The Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison, will now make a statement on the Vale of Leven hospital inquiry.
14:50
The national health service failed the 34 patients who died at the Vale of Leven hospital, it failed the patients who suffered due to the outbreak of Clostridium difficile, and it failed the families of those patients. Our NHS failed all those patients and their families and for me—and, I am sure, for everyone here today—that is deeply regrettable. I am sorry, on behalf of the Scottish Government.
Lord MacLean highlights 34 deaths—an increase on previous findings—following his detailed scrutiny of medical records. It was an important purpose of the inquiry to establish the facts. On behalf of the Scottish Government and our NHS, I offer a profound and sincere apology to all patients and their families who have been affected by this tragedy. Our thoughts must be with all of them today; I am aware that some of them have joined us in the chamber this afternoon.
This statement is the Scottish Government’s initial response to the “Vale of Leven Hospital Inquiry Report”, which was published by Lord MacLean yesterday. The report was also laid in Parliament yesterday, in line with the requirements of the Inquiries Act 2005.
I believe that the report addresses the wide-ranging terms of reference that were set by the chairman, who was charged with undertaking a thorough investigation into the circumstances that contributed to the occurrence and rates of C difficile infection at the Vale of Leven hospital from 1 January 2007 to 1 June 2008. I take this opportunity to thank Lord MacLean and his team for their hard work and commitment to the inquiry.
I would also like to record my personal thanks to the patients and families for their frank and honest evidence to the inquiry. The patients and families of those who were affected by the outbreak quite rightly demanded this public inquiry to investigate what happened, and why it happened and to ensure that lessons are learned. It is clear from my meeting with them that those issues are still driving their search for answers. I believe that the report is balanced and fair and I hope that it will go some way towards giving the answers that the patients and families are seeking.
Since the inquiry was established, there has been some criticism of its cost and of the length of time that it has taken to report its findings. Under the Inquiries Act 2005 and the rules, it is clear that it is a matter for the chairman of an inquiry to determine the procedure and conduct that will be required in order effectively to carry out the duties of that inquiry. I believe that the chairman published the costs of the inquiry up to 24 November 2014 at the launch of the report yesterday and that final costs will be provided later this year.
Although Lord MacLean acknowledged in his report that ministers wanted a shorter inquiry, it is clear that the length of the delay had a profound effect on patients and families and did nothing to alleviate their distress. I hope that publication of the report will begin to bring closure to those patients and families.
For those of us who have read the report, it makes terrible reading and identifies system-wide and individual failures at the Vale of Leven hospital. The report is a thorough and definitive explanation of what went wrong; it is clear that there was failure at all levels, from nursing and medicine through to management.
Lord MacLean’s findings outline the lack of investment in the hospital, which was simply no longer fit for purpose. There was a lack of basic care being provided to patients, no inspection regime was in place, communication was poor at all levels, and staff morale was low. Much of that was related to the uncertainty of the merger, which was announced in 2005, of part of NHS Argyll and Clyde with what was the Greater Glasgow NHS Board. That merger was not implemented until after the outbreak and resulted in a fundamental breakdown in lines of reporting. As I said to the patients and families whom I met yesterday, it is completely unacceptable that that happened in our national health service.
The report identifies 75 recommendations: nine for the Scottish Government, 65 for the NHS boards and one for the Crown Office and Procurator Fiscal Service. Let me make it very clear that I accept them all and, more important, that I intend to address them all. There are a number of recommendations that will need to be worked through and others where we can go even further.
I reassure everyone that the Scottish Government and the NHS have not been idle since the inquiry began—let me tell everyone what we have in place.
Our national healthcare-acquired infection task force drives the wide range of work that is required to ensure that we continue to improve and reduce HAIs. In 2009, we established an effective inspection process through the Healthcare Environment Inspectorate, which completes comprehensive unannounced inspections and demands urgent actions from boards, where that is required. Those inspections also provide key information that is used nationally and locally to drive continuous improvement.
As an outbreak is defined as two or more cases, timely local intervention is critical. Therefore, robust systems are in place that enable NHS boards effectively to recognise and manage outbreaks as they happen, and to close wards if required. We expect outbreak concerns to be reported to Health Protection Scotland, which will monitor the situation, support the board and escalate to the Scottish Government, if necessary.
The work to date has led to a significant reduction in C difficile rates across Scotland’s hospitals. The rates have been at their lowest level this year, with an 82 per cent reduction in C diff cases in the over-65s since 2007. In addition, the hospital standardised mortality ratio is down by 16 per cent. Lord MacLean’s report provides clear direction on how we can build further on that progress. It is encouraging to note that Lord MacLean identified that NHS Greater Glasgow and Clyde was quick to learn the lessons from the outbreak. The board has continued to work hard to reduce the incidence of healthcare associated infections in its hospitals, and it now leads the way in reducing the occurrence of such infections.
I spoke to NHS Greater Glasgow and Clyde yesterday and earlier today about the report and told it how I expect it to consider and address the report’s findings. Although the focus is on NHS Greater Glasgow and Clyde, I have today, along with the chief executive of NHS Scotland, written to all boards asking them to consider the implications of Lord MacLean’s report. We have requested that they report back to me by 19 January 2015.
I reassure members that work on implementing many of the recommendations has either been completed or is well under way. I will establish an implementation group to consider all the report’s recommendations for health boards, and how they can be taken forward in partnership across the NHS. I have invited those who have been affected or who have lost loved ones to consider how they wish to be involved in taking forward the report’s findings. That will help to ensure that the memories of those who died continue to make lasting improvements in our NHS.
I have asked the chief medical officer to lead the Scottish response for the United Kingdom five-year antimicrobial strategy, in association with the royal colleges and board medical directors, in order to address and promote prudent prescribing of antimicrobials to reduce the risk of C diff infection and antimicrobial resistance.
I have also asked the chief nursing officer to work with board nurse directors to roll out a robust quality assurance system, to put patients, families and their experience at the centre of that work and to ensure that information on it is publicly available and easily accessible in the clinical environment. Additionally, my chief nurse will work with boards to roll out nationally agreed standards for nursing documentation and care planning, including a minimum dataset for patient records. That will be monitored as part of the on-going quality assurance processes.
I have written to the Health and Sport Committee to offer to discuss the report in more detail and I will return to Parliament with the Scottish Government’s full response in the spring of next year.
As the minister who is now responsible for our NHS, I pledge to members my commitment that we will take all necessary steps to ensure that a tragedy of such magnitude can never happen again. Finally, I apologise again to the patients, families and relatives who were let down by our NHS at such a vulnerable time in their lives.
I congratulate the cabinet secretary on her appointment. I know that in her first outing in her new job, she will, like the rest of us, be extremely concerned and disturbed by Lord MacLean’s report on the C diff outbreak at the Vale of Leven hospital. It is a truly shocking report. In a hospital of only 136 beds, at least 34 people, and maybe more, lost their lives to C diff. As Lord MacLean said, the families of the victims have been “fully vindicated” in demanding the inquiry, and we should pay tribute to them for their perseverance and their commitment to their deceased loved ones.
The report lists management and governance failures, a failure by the health board and Government to heed what was happening following outbreaks elsewhere in the UK, deficiencies in infection prevention and control practices, compromised patient care, low staff morale, recruitment problems and a weak management culture, all of which contributed to the avoidable deaths at the hospital. If that loss of life had been the result of a major incident or disaster, it would have dominated our news for weeks. Sadly, I suspect that it will not.
Will the cabinet secretary now take action to create an independent health regulatory regime that is free from Government and which has powers to protect patients and to close down facilities if they are failing patients? Does the Health and Safety at Work etc Act 1974 apply to patient safety in Scotland? What is the timescale for all the recommendations to be implemented? Who is accountable for ensuring that they are followed through and how is the Parliament to be kept informed of the process? Will she ensure that Government time is made available soon so that we can discuss the report in full? Patients, families and everyone else involved deserve no less.
The Healthcare Environment Inspectorate is a powerful organisation that can go into a hospital announced or unannounced to examine all aspects of the care there. Many of the improvements in our hospitals are due to the fact that it has been set up.
Lord MacLean’s first recommendation is that the Healthcare Environment Inspectorate be given the power to close wards. Of course, wards can be closed if the local infection control team decides that that is required, and that often happens. However, we agree with the recommendation that the inspectorate should have that power. No one should be under any illusion about the power and effectiveness of the Healthcare Environment Inspectorate, and we should support it in its work.
On health and safety at work, there is a UK body that has relevance to many aspects of health and safety within the workplace in Scotland.
On timescales for implementing recommendations, I have said to boards that I want them to come back to me by 19 January laying out clearly which recommendations they have already implemented, which ones they will implement and by when they will do that.
On parliamentary involvement, I said in my statement that I will come back to Parliament with fuller information. I am happy to do that. Of course, the Health and Sport Committee will have an interest in the matter as well, so I expect that it will want to discuss the report in detail with us.
I thank the cabinet secretary for the advance copy of her statement and welcome her to her new position.
I extend the condolences of Conservative members to the families of the 34 patients who tragically died in the C diff outbreak, which first occurred nearly eight years ago.
We welcome the thoroughness of the report and the fact that the Scottish Government has moved quickly to accept all 75 of Lord MacLean’s recommendations. We will carefully monitor whether NHS boards throughout Scotland implement the recommendations without delay. Families and patients in the NHS Greater Glasgow and Clyde area will not forget the failings at health board and Government level to provide an adequate infection control and inspection system.
Does the cabinet secretary agree that, to control hospital-acquired infection throughout the NHS in Scotland, there needs to be an emphasis on the role of responsible antibiotic prescribing to prevent the development of resistant strains of organisms, on maintaining meticulous hygiene in hospitals and on ensuring that all NHS staff in primary and secondary care have a clear understanding of infection control? Does she also agree that responsibility for that lies with everyone who is involved in the care of patients? In particular, does she agree that, among the many recommendations in the report, those regarding the senior ward nurse’s role in controlling infection are particularly important, as I argued in the chamber when we discussed hospital-acquired infections nearly seven years ago?
All the issues that Nanette Milne raised have been a focus of the NHS for many years. There have been huge changes in the practice of antibiotic prescribing, and hygiene procedures and awareness of best practice in infection control are front and centre of what happens in our hospitals. The patient safety programme that operates across Scotland has been internationally recognised for the good practice that it has brought.
Nanette Milne commented on the senior ward nurse and leadership in wards, which are hugely important.
We will take forward all the recommendations, because more can always be done to build on the good work that has happened since 2007. We will ensure that that happens.
How has the Vale of Leven hospital changed since 2007? By that, I mean how many C diff cases have there been in 2014? How does that compare with the number in the outbreak period and the number nationally?
As I said in my statement, there has been a huge change in the number of C diff cases since 2007: an 82 per cent reduction in cases in the over-65 age group. The good practices that are in place and the performance of the Healthcare Environment Inspectorate have led to that huge reduction.
Since 2007 we have reduced the number of Clostridium difficile infections in NHS Greater Glasgow and Clyde in those aged 65 and older by 84.7 per cent; the number has fallen from 472 cases in the quarter January to March 2007 to 72 cases in the quarter April to June 2014.
Nationally, the latest C diff rates show a reduction of 81.9 per cent over the same timeframe, from 1,775 cases in 2007 to 322 cases in 2014. I hope that Stuart McMillan agrees that that is a significant decline in the number of C diff cases. However, we can never be complacent, which is why we will take forward all the recommendations in Lord MacLean’s report.
I am sure that members share my pride in the determination and dignity of the families throughout this process.
It has been seven years since the first deaths at the Vale and it has taken five years for the public inquiry to report. I welcome the robust recommendations in the report.
The cost of the inquiry is in excess of £10 million, but the offer of compensation to the families—the victims in all this—is about £1 million. Although the families are motivated solely by the desire to ensure that this does not happen to anyone else in Scotland, I cannot help but feel that justice has not yet been done. What actions can the cabinet secretary take to ensure that the level of compensation is reviewed?
I recognise Jackie Baillie’s role in supporting the families and patients—I saw yesterday how much they appreciated that. I absolutely agree with her comments about the families’ determination. They should be respected for what they have endured and the dignity that they have brought to this process.
Jackie Baillie will be aware that detailed discussions on compensation are going on between the health board and the families, and that there is a legal basis for how the process will be worked through. I am clear that those who have lost loved ones as a result of negligent acts by the NHS should be adequately compensated for their loss. It is absolutely essential that, when clinical negligence claims arise, boards learn from those claims and put in place steps to ensure that there are no repeat cases. Although the matter is confidential, I have made it clear to NHS Greater Glasgow and Clyde that it should be as helpful as possible in that regard.
I understand what Jackie Baillie says about the difference between the inquiry cost and, potentially, the settlement of claims. She will appreciate that it is difficult for a Government to have any control over the costs of an inquiry. That is an issue with the Inquiries Act 2005 that we should look at. Indeed, the inquiry has been a long process and, as Jackie Baillie said, it has reached a cost of about £10 million.
I reiterate that these are sensitive discussions, but I have made clear to the health board that I expect it to be as helpful as it possibly can be in its discussions with the families.
Significant progress may have been made on C diff, in the Scottish patient safety programme and with the new Healthcare Environment Inspectorate. However, chapter 15 of the MacLean report makes a detailed series of significant recommendations on infection prevention and control. Will the cabinet secretary assure me that the recommendations will feed directly into the work of the patient safety programme and the Healthcare Environment Inspectorate and, as important, that that will be monitored to make sure that it is effective?
Were an outbreak similar to that at the Vale of Leven to happen today, we all want to know whether the scale and significance of that tragedy would be dramatically reduced because hospitals are safer and that this Government is doing all that it can, including adopting all the report recommendations, to achieve that.
We will absolutely ensure that all the recommendations are implemented. I am absolutely confident that we will not see another situation like the one at the Vale of Leven hospital. I say that because the mechanisms that we have in place pick up outbreaks. There are and there will be outbreaks in the NHS, but the issue is what is then done about those outbreaks.
I will give a good example of that. In January, there was an outbreak at the Victoria infirmary. In 24 hours, three cases were identified and, because of that, it was counted as an outbreak. All the correct procedures were taken, there was no further spread of the infection and no death arose from it. That is how our NHS should work—an effective response to the challenges that arise with infections in our hospitals. Because of the robust processes that quickly pick up outbreaks, I am absolutely confident that we will not see a Vale of Leven situation arise again.
At the Vale of Leven, as Lord MacLean identified in his report, infections were identified and outbreaks that should have been identified going back to January 2007 were not picked up. The infection then ran rampant throughout the hospital. I am absolutely confident, with the processes that we have in place in the NHS, that that would simply not happen now. People should take confidence from that.
The last thing that I want to see arising from this tragic and disturbing report is for patients to be worried about going into hospital. Our NHS is a different institution from the one that it was in 2007. Patients, particularly elderly patients, should have the confidence when they go into hospital that everything will be done to minimise any chance of them acquiring an infection while they are being treated.
I thank the minister for advance sight of the statement and welcome her to her new post. I add my thanks to the inquiry team and I recognise the suffering of the friends and families of those who were affected. There have been criticisms of delays and, although those might be valid, it is right that time was taken to get this right. The report is a substantial piece of work and I welcome the minister’s indication that the Government will implement the recommendations.
Recommendations 31 and 36 focus on staffing and the skills mix on wards. Given the pressures that we know exist in some areas in attracting and retaining consultants and lead clinicians, what does the Government propose to do to ensure that the skills mix meets demand at all times?
It is important that the issue of staffing was explored in great detail in the report. On page 211, the report states that the infection control nursing expert—a Mrs Perry—looked into the staffing levels and ratios at the Vale of Leven and found that although they were acceptable, when patients became acutely ill, there was no change to those levels and ratios or the skills mix. One of the key findings of the report was that there has to be leadership on the wards and in management so that, when the circumstances on a ward change and there are suddenly more acutely ill patients, there is the ability to take action to address that.
Recommendations 31 and 36 are important and we will certainly take them forward and make sure that they are implemented.
I associate myself with Jim Hume’s comments. I do not want to repeat them, but I would have made exactly the same ones.
Lord MacLean’s report states that the Vale of Leven hospital had suffered from a decade of lack of investment. What investments have been made in the hospital since 2007 and how has the service that it provides changed?
I reassure Gil Paterson that there has been a significant level of investment. The capital investment at the Vale of Leven in the past 10 years has been more than £9 million. That has, without doubt, improved the fabric of the building, the ward layout and the hand-washing facilities, addressing many of the criticisms of the fabric that are contained in the report. I assure the chamber that that investment has made the Vale of Leven a very different hospital and one that is very well regarded and thought of within the local community.
I should also say that patients have a very positive experience at the Vale these days. The most recent patient satisfaction survey showed a huge level of positive rating for care and treatment. That was not the case before 2007 and through the period of this outbreak. It is fair to say that the hospital at that time was out of sight and out of mind. It had suffered from a lack of investment; it fell between two stools of organisational change. That led to a lack of morale among staff and a feeling that the hospital had a major question mark over its future. All of that, along with all the poor practices, is very much the backdrop to the infection outbreak, as Lord MacLean laid out clearly.
I am pleased that Greater Glasgow and Clyde NHS Board has invested in this hospital. It is now a well-functioning hospital and, as I said earlier, it is held in high regard by the local community.
After the Vale families called for an inspection regime, I lodged motion S3M-02697, on 9 October 2008, entitled, “Regret for Continuing Complacency on Reducing Clostridium Difficile Hospital Infections”. In that motion, I called for an immediate move from health board to individual hospital reporting and for an inspection system similar to that which had been introduced in England in 2007. It was April 2009 before the health inspectorate started its very welcome work. Does the cabinet secretary therefore agree with Lord MacLean that we need to look at other jurisdiction reports as they come out on the issues that also affect our people?
Five years on from the outbreak, does the cabinet secretary—who has properly indicated that we have made enormous progress on C difficile—think that the system is working well, when the Hairmyres report showed that Lanarkshire NHS Board left a senior infection control post vacant for five months this year?
I conclude by saying that I am glad that the cabinet secretary agrees with the MacLean report that we need an independent and robust inspection system with enforcement powers, as Labour has been calling for since 2011, but I hope that she agrees that it needs to apply to all aspects of healthcare.
The Healthcare Environment Inspectorate—as Richard Simpson has himself implied—is a good inspection regime. Its establishment was announced back in 2008 and it started its work in 2009, as he said. We will be extending its powers to include the ability to close wards if that is what it recommends.
The inspection regime is one that I believe works well, and it is an independent scrutiny tool in our health service that should probably have been around for many years before it was established. The fact that it was not established earlier is something for us all to reflect upon, but it is there now and we will ensure that it continues to do its good work. If further improvements can be made to the HEI system, I am certainly prepared to consider them, in addition to accepting all the recommendations that have been made in the report.
On the vacancy for an infection control nurse at Hairmyres, I agree that such roles are critical and that there should, where possible, be no delay in the recruitment of those key personnel. However, what is important is that systems now do not rely on one person. That is one of the lessons that have been learned from the past: systems must be robust and not succeed or fail because of one individual infection control nurse. Nevertheless, it is important that those roles are there.
Lessons have been learned from previous reports. After the CDI outbreak in 2007 to 2008 in Northern Ireland, a number of actions were taken in Scotland, and hugely important lessons were also learned from Mid Staffordshire and in response to the Francis inquiry. That led to a huge amount of work in the NHS. I remember attending meetings as Minister for Public Health and Sport and going through in fine detail what those lessons were going to be and how they would be applied to the NHS in Scotland.
We will always learn lessons from elsewhere. Importantly, I also wrote to health ministers across the UK yesterday to share the findings of the latest report, because it is important that people, whether in the UK or beyond, learn lessons from the report.
Could the cabinet secretary explain how she will take forward recommendation 71 in the report, that the Scottish Government should identify a national agency to undertake routine national monitoring of deaths related to CDI?
We will be looking at that recommendation to decide which national agency is most appropriate to take that forward. There are a number of recommendations that we will have to consider in some detail before we decide what is most appropriate, but it is important to remember that the recommendations apply not only to the territorial boards but to the national boards as well, and we will discuss with them which agency is most appropriate. I can assure Colin Keir that the recommendation will be taken forward and implemented.
I join others in paying tribute to the families who fought so hard for the inquiry. I hope that lessons can be learned so that, in future, families do not have to fight so hard for inquiries at such a difficult time for them.
Will the chief nursing officer, as part of the work being done with the nursing director, consider the standards for testing, to ensure that individual cases are identified and isolated so as to stop outbreaks in the future? Will she also examine how patients and their relatives can raise concerns and request testing if they are concerned about an outbreak occurring in a ward that they are in?
Yes—that is definitely something that we want to take forward. As I have said, we may well go beyond some of the recommendations in some of the elements that we implement.
Rhoda Grant touches on an important point. We discussed this a little with the families yesterday. The issue is how best we utilise the information and the desire of families to communicate when they are not happy with something that they see or experience while they or their family member are receiving treatment. That is a matter of good communication. Indeed, one theme running through the report is how poor the communication was.
Many of the systems are better now. There is better communication and better patient involvement, whether that is provided through patient satisfaction surveys or basic communication with families on wards. It is also a matter of making time for that. There have been changes to how shift patterns work, so that one shift of nurses are not all leaving at the same time as another shift is starting. There needs to be communication there, which it is important to be able to impart to the families.
Without a doubt, there is more that we can do in order to ensure that, if families or patients have something that they wish to feed back or say, the opportunity is afforded to them. That means that we can continue to improve the national health service further.
I thank the cabinet secretary for her statement and wish her well in her new job.
In her statement, the cabinet secretary has detailed what she intends to do with regard to all the recommendations that have been made and the actions that she intends to take. Does she intend to ensure that all steps are taken to update regularly all those involved—families, the Parliament and the Health and Sport Committee—about the action that she is now taking and will continue to take with regard to the statement?
Yes, absolutely. As I said in my statement, we will be discussing with the families—as will Greater Glasgow and Clyde NHS Board—how they wish to be involved in the implementation of the recommendations. That might not be for everybody but, for those families who wish to be involved, it is a very important part of implementing the recommendations.
As regards updating Parliament, I am committed to coming back to Parliament as often as is required, to ensure that Parliament is kept up to date with the process and the progress of implementation of the recommendations. I reiterate the offer to the Health and Sport Committee to discuss the report in more detail and, also importantly, to keep the committee informed as to the progress of implementation.
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