We are striving for the safest healthcare facilities in the world
The Cabinet Secretary for Health and Sport JEANE FREEMAN says the tragedy of the loss of 34 lives in the Vale of Leven Hospital, where C diff was a contributory factor, has spurred on NHS Scotland to identify incidents and outbreaks much earlier and take immediate action. This is an edited version of what she had to say in the Scottish Parliament in the wake of recent infection-related deaths in local hospitals.
The recent loss of life in which a healthcare associated infection was a contributory factor is a stark reminder of how vital infection prevention and control measures are. I am sure that I speak for everyone in the chamber when I offer my sincere sympathies and condolences to the families and friends who have lost loved ones.
I know from speaking with NHS staff that they, too, are profoundly affected by the loss of their patients. Every day, our front-line NHS staff work to prevent and control, as much as is possible, healthcare associated infections. They have my thanks—and the thanks, I am sure, of everyone in the chamber—for the vital role that they play and the responsibility that they take.
The step change in the approach to managing infections in Scotland stems from the Clostridium difficile outbreak in 2007-08 at the Vale of Leven hospital. At that time, C diff and MRSA were the biggest infection threats to patients. Identification of the outbreak did not happen quickly enough to stop the spread of infection, and many of the cases were only identified as being part of a major outbreak through retrospective analysis. The subsequent inquiry and efforts of the Scottish Government and the NHS led to the introduction of a national inspection and scrutiny programme of healthcare facilities, and the development of a national infection prevention and control manual, with clear and wide-ranging procedures for healthcare professionals to follow. We also set up the world-leading Scottish patient safety programme, which has contributed to significant and sustained improvement in a range of areas, including healthcare associated infection.
Those approaches have delivered real results. In people who are the most at risk—those who are over the age of 65—C diff infections have reduced by 85 per cent, from 6,325 cases in 2008 to 917 cases in 2017. However, although infection incidents on the scale of the Vale of Leven are now markedly rarer, it remains vital that we continue to learn from them and take whatever further steps are necessary to make sure that our NHS is as safe as possible.
Last year, there was a water contamination incident in the Royal hospital for children in Glasgow. The previous cabinet secretary asked Health Protection Scotland to examine the issues and I published its report, Summary of Incident and Findings of the NHS Greater Glasgow and Clyde: Queen Elizabeth University Hospital/Royal Hospital for Children water contamination incident and recommendations for NHS Scotland on Friday.
The report makes a number of recommendations, and today I give members my commitment that the recommendations will be addressed.
The report will be passed to the independent review group for it to consider as part of its work to review the design, commissioning, construction, handover and maintenance of the Queen Elizabeth university hospital and how such matters contribute to effective infection prevention and control. My officials are in the concluding stage of appointing two co-chairs of the review. The potential co-chairs have asked for time to consider what would be required of them, in order to ensure that they can fulfil their responsibilities.
The Queen Elizabeth University Hospital and Vale of Leven District General Hospital in Alexandria, West Dunbartonshire.
I fully appreciate that members will be keen to see the work begin as a matter of urgency—I am, too. However, I am also adamant that we take the time that we need to appoint the right clinical experts to lead this critically important work. The focus is on the Queen Elizabeth university hospital, but the lessons are for NHS Scotland. We need to ensure that our physical infrastructure is designed, built and maintained to maximise infection prevention and control. I expect to be able to advise Parliament shortly on the review’s co-chairs, and then its remit and membership, in line with Professor Britton’s recommendations.
Since the water contamination incident, NHS Greater Glasgow and Clyde has given notification of a number of other infection outbreaks. Such notifications happen as a result of the clear procedures that were agreed after the Vale of Leven tragedy and set out in the “National Infection Control and Prevention Manual”, which is evidence of a monitoring and control system that acts much earlier to identify and control infection and protect patient safety.
Some infections, such as the Staphylococcus aureus bloodstream infections at the Princess Royal maternity unit, are common in the general population but can impact acutely on patients who are very unwell and likely to have a lower immunity. Other infections, such as the Stenotrophomonas maltophilia infection at the Royal Alexandra hospital, are rare. However, no matter whether the infection is rare or not, it is crucial that staff identify it early, deal with it and prevent it from spreading. In all infection outbreaks, immediate additional measures are put in place to ensure that hygiene and infection prevention is absolutely as good as we need it to be.
Given the serious nature of these incidents, my officials have daily phone calls with Health Protection Scotland so that I can be updated, and the healthcare incident infection assessment tool—HIIAT—reports are delivered following multidisciplinary incident management team updates.
Following the Cryptococcus infection at the Queen Elizabeth university hospital, I asked the healthcare environment inspectorate to undertake an unannounced inspection of the hospital. The report on that inspection will be published by Healthcare Improvement Scotland on 8 March. We will publish our response to it at that time, and it, too, will feed into the work of the expert review.
All those steps are important and it matters that, while the independent review undertakes its work, we make any immediate improvements that are necessary and identified by the reports. I want to make sure that the clinical voice is heard with regard to clinicians’ work environment, so that they can continue to deliver safe, effective and person-centred care to their patients.
The Health and Care (Staffing) (Scotland) Bill, which will reach stage 3 in the chamber in the coming months, follows Lord MacLean’s recommendation from the Vale of Leven inquiry that we should act to ensure that the staffing and skills mix is appropriate for each ward and that, where that is not the case, an escalation process is in place to respond. The bill provides an opportunity to enable a rigorous evidence-based approach to decision making on staffing, taking account of service users’ health needs, including in infection prevention and control.
It is important, too, that we recognise the role and voice of all our front-line staff in NHS Scotland. Porters, domestic and housekeeping staff, catering staff, receptionists and maintenance staff all have a critical role to play in effective patient safety. I will be giving further thought to how we can ensure that, across all our health boards, the voices and expertise of those staff members are integral to the work on infection prevention and control.
Scotland’s response to healthcare associated infections is wide ranging, and a number of expert agencies are involved. Health protection Scotland is responsible for undertaking surveillance and horizon scanning for emerging threats and seeking advice from United Kingdom and international organisations where required. When HPS is made aware of threats, it produces guidance for NHS Scotland to prevent on-going transmission of infections. The Healthcare environment inspectorate leads on independent inspections of every NHS acute and community hospital in Scotland. Since 2009, HEI has published 261 hospital inspections as well as thematic inspections of theatres and invasive devices.
The Scottish Government has underpinned those efforts by launching the mandatory national infection prevention and control manual in 2012, using a once-for-Scotland approach. The manual provides a framework for staff to apply effective infection prevention and control practice and it sets out the process that health boards must follow to manage incidents and outbreaks. We have led the world with the national infection prevention and control approach. It has been adopted by NHS Wales and there are calls for it to be adopted across the UK.
In the past decade, Scotland has made significant progress on infection prevention and control. Spurred by the tragedy of the loss of 34 lives in the Vale of Leven, where C diff was a contributory factor, NHS Scotland is now in a position to identify incidents and outbreaks much earlier and take immediate action.
Infections are present in everyday life. We cannot avoid all infections, but we must ensure that our systems include horizon scanning for emerging infection threats and ensuring preparedness and resilience. I assure Parliament and, through members, the public that a culture of improvement and safety is woven through our national health service and that I am committed to ensuring that our hospitals remain some of the safest healthcare facilities in the world.