Hansard

I have listened with interest to this constructive, stimulating and wide-ranging debate, which has served as a stark reminder that the Scottish Government and the NHS have a range of complex issues to tackle.

I will respond to as many of the issues that have been raised as I can. First, I want to underline some of the key points on our commitment to tackling HAI that the cabinet secretary outlined. The publication of the Scottish point prevalence survey came when we were new to government, but we reacted swiftly and made it clear that we simply would not tolerate a situation in which 9.5 per cent of patients in our acute hospitals suffer from some form of health care associated infection, with some of our elderly patients caught up in a seemingly endless cycle of infection and treatment.

Our investment of £54 million over three years is 260 per cent higher than the previous budget. It is a thorough and more robust HAI programme, which will bring about a number of benefits and make huge inroads into reducing the estimated £180 million that it costs the NHS in Scotland every year to treat patients with health care associated infections.

We have set a number of challenging targets for NHS boards to deliver on, not least the target to achieve a 30 per cent reduction in S aureus blood infections by 2010. The target of reaching at least 90 per cent hand hygiene compliance by November 2008 is another major challenge for boards, but we have made it clear that they will be given all the help that they need from infection control managers, local health board hand hygiene co-ordinators and Health Protection Scotland.

Our £7 million MRSA screening programme, which will be implemented by pathfinder boards next year, will take us a step further towards ensuring that each and every pre-admission patient is not unnecessarily exposed to an avoidable infection. We are convinced that, taken together, the measures in our coherent HAI delivery plan will make huge inroads into achieving our long-term goal of substantially reducing the rate of HAI in Scotland.

The debate has raised a number of interesting points, to which I have listened carefully. I will do my best to respond to them and I apologise if I do not cover them all. Margaret Curran and, I think, Rhoda Grant referred to the training of cleanliness champions. I remind members that all undergraduate nurses and doctors undergo cleanliness champion training. Nearly 4,500 have now completed that training programme.

Mary Scanlon, Michael Matheson and, I think, Helen Eadie mentioned MRSA being recorded on death certificates. Our quality control measure of MRSA instance is the national surveillance programme for blood infections. Those data give us a hard measure of the problem, whereas ascribing the cause of death can often be a subjective judgment. Having said that, I recognise the concerns that have been raised in the debate and we will consider the issue further.

Ross Finnie talked about the need to measure all HAIs, not just MRSA. We know from the point prevalence survey that MRSA and MSSA are a good proxy for HAI rates in general. It is not necessary to measure all types to know that we are winning the fight against infection.

Helen Eadie asked us to revisit the Quality Improvement Scotland review of NHS boards' HAI policies. QIS has just published a revised set of HAI standards, against which boards will be assessed in 2009.

Michael Matheson spoke about the design of hospitals contributing to infections. We acknowledge that, and we have national guidance on hospital construction specifically for reducing infection risks. We are considering specifying single-room provision in hospitals, which, in future, will have many more en suite single rooms—up to 100 per cent where appropriate. The existing estate is more challenging, and we need to make progress on that.

Michael Matheson also talked about getting across the message about good hand hygiene to patients and visitors. A lot of work has gone into that. We had the six-week television and radio campaign at the beginning of the year, and a new campaign—aimed at members of the public who visit hospitals—is scheduled to begin later this year. That marks a shift in emphasis, which I am sure that many members, having raised the matter in the debate, will welcome.

Sandra White spoke about targeted hospital cleaning. As was indicated in the cabinet secretary's speech, the cleaning monitoring tool is being revised to ensure that improved, modern and rigorous standards apply in all NHS board areas.

Jackson Carlaw and Nanette Milne spoke about the nurse in charge—the matron, as I think Jackson Carlaw said. We are concluding a fundamental review of the role of the ward sister and charge nurse, which we will publish in the spring. That review makes it clear that the central responsibility of the ward sister lies in compliance with standards. I hope that that reassures those members.

Much of our new delivery plan will bring about quick results and improve patient care straight away. Care bundles will bring significant benefits to patients, who will receive consistent provision of care in many areas of hospital practice. However, there are other issues that we will not be able to solve so quickly. For example, it will take until 2010 for health boards to achieve our target of a 30 per cent reduction in S aureus blood infections, and it will be April 2009 before the national MRSA screening programme can be rolled out.

If we are to deliver our ultimate goal of a safer, cleaner and more efficient health service, I ask for members' patience. There are no quick or easy solutions, and we need everyone to play their part. We want to get it absolutely right, so that everyone in Scotland can once again be proud of our NHS and the service that it provides.

We have set out our stall today, and a huge amount of action will take place over the coming months and years to tackle HAI. We aim to bring about significant change in attitudes and behaviour across the NHS, and we will make a number of changes to the way in which services are delivered, so that patients can once again be confident that they will be safe and cared for while they are in hospital. We are instilling a sense of pride, progress and direction. However, as the cabinet secretary and I have both said, action on HAI must be taken over the longer term and across a wide range of fronts if we are to succeed.

It is clear from today's debate that HAI is an issue on which there is wide, cross-party support, as well as broad engagement from a wide variety of agencies, which are actively and enthusiastically tackling the problem. With the Parliament's support, the Scottish Government and the multi-agency HAI task force will do all that they can to reduce the rate of infections in our hospitals and other health care environments. I thank all members who contributed to this important debate.