 I invite members who wish to ask a question of the Cabinet Secretary to press a request-to-speak button and I now call the Cabinet Secretary. Round about 20 minutes. Sorry, 10 minutes. The NHS failed the 34 patients who died at the Vale of Leven hospital. It failed the patients who suffered due to the outbreak of Cedif Seal and it failed the families of those patients, too. Our NHS failed all of those patients and their families and for me, I'm sure everyone here today, that is deeply regrettable and I'm sorry on behalf of the Scottish Government. Lord MacLean highlights 34 deaths, an increase on previous findings and this follows his detailed scrutiny of medical records and that was an important purpose of the inquiry to establish the facts. On behalf of the Scottish Government and our NHS, I want to offer a profound and sincere apology to all those patients and families affected by this tragedy. Our thoughts must be with all of them today and I'm aware that some of them have joined us today in the chamber this afternoon. This statement is the Scottish Government's initial response to the Vale of Leven hospital inquiry report published by Lord MacLean yesterday. The report was laid in Parliament yesterday in line with the requirements of the Inquiries Act 2005. I believe that the report addresses the wide-ranging terms of reference set by the chairman, who was charged with undertaking a thorough investigation into the circumstances contributing to the occurrence and rates of Cedif Seal infection at the Vale of Leven hospital from 1 January 2007 to 1 June 2008. I would like to take this opportunity to thank Lord MacLean and his team for their hard work and commitment to the inquiry. I would also like to put on record my personal thanks to the patients and families for their frank and honest evidence to the inquiry. The patients and families of those who were affected by the outbreak quite rightly demanded this public inquiry to investigate what happened, why it happened and the sheer lessons are learned. It's clear from my meeting with them that those issues are still driving their search for answers. I believe that the report is both balanced and fair and I hope that it will go some way to addressing those answers that the patients and families are seeking. Since the inquiry was established, there have been some criticism of the cost and length of time that it has taken to report its findings. Under the Inquiries Act 2005 and the rules, it is clear that this is a matter for the chairman of the inquiry to determine the procedure and conduct that is required in order to carry out its duties effectively. I believe that the chairman has published costs of the inquiry up to 24 November at his launch yesterday and at final costs will be provided later this year. Although Lord MacLean did acknowledge in his report that ministers wanted a shorter inquiry, it's clear that the length of delay had a profound effect on patients and families and did nothing to alleviate their distress. I hope that the publication of this report will begin to bring closure for those families and patients and families. For those of you who have read the report, it makes terrible reading and identifies system wide and individual failures at the Vale of Leven hospital. The report is a thorough and definitive explanation of what went wrong and it's clear that there was failure at all levels from nursing medicine through to management. Lord MacLean's findings outline the lack of investment in the hospital, which was simply no longer fit for purpose. There was a lack of basic care provided to patients, no inspection regime was in place, communication was poor at all levels, morale of staff was low. Much of that was related to the uncertainty of the merger of Clyde into NHS Greater Glasgow, which was announced in 2005. That wasn't implemented until after the outbreak and resulted in a fundamental breakdown in lines of reporting. As I said to the patients and families that I met yesterday, it's completely unacceptable that this happened in our national health service. The report identifies 75 recommendations, nine for the Scottish Government, 65 for the NHS boards and one for the Crown Office. Let me be very clear, I accept them all and more importantly intend to address them all. There are a number of the recommendations that will need to be worked through and others where we can go even further. I want to reassure you that the Scottish Government and the NHS hasn't been idle since the inquiry began and let me tell you what we have in place. Our national HDI task force drives the wide range of work that is required to ensure that we continue to improve and reduce HDIs. In 2009, we established an effective inspection process through the healthcare environment inspectorate. It completes comprehensive unannounced inspections, demanding urgent actions from boards where it is required. Those inspections also provide key information, which is used both nationally and locally, to drive continuous improvement. As an outbreak is defined as two or more cases, timely local intervention is critical. Therefore, there are robust systems in place enabling NHS boards to effectively recognise and manage outbreaks as they happen, closing wards if required. We expect outbreak concerns to be reported to Health Protection Scotland, who will monitor the situation, support the board and escalate to the Scottish Government if needed. Work-to-date has led to a significant reduction in sea difficile rates across Scotland's hospitals, which have been at their lowest level this year, with an 82 per cent reduction in sea difficile cases in the over 65s since 2007. In addition, hospital standardised mortality ratios are down by 16 per cent. Lord McLean's report provides clear direction on how we can build further on this progress. It is encouraging to note that Lord McLean identified that NHS Greater Glasgow and Clyde were quick to learn the lessons from the outbreak. They have continued to work hard to reduce the incidence of healthcare-associated infections within their hospitals and now lead the way in reducing their occurrence. I have spoken to NHS Greater Glasgow and Clyde yesterday and today about the report and told them how I expect them to consider and address its findings. Although the focus is on NHS Greater Glasgow and Clyde today, I have, along with the chief executive of NHS Scotland, written to all boards, asking them to consider the implications of Lord McLean's report. We have requested that they report back to me by 19 January next year. I would like to reassure you that many of the recommendations will have either been completed or are well under way. I will establish an implementation group to consider all of the report's recommendations for health boards and how they can be taken forward in partnership across the NHS. I have invited those affected or who have lost loved ones to consider how they wish to be involved in taking forward the report's findings. That will help to ensure that the memories of those who died continue to make lasting improvements in our NHS. I have asked the chief medical officer to lead the Scottish response for the UK five-year antimicrobial strategy and association with the royal colleges and board medical directors to address and promote prudent prescribing of antimicrobials to reduce risk of seed of infection and antimicrobial resistance. I have also asked the chief nursing officer to work with board nurse directors to roll out a robust quality assurance system, putting patients, families and their experience at the centre of this work, ensuring that it is publicly available and easily accessible in the clinical environment. Additionally, my chief nurse will work with them to roll out nationally agreed standards for nursing documentation and care planning, including a minimum dataset for patient records. That will be monitored as part of the on-going quality assurance processes. I have written to the health and sport committee to offer to discuss the report in more detail and I will return to Parliament with the Scottish Government's full response in the spring of next year. As the minister now responsible for our NHS, I am pledging my commitment to you today that we will take all necessary steps to ensure that a tragedy of this magnitude can never happen again. Finally, I apologise again to the patients, the families and relatives who were let down by our NHS at such a vulnerable time in their life. I congratulate the cabinet secretary on her appointment. I know that, in her first outing, in her new job, she will, like the rest of us, be extremely concerned and disturbed by Lord McLean's report on the CDIF outbreak at the Vale of Even hospital. It is a truly shocking report. In a hospital of only 136 beds, at least 34 people lost their lives to CDIF, maybe more. The families of the victims, as Lord McLean said, have been fully vindicated in demanding the inquiry and we should pay tribute to them for their perseverance and commitment to their deceased loved ones. Their report lists management and governance failures, a failure by the health board and government to heed what was happening following outbreaks elsewhere in the UK, deficiencies in infection prevention and control practices, patient care compromised, low staff morale, recruitment problems and a weak management culture, all of which contributed to the avoidable deaths at the hospital. If this loss of life had been the result of a major incident or disaster, it would dominate our news for weeks. Sadly, I suspect it won't. Will she now take action to create an independent health regulatory regime free from government with powers to protect patients in closed-down facilities where they are failing patients? Can I ask if the Health and Safety at Work Act applies to patient safety in Scotland? What is the timescale for all of the recommendations to be implemented? Who is accountable for ensuring that recommendations are followed through and how is Parliament to be kept informed of the process? Finally, will she ensure that Government time is made available soon so that we can discuss this report in full, because patients, families and everyone involved deserve no less? I thank Neil Findlay for his questions. The first point on the healthcare environment and spectra is that it is a very powerful organisation that can go into hospitals unannounced and announced to look at all aspects of the care in that hospital. It is due to the fact that the healthcare environment inspectorate has been set up and that we have seen many of the improvements in our hospitals. Of course, one of the recommendations—in fact, the first recommendation that Lord McLean makes—is that the healthcare environment inspectorate should be given the power to close wards. Of course, wards can be closed if the local infectious control team decides that that is required and that often happens. However, we agree with that recommendation that the healthcare environment inspectorate should have that power. No one should be under any illusion about the power and effectiveness of the healthcare environment inspectorate, and we should support it in its work. In terms of health and safety at work, yes, of course, there is a UK body that has relevance to many aspects of health and safety in the workplace in Scotland. In terms of the timescales for taking forward the recommendations, I have said to boards that I want them to come back to me by 19 January, laying out very clearly which recommendations they have already implemented, which recommendations they will implement and by when. In terms of the parliamentary involvement, I have said in my statement that I will come back to parliaments with a fuller information. I am happy to do that. Of course, the committee will have an interest in that as well, and I would expect them to want to discuss the report in some detail with us. I thank the cabinet secretary for the advance copy of her statement, and I also take this opportunity to welcome her to her new position. On behalf of those of us on these benches, can I extend our condolences to the families of the 34 patients who tragically died in the CEDIF outbreak, which first occurred nearly eight years ago? We welcome the thoroughness of the report and the fact that the Scottish Government has quickly moved to accept all 75 of Lord McLean's recommendations, and we will carefully monitor that they are implemented by NHS boards across Scotland without delay. The failings at health board and government level to provide an adequate infection and inspection system will not be forgotten by families and patients in Greater Glasgow and Clyde in the NHS area. Will the cabinet secretary agree with me that to control hospital-acquired infection right across the NHS in Scotland, there needs to be an emphasis on the role of responsible antibiotic prescribing to prevent the development of resistant strains of organisms, on maintaining meticulous hygiene within hospitals and on ensuring that all NHS staff at both primary and secondary care levels have a clear understanding of infection control and that the responsibility for this lies with everyone involved in the care of patients? In particular, would she agree that among the many recommendations in the report, those regarding the role of the senior ward nurse in controlling infection are particularly important, as I argued in this chamber when we discussed hospital-acquired infections nearly seven years ago? I will say to Annette Millon that absolutely all the issues that she raises are, of course, has been a focus of the NHS for many years now. There has been huge changes in the practice of antibiotic prescribing, the hygiene procedures, the awareness of best practice in infection control are all absolutely front and centre of what happens within our hospitals now and, of course, the patient safety programme that operates across Scotland now has been internationally recognised for the good practice that it has brought. Of course, the comments that she makes about the senior ward nurse and the leadership within the ward is hugely important. Of course, we will take forward all those recommendations, because there is always more that can be done to build on the good work that has happened since 2007, and we will make sure that that happens. Can the cabinet secretary tell me how the veil leaving has changed since 2007? How many CDIF cases have there been in 2014, and how does that compare to the outbreak period and nationally? As I said in my statement, there have been huge changes in the number of CDIF cases since 2007. The figure that I used in my statement was an 82 per cent reduction in CDIF cases in the over 65 age group over that period. I think that that shows that many of the good practices that are now in place, as well as the performance of the healthcare environment inspectorate, have led to a huge reduction in those cases. In terms of the cases within NHS Greater Glasgow and Clyde, we have reduced CDIF by 84.7 per cent since 2007, in those age 65 years and older, from 472 cases in the quarter of January to March 2007 to 72 cases in the quarter of April to June 2014. The nationally latest CDIF rate show a reduction that has been said by 81.9 per cent over the same time frame. That is 1,775 cases in 2007 to 322 cases in 2014. I hope that the member will agree that that shows a significant decline in CDIF cases, but we can never be complacent. Of course, that is why we are going to make sure that we take forward all of the recommendations in Lord McLean's report. Jackie Baillie, followed by Bob Dorris. I am sure that the chamber will share my pride in the determination and dignity of the families throughout this process. It has been seven years since the first deaths at the Vale, five years for the public inquiry to report, and I welcome the robust recommendations. The cost of the inquiry is in excess of £10 million, but the offer of compensation to the families—the victims in all of this—is about £1 million. Although the families are solely motivated by the desire to ensure that that does not happen to anybody else in Scotland, I cannot help but feel that justice has not yet been done. Can I ask the cabinet secretary what action she can take to make sure that the level of compensation is reviewed? Can I say to Jackie Baillie that, first of all, I very much recognise her role in supporting the families and patients? I could see yesterday how much that has been appreciated by the families and patients. Her comments about the determination of those families are absolutely agree with me. I think that it should be respected for what they have endured and the dignity that they have come to this process. On the issue of compensation, Jackie Baillie will be aware that there are detailed discussions going on between the health board and the families. Those matters have a basis in law on how that process will be worked through. I am clear that those who have been harmed or those who have lost loved ones as a result of negligent acts by the NHS should be adequately compensated for their loss. It is absolutely essential that, when clinical negligence claims do arise, that boards learn from those cases and put steps in place to ensure that there is no repeat in future. I understand that, although it is a confidential matter, I have made it very clear to the NHS Greater Glasgow and Clyde that it should be as helpful as possible in that regard. I understand what Jackie Baillie says about the difference in the cost of the inquiry and potentially the settlement of claims. I know that she will appreciate that it is very difficult for a Government to have any control over the costs of an inquiry. That is partly one of the issues with the inquiries act that I think that we should look at. It has been a long process and has reached a cost of around £10 million. That is something that we should look at. Those are very sensitive discussions, but I have made it very clear to the health board that I would expect them to be as helpful as they possibly can in their discussions with the families as they go forward. Significant process might have been made on CDIF, the Scottish patient safety programme, and with the new healthcare environment inspectorate. However, chapter 15 of the report still makes a detailed series of significant recommendations in relation to infection prevention and control. Will the cabinet secretary give me an assurance that those recommendations will feed directly into the work of both the patient safety programme and the work of healthcare environment inspectorate? It is important that it is monitored to make sure that it is effective. We are all really wanting to know that, if an outbreak is similar to what happened at the Vale of Leven, it is to happen today that the scale and the significance of that tragedy could be dramatically reduced because hospitals are safer and that this Government is doing all that it can, including adopting its recommendations to achieve that. I say to Bob Doris that we will absolutely make sure that all those recommendations are implemented. However, let me take the opportunity response to Bob Doris's question to say that I am absolutely confident that we will not see another situation that we saw at the Vale of Leven hospital. The reason that I say that is that the mechanisms that we now have in place pick up outbreaks is because there will still be outbreaks and there are still outbreaks within the NHS in Scotland, but it is what is then done about those outbreaks. Let me give a very good example of that. In January of this year, there was an outbreak at the Victoria infirmary. Within 24 hours, that was identified. The three cases were identified, so it was counted as an outbreak. All of the correct procedures were taken and there was no further spread and there were certainly no deaths arising from that. That is how our NHS should work, that there is an effective response to the challenges that still arise with infections within our hospitals, but it is what is then done about it and because of those robust processes that very quickly now pick up those outbreaks, I am absolutely confident that we will not see a situation that we saw at the Vale of Leven. What happened at the Vale of Leven was that infections that were identified and outbreaks that should have been identified going back to January 2007, as Lord McLean has identified in his report, were not picked up and that infection then ran rampant throughout that hospital. I am absolutely confident with the processes that we have in place in the NHS now that that would simply not happen and people should have and take confidence from that because the last thing I want to see from this very tragic report and very disturbing report is for patients to be worried about going in to hospital. Our NHS is a very different institution now and very different than it was in 2007 and patients should have the confidence, particularly elderly patients, when they go into their hospital that everything is done to minimise any chance of them acquiring an infection while they are getting their treatment. Jim Cewm for Vagail Paterson. I thank the minister for advance sight of the statement. I welcome her to a new post. I add my thanks to the inquiry team and of course recognise the suffering of the friends and families of those who have suffered. There have been criticisms of delays and whilst they may be valid it is right that the time was taken to get this right. The report is a substantial piece of work and I welcome the minister's indication that the Government will implement the recommendations. Recommendations 31 and 36 focus on staffing and the skills mix on wards. Given the pressures that we know exist in some areas in attracting and maintaining consultants and lead clinicians, what does the Government propose to do to ensure that the skills mix meets demand at all times? First of all, I will say to Jim Cewm that what is important within the report is that on the issue of staffing that was explored in a great detail, a lot of detail, and if you look at page 211 of the report, the infection control nursing expert who was a Mrs Perry looked into the issues of the staffing levels at the Vale of Leven and what they found was that there was an acceptable level of staffing and ratios within the hospital but that when patients became acutely ill there was no change to those staffing levels, racial skill mix. That is one of the key things from the report that there has to be the leadership there within the wards and within management to recognise that if the circumstances on award change and you have suddenly more acutely ill patients that there is the ability to take action to address that so absolutely those recommendations 31 to 36 are very very important and those will certainly be ones that we'll be taking forward and making sure that they're implemented. Gil Paterson followed by Dr Richardson. Thanks, Presiding Officer. Can I associate my comments with Jim Cewm's comments? I wouldn't want to repeat them but the exact same comments. Can I ask the Cabinet Secretary to say that Lord McLean's report said that the Vale of Leven hospital has suffered from a decade of lack of investment. What investments have been made in the hospital since 2007 and how has the service it provides changed? Can I reassure Gil Paterson that there has been a significant level of investment? The capital investment at the Vale of Leven in the last 10 years is over £9 million. That has without doubt improved the fabric of the building, the ward layout, the hand washing facilities, many of the criticisms of the fabric that are contained in this report. I can assure the chamber that that investment has made the Vale of Leven a very different hospital and one that is very well regarded and thought of within the local community. I should also say that the patients have a very positive experience at the Vale these days. The last patient satisfaction survey showed a huge level of positive rating for care and treatment. That was not the case back before 2007 and through the period of this outbreak. It is fair to say that the hospital at that time was a hospital that was out of sight and out of mind. It had suffered from a lack of investment. It fell between two stools of organisational change and that led to a lack of morale among staff of feeling that the hospital had a major question mark over its future. All that, along with all the poor practices, is a backdrop to the infection outbreak, as Lord McLean has laid out very clearly. I am very pleased that the Greater Glasgow and Clyde board has invested in the hospital. It is now a well-functioning hospital and, as I said earlier, is one that is held in high regard by the local community. After the Vale families called for an inspection regime, I tabled motion 3M 02697 on 9 October 2008, entitled regret for the continued complacency on reducing clostridium difficile. In that, I called for an immediate move from health board to individual hospital reporting and for an inspection system similar to that that has been introduced in England in 2007. It was April 2009 before the very welcome health inspectorate started its work. Does she agree with Lord McLean that we need to look at other jurisdiction reports as they come out on the issues that also affect our people? Five years on from the outbreak, does the cabinet secretary, who has very properly indicated that we have made enormous progress on C-divisio, think that the system is working well when the Hermars report showed that Lanarkshire health board left a senior infection control post vacant for five months this year? I am glad that she agrees with the McLean report that we need a robust inspection system with enforcement powers, as Labour has been calling for since 2011, but it needs to apply, I hope that she agrees, to all aspects of healthcare—independence, robust, with enforcement powers. I say to Richard Simpson that the healthcare environment inspectorate—I think that he was implying this himself—is a very good inspection regime. The establishment was announced back in 2008, and, as he quite rightly said, it started its work in 2009. We have, as I said earlier on, that we will be extending its powers to be able to close wards, if that is what it recommends. It is an inspection regime that I believe works well, and it is a tool, an independent scrutiny tool within our health service that should have probably been around for many, many, many years before it was established. The fact that it was not should be something for us all to reflect on, but it is there now, and absolutely we will make sure that it continues to do its good work. If there are further improvements that can be made to the HEI system, I am certainly prepared to look at that, in addition to, obviously, accepting all the recommendations that have been made in that report. In terms of hair mires and the vacancy for the infection control nurse, I absolutely agree that those roles are critical roles, and there should certainly be no delay in the recruitment of those key personnel. What is important in the systems now is that the systems do not rely on one person. I think that those are the lessons that have been learned from the past. They absolutely are systems that are robust and do not succeed or fail on the basis of one individual infection control nurse, but nevertheless it is important that those roles are there. In terms of learning lessons, absolutely lessons have been learned from previous reports. That is the CDI outbreak in 2007-08 in Northern Ireland. There were a number of actions taken in Scotland after that outbreak. Of course, the hugely important lessons learned from Midstaffisher and the response to the Francis inquiry led to a huge amount of work within the NHS. I remember sitting at meetings as the Minister for Public Health going through and finding detail what those lessons were going to be and applying to the NHS here in Scotland. We will absolutely learn lessons from elsewhere. Importantly, I wrote to health ministers across the UK yesterday sharing the findings of the report, because it is important that, whether it is in the UK or beyond, people will learn the lessons of the report. That is something that I did yesterday. The Cabinet Secretary for Health and Sport explained how she might take forward the recommendation 71 in the report that the Scottish Government should identify a national agency to undertake routine national monitoring of deaths related to CDI. We will be looking at that recommendation in terms of which national agency is the most appropriate to take that forward. There are a number of recommendations that we will have to consider in some detail about what is the most appropriate. However, the recommendations do not just apply to the territorial boards, they apply to the national boards as well. We will be looking and discussing with them which agency would be the most appropriate to take that forward. I assure the member that it will be taken forward and implemented. Rhoda Grant, followed by Richard Lyle. Can I join with others to pay tribute to the families who fought so hard for this inquiry, and hopefully lessons can be learned so that, in future, families do not have to fight so hard for inquiries at such a difficult time for them? Will the chief nursing officer, as part of the work with the nursing director, look at the standards for testing to ensure that individual cases are identified and isolated to stop outbreaks in the future? Will the chief nursing officer examine how patients and their relatives can raise concerns and request testing if they are concerned about an outbreak occurring in a ward that they are involved in? That is definitely something that we want to take forward. On the recommendations, I have said that we may well go beyond some of the recommendations and some of the elements that we take forward. Rhoda Grant touches on an important point, and we discussed that a little bit with the families yesterday. How do we best utilise the information and the desire of families to communicate when, perhaps, they are not happy with something that they see or experience while they are either receiving treatment themselves or their family member? That is about good communication. Part of the running theme through the report is how poor the communication was. A lot of those systems are better now. There is better communication and better patient involvement, whether it is through patient satisfaction surveys or basic communication with families on wards. Making time for that has been changes to the way shift patterns work. One shift of nurses is not all leaving at the same time as another is coming on. There is communication there that is important to be able to impact to the families. Without a doubt, there is more that we can do there in order to make sure that families or patients have something that they want to feed back and say that that opportunity is afforded to them, because all of that means that we can continue to further improve the national health service. Thank you for your statement, cabinet secretary, and I wish you well on your new job. In the statement, the cabinet secretary has detailed what she intends to do in regards to all the recommendations and the actions that she intends to take. Does she intend to ensure that every step, all steps are taken to update regularly, all involved families, parliament and the health committee regarding this action that she is now taking and will continue to take regarding this statement? Can I say to Richard Lyle? Yes, absolutely. As I said in my statement, we are going to be discussing with the families as will Greater Glasgow and Clyde health board about how the families wish to be involved in the implementation of those recommendations. That might not be for everybody, but I think that those families who wish to be involved are a very important part of taking forward those recommendations. In terms of updating Parliament, I am committed to coming back to Parliament as often as required to ensure that Parliament is kept up-to-date with the process and progress of the implementation of those recommendations and, likewise, the offer to the health and sport committee to discuss the report in more detail but also, importantly, to keep them informed of the progress of the implementation. That ends the statement from the cabinet secretary on the Vale of Leven. We now move to the next item of business, which is a beta motion number 11664, in the name of Fergus Ewing, on the legal writings, counterparts and delivery.