 yn y bryd. The First Minister's Questions, we now move to Members Business. Members who are leaving the chamber should do so quickly and quietly. The next item of business today is a Members Business debate on motion number 11602, in the name of Jim Eadie, on the Royal Pharmacutical Society in Scotland and European antibiotic awareness day. This debate will be concluded without any Are there any questions being put and I invite those members who wish to speak in the debate to please press the request to speak buttons now or as soon as possible and Mr Eedy, if you are ready I would call on you to open this debate and you have 7 minutes or thereby please. Thank you, Presiding Officer. I'm grateful to colleagues in all parties who have supported the motion in my name. I welcome this opportunity to open today's debate on European Antibiotic Day of Awareness that took place in November last year and to pay tribute to the valuable work undertaken by the Royal Pharmaceutical Society in raising awareness of the issue of antimicrobial resistance. This is an important issue not just for individuals but for healthcare professionals and for society as a whole, presenting as it does a major global health challenge. Antimicrobial medicines include antibiotics, antifungal and antiviral treatments, and resistance arises through naturally occurring mutations. Overuse and misuse of antibiotics is thought to be a major cause of resistance and this is facilitated in many countries by their availability to buy over the counter without prescription. However, even where this is not the case as in the UK, prescribing practices do vary immensely. Not completing courses of antibiotics and prescribing two low doses or four too short a period of time allows stronger more virulent bacteria to flourish and encourages development of resistance. Resistance to antifungal and antiviral medicines is now also beginning to appear and none of us should be in any doubt as to the scale of the problem. The global impact of antibiotic resistance cannot be underestimated and has been compared to climate change in terms of its effect on human health. The emergence of infections which are resistant to drug treatment is a growing public health problem. If antibiotics are not used responsibly, then we could be facing a situation in the future in which we simply do not have effective cures for infection. In April 2014, the World Health Organization stated that, without urgent co-ordinated action by many stakeholders, the world is herded for a post-antibiotic era in which common infections and minor injuries that have been treatable for decades will once again kill. That is the scale of the problem that we face. Across the European Union, 25,000 people die from infections caused by multi-drug-resistant bacteria. It has been estimated that antimicrobial resistance will affect 10 million more people annually worldwide by 2050. Inappropriate use of antibiotics can have serious public health risks. Antibiotics can disrupt the natural and intestinal bacteria, which we all have, allowing organisms such as Clostridium difficile to flourish with potentially severe consequences for patients. Without effective antibiotics, many routine treatments will become increasingly dangerous, setting broken bones, basic operations and chemotherapy all rely on access to antibiotics that work. Many procedures such as hip operations, which currently allow people to live active lives for longer, might become too risky to undertake. Organ transplantation would be severely compromised without the ability to treat secondary infections. The World Health Organization estimates that the average human lifespan is extended by 20 years through the use of anti-microbials. Global consumption of antibiotics in human medicine rose by nearly 40 per cent between 2000 and 2010, yet over the past 30 years a new infectious disease has been discovered almost every year, whereas only two new classes of antibiotics have been introduced. For a variety of reasons, antimicrobials are difficult to develop. Potential treatments can be difficult to formulate as medicines and expensive in terms of the cost of individual clinical trials for each therapeutic area where the antimicrobial will be used. Furthermore, there is little incentive for pharmaceutical companies to develop medicines that are only used for short periods of time to treat and cure infections. In November last year, I was pleased to host a seminar on behalf of the Royal Pharmaceutical Society in Parliament where the Scottish Government's health care associated infection medical adviser, Professor Alistair Leonard, outlined the Scottish Government's strategic objectives in this area to improve the knowledge and understanding of antimicrobial resistance, to conserve the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. The Royal Pharmaceutical Society recently published a scientific guide on new medicines, better medicines and better use of medicines, which recommends educating the public and patients on the use of antibiotics and their place in therapy, encouraging further development of antimicrobial stewardship by healthcare professionals to maintain the effectiveness of current and any future antimicrobials and supporting the discovery and development of new antimicrobials or treatment methods by developing new financial incentives. Antimicrobial stewardship means prescribing appropriately and conserving the antibiotics that we currently have using the evidence-based guidelines developed by specialist teams. Only today have we seen the publication of the recommendations of the review on antimicrobial resistance chaired by the economist Jim O'Neill tackling a global health crisis initial steps. This UK-wide initiative is one that has attracted a range of clinical and technical input, including from Professor Mark Woolhouse, the Professor of Infectious Disease Epidemiology at the University of Edinburgh. Among the recommendations are a global innovation fund of around $2 billion and the training of a new generation of scientists in this field of study. New approaches to developing antimicrobials are urgently required to make it more attractive and to promote innovative research, such as therapies to boost immune systems and using specific viruses that kill bacteria without producing resistance or damaging human cells. Scotland is well placed to encourage this type of research and to work with industry to develop better and safer medicines through innovative research. We must also reduce prescribing to the lowest and safest levels. Here, I am thinking of the need to minimise the overuse of broad-spectrum antibiotics. In secondary care, prescribers should review prescriptions daily and consider whether antibiotics can be safely stopped or changed from a broad spectrum to a narrow spectrum antibiotic, which has less potential to allow resistant clostridium difficile infections to develop, improving patient safety in hospitals. Success depends on sustainable change. There needs to be more awareness among patients and the public on the seriousness of the challenges that we face if we are not to return to an error where infections are untreatable. It seems to me that all healthcare professionals must work in partnership with their patients to talk about when antibiotics are necessary and when they are not required. Healthcare professionals are also ideally placed to point out the alternatives that may be available. It is here that pharmacists have a specific role to play. Specialist pharmacists in Scotland play a leading role in stewardship to ensure appropriate prescribing of antibiotics as part of a multi-disciplinary approach through the Scottish antimicrobial prescribing group. Much has already been achieved by antimicrobial pharmacists working with NHS board antimicrobial management teams to influence hospital prescribing. The Scottish Government, Healthcare Improvement Scotland, Community Pharmacy Scotland and the Royal Pharmaceutical Society supported European Antibiotic Awareness Day, with a resource pack comprising a poster, patient information leaflets and self-care information sheets, which were distributed to all community pharmacies in Scotland. In addition, a self-care guide from the Royal College of General Practitioners has now been adapted for use by community pharmacy within Scotland, and it is designed to manage patients' expectations of illness duration and also highlights potentially serious symptoms that warrant further review. It is only through Government's academic research communities, pharmaceutical companies and other stakeholders working together in Scotland, across the UK and internationally, that we will raise awareness of this important issue and develop the new funding models necessary to incentivise the development and appropriate use of new antibiotics. In doing so, we will be saving and improving the lives of millions of people, not just here in Scotland but across the world. What better endeavour could there be than that? I now call on Malcolm Chisholm to be followed by Dr Annette Millmond. Presiding Officer, I congratulate Jim Eadie on bringing forward this important motion today. The World Health Organization estimates that average human life has been extended by 20 years through use of antimicrobial agents, yet at the same time we now know that they are a major threat potentially to public health and patient safety. That is why the central message of European antibiotic awareness day, which is mentioned in the motion, is that antibiotics must be used responsibly to preserve their effectiveness for future generations. The central scientific fact underlying all this is naturally occurring mutations that result in antimicrobial resistance. By passing scientific language, the message has to be that we must not misuse or overuse antibiotics. In terms of overuse, I am told that 55,000 people take antibiotics every day in Scotland and that up to 50 per cent are for conditions that would get better without them. I am also told that a European survey has indicated that 52 per cent of people in the UK do not realise that antibiotics are ineffective against viruses. It is an even higher percentage in other European countries, but that clearly is an alarming statistic. The first task in all of this is clearly to educate the public not to demand antibiotics when they are not required, although it will come on to the responsibilities of health professionals in a moment. Another issue is that when antibiotics are prescribed to patients, they must complete the course. Otherwise, stronger bacteria are encouraged to flourish. MSPs—this is alluded to in the motion as well—have a role here in publicising some of this. The motion refers to antibioticguardian.com, which I have visited—I am sure that others in the chamber may have done—but I hope that all MSPs will visit that site and make their own pledge about not overusing antibiotics and make sure that they put that post on their Twitter and Facebook pages, as I have done today. As I have said, health professionals clearly have an equal, if not greater, responsibility in all of this. I was interested to read again the anti-microbial resistance strategy and social action plan from 2002, when I was health minister. Among other things, it referred to the importance of prudent anti-microbial use but also of the need for greater coverage of this in the undergraduate and postgraduate medical curriculum. I think that there has been some progress. Again, figures that I read for last year said that there were as many as 276,000 fewer antibiotic prescriptions in primary care, so I imagine that that is progress. However, I have been surprised to read of the extent of the problem in secondary care. The Scottish management of anti-microbial resistance action plan 2008 says that it is known that a significant proportion of current antimicrobial usage in hospitals is not prudent. Again, that could be through excessive or inappropriate use. Jim Eadie gave the example of clostridium difficile. The point is that, if a broad spectrum rather than a narrow spectrum antibiotic is used, it can destroy benign bacteria in the gut and encourage the development of clostridium difficile. Of course, we all know about MRSA, which operates in a related kind of way. The public are very aware of the superbugs, but they may not be aware of the relationship of those superbugs to inappropriate use of antibiotics. In conclusion, we must mention that, as Jim Eadie did the Royal Pharmaceutical Society in general for their work, particularly for the guide that Jim Eadie referred to, and he highlighted the three main points in their guide on new medicines, better medicines and better use of medicines. I will not repeat the words, but clearly much of that was to do with educating the public and health professionals. However, the final point that they emphasise, of course, is the importance of supporting the discovery and development of new anti-microbial agents, and they also talk about developing new financial incentives for that. I am not entirely clear what that might involve, but it is a striking fact that there have been so few anti-biotics developed over the past few decades, and there are financial reasons for that in terms of people obviously only taking them for a short period of time and so on. It may not be the most attractive investment for pharmaceutical companies, but clearly that aspect of the subject is also one that we should remember today. I once again thank Jim Eadie for introducing the debate, and I hope that all MSPs will do what they can to promote awareness of this important issue. Many thanks. I now call on Dr Annette Milne to be followed by Roderick Campbell. Thank you, Deputy Presiding Officer. I begin by thanking Jim Eadie for highlighting the vital role that the Royal Pharmaceutical Society plays in Scotland, and also for raising our awareness of European antibiotic awareness day. I would like to commend this annual awareness day, now in its seventh year, when marked on 18 November. The key message from this initiative is worthy of repetition, namely that antibiotics must be used responsibly to preserve their effectiveness, not just for people now, but also for generations to follow. The various leaflets and posters produced highlight the simple fact that common infections, such as coughs, colds, sore throats and eric, should not be treated by the use of antibiotics initially. Indeed, despite the fact that antibiotic prescribing for those conditions rose by 40 per cent during the period 1999 to 2011, they were effective in only about 10 per cent of cases. Coming from a medical background and having a husband who is a retired GP, I am all too well aware that there are instances where prescribing medicines for those types of conditions seems the easy option, but culture has to change. NHS Scotland has supported other UK-wide activities on 18 November, such as the antibiotic guardian campaign, which is a grassroots initiative asking people from the healthcare professions and ordinary members of the public to read up on the facts and figures regarding antibiotics and to share that information with others. An alarming 25,000 people across Europe die each year as a result of infections that have become resistant to antibiotics. That is one of the biggest threats that are facing us today, as Jim Eadie indicated, and is caused by bacteria, essentially fighting back against antibiotics. Community Pharmacy Scotland has also supported this campaign with the promotion of resource packs to 12 1,250 community pharmacies throughout Scotland, giving invaluable advice on where and when antibiotics should be used, and letting people know that pharmacies often have a dedicated healthcare team who can advise on the right type of treatment for minor ailments without necessarily resorting to the use of antibiotics. Community Pharmacy Scotland also plays a pivotal role in the Scottish antimicrobial prescribing group, or SAPG, which acts as the umbrella organisation for pharmaceutical healthcare in Scotland, bringing together other bodies such as the Royal Pharmaceutical Society in Scotland and Pharmacy Voice. The joined-up approach helps to foster a greater understanding of the use of antibiotics by healthcare professionals, and I was pleased to read that there has been a significant decrease in their unnecessary prescribing in the last two years. I endorse the general ethos of SAPG, which is making the best use of antimicrobials to manage infection, so as to ensure optimal outcomes and minimal harm to patients and the wider society. Although there are approximately 160 varieties of antibiotics available, of which there are seven different categories, one of the problems that exists is the clear difference between broad-spectrum and narrow-spectrum antimicrobials. The former covering all manner of infections and the latter targeted at specific bacteria, and the importance, of course, of using the right drug for a specific infection. The rapid spread of multi-drug-resistant bacteria brings us closer to the point where we may not be able to prevent or treat everyday infections or diseases, which would have a devastating impact, as Jim Eadie said in his opening remarks. Making routine procedures such as setting bones, hip replacement, heart surgery and chemotherapy dangerous because all those procedures rely on effective drugs to either prevent or treat infection. Wininglay, there are now only a handful of pharmaceutical companies investing in antibiotic development, resulting in a call for all stakeholders to work together to develop a new funding model to incentivise the development and appropriate use of new products. One such drug that was brought to my attention just last week is the narrow-spectrum fedaxomycin, which I understand is the first in its class to be introduced in the past 50 years. It has been approved for use against the Studium difficile in adults and has already benefited nearly 14,000 patients across Europe and over 4,000 in the UK. The development of such narrow-spectrum drugs effective against specific organisms would make a significant contribution to combating antimicrobial resistance, hence the need to incentivise the development of new products. Presiding Officer, time precludes me from saying more. I will close by reiterating my thanks to Jim Eadie for alerting us to the urgent need to combat antimicrobial resistance if we are not to return to an era when infections are untreatable, as they were in the dark ages of my very early childhood before antibiotics were available. I thank Jim Eadie for bringing this debate to the chamber today on an important subject, and I can perhaps move on to a history lesson. In 1877, Louis Pasteur was the first to observe some types of bacteria obstruct the growth of others. However, it was not until the great Ayrshire biologist, pharmacologist and botanist Sir Alexander Fleming returned from holiday in September 1928 to find his petri dish contaminated with a strange mould that significant progress was made. It transpired, of course, and he had found penicillium notatum. It was as if the mould had secreted something that inhibited bacterial growth. That discovery created a revolution in the treatment of infections that enabled the successful treatment and prevention of many illnesses that had until then been virtually untreatable. As a result of his endeavours, as we know, Fleming went on to be jointly awarded the Nobel Prize in Physiology and Medicine in 1945. One of penicillism's great successes, of course, was in treating trauma injuries and illnesses sustained by soldiers during World War II. In many of those cases, it stopped what previously would have been an almost certain decline to gangrenous wounds and an inevitable amputational septosemia at the very least, which could, of course, be fatal. As a result of this experience, subsequently penicillium was used to treat a multitude of infections, even for those in fortune after hand analogy. In due course, there was a development of n-thru mycin and other non-penicillin-based antibiotics for which many in my family have a great deal of use. Progress has been substantial. A very good example has to be tuberculosis. At one time, threatening the masses, however, as a direct result of antibiotics and an inoculation programme, TB has virtually been eradicated, at least in the western world. However, TB has seen a recent upsurge in the world's population. That is in part due to the over-enthusiasm for the use of antibiotics and there are, at times, inappropriate and incorrect use. It could not escape the attention of anyone. It is becoming increasingly the case that conditions previously successfully treated are no longer so successfully treated. For the science enthusiasts among you, there could be no better micro-example of the process of evolution. The antibiotic's attack on the offending bacterial infection is brilliant in that it defeats the dominant bacteria, but in doing so it leads other bacterium that previously were out-competed. Despite their previous weaknesses, the remaining bacteria unaffected by the antibiotic become dominant, not only resistant to the treatment, but now without a bacterial competitor. Hence, we have the superbugs. Natural selection, survival of the fittest, this has left us with ever-evolving strains of bacterium such as MRSA. We were warned, of course, through Alexander Fleming spoke of the dangers of resistance back in his noble Bryce Feach in 1945. So where do we go from here? One way, obviously, is to continue to evolve drugs. Not quite out-competing, but at least reacting to a changing common enemy. However, developments in new-bound antibiotics have been few and far between, apart from the recent discovery by US scientists published in the journal Nature, which has been described as a game changer, where experts believe that the antibiotic call is just the tip of the iceberg. Clearly, raising standards of health in the population creates a population less susceptible to infection, but there will always be those unfortunate enough to require medical attention. So we have to be particularly mindful of the elderly and sufferers of diseases such as HIV and AIDS that make them particularly susceptible to infection. I am pleased with others that the Scottish Antibio-microbial prescribing group SAPG has demonstrated an impact through the decrease of 6.5 per cent in the number of prescriptions last year. Jim Eadie has already referred to the World Health Organization report. It was a bit more graphic in its opening bit when it said that global surveillance of antimicrobial resistance reveals that antibiotic resistance is no longer a prediction for the future. It is happening right now across the world and is putting at risk the ability to treat common infections in the community in hospitals. We have a real problem and one that I think this debate has done well to highlight. I thank Jim Eadie once again for bringing this debate to the chamber. Dr Richard Simpson, after which we will move to the closing speech of the minister. Thank you, Deputy Presiding Officer. I can begin by reiterating thanks to Jim Eadie for bringing the most important debate for describing antibiotic awareness day, which is important. The programme of signing up as antibiotic champions is an interesting development, which we will see how it proceeds. The work with the Royal Pharmaceutical Society and Nanette Milne referred to that in community pharmacy. Just one issue on community pharmacy is that we do in Scotland have a fairly unique approach in the minor ailment scheme. That is currently restricted to those who were previously eligible for free prescriptions, a bureaucratic area that seems to me needs to be addressed by the new health team, as it is regrettable. Historically, when I was a student, we had major concerns about rheumatic heart disease arising from staphylococcal or streptococcal, usually infection in the throat. Therefore, we used antibiotics, sometimes sprayed antibiotics around the place. We now know that they are not a very good course of action. However, there is undoubtedly pressure from patients on general practitioners. General practitioners are, we should recognise, under absolutely massive pressure. Therefore, taking the time to explain to a patient that their condition is probably viral is difficult. They do not have diagnostic tests that they can apply on the spot, and that is an area of research that we need to develop. If we had that, we might be able to more readily distinguish between those upper respiratory tract infections, which were bacterial and acquired treatment to prevent rheumatic heart disease, or when they were indeed viral. There have been attempts by general practitioners to introduce things like delayed prescribing, where they give the patient the prescription but ask them not to take it for two or three days, and only to take it if the condition worsens. There is some evidence that that is quite useful and helpful. Roderick Campbell mentioned tuberculosis. Of course, it has been a massive advance to streptomycin passina. I cannot remember the name of the third. Izanizad was the traditional three treatments for tuberculosis. However, we now have resistant tuberculosis. The minister will probably be aware that I have asked a number of questions about the development of techniques to try to ensure that that does not become a significant problem among certain populations like some of the refugees who come from very difficult situations in our country. We need to have a situation that ensures that that is taken care of. The tuberculosis was something that every student entering university was x-rayed for at the beginning of their course. I am not in any way advocating a return to that sort of global screening, but I think that we need to keep a very close watch on this issue. We debated it in the public health bill in the last Parliament because in South Africa, people with resistant tuberculosis are actually locked up until their treatment is successful, and that is sometimes extremely difficult. We are in an era that recognises that antimicrobial resistance is, in fact, very important. Anything that the Government can do by way of publicity, as part of its winter resilience programme, to advocate the non-use of antibiotics will be welcome. Gimedi and others have mentioned specialist pharmacists, and they have played an enormous role within the hospital setting to ensure that junior doctors do not, in fact, misuse antibiotics. The use of broad-spectrum antibiotics has contributed to the reduction in the use, has contributed to the significant reduction in C. difficile, which the Government should be applauded for in its programme. However, I have to say to them that we are now falling behind England in terms of what we are achieving. The introduction of the new Fidexa mycency difficile, which was approved by the Scottish Medicines Consortium, is only just on to the protocols in many hospitals, and we are considerably behind England in its use. In England, health protection is there. Our equivalent public health England actually issued guidance 18 months ago, whereas HPS only issued guidance three months ago. We cannot continue to have situations in which we are behind others. There is a whole new science around what is called the microbiome. Every one of us has billions of bacteria in our gut. The good bacteria are essential to our liver. We live in a symbiotic relationship with our bacteria and our gut, and we treat them with disrespect at our peril, because that can lead to all sorts of problems. I have one final concern, which is not the area for the current minister who is about to reply, but that is the use of antibiotics in veterinary medicine. I think that that is something that we need to look very carefully at. Fifty years after the swan report, this is still a significant issue. Many, many thanks. Now, calling on the minister to close the debate. On behalf of the Government, Minister, seven minutes are thereby pleased. Thank you very much, Presiding Officer. I, too, would like to congratulate Jameedy on bringing this subject forward for debate and setting out the stark situation. I also welcome the work of the Royal Pharmaceutical Society in Scotland and the Scottish Anti-Microbial Prescribing Group, and the work that they are doing to heighten the awareness of the issue. I thank all the members for their contributions from Rod Campbell, giving us a history lesson to the contributions from the net mill and Richard Simpson, who bring their professional knowledge to the subject. In 2008, the Government recognised the importance of raising awareness of resistance to antibiotics and the need for specific actions and advice to provide all healthcare professionals and the public on what we need to do to help to prevent such resistance increase. That is why we set up SAPG, a national clinical multidisciplinary forum. European Antibiotic Awareness Day is a major public health initiative, now held annually since 2008. It aims to encourage responsible use of antibiotics and tackle the global issue of resistance to them. I commend the contribution of the Royal Pharmaceutical Society in Scotland to the EAD campaign. It has supported EAD from the outset through media and communications to pharmacists, and for the past two years it has been greatly involved in the planning of the Scottish activities. During the 2014 campaign, RPF Scotland, in partnership with the Scottish Government, SAPG and community pharmacy Scotland, were central to our self-care leaflets initiative. Those leaflets support pharmacists in providing patients with specific advice about symptoms of respiratory illness, as well as facilitating referral to a GP, if required. The primary aim of those leaflets is to promote community pharmacies as the first port of call for advice and treatment for winter illnesses, which are typically caused by viruses, and to reduce patient expectations for antibiotics as the first line of treatment. That has attracted interest from Public Health England, who are looking to replicate that approach. Each year, Scottish Antimicrobial Prescribing Group organises distribution of EAD support packages to each NHS board. Those are tailored and disseminated to hospitals, GP practices, care homes and other healthcare providers. Community pharmacies receive their packs as part of their year-round support of national public health campaigns. As Jim Eadie highlighted, an important component of the annual campaign is the antibiotic guardian initiative. Anyone can sign up to be a guardian, and I am pleased that Malcolm Chisholm has done it, from healthcare professionals, vets and farmers to members of the public. SAPG promotes signing up to this initiative in all communications about EAD, and many staff working in the area of antimicrobial stewardship have used the antibiotic guardian logo signature strip to promote it. To date, more than 12,000 people have signed up across the UK. On signing up, the guardian chooses an action pledge to help to support the overarching aim to ensure that antibiotics work now and in the future. Public Health England will shortly be sending an evaluation questionnaire to all guardians who have consented to follow up. That will help to measure and confirm if guardian pledges were kept. Planning for the 2015 campaign will commence in the spring, and I would encourage members to play their part locally in raising awareness of what better way than to become an antibiotic guardian. Since 2008, infection prevention and quality improvement teams have achieved a significant reduction, as has been mentioned, in sea diff rates, and a reduction in the prescribing of high-risk antibiotics through the introduction of local and national prescribing indicators. The latest SAPG annual report that was published in January last month shows that there has been a decrease of 5.4 per cent in the number of prescriptions for antibacterials in primary care GP practices in Scotland. Also, the use of broad-spectrum antibacterials associated with higher risk of sea diff reduced by 12.7 per cent in primary care settings. Those figures are encouraging. However, further work linking sea diff cases with morbidity, mortality and prescribing data is being carried out to help to understand the epidemiology of disease in the community and identify areas for further reduction measures. As many of the members taking part in the debate mentioned, resistance to antimicrobials continue to pose a serious public health threat globally. The loss of effective antimicrobials undermines our ability to fight infectious diseases and manage the infectious complications common in vulnerable parents. A key challenge is the fact that few new antimicrobials have been developed. A key area of work in the effort to tackle the threat of global antimicrobial resistance was the setting up of a UK five-year AMR strategy, which launched in September 2013. The UK and Sweden led the development and adoption of a new world health organisation resolution on AMR, providing a mandate for the development of a WHO-led global action plan by May 2015. Through the UK strategy, we are working with the WHO and member states to develop the plan, which will take a one-health approach. This Government works closely with the UK Government and the other devolved Administrations to drive forward the work aimed at slowing the development and spread of antimicrobial resistance. The first annual report published in December 2014 showed that good progress had been made. The Scottish Government is fully committed to supporting the strategy and related initiatives to maintain focus and pace around achieving further reductions in HAIs and ensure appropriate antibiotic prescribing and vigilance against resistance to antibiotics. To tie in with that work, the Government, through the Scottish HAI task force, set up an expert group controlling antimicrobial resistance in Scotland, or CARS for short, chaired by the Scottish Government's chief medical officer to oversee Scotland's antimicrobial resistance strategy and support delivery of the UK AMR strategy. CARS will also build upon and maintain the momentum generated by the Scottish management of antimicrobial resistance action plan version 2, which was published last July and is up at the back of the chamber. CARS will produce a delivery plan focusing on the seven key areas of the UK strategy. It will develop outcome measures and publish an annual report on progress that aligns with the UK strategy. Within NHS Scotland, an AMR public awareness campaign will be developed and delivered by Health Scotland with input from other key agencies in 2015-16. The Government is committed to supporting this important work through the Scottish HAI task force. In conclusion, Scotland has established itself as a leader in antimicrobial stewardship and is recognised worldwide as having an exemplar antimicrobial stewardship programme. Through the work of organisations such as the RPSS, SAPG and other key stakeholders, huge inroads have been made in ensuring adherence to local prescribing guidelines across hospital and primary care settings. However, continued efforts are required to sustain and further improve this. I thank Jim Eadie for bringing the debate to the chamber today.