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Plenary, 26 Mar 2008

26 Mar 2008 · S3 · Plenary

Item of business

Health Care Associated Infection

Simpson, Dr Richard Lab Mid Scotland and Fife Watch on SPTV

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 comfort to people out there. The problem is not new—it used to be called hospital-acquired infection. More than a century ago, Semmelweis solved some of the problems of puerperal deaths by getting people to wash between practising anatomy on cadavers and attending women in childbirth. That simple approach saved many lives. Jackson Carlaw is right that some of what we need to achieve is simple, or appears to be simple, yet it has been hard to achieve.

The first step in dealing with any such matter is to recognise the problem. I thank the cabinet secretary for her courtesy in accepting our amendment. I pay tribute to the 2002 action plan and the establishment of the ministerial task force, which, led by the chief medical officer and chief nursing officer, has been instrumental in setting up a model that has been praised as being excellent. However, despite that work, levels of MRSA have remained stubbornly high and consistent in the past few years.

Members mentioned some of the factors in that. Ian McKee referred to overoccupancy, although I must say that, despite the references that he made, the number of acute beds per capita in Scotland is still substantially greater than in England. However, it is true that overoccupancy rates of more than 90 per cent are associated with increased rates of infection. Delayed discharges were a major problem, because they increased the occupancy problem. The target that was set to eliminate delayed discharges by March 2008 has freed up more than 3,000 beds, which is a massive contribution to tackling the occupancy problem, as well as to tackling the problem of people who are kept in beds for a long time in hospital being more likely to contract a condition. Important changes have been made.

The rapid throughput of patients is another contributory factor, as has been said. Another factor that contributes to the problem is boarding out—rather than hot-bedding—which is the movement of patients between wards to allow more acute patients into the appropriate wards. Several members referred to those pressures.

Members have also referred to antibiotics—their type and their appropriate use. Such issues are of great importance, as Sandra White, Ross Finnie and others said. Not only must we have a public education programme on the appropriate use of antibiotics, but we must have antibiotic pharmacists in every trust, who can teach junior doctors and ensure that prescribing is appropriate, stating which antibiotic should be used, when and for how long. That will help to reduce rates of resistance. The national guidance that the cabinet secretary mentioned is indeed welcome.

Michael Matheson and other members referred to the physical environment. Redesign of some of the less appropriate elements will be important. Another important issue is decluttering—removing from wards items that do not need to be there. A more pristine environment can help.

Effective control of sterilisation of instruments is needed, and that issue has been tackled effectively. Irene Oldfather spoke about cleaning of soiled clothes, and that issue should be investigated. It would be useful if the task force could comment on whether the issue is important.

Helen Eadie, Ian McKee and others also spoke about clothing. Jackson Carlaw wittily but seriously discussed the clothing of all staff. It is important that people's clothing is right, so I welcome the cabinet secretary's announcement of a national clothing specification. The BMA would say, "Ditch the tie." In Ian McKee's early days and mine, if a doctor turned up without a tie, he was not allowed on the ward, but now he must turn up without a tie or he will not be allowed on the ward. That, I suppose, is progress.

Helen Eadie referred to cleaning of wards. I take issue with Nanette Milne about one issue among her reminiscences about the good old days. It was the Conservatives who, in effect, privatised cleaning services in hospitals; but it was the Labour Party, when it came to power with its Liberal colleagues in 1999, which said that there would be a presumption that the services would be taken back in-house. Cleaners are a very important part of the care system.

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Plenary, 26 Mar 2008

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