First Minister's Question Time
Today, questions to the First Minister will be taken by the Deputy First Minister.
Engagements
To ask the Deputy First Minister what engagements she has planned for the rest of the day. (S3F-1190)
As members may be aware, the First Minister is unwell today; I am sure that we all wish him a speedy recovery. Later today, among other things, I will appear on the BBC's "Question Time" with Tavish Scott, the leader of the Scottish Liberal Democrats, and Jim Murphy, the leader of the Scottish Labour Party. [Laughter.]
Perhaps this is a game that we can play another day—I want to ask questions about Clostridium difficile. The outbreak of C difficile at the Vale of Leven hospital was the worst ever in the United Kingdom—18 people lost their lives. Yesterday, world-renowned epidemiologist Hugh Pennington warned that the real number of deaths may have been substantially higher, because C diff is not always recorded on death certificates. In September, the Parliament voted for a public inquiry into the C difficile outbreak, to ensure that all of Scotland learns lessons from the Vale of Leven. Last night, the Deputy First Minister did not rule out a public inquiry. Will she confirm today whether a public inquiry will be forthcoming—yes or no?
I thank Iain Gray for raising an issue of the utmost seriousness—I am sure that every member of the Parliament will treat it with the seriousness that it undoubtedly deserves. I repeat what I said on television last night and have said in the chamber previously: I have not ruled out a public inquiry. When the scale of events at the Vale of Leven hospital came to light earlier this year, I took the decision to order a rapid independent investigation, so that we could identify the significant failings at the hospital and take quick action to put them right. I stand by that judgment absolutely. The report that I ordered and the accompanying Health Protection Scotland report led to 40 recommendations, each of which is in the process of being implemented.
As Iain Gray knows, when the reports were published, I decided to pass them to the Lord Advocate. As a result of that decision, a police investigation into events at the Vale of Leven hospital is under way. In the interests of due process for all concerned, it is appropriate for me to allow that investigation to continue before making any further pronouncement. I repeat: on an issue of such seriousness, a public inquiry has not and should not be ruled out.
The Deputy First Minister is hiding behind due process. Any lawyer will tell her that there is nothing to stop her holding a public inquiry now. The due process to which she refers is based on a report with which she says she is satisfied, but the report has been condemned by the families of those affected and criticised by the experts; it has now been disowned by its author. Britain's leading patient safety specialist has called the report the worst that he has ever seen,
"not fit for purpose under any circumstances"
and "appalling". Even the report's author said that it
"didn't get to the bottom of every aspect".
Of the 30 people who were interviewed, only six were front-line staff, and not one ward nurse was spoken to. Is the Deputy First Minister seriously saying that she is satisfied with the report?
I will make a couple of points for the sake of accuracy and for the record. If Iain Gray cares to check the record for the comments that I have made in the chamber previously, he will find that I have never said that I am unable at this stage to order a public inquiry. I have said that it is appropriate to focus first on the actions that will rectify the significant failings at the Vale of Leven hospital and to observe due process by allowing the on-going police investigation to take place.
It is possible in theory—although it is not for me to say—for the Lord Advocate to order a fatal accident inquiry, a public inquiry or indeed a criminal prosecution. Perhaps unlike Iain Gray, I believe that due process is important.
Anybody who watched the BBC programme on the matter last night, as I did, would take issue with Iain Gray's claim that the author of the report disowned it. He said that he was commissioned to carry out a rapid investigation to identify quickly the significant failings at the Vale of Leven. That is the exercise that he carried out, and I think that he carried it out well.
As a result of the report, 40 recommendations are being pursued, which allows us to make real improvements to infection control procedures at the Vale of Leven and to the surveillance systems there, which failed significantly earlier this year. There is also a continuing programme of investment in the maintenance and the fabric of the hospital. That is entirely the right way to proceed.
As I have said previously, tackling infection in our hospitals is the top priority for me as Cabinet Secretary for Health and Wellbeing, and for the Government. That is why one of the first decisions that I took in office was to more than triple the budget for fighting infections in hospitals. I will continue to take my responsibility to reduce the incidence of infections very seriously.
The problem is that due process cannot be based on a report that is so fundamentally flawed. Michelle Stewart's mother-in-law died in the C diff outbreak, and here is why she thinks that a public inquiry is so important:
"We're just skimming the surface … We've not learned enough about what happened during the outbreak for them to learn every lesson … We don't want any other family across the whole of Scotland to have to go through what we went through and think their family died needlessly."
The families of those who died want a public inquiry now. Britain's leading epidemiologist wants a public inquiry now. This Parliament voted for a public inquiry in September. Ms Sturgeon has admitted today that there is no reason why that cannot happen. She herself is the only obstacle. How many people need to tell her that she is wrong before she calls a public inquiry?
As I have said, a public inquiry is not being, and will not be, ruled out at this stage. This is a matter of the utmost seriousness, and I have nothing but respect for the families involved in the Vale of Leven outbreak. I have met the families on two occasions. I know how difficult and dreadful the situation has been for them. Some years ago, I watched my grandmother battle C difficile, so I know how horribly distressing it is. It is important not only that we allow due process to take its course in this case but that I, as health secretary, ensure that the failings that have been identified at the Vale of Leven are put right, so that the sort of reduction that took place in C difficile rates in Scotland in the last quarter can continue. At this stage, I would not claim that reduction as a trend, but it is an encouraging development.
Anybody who suggests that the report that was carried out by Professor Cairns Smith was not important does not, I believe, have the interests of patients at heart. That report has allowed us to focus on improving infection control and the fabric of the Vale of Leven hospital, and on ensuring that we have robust surveillance systems in place, so that no outbreak can go unnoticed again. I would have thought that all those actions would be welcomed by everybody in the chamber.
Of course the issue is of the utmost seriousness, but it is of the utmost urgency, too. It is not just at the Vale of Leven—there have been C difficile outbreaks at Hairmyres, at the Queen Margaret hospital in Dunfermline, at the Royal Alexandra, at Stobhill, at the Victoria infirmary and at Woodend hospital in Aberdeen. Under the health secretary's watch, the number of C diff cases in Scotland has increased by more than 9 per cent. Under her watch, the key budgets for hospital cleaning and maintenance are being cut in real terms in most hospitals. The relatives of C diff patients are still taking laundry home—although the health secretary seemed not to know that last night. This is not getting better; it is getting worse.
When she was in opposition, the health secretary called for public inquiries with monotonous regularity but, now that she is in government, she resists doggedly. What is she afraid of? What is she trying to cover up? She is the only obstacle to the inquiry that we need. In the interests of the families, will she change her mind now?
The budgets for cleaning in our hospitals are not being cut. If Iain Gray studies the information that was provided to the BBC by NHS boards, as I have done, he will see that the presentation of the information significantly distorts reality. I encourage him to study the information.
On the subject of statistics, I readily acknowledge that C difficile is a growing concern. It is not a new concern; death rates from C difficile in Scotland have been rising steadily throughout this entire decade. The issue is a problem, which we are determined to tackle.
I will tell Iain Gray what the Government is doing to tackle infections in our hospitals, and I ask him to listen carefully. The Government has tripled funding to tackle infections; we have set a target for the reduction of C difficile; we have provided extra funding for antimicrobial prescribing policies, which are a key factor in tackling C difficile; we have raised hand hygiene performance requirements; we are toughening up cleaning standards; we are empowering senior charge nurses; we are establishing an independent inspectorate that can carry out random inspections of our hospitals; we have banned, for the future, the privatisation of cleaning contracts that Labour was so keen on; and we have decided that, in future, all new hospitals will be 100 per cent single rooms. Those are real actions to tackle infections, and I would have thought that Labour could welcome them.
Secretary of State for Scotland (Meetings)
I, too, am sorry to hear of the First Minister's indisposition. I wish him a speedy recovery.
To ask the Deputy First Minister when the First Minister will next meet the Secretary of State for Scotland. (S3F-1191)
I am not sure when the First Minister will next meet the Secretary of State for Scotland but, as I indicated earlier, I will see him in Glasgow this evening.
I have listened to the exchanges between the Deputy First Minister and Mr Gray, but there are some basic, inescapable and chilling facts. First, Scotland has the highest rate of hospital-acquired infection in the United Kingdom. None of us can be proud of that, and all hospital patients will be deeply disturbed by it. Secondly, and sadly, the Vale of Leven hospital is not unique among our hospitals in having an unacceptably serious level of infection risk. According to the BBC, there are alarming levels of C difficile cases throughout Scotland.
Last night on television, the health secretary claimed that what has happened at the Vale of Leven is
"not reflective of general practice across the NHS in Scotland."
The facts do not support that assertion. Clearly, the health secretary does not know what is going on in our hospitals in Scotland. Does she now accept that the problem is much more serious and much more widespread than she indicated?
I will not—for party-political or any other purposes—try to diminish the issue of infection in our hospitals. It is one of the most serious issues that I, as health secretary, face. That is not just because of the impact that it has on the people affected and their families but because it undermines confidence in our health service. That is why tackling the issue is my top priority.
We can bandy about statistics, but we have to take care. I accept that the rate of C difficile has been increasing—not just since this Government took office but for some time. However, let us consider the death rate from C difficile—and let me start by saying that every death from C difficile is a death too many. The death rate from C difficile in England, proportionately, is double the rate in Scotland. I say that simply because we have to take care with statistics.
To answer Annabel Goldie's question, no, the rate of infection in our hospitals is not greater than I thought. I am well aware of the rate of infection in our hospitals; I commissioned the Health Protection Scotland study that accompanied the Vale of Leven independent review that told us the extent of the problem with C difficile over the same six-month period. We can talk about the scale of the problem or we can focus on the actions that the Government is taking to tackle the problem. I prefer the latter approach. The Government is determined through its actions to reduce the rate of all infections in our hospitals. I hope that all members welcome the reduction in the number of cases of MRSA, which I hope will continue as we roll out MRSA screening. I am determined to see such a reduction in the number of cases of C difficile as well.
The Deputy First Minister needs to take a reality check, in her own words, "to tackle the problem". To tackle the problem, we need to know what is happening, where it is happening, why it is happening and when it is happening. We need robust, real-time data to be provided not on a health-board-by-health-board basis but, at the very least, on a hospital-by-hospital basis—preferably on a ward-by-ward or even bed-by-bed basis. When hospital-acquired infections threaten, we must move from being reactive to being proactive, anticipating what is happening and being able to deal with that, not looking at what has happened and having to analyse why. We are behind the game.
The Deputy First Minister said, five years ago:
"It is up to the Health Minister to ensure that superbugs are kept to a minimum and that patients enter Scotland's hospitals to be treated not infected".
She was right—I could not agree with her more. She is now the health minister, so when is she going to live up to her own fine words and turn the rhetoric into reality?
In case there is any doubt in the mind of anybody in the chamber, let me repeat what I said in opposition. It is the responsibility of the health secretary to tackle infection in our hospitals. That is a responsibility that I understand probably better than anybody else in the chamber, and it is a responsibility that I will never shirk.
Annabel Goldie is correct on two points. First, she says that we are behind the game. Since I took office, we have been playing something of a catch-up game with England in relation to C difficile. The reason for that is that the previous Administration introduced mandatory surveillance of C difficile three years after it was introduced in England. There has been an element of catching up.
Secondly, we need better real-time information, which is why we are improving the surveillance systems that are in place in our hospitals. It is also why we are introducing new reporting requirements for hospitals, so that health boards have real-time information that is broken down not just by hospital but by specialty. That will enable them to know exactly what the situation is and target their efforts to ensure that they bring down the infection rates.
It is too early—as I heard somebody say from a sedentary position—to read too much into the figures from the last quarter. However, any reduction in the number of cases is surely welcome. I believe that, if we continue to take the right action, particularly around antibiotic prescribing, we will see a reduction in the number of cases of C difficile. I hope that every member will welcome that when it comes.
Cabinet (Meetings)
To ask the Deputy First Minister what issues will be discussed at the next meeting of the Cabinet. (S3F-1192)
The next meeting of the Cabinet will discuss issues of importance to the people of Scotland.
An e-mail from an electronics company in Galashiels, which has 40 employees, says this:
"Our banking facility has been … at base +1.5% for years … Last Friday we had a meeting with our bank manager … and were stunned to be advised that they would require base +4%."
The Government has a Financial Services Advisory Board. Does the Deputy First Minister expect it to help Scottish business during the recession?
I very much share the concerns that Tavish Scott has just articulated. We all appreciate that small businesses are suffering in the current financial climate and that the lending conditions that many of them now face are an aspect of the difficulties that they are encountering. The Cabinet Secretary for Finance and Sustainable Growth, John Swinney, has written to the banks, asking them to change their lending practices to ensure that they do not penalise small businesses.
Of course, the key player in all of this is the United Kingdom Government, which has made the decision to put significant amounts of taxpayers' money into our banks. I would have thought that we should all be demanding that the condition of that support—which was that the banks return to 2007 lending conditions—should now be insisted on by the UK Government in the interests of everyone in Scotland.
For years, we have all supported the financial services industry in Scotland. Now, we need its help in return. Small business is being hit by banks. The collapse in competition will make that worse, and now the banking industry has been shamefully let down by the UK Government over HBOS. The Government has ripped up the level playing field, broken its promises and thrown 20,000 jobs to the wind. At the dawn of a recession, Scottish business has found itself raided by the banks and abandoned by Labour at the Treasury. [Applause.]
Order.
Will the Government call in what is left of Scottish banking this week and get it to drop the punishment charges for small business? Further, will the Government establish a banking jobs task force to tackle the crisis that the UK Government has created?
I assure Tavish Scott that John Swinney and the rest of the Government will persist with that dialogue with banks to ensure that we get fair treatment for our small businesses.
On the issue of the task force, Tavish Scott will be aware that the Financial Services Advisory Board is already in place. It is an important body.
I hope that all members appreciate the Government's commitment to our small business sector, which is evidenced by our small business bonus, which is providing help to small businesses in difficult circumstances. It is important that we all, with a united voice, call on the UK Government to take action as well to ensure fairness for our small business sector.
I have to say that I have sympathy with Tavish Scott's more general points about the financial sector. On several occasions, the First Minister has made clear that he will work for the best deal for Scottish jobs and Scottish decision making and, of course, in the interests of competition. We have also said that our preference has been for HBOS to remain as an independent bank. Members might like to know that the First Minister wrote to the Chancellor of the Exchequer on 19 November—yesterday—to express his great concern at the statement that the chancellor issued on Tuesday, which gave the lie, at long last, to any pretence that the UK Government has to being committed to the maintenance of a level playing field.
I agree that the UK Government has not treated our financial sector with the fairness that we should have expected.
I am sorry, but I simply do not have time to take any constituency questions. I will wish to discuss—
You let her go on too long.
Lord Foulkes, if you would be quiet, please, I might say something.
I will wish to discuss with business managers over the next week how we can speed up these opening exchanges.
Children (Stigmatisation)
To ask the First Minister, in light of the recent report by Barnardo's regarding the increased stigmatisation of children, what action the Scottish Government can take to help reverse this trend. (S3F-1200)
I believe that the vast majority of Scotland's children and young people are making a meaningful and positive impact in their communities. The report raises the issue of the gap that exists between reality and perception. The reality is that 99 per cent of headteachers believe that all or almost all pupils are generally well behaved in class; that more than 185,000 young people are actively engaged with voluntary youth organisations across Scotland; and that fewer than 1.5 per cent of young people commit crime.
To show his personal commitment to this issue, the First Minister recently hosted a dinner with opinion formers in the public and private sectors. The aim of that was to move forward an ambitious agenda for our young people through the Young Scot active initiative, an element of which will specifically target unfair and negative reporting on young people.
I share the Deputy First Minister's belief that the vast majority of children are not involved in the activities that they are often presumed to be involved in.
This morning, we had an interesting debate about looked-after children. What steps is the Government taking to ensure that the necessary services are in place to deliver early interventions where they are required by that group of children?
The early years framework, which is being produced in partnership with our local authority partners, will be produced shortly. It will be an important contribution to this debate. In addition, the Scottish Government works closely with partners in the youth sector to ensure that young people are supported to make a positive impact in their communities and nationally, and that that impact is recognised and rewarded. We are ensuring that that work is supported with significant resources. I am sure that, with all of us working together on this important agenda, we can give young people in our society the recognition that the vast majority of them thoroughly deserve.
Knife Culture
To ask the First Minister what action is being taken to address violent knife culture. (S3F-1214)
The Government is fully committed to getting knives off our streets, and we are working with the national violence reduction unit and a number of other partners to tackle the issue head on. Co-ordinated and sustained enforcement, targeted education, and earlier, more effective intervention are key elements of our approach. The medics against violence initiative, which I launched on Tuesday with the Cabinet Secretary for Justice, is just one example of the innovative work that we are now undertaking in Scotland.
I, too, look forward to seeing the medics against violence initiative at work in my constituency. I am confident that sharing real-life experiences from the front line will have a positive effect over time.
However, the toll is growing here and now. Every year, around 1,000 patients attend Glasgow dental hospital alone as a result of knife-related facial injuries. The most common way of committing murder in Scotland is with a sharp instrument or knife—indeed, such crimes are up 59 per cent since 2006, and the use of such a method of killing is three times greater than the use of any other method of killing. Therefore, it is clear that measures to tackle knife crime have not had the desired effect. Will the Deputy First Minister assure us that she supports the campaign to ensure that violent criminals who are found in possession of a knife face an automatic jail sentence?
I certainly assure the member that the Government will do everything possible to reduce knife crime on our streets and in our communities. As he knows, the Cabinet Secretary for Justice is considering the issue that he raises.
From a political perspective, probably no other member knows more than I do about the toll that violence takes on our national health service. Duncan McNeil is right to point out that toll, but he is not right to say that we are not taking strong action. For example, effective, co-ordinated police action has taken 2,000 knives off the streets in this year alone. Tougher prosecution guidelines are already in place, which means that more knife carriers are in custody with tougher sentences, and we continue to support the violence reduction unit, of course, through direct Government investment of more than £900,000. As with other issues that we have discussed during this question time, I hope that there will be cross-party support for tackling the scourge of knife crime in our communities to ensure that we deal effectively with the problem.
Organ Donation
To ask the First Minister whether the Scottish Government accepts the findings of the United Kingdom organ donation task force's report on presumed consent for organ donation. (S3F-1197)
I have made it clear that I am personally sympathetic to opting out as the basis of organ donation, but I have also said that the Government and I will be guided by expert opinion.
The organ donation task force concludes that moving to an opt-out system now could deliver real benefits but that such a move carries a significant risk of making the current situation worse. Therefore, it recommends working within the current system to boost the number of donors and having a further review of opting out in five years' time.
We want donor numbers in Scotland to double. To make that happen, we will provide increased resources to raise awareness of the organ shortage and build on the impact of our television campaign. We will also continue to work with NHS Scotland on making the necessary improvements to ensure that we achieve such an increase in the donor rate.
Does the Deputy First Minister agree that our national health service is founded on the principle of informed consent and that so-called presumed consent is a complete misnomer, as presumed consent is not consent at all? Does she agree that, in addition to promoting donations, the key to obtaining more transplants is having specialists in every major hospital, as there are in Spain, for instance?
I have some sympathy with those comments. I think that Mike Rumbles and I are on opposite sides of the debate, but I do not think that there is a great divide between us.
I agree that presumed consent is a misnomer. Consent must underpin both an opt-out system and an opt-in system. It is important to stress that our objective is to increase the number of donated organs; how we do that is a secondary issue.
Mike Rumbles is right to point to Spain. It is thought that practical measures rather than a change in the law have increased the donor rate there. If we can do the same in Scotland, I for one will be happy. If we cannot, it would be right to review the opt-out situation, which is why we have not closed the door on the issue.
Does the Deputy First Minister agree that, in the short term, we should seriously consider introducing an opt-out register, so that people who definitely want to opt out can do so? Will she also join me in welcoming the fact that, in my area of Clackmannanshire, the Alloa and Hillfoots Advertiser has been running a campaign to increase the number of people in the donation system? Should we not encourage all local newspapers to engage in similar campaigns? That will at least help the situation in the short term.
I congratulate the Alloa and Hillfoots Advertiser and encourage other local papers that have not already done so to follow suit. I also take the opportunity to encourage everyone in the chamber and outwith who is not on the organ donor register to take the step of signing up.
On Richard Simpson's first point, the register is set up to record positive wishes that people express, but the task force heard suggestions that the register could also be used to allow people to record their objection to donating organs after their death. I am happy to ask the programme delivery board that has been set up to implement other recommendations to consider that point.
Meeting suspended until 14:15.
On resuming—