Chamber
Plenary, 26 Mar 2008
26 Mar 2008 · S3 · Plenary
Item of business
Health Care Associated Infection
This debate on dealing with health care associated infections is extremely important. However, I cannot help feeling sad that the reputation of a health service that has achieved so much for so many patients has been blighted by a problem that, to a large degree, is preventable. There have always been patients who have developed wound infections following surgery, and cross-infection has always been an issue. However, many people now live into frail and advanced old age; large numbers of patients are on treatments that impair their immunity; many more invasive procedures are routinely carried out in a variety of clinical settings; and many people expect to be given antibiotics for the most minor of ailments, whether or not there is a proven scientific need for them. As a result, it is hardly surprising that HAIs have become a significant problem.
As infecting organisms increasingly develop resistance to antibiotics, it is important to try to prevent infections in the first place. Such attempts will be successful only if people work together and constantly bear in mind the need to avoid passing infections on from person to person. There must be awareness of how to prevent infections at all levels of health care and in all clinical settings.
Almost all health professionals of my vintage bemoan the informality and apparent lack of discipline in today's NHS compared with what happened when we started our careers. We all have tales of belligerent ward sisters whose eyes were everywhere and who would pick up the slightest infringement of the strict disciplinary code of the ward—a code of efficiency and cleanliness. In those days, no pieces of fluff were seen under beds or in corridors and bedpans and urine bottles were disposed of immediately. Any visitor or doctor who sat on a patient's bed could expect an explosion of wrath and visitors were strictly kept to their visiting hours. No more than two visitors were allowed around a bed unless the patient was close to death. White coats and uniforms were for wearing inside hospitals; we never saw nurses, physiotherapists, radiographers and suchlike in uniform in buses or shops. There was constant polishing and cleaning, and there was obsessive tidiness in general. Perhaps such an approach is old-fashioned, but it seemed to work. I will be honest: I do not recall huge emphasis being put on hand hygiene then, except, of course, when people were preparing for invasive procedures, when they were thorough and meticulous. However, MRSA was not endemic in the population then and few organisms were resistant to antibiotics.
As Ian McKee highlighted, life in the NHS was less pressurised in those days. Managers did not breathe down people's necks to push more and more patients more rapidly through the system, and the turnover of beds was slower. Time was taken to clean and fumigate all equipment thoroughly between patients' use of it. Things have now changed and it is even more important to run a tight ship, with rigid control of hygiene at institutional and personal level. Therefore, infection prevention and control activities must be everyday practice and applied consistently across the board, with all health care professionals sharing responsibility for them. The BMA's guidelines on health care associated infection must be heeded by all staff, including—perhaps especially—the more senior staff, who are role models for their juniors.
Antibiotic prescribing should be done responsibly to reduce the development of organism resistance. That can be difficult for a busy clinician, especially in primary care where patients demand treatment for minor ailments that would get better if left alone, although they might last a day or two longer. I must say that I am concerned about what will happen once prescription charges are dropped. Many patients nowadays think that they know it all—they browse the internet; they watch health programmes on television; they think that they know best—but they lack the years of training that go into making a competent health professional. Somehow, such patients must be educated to accept that a doctor who says that treatment is unnecessary is usually right, that viruses such as the common cold do not respond to antibiotic treatment and that, in normal people with normal immune systems, nature can often be an effective healer without the need for adjuvant drug therapy.
I think it sad that we need an HAI task force within the NHS, but I agree that, unfortunately, such a body is now needed if we are to be effective in combating such infections. I also think that the Government is right to pilot MRSA screening, and I very much welcome the cabinet secretary's announcement that three health boards will be involved. I will take a particularly keen interest in the pilot in the NHS Grampian area.
I accept that there must be a coherent approach to NHS service delivery, with links between patient safety and experience programmes and the HAI agenda. However, although I accept that a 90 per cent hand hygiene compliance target across Scotland may be reasonable and is right for this year, I think that we should nonetheless aim higher by seeking 100 per cent compliance as soon as possible thereafter. I am old-fashioned enough to recognise that that will be achieved only through stringent local enforcement by those who are responsible for the behaviour of staff, patients and their visitors—the old-fashioned ward sister, if you like—so that junior staff become so inured to good practice that it soon goes against their nature ever to breach the hygiene code and so that patients and visitors are constantly supervised to achieve the same result. I have seen that work effectively in a transplant unit, where infection control is, of course, vital. I see no reason why such enforcement should not work throughout the entire NHS.
I commend the cabinet secretary for her announcement this afternoon. I wish the Government every success in its endeavours to overcome HAIs and I hope that it will soon be able to report a very much reduced incidence of such infections in all health care settings.
As infecting organisms increasingly develop resistance to antibiotics, it is important to try to prevent infections in the first place. Such attempts will be successful only if people work together and constantly bear in mind the need to avoid passing infections on from person to person. There must be awareness of how to prevent infections at all levels of health care and in all clinical settings.
Almost all health professionals of my vintage bemoan the informality and apparent lack of discipline in today's NHS compared with what happened when we started our careers. We all have tales of belligerent ward sisters whose eyes were everywhere and who would pick up the slightest infringement of the strict disciplinary code of the ward—a code of efficiency and cleanliness. In those days, no pieces of fluff were seen under beds or in corridors and bedpans and urine bottles were disposed of immediately. Any visitor or doctor who sat on a patient's bed could expect an explosion of wrath and visitors were strictly kept to their visiting hours. No more than two visitors were allowed around a bed unless the patient was close to death. White coats and uniforms were for wearing inside hospitals; we never saw nurses, physiotherapists, radiographers and suchlike in uniform in buses or shops. There was constant polishing and cleaning, and there was obsessive tidiness in general. Perhaps such an approach is old-fashioned, but it seemed to work. I will be honest: I do not recall huge emphasis being put on hand hygiene then, except, of course, when people were preparing for invasive procedures, when they were thorough and meticulous. However, MRSA was not endemic in the population then and few organisms were resistant to antibiotics.
As Ian McKee highlighted, life in the NHS was less pressurised in those days. Managers did not breathe down people's necks to push more and more patients more rapidly through the system, and the turnover of beds was slower. Time was taken to clean and fumigate all equipment thoroughly between patients' use of it. Things have now changed and it is even more important to run a tight ship, with rigid control of hygiene at institutional and personal level. Therefore, infection prevention and control activities must be everyday practice and applied consistently across the board, with all health care professionals sharing responsibility for them. The BMA's guidelines on health care associated infection must be heeded by all staff, including—perhaps especially—the more senior staff, who are role models for their juniors.
Antibiotic prescribing should be done responsibly to reduce the development of organism resistance. That can be difficult for a busy clinician, especially in primary care where patients demand treatment for minor ailments that would get better if left alone, although they might last a day or two longer. I must say that I am concerned about what will happen once prescription charges are dropped. Many patients nowadays think that they know it all—they browse the internet; they watch health programmes on television; they think that they know best—but they lack the years of training that go into making a competent health professional. Somehow, such patients must be educated to accept that a doctor who says that treatment is unnecessary is usually right, that viruses such as the common cold do not respond to antibiotic treatment and that, in normal people with normal immune systems, nature can often be an effective healer without the need for adjuvant drug therapy.
I think it sad that we need an HAI task force within the NHS, but I agree that, unfortunately, such a body is now needed if we are to be effective in combating such infections. I also think that the Government is right to pilot MRSA screening, and I very much welcome the cabinet secretary's announcement that three health boards will be involved. I will take a particularly keen interest in the pilot in the NHS Grampian area.
I accept that there must be a coherent approach to NHS service delivery, with links between patient safety and experience programmes and the HAI agenda. However, although I accept that a 90 per cent hand hygiene compliance target across Scotland may be reasonable and is right for this year, I think that we should nonetheless aim higher by seeking 100 per cent compliance as soon as possible thereafter. I am old-fashioned enough to recognise that that will be achieved only through stringent local enforcement by those who are responsible for the behaviour of staff, patients and their visitors—the old-fashioned ward sister, if you like—so that junior staff become so inured to good practice that it soon goes against their nature ever to breach the hygiene code and so that patients and visitors are constantly supervised to achieve the same result. I have seen that work effectively in a transplant unit, where infection control is, of course, vital. I see no reason why such enforcement should not work throughout the entire NHS.
I commend the cabinet secretary for her announcement this afternoon. I wish the Government every success in its endeavours to overcome HAIs and I hope that it will soon be able to report a very much reduced incidence of such infections in all health care settings.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
The next item of business is a debate on motion S3M-1621, in the name of Nicola Sturgeon, on the health care associated infection task force.
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am pleased to open the debate and to present our ambitious new plans for tackling health care associated infection in Scotland during the next three years ...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I emphasise how much we in the Labour Party welcome the debate. We acknowledge that our amendment will be accepted. I associate myself with many of the point...
Nicola Sturgeon:
SNP
I hope that I can reassure Margaret Curran that the investment that we have set aside for the next three years is 260 per cent higher than the investment ove...
Margaret Curran:
Lab
I will take that—graciously, I hope—as an indication of the cabinet secretary's commitment. However, as I understand it, England has prioritised the issue, a...
Mary Scanlon (Highlands and Islands) (Con):
Con
It is always good to follow the gracious Margaret Curran. The Conservatives welcome the debate on health care associated infection. We also welcome the inves...
Ross Finnie (West of Scotland) (LD):
LD
I do not discern—and I suspect that, by the end of the debate, I will not discern—any disagreement with the proposition that, because health care associated ...
Nicola Sturgeon:
SNP
I am pleased to intervene on that very serious point. I hope that the member will take some reassurance from my pronunciation of "coherence" during my speech...
Ross Finnie:
LD
I am greatly comforted. We must maintain standards in the chamber.Health care associated infection is a serious issue, and I welcome the debate. Margaret Cur...
Ian McKee (Lothians) (SNP):
SNP
We have heard a lot—and I am confident that we will hear a lot more as the debate progresses—about the virtues of cleanliness in preventing health care assoc...
Helen Eadie (Dunfermline East) (Lab):
Lab
I agree with Ross Finnie's suggestion that there is likely to be near unanimity on this vital issue. I welcome the cabinet secretary's announcements about th...
Nicola Sturgeon:
SNP
I am always happy to consider lessons from elsewhere, and I appreciate Helen Eadie's point, but I remind her that I mentioned our policy, which I launched ea...
Helen Eadie:
Lab
I am sorry that the cabinet secretary feels aggrieved, but if she had been listening she would know that I congratulated the Government on its screening init...
Michael Matheson (Falkirk West) (SNP):
SNP
I welcome the Cabinet Secretary for Health and Wellbeing's statement. In the spirit of consensus, I acknowledge the work that the previous Labour and Liberal...
Irene Oldfather (Cunninghame South) (Lab):
Lab
I welcome the commitment that the cabinet secretary has made and the opportunity that the debate gives us to consider how we can reduce the risk of contracti...
Nanette Milne (North East Scotland) (Con):
Con
This debate on dealing with health care associated infections is extremely important. However, I cannot help feeling sad that the reputation of a health serv...
James Kelly (Glasgow Rutherglen) (Lab):
Lab
I welcome the opportunity to take part in this afternoon's debate on health care associated infections. I endorse the cabinet secretary's announcement and, o...
Sandra White (Glasgow) (SNP):
SNP
The cabinet secretary is to be congratulated on this initiative. As the Labour amendment states, the previous Government is to be commended for the establish...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
Many members have talked about consensus, but consensus does not make the debate any less important—we should debate such issues.The cabinet secretary mentio...
Nicola Sturgeon:
SNP
Rhoda Grant makes an important point. It may be of interest to her and other members to know that we are working with the trade unions on a national uniform ...
Rhoda Grant:
Lab
Yes. I am grateful to the cabinet secretary for that information. The BMA position shows that doctors have the will and wish to see the proposal progressed.W...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
I agree with nearly everything that has been said in this worthwhile debate. The unanimity of the message will be encouraging to patients and health professi...
Jackson Carlaw (West of Scotland) (Con):
Con
We welcome all that Nicola Sturgeon has said today in her speech and her interventions, including the MRSA pilot that she announced, in what has been a usefu...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
As all other members who have spoken have said, the debate has been consensual, informed and of a high standard. As Jamie Stone said, that should give comfor...
Nanette Milne:
Con
My point was that it does not matter who actually does the cleaning. What is important is the supervision of a high standard of cleaning.
Dr Simpson:
Lab
I hate to say this, but I could tell Nanette Milne numerous stories of when contract cleaners have come in, done their bit and gone away, leaving the questio...
The Minister for Public Health (Shona Robison):
SNP
I have listened with interest to this constructive, stimulating and wide-ranging debate, which has served as a stark reminder that the Scottish Government an...