Vale of Leven Inquiry
The next item of business is a statement by Nicola Sturgeon, providing an update on the Vale of Leven inquiry. The cabinet secretary will take questions at the end of her statement, so, as always, there should be no interventions or interruptions during it. It will be a 10-minute statement.
I undertook to make a statement to Parliament when the Crown Office had received the area procurator fiscal's report on the police and Health and Safety Executive investigations into the tragic deaths from Clostridium difficile at the Vale of Leven hospital last year. I received an update from the Crown Office during the Easter recess and I am therefore taking the first opportunity available to me to update Parliament.
Before I do so, however, I want to reflect on the improvements that have been made at the Vale of Leven since the publication of the independent review team's report last August. The report's recommendations have been taken forward as an action plan by NHS Greater Glasgow and Clyde, and the recommendations have also informed the national health care associated infection action plan. The independent review team, supported by representatives of families and patients, assessed progress at the Vale of Leven at the end of last year, and the team published a follow-up report in February. I was encouraged by the findings. The team reported documented evidence of rapid and significant progress on all the recommendations, and a much improved and more direct organisation for the control of infection at the Vale, which is now fully integrated with the rest of the NHS Greater Glasgow and Clyde area.
Building sustainability in each of the seven areas covered by the original report will be crucial to maintaining the significant progress that has been made. Also, as the report confirmed, the long-term commitment of NHS Greater Glasgow and Clyde to the Vale of Leven will contribute to the sustainability of the achievements that have been made so far. Of course, monitoring of the hospital will continue, and I expect the progress that has been made to be maintained.
Members will be aware that, in parallel with those substantial improvements at the Vale of Leven hospital, the police and the Health and Safety Executive have been conducting investigations into the circumstances surrounding the C difficile outbreak. The investigations are being undertaken at the request of the Crown Office. I have been informed by the Crown Office that interim reports from the police and the Health and Safety Executive were submitted to the area procurator fiscal for Argyll and Clyde at the beginning of this month. The reports have now been fully considered by Crown counsel, and certain further inquiries have been instructed. The Crown Office has advised me that it expects the further inquiries to be completed by the end of May. It is expected that a decision on whether to instigate any criminal proceedings will be taken by the end of June.
I turn to how this information affects my deliberations about a public inquiry. As members know, I have never ruled out a public inquiry. Indeed, I have said on many occasions that I fully understand the demand for such an inquiry. However, it has always been my judgment that a public inquiry running in parallel with a detailed and complex police investigation could both restrict the work of the inquiry and pose a risk of prejudice to any criminal proceedings that might follow. That remains my view.
I have also, until now, judged that to announce an intention to have a public inquiry in future would not be appropriate while there was still considerable uncertainty about when it might be able to begin its work. However, it is now clear that the investigations have made significant progress and that the Crown Office is much closer to the point at which a decision about criminal proceedings can be taken. I therefore consider that the time is right to confirm that there will be a public inquiry into the C difficile outbreak at the Vale of Leven hospital following the conclusion of the on-going investigations. The public inquiry will be held under the terms of the Inquiries Act 2005. It is also appropriate that I announce that decision to Parliament now rather than await the decision of Crown counsel, which is expected by the end of June, because, depending on the precise timing of that decision, that might not have left me enough time to make a statement to Parliament before the summer recess.
It remains the case that the inquiry will be able to start its substantive work only when the current investigations and any prosecutions that might arise from them have been concluded. However, the decision today to hold a public inquiry means that preliminary work can be done to ensure that the inquiry is able to start its substantive work at the earliest opportunity.
To that end, I am pleased to announce that the Rt Hon Lord Coulsfield has agreed to chair the inquiry. Lord Coulsfield is a highly respected former judge. He will bring a wealth of knowledge and experience to the task, having previously served as chairman of the Medical Appeals Tribunal for Scotland. He has also acted as chair in a number of influential reviews, including the review of the law and practice of disclosure of evidence in the Scottish criminal justice system. I am sure that I speak for the whole Parliament in expressing my thanks to him for agreeing to undertake this important task.
Work will now be undertaken to frame the terms of reference of the inquiry, which may be influenced by the findings of the current investigations. I will report back to Parliament on the terms of reference as soon as possible. It will also be open to Lord Coulsfield to do any other preliminary work that he considers appropriate in accordance with the terms of the Inquiries Act 2005 and consistent with the obligation not to prejudice the on-going investigations.
I am sure that everybody in the chamber agrees that it is essential that we learn all the lessons from the C difficile tragedy at the Vale of Leven. I hope that my decision to hold a public inquiry once again highlights the Government's determination to learn those lessons.
I will briefly update Parliament on the range of actions that are being taken across NHS Scotland to tackle and drive down rates of infection and the impact that those actions are having. The national HAI action plan, which was developed following the publication of the independent review team's Vale of Leven report last year, is being used to ensure that NHS boards have the necessary infection control policies and practices in place across the key areas of governance, leadership and surveillance. Over the past few months, I have announced a range of initiatives that will help us to drive down infection rates in the long term. Those include the toughening up of cleaning standards; a policy of zero tolerance of non-compliance with hand hygiene protocols; a new national uniform and dress code; additional funding for anti-microbial pharmacists; a new health improvement, efficiency, access and treatment target for the reduction of C difficile rates; the establishment of the new care environment inspectorate, headed by a chief inspector, to police standards in our hospitals; and the provision of 100 per cent single rooms in all new hospitals.
I have commissioned a study of the electronic bed management system that is being piloted in NHS Grampian and which is supported by the Scottish Conservatives, to ensure that lessons that are learned from its use are available to other boards quickly. I have also asked the HAI task force to consider how Labour's 15-point plan might contribute to the 57-point action plan that we already have in place. More recently, I have announced that a national MRSA screening programme will be rolled out this year throughout Scotland, targeting most elective admissions to acute specialities and both elective and emergency admissions to the four specialities of nephrology, vascular surgery, dermatology and care of the elderly. To ensure that the highest standards of cleanliness are maintained in our hospitals, I have announced more than £5 million of recurring funding to employ an additional 600 new cleaners across the national health service.
More will always require to be done to beat infection in our hospitals. I have said before that that is and will remain my top priority. Nevertheless, I hope that members will welcome the fact that the action that we are already taking is beginning to show results. MRSA rates over the two most recent quarters were at the lowest level since surveillance reporting began. The most recent statistics on C difficile show a drop of 11 per cent from the previous quarter and a drop of 19 per cent in comparison with the same quarter last year. That is promising progress, but we must continue to be focused and vigilant. I hope that my statement today, my confirmation of a Vale of Leven public inquiry and the continued concerted action of the Government demonstrate our determination to build on that progress. I look forward to the support of the chamber as we do so.
The cabinet secretary will now take questions on the issues that were raised in her statement.
I thank the cabinet secretary for giving me an advance copy of her statement. I want to put on record our welcome for the announcement of the public inquiry and pay tribute to the families who have campaigned for it, with the support of their local MSP, Jackie Baillie, who has put a tremendous amount of effort into working with them. It is important for the families that a timescale has been identified. I am sure that Lord Coulsfield will adopt as thorough an approach to this inquiry as he has done in relation to other issues. I also thank him for taking on the task of chairing the inquiry.
I appreciate that the cabinet secretary said that she will issue information on the precise terms of the remit of the inquiry as soon as possible. However, can she tell us whether she intends to await the decision of the Crown Office before announcing the detail of that remit, or will she be in a position to give us that detail sooner? Can she at least confirm that the remit will ensure that, while the primary focus is, rightly, on the Vale of Leven, any lessons that can be learned from incidences of C difficile that have lead to ward closures in other parts of Scotland will be taken account of?
The cabinet secretary outlined a number of areas in which work has been taken forward, including work that has been done around the 15-point action plan that was produced by Labour. Can she tell us when the results of the HAI task force's deliberations on that plan will be reported to Parliament?
I, too, pay tribute to the Vale of Leven families. They have gone through an agonising time in the past months and have behaved with great dignity. For reasons that I have alluded to before in the chamber, I have a great deal of empathy with them, and I hope that today's decision will give them some comfort.
I will consider the terms of reference in consultation with Lord Coulsfield, in keeping with the terms of the Inquiries Act 2005 and good practice. Therefore, it would be wrong of me to say more at the moment about their content or exactly when they will be finalised.
I want to ensure that any relevant lessons or messages that come out of the police or Health and Safety Executive investigations can be included in those terms of reference. That means that we either wait until the conclusion of those investigations before finalising the terms of reference or finalise them earlier and then amend them later if necessary. That is a question that I will discuss with Lord Coulsfield.
On the question about broader lessons, I have taken the view all along that lessons that are learned from the Vale of Leven should be applied more generally. That is why the independent review team's report influenced the HAI task force action plan. I am clear that the focus of the inquiry must be on what went wrong at the Vale of Leven—that is particularly important from the point of view of the families of those who died—but, clearly, any lessons that are learned in the course of the inquiry that are of relevance to other NHS boards must be learned by everyone in the NHS.
Cathy Jamieson's final question concerned Labour's 15-point action plan. As I previously committed to doing, I have asked the HAI task force to consider that. Those deliberations are under way, and I expect to receive a full report with recommendations by the middle of May. I will update Cathy Jamieson, the Labour Party and Parliament as soon as possible after that point.
I thank the cabinet secretary for advance sight of her statement. Scottish Conservatives have shared her analysis of how best to proceed in the aftermath of the tragedy at the Vale of Leven, and we welcome the approach that she has announced today and the fact that there is now a clear timescale ahead for the families, given that the investigation will take a little longer yet.
Although the cabinet secretary will not be party to the detail, is she nonetheless satisfied as a result of her discussions with the Crown Office that the further inquiries that it has instructed are justified, in the sense that they may yet affect the outcome of the investigation rather than simply substantiate a decision that has already been reached? Can she confirm that, although lessons will be learned from elsewhere, she expects that the principal objective of the inquiry will be to focus on the tragedy that occurred at the Vale of Leven and the circumstances that led up to it during the preceding decade?
Scottish Conservatives welcome the cabinet secretary's comments on progress on infection control, and Mary Scanlon and I look forward to participating next week in the workshop to take forward electronic bed management and infection control systems. Will the cabinet secretary confirm that she will act urgently to ensure that that technology is brought into use throughout the NHS to help prevent future loss of life?
I thank Jackson Carlaw for his questions; I will respond to them in order. With regard to the first question, I have—as he understands—been updated by the Crown Office on the progress and the process of the investigations, rather than on their substance, as that would not be appropriate. I am not party to the detail of the further inquiries that the Crown Office has instructed; it is the Crown Office's decision, based on the interim reports that it has received, to determine what further inquiries are necessary.
I am grateful to the Crown Office for the update on the timescales to which it expects that it will now be working. Decisions on any further process following those investigations will be entirely for the Crown Office to make, acting independently of ministers, as I know members on all sides of the chamber understand very well.
In response to Jackson Carlaw's second question, I think that—as I said in response to Cathy Jamieson—if we are to do justice to those who died at the Vale of Leven and their families, we must focus clearly on what went wrong there. As I said to Cathy Jamieson, we need to draw up the terms of reference, but I make it clear that the public inquiry must examine all factors—whatever they may be—that contributed to the outbreak of C difficile at the Vale of Leven. Lessons that are learned in the inquiry should be applied more generally, but I repeat what I said in my statement: I am not saying by any means that we can take our foot off the pedal, as much work still needs to be done, but I am heartened that we are beginning to see a downward trend in the incidence of not only MRSA, but C difficile. My focus is on ensuring that the NHS continues that trend.
Jackson Carlaw's final question was on electronic bed management. I thank him and Mary Scanlon for the constructive way in which they have sought to work with us on that issue. I am glad that they will take part in the workshop next week. They may get some useful insights and certainly we will welcome their input.
It is important that we act as quickly as possible. However, I am sure everyone would agree that we must ensure that the work we do is robust, that the pilot in Grampian is properly evaluated and that the lessons that can be learned are properly disseminated. That is what we are seeking to do as quickly as possible.
I thank the cabinet secretary for the advance copy of her statement. Although the Liberal Democrats did not share her analysis, it would be churlish to do other than welcome the fact that a public inquiry will be held under the terms of the Inquiries Act 2005. Like the cabinet secretary, we also welcome the fact that Lord Coulsfield has agreed to undertake the inquiry.
I will press the cabinet secretary a little more on section 5 of the 2005 act and the terms of reference for the inquiry. I understand perfectly why you are not able to announce the terms of reference today. However, you quite rightly pointed to the fact that you need to make a statement today rather than await the decision of Crown counsel because that might cross over into the summer recess. I am not quibbling with that—it is a perfectly acceptable position.
However, I put it to you that the circumstances that have caused you to make the announcement now could create difficulties for you in announcing the terms of reference in a way that allows Parliament properly to adjudge whether they address the requirements of the 2005 act. I am not expecting an immediate response to my question, but it would be helpful if you could reflect on whether, given the difficulties that you have outlined, there would be an opportunity for the terms of reference to be brought to Parliament for comment before the matter is concluded between you and Lord Coulsfield.
That is a fair question. However, I say as a matter of fact, not as a statement of intent, that there are many ways of putting an inquiry's terms of reference before Parliament. For example, I announced the terms of reference for the hepatitis C inquiry in response to an inspired parliamentary question. I am not saying that I intend to do so in this case; I am simply pointing out that such an option is available.
I take on board Ross Finnie's comments. I do not mean to dodge his question in any way—indeed, quite the reverse—but for the reasons that I set out to Cathy Jamieson I do not think that it would be right for me to comment on the terms of reference beyond what I have already said about where I feel their focus should lie. It is right and proper that I have that discussion with Lord Coulsfield and give his views due deference before I reach any further decisions.
Finally, I do not mean to blow my own trumpet but, whatever else I might be criticised for on this or any other issue, I cannot be criticised for not coming before Parliament in an open way. Members can take it that I will ensure due and appropriate parliamentary scrutiny of all my decisions on this matter.
I did not want to interrupt that question or the answer, because they were on a serious subject. However, I remind all members—and perhaps Mr Finnie in particular—that I have always asked that questions be addressed through the chair and for members not to ask other members direct questions.
We come to open questions. As a number of members wish to ask questions, brevity will be important.
I very much welcome the announcement of a public inquiry into the tragic events at the Vale of Leven hospital. Given that, as we all know, the outbreak was not the result of any short-term decision and that the problem itself dates back many years, will the cabinet secretary ensure that the inquiry is long term in scope and will look not just at this specific outbreak?
Gil Paterson has, with Jackie Baillie and other members, very assiduously pursued this issue on behalf of the families involved. Some of my response to his question will inevitably repeat previous responses but, as I have said, it is important that I consult Lord Coulsfield properly before I reach a final determination of the terms of reference. However, as I said in response to Jackson Carlaw, if we are to get to the nuts and bolts of what went wrong at the Vale of Leven and to ensure that all lessons are learned, we must ensure that every factor that might have contributed to the tragic events at the hospital is available for inspection by the public inquiry. I will certainly do my best to ensure that the terms of reference enable that to happen.
I very much welcome the cabinet secretary's announcement of a public inquiry, which is, of course, something for which the families from the Vale of Leven have consistently campaigned. I consider the decision to be a victory not only for common sense but for the families' persistence and courage in pursuing the matter. I am grateful to the cabinet secretary for listening to their case.
That said, will the cabinet secretary ensure that the families in the C Diff Justice Group are involved in shaping the public inquiry's terms of reference and that they can participate fully in the hearings—for example, by leading evidence and cross-examining witnesses—by enabling the costs of solicitors and counsel to be covered by the state?
As I did with Gil Paterson, I pay due credit to Jackie Baillie for her pursuit of this issue.
On the question about the terms of reference, I realise that I am beginning to repeat myself endlessly. As I have said, it is important that I discuss them. However, deciding in consultation with Lord Coulsfield what those terms of reference will be is one of my responsibilities.
From the moment that the outbreak came to light and from the publication of the independent review team's report, I have sought to be as open with the families involved as possible. I think that I have met them on three separate occasions. I will continue to be as helpful to them and as open with them as possible and to allow them to make their views known in a way that is consistent with my ultimate responsibility to decide the inquiry's terms of reference.
On Jackie Baillie's wider question, the conduct of the inquiry will not, of course, be a matter for me; rather, it will be a matter for Lord Coulsfield. The Inquiries Act 2005 is clear about that. It will be for him to make decisions about the kind of questions that Jackie Baillie raised. As Cathy Jamieson said, given Lord Coulsfield's experience and pedigree, we can all be assured that the inquiry will be rigorous and robust and that everybody who has something to contribute to it will be allowed to contribute to it.
How long is the public inquiry expected to last? Irrespective of whether proceedings or prosecutions will take place following the Crown Office and Health and Safety Executive inquiries and the public inquiry, is Greater Glasgow and Clyde NHS Board taking any action that it deems necessary through disciplinary procedures against NHS personnel, in relation to gross misconduct, for example? What progress is being made to tackle infections in the care home sector, given that many elderly residents are admitted to hospital?
On Mary Scanlon's first question, it is not possible for me to estimate the length of the inquiry at this stage. Estimating its length may become more possible once it gets under way, but it is impossible to know at this stage how much documentary evidence may be submitted or to judge how much oral evidence people might want to take. Of course, that is entirely a matter for Lord Coulsfield and the inquiry team. That said, as with all inquiries, we want the inquiry to be conducted as quickly as possible, but we also want it to be rigorous and robust. That is important, and those two desires must be balanced.
On Mary Scanlon's second question, there are no on-going disciplinary proceedings in NHS Greater Glasgow and Clyde as a result of what happened at the Vale of Leven hospital. Obviously, I cannot comment on what might or might not come out of the Crown Office and Health and Safety Executive reports; that is a matter for others. What flows from that will also be a matter for others.
Mary Scanlon's third question about how we deal with infections not only in our acute hospitals but in community hospitals and care homes is important. The HAI task force is concerned with that issue as well. It is important, for example, that we are getting to grips with antibiotic prescribing in hospitals, but we are also ensuring that the guidelines and guidance apply in primary care and more broadly. I assure Mary Scanlon that we are trying to pursue a holistic view of tackling infection.
I welcome the significant progress that has been made on tackling the prevalence of HAIs, which has been described, but there is no cause for complacency. The causative factors for one HAI may differ from those for another HAI. Will the cabinet secretary ensure that all health boards not only concentrate on hygiene standards—important though those are—but rigorously review antibiotic prescribing procedures, as they play an important role in fighting C difficile?
I agree with Ian McKee. Over the past number of months, I have reluctantly reached the conclusion that we will probably never conclusively and decisively win the battle against infection because as we get on top of one infection, another infection or another strain of the same infection will appear. The battle is on-going. That means that we must try to get ahead of the curve and not just be catching up. That is very difficult, but I am trying to ensure that such a culture exists in the NHS. I cannot stand here and say that we will have no outbreaks of infections, but it is important that we learn lessons so that we do everything that we can to prevent infections and infection outbreaks, and that we have in place the right surveillance systems and control procedures to ensure that we minimise their impact. All lessons must be learned, and they must be learned over and over again.
Along with all other members, I welcome the public inquiry, which the families have long campaigned for. I look forward to seeing the terms of reference, which I hope will be broad and will incorporate lessons from elsewhere.
On the generality of tackling HAI, the cabinet secretary has announced a move to 100 per cent of beds being in single rooms in new-build hospitals, but there is a priority need now to be able to isolate affected patients. Has an audit been undertaken of the shortfall in isolation rooms? What progress does the cabinet secretary expect on delivering that?
Two members have referred to anti-microbial prescribing. The figures for general practice prescribing are absolutely level, at just over 14 million scripts a year for the past three years. What specific action will the cabinet secretary take beyond encouraging general practitioners on that? What steps will she take to remove the public pressure on them to prescribe antibiotics?
In response to Richard Simpson's first question about single rooms and isolation facilities, we want as many isolation facilities as possible in our hospitals, but neither I, nor Richard Simpson, nor any other member, can reinvent our hospital estate overnight. The considerable investment in our hospital estate will allow us to ensure that 100 per cent of beds are in single rooms in new hospitals. In relation to refurbished hospitals, the guidance contains a presumption that 100 per cent of beds should be in single rooms and states that at least 50 per cent should be in single rooms. As we modernise our hospital estate, which is an on-going programme, provision will improve. In the meantime, we must do as much as possible to maximise isolation facilities. Where isolation facilities are not available, that puts an absolute premium on ensuring that the right infection control policies are used to minimise the risk of infection spreading. There must be a focus on all those issues to ensure that we do everything possible to stop the spread of infection.
Richard Simpson also asked about antibiotic prescribing. From the member's portfolio interest as well as his professional interest, he will be well aware of the existing anti-microbial guidance and the obligation on all NHS boards to have in place anti-microbial teams. I believe that that work will have an impact, although I cannot prove that it will. I am not an expert on the issue, but I suspect that the work that is being done on antibiotic prescribing is already beginning to have an impact, particularly on the rates of C difficile.
Richard Simpson is right to point out that there are two sides to the coin. We must ensure that clinicians are not being irresponsible or prescribing antibiotics inappropriately, but we must also educate the public about appropriate use of antibiotics. I cannot do that alone. Every member and everybody in the NHS has a responsibility to ensure that the public understand the dangers of overuse of antibiotics and the need to use them appropriately. That work will not be a magic-wand solution—there is no such thing—but it will contribute to a continuing reduction in infection rates.
The cabinet secretary referred to the provision of an additional 600 cleaners in the NHS, which will mean an extra 32 cleaners in my health board, Forth Valley NHS Board. However, she will be aware that quality is as important as quantity. Will she therefore ensure that tackling or assisting in tackling HAI will be a key priority for the new cleaners?
That is an important point, although I should say that quantity also matters and that having 600 more cleaners to do the job will help greatly in ensuring that our hospitals are as clean as the public expect them to be. However, Michael Matheson is absolutely right that we must ensure that the new cleaners, as well as the existing ones, see their job as part of the overall infection control agenda. One reason why we will be able to ensure that the 600 additional cleaners have that very much in mind is that, because of a previous decision that there will be no further contracting out or privatisation—call it what you will—of cleaning services, the cleaners will be unambiguously in the NHS, working for the NHS and part of the NHS family. That is extremely good news.