Clostridium Difficile

Speech by Ross Finnie on Thu 19th Nov 2009

Clostridium Difficile

The Presiding Officer (Alex Fergusson): The next item of business is a debate on motion S3M-5221, in the name of Jackie Baillie, on tackling Clostridium difficile.

We have a little time in hand in this debate. Jackie Baillie, you have around 13 minutes in which to speak to and move the motion.

Ross Finnie (West of Scotland) (LD): There is no dispute across the chamber that hospital-acquired infections and C difficile, in particular, continue to be a significant problem across Scotland. I do not think that there is any doubt or disagreement about that, nor is there any disagreement about the need for concerted efforts to be made to tackle such infections. The recent outbreaks of C diff at Ninewells and at other hospitals have served only to underline how susceptible our hospitals are and-as Brian Adam made clear in his intervention-that is also the case in our communities.

It is perfectly understandable, therefore, that the Labour Party should choose to use its debating time to discuss an important topic that has already occupied, quite rightly, a great deal of the Parliament's time and attention. However, a consistent difficulty in such discussions is that, although we want of course to concentrate on reducing and containing infections, we all admit that we cannot guarantee that we will be able to eliminate them. Therefore, I have some difficulty with any speech that gives the impression that, somehow, if we all do what we have said, we will never again have an outbreak of C difficile. That is not compatible with acknowledging that totally eliminating such infections is not within our capability.

Although I accept that it is perfectly legitimate-indeed, it is the correct process-that those of us who occupy the Opposition benches should question the cabinet secretary and call her to account on the efficacy with which the recent raft of initiatives has been introduced and on how those initiatives are working, I am not at all clear why Jackie Baillie, having used her speech to list a litany of what she believes to be errors in the efficacy of those measures, suggested that the solution is to introduce a new regime. I can understand individual criticisms and requests that certain recently established bodies should do better, but I have difficulty with her call for a new regime.

Having considered Jackie Baillie's motion and her speech, I still find much more sympathy with the Royal College of Nursing, whose briefing expressed concern that the number of action plans, initiatives and strategies is causing stress and confusion among national health service staff.

Jackie Baillie: The member might recall that Labour's 15-point action plan specified the need for a tough inspection regime, which was followed up by the establishment of the health care environment inspectorate. All that we seek is for that regime-the existing regime-to move in much earlier.

Ross Finnie: If I may say so, that is not entirely clear from the wording of the motion. Jackie Baillie's speech was, I might respectfully suggest, slightly clearer about the purpose of today's debate than is the motion on which she seeks the Parliament's support.

A second point that the RCN makes is that it believes that the updating and consolidation of existing plans should continue, but there should be a moratorium on any new initiatives or action plans on HAIs unless they are demonstrably needed. That is quite an important point.

As the cabinet secretary pointed out, and as all members are fully aware, the independent health care environment inspectorate was established only in April this year. Like other members who have expressed concern, I was concerned at the time that its first inspection was not conducted until September. Criticism has been made by Jackie Baillie about the length of time before the inspectorate started working. However, that is a criticism not of the regime but of the way in which the inspectorate appears to be tackling its job. I have no doubt that the HEI ought to understand that greater urgency is required in the way that it deals with such infections if it is to discharge its duties properly, but we do not need to invent a new regime for that. We can make that point without demanding that new plans, procedures and processes be created to carry out those duties. We accept the criticisms, but we have no problem with the nature, way and purpose of the inspectorate. From its existing reports, actions and findings, it is absolutely clear that the HEI is designed to establish infection control regimes and to ensure better awareness of surveillance procedures and greater consistency across the NHS. That is what the inspectorate was set up to do in April this year. However, I join those who say that greater urgency is needed.

Nor, indeed, do I have difficulty with the strategic approach for tackling such infections, which was the task given to the HAI task force that was established in 2003-a date I well remember because, of course, we had a much better Government in place then-and is now dealing with its third programme of work. Again, I find difficulty with the suggestion that, at that strategic level, we were wrong-or, indeed, that the current Government is wrong-in asking the HAI task force to devote itself to five areas of work: patient safety, practice and culture; education; surveillance, information and audit; guidance and standards; and the physical environment. We believe that that was the right approach. Again, the need for urgency is an issue, but that does not mean that we need a fundamental and radical change. Rather, we need to address the issue through the existing bodies.

However, as a party, we are certainly not unconcerned about recent circumstances. Like Jackie Baillie, I received a copy of the letter that she quoted from. Indeed, I immediately sought information from the cabinet secretary on what exact steps were being taken and what inquiries were being made with the hospital about those appalling circumstances, but I was not aware whether those circumstances reflected the situation in the hospital as a whole or only a particular case in one part of the ward. I sought that information, but for reasons of confidentiality-on which Jackie Baillie has clearly received different guidance-I am not able to pursue the matter further in this debate.

It is clear that all parties in the Parliament can claim credit for supporting and introducing the many initiatives that have been brought in-there has been a very large number of them-but, as the RCN reminds us, the NHS Quality Improvement Scotland report that was published in June found areas in which implementation of the initiatives still needs to be improved. I have no difficulty in making that point.

We will continue to support the Government's overall strategy on combating HAI-much of which was in place before the current Government took office-but, as an Opposition party, we will continue to look very critically indeed at the monitoring and reporting of the strategy. However, one issue that continues to cause us concern is the terms of reference of Lord MacLean's inquiry into the C diff outbreak at the Vale of Leven hospital-

The Presiding Officer: I must hurry you.

Ross Finnie: I appreciate that there are stateable reasons for distinguishing the Vale of Leven outbreak from other outbreaks. I also appreciate that paragraph f of the terms of reference allows Lord MacLean to consider other outbreaks if he so wishes. However, I believe that it would be in the public interest for the cabinet secretary to change those terms to call on Lord MacLean expressly to consider the circumstances of the other outbreaks. Although I believe that the public will welcome Lord MacLean's reporting on the outbreak at the Vale of Leven, I think that they will think it more than a little odd if the findings of his report are not informed by the circumstances surrounding those other outbreaks.

I move amendment S3M-5221.1.1, to insert at end:

", and calls on the Scottish Government to review the remit of the public inquiry currently being conducted by Lord MacLean so as to require that inquiry to consider the circumstances of other cases of Clostridium difficile in hospitals across Scotland to verify that the measures taken by the Scottish Government are sufficient to meet the needs of all Scottish hospitals."