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A robust structure is already in place. All NHS boards employ infection control managers who are managerially accountable for ensuring implementation and monitoring of national healthcare associated infection (HAI) strategy. Every hospital has access to a team of infection control professionals to help manage outbreaks and incidents of HAI. The ward sister or charge nurse is professionally responsible for ensuring that their ward is a clean, safe environment, and a structure is in place to ensure that these staff complete the cleanliness champions training programme.

The approach taken by the Scottish Government’s Healthcare Associated Infection (HAI) Task Force is to encourage higher standards of hand hygiene by NHS staff, patients, visitors, and members of the public through a range of actions including a national poster campaign in main hospital thoroughfares (these posters are routinely refreshed), the provision of the Chief Nursing Officer and Chief Medical Officer’s five top tips which visitors and patients should be made aware of, the availability of alcohol hand gels at every acute bed and ward area for patients and visitors to routinely use and monitoring of compliance of NHS staff by local hand hygiene co-ordinators against an audit tool produced by Health Protection Scotland. The latest health protection quarterly monitoring report reveals that compliance in Scotland has increased from 68% in the first audit in February 2007 to 88% now.

Alongside the NHS element of the hand hygiene campaign, our national TV and media advertising campaign Germs - Wash Your Hands of Them, which ran for six weeks in early 2007 and again in early 2008, carried the clear message to the general public that regular hand hygiene will help them avoid catching and spreading infections. To get the message across to young children and their families, we issued hand hygiene information packs and a DVD to all primary schools and nurseries in Scotland in September last year. On a local level, it is for each infection control team at NHS boards to decide how their visitors are best encouraged to wash their hands and make use of the alcohol hand gels.

All NHS boards are expected to follow the guidance set out in Annex 4 of the 2003 guidance document Managing Incidents Presenting Actual or Potential Risks to the Public Health: Guidance on the Roles and Responsibilities of Incident Control Teams. This document is currently under review and an updated version of Annex 4 will be issued shortly. All NHS boards must also follow the guidance in key documents such as the NHS Quality Improvement Scotland Healthcare Associated Infection (HAI) Standards, the NHS Scotland Code of Practice; the Standard Infection Control Precautions and the Transmission Based Precautions model policy and the prudent antibiotic prescribing guidance documents published in 2005 and 2008.

It is for NHS board chief executives to ensure that all the appropriate policy and procedures in relation to HAI are in place. They were reminded of this responsibility in a letter of 27 June 2008 from the Director-General of the Scottish Government Health Directorate and Chief Executive of NHSScotland. Managerial responsibility for effective implementation and monitoring of the procedures set out in the above guidance documents rests with the infection control managers. Professional advice in the prevention and management of outbreaks rests locally with the infection control doctor and infection control nurses and responsibility for ensuring that the ward is a clean and safe environment primarily rests with the ward sister/charge nurse.

Twenty-two patients of the 55 patients we are now aware of have died. Of these, clostridium difficile was recorded on nine death certificates as being the likely underlying cause of death, and was recorded as a possible contributory factor in a further nine deaths.

Although the chief executive is ultimately accountable for ensuring that all the appropriate policy and procedures aimed at preventing outbreaks of healthcare associated infection are in place at the NHS board, it has been a consistent message that “infection control is everyone’s business” within NHSScotland. It also has to be acknowledged that a significant number of C.difficile cases come into hospital from the community. The issue of hygiene and infection control is raised in annual reviews and was raised with NHS chairs at my meeting with them on 30 June.

I refer the member to the answer to question S3W-14657 on 4 July 2008. I also announced on 18 June 2008 that an independent review would be held into the circumstances surrounding the clostridium difficile cases at the Vale of Leven Hospital. The review team’s report will be published at the end of July 2008.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

National Services Division (NSD) of National Services Scotland (NSS) manage a national service agreement for interventions to treat thoraco-abdominal aortic aneurysm. This was designated a national service from April 2001. The following table shows the numbers of patients undergoing endovascular and open repair for aortic aneurysms with thoracic involvement in each year ending 31 March: 2002-08. A geographical breakdown is precluded for reasons of patient confidentiality.

Source: National Services Division of National Services Scotland.

Information Services Division (ISD) have provided the number of patients that were treated for abdominal aortic aneurysms, these are:

(a) Endovascular aneurysm repair using a stent graph – 26 patients were discharged in 2006 and 47 patients discharged in 2007 for NHSScotland. Information is not centrally held prior to April 2006.

(b) Open surgical repair – by NHS board of residence, during the period 1999-2007 are shown in the following table:

Numbers of Patients Undergoing Open Repair of Abdominal Aortic Aneurysm

	Patients Discharged During Year End 31 December
NHS Board Residence	1999	2000	2001	2002	2003	2004	2005	2006	2007P
Ayrshire and Arran	34	21	28	29	25	22	14	7	9
Borders	<5	9	7	6	10	13	12	7	14
Dumfries and Galloway	14	16	27	28	25	25	13	10	18
Fife	37	43	40	24	36	30	38	23	19
Forth Valley	26	45	27	32	36	25	23	23	31
Grampian	47	40	45	30	53	34	26	38	45
Greater Glasgow and Clyde	52	71	54	75	65	50	42	53	48
Highland	42	32	35	40	47	49	42	52	55
Lanarkshire	30	25	22	28	17	14	19	16	<5
Lothian	45	48	48	51	54	45	50	60	43
Orkney	0	<5	<5	<5	0	<5	0	<5	<5
Shetland	<5	<5	<5	5	0	0	<5	<5	<5
Tayside	26	33	26	26	34	35	45	30	20
Western Isles	<5	<5	5	<5	7	<5	<5	6	<5
Outside Scotland/ Other/Not Known	<5	<5	<5	<5	<5	<5	0	0	<5

^PData for the year to 31 December 2007 are provisional.

Source: ISD SMR01 Linked Database.

Note: <5 indicates a cell with fewer than five patients; the actual number of patients has been suppressed for confidentiality reasons.

Agenda for Change is still in the process of being implemented in Scotland but is designed to ensure staff receive equal pay for work of equal value. It is also designed to support the improvement of all aspects of equal opportunity and diversity for staff and provides working patterns which are flexible and responsive to family commitments. Partnership arrangements are also in place to consider and address any issues arising from the implementation of Agenda for Change on an on-going basis.

Implementation of the Agenda for Change pay system in Scotland is still ongoing and as such there are no plans to launch an independent review at this stage.