Scottish Parliament, 19 November 2009

358 contributions from 79 members. The official report.

Official Report 19 November 2009

Business Motion

Alex Fergusson (None, Galloway and Upper Nithsdale)

Good morning. The first item of business is consideration of business motion S3M-5321, in the name of Bruce Crawford, on behalf of the Parliamentary Bureau, setting out a timetable for the stage 3 consideration of the Schools (Consultation) (Scotland) Bill.

Motion moved,

That the Parliament agrees that, during Stage 3 of the Schools (Consultation) (Scotland) Bill, debate on the group of amendments shall, subject to Rule 9.8.4A, be brought to a conclusion by the time limit indicated, that time limit being calculated from when the Stage begins and excluding any periods when other business is under consideration or when a meeting of the Parliament is suspended (other than a suspension following the first division in the Stage being called) or otherwise not in progress:

Group 1: 35 minutes.—[David McLetchie.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Superbly moved, Mr McLetchie.

Motion agreed to.

Clostridium Difficile

Alex Fergusson (None, Galloway and Upper Nithsdale)

The next item of business is a debate on motion S3M-5221, in the name of Jackie Baillie, on tackling Clostridium difficile.

We have a little time in hand in this debate. Jackie Baillie, you have around 13 minutes in which to speak to and move the motion.

Jackie Baillie (Labour, Dumbarton)

I need no further invitation to speak at length, Presiding Officer.

I believe that hospital-acquired infections are the greatest challenge that faces our health service. We in this chamber have a duty to meet that challenge head-on so that the people whom we represent in all parts of Scotland can feel confident that, when they enter their local hospital for treatment, they will be treated in safe and clean conditions. Our natural expectation is that we go into hospital to get better, not to be made more ill.

I recognise that some progress has been made and that the overall number of cases is reducing, but that improvement is not reflected equally across Scotland. Persistent problems remain in some hospitals in various parts of the country.

I pay tribute to the staff for all their efforts in trying to drive down infection rates. Often, they are working in difficult conditions, without the right resources to do their jobs. Many places are understaffed and ill-equipped. Staff are faced with a plethora of initiatives, different sets of guidance and no clarity about priorities. They clearly need our support and our help in the fight against C diff, but they also need clear leadership.

I recognise that C diff will always be with us. Experts tell me that it cannot be eradicated but, more importantly, they also tell me that deaths are preventable. That is the nub of the matter. The real challenge for us all is how we can minimise the number of people who die as a result of C diff and, ultimately, prevent anyone from dying from it.

I pay tribute, too, to the C Diff Justice Group. From a small number of families who were affected by the outbreak at the Vale of Leven hospital and came together to share their grief, the group has grown in numbers and in determination. Its members have pursued the Government relentlessly, demanding action and fighting hard to secure a public inquiry. Their purpose is simple and clear: no other family should have to go through what they have been through.

Since the outbreak at the Vale of Leven, however, we have witnessed outbreaks in Balfour hospital in Kirkwall; Caithness general hospital in Wick; Dr Gray's hospital in Elgin; Woodend hospital; Aberdeen royal infirmary, which had the highest number of cases, with around 438 people infected in a year; and Ninewells in Dundee. Our thoughts are, of course, with the families who have suffered the loss of a loved one to C diff. However, I suspect that, like the families from the Vale of Leven, they would much rather have action than warm words.

Brian Adam (Scottish National Party, Aberdeen North)

The member said that there were more than 400 cases at Aberdeen royal infirmary. I hope that she is not trying to imply that all those cases were acquired in the hospital, because many of the cases occurred in the community. The fact that more than 400 people with the infection have been identified does not mean that they acquired that infection in the hospital.

Jackie Baillie (Labour, Dumbarton)

I agree that there is a problem in the community as well, but it is regrettable that one action that we have previously talked about in this chamber and which would do something about that problem—monitoring what goes on in care homes—has yet to be properly taken. I hope that Brian Adam will support the extension of rigorous inspection to care homes.

Last week, we learned that five of the eight patients who contracted C diff in ward 31 at Ninewells hospital had died. On 14, 17 and 18 October, three patients were confirmed as having C diff. On 19 October, an outbreak was declared, and the cabinet secretary was told on 21 October. It emerged that Health Protection Scotland visited the hospital on 29 October—15 days after the first case was identified. On 11 November—a full 28 days after the first case—the new health care environment inspectorate went in. That is, frankly, extraordinary. I do not think that the scale of the problem has quite been grasped.

Last week, the cabinet secretary told us that we should not make comparisons with the Vale of Leven. The outbreak there affected 55 people, 18 people died, and it occurred over a six-month period across six wards. The mortality rate—the worst in the United Kingdom at the time—was 33 per cent. At Ninewells, the mortality rate is 62 per cent and the infection appears to be concentrated in one ward, yet it is 15 days before Health Protection Scotland shows up and 28 days before the new inspectorate pitches up.

Did it not occur to anyone that the staff at Ninewells could have done with some support, advice and guidance on what needed to be done? It is shocking to discover that our procedures for dealing with food poisoning outbreaks are more robust than those for tackling C diff, which we know is more deadly and has claimed more lives.

Professor Hugh Pennington said:

"current policy leaves the failing hospital to investigate itself at the most important time in an outbreak—its early stages, when prompt action is most likely to nip it in the bud.

In regulatory terms, the contrast with the action that is taken in response to a food-poisoning outbreak is stark. Such outbreaks are caused by microbes that have mortality rates much less than C.difficile ... But as soon as they are declared they are investigated by independent outbreak control teams with speedy action as their hallmark. The inspectors dig deep at once. They have powers to close premises, which they use. They prosecute. On the other hand, for the NHS in Scotland just now, it is like a supermarket with a food-poisoning outbreak being left to investigate itself and handle its own media inquiries, only being inspected weeks later."

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I am sure that Jackie Baillie does not want to give a misleading impression. However, will she accept that she is giving the impression that, when the outbreak was declared at Ninewells, nothing happened for several days? Will she state her acceptance of the fact that, as soon as the outbreak at Ninewells hospital was declared, the ward was closed, the outbreak control team was established and the outbreak was being actively managed by the staff?

Jackie Baillie (Labour, Dumbarton)

The cabinet secretary knows very well that I am not suggesting that at all; I am suggesting that the Scottish Government must act. We need earlier intervention. The inspection team must be in right away, not 28 days later. It must have the powers to close wards, tackle the problems and ensure the safety of patients. That would be a sensible measure that recognises the seriousness of the problem, yet the cabinet secretary resists it. Families will be left wondering why.

I will now deal with the information that is provided to patients, relatives and the public. I strongly believe that the public have a right to know what is happening in their hospitals and will be our partners in tackling C diff.

I invite members to consider the commitment that was made by the cabinet secretary some time ago, and which was repeated in a press release in January this year, to establish hospital-by-hospital reporting on a web portal that the general public could access. How many members have looked at that portal? It takes the form of a web page, tucked away on the Scottish Government website, that provides links to non-standardised, complex information that is, incidentally, two months in arrears. That is nowhere near good enough to allow people access to information. Some health boards do not provide information about individual hospitals, and others do not provide any information at all. The recent report by NHS Tayside, which was considered by the board on 5 November, says nothing about the outbreak because it is out of date. We need a single website, updated in real time, showing the performance of every hospital across Scotland.

We also need to issue guidance to national health service boards about when and how they should report outbreaks. I regret that it was three weeks before NHS Tayside reported the outbreak publicly and that only then did the cabinet secretary make a statement to the Parliament. I also deeply regret that her statement was misleading. I do not believe for a minute that that was her intention, but that was the outcome.

Let me back up that charge. Members will recall the cabinet secretary making it clear that the patients and relatives were kept fully informed at all times. I have been contacted by a family that lost a loved one in the recent outbreak at Ninewells. I have their permission to describe their experience, and I will quote from their letter:

"Never at anytime were we aware or had we been told that it was the virulent 027 strain. This information we have distressingly had to read in our local newspapers therefore the quote in today's Evening Telegraph that 'families were kept informed at all times' is utter rubbish! We (the family) were extremely upset by the lack of continuity between staff with their hygiene. So this confession of an outbreak of C Diff in Ward 31, Ninewells Hospital to the press and television comes as no surprise although very distressing."

The cabinet secretary told members in the chamber that patients and relatives were kept fully informed at all times. I am sure that she will want to reflect on what NHS Tayside told her, because the clear view of that family is that that was not the case.

Here are some of the family's other concerns:

"The smell from the bin, which was full of soiled pads, was absolutely disgusting and I asked a Senior member of staff if it could be emptied ... her reply 'use the airfreshner spray, that's what it's for!'"

Joe FitzPatrick (Scottish National Party, Dundee West)

The member might reflect that that kind of line of argument is seen by staff in our NHS and in particular in the hospital concerned as a direct attack on their professionalism. [ Interruption. ]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Jackie Baillie (Labour, Dumbarton)

I think that it is appropriate to reflect the very real concerns of patients. I said at the start that I think that our NHS staff do a tremendous job, but I also think that they need to be resourced and properly equipped and that they should not be understaffed.

The family's letter continued:

"Staff would come in to the room at night no apron, no gloves and remove the water jug and glass that was used throughout the day then again move on to another patients room. The oxygen mask, blanket and pillow were lying on the floor at visiting time. At this point we had been told that the infection was now airborne .... the nurse picked up the mask, pillow and blanket and put the mask back on her face and the pillow and blanket that had been on the floor back onto the bed! When I arrived she was sitting in her chair by the sink in the room. There was faeces on the floor, in the sink, on mum's nightie and all over her slippers."

The most basic lessons from the Vale of Leven hospital have not been learned at Ninewells, and that family's experience is heartbreaking.

Let me turn to another patient at Ninewells, this time from another ward a few months earlier. The patient had been discharged from hospital while she was still feeling unwell. Here is what she had to say:

"On arriving home I received a call from ward 14 to inform me that a stool sample had tested positive for C Diff. No information was provided by Ninewells on how to manage the infection. To be quite frank and honest I had no idea exactly what c-diff was or how to manage it. My mother who is registered disabled and has previously had 2 strokes and 2 heart attacks took over my care as I was so unwell. As you can appreciate I was extremely concerned throughout for her health and wellbeing and the thought that I could pass the infection on to her."

That lady was not readmitted to hospital or advised what to do. She was left to manage herself with the help of her aged mother and her local general practitioner, whom she had the presence of mind to contact. She has been ill for three months now.

The lady was also not on ward 31. Clearly, other wards at Ninewells were affected over a relatively similar time. Did the look-back consider those, or did it just consider ward 31? What was the trigger-point in that other ward? Would that lady have even been counted in the statistics, given that she was already at home? Is that the kind of experience that patients should expect?

I say to the cabinet secretary that, frankly, this is not good enough. We need the Scottish Government to be more ambitious in tackling C diff. Let me encourage the cabinet secretary to look again at Labour's 15-point action plan. The Government claims to have accepted five points, but that is stretching credibility. I can identify only three points, and one is so grudging that it only qualifies as a half. We suggested more robust inspections, and we do so again today. We suggested hospital-by-hospital reporting, as we do again today. We suggested a more ambitious health improvement, efficiency, access and treatment target, as we do again today. The current HEAT target is to achieve a reduction of C diff in Scotland of 30 per cent by 2011. England has managed a reduction of more than 40 per cent in just one year. We believe that the target should be 50 per cent. Is the cabinet secretary content that Scotland should aim lower? Let us remember that behind each of those statistics are real people and their families. We should be much more ambitious in our determination to tackle C diff and prevent needless deaths.

That determination needs to be backed by resources. I was bemused by the cabinet secretary's claim to have increased funding for C diff by 260 per cent, so I went on a journey of discovery, assisted by the Scottish Parliament information centre. Members may recall the cabinet secretary leading a debate in Parliament on hospital-acquired infections in March 2008. There was no mention of C diff in her contribution; the focus was only on MRSA. She did announce in the debate increased resources of £54 million over three years, starting in April, but that was months before the outbreak of C diff at the Vale of Leven. That budget line has not increased, despite the plethora of initiatives. The Royal College of Nursing rightly made that point during the most recent budget round, and it remains true today.

Alex Fergusson (None, Galloway and Upper Nithsdale)

I must ask you to close now, please.

Jackie Baillie (Labour, Dumbarton)

Okay, Presiding Officer.

The cabinet secretary said that the NHS would learn lessons from the Vale of Leven. On 18 June, she told the Parliament:

"I am determined to ensure that the lessons learned from the exercise will help us to drive C difficile ... rates down and reduce the risks to patients."—[Official Report, 18 June 2009; c 9893.]

She said that again in August 2008. On 11 September 2008, she said that wider lessons need to be learned. On 10 February and 22 April 2009, she said that she would "learn lessons". She repeated that on 24 June and 24 August, and just last week in the chamber, she said:

"It is important to learn lessons."—[Official Report, 12 November 2009; c 21105.]

I say to the cabinet secretary that it is almost two years on from the outbreak at the Vale of Leven hospital, and two years on from people dying of C diff.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Ms Baillie, you must close now, please.

Jackie Baillie (Labour, Dumbarton)

The families of all those who died then and have died since want to know how long it will take the Scottish Government to learn those lessons.

I move,

That the Parliament commends all NHS staff for their efforts in the fight against Clostridium difficile; recognises that significant challenges remain in reducing the number of deaths from Clostridium difficile in all NHS board areas; calls on the Scottish Government to establish a more robust inspection regime that provides for an immediate inspection of any hospital at which there is an ongoing outbreak to provide advice and ensure that guidelines are properly followed; considers that the inspectors should have the power to close wards, or any other part of the NHS estate, that might contribute to the spread of infection; regrets the delay by the Cabinet Secretary for Health and Wellbeing in making matters public following the outbreak at Ninewells Hospital; believes that patients, relatives and the public have a key role to play in preventing the spread of Clostridium difficile, and further believes that there should be a single website, updated in real time, showing the performance of every hospital in Scotland and guidance provided to NHS boards on reporting outbreaks immediately.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I will first pick up on Jackie Baillie's closing statement. I say again that the Government will always look to learn lessons—we do learn lessons and we will continue to do so—but I also point to the fact that, since the Government took office, rates of C difficile in our hospitals have come down by more than 40 per cent. That is not good enough, but it is progress that I think Jackie Baillie should acknowledge and should have acknowledged more prominently in her speech.

I welcome this debate because it gives me further opportunity to reinforce the importance that I attach to driving down levels of infection and it allows me to set out the detail of the actions that we are taking to reduce the risk of health care associated infection-related harm. It also gives me the opportunity again to offer my condolences to the families of those patients who died following the recent outbreak in Ninewells hospital.

On Ninewells, Jackie Baillie raised a number of serious concerns that were expressed by a relative of a patient who died at Ninewells. I advise members that the concerns were contained in a letter to me last Thursday evening. That letter was copied to Jackie Baillie and, I believe, to Ross Finnie. I responded to the letter on Friday, advising the relative that I had asked NHS Tayside to carry out a full investigation of the concerns raised in it. The relative will obviously be kept fully informed, as is her absolute right. I have also offered to meet her to discuss the serious concerns that she raises. However, she did ask me to treat her letter confidentially, and I will continue to respect that.

Jackie Baillie (Labour, Dumbarton)

Does the cabinet secretary acknowledge that I stated in my speech that I had been given explicit permission by that lady to raise the substance of her case?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Jackie Baillie may have taken what I said as a criticism of her, but it was not intended to be. She may have the permission of the relative to discuss the detail, but I do not. I will therefore respect the confidentiality that she requested.

The fact that any patient contracts infection in any hospital in Scotland frankly appals me. As I have said in the chamber before, I have personal experience of a relative contracting C difficile in a hospital. I know how deeply distressing it is. That is one of the reasons why I have said and will continue to say that tackling infection is my top priority. It is a challenge—I will never hide the fact that it is a challenge—and I hope that all members, throughout the chamber, will unite in addressing it because it is too important to be subject to party politics. I agree with Jackie Baillie that it is the biggest challenge that our NHS faces, and the NHS has a right to expect the support of all of us in facing and meeting it.

We know that regular and effective hand hygiene with soap and water is key to preventing the spread of C difficile. It is also vital that the hospital environment is kept scrupulously clean, especially when patients are known to have C diff. It is for those reasons that we have introduced a zero-tolerance approach to hand hygiene, provided additional funding to pay for extra cleaners, and deepened and made more robust the cleaning specification and the monitoring framework. To ensure that all those measures are having the desired effect, we have established the health care environment inspectorate—the HEI—which I will say more about later.

Prudent antibiotic prescribing is another vital element in reducing the incidence of C diff. The Scottish management of antimicrobial resistance action plan is currently being implemented by the Scottish antimicrobial prescribing group, which details the national programme for the promotion of prudent prescribing in both primary and secondary care. All NHS boards now have an established antimicrobial management team, and we have provided additional funding for the appointment of antimicrobial pharmacists to ensure that that is the top priority that it needs to be. Quality measures for antimicrobial prescribing have also been integrated into the HEI process.

The independent review team that I established to look into the events at the Vale of Leven hospital last year produced a report containing seven key recommendations. Those were translated into an action plan for NHS Greater Glasgow and Clyde and were also used to inform the national action plan for all NHS boards to drive improvements in the key areas of governance, leadership and surveillance.

The action plans were in addition to the comprehensive work programme that is being overseen by the HAI task force. The task force includes members with clinical, scientific and education backgrounds as well as, crucially, members of the public. The work programme, in its entirety, is backed by record investment of more than £50 million over three years In addition to all that, initiatives such as the new national uniform and the piloting of approaches to bed management and infection tracking that have been promoted by the Conservatives will all help us, over time, to continue to drive the rates of infection down even further.

Recent events at Ninewells have once again brought into sharp focus the importance of ensuring that we are doing everything possible to control infection. I said last week and I say again today—this is relevant to Ross Finnie's amendment—that I will reflect carefully on the outcome of the investigations into that outbreak and I will ensure that any action that needs to be taken is taken. The HEI carried out a follow-up visit this week to ward 31 and the findings of that inspection will, of course, be made public.

I am very aware of people's anxiety about the risk of infection in hospitals. That is why we must continue to ensure that all our health care environments have robust processes, policies and procedures in place to minimise the risks.

Richard Simpson (Labour, Mid Scotland and Fife)

Will the cabinet secretary give way?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Not just now. I want to make progress in outlining the action that we are taking.

The new health care environment inspectorate is vital to the process of ensuring that health care environments are up to the standard that patients have a right to expect. When the inspectorate inspects a hospital, it has the power to make whatever recommendations it thinks fit. I believe that the HEI, which was recently established, should now be allowed to get on with its work and make a difference in hospitals across Scotland.

Of course, no inspectorate—neither the one in existence nor the one that Labour now seems to think should be in existence—can be in every ward all of the time. That is why it is so important that, when infection is identified, the staff on the ground can take all the necessary action to safeguard patient safety. It is important to stress, again, that it was the staff at Ninewells who took the action to close ward 31.They did not need to wait to be told by an inspectorate; they took the right action at the time.

Richard Simpson (Labour, Mid Scotland and Fife)

No one is suggesting, no one has suggested and no one will suggest that the actions of the staff after the outbreak occurred were anything less than excellent in controlling the outbreak, but the fact remains that neither the HPS nor the HEI—the two bodies charged by the Government to oversee—offered on-the-spot guidance from their experience of the four previous outbreaks. That is the point that we are trying to make; we are not criticising the staff at Dundee.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

In these circumstances, staff groups and boards will take advice and guidance from HPS on an on-going basis, whether or not HPS is on the ground in the hospital. It is important to say, because I do not think that Jackie Baillie stressed this as strongly as she should have, that the ward was closed. It did not need an inspectorate to close the ward, because the staff took the right action.

I believe very strongly that transparency is important. That is why we introduced local reporting, hospital by hospital, on performance on MRSA, C diff, hand hygiene, environmental cleaning and the causes of adverse incidents. We have also introduced a single website portal, which was never previously in existence, so that there is access to the information. There is now greater transparency, around C diff in particular and hospital infection in general, than there has ever been.

I have said before and I say again that I think that reducing infection should be above and beyond party politics. Nevertheless, I cannot ignore the fact that for most of the previous Administration's time in office we had no idea how many cases of C diff there were, either locally or nationally, because prior to the end of 2006 the information was not even collected on a mandatory basis and was not published for the first time until early 2007. That was the reality under the previous Administration, whether Labour members like it or not, and we now have greater transparency around C diff than ever before, which I believe is right.

I acknowledge the concern that has been raised about when it is appropriate to inform the public of an outbreak. I hope that all members will recognise that, in the case of Ninewells, the reason for not doing that immediately was to allow the staff to focus on managing the outbreak. I also hope that all members will recognise that early public notification would have changed not one single thing about the management of the outbreak. However, given the concerns that have been raised, I have asked the HAI task force to review the arrangements in place for notifying the public about outbreaks of C difficile, with a view to issuing guidance to NHS boards. I have also asked the task force to ensure that any change ensures consistency of approach across the NHS but does not detract from the absolute priority that staff on the ground have of protecting patient safety and ensuring that the interests of patients and their families are preserved at all times.

I make no apology for the fact that this Government has, for the first time, set challenging targets for the reduction of C diff. The 30 per cent reduction is the minimum that we expect to be achieved and we will ensure that it is subject to on-going review, but let us not lose sight of the fact that progress is being and has been made. The latest figures indicate that there has been a 14 per cent reduction in C diff from the previous quarter and a 42 per cent reduction compared with the same period in the previous year and, as I said earlier, since this Government took office there has been a 44 per cent reduction in rates of C diff.

Is that good enough? No, it is not, because, as I also said earlier, every single time a patient contracts an infection in hospital it appals me. While that is still happening, I will take the view that we have more work to do. However, staff should be given the credit for the progress that has been made and, more important, they should be given the support of all members in the chamber as they strive to make even more progress.

I move amendment S3M-5221.1, to leave out from "commends" to end and insert:

"agrees that tackling Healthcare Associated Infection (HAI) must continue to be a top priority for the Scottish Government; notes the range of actions that are now in place to drive down infections, backed by an investment in excess of £50 million; welcomes the establishment of an independent Healthcare Environment Inspectorate that has begun its programme of announced and unannounced visits to all acute hospitals over the next three years; acknowledges that the establishment of a public inquiry into the events at the Vale of Leven Hospital last year will ensure that any additional actions are identified to help prevent such a tragedy happening again; further acknowledges that the HAI Taskforce has fully considered the Labour Party 15-point action plan and has agreed to further consider those measures not already included in its current three-year work programme; recognises the progress that has been made on a national staff uniform for NHS Scotland; further notes that the Scottish Government has agreed to pilot approaches to electronic bed management and tracking infections and will fully evaluate these pilots and take whatever action is appropriate, and further notes that the Cabinet Secretary for Health and Wellbeing will continue to ensure that systems and processes for the notification and management of outbreaks are improved in light of experience."

Ross Finnie (Liberal Democrat, West of Scotland)

There is no dispute across the chamber that hospital-acquired infections and C difficile, in particular, continue to be a significant problem across Scotland. I do not think that there is any doubt or disagreement about that, nor is there any disagreement about the need for concerted efforts to be made to tackle such infections. The recent outbreaks of C diff at Ninewells and at other hospitals have served only to underline how susceptible our hospitals are and—as Brian Adam made clear in his intervention—that is also the case in our communities.

It is perfectly understandable, therefore, that the Labour Party should choose to use its debating time to discuss an important topic that has already occupied, quite rightly, a great deal of the Parliament's time and attention. However, a consistent difficulty in such discussions is that, although we want of course to concentrate on reducing and containing infections, we all admit that we cannot guarantee that we will be able to eliminate them. Therefore, I have some difficulty with any speech that gives the impression that, somehow, if we all do what we have said, we will never again have an outbreak of C difficile. That is not compatible with acknowledging that totally eliminating such infections is not within our capability.

Although I accept that it is perfectly legitimate—indeed, it is the correct process—that those of us who occupy the Opposition benches should question the cabinet secretary and call her to account on the efficacy with which the recent raft of initiatives has been introduced and on how those initiatives are working, I am not at all clear why Jackie Baillie, having used her speech to list a litany of what she believes to be errors in the efficacy of those measures, suggested that the solution is to introduce a new regime. I can understand individual criticisms and requests that certain recently established bodies should do better, but I have difficulty with her call for a new regime.

Having considered Jackie Baillie's motion and her speech, I still find much more sympathy with the Royal College of Nursing, whose briefing expressed concern that the number of action plans, initiatives and strategies is causing stress and confusion among national health service staff.

Jackie Baillie (Labour, Dumbarton)

The member might recall that Labour's 15-point action plan specified the need for a tough inspection regime, which was followed up by the establishment of the health care environment inspectorate. All that we seek is for that regime—the existing regime—to move in much earlier.

Ross Finnie (Liberal Democrat, West of Scotland)

If I may say so, that is not entirely clear from the wording of the motion. Jackie Baillie's speech was, I might respectfully suggest, slightly clearer about the purpose of today's debate than is the motion on which she seeks the Parliament's support.

A second point that the RCN makes is that it believes that the updating and consolidation of existing plans should continue, but there should be a moratorium on any new initiatives or action plans on HAIs unless they are demonstrably needed. That is quite an important point.

As the cabinet secretary pointed out, and as all members are fully aware, the independent health care environment inspectorate was established only in April this year. Like other members who have expressed concern, I was concerned at the time that its first inspection was not conducted until September. Criticism has been made by Jackie Baillie about the length of time before the inspectorate started working. However, that is a criticism not of the regime but of the way in which the inspectorate appears to be tackling its job. I have no doubt that the HEI ought to understand that greater urgency is required in the way that it deals with such infections if it is to discharge its duties properly, but we do not need to invent a new regime for that. We can make that point without demanding that new plans, procedures and processes be created to carry out those duties. We accept the criticisms, but we have no problem with the nature, way and purpose of the inspectorate. From its existing reports, actions and findings, it is absolutely clear that the HEI is designed to establish infection control regimes and to ensure better awareness of surveillance procedures and greater consistency across the NHS. That is what the inspectorate was set up to do in April this year. However, I join those who say that greater urgency is needed.

Nor, indeed, do I have difficulty with the strategic approach for tackling such infections, which was the task given to the HAI task force that was established in 2003—a date I well remember because, of course, we had a much better Government in place then—and is now dealing with its third programme of work. Again, I find difficulty with the suggestion that, at that strategic level, we were wrong—or, indeed, that the current Government is wrong—in asking the HAI task force to devote itself to five areas of work: patient safety, practice and culture; education; surveillance, information and audit; guidance and standards; and the physical environment. We believe that that was the right approach. Again, the need for urgency is an issue, but that does not mean that we need a fundamental and radical change. Rather, we need to address the issue through the existing bodies.

However, as a party, we are certainly not unconcerned about recent circumstances. Like Jackie Baillie, I received a copy of the letter that she quoted from. Indeed, I immediately sought information from the cabinet secretary on what exact steps were being taken and what inquiries were being made with the hospital about those appalling circumstances, but I was not aware whether those circumstances reflected the situation in the hospital as a whole or only a particular case in one part of the ward. I sought that information, but for reasons of confidentiality—on which Jackie Baillie has clearly received different guidance—I am not able to pursue the matter further in this debate.

It is clear that all parties in the Parliament can claim credit for supporting and introducing the many initiatives that have been brought in—there has been a very large number of them—but, as the RCN reminds us, the NHS Quality Improvement Scotland report that was published in June found areas in which implementation of the initiatives still needs to be improved. I have no difficulty in making that point.

We will continue to support the Government's overall strategy on combating HAI—much of which was in place before the current Government took office—but, as an Opposition party, we will continue to look very critically indeed at the monitoring and reporting of the strategy. However, one issue that continues to cause us concern is the terms of reference of Lord MacLean's inquiry into the C diff outbreak at the Vale of Leven hospital—

Alex Fergusson (None, Galloway and Upper Nithsdale)

I must hurry you.

Ross Finnie (Liberal Democrat, West of Scotland)

I appreciate that there are stateable reasons for distinguishing the Vale of Leven outbreak from other outbreaks. I also appreciate that paragraph f of the terms of reference allows Lord MacLean to consider other outbreaks if he so wishes. However, I believe that it would be in the public interest for the cabinet secretary to change those terms to call on Lord MacLean expressly to consider the circumstances of the other outbreaks. Although I believe that the public will welcome Lord MacLean's reporting on the outbreak at the Vale of Leven, I think that they will think it more than a little odd if the findings of his report are not informed by the circumstances surrounding those other outbreaks.

I move amendment S3M-5221.1.1, to insert at end:

", and calls on the Scottish Government to review the remit of the public inquiry currently being conducted by Lord MacLean so as to require that inquiry to consider the circumstances of other cases of Clostridium difficile in hospitals across Scotland to verify that the measures taken by the Scottish Government are sufficient to meet the needs of all Scottish hospitals."

Mary Scanlon (Conservative, Highlands and Islands)

On behalf of the Scottish Conservatives, I join others in extending our sympathies to all those who have lost family members to Clostridium difficile outbreaks in Scotland. I acknowledge the tone of Ross Finnie's speech, which stressed that we have a constant battle against C diff and other health care associated infections.

Let me start by addressing the issues that are contained in the Labour motion. First, the motion calls on the Scottish Government

"to establish a more robust inspection regime that provides for ... immediate inspection".

However, I understand that the six-month-old health care environment inspectorate, which issued its first report into Forth Valley NHS shortly before the Ninewells outbreak, already has the power to make an immediate inspection if that is felt to be necessary.

Secondly, as Ross Finnie referred to, the motion states that

"inspectors should have the power to close wards".

The Labour Party's adviser, Professor Hugh Pennington, commended NHS Tayside for closing the ward immediately on 19 October when an outbreak was determined. The call for inspectors to take the necessary action to close wards illustrates little trust in the competence of NHS staff to deal with the outbreaks. We think that NHS staff need support and guidance, but equally we think that they are trained and competent, and committed to tackling infections.

I do not think that I can make my next point as sensitively as it needs to be made against the background of the tragic circumstances that we are talking about. Mandatory surveillance of C diff in England commenced in 2004, but the Liberal-Labour Executive in Scotland introduced it only in the last quarter of 2006, or two years after it was introduced in England. Why did the Labour Party take two years longer to commence mandatory surveillance in Scotland? C diff cases in England have fallen by more than 60 per cent, compared with 44 per cent in Scotland. That is undoubtedly the result of reporting measures having been put in place in England to ensure that outbreaks are known about, and of outbreaks having been recorded and appropriate action having been taken there.

I say as sensitively as I can against the background of tragic circumstances that Labour was in charge of the health service for 10 years prior to the outbreak at the Vale of Leven hospital. As a Highlands and Islands MSP, I have met campaigners in Argyll who were very worried about the running down of services at that hospital. If Argyll patients came to me and to Jamie McGrigor to express their serious concerns about that hospital, surely Jackie Baillie was aware of the problems there, given that the hospital is in the heart of her constituency. I had hoped that the Labour Party would apologise to families and patients today.

Jackie Baillie (Labour, Dumbarton)

That is outrageous. If Mary Scanlon had been around the Vale of Leven hospital and had paid attention to the C diff outbreak there, she would understand that there was a lack of surveillance. It was not a question of whether the hospital was being changed or altered in any way. The member does the families a disservice if she does not acknowledge that.

Mary Scanlon (Conservative, Highlands and Islands)

To be honest, if I had Jackie Baillie's pride in what went on there, I think that I would be hiding behind my desk rather than jumping up to make an intervention.

The findings of the independent review into the C diff outbreak at the Vale of Leven hospital confirmed that there had been underinvestment in upgrading and maintenance for a decade, and ineffective isolation and infection control. Facilities were described as inadequate for effective patient isolation. The findings confirmed that there had been a lack of leadership and no clear line of professional responsibility, which led to the inadequate management of outbreak cases, poor hand-washing facilities, insufficient toilets, inappropriate spacing between beds, poor information on hand washing and laundry, a failure to monitor antibiotic levels, and very low staff morale due to the uncertainty surrounding the hospital. I could continue, but the picture is clear. I am sorry to say that all that happened on Labour's watch. Jackie Baillie can have as many debates on C diff as are necessary, but she cannot shirk from her party's responsibility in government when it was in charge of the NHS in Scotland.

I raise again the issue of electronic bed management and infection tracking, particularly given the C diff case in Ninewells hospital in August, two months before the outbreak. Such a system records each patient journey by bed space and ward, and gives a history of bed space, including patient occupancy and cleaning information. It also allows the easy and quick identification of contact trace adjacent patients. That would undoubtedly have been helpful in the Vale of Leven hospital and in the recent outbreak at Ninewells hospital. An audit trail is essential in such situations. The benefits of such a system are that it reduces infections, the antibiotics that are used and lengths of stay in hospital, and it leads to the more effective use of resources, the safer management of beds and the integration of infection control into daily staff routines. That is why we promote it and are committed to it.

I was not going to say what I am about to say until I heard Jackie Baillie talking about patients in Dundee and in the Vale of Leven hospital. My mother died in a hospital in Dundee in 2001. An in-house tender had been used, and the hospital was anything but clean. I complained and raised the issue then, but nothing was done. I am sorry to raise that matter; I would not normally bring a family member into such debates.

I thank the Labour Party for lodging the motion on the basis that, although considerable action has been taken, we can never be complacent in our efforts to tackle Clostridium difficile. The Royal College of Nursing made an important point about the existing initiatives, which my colleague Nanette Milne will expand on in her speech. We will not support Labour's motion, but we will support the Government's amendment.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

Given the tone of the debate, I do not think that anybody could question Jackie Baillie's commitment to the C difficile campaign or to the Vale of Leven hospital. I did not intend to say that, but an approach seems to have been taken that personalises the motion. I regret that.

Tackling Clostridium difficile is an important issue that matters to people in Scotland and throughout the UK. I want to put it in context. In 2007, a major outbreak of C diff prompted an inquiry at Maidstone district general hospital in Kent. Following that inquiry, Maidstone and Tunbridge Wells NHS Trust set in place an action plan. In 2008-09, there was a reduction of more than 60 per cent in C diff infections in that hospital, compared with the figure for the previous year. The hospital has maintained that improvement. That is an important point. There has been a further 26 per cent year-on-year reduction in such infections to the end of September this year. That means that the hospital has exceeded its 2010-11 targets two years ahead of schedule. I was interested in how the hospital had achieved that improvement—its reduction is well in advance of our targets—so I visited it during the October recess.

The first thing that visitors see when they arrive at the hospital is a large display that explains the trust's crusade against hospital-acquired infections. A hand-gel process is meant to be used by everyone who enters the building. If anybody passes by without using the gels, they are immediately met by a volunteer or a member of staff, who points out the hand hygiene policy and ask them to comply with it. That is before the person gets as far as even the main reception desk, never mind a ward or clinic.

A number of important factors have been progressed in Maidstone. Permanent isolation wards have been opened, a restricted antibiotic policy has been introduced, and new rapid risk assessment procedures have been introduced for patients with diarrhoea. Those measures have helped to reduce C diff cases and have dramatically reduced the number of beds that have been closed because of norovirus over the winter months. Every case of C diff or HAI is now subjected to a root cause analysis. Only two episodes of cross-infection, which affected four patients, occurred there in 2008-09. Efforts have also been made to tackle MRSA by screening all patients who come into the hospital for elective treatment, and improving procedures on blood culture practice. In that context, perhaps it is worth comparing HAI rates in England and Scotland in the past couple of years. MRSA rates have reduced by 57 per cent in England; the 23 per cent reduction rate in Scotland lags somewhat behind that figure.

Maidstone and Tunbridge Wells NHS Trust has done other things that we are seeing happening here or want to see happen here. It has introduced a new uniform and dress code, including a bare-below-the-elbows regime, and more than 4,000 staff members have attended additional training sessions in hand hygiene. When I spoke to staff, they said that those sessions had been useful because they explained why the new procedures were being introduced. That is important in the context of the RCN's comments. The trust plans to continue that training and also plans to increase the use of hydrogen peroxide fogging to decontaminate side rooms and isolation wards. It will extend its root cause analysis to include surgical wound infections, and it intends to extend the screening for MRSA of patients on admission.

All those measures are vital—I acknowledge that they mirror some of the things that are happening here—but perhaps the most significant thing in Maidstone was the fact that there had been a radical change of culture within the hospital and the organisation. Clear responsibilities were laid down, with senior staff in microbiology and nursing leading the work but on the basis that every member of staff in the trust also had a responsibility. That was very important. The appointment of an additional consultant microbiologist and two senior matrons to work on infection control was seen as absolutely critical to making the improvements. On a tour of the wards, I had the opportunity to hear from those matrons and the consultant microbiologist exactly what had happened at ward level.

Jackie Baillie spoke of the need for information to be provided on the NHS website, and I agree with her comments. It is difficult for members of the public to find that information. In Maidstone hospital, the information on instances of C diff in particular wards is displayed on posters at the entrance to each ward so that people going into the hospital—visitors and patients—can see it. That is also a reminder for the hospital staff of how important the infection control measures are.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I am happy to learn lessons from anywhere, Maidstone included. However, has Cathy Jamieson visited any of the Scottish hospitals that are participating in the patient safety programme? If so, she will have seen the same poster displays showing improvement in performance in a range of areas. It is fine to draw lessons from elsewhere, but it is not fine to ignore the similar progress that is being made in hospitals in Scotland.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

I hope that Nicola Sturgeon heard me say that I recognise that the measures that are being taken in Maidstone mirror some of the initiatives that are being pursued in Scotland. I am aware of the patient safety programme, but I am trying to get across the change in culture that is needed.

All the measures that I have described were important in Maidstone. It was not about taking individual measures; it was about using those measures to change the culture. The nursing staff in Maidstone felt that that was very important. One member of staff described how, during previous outbreaks and episodes of infection,

"numbers had been collected, but no-one spotted what was actually going on".

Another member of staff told me that, previously, everybody had been working in their own areas and the bigger picture had been missed. That is relevant to the suggestions that have been made today that, somehow, in calling for additional work to be done we are attacking staff in the NHS. Far from it—we want to recognise the work that is being done by NHS staff and to support them.

Several members of staff whom I met in Maidstone made the point that much of what is being done could be described as common sense; yet, it needs constant monitoring and direction to ensure that the good practice and the consistently applied standards do not slip. The situation is mirrored in Scotland, and that is important in the context of our motion. Everyone in Maidstone is acutely conscious of the fact that it is about not just ticking boxes, but saving lives. We will, no doubt, learn further lessons from the Vale of Leven inquiry, but we cannot stand still in the meantime. I am glad that Nicola Sturgeon is more than happy to learn lessons from anywhere, whether in Scotland or elsewhere in the UK. There are lessons to be learned from what has been achieved in Maidstone, and I hope that we can stretch our aspirations further than the very modest targets that have been set in Scotland.

Ian McKee (Scottish National Party, Lothians)

At the risk of annoying Cathy Jamieson by personalising matters further, I congratulate Jackie Baillie on her restoration to a position on the Opposition front bench. She is renowned for her intelligence and perseverance, and I wish her well. I also join others in expressing my condolences to those families who have been affected by the terrible outbreaks of C diff that we are debating. However, I am sad to say that I am more than a little disappointed by the terms of the motion. I will take a little time to say why.

Clostridium difficile is a bacterium that is resident in the digestive systems of up to 5 per cent of the general population. It usually lives quite happily alongside the many other flora that inhabit the gut; however, things can go wrong when antibiotics—especially those belonging to a group called the fluoroquinolones—that are taken to treat serious infection also wipe out large numbers of harmless gut bacteria. In such circumstances, left to its own devices, Clostridium difficile multiplies and spreads to take up the extra available space. C diff produces toxins—potential poisons—that normally do no harm because they are produced only in small quantities, but it is a different story when C diff multiplies. Large quantities of the toxins cause symptoms such as bloating, constipation and diarrhoea. Those symptoms would be bad enough, but if the person is debilitated with other conditions—if they are immunosuppressed for some reason, or if they are very elderly—C diff diarrhoea can be fatal, especially if the strain is an extra-toxic one such as the 027 strain. It must, therefore, be taken very seriously. Furthermore, as C diff is spread from person to person via the faecal-oral route, those who live closely together for a period of time, such as long-term nursing home residents, are at greater risk. It has been suggested that 50 per cent of patients who are in hospital for longer than four weeks will acquire the bacterium.

As the cabinet secretary has said, C diff multiplication within a person is a side-effect of antibiotic consumption. Therefore, it follows that the most important way of preventing overt infection is to modify antibiotic prescribing policies, especially in the categories of patient that I have mentioned. Yet, the motion does not even mention antibiotics let alone suggest that anti-microbial prescribing policies need to be reviewed. It is estimated that much of present-day anti-microbial use is inappropriate. The situation is easy to identify but extremely difficult to remedy; nonetheless, we should at least acknowledge the fact. To use an old cliché, I suggest that the proposals in the motion, although important, are like concentrating on pulling people out of a river rather than on preventing them from falling in in the first place.

Richard Simpson (Labour, Mid Scotland and Fife)

I fully understand Ian McKee's analogy. The concept of an antibiotic policy was introduced in around 2003 or 2004. We did not mention it in the motion because it is not new. The problem is the implementation of the policy, not the policy itself. The motion simply refers to the robustness of the regime that we have.

Ian McKee (Scottish National Party, Lothians)

I accept Richard Simpson's point, but it is strange that the motion misses the most important way of preventing the multiplication of Clostridium difficile, given that we are spending a whole morning in discussing Clostridium difficile.

I am saddened by the fact that an element of party politics has been introduced into the debate. I could respond by pointing to Labour's extremely poor record in the field when it was in power, which Mary Scanlon mentioned. I could remind members of the 145 per cent increase in the number of C diff infections between 2001 and 2006 or the seven long years that it took Labour to set up a monitoring system. I could also mention the increase of 8 per cent in the number of C diff infections in England's Labour-run health service in the last quarter of 2008-09. We have heard boasts today of a 40 per cent decrease in that number, but the British Medical Journal five days ago said that the trend has been reversed and that the number of cases is starting to increase again in England. There are also accusations that some English hospital risk managers have felt obliged to record C diff outbreaks as being due to norovirus, as an increase in the number of C diff cases would have led to the risk of their being sacked. Perhaps that had something to do with the 40 per cent decrease in the number of notifications that has been mentioned. However, I will not dwell on such matters. Health care acquired infections, including C diff, are a growing problem throughout the western world and we will not succeed in taming them by bickering among ourselves.

We now have Professor Pennington's 15-point plan, although to call it Labour's action plan is a bit like someone claiming authorship of "War and Peace" simply because they have borrowed a copy of it from the library. I have already described how C diff spreads from person to person. Its spores can survive a long time and are resistant both to heat and to alcohol cleansing. It contaminates all areas around an infected patient, but is susceptible to bleach and chlorine; as a result, it is most important to thoroughly clean areas around an affected patient, to nurse such patients in isolation and to ensure that thorough hand washing is done. As the cabinet secretary has pointed out, she has treated Professor Pennington's recommendations very seriously indeed.

As in many other aspects of life today, we are faced in this situation with quantification of risk. Of course, I could take things to a ridiculous extreme and suggest that the C diff problem could be resolved almost overnight if we stopped all broad-spectrum antibiotic prescribing. However, many more people would suffer serious illness and die from untreated infections. Only to prescribe such antibiotics when one could prove that they were absolutely necessary would still lead to fatalities, as it is impossible to make such decisions with absolute certainty, and some patients in need of treatment would be denied it. The dilemma is difficult, but we must face up to it by reviewing and refining our antibiotic policies, which is indeed what is happening in every clinical setting.

Other measures that have been outlined today are important, and we need to tackle with care the problems that Jackie Baillie has highlighted. However, I gently point out to the member that, in the years when I was in general practice and the Labour-Liberal Democrat Government was in charge, I heard almost daily similar stories of what was going on in hospitals. Every case needs to be investigated, but to lay the blame for what happens in an individual hospital at a particular time at the feet of the cabinet secretary is carrying things too far.

I support Nicola Sturgeon's amendment.

Marlyn Glen (Labour, North East Scotland)

I welcome the opportunity to take part in this debate on tackling Clostridium difficile. As I said last week, I am simply seeking reassurance for the public in Tayside after the outbreak at Ninewells hospital. I note that ward 31 has reopened. It is essential that patients and visitors to the ward and, indeed, to the rest of the hospital are confident about its safety—a hard task, considering the frightening mortality rate that has been reported.

Last Friday, local MSPs attended a useful briefing on C diff. I am convinced that staff at Ninewells did their utmost clinically to deal with the outbreak. I commend NHS staff for their efforts in fighting C diff but, as Jackie Baillie's motion makes clear, significant challenges remain. After such an outbreak, the public's trust in both the NHS and the Scottish Government has to be rebuilt.

Patients, their relatives and the public can play a key role in preventing the spread of infection. I believe that many people understand that and, indeed, play that role, although it would not surprise me if it turned out that some people were confused, particularly with the wider availability of alcohol gel, even here in the Scottish Parliament. For example, we must be confident that everyone is getting the message that hand washing with soap and water is also necessary.

I am quite distressed by some of the personal reports that are emerging from Ninewells. Visitors have seen and reported real problems with hygiene handling around their relatives, from the lack of Hibiscrub soap to what appears to be a lack of urgency in responding to patients' basic care needs. That is not so-called scaremongering by the media or others; those are serious complaints that are being followed up.

The Scottish Government could also help public understanding by changing its style of communication. First, it must demonstrate by its actions that it regards tackling C diff as a priority. Secondly, it needs to take decisions more quickly. For instance, in a Labour debate on HAIs that took place in February, the cabinet secretary's amendment stated:

"the Healthcare Associated Infection Task Force has been asked to consider implementation of the elements of the Labour Party's 15-point plan not already underway".

Nine months later, we learn from the cabinet secretary—through the media—that five of the 15 points are to be assimilated into new health regulations.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

As I am sure Cathy Jamieson will confirm, the gap in question has not been from February to November. In fact, Mrs Jamieson was advised some months ago of the HAI task force's conclusions and the points in Labour's 15-point plan that were being taken on board. I have no problem with members holding this Government to account, but I do have a problem with the trend this morning of Labour misrepresenting the reality of the situation.

Marlyn Glen (Labour, North East Scotland)

My point is about communication, not just personal one-to-one communication with MSPs but communication with the general public.

Ian McKee (Scottish National Party, Lothians)

What about communication within your own party?

Marlyn Glen (Labour, North East Scotland)

And that as well, if I can respond to the comment that has come from a sedentary position. My point is that information has to be given to the public, because if we are to do anything about the problem, the general public need to be absolutely clear about the message.

Full information has to be provided at the same time. In April, RCN Scotland called for a

"co-ordinated and well planned course of action to reduce the occurrence of healthcare-associated infections"

and added:

"Rarely a week goes by without a new way to tackle HAIs being announced. It is imperative that all of these initiatives are given focus and direction."

That perhaps explains why, in June, NHS Quality Improvement Scotland reported widespread confusion about C diff guidance. After looking at three health boards, one of which was NHS Grampian, it concluded:

"We found widespread lack of clarity at all levels within the organisations—from ward to Board—around the status, uses and application of the large number of documents, tools and guidance produced at national level."

We need clear and unambiguous information on funding and action plans, because anything else simply raises false expectations about health boards' resources for tackling C diff.

In last week's statement, the cabinet secretary implied that spending on tackling C diff had increased by 260 per cent. However, as Jackie Baillie made clear, that applies to the total budget for screening for HAIs, including MRSA, over the whole budget review period. We have to face up to the fact that tackling C diff and other HAIs is not cheap. However, it is estimated that simply doing nothing will cost the NHS in Scotland more than £180 million a year, with upwards of 380,000 bed days lost through delayed discharge, ward closures and cancelled operations.

After the tragic deaths at Ninewells, people need reassurance, and confidence about their safety at the hospital must be restored. In that respect, I welcome the review of arrangements for when such matters should be made public. People need to be convinced that, as far as is practicable and wherever they are in Scotland, everyone is receiving the same standard of protection from C diff and HAIs. That might not be particularly easy, but the spread of C diff is certainly preventable. We need a comprehensive and professionally endorsed strategy that in the short and long term does what is necessary to tackle C diff. I believe that the 15-point plan provides a comprehensive guide and that, with the right support, NHS staff are our best resource. However, they need that support urgently. There are still many detailed questions about, for example, patients' laundry and nurses' uniforms to deal with but, in general, we need transparency and speedy intervention.

Joe FitzPatrick (Scottish National Party, Dundee West)

I, too, give my condolences to the families of those who died in ward 31 of Ninewells hospital as a result of the recent Clostridium difficile outbreak.

Although the debate is important and although I welcome the opportunity to discuss the issue, I have to say that I have been disappointed by the tone of some of the speeches. I believe that it is possible for an Opposition to challenge the Government; indeed, in her speech, Marlyn Glen adopted the right tone and showed how that might be done. Perhaps some of the Labour front bench will consider her example later.

Last week, there was a ministerial statement on C difficile at Ninewells. The Labour Party has brought today's debate; the Conservatives have contributed to it by championing electronic bed management; and Ross Finnie has always treated the issue in a constructive manner. It is not often that the Parliament unites over an issue but, this morning, we are united in the common goal of seeking to reduce the number of deaths in Scotland from C difficile.

Health Protection Scotland's latest figures show that the number of C difficile cases is continuing to fall, with a reduction of 14 per cent in the last quarter and 42 per cent over the past year. As the cabinet secretary has made clear, that is still not good enough, and we must continue to drive down those figures. That said, although the fact that we have reduced the number of C difficile cases to the lowest level since mandatory surveillance began will not give much solace to those who have lost loved ones, we should be encouraged by the speedy progress that is being made under the cabinet secretary's leadership.

What happened at Ninewells was very serious. However, the outbreak was not allowed to develop in the same way as last year's outbreak in the Vale of Leven hospital, which spanned six wards and led to the death of 18 patients.

Jackie Baillie (Labour, Dumbarton)

I think that all members struggle to understand the high mortality rate at Ninewells hospital. When the board briefed members, was that explained?

Joe FitzPatrick (Scottish National Party, Dundee West)

Yes. The ward in question was for the care of elderly patients, many of whom had problems that required the very antibiotics that Dr McKee talked about earlier. Also, we must be careful when using percentages when we are talking about single-figure numbers, because a single incident can put the percentages out by tens. Statistics are useful but, in the case of small numbers, percentages are not particularly useful. Obviously, mortality depends on the health of the individuals concerned, and we must always remember that we are talking about individuals.

At Ninewells, early intervention contained the outbreak, but we need to learn lessons about not just what went wrong there but what went right. When the Minister for Public Health and Sport, Marlyn Glen, Dr Simpson and I were at Ninewells, we heard about some particularly good practice that we might need to ensure is used elsewhere.

The SNP Government, with support from across the chamber, is making progress on the issue. Lessons have been learned from previous outbreaks and new procedures have been put in place to reduce the risk of harm from infection. A national health care associated infection action plan has been put in place, and an independent health care environment inspectorate has been created. An extra £5 million has been made available to pay for more domestic staff throughout the national health service.

Further measures are also being taken, such as the revamp of the senior charge nurse role and various electronic bed management and infection tracking pilots, all of which should help to ensure that the number of infections continues to drop. It was right of the cabinet secretary to acknowledge the positive contribution of the Conservative party, and Mary Scanlon in particular, in pushing those measures forward.

Although the Scottish Government and NHS Scotland are doing more than ever, we cannot afford to be complacent. The Opposition continues to play an important role in ensuring that that does not happen.

Before I finish, I would like to touch on an issue that was raised at last week's briefing, which I attended with Labour Party colleagues. I was shocked to hear of the verbal abuse to which staff from ward 31 have been subjected as a result of the deaths. We also heard about how upset the staff were at the language that was used by some politicians, which was then twisted and manipulated by the media in a way that the staff viewed as a direct attack on their professionalism. I know that that was not the intention behind the comments, but that is how they were seen by the members of staff, so we have to be careful about the language that we use, and ensure that our contributions are seen as helping the debate, not as attacks on staff, although I acknowledge that that was not the intention.

Marlyn Glen (Labour, North East Scotland)

Will the member take an intervention?

Joe FitzPatrick (Scottish National Party, Dundee West)

I am sorry, but I am in my final minute.

This is a very serious issue, and NHS staff are the front line against hospital-acquired infections, so we must support them in their work. Yes, we must debate the important issues, such as the outbreak at Ninewells, but we must be careful not to fuel the media witch hunt that often ensues, with blame being directed at the front-line staff.

Today's debate is evidence that all parties take the regrettable outbreak at Ninewells seriously. I am sure that none of us wish to have to have such debates but, as I have said, they are important to ensure that lessons can be learned and that we reduce the incidence of such tragic events. Action was taken swiftly in the case of Ninewells, and across Scotland action is being taken that is leading to a reduction in the number of hospital-acquired infections. We must continue to build on that.

Nanette Milne (Conservative, North East Scotland)

As the RCN reminded us in its briefing for the debate, health care acquired infections are not new, be they MRSA, Clostridium difficile or anything else, but they have become a serious problem within our hospitals for two main reasons.

First, strains have developed that are resistant to antimicrobial drugs, and secondly, the organisms have ready access to an increasing number of patients who are susceptible through frailty or immunosuppression.

Like all other organisms that cause HAIs, C diff is present in the community. Indeed, some strains exist in healthy people as part of their normal gut bacterial flora, as Ian McKee pointed out. My husband tells me that when he was in general practice, it was not uncommon to get a report indicating the presence of C diff in a specimen, and the bacteriological advice was usually that no treatment was required.

However, when infection occurs, causing symptoms such as diarrhoea, C diff spores can survive in the environment for many months. Infection, particularly in older and frail people can, as we know only too well, be fatal, or can result in serious complications or many months of morbidity or hospitalisation. The problem therefore has to be tackled from several different aspects, as the Government and health boards have been doing in recent months, with some success, although more remains to be done.

Much of the ground has already been covered in previous speeches, so I will speak about just three issues, two of which have already been mentioned.

The first is antibiotic prescribing, because that has probably been one of the main causes of our present problems with antimicrobial resistance. GPs are still under severe pressure from patients who want an instant cure for their symptoms. They resent having their lives disrupted by minor ailments, and they see antibiotics as the instant cure for everything, even though the viruses that afflict us all from time to time are impervious to them. The prescribing of such drugs for illnesses that are usually self-limiting has undoubtedly resulted in the development of resistant strains of bacteria, but still the pressure is on GPs to prescribe them. A tough, on-going education regime is needed to make people understand that antibiotics are not a panacea, and GPs have to be strongly discouraged from indiscriminately prescribing them.

Secondly, cleanliness, both personal and in the community, our hospitals and other health care settings, is an essential part of tackling HAIs, and on-going education campaigns to encourage regular hand washing are of major importance in containing the spread of organisms such as C diff. Rigorous enforcement of hand washing before visitors and staff make contact with patients can make a huge difference, and I welcome the role that has been given to senior clinical nurses in overseeing that on wards.

Thorough cleaning of clinical areas is also essential, and the highest standards are expected. Frankly, I do not care whether that is done in-house or by outside contractors. The end result must be scrupulous cleanliness, and it can be achieved by any provider if it is properly supervised. If that is not happening, it should be.

The interesting fact that hospitals that are cleaned by outside staff actually appear to have a somewhat better record on C diff infection puts the lie to the dogma that only in-house cleaning is effective. The service for patients is what is important, not the provider of that service, and that is where I part company with those who believe that private provision is automatically bad for NHS patients.

Finally, and importantly, I want to consider those who are in the front line of health care provision in our NHS hospitals, particularly the nursing staff, who have a huge role to play in infection control, and who, by and large, do a fantastic job for their patients. As Ross Finnie said in his speech, when the Royal College of Nursing focuses its briefing for the debate on its concern about the plethora of strategies for controlling HAIs that are being pushed at nursing staff, to the extent that staff are becoming stressed and confused, the Government must sit up, take notice and do something about it.

Undoubtedly the HAI task force delivery plan, the national action plan arising from the Vale of Leven C diff outbreak, and the health care environment inspectorate that was set up earlier this year are important initiatives, but when a further nine or 10 strategies and standards are thrust at front-line staff as they face the challenges of seriously ill patients, something has to give.

The NHS QIS report that was published earlier this year after it visited three health boards that experienced C diff outbreaks clearly indicates the need for a fresh look at how front-line interventions in the management of HAIs are coordinated. It found

"widespread lack of clarity at all levels"

within health boards, due to the

"perceived large volume and complexity"

of the national, specific and general guidelines, tools and documents on managing HAIs.

I conclude by urging the cabinet secretary to take heed of that report, and to examine how things can be simplified for those who are in charge of patient care. Perhaps one advisory body to set the standards and one other to monitor their implementation would clarify the situation for health care practitioners, and would lead to better infection control.

Like others, I look forward to the outcome of the public inquiry into the Vale of Leven C diff outbreak, but in the meantime we should do everything possible to support our hard-working front-line staff in their on-going battle to protect patients from the HAIs that can all too easily endanger their lives.

Helen Eadie (Labour, Dunfermline East)

This morning, as we debate the issues arising from C difficile, we feel for the relatives of those who were involved in the tragedy at Ninewells hospital and the NHS staff. The debate is about the expectations of all our constituents throughout Scotland, not just those who use Ninewells, and their desire to feel safe when they go into hospital. For example, in my work as a constituency member, complaints have reached me about Queen Margaret hospital in Dunfermline. My constituents are also treated at Ninewells, although I have never been invited to a meeting with Tayside NHS Board regarding the tragedy there.

In the year to June 2009, 244 cases of C difficile occurred in Fife. I have been unable to determine how many of them were in Queen Margaret hospital and other Fife hospitals. My constituents have raised a range of concerns about infection control and information sharing with relatives and patients. For example, families can be told that C difficile was the cause, or a contributory cause, of the death of their loved one, but that is not recorded on the death certificate. I raised the issue with the Scottish Government and was given assurance that guidance would be issued on the matter. In at least one case in my files, the experience that was described by the patient who wrote to the cabinet secretary and Jackie Baillie matches almost word for word with the experience of my constituent at Queen Margaret hospital.

Statistics from the General Register Office for Scotland show that, in 2008, C difficile was a cause or contributory cause of death in 765 cases, compared with a figure of 597 in 2007. That is an increase of 28 per cent. Improvements in later quarters of 2008 suggest that deaths could have been avoided if the SNP had acceded to Labour's demands earlier.

The issue that Joe FitzPatrick raised about members' comments related to hospital staff wearing uniforms in Tesco. In my opinion, that is a legitimate concern. Marlyn Glen has just passed that information to me.

Joe FitzPatrick (Scottish National Party, Dundee West)

rose—

Helen Eadie (Labour, Dunfermline East)

I welcome the fact that Fife NHS Board has tackled the issue of staff wearing scrubs outside hospitals.

Joe FitzPatrick (Scottish National Party, Dundee West)

Will the member take an intervention?

Helen Eadie (Labour, Dunfermline East)

No. I am sorry, but the member has already spoken.

Members had major concerns about the Vale of Leven hospital tragedy. Then, in the first five months of 2009, we had C difficile outbreaks in the three hospitals that my colleagues have mentioned, in Orkney, Caithness and Elgin. I, too, read the NHS QIS report on those three outbreaks, which was published in June. The report is a damning indictment of the lack of action by the Scottish Government, but it does not go far enough because, on every occasion, it suggests that communication should stop at board level. The whole thrust of our argument is about urgently communicating to everyone in Scotland appropriate and up-to-date information. Where is the action to follow through with the appropriate urgency on command and control? That is not apparent. The people of Scotland have a right to expect urgency, to feel safe and to expect that their loved ones will come home from hospital.

The issue is about local surveillance matched with national action. The NHS QIS report said that surveillance is a specialist area, but basically it is information for action. The report stated:

"As an activity, local surveillance needs to be applied in a highly systematic, structured and well-managed fashion".

Such surveillance is a vital part of infection control. We require effective local reporting procedures for the collection and feedback of real-time data to everybody, from local ward and managerial staff to those at the very top of the NHS and politicians. That must occur as events happen, not weeks later. Labour's demand for a single website should be agreed without further delay. The website should be updated in real time, showing the performance at every hospital in Scotland. Guidance should be provided to health boards on reporting outbreaks immediately. The current portal, which is buried away on the Scottish Government website, is totally inadequate and has information that is months out of date.

There is no reassurance from the NHS QIS report or from anything that the Scottish Government has done. We continue to have complacency. Where are the indications of urgency or of any clear command and control on the C difficile issue? What action has the SNP Government taken on the NHS QIS report? Not long ago, we learned through the work of my colleague Richard Simpson that Health Protection Scotland could not provide the figures, broken down by individual hospital, for the number of fatalities in which the infection was the primary or a contributory factor. A year later, that information still does not seem to be available, or it has not been published on the Health Protection Scotland website.

Last week, I tried to get information from the NHS Fife website about Fife hospitals. Even that proved impossible, with my first efforts showing that reports and the minutes of summer meetings were not posted. Thankfully, there has been a degree of progress this week. However, one has to dig deep into the reports that are published on the website and, even then, one finds that barely three lines are devoted to what is a hugely important health concern for the people of Fife. That is not acceptable. The Scottish Government should show leadership and should require Health Protection Scotland to provide detailed data on each hospital. The Scottish Government should also require the NHS chief executive to take action on the points that have been raised by NHS QIS. Targets are not enough, cabinet secretary—the public want and demand information on their local hospitals so that they can work in partnership with others in the health service.

As members have said, the Ninewells incident has raised concerns about transparency and the speed of intervention. Nicola Sturgeon was aware of the deaths for nearly three weeks before NHS Tayside made them public. After the first positive case on 14 October, it took about two weeks for Health Protection Scotland to visit the hospital. The health care environment inspectorate did not arrive until its previously scheduled inspection date of 11 November, which was nearly a month later.

The NHS QIS report that I mentioned highlighted the need for a "fresh look". The points that Marlyn Glen and Nanette Milne made about clarity and complexity are vital. The Royal College of Nursing in its briefing to MSPs for the debate strenuously shared those concerns. The college says that the enormous amount of information causes huge stress and anxiety among its members.

The Scottish Government's actions so far look like a job half done. Ministers are still overreliant on self-assessment, which was shown to fail in the Vale of Leven. We still do not have adequate information about the performance of individual hospitals. The recent outbreak in Orkney indicated that many health boards are failing properly to implement guidance on infection control. That is why Labour calls for a fully independent inspection regime.

Brian Adam (Scottish National Party, Aberdeen North)

I am pleased to support the cabinet secretary's amendment. We have heard some fairly measured speeches and some that were perhaps rather more heartfelt than measured. I point Helen Eadie to the cabinet secretary's amendment, which states:

"the Scottish Government has agreed to pilot approaches to electronic bed management and tracking infections and will fully evaluate these pilots".

That is not about publishing data with a hospital-by-hospital approach; it is almost a bed-by-bed approach. It will be interesting to see the outcome of the pilots and to find out the contribution that the approach can make to managing infection control.

I was disappointed when Jackie Baillie mentioned a very large number of reported C diff infections in patients in Grampian. The implication in what she said and in her response to my intervention was that C diff is acquired only in hospitals and care homes. Although I acknowledge that the infection can be acquired in those places, they are not necessarily the primary source. Many people—perhaps as many as one in 20—have C diff in them.

Jackie Baillie (Labour, Dumbarton)

rose—

Brian Adam (Scottish National Party, Aberdeen North)

If Jackie Baillie wishes to correct the impression that she gave earlier, I am delighted to give her the opportunity.

Jackie Baillie (Labour, Dumbarton)

I am clear about the impression that I gave. Given that we know that, aside from hospitals and wider settings, care homes are a significant problem in the incidence of C diff, does the member support the inspection of care homes?

Brian Adam (Scottish National Party, Aberdeen North)

There is no doubt that, in both types of place, there is a greater risk of the transfer of infection, because people there are more vulnerable. The question of surveillance in care homes is interesting. I am happy to pass that challenge to my colleagues the minister and the cabinet secretary.

On the information that needs to be provided, much has been said today about the need to have a single website. I am not sure how other people approach their health care, but my first reaction when something goes wrong is to get it dealt with; I do not go to a website to find out just how good, bad or indifferent the local hospital might be. I am not certain that any choice that I might make as a consequence of consulting such a website would be meaningful. It is important that information on the level of health care that is on offer is available to the public, but on the basis of giving confidence that the health professionals who are responsible for delivering that care are on top of any problems. However, to suggest that a single website containing public information is a meaningful contribution to tackling the problem stretches credulity almost to breaking point.

On supplying information to the public, the primary role should be to encourage appropriate behaviour in managing our resources and to give the public confidence. However, the way in which some members have spoken about the subject today has the consequence—perhaps unintended—of raising anxiety levels. The last thing that we want to do is to go around suggesting that if someone goes to hospital, they are very likely to catch some horrible disease and die. To suggest that that will never happen would be inappropriate, but to use language that suggests that it is a likely outcome is irresponsible. Others have dealt with the subject in a more realistic way and taken a sensible and measured approach: that was particularly shown by Ross Finnie in his sensible analysis of where we are at. What we really want to do is to ensure that we can reduce—because we cannot eliminate—the risks associated with C diff and other health care associated infections, to use the current jargon, which has moved on from the hospital-acquired infections that we debated in the early days of this parliamentary session.

We need to look at the unintended consequences of actions in health care settings. My colleague Dr Ian McKee pointed out rightly that many of the problems associated with hospital-acquired infections relate to the use of broad-spectrum antibiotics. That is an unintended consequence. As to how we deal with the action plans from the Government and as suggested by the Labour Party, perhaps we ought to consider carefully the unintended consequences. Nobody thought that we would see situations involving MRSA, let alone the difficulties around C difficile, among others. Who is to know what the next infection might be? We ought to try to anticipate what might happen.

When we debated MRSA, I recall that manufacturers of linoleum products suggested that lino had inherent antibiotic properties that would prevent onward transmission of infections. There might have been unintended consequences in moving to vinyl from lino. I am not in a position to give a definitive answer on whether any unintended consequences resulted from changing linoleum floor coverings for vinyl, but when we make such changes, particularly as part of the current significant building and refurbishment programme in the NHS, we ought to consider what the unintended consequences might be.

Christopher Harvie (Scottish National Party, Mid Scotland and Fife)

Should we decide to go back to lino from vinyl, 500 or so people in Kirkcaldy would be glad of the decision.

Brian Adam (Scottish National Party, Aberdeen North)

We need to get the balance right in any debate about such infections. We must be careful not to raise anxiety levels unnecessarily. We need appropriate information, but most of all we need to take appropriate action that has no unintended consequences.

Hugh O'Donnell (Liberal Democrat, Central Scotland)

My colleague Ross Finnie laid out more than adequately the Liberal Democrat position in this debate and it is not for me to try to outdo either his clear knowledge and understanding of the issues at hand or his entirely effective oratory. I simply observe that, as I understand it, were the Labour motion to be accepted by the Parliament, we could end up in a situation in which inspectors inspect inspectors who inspect inspectors, but nobody has any time to inspect C diff.

Jackie Baillie (Labour, Dumbarton)

Will the member take an intervention on that point?

Hugh O'Donnell (Liberal Democrat, Central Scotland)

I would like to make some progress.

Brian Adam mentioned the website, and I have some sympathy with his position. A relative of mine recently went into hospital. My concern was with her wellbeing rather than with infection levels in the hospital she was taken to. Patients—and their relatives—seldom have any choice in where they go, and I am not sure that a website with information about infection levels would be their first port of call. However, I recognise that there is a need for information about what is going on to be put into the public domain.

My recent personal perspective illustrates the challenges that are faced by front-line staff who are fighting hospital-acquired infections generally, as well as C diff in particular. I recently saw for myself some of the difficulties that front-line staff in a Glasgow hospital face in extending the zero-tolerance approach to try to combat HAIs in Scotland. There is no doubt that the effective practice of hand hygiene is one of the keys to preventing avoidable infections, although in fairness to other speakers, including Dr McKee and Nanette Milne, I accept that our historical overreliance on antibiotics might be the genesis of much of our current difficulty.

To go back to my recent experience, I watched and participated in the hand-washing process that involves visitors being prompted by ward staff and instructed by them in the use of alcohol scrubs that are located on the ward. There seems to be a problem with scrubs that are located outside wards: some tubs have disappeared when they were out of view of staff.

Given the short time that people have to visit relatives in hospital, the start of visiting time was—understandably—a bit like the start of the grand national. The ward doors opened and everyone charged forward to approach the bedside of their relative or friend, barely stopping to use the hand wash, let alone take instructions from the staff who were positioned to give them guidance on its use. The poor staff barely avoided being bowled over by the onslaught, let alone had time to give proper guidance to the throngs of visitors who were more interested in dispensing grapes, magazines and Lucozade to patients. There is no question but that that is a major challenge for front-line staff. Although what I have said might conjure up quite a comical picture, the consequences for those who contract an HAI or C diff are far from funny.

Although the hand-washing regime is well known by staff and facilities are adequately posted around hospitals, unforeseen consequences and situations arise. The regime will work properly in addressing the communication of infections from outside into our hospitals only if everyone buys into the process with consideration. Given my recent experience, my perception is that not everyone does that. Not only was the issue of hand-washing a problem but people—quite understandably—were coming to the hospital straight from work, wearing work uniforms or muddy boots and so on. It is very difficult to legislate for how front-line staff should proceed in those circumstances. If a patient was told that their relative did not get in to see them because they were not clean and their hands were not washed, that would add to the stress that everyone who is in hospital feels.

I do not think that a new inspection agency will deal with those issues, but having a few extra staff to manage and instruct the visiting hoards who descend on our hospitals at visiting time might give us a better chance of cutting infection, at least from that angle.

Rhoda Grant (Labour, Highlands and Islands)

I have previously called for the Vale of Leven inquiry to be extended to cover all C diff cases in Scotland, and I continue to make that call.

Each time there is an outbreak, we realise that the lessons that were learnt from previous outbreaks have not been passed on. Each hospital appears to be working in a vacuum, with little central advice and guidance.

It is hugely frustrating that there is no clear patient pathway to deal with outbreaks. The Government needs to issue clear advice to boards and their staff on best practice during an outbreak to ensure that it is dealt with appropriately and efficiently.

Let me be clear: health professionals deal with this deadly infection daily and most do so in a way that halts the spread, but they never make the headlines. We need all outbreaks to be dealt with in that way, which requires more information and support from the centre. I appreciate that the Government will wish to take on board the findings of the Vale of Leven inquiry and reflect them in central guidance, but that should not be used as an excuse not to issue clear and accessible guidance now. However, it is a reason to extend the inquiry to the rest of Scotland. Information needs to be made widely available to patients and visitors in hospitals and to people in the community in general.

Although it should be easier to deal with the risks of infection spread in the care home sector, given the use of single rooms, there are still issues for staff, clients and visitors to bear in mind in order to stop the spread. We have anecdotal evidence from health professionals that some care homes do not deal adequately with infection spread, which leads to emergency admissions to hospital and the subsequent spread of infection while the problem is being diagnosed and dealt with.

There must be clear information for the public about what they should do to stop the spread of infection. That very much applies to my region, where hospitals tends to cover large areas and visitors might know several people in the hospital and visit them all at the same time.

Jackie Baillie mentioned the website. I looked at the Government's website as I was preparing my notes for the debate. I found it easily, given that SPICe had sent me a link to it. I looked to see what advice was available to members of the public. In the "frequently asked questions" section, I clicked on the question:

"What can I do to prevent infections?"

The answer started off well enough:

"The most important thing you can do is to wash and dry your hands".

However, that was followed by:

"(or use alcohol gel if provided)."

The use of the word "or" implies that using the alcohol gel is an adequate substitute for washing hands, but it is not, because C diff is not killed by alcohol gel—and yet that is the advice on the Government's own website. Our hospitals have a profusion of bottles of alcohol gel, which provide a false sense of security that is backed up by misleading information on the Government's website.

The only way that we can deal with hospital-acquired infections is to wash our hands when arriving, when leaving and between visits to different patients. We should also use the hand gels that are provided for additional protection against MRSA. Until that message is common knowledge, hospital staff will be fighting a losing battle.

In addition to advice and guidance on best practice being made available to patients, they should also be informed of outbreaks on the wards where they are placed. That information, together with additional guidance on hygiene, would be helpful in allowing patients themselves to tackle the spread of infection and it would remove some of the concern that people have when they go into hospital. If they were assured of open, honest information, they would be much more at ease with the prospect of being hospitalised and the risks involved.

There needs to be the same emphasis on cleaning in hospitals that there is on general patient care. We have heard reports of patients having to use soiled toilet facilities and of very ill patients attempting to clean up after themselves without equipment or disinfectant.

A reactive cleaning service needs to be available to nursing staff when a patient soils a communal area. It is unacceptable that the patient should be left to try to clean up or that that task should fall to already overstretched nursing staff. We need specialist, trained cleaners to be available to provide a rapid response.

We also hear of families being asked to wash soiled linen with no advice on how they should do that to eradicate infection. Although families might wish to do washing for loved ones, they should be advised against doing so. If that means that the hospital needs to provide night clothes and gowns—in place of the patients' own clothes—during an outbreak, that is what should happen. In some hospitals, a patient's laundry is given to the family in sealed bags that dissolve in the washing machine. We need good advice and investment in good practice.

The Government's purchase of steam cleaners for hospitals was welcome, but that intervention cannot sit alone.

When patients are diagnosed with an infection, the risk of spread is apparent. C diff can remain on hospital surfaces and, unless they are cleaned sufficiently with disinfectants that contain bleach, the threat of infection spread remains. Such cleaning must be applied to infected patients' hospital beds and cabinets, which might be moved between wards and single rooms during a patient's treatment. On the patient's recovery, those items should be deep cleaned in the same way that the rooms are deep cleaned, because moving that furniture back into a ward will only spread infection.

I am conscious that everything that I have said is about protocols, systems and guidance, which are imperative. However, we cannot afford to lose sight of the individual stories behind the debate of those who have lost loved ones and those who have been struck down by these infections—their feelings, their dignity and their pain. As we strive to eradicate these deadly infections, we should never lose sight of the fact that each statistic represents a human cost. Each of the families involved is entitled to an inquiry, and those families are being failed by this Government.

Gil Paterson (Scottish National Party, West of Scotland)

Like many other members, I start by expressing my condolences to those who have lost loved ones to C diff. Losing someone in those circumstances is a difficult and distressing event.

We must acknowledge that the spread of C diff did not happen overnight. Dr Ian McKee has already highlighted the fact that there was a 145 per cent increase in the number of C diff-related deaths between 2001 and 2006. Thankfully, cases have decreased considerably over recent years, but the disease has still resulted in unfortunate loss of lives.

We have to realise that it will take a long time to tackle the problem, although the disease will not be completely eradicated from our hospitals, as the cabinet secretary confirmed after her statement last week when she was asked questions on the matter.

Mary Scanlon (Conservative, Highlands and Islands)

I ask the member to acknowledge that, from 2001 to 2006, there was a code of voluntary reporting, so, although the figure is exceptional, it might have been grossly underreported.

Gil Paterson (Scottish National Party, West of Scotland)

Mary Scanlon makes a very good point that has enormous resonance, so I do not think that I need to answer it.

What is important is minimising the spread of any infection that is found in our hospitals and prioritising a reduction in cases. I am glad that the Scottish Government is working towards those aims.

Many members have spoken about actions that the Government has taken to tackle the problem of C diff head on, which must be welcomed. Actions speak louder than words. For instance, under the cabinet secretary's stewardship, the number of cases in Tayside has reduced by 25 per cent. Since this lady came to power, additional money has been provided for extra domestic staff; a zero-tolerance approach to non-compliance with hygiene policies has been introduced; and a national HAI action plan has been implemented to ensure that NHS boards have in place the necessary policies and practices to drive improvements in key aspects of governance, leadership and surveillance throughout Scotland. All those actions combined appear to be working, but we must not rest on our laurels. More must and will be done to continue the battle against C diff and other infections that endanger our people.

The Vale of Leven hospital has been one of the worst-hit hospitals for deaths from C diff. Why? What factors contributed to the Vale becoming vulnerable to the spread of infection? Could one factor have been the fact that, under the previous Labour Administration, services were cut—slice by salami slice—to the extent that the hospital was about to close, as we all know? Mary Scanlon was bang on—the effect on morale and the constant worry among staff about their hospital and their future must have made a major contribution to the Vale's appalling record and the tragic consequences for some of its patients. That is my view and that of many others.

Jackie Baillie (Labour, Dumbarton)

Were the circumstances similar in the outbreaks at the Victoria hospital in Glasgow and in the NHS Orkney, NHS Grampian and NHS Tayside areas?

Gil Paterson (Scottish National Party, West of Scotland)

I say with all due respect to Jackie Baillie that the circumstances are not comparable. The circumstances at the Vale of Leven hospital were without doubt a factor—the record speaks for itself. The place was practically ready to fall down, never mind be shut, as she well knows.

Rhoda Grant (Labour, Highlands and Islands)

Will the member give way?

Gil Paterson (Scottish National Party, West of Scotland)

No—I will press on. If the member wants to intervene later, I might give way.

The cabinet secretary has made the difference. Nicola Sturgeon saved the Vale of Leven and she is making the difference in the attack on C diff.

Of course, another dimension to C diff and other illnesses that are caused by infections comes from the privatisation of cleaning services. The control of cleanliness is now managed outside hospitals. Oh, for the days of the ward sister, who knew her ward inside out, who had the staff under her control and who had at her disposal the power to ensure that cleanliness was not only a must but so basic in a day's work that it was almost taken for granted.

The Government and the cabinet secretary have reversed trends and started to end the use of outside contractors—or should I say privateers?—in health service cleaning contracts. Further, the Government has deepened the cleaning specification and monitoring framework to ensure the highest possible standards of cleaning throughout NHS Scotland.

Action to tackle C diff and other infections comes from all directions but, as we tackle one infection, we must be ready to tackle the next. The Government has put in place measures to ensure that our NHS is ready to fight any new infections that occur at our hospitals.

We owe it to the families who have lost loved ones to ensure that no other family goes through what they have gone through in the recent past.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

I echo my colleague Ross Finnie's comment that, even with the best will in the world, C diff cannot be eliminated. No matter what science might try to do, the organism will be around for a long time to come. Against that backdrop, every speaker in the debate has agreed that we must maximise the safeguards against acquiring the infection for vulnerable patients—and any other patients.

I have heard members speak of the tragedies at Ninewells and the Vale of Leven and I understand completely the emotion that lies behind and charges the debate. I heed Mary Scanlon's caution about using personal examples, but I recall—although the story had a happy ending—that when my wife went into Raigmore hospital some 10 years ago for dangerous surgery, she contracted MRSA. I sympathise absolutely with Jackie Baillie's sentiment that people hope to get better and not to catch something nasty when they go into hospital. It was a sickener for me, my family, my wife and all our friends to find that my wife would have to remain in hospital for far longer than we expected.

In fairness, I pay tribute to both colours of Scottish Government regime that we have had since devolution. When I think back to the hygiene regimes that I saw when my wife was in Aberdeen royal infirmary and in Raigmore, I have no doubt that we have moved light years forward. I recently visited Caithness general hospital in Wick, where I was impressed by the hand-cleaning regime that I was shown. All the doctors will smile at hearing that I thought that I had cleaned my hands properly, but when they were put under an ultraviolet light, I realised that I had not done a proper job—bacteria or dirt remain under nails and in unexpected parts of hands. The professionalism of that regime is to be applauded.

I am glad that Jackie Baillie set the scene by referring to the patient's confidence that they will get better, which I mentioned. She was right to pay tribute to staff. They are on the front line and all of us agree that we must support them at all costs.

I welcome the fact that Nicola Sturgeon said that a full investigation would be made into the circumstances that the harrowing letter that Jackie Baillie read out described, and that Nicola Sturgeon will reflect on the outcome of the investigation into the outbreak at Ninewells. That is important.

Before I return to my colleague Ross Finnie's speech, I will pull out nuggets from the speeches that have been made from all sides of the chamber. I was particularly interested in Cathy Jamieson's comments about the regime at Maidstone, from which we have much to learn. I accept that the cabinet secretary said that we are already on that path, which is fine. We must keep the radar switched on and learn everything that we can.

Dr McKee's expert description of the problems and of how the organism operates was most informative. He and other members zeroed in on the problems of the antibiotic policy.

I liked Marlyn Glen's point that we must involve the public in the approach to tackling the problem. Of course, a balance must be struck between giving information to the public and the danger of frightening the public, as Brian Adam said. However, involving the public in the hygiene regime and in every other front on which we tackle the infection is crucial.

Joe FitzPatrick made an important point about the small sample base for the statistics. If I understood him, the point is that one or two fatalities more in a small sample can skew the statistics in a big way.

Richard Simpson (Labour, Mid Scotland and Fife)

I accept that one must be careful with statistics, but the problem—which has not been acknowledged in the debate—is that the 027 strain is involved. That strain is regarded as hypervirulent and hypertransmissible—it transmits well and it kills. We have not had that problem before.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

I respect Dr Simpson's view and his knowledge of the subject. I imagine that the cabinet secretary will cover that issue in summing up.

I thank Nanette Milne for her speech. She displayed impressive knowledge of what is happening. Some of us might take issue with the question whether in-house staff or contracted-out staff achieve better cleanliness—we could talk about that. However, the point is that both types of cleaning staff must observe the highest levels of professionalism.

That takes me back to last week's statement, when I asked the cabinet secretary about the training regime that would be put in place for the new staff who would be hired. She assured me that such a regime was in place, but we must always be vigilant on that front.

As Ross Finnie said, we already have a regime in place. I do not see the point of putting another regime in place on top of it. The point is to make this regime work.

On the Liberal Democrat amendment, I support the idea that Lord MacLean's work should be widened out to cover other outbreaks in Scotland That would give us the fullest terms of reference and allow us to consider which is the right approach. I beg members to support the amendment in Ross Finnie's name.

Jackson Carlaw (Conservative, West of Scotland)

And so we come to the closing stages of this further extended debate on a Labour motion on tackling Clostridium difficile. Although this is not the first debate on the matter in the chamber—neither was last week's statement the first—it is the first debate to be introduced by Jackie Baillie in her new role. I mention in passing the occasionally formidable act, Cathy Jamieson, which Jackie Baillie has to follow.

This is also my first chance to welcome Jackie Baillie as a health team season ticket holder. I do so with a genuine sense of anticipation. As a fellow West of Scotland member, I can attest to her splendid ability—repeatedly demonstrated—to distance herself so adroitly from not just the record of the previous Administration but, as Murdo Fraser pointed out recently, her own previously published positions, recently so heavily advertised on her website. We must all hope that, under Jackie Baillie's direction, much of her party's previous dogma, which was so instrumental in securing its place in opposition, will be abandoned. Jesting aside, Iain Gray has taken something of a political gamble in Miss Baillie's appointment, for reasons I shall touch on later.

As I observed a moment ago, we have debated the subject previously. That is not to detract in any way from the importance of sustained intervention to tackle this scourge, and the scourge of other health care acquired infections. It remains a tragedy that patients continue to succumb to a fatal, yet potentially largely avoidable infection. Ross Finnie spoke effectively to that point. Also tragic are the 38 deaths in recent months from H1N1 or related complications, and the deaths from malnutrition and many other conditions, about which less time has been spent discussing remedies and action plans.

Progress has been and is being made on tackling HAIs, and C diff in particular, as a result of events, discussions in Parliament and Government action. The cabinet secretary, Mary Scanlon and other members referred to that. All that is to be welcomed and, in welcoming it, let no one suggest that any of us or anyone in the NHS is complacent. I know from visiting hospitals that they are not complacent. Anyone visiting a patient in hospital this afternoon or tonight will be acutely aware of the new emphasis on hygiene and infection control, although I noted with interest the contribution from Rhoda Grant.

The Scottish Conservatives have contributed to two areas of policy in particular. First, we strongly support the senior charge nurse programme, although we remain to be convinced that, in practice, that position will be able to exercise the authority that we believe is necessary. I have met the RCN to establish whether it is aware of slippages in any health board, and it has told me that it is not. By 2010, all hospitals should have an empowered champion against HAIs.

Secondly, the Conservatives have championed the introduction of electronic bed management and infection tracking in our hospitals. We persuaded the Government to run various pilots, which are on schedule. We believe in such a system not just because a relatively cheap, bolt-on, all-systems-compatible package would make the management of hospital beds simpler and more efficient, but because infection tracking could play a substantial role in tackling and controlling future hospital infections.

Electronic tracking can monitor the bed space, the bed frame, the mattress, the cleaning records and the patient occupation records. It will allow staff to see who may have introduced infections, who is potentially at risk and where those individuals moved to and from. It is a tool designed in consultation with front-line clinical staff, and it means that those staff can have confidence in the quality of information produced and in the simplicity of the system's operation. We are pleased that the cabinet secretary has kept us informed of the progress of the pilots and we look forward to seeing the detailed results in early course.

I regret the thinly-veiled partisan tone of Labour's approach. How can Labour express regret about the conduct of this health secretary, who is tackling the issue, yet not find the courage to express regret to the people of Scotland for its woeful negligence over the previous decade? At the heart of that is the disaster at the Vale of Leven. It will be extraordinary if the public inquiry does not seek to establish the consequential effect of a decade of uncertainty, underinvestment and downright neglect of the hospital. The regret that needs to be expressed today is about that lack of investment and the disregard of the calls to action by the NHS staff in that hospital. We are entitled to ask what advice Professor Hugh Pennington offered to the former Government. Was Professor Pennington concerned about the litany of disaster, outlined in detail by Mary Scanlon, or did he find a voice and an action plan only when he became a Labour adviser, rather than tackling Labour's lack of action when it was in government?

Contrast that with the transformation at the Vale now. I recently visited the hospital with my Westminster colleague Andrew Lansley, who was keen not to come and preach but to listen and learn so that he can benefit from our experience. What we saw was a committed, motivated staff, relieved that at last the investments were being made—investments instructed during the tenure of this SNP Government. Herein lies the nature of lain Gray's political gamble for, if the public inquiry into events at the Vale criticises the actions and conduct of the former Scottish Executive, it will be intolerable for Parliament to be detained any longer by the views from the front bench of the local representative of an indicted and discredited former Administration. In short, in those circumstances Miss Baillie would have to consider her position, notwithstanding the obvious personal distress the experience of other families has caused her.

Tackling Clostridium difficile has become a priority for not just the Government but the Scottish Parliament and all those in Scotland's NHS. Many are the areas of policy in which the Parliament stands divided, but in our collective determination to make further early and significant progress on this challenge, we must not allow C diff to be one of them. The motion, however, seeks to make the challenge partisan and is not consensual so, although we welcome the chance afforded by Labour's choice of business to debate the matter again, we will vote for the Government's amendment tonight.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I thank all those who have taken part in the debate. There have been a large number of good and constructive contributions. I single out two in particular, from Mary Scanlon and Ross Finnie and I do so to make a serious point. I know from experience that, in the position of Opposition spokesperson—on health or any other issue—it is often difficult to rise above the simple party politics of the issue. Mary Scanlon and Ross Finnie did great justice to the subject matter, although they both regularly subject me to as much scrutiny as any other member, on a range of issues.

I welcome the debate and I do not shirk from the scrutiny that it subjects me to. That is my job—it is the lot of any minister. However, what I sometimes find difficult is the notion that someone or some party has all the answers to the problem that is C diff, and that cases or outbreaks of C diff are evidence that the rest of us—me in particular—are somehow negligent in our handling of the matter. While I accept absolutely that the buck stops with me—and I will never shirk that responsibility—the picture is significantly more complex than that painted by Labour.

First, Mary Scanlon and Jackson Carlaw pose valid and legitimate questions. Why were none of the measures now advocated by Labour implemented during its years in office? Why were the figures on C diff infection in our hospitals not collected by the previous Administration on a mandatory basis until the tail end of its time in office? The result of that is that while we know, because of the voluntary surveillance mentioned by Mary Scanlon, that there were many thousands of cases of C diff during that period, we do not know exactly how many. Mary Scanlon is therefore right to say that the figures quoted by Ian McKee are, in all likelihood, an underestimate. Of course, that is history, but it is important to recognise that there is now transparency on the issue—transparency that has allowed members to make the informed contributions that we have heard today. That is progress.

The second reason for the complexity of the picture is the truth that no one has all the answers on how to tackle C diff. Cathy Jamieson was right to say that we should learn lessons from wherever we can find them. Part of the problem that we face with C diff is that no one fully understands it yet. However, among the many improvements that are being made is a better understanding of the different C diff strains, through the work of the national reference laboratory. NHS Tayside had early information on the strain of C diff that was present in ward 31. Richard Simpson is right to point to 027 as a particularly serious and potentially deadly strain of the infection.

The third reason that the picture is more complicated is that a great deal of action is being taken. I will listen to anyone who says that there are other things that we should do and other ideas that we should pursue. I have already responded to many of the suggestions that have been made in the chamber—electronic bed management is a case in point.

I highlight four key strands of work, the first of which relates to surveillance. Jackie Baillie was right to say that one of the key failures at the Vale of Leven was a failure of surveillance, although she was wrong to say that that was the only failing. The failure of surveillance at the Vale of Leven led to the outbreak there going unnoticed for many months. Improvements in surveillance have meant that outbreaks since then have been identified quickly. Staff at Ninewells acted quickly and correctly. In my opening remarks, I said that the appropriate time at which to declare an outbreak publicly is an issue. However, it does a deep disservice to staff on the ground at Ninewells to suggest that the fact that the outbreak was not immediately declared publicly changed in any way their handling of it.

The last point that I want to make on surveillance relates to care homes. Points have been made on the issue, principally by Jackie Baillie. Members should be aware that the Scottish Commission for the Regulation of Care inspects care homes and reviews infection control policies as part of that process. Anyone who has paid any attention to the HAI delivery plan will know that it included a trial of surveillance in care homes. That trial is under way and is due to be reported on before the end of the year. Members are welcome to raise concerns, but they should not misrepresent the facts of the situation.

The second key area of work relates to antibiotic prescribing. Ian McKee was right to highlight the issue. I have already referred to the work of the antimicrobial management teams that are now in place in every NHS board area and to the funding that has been made available for antimicrobial pharmacists, who are key to tackling C diff effectively.

The third area is the range of work that is being done to improve standards of hygiene and cleanliness. Nanette Milne was right to mention work on hand hygiene. There is no excuse for non-compliance with hand hygiene protocols by staff or anyone else in hospitals.

Rhoda Grant (Labour, Highlands and Islands)

In light of her comments, will the cabinet secretary ensure that the Government's website is amended to give the correct information about hand hygiene?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I will check the point and inform Rhoda Grant of the outcome in writing. I make it clear for the purposes of this debate, as I have done on many previous occasions, that tackling non-compliance with hand hygiene protocols is a must. We have funded 600 extra cleaners—there are more cleaners in our NHS now than ever before. Cleaning standards are also tougher. We are taking those actions to address the legitimate concerns that have been expressed.

The fourth area of work relates to public assurance. None of our work really matters if the public do not think and see that it is making a difference. Public confidence in our NHS is crucial. We established the health care environment inspectorate to ensure that the right standards are maintained in our hospitals. I may be proved wrong, but I predict that, over the months and years to come, inspectorate reports will be used as a stick with which to beat the Government, if they identify problems in one hospital or another. So be it—if there are problems or failings in any of our hospitals, I want to know about them and want the public to know about them. More important, I want those failings and problems to be put right.

The inspectorate will ensure that that happens. However, the inspectorate is not a substitute for the responsibility of front-line staff to follow infection control procedures, both to prevent outbreaks and to deal with them when they occur. Staff at Ninewells did that and did it properly. Rightly, they did not wait for anyone else to tell them to close ward 31.

All the action that we are taking is having an impact. C diff rates are down and are at their lowest level since surveillance began. That is not good enough—I would never stand here and say that it is—but it is progress. Because I do not believe that it is enough, I make no apology for maintaining our emphasis and focus on the issue.

I reserve my last words for staff. Joe FitzPatrick was excellent on that point. We should never be blind to failings—no examples of unacceptable practice should be tolerated. However, I know of no member of staff who does not go to work every day wanting to do their best for patients. Outbreaks of infection devastate NHS staff. Recently I visited the staff who dealt with the outbreak at Dr Gray's hospital in Elgin, where I saw and heard about the situation for myself. Any distress that I feel—I do feel distress about C diff outbreaks—or that other members feel is as nothing compared with the distress that is felt by staff on the front line, who often feel responsible for what has happened. We all have a duty not just to stand in the chamber and say that we support staff but, through our actions and the tone and content of our debates on the issue, to demonstrate that we support staff. Scottish National Party members will always do that.

I commend the amendment in my name to the chamber.

Richard Simpson (Labour, Mid Scotland and Fife)

I hope that this has been a useful debate and will lead to some changes, although I am not convinced that it will.

Ross Finnie, Ian McKee and others talked about the history of the disease, which I do not want to reiterate. I take Brian Adam's point that, if in 1999 someone had told us that we would be debating C difficile as one of the main public health challenges that we face, we would have asked why. The reason is that the figures have changed. MRSA and C difficile were not a massive problem in 1999. They grew into a problem, which the previous Government began to tackle. I acknowledge that the present Government is trying to tackle it—I do not say that it is not. However, we in opposition are trying to point out where we think improvements can be made.

I recommend that members read the report published by the Public Accounts Committee at Westminster on 10 November this year, which shows that MRSA and C difficile account for only 20 per cent of health care acquired infections. A major problem is still ahead of us. If anyone thinks that C difficile is the last type of infection with which we will have to deal, they will be sorely discommoded.

The trends are there and are welcome. There is no doubt about the drop in infection rates that has occurred, in part because of the measures that the previous Government and its successor put in place. The cabinet secretary acknowledged the importance of surveillance. Initially surveillance was voluntary but, as C diff developed, it became clear that it needed to be mandatory. Although the drop in C diff rates is welcome, Cathy Jamieson made the point that it is not as great as that which has taken place in England. We may not like that, but it is a fact. In some trusts in England, rates have dropped by 80 per cent, which is significant. We must think about why the drop in Scotland has been smaller.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I appreciate Richard Simpson's tone so far. Will he concede that one reason that the drop has been faster in England is that mandatory surveillance of C diff started there two years earlier than in Scotland, so the extent of the problem and how to tackle it was known much earlier?

Richard Simpson (Labour, Mid Scotland and Fife)

I do not think that that is the reason. The PAC report to which I referred, and its previous report, indicate that the improvements were achieved by implementing a tough, robust, legislated-for inspection regime. That is what our motion is about. We are not calling for a new regime—I do not know how the Liberals got that idea. We are looking for a rapid, robust response by someone in Government when there is an outbreak.

There have been four outbreaks since that at the Vale of Leven—in Orkney, Highland, Grampian and, now, Tayside. This year alone, we have had three outbreak reports and new guidance from Health Protection Scotland. As Nanette Milne and others indicated, we do not need a lot more guidance. We have had 130 pages of report this year, and there are 31 linked documents—to guidelines, protocols, toolkits and further guidance. There is a plethora of information that is stressing front-line staff, as the RCN says, because matters are not clear.

As if that were not enough—I repeat the comments that I made in the previous debate on the issue—there is a clutter of organisations, from the Government issuing chief executive letters, through the health care associated infection task force, HPS, health facilities Scotland, NHS QIS and the health care environment inspectorate, to the care commission, which, I acknowledge, is beginning to do work on the matter. That is clutter. Nanette Milne called for clarity and I absolutely agree with her. Things must be much clearer so that the front-line staff understand the situation. If the cabinet secretary does not accept that point, let me refer to the HPS website. We read that there is no general access to the outbreak control information on the Scottish health protection information resource website, which says:

"we are developing a Managing Incidents and Outbreaks Section ... At present, SHPIR is not a publicly available resource ... although this may change in the future."

That is what our motion is about: full, adequate information that should be given timeously.

I turn now to the Ninewells outbreak—as others have mentioned, I went to the briefing about it. I suggest that the cabinet secretary reads the report from the Scottish Public Services Ombudsman on the Mr A case, which demonstrates that there were significant problems. The complaint about things being unhygienic was upheld; there were lots of problems. With the individual's permission we have quoted from the letters that were sent on the matter. They describe the appalling, unacceptable circumstances that applied to one particular patient.

I agree with the cabinet secretary that the outbreak itself was handled extremely well by the hospital—that was not faulted. When HPS came in, 10 days later, it said that it had been handled well. I asked the hospital's management why it had not asked HPS to come in earlier. They said, "We didn't ask them until we saw some slight peculiarities that we needed advice on." HPS were the experts, however. They had seen the previous outbreaks, and they should have been in there on day 1, albeit not to order people around—not necessarily to order the ward to be closed, even, as that had been done already. The management should be there to offer their experience and advice. The cabinet secretary has just said that that is not going to happen. That should happen—or the inspectorate should have gone in.

A further point is that confusion was caused by the press release that said that the index case was from 10 weeks previously. It looked as though there had been a cover-up and staff were dismayed by the resulting attack on their competence. When the three index cases occurred, the outbreak was declared and the ward was closed. The board took a deliberate decision, on the basis of protecting the patients and their families from press harassment, not to tell the public. The question is whether or not that was acceptable.

When I asked the management why they did not make an announcement until 6 November, they said that they waited until the outbreak had concluded. I asked, "What if it hadn't concluded by 6 November? At what point would you have informed the public?" The managers' response was, "We would value clear guidance from the cabinet secretary as to how to manage the press." If that was the first such request, I would understand and I would not criticise, but it is in the NHS QIS report, too. There is a specific statement regarding Orkney and Grampian—the cabinet secretary may shake her head, but it is there—saying that there is a need for much clearer management of the media regarding the provision of public information.

I say to the Conservatives and the Liberals that we will support the Government on the measures that it is taking, but we will also criticise.

I return to the index case. NHS Tayside has a system under which it can identify the 027 strain within two hours of a sample being tested. I asked why staff were not testing all samples, and the reply was that it was too expensive. I pass that on to the cabinet secretary—and I am sure that the Minister for Public Health and Sport, who is also in the chamber, will also pass it on. If the index case had been seen and diagnosed in August from testing carried out at that point—which was not done for reasons of cost—I say that lives might have been saved. I know that that is a very serious statement to make.

Shona Robison (Scottish National Party, Dundee East)

That is very serious.

Richard Simpson (Labour, Mid Scotland and Fife)

Indeed—it is very serious. If the 027 strain is recognised, people become hypervigilant. The cleaning measures that have been described in correspondence as having occurred in September would have come in with a much greater intervention. I ask for that to be looked into.

Antimicrobial policy is being considered, and it is hugely important, but reports to the Government from NHS QIS have repeatedly said that there is a policy in place, yet it is not being followed. When I raised the problems of recruitment and retention among hospital pharmacists, I was blown off: "It's not a problem. That isn't the case," I was told. However, the management in Dundee admitted to me that the recruitment and retention of pharmacists is a problem, because community pharmacists are now paid much more. I ask the Government to look into that, too.

We need clear guidance, clear information, reduced clutter, robust and timeous inspection, clarity and resources in order to tackle the issue. That is all that we want. We acknowledge what the Government is doing, and we acknowledge that staff are making huge efforts, but we need clarity of purpose.

We need the cabinet secretary to acknowledge that the current web portal is sadly inadequate, and that the mechanisms for dealing with the media during an outbreak, which is her responsibility, are not adequate either.

I support the motion in Jackie Baillie's name. The Labour Party supports the Liberal amendment, but not the Government's.

Question Time — Scottish Executive — General Questions

Alex Fergusson (None, Galloway and Upper Nithsdale)

I say to members at the outset of general question time that the Presiding Officers are all keen to tighten up the whole process of questioning and answering in order to get more members involved. I hope that members will respect that today. Having said that, I have acceded to a request from the Minister for Environment to give a brief update on the flooding situation in the south-west in response to question 1, so I will give her a small amount of leeway for that.

Maureen Watt (Scottish National Party, North East Scotland)

To ask the Scottish Government when the Minister for Environment will next meet officials from the Scottish Environment Protection Agency to discuss issues relating to flood management. (S3O-8489)

Roseanna Cunningham (Scottish National Party, Perth)

As the member might expect me to confirm, I meet officials from SEPA very regularly to discuss issues relating to flooding. The most recent meeting was on 12 November, when we had a detailed discussion about the recent flooding events in the north-east of Scotland.

I have been involved in a teleconference this morning in respect of the situation that is beginning to unfold across much of the central belt and the south-west, where a very severe event is anticipated, as the Presiding Officer may know. The local strategic co-ordinating groups have been activated, and we are in as constant contact with them as is possible. We wish to reassure all members that everything that can be done in advance of any potential impact is being carried out. However, if individual members wish to know more specific information about their areas, I invite them to get in touch with my office directly.

Maureen Watt (Scottish National Party, North East Scotland)

I am sure that we all hope that the level of preparedness for the present flooding is better than it was previously.

The minister will be aware of the recent flooding in Stonehaven. Locals tell me that the Carron Water and the Cowie Water, which burst their banks, used to be significantly deeper than they are now. SEPA does not allow them to be deepened, as that would disturb wildlife habitats.

Will she ask SEPA to review that policy, which has resulted not only in the destruction of wildlife nesting sites but in the devastation of the homes and businesses of many families?

Roseanna Cunningham (Scottish National Party, Perth)

SEPA allows dredging in certain places. It has a difficult decision to make when requests are made. Since 1997, local authorities have been under a duty to cleanse watercourses of debris and sediment where the authority considers that such works would substantially reduce the risk of flooding of non-agricultural land. That position might change very slightly under the Flood Risk Management (Scotland) Act 2009. Individual requests for dredging are dealt with on an individual basis. I am not aware of generalised requests having been turned down in Aberdeenshire. If there are specific ones that the member wishes to raise, I can get back to her.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The minister will be aware that there have been calls in Stonehaven, in my constituency, for a public local inquiry into the actions—or the lack of action, it has been suggested—of SEPA, Scottish Water and other agencies. Does she support the call for a public local inquiry?

Roseanna Cunningham (Scottish National Party, Perth)

The setting up of a public local inquiry would not be a matter for the Government. I am aware that other members have added their voices to that call. How such an inquiry might be organised would be a matter for the various agencies involved. I certainly would not stand in the way of an inquiry taking place.

Tricia Marwick (Scottish National Party, Central Fife)

To ask the Scottish Government what the costs were of the G20 finance ministers meeting in St Andrews and whether Her Majesty's Treasury has agreed to meet all costs from HM Government budgets. (S3O-8478)

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

We are in close contact with Fife Constabulary, which is currently collating information about the final costs of the event. We have asked HM Treasury to confirm that the United Kingdom Government will meet the costs associated with the event, in line with the statement of funding policy that was agreed between the Treasury and the devolved Administrations. A response is awaited.

Tricia Marwick (Scottish National Party, Central Fife)

I note that the cabinet secretary is in touch with HM Treasury and that there is no agreement yet that the Treasury will meet the costs. The cabinet secretary is aware that the costs of the G8 summit in 2005 were more than £90 million, two thirds of which was eventually paid by the Scottish Government. Such a situation would simply not be acceptable on this occasion.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question, please.

Tricia Marwick (Scottish National Party, Central Fife)

Does the cabinet secretary agree that the costs of the G20 meeting should not be paid by the Scottish Government or Fife Constabulary?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

That is certainly our position, which is why the protocol and arrangements were entered into. The G20 meeting was substantially smaller in scale than the G8 summit. It was remarkably well policed by Fife Constabulary and we are extremely grateful to the police that the event was trouble free and had only a limited impact on the community.

Arrangements are in place and we are in regular communication with HM Treasury. We do not want to anticipate a problem and we hope that there will be no problem, but we will seek to defend the interests of the people who pay their taxes and fund the police, whether through the Government or through their council tax. Let us see what the discussions bring.

Ted Brocklebank (Conservative, Mid Scotland and Fife)

It is always important to allocate the costs for policing big events appropriately. Does the cabinet secretary agree that it is also important to say, "Thanks for a job well done"? He concedes that the policing of the recent G20 summit in St Andrews was impeccable, combining excellent public order with a degree of flexibility. Although it is not—

Alex Fergusson (None, Galloway and Upper Nithsdale)

Quickly, please.

Ted Brocklebank (Conservative, Mid Scotland and Fife)

Although it is not the convention for ministers to sign members' motions, does the cabinet secretary agree that Tricia Marwick might consider signing the motion of congratulation to Fife Constabulary that was lodged in my name?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

Every elected representative in Fife, whichever party they represent, is aware of the excellence of Fife Constabulary. Indeed, every member of the Scottish Parliament is aware that we have an excellent police force. Whether a member signs a motion is a matter for them, but I think that all members heartily pay tribute to Fife Constabulary. The event passed safely, with no disruption to the surrounding community, and there were only five arrests, after a small group of protesters chained themselves together. That is testimony to the excellent policing that was provided by the police in Fife.

Aileen Campbell (Scottish National Party, South of Scotland)

To ask the Scottish Government whether it had an input into the Welsh Assembly Government's All Wales Convention. (S3O-8467)

Michael Russell (Scottish National Party, South of Scotland)

The constitutional future of Wales is a matter for the people of Wales.

Officials have had limited contact with the All Wales Convention. However, the First Minister and I met the Independent Commission on Funding and Finance for Wales—the Holtham commission—which, given its remit to study the Assembly's funding arrangements, as well as tax-varying and borrowing powers, was of more relevance to Scotland's interests.

It is right for the people of Wales to have a say in their future, just as the people of Scotland should have their say on the constitutional future of Scotland in a referendum.

Aileen Campbell (Scottish National Party, South of Scotland)

Will the minister join me in welcoming the publication of the All Wales Convention's final report? He will be aware of the consensus in Wales in favour of a referendum to decide the country's constitutional future. Does he agree that it is untenable for politicians such as David Cameron to support a referendum on the constitutional future of Wales while opposing a referendum in Scotland?

Michael Russell (Scottish National Party, South of Scotland)

I can say without difficulty that I regard that position as untenable. The member will be aware that not just David Cameron's position but the Liberal Democrats' position is untenable. The one consistency to be found is within the Labour Party, which, despite its agreement with Plaid Cymru in the programme for government that it would back a referendum, is now saying that it is not sure whether it should do so. In Wales and in Scotland, the Labour Party is against reasonable change and letting people have their say.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question 4 has been withdrawn.

Duncan McNeil (Labour, Greenock and Inverclyde)

To ask the Scottish Government what plans it has to improve the school estate for pupils with additional support needs. (S3O-8522)

Fiona Hyslop (Scottish National Party, Lothians)

Our new school estate strategy recognises the importance of good-quality buildings and facilities for all pupils, including those with additional support needs. It sets an ambitious target of having well in excess of 90 per cent of pupils educated in good-condition schools, and plans for the rest.

Following an invitation in the context of the next phase of the new school building programme, Inverclyde Council submitted a proposal to us, which would improve the school estate for pupils who have additional support needs. Although I cannot say anything in advance of an announcement about the next phase of the programme, I assure Duncan McNeil that Inverclyde's proposal will be considered alongside all the others that were submitted to us and to the Convention of Scottish Local Authorities, with which we are working on the matter.

Duncan McNeil (Labour, Greenock and Inverclyde)

I thank the cabinet secretary for her answer, which anticipated my supplementary question. She is aware that Inverclyde Council has spent a significant amount of money on the school estate. It would be a terrible tragedy if special needs children lost out on new schools. I am pleased that the cabinet secretary confirmed that the council's proposal is being properly considered. When will she meet council representatives to ensure that there is quick progress on the proposal?

Fiona Hyslop (Scottish National Party, Lothians)

As the member knows, the taxpayer is currently supporting Inverclyde Council to the tune of £5.73 million a year over 30 years for a school building programme, the financial close of which was October 2008. He was correct to identify the importance of driving forward the programme and proposals on the estate, particularly for pupils who have additional support needs.

The member will appreciate that I cannot pre-empt the discussions with COSLA. However, when the announcement has been made we will move swiftly to engage with all councils for which the announcement means that they will be able to progress the school building programme, and particularly with Inverclyde Council, should it be part of the programme.

Stuart McMillan (Scottish National Party, West of Scotland)

Does the cabinet secretary agree that local authorities should prepare robust proposals for additional support needs education? Does she also agree that pupils who require such education must not be used as a political football and should be considered on their own merits and needs?

Fiona Hyslop (Scottish National Party, Lothians)

The point is well made. It is striking that the successful councils in Scotland are those in which political parties come together. For example, the Scottish National Party group in Inverclyde Council has made representations, as has Duncan McNeil. It is important that the individual child's needs are supported. Political posturing by any party in that context can sometimes hamper rather than support education.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question 6 was not lodged.

Karen Gillon (Labour, Clydesdale)

To ask the Scottish Executive when the Cabinet Secretary for Education and Lifelong Learning last met representatives of South Lanarkshire Council. (S3O-8506)

Fiona Hyslop (Scottish National Party, Lothians)

I most recently met representatives of South Lanarkshire Council on 2 July, as part of a programme of visits by ministers to all local authorities in Scotland, to discuss a range of education issues. The council noted that it has reduced class sizes in early primary classes and in deprived areas. It expects an educational impact, through active learning and greater interaction between pupils and teachers. Research shows us that smaller class sizes make a big difference in the early years.

Karen Gillon (Labour, Clydesdale)

I congratulate that Labour council on its work to secure good education for young people in Clydesdale.

What is the cabinet secretary doing about the increasing number of teachers who are seeking employment, who could be further reducing class sizes to meet the Government's manifesto objective of reducing class sizes in the early years to fewer than 18 pupils?

Fiona Hyslop (Scottish National Party, Lothians)

The Government moved swiftly to set up a teacher employment working group, all of whose recommendations are being enacted. I am pleased that, in South Lanarkshire, the proportion of P1 to P3 pupils who are in classes of 18 or fewer pupils increased from 9.4 per cent to 13.7 per cent last year. I look forward to seeing the figures in future.

It is important to remember that the resources that are being put into the local government settlement would enable councils to employ teachers. In particular, it is unfortunate that Glasgow City Council has reduced the number of teachers and teaching positions by 300 in one year—that represents 300 jobs that could have been available for post-probationers, had the council chosen to use the resources that it was given to employ teachers. [Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Linda Fabiani (Scottish National Party, Central Scotland)

Is the cabinet secretary aware of the concern of elected members of South Lanarkshire Council that restrictions on the future revenue budget are due to the increasing servicing costs of the private finance initiative/public-private partnership schools project?

Fiona Hyslop (Scottish National Party, Lothians)

South Lanarkshire Council has indicated that it wants to use the savings that it can make from falling school rolls to fund its ambitious programme of school building. At one point, the biggest PFI school project in Europe was in South Lanarkshire. The continuing revenue costs, which are supported by the Government, continue to put pressure on the council's budget. The Government has had to find up to £60 million a year to fund unfunded PPP commitments from the previous Administration. We have honoured our promise to do that, but doing so puts constraints on other parts of the budget.

Andy Kerr (Labour, East Kilbride)

Does the cabinet secretary accept that South Lanarkshire Council has renewed all its secondary schools and is in the midst of a programme of renewing all its primary schools? Further, does she accept that it would have been in that position a lot sooner if funding had been made available from this Government? Does she accept that the revenue support that is made available for PPP projects has been reduced by the Scottish Government to less than it was under Labour and that, as a result of that policy, fewer schools will be built?

Fiona Hyslop (Scottish National Party, Lothians)

I am sure that the member is familiar with the Scottish Government's budget. I refer him to the pages that show how much revenue support is being provided by this Government for PFI and PPP programmes, many of which were unfunded when we came into office. I also point out that the reason why South Lanarkshire Council can put so much money into the capital funding of primary schools in particular is because this Administration has put £2 billion of capital funding into the local government settlement for 2008 to 2010. The member should welcome that.

Gil Paterson (Scottish National Party, West of Scotland)

To ask the Scottish Executive whether it is sending representatives to observe referenda on the constitutional future of Catalonia that will be carried out in towns across Catalonia on 13 December 2009. (S3O-8486)

Michael Russell (Scottish National Party, South of Scotland)

It is, of course, for the people of Catalonia to decide on their constitutional future. There are currently no plans to send representatives to observe the Catalan referenda, but I am following developments there with interest and I have enthusiasm for that democratic process.

Gil Paterson (Scottish National Party, West of Scotland)

It seems to be a normal part of the process of devolution in Catalonia to seek the views of the public on constitutional matters. Why is it that, according to the unionist parties, Scots should be denied the same opportunity to decide their constitutional fate? I certainly hope that the minister is not deflected from his purpose.

Michael Russell (Scottish National Party, South of Scotland)

I suspect that the significant difference between the situation in Catalonia and Wales, where these issues are current, and the situation in Scotland is that, in Catalonia and Wales, there is a range of political parties that are enlightened and democratic while, in Scotland, there appear to be only two—the Scottish National Party and the Green party.

Margaret Mitchell (Conservative, Central Scotland)

To ask the Scottish Executive what its position is on the setting up of a dyslexia mentoring programme in Scotland similar to the one that operates between the British Dyslexia Association and Sir John Cass business school, City of London, which involves successful businessmen and prominent people with dyslexia working with and encouraging students with dyslexia. (S3O-8460)

Adam Ingram (Scottish National Party, South of Scotland)

Dyslexia Scotland was involved in the setting up of the United Kingdom dyslexia mentoring programme and is in the process of looking for more mentors to participate in the scheme in Scotland. To date, three people have registered in Scotland to take part as students, as well as one mentor, with other applications currently being processed.

Dyslexia Scotland plans to hold the first mentoring workshop in Scotland early in 2010. The Scottish Government welcomes the work that Dyslexia Scotland is taking forward with the mentoring programme and wishes it every success with its forthcoming workshop.

Margaret Mitchell (Conservative, Central Scotland)

That is encouraging. The minister will be aware that one of the aims of the mentoring programme is to build confidence in people who have dyslexia. What is the Scottish Government doing to increase the support for detecting dyslexia in undiagnosed adults and children?

Adam Ingram (Scottish National Party, South of Scotland)

As the member will be aware from her role on the cross-party group on dyslexia, the Scottish Government has developed a framework for inclusion, which is being introduced in our initial teacher education colleges throughout the country. That will give our new teachers the tools to identify dyslexia in the children whom they teach. We are also developing continuous professional development to ensure that children with dyslexia have their needs met in the classroom.

Tom McCabe (Labour, Hamilton South)

To ask the Scottish Executive, further to the answer to question S3O-7756 by Shona Robison on 10 September 2009, what third sector organisations are being tracked over the next five years to determine the impact of single outcome agreements and the ending of ring fencing and how those organisations were selected. (S3O-8518)

Alex Neil (Scottish National Party, Central Scotland)

The organisations to be tracked are being selected by independent researchers. We expect to have the list by the end of December.

Tom McCabe (Labour, Hamilton South)

Will the Scottish Executive intervene at any point during the research if a third sector organisation is found to be struggling under the challenges that ministers have said that the organisations might face as a result of the concordat relationship?

Alex Neil (Scottish National Party, Central Scotland)

The organisations to be tracked are being selected by independent researchers. We expect to have the list by the end of December.

Tom McCabe (Labour, Hamilton South)

Will the minister clarify whether the Scottish Executive will intervene at any point during the research if a third sector organisation is found to be struggling under the challenges that the minister has said they might face as a result of the concordat relationship?

Alex Neil (Scottish National Party, Central Scotland)

We have regular discussions with all the third sector organisations. Irrespective of the research exercise, we would always be cognisant of and responsive to any concerns by any third sector organisation at any time.

Alex Fergusson (None, Galloway and Upper Nithsdale)

That concludes general questions. Before we come to the next item of business, I am sure that members will wish to join me in welcoming to the gallery the Speakers of the Parliaments of Penang, Uganda, St Lucia and the Pakistani province of the Punjab. [ Applause. ]

First Minister's Question Time

Iain Gray (Labour, East Lothian)

To ask the First Minister what engagements he has planned for the rest of the day. (S3F-2018)

Alex Salmond (Scottish National Party, Gordon)

Later today, I will have meetings to take forward the Government's programme for Scotland.

Iain Gray (Labour, East Lothian)

This week, one of Scotland's leading think tanks reminded us of the First Minister's promise to raise Scotland's gross domestic product growth rate to the United Kingdom level by 2011. Is the First Minister going to keep that promise?

Alex Salmond (Scottish National Party, Gordon)

That is the target. I have to say that we did not expect in 2007 that the GDP of the United Kingdom would go into sharp decline—I do not think that anybody anticipated it. I certainly know that the then Chancellor of the Exchequer did not anticipate it, because he told us that he had "abolished boom and bust". In fact, he abolished just the boom bit. Nonetheless, we should be encouraged by the fact that the Scottish economy, despite the concentration on financial services of one of the great impacts of the recession, has actually had a fall in GDP that is slightly less than that for the rest of the UK. We should also be encouraged that employment in Scotland is higher, unemployment is lower and economic activity is higher. On that basis, I think that our target is the right one to have, and this Government is intent on achieving it.

Iain Gray (Labour, East Lothian)

In the First Minister's Brigadoon bunker in Bute house things may not be so bad, but the truth is that in the real world, under his Administration, we face a deeper recession and a slower recovery than the rest of the UK. The promise of matching Scotland's growth to that of the rest of the UK is just another broken promise, is it not? Two months ago, he was still promising to build a rail link to Glasgow airport. Business, trade unions and local government all agreed that that was just what the economy needed, so John Swinney cancelled it. When it comes to the economy, is the First Minister not all talk and no trousers?

Alex Salmond (Scottish National Party, Gordon)

Let us just tackle this nonsense and the argument that we are enduring a deeper recession than the rest of the United Kingdom. It is simply not true. From the first part of 2008, when the recession started in the UK, the decline in Scottish domestic product—gross value added—is slightly less than that of the UK as a whole. I do not claim that as a triumph, because it is the sharpest decline in living memory. However, I will just say to Iain Gray that, given the nature of the recession—for which the Labour Government in Westminster must accept some degree of responsibility—is it not significant that construction has done significantly better in Scotland, that the production industry has done significantly better and that the primary industries have done significantly better? Indeed, with the sole exception of financial services—for understandable reasons—much of the Scottish economy is proving incredibly resilient.

As far as the rail link to Glasgow airport is concerned, the solution lies in the Labour Party's hands. Let it restore the £160 million year-on-year cut in the Scottish capital budget; then we will be able to fulfil the programme that we intended to fulfil.

Iain Gray (Labour, East Lothian)

If the First Minister presents what is happening in Scotland's construction industry as an example of the success of his Government, he has lost touch with reality to a degree that even I find hard to believe.

The ridiculous Scottish Futures Trust has cost 25,000 construction jobs—that is the industry's figure—and cancelling the Glasgow airport rail link will cost another 1,300 jobs. If the First Minister cares in the slightest about growth in the Scottish economy, will he cancel the Scottish Futures Trust and reinstate the rail link?

Alex Salmond (Scottish National Party, Gordon)

I do not claim what has happened to the construction industry as an enormous success. It has had one of the heaviest falls in its output in history, but let us look at the exact figures. The Scottish construction industry has declined by 6.3 per cent. That is a savage decline, but that is with the Scottish Futures Trust coming in at present. The exactly comparable figure for the UK construction industry, without the Scottish Futures Trust, is a decline of 8.2 per cent. Will Iain Gray tell us why—despite the fact that the UK has managed to resist the idea that we should not in the future pay through the nose for private finance initiative projects—the decline in construction across the UK is greater than the decline in construction in Scotland, or does that rather inconvenient fact destroy his entire question?

Iain Gray (Labour, East Lothian)

The fact is this: the Fraser of Allander institute's report says that this is the first time since world war two that Scotland has done worse than the rest of the country in a recession. That is the difference that the SNP is making.

If Alex Salmond thinks that the 25,000 construction workers who are looking for work will be impressed by those figures, he is losing it. Indeed, the business community is saying that Alex Salmond is losing it, the trade unions are saying that he is losing it, economists are saying that he is losing it, his own party is saying that he is losing it and—yes—the people of Glasgow North East said that he is losing it big style last Thursday. Willie Bain, Scotland's newest member of Parliament, is sitting in the public gallery—that says it all. Alex Salmond—

Alex Fergusson (None, Galloway and Upper Nithsdale)

I must press you for a question, Mr Gray.

Iain Gray (Labour, East Lothian)

Alex Salmond is losing it. It is time he started listening and it is time he accepted that he is the problem. When will he accept that he is the problem?

Alex Salmond (Scottish National Party, Gordon)

I think Iain Gray went on a bit long in that answer, but let me be generous and welcome Willie Bain to our proceedings and congratulate him on his success in Glasgow North East. I hope that he is not one of those people who go for a dual mandate in various Parliaments—[ Interruption. ]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Alex Salmond (Scottish National Party, Gordon)

I have a good memory and I remember welcoming with equal generosity the victor of the Glenrothes by-election to our proceedings just a year ago. I also remember Iain Gray being incredibly enthusiastic about that by-election victory. Six months later, the Scottish National Party wiped the floor with Labour in an election across Scotland—the European election—by a margin of 10 per cent.

I have heard a rumour that there might well be an election in six months' time in Scotland. We will see then whether Iain Gray has the same enthusiasm that he has today.

Lastly, I understand that we are also welcoming the Scottish Labour Party leader, Mr Jim Murphy, to our proceedings this afternoon. I hope that Iain Gray will accept that, when he says that he enjoys his election victory, I would not rob him of being content about that election success, for which I can easily congratulate the Labour Party. I can tell him, however—he should reflect on this—that many people, not just in the Labour Party but across Scotland, believe that with Iain Gray it is a question not of losing it but of never having had it in the first place.

Annabel Goldie (Conservative, West of Scotland)

I would ask the First Minister who he thinks should be the next manager of the Scottish football team, but I will leave that to Tavish Scott.

To ask the First Minister when he will next meet the Prime Minister. (S3F-2019)

Alex Salmond (Scottish National Party, Gordon)

I have no plans to meet the Prime Minister in the near future.

Annabel Goldie (Conservative, West of Scotland)

I was alarmed and appalled when I discovered this week that, of 1,500 children who were admitted to the Royal hospital for sick children in Glasgow, more than 150 were suffering from malnutrition. That is a disgrace and an affront in modern-day Scotland. However, Government statistics that were recently obtained by the Conservatives claim that only 48 children across the whole of Scotland were admitted to Scottish hospitals suffering from malnutrition. Given the huge variation between those figures, and given that the figures cover only hospital admissions, can the First Minister tell me the true extent of child malnutrition in Scotland? If he cannot, why cannot he do so and what will he do to find out?

Alex Salmond (Scottish National Party, Gordon)

Several hundred thousand children in Scotland live in relative poverty. I will certainly investigate the malnutrition figures and try to reconcile the different figures that Annabel Goldie has given. Both the United Kingdom Government and the Scottish Government are committed to ending child poverty throughout the UK and Scotland. Of course, many of the instruments by which that can be delivered lie within the social security system, but others lie within the province of this Parliament. That is why I believe that the drive for early intervention in the education system is an effective and important measure. I also believe that this Administration's school meals policy, given what we know from the trial about the uptake figures and its success across Scotland, will be of substantial assistance in ensuring that every young child in Scotland has at least one decent square meal a day.

Annabel Goldie (Conservative, West of Scotland)

It is worrying that the First Minister does not know the true extent of the problem. I urge him to find out, and to do so quickly, because unless we know the extent of the problem, we will certainly not know how bad it is or how to deal with it.

Let me make one suggestion to the First Minister. In the meantime, we can start by having more health visitors, who are the key to preventing child malnutrition. I have discovered that a general practitioner practice in Springburn with 7,000 patients on its books has only one health visitor. Another GP practice in Possil has no health visitor at all. That is totally unacceptable. The scandal of child malnutrition and the scandal of there being too few health visitors go hand in hand. Will the First Minister demonstrate his resolve in tackling child malnutrition by backing Conservative policy for more health visitors for all our children throughout Scotland?

Alex Salmond (Scottish National Party, Gordon)

I will certainly examine any constructive suggestions. On the specific case that Annabel Goldie mentioned, I know that the Deputy First Minister has written to Jackson Carlaw—who I think raised the issue as the area MSP—to point out that the practice in question has a vacant position. I will certainly look at any constructive suggestions, whether from Annabel Goldie or from any other member, on tackling child malnutrition and poverty among children, which should concern the entire Parliament and go beyond party boundaries.

Tavish Scott (Liberal Democrat, Shetland Islands)

To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. (S3F-2020)

Alex Salmond (Scottish National Party, Gordon)

The next meeting of the Cabinet will discuss issues of importance to the people of Scotland.

Tavish Scott (Liberal Democrat, Shetland Islands)

The First Minister will have seen in this morning's papers the list of quango executives in Scotland who are paid more than him. Some of them are paid even more than his MP, MSP and First Minister salaries put together. Does he think that there are too many people on too much money?

Alex Salmond (Scottish National Party, Gordon)

The previous Administration set the terms and conditions of the vast majority of agencies and quangos in Scotland. I am trying to remember; Tavish Scott was not Deputy First Minister in the previous Administration, but I think that he was a minister in it.

The Cabinet Secretary for Finance and Sustainable Growth, John Swinney, has made clear, both to the Parliament's committees and more generally, the policy on unwarranted bonuses and rewards across the public sector in Scotland, which is that bonuses and rewards must relate strictly to performance. John Swinney has already acted to restrict the position. Is Tavish Scott suggesting that we should tear up contracts that were fixed by the previous Labour-Liberal Administration, or will he accept at some point that if he asks a question and gets an answer to it, he has a responsibility to explain how the situation came about in the first place?

Alex Fergusson (None, Galloway and Upper Nithsdale)

I have said many times before that it is for members to ask questions during First Minister's question time.

Tavish Scott (Liberal Democrat, Shetland Islands)

That was a "No", then.

Does the First Minister know that such reports only scratch the surface? Through freedom of information requests, the Liberal Democrats have discovered that at least 3,400 people in the public sector in Scotland are paid more than Scottish Government ministers and that they receive a total of £401 million in pay every year. People at the bottom of the income scale are being threatened with losing their jobs and the number of young people who are unemployed has never been higher—[Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Tavish Scott (Liberal Democrat, Shetland Islands)

In these tough times, does the First Minister think that the tiny proportion of people who get such a vast share of public money should shoulder a fairer share of the burden? As part of his budget, will he set a target to reduce that pay bill and to spend the money instead on creating skills and jobs for young people?

Alex Salmond (Scottish National Party, Gordon)

On leadership from the top, last year, Scottish ministers proposed and accepted—all of us—a pay freeze. I do not recall Tavish Scott or his MSPs reciprocating that to any extent. Indeed, Mike Rumbles thought that the suggestion was ridiculous. That was done and it set an example. John Swinney has already dealt with quango bonuses.

I have two things to say to Tavish Scott.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Answer the question.

Alex Salmond (Scottish National Party, Gordon)

I am answering it. I remind Tavish Scott that bonuses were set and settlements were made by a Labour-Liberal Administration in Scotland. I do not accept the Liberal Democrat party's proposition that the solution to this country's economic problems is to freeze the wages of people across the public sector. Every nurse and every policeman in Scotland would be a casualty of that Liberal Democrat policy.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Bill Butler has a brief supplementary question.

Bill Butler (Labour, Glasgow Anniesland)

The First Minister will be aware that a ministerial statement on sectarianism was made yesterday. That statement is welcome as a first step, but it fell short of the coherent strategy that is required. The lack of a specific commitment to halt the decline in the number of school twinning projects is of particular concern. Given that education must be at the heart of any successful developed strategy, will the First Minister commit his Government to working with local authorities to reverse the alarming decline in the number of twinning projects?

Alex Salmond (Scottish National Party, Gordon)

In his statement, Fergus Ewing set out the range of activities that are taking place and the range of organisations that campaign and work daily against sectarianism in Scotland. All members should embrace that cause. I deprecate any attempt to take the battle against sectarianism into the party-political arena in Scotland. Therefore, we will discuss with our partners in the Convention of Scottish Local Authorities how valuable school projects can be sustained and maintained.

Of course, tackling sectarianism is an enormous priority for the Government. However, Labour members will have to accept at some point that among the implications of the deep public expenditure cuts that are being directed from Westminster are pressure on local authorities, vital projects and the Scottish Government, and pressure across the public services and right across the country. I know that Bill Butler accepts that there will be consequences in Scotland if expenditure is cut back by Westminster. I hope that the Labour Party can explain that to the people when it is called to account next year.

Bob Doris (Scottish National Party, Glasgow)

To ask the First Minister what support the Scottish Government is providing to the 2014 Commonwealth Games. (S3F-2032)

Alex Salmond (Scottish National Party, Gordon)

Earlier this week, the Glasgow 2014 organising committee announced an increase in the overall budget for the games. The additional budget was required mainly in response to an increase in broadcasting costs and the need to set aside a greater contingency fund. The new games budget is still only one 20 th of the public funding that is being provided for the 2012 Olympics. The Scottish Government's contribution has risen by £59 million to £297 million at 2007 prices. That necessary increase is challenging for the public purse, but the funding boost will help us to stage an event that will have lasting benefits for generations to come. The games are good news for Glasgow and Scotland, which is why we have also recently launched a £23.5 million legacy plan for Scotland to capitalise on the opportunities of 2014.

Bob Doris (Scottish National Party, Glasgow)

I want to ensure that, in terms of its budget, Glasgow's Commonwealth games is treated equally with the London Olympics by the United Kingdom Government. Will the First Minister back my call for Glasgow City Council to join me and the Scottish Government in insisting that the £300 million that is owed to Scotland through London Olympics regeneration funding is paid to Scotland? Will he also ensure that a significant share of those funds—if they are recovered—will be used for regeneration projects in Glasgow to build a lasting legacy of the 2014 games? I fear that, if that does not happen, the UK Government will not only rip off Glasgow, but will let down Scotland.

Alex Salmond (Scottish National Party, Gordon)

Glasgow City Council and the Scottish Government are co-operating fully on delivering the Commonwealth games for Scotland, as we demonstrated at a press conference in Glasgow on Monday. Nonetheless, I thank Bob Doris for his question and the points to which he has drawn attention.

I find it disappointing that Jim Murphy and Gerry Sutcliffe cancelled the meeting with the Minister for Public Health and Sport on 10 November to discuss the return of £150 million of lottery money to Scotland. Scotland is losing out not just on the lottery money, but on another £165 million because of the UK Government's decision not to subject regeneration expenditure on the Olympics to the Barnett formula in the normal way. There should be support across the chamber, not just from Glasgow City Council, for Scotland to get its fair share. It is about time the United Kingdom Government stepped up to the plate on the issue and stopped ripping off Scotland.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Several members want to ask supplementary questions on this important matter, and I am keen to allow as many as possible. Questions should therefore be short and sharp, as should the answers.

Jamie McGrigor (Conservative, Highlands and Islands)

Although we all want to see Glasgow hosting the best ever Commonwealth games in 2014, what specific guarantee can the First Minister give to council tax payers in Glasgow and all other taxpayers throughout Scotland that the increase of £81 million will be the final such increase?

Alex Salmond (Scottish National Party, Gordon)

What was announced on Monday was the result of many months of careful work. I have every confidence—as has Glasgow City Council—in the audit that has been done of the expenditure that needs to be devoted to the games.

Some people have argued that the broadcasting costs should have been better anticipated—I saw that argument deployed in one of our newspapers. The Government inherited the estimate that broadcasting rights would offset broadcasting costs on the home broadcaster, and I have no complaint whatever with the estimate that was formulated in 2007, which was based on the experiences of Manchester in 2002 and of Melbourne in 2006. It was an entirely reasonable estimate to make at the time—indeed, I still hope that the BBC can be prevailed upon to give Scotland the same treatment for 2014 as Manchester received for 2002.

Ross Finnie (Liberal Democrat, West of Scotland)

The Government reports of the overspend stated that £20 million of the £81 million that was needed to fill the gap would come from a reserve fund. Should further contingencies arise, how much will be left in the reserve fund?

Alex Salmond (Scottish National Party, Gordon)

There are two aspects: there is a contingency fund of £80 million, which has received a £48 million increase as a result of the announcements on Monday, and there is a reserve fund of £20 million beyond that. The reserve fund is the only part of the funding that does not ascribe to the formula of 80 per cent coming from the Scottish Government and 20 per cent coming from Glasgow City Council. The reserve fund is funded entirely by the Scottish Government and the Scottish public purse. I think that that is right and proper, because although the benefit of the games will be felt predominantly in the city of Glasgow, their underlying benefits will stretch across the country.

At a time of severe pressure on the public purse, meeting the obligations will undoubtedly be a huge strain. Nonetheless, we should keep our eyes on the prize—the prize for Scotland is enormous. This major international event is going to have enormous beneficial effects not only on infrastructure and immediate building but for future generations of young Scots.

Margaret Curran (Labour, Glasgow Baillieston)

Does the First Minister appreciate the deep frustration that is felt by those of us in Glasgow who have worked so hard to bring the Commonwealth games to the city at his attempts always to pass the buck and blame other people whenever we raise an issue about them? Whether he likes it or not—

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question, please.

Margaret Curran (Labour, Glasgow Baillieston)

How does the First Minister square in his own mind this great commitment that he parades so publicly with the cancellation of the Glasgow airport rail link project which, as he knows, was a vital part of the bid document? Will he attempt to reinstate his credibility by reinstating the GARL project?

Alex Salmond (Scottish National Party, Gordon)

Margaret Curran's view is not shared by the Commonwealth Games Federation, which pointed out that the project was not an integral part of either the games bid or their successful delivery. Now that the smoke of by-election has cleared, I hope that even the constituency member will somehow concede that the billions of pounds of infrastructure investment that is now being made in and around Glasgow is ample demonstration of this Government's commitment to that great city. Prime among these projects is, of course, the M74 motorway, which has been awaiting completion for the best part of 40 years and which will, under a Scottish National Party Government, finally be finished.

James Kelly (Labour, Glasgow Rutherglen)

To ask the First Minister, in the light of the Justice Committee's rejection of the Scottish Government's plans to create a statutory presumption against custodial sentences of less than six months, whether the Scottish Government will now abandon these plans. (S3F-2036)

Alex Salmond (Scottish National Party, Gordon)

Custodial sentences of six months or less are simply not working and do little to stop offending behaviour. Indeed, the Justice Committee itself acknowledges that short sentences

"have limited effect as a deterrent".

The figures show that three quarters of those who are released from short sentences go on to reoffend within two years of getting out. In contrast, three out of five people who are sentenced to community punishment do not go on to reoffend over the same period. It is clear from the vast array of comments on the matter that more and more people agree with the Scottish Government's position, so we will continue to build on that growing consensus outside the Parliament, which I believe will be reflected in a majority in the Parliament.

James Kelly (Labour, Glasgow Rutherglen)

Does the First Minister not realise that communities throughout Scotland are looking for tough action on crime? Does he not accept that the scrapping of six-month sentences, which will free 40 per cent of those who have been convicted of indecent assault, 71 per cent of those who have been convicted of housebreaking and 75 per cent of those who have been convicted of all crimes and offences, is the wrong policy and that it is time to follow the Justice Committee's sound advice?

Alex Salmond (Scottish National Party, Gordon)

I will tell James Kelly what tough action on crime is: it is having in Scotland a record number of police on the streets and the record low in criminal behaviour for a generation.

What James Kelly is proposing is a cycle and policy of despair. It is exactly the policy that the Labour Party tried when it was in office and exactly the policy that failed. I know that the member is a keen advocate of his party's policy, but I also know that other members on the Labour benches do not share his opinion. For example, one Labour MSP confided to the Edinburgh Evening News that he found his party's approach "depressing" and said:

"Anyone who knows anything about it feels uncomfortable with what we're saying."

No wonder, because Labour does not have a single answer for improving Scotland's justice system and no policy except the counsel of despair, which has been tried—and has failed—for so long.

Linda Fabiani (Scottish National Party, Central Scotland)

Is the First Minister aware that former Conservative leader Iain Duncan Smith recently called for the scrapping of sentences of two months or less in England? Does he welcome this admission from the Conservative Party that short sentences are, to quote IDS, "farcical"? Does he agree—

Alex Fergusson (None, Galloway and Upper Nithsdale)

Hurry up, please.

Linda Fabiani (Scottish National Party, Central Scotland)

Does the First Minister agree that Conservatives and Labour members in Scotland should start to base their prison policy on evidence rather than perceived populism?

Alex Fergusson (None, Galloway and Upper Nithsdale)

As briefly as possible, please, First Minister.

Alex Salmond (Scottish National Party, Gordon)

If I remember correctly, Iain Duncan Smith has no reputation for being soft on crime or anything else, and I know that his remarks will weigh heavily with members in this chamber, as will the words of Cherie Blair, who is another advocate of the Scottish Government's approach to criminal justice.

Murdo Fraser (Conservative, Mid Scotland and Fife)

To ask the First Minister when the Scottish Government will announce the minimum price per unit of alcohol that it plans to introduce. (S3F-2021)

Alex Salmond (Scottish National Party, Gordon)

Expert advice from the World Health Organization and many others tells us that minimum pricing will be a targeted and effective intervention that will save lives. If the bill is successful, it will be for ministers to propose to Parliament an effective minimum price, but we encourage debate on the illustrative example of 40 pence per alcoholic unit.

No single action will bring about the change that is required to rebalance Scotland's relationship with alcohol. That is why we have outlined a comprehensive range of measures in our alcohol framework, and why we want full and effective enforcement of existing laws.

Murdo Fraser (Conservative, Mid Scotland and Fife)

I am sure that the First Minister will agree that we need, before we can discuss the minimum price, to know whether such a policy would be legal. Three weeks ago in the chamber, the First Minister said about the legal advice that the Government had taken on minimum pricing:

"I hope and believe that such information can be made available to members to enable us to discuss and address the issue in a serious way."—[Official Report, 29 October 2009; c 20682.]

The following week in the chamber, his deputy said:

"I want to work with other parties ... but we are working within the same constraints as the previous Administration. I have acres of quotations from previous ministers ... on why legal advice cannot be shared."—[Official Report, 5 November 2009; c 20913.]

What is the Scottish Government's position? Is it that of the First Minister, who wants to share the legal advice, or that of his deputy, who does not?

Alex Salmond (Scottish National Party, Gordon)

If the member examines his quotations further, he will see that I said that we are keen to share as much information as we possibly can.

The restrictions on sharing legal advice are well known. Murdo Fraser will also be aware of certain precedents that allowed information to be provided to members to help them to make the decisions.

I know that Murdo Fraser will take what I am going to say in the way in which it is meant. In addition to giving indications of support for the Scottish Government's criminal justice policy on short sentences, I notice that Iain Duncan Smith has come out firmly on the side of minimum pricing on alcohol, and has said that it is the key way to tackling the problem among young people. Given that Murdo Fraser once slavishly followed Iain Duncan Smith when he was Tory leader, will he now give some regard to those wise words from his former chief?

Question Time — Scottish Executive — Finance and Sustainable Growth

Alasdair Morgan (Scottish National Party, South of Scotland)

Before we come to questions, I echo what the Presiding Officer said earlier: in order to get as many people in as possible, we would prefer short and succinct questions, and answers to match.

Sandra White (Scottish National Party, Glasgow)

To ask the Scottish Government whether it will provide an update on the proposed job losses in the Lloyds Banking Group and in particular the impact on Glasgow. (S3O-8491)

John Swinney (Scottish National Party, North Tayside)

On 10 November, Lloyds Banking Group announced a number of changes, which will affect around 5,000 roles in the group. I understand that they will mean a net reduction of around 2,600 permanent jobs across the United Kingdom by the end of 2010. The company has not announced a breakdown of the locations of the affected jobs.

I spoke to Archie Kane of Lloyds Banking Group on this matter on the morning of the announcement, and the company has made clear its commitment to work with the finance sector jobs task force. Combined with the work of the partnership action for continuing employment initiative, that will ensure that staff who are affected are provided with the employment and retraining opportunities that they need to get back into work as quickly as possible.

Sandra White (Scottish National Party, Glasgow)

I thank the cabinet secretary for that concise answer.

It has been mentioned that up to 1,600 jobs might be lost in the city of Glasgow. What role can the Scottish Investment Bank play in safeguarding jobs and the creation of future opportunities in Glasgow and beyond?

John Swinney (Scottish National Party, North Tayside)

The focus of the Scottish Investment Bank is to assist the process of employment creation in Scotland, and it will do that through the various initiatives in which it is involved.

On financial services employment, although there are regrettable announcements of job losses—I made clear in my initial answer the ways in which the Scottish Government will provide support to the individuals who are affected—there are many announcements of new jobs being created in financial services in Scotland, particularly in Glasgow, with the welcome announcement by Tesco Personal Finance some weeks ago.