Chamber
Plenary, 01 Oct 2008
01 Oct 2008 · S3 · Plenary
Item of business
Action on Thrombosis
I add my congratulations to those of other members on Trish Godman securing this debate and on the way in which she graphically illustrated the tragic early loss of life that can result from sustaining a DVT that moves to a pulmonary embolus.
The numbers involved, however, must not be confused with those for total thrombosis, where the number of deaths is substantial. Trish Godman's parliamentary questions elicited the response that about 172 deaths were recorded from that cause in 2003, which reduced to 130 in 2007. That indicates a measure of progress, although it is not enough. Almost every one of those deaths—not all, but almost all—would have been untimely. Tackling the problem is an increased priority, especially because it is, to an extent, preventable. It is important that measures are taken to identify risk, and that, if something occurs, there is early diagnosis and rapid treatment.
What about screening, which is a core part of the motion? Dr McKee graphically illustrated the fact that there are rules surrounding mass screening. One of the fundamental tenets is that we must not create a situation in which we cannot ameliorate the condition that is being screened for. Frankly, it is not possible at present for us to do anything about the genetic condition of the so-called factor V Leiden gene. However, that does not mean that we should not have focused screening. It is certainly true that anyone who has a personal or family history of the condition needs to be much more aware of the potential risk and should be entitled to have screening if they so wish—that should be made available to them.
One of the best developments in surgical procedures in the past few years has been the pre-assessment of risk prior to the patient coming into hospital. That is undertaken by nurses, who are good at looking at lists of risk factors of the sort that NICE has produced, some of which were referred to by Jackson Carlaw and Ian McKee. However, as they said, the list is considerably longer and neither they nor I have time to address all of it in this debate.
I have particular concerns about two issues. One is the use of oral contraceptives, which is not generally recognised as a risk factor. The other is the use of hormone replacement therapy. Those two treatments have their consequences in increased risk, so tackling that in terms of stopping oral contraception before surgery can be important. For the pre-assessment of risk, it is important to look at the list and assess the likely risk for an individual.
The second part of the risk that needs to be assessed is whether the procedure, the likely stay in hospital and the degree of immobility are likely to contribute to increasing the risk. If they are, steps should be taken. At the most extreme, there should be prophylactic treatment in a preventive form, using either low molecular-weight heparin or aspirin. For very high-risk procedures, particularly orthopaedic ones, that may be an appropriate measure. For people at intermediate or slightly lower risk, the proper and effective use of compression stockings is believed to have considerable benefit.
During my professional life, we have moved a long way. In the past, for many surgical procedures one was required to stay immobile for long periods, and one was often kept in hospital for long periods. We have moved on—and I believe that we may at some point have a debate on day surgery. The amount of day surgery has increased enormously, and that reduces the risks of venous thrombosis. However, the great disparity between health boards in the rates of day surgery is regrettable. We could contribute to the reduction of unnecessary deaths by making further movement in that direction. The use of regional anaesthetic rather than general aesthetic can also make an important contribution to reducing risk.
This matter is important. The deaths are preventable and we must address that. We must assess risk carefully, and we must provide prophylactic treatment when appropriate.
I close with an issue that I have not yet referred to, although Trish Godman referred to it in more detail. If any signs of problems are seen, there must be rapid and appropriate testing, diagnosis and monitoring. Sometimes the venogram can be equivocal, but simply to send somebody home is not good enough. People should be monitored in some way, so that risk can be assessed and treatment applied. In the cases that we have been discussing, treatment would prevent death. As I have said, such deaths are unnecessary and should be prevented.
The numbers involved, however, must not be confused with those for total thrombosis, where the number of deaths is substantial. Trish Godman's parliamentary questions elicited the response that about 172 deaths were recorded from that cause in 2003, which reduced to 130 in 2007. That indicates a measure of progress, although it is not enough. Almost every one of those deaths—not all, but almost all—would have been untimely. Tackling the problem is an increased priority, especially because it is, to an extent, preventable. It is important that measures are taken to identify risk, and that, if something occurs, there is early diagnosis and rapid treatment.
What about screening, which is a core part of the motion? Dr McKee graphically illustrated the fact that there are rules surrounding mass screening. One of the fundamental tenets is that we must not create a situation in which we cannot ameliorate the condition that is being screened for. Frankly, it is not possible at present for us to do anything about the genetic condition of the so-called factor V Leiden gene. However, that does not mean that we should not have focused screening. It is certainly true that anyone who has a personal or family history of the condition needs to be much more aware of the potential risk and should be entitled to have screening if they so wish—that should be made available to them.
One of the best developments in surgical procedures in the past few years has been the pre-assessment of risk prior to the patient coming into hospital. That is undertaken by nurses, who are good at looking at lists of risk factors of the sort that NICE has produced, some of which were referred to by Jackson Carlaw and Ian McKee. However, as they said, the list is considerably longer and neither they nor I have time to address all of it in this debate.
I have particular concerns about two issues. One is the use of oral contraceptives, which is not generally recognised as a risk factor. The other is the use of hormone replacement therapy. Those two treatments have their consequences in increased risk, so tackling that in terms of stopping oral contraception before surgery can be important. For the pre-assessment of risk, it is important to look at the list and assess the likely risk for an individual.
The second part of the risk that needs to be assessed is whether the procedure, the likely stay in hospital and the degree of immobility are likely to contribute to increasing the risk. If they are, steps should be taken. At the most extreme, there should be prophylactic treatment in a preventive form, using either low molecular-weight heparin or aspirin. For very high-risk procedures, particularly orthopaedic ones, that may be an appropriate measure. For people at intermediate or slightly lower risk, the proper and effective use of compression stockings is believed to have considerable benefit.
During my professional life, we have moved a long way. In the past, for many surgical procedures one was required to stay immobile for long periods, and one was often kept in hospital for long periods. We have moved on—and I believe that we may at some point have a debate on day surgery. The amount of day surgery has increased enormously, and that reduces the risks of venous thrombosis. However, the great disparity between health boards in the rates of day surgery is regrettable. We could contribute to the reduction of unnecessary deaths by making further movement in that direction. The use of regional anaesthetic rather than general aesthetic can also make an important contribution to reducing risk.
This matter is important. The deaths are preventable and we must address that. We must assess risk carefully, and we must provide prophylactic treatment when appropriate.
I close with an issue that I have not yet referred to, although Trish Godman referred to it in more detail. If any signs of problems are seen, there must be rapid and appropriate testing, diagnosis and monitoring. Sometimes the venogram can be equivocal, but simply to send somebody home is not good enough. People should be monitored in some way, so that risk can be assessed and treatment applied. In the cases that we have been discussing, treatment would prevent death. As I have said, such deaths are unnecessary and should be prevented.
In the same item of business
The Deputy Presiding Officer (Alasdair Morgan):
SNP
The final item of business today is a members' business debate on motion S3M-2482, in the name of Trish Godman, on action on thrombosis. The debate will be c...
Motion debated,
That the Parliament notes with concern that, according to provisional figures from the Scottish Government, the total number of deaths from thrombosis in 200...
Trish Godman (West Renfrewshire) (Lab):
Lab
Katie was 23 years old when she died of deep vein thrombosis. She had tried three times to get treatment, in two hospitals and from her general practitioner....
Ian McKee (Lothians) (SNP):
SNP
I congratulate Trish Godman on initiating this important members' debate, and I join her in extending my condolences to Katie McPherson's family. We need to ...
Trish Godman:
Lab
I hear what the member is saying, but because there are so many questions about DVT—he is asking them himself—we need money so that we can research whether t...
Ian McKee:
SNP
I agree that research should be done, and that not enough has been done into the causes of DVT and its treatment. However, I still hold that it is wrong to e...
Jackson Carlaw (West of Scotland) (Con):
Con
Once again, Trish Godman has brought to members' business an important and substantial issue. Seven months ago, the issue was the human rights of wheelchair ...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
I add my congratulations to those of other members on Trish Godman securing this debate and on the way in which she graphically illustrated the tragic early ...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I, too, thank Trish Godman for securing tonight's debate. As others have acknowledged, she has made a significant contribution to raising awareness of thromb...
The Minister for Public Health (Shona Robison):
SNP
I add my thanks to Trish Godman for securing a debate on this important but complex issue. Her motion mentions the death of Katie McPherson, and the first th...
Ian McKee:
SNP
Does the minister not agree that cigarette smoking is also a lifestyle choice that leads to an increased risk of DVT?
Shona Robison:
SNP
Yes, of course. I will say a bit more about that.The other risks for DVT include pregnancy, age, underlying cancer, being on the pill or hormone replacement ...
Trish Godman:
Lab
You are saying that screening would be done in some circumstances. It seems to me that Katie McPherson's family should have some support and screening, but t...
Shona Robison:
SNP
I am just about to deal with that issue. We agree that high-risk groups should be tested, and we are clear that the adult relatives of someone with factor V ...
Meeting closed at 17:35.