It would not be appropriate for me to comment until the independent review announced by me on 18 June 2008 has examined all the circumstances surrounding the clostridium difficile cases at the Vale of Leven Hospital. The review team’s report is due to be published by the end of July 2008.

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

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

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

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

Source: National Services Division of National Services Scotland.

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

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

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

Numbers of Patients Undergoing Open Repair of Abdominal Aortic Aneurysm

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

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

Source: ISD SMR01 Linked Database.

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

Subject to the need for ministerial approval of major service changes, NHS boards are responsible for the configuration and location of the services they provide to their local communities. The information requested is not held centrally. style

Leapfrogging affects only a very small number of staff and can arise as part of the assimilation process. The current assimilation process in Scotland has been agreed in partnership following discussion between Scottish Government, staff representative groups and employers and there are no plans at present to amend the agreement reached.

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

The recommendations of the independent review into Agenda for Change in Wales was specific to Welsh implementation issues. In Scotland implementation is being taken forward in partnership and any issues arising are being dealt with using the appropriate partnership arrangements for such discussions such as the Scottish terms and conditions committee.