about a range of matters.
The role of our non-execs should be one of asking questions and scrutinising, but they have to be well informed, supported and trained to be able to do that. In relation to infection control, they are absolutely expected to discharge their role, and they will be supported in that—work on that is well under way. They are not only expected to ask the right questions about the data that is put before them but encouraged to walk through the wards and hospitals, speak to staff and see things for themselves. I can furnish Jackson Carlaw with more detail as that work is rolled out.
We have an absolute duty to support our non-execs. We bring them in for a specific purpose because we want that external scrutiny and those other voices around the board table. However, those voices are only as good as the information that board members have and scrutinise. The role of non-execs is critical, and I am happy to keep Jackson Carlaw and others informed about it.
The cabinet secretary highlighted a number of action points in her statement. Will she outline how the Scottish Government will ensure that health boards are implementing Lord MacLean’s recommendations?
I am happy to do that. As I said in my statement, we need to do more than ask boards to provide assessments against the 65 recommendations. They obviously did that, but we need to ensure that assurance systems are place, so that we know that what boards are telling us is actually happening. That is not to question whether boards are telling us the truth; we just need to assure ourselves that that is the case.
The chief nursing officer has written to ask NHS boards for progress reports. As I said in my statement, this time the reports will be considered and agreed by each board’s area partnership forum, area clinical forum and, importantly, the public involvement network in order to ensure that what the report says is correct. The role of the implementation and reference groups is critical in reviewing which recommendations are scrutinised as part of existing governance, and in ensuring that efforts are focused. The involvement of families and patients in the implementation and reference groups is really important because it provides an external assurance process.
I hope that that gives Stuart McMillan some reassurance. I will be happy to keep Parliament updated. The website will be populated with a lot of the information that comes back to us. Members should be assured that there will be external and rigorous investigation and probing of what boards tell us.
I welcome the cabinet secretary’s decision to ensure that the next round of reports is signed off by the partnership and clinical fora, and by the people who are involved in the network. Publication of the data by health board is also really important.
HAI reports on the elderly show no record of cognitive assessments having been done in 50 per cent of patients, and Scottish research shows that the figures are even worse where there is a diagnosis of dementia prior to admission. Also, repeated reports have to be made on things such as peripheral vascular catheter bundles. The cabinet secretary is giving the HEI powers, but will she give the HAI task force teeth to enforce when it finds that it has to repeat requirements in successive reports?
The HAI reports are rigorous and they do not pull any punches. They are sometimes hard reading and that is as it should be. If standards of care are not as good as they should be, we need to know about that.
Some more recent reports show significant improvement in respect of the problems that previous reports highlighted. I made it clear to board chairs and, through them, the chief executives that I did not expect them to wait for HAI reports to be done on their facilities and hospital wards, but to look at the reports that had already been published, learn the lessons and assure themselves personally that what is going on in their wards and hospitals is up to the required standard.
On the HAI task force and our oversight of it, we will make sure that issues that are raised, especially if they are raised often, are addressed across all our board areas. I will also be happy to keep Parliament updated on that.
I need to finish this item of business by 3 o’clock. A number of members wish to ask questions, so it would be helpful if members could keep their questions brief, and if we could have brief responses from the cabinet secretary.
What progress is being made by the Scottish antimicrobial prescribing group?
The group has made a lot of progress. In response to a previous question from Nanette Milne, I outlined the important progress that has been made and the statistics that show the important work that is being done. We are working with the group and with Health Protection Scotland to reduce inappropriate use of antibiotics in order that we can combat the emergence of resistant organisms. There was a five-year Scottish management of antimicrobial resistance action plan, which is now complete.
It is important that we are working closely with the UK Government and other devolved Administrations on the UK five-year AMR strategy, which was launched two years ago and which, in its first annual report, showed good progress across all the Administrations. I will be happy to put a bit more detail about that on the record later in order to save time now, Presiding Officer.
The report highlighted in its recommendations the need to
“ensure that the staffing and skills mix is appropriate for each ward, and that it is reviewed in response to increases in the level of activity”
and/or
“dependency in the ward. Where the clinical profile of a group or ward of patients changes”
there must be a
“review framework and process ... to ensure that the ... skills base ... requirements”
are met. What discussions has the Scottish Government had with health boards on the feasibility of implementing such a review framework and process? What support will it give to that?
A lot of work has gone on around that, particularly on getting the workforce planning tools correct. This is not just about staffing and staff ratios on particular wards, albeit that those are important. It is also about the skills mix and, potentially, changing levels of acuity in the ward.
When I met patient representatives earlier today, an emerging issue was that there must be the ability to respond quickly with flexibility to increase staffing levels when required. Therefore, the work is important: indeed, it is central to our work with boards. We will ensure that information on that goes on the website as the work progresses.
I welcome the Scottish Government giving powers to the Healthcare Environment Inspectorate to close wards to new admissions. I hope that that power will be used only rarely, given the significant fall in HAIs. Is the Scottish Government confident that the HEI will have access to appropriate information that will allow it to move swiftly to use the power in the unlikely event that it is needed?
Obviously, we hope that circumstances would seldom arise in which HEI would have to use that power. However, that is an important recommendation and backstop. Infection control teams have powers in that regard. It is an important additional power. HEI will have at its fingertips all the information that it will require to make its decisions. As we progress the secondary legislation that will put in place that power, we will ensure that there is guidance so that closure of wards can be achieved quickly.
What enforcement powers is the Scottish Government giving to the Healthcare Environment Inspectorate? When will it have those powers?
HEI has a great many powers, which members can see by the scope of its reports. As I said to Dr Richard Simpson, the reports are hard hitting. Nothing holds back HEI from carrying out its work, and it is doing a good job.
The secondary legislation to which I have just referred, which will give the power in respect of ward closures, will be introduced later this year.
It is important to recognise that, as we sit here, our infection control teams have quite considerable powers to react to infection outbreaks. As I said to Jenny Marra, there is an escalating set of responses to ensure that outbreaks are brought swiftly under control. Nothing stands in the way of the action that can be taken by the infection control teams. I would not want people to think that there are not procedures for responding quickly to outbreaks. The additional power that I have mentioned will help as a backstop, should HEI require to use it.
I note that the cabinet secretary said that we will learn lessons from the inquiry. What work has the Scottish Government done to look back at reports in recent years on patient care from elsewhere in the UK in order to ensure that lessons are learned here in Scotland?
My response to Dr Richard Simpson was along similar lines. Following publication of the Francis report and, more recently, the Morecambe Bay report, we have written to all NHS boards asking them to take account of the reports’ finding and to assess themselves against their recommendations.
Health Protection Scotland currently reviews reports from outside Scotland and provides relevant guidance if a report contains recommendations that are not already covered in Scotland. Richard Lyle should be assured that wherever a report is from—whether it is issued in another part of the United Kingdom or internationally—we will always look to see whether there are any lessons to apply to the health service in Scotland.
That ends the statement from the cabinet secretary. I offer my apologies to Dennis Robertson.
Previous
Business Motion