Seòmar agus comataidhean

Following the interim reports which I received from NHS Greater Glasgow and Clyde on 13 and 17 June 2008, I announced in Parliament on 18 June 2008 an independent review of the Clostridium difficile outbreak in the Vale of Leven Hospital.

I also asked Kevin Woods, Chief Executive of NHS Scotland to ask Health Protection Scotland (HPS) to collate data from NHS boards on whether there were other unidentified outbreaks and excess deaths associated with CDAD (Clostridium difficile Associated Disease).

Both reports were published on 7 August 2008.

The national response time target for category A calls (life threatening) across mainland Scotland is that, by March 2009, 75% of all incidents should be reached within eight minutes.

The national response time target for category B calls (serious but not life threatening) across mainland Scotland is that, by March 2009, 95% of all incidents should be reached within 14, 19 or 21 minutes depending on population density. For the locations requested, the target is 21 minutes.

The information requested has been provided by the Scottish Ambulance Service for 2007-08 and is set out in the following tables.

Station	Cat A Demand	Cat A Performance	Cat B Demand	Cat B Performance
Arrochar	115	10.4%	144	50.7%
Helensburgh	773	54.6%	1702	92.3%
Vale of Leven	1,396	61.7%	2,488	94.6%

 

Station	Urgent Demand	Urgent Performance
Arrochar	61	88.3%
Helensburgh	986	89.5%
Vale of Leven	1,275	88.9%

Notes:

1. The figures provided are for activity recorded against Arrochar, Helensburgh and Vale of Leven Stations.

2. Urgent performance is measured by the service as the crew being at the patient within 15 minutes of the agreed time in 95% of cases. The time is agreed with the GP or hospital at the time of the call request and is determined by the needs of each patient.

The Scottish Government regularly reviews and updates the information that is made available on their website. Information about Clostridium difficile was last reviewed and updated following the publication of the independent review on 7 August 2008.

This is a matter for the Crown Office and Procurator Fiscal Service (COPFS). COPFS has issued guidance to doctors on the categories of death that must be reported to the Procurator Fiscal. This guidance is available on the Crown Office website, www.copfs.gov.uk. Clostridium difficile is not a cause of death which doctors are currently obliged to report in terms of this guidance.

The Scottish Government has already announced a record level of investment of £54 million over three years to tackle all healthcare associated infection, including Clostridium difficile.

In addition, all NHS boards have been instructed to ensure that they have an antimicrobial management team in place, and £520,000  has now been released to enable NHS boards to establish antimicrobial pharmacist posts which will support high quality prescribing.

The review report was referred to the Lord Advocate because she is responsible for the investigation of deaths in Scotland. The Procurator Fiscal has a duty, on behalf of the Lord Advocate, to investigate all sudden, suspicious, accidental, unexplained and unexpected deaths, as well as deaths which give rise to serious public concern.

The majority of these deaths were not reported to the Procurator Fiscal at the time but when the full extent of the situation at the Vale of Leven Hospital became known, I ordered a review. In the circumstances, it was appropriate for the Procurator Fiscal to await the outcome of the independent review before considering what further action was necessary. However, the number of deaths at the Vale of Leven hospital has clearly given cause for concern within the community and it is therefore appropriate for the area Procurator Fiscal to conduct an independent inquiry into the circumstances of those deaths in the first instance.

All infection control managers report directly to the relevant NHS board Chief Executive.

The responsibility for following up on NHS QIS inspections lies within the remit of the relevant NHS board.

If a medical practitioner knows the cause of death he/she can complete a death certificate. If not, the case should be discussed with the Procurator Fiscal who may decide there is enough information available to sanction the completion of a death certificate, or alternatively instruct further enquiry, which may include a postmortem. The NHS undertakes hospital postmortems with proper authorisation from the deceased person''s relatives, if a clinician wishes to learn more about the cause(s) of death. Postmortems very often reveal that a patient has more than one medical condition, some of which may not have been evident in life. Equally, the cause of death is still on occasion unknown, even following a postmortem. There is no legal requirement for a postmortem in cases of Clostridium difficile, and this condition is diagnosed by microbiological tests on stool samples in life.

Yes. The summary report on the two previous Healthcare Associated Infection (HAI) delivery plans (2002-05 and 2005-08) are available from the HAI Task Force website at:

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/19529/2005.