The Scottish Government's Response to the Vale of Leven Hospital Inquiry Report

Chapter 5 Next steps

What happened at the Vale of Leven Hospital (VOLH) was a tragedy that should never be repeated. While the Government and NHSScotland have taken action since the C. diff outbreak in 2007/08 to improve patient care and outcomes, we know there is still more to do. This brief closing chapter sets out where we go next with implementation of the report's recommendations, building on the strong foundations of progress reported in Chapters 2-4.

5.1 Progress since publication of Lord MacLean's report

We accepted all 75 recommendations from Lord Maclean's report and have committed to a number of actions to ensure they are fully implemented.

First, we wrote to the Crown Office andamp; Procurator Fiscal Service and all NHS boards in December 2014, requesting they provide an assessment of progress against the 66 recommendations set out in the report (65 for NHS boards and one for the Crown Office andamp; Procurator Fiscal Service), while we undertook a similar exercise in the Scottish Government. We summarised the responses NHS boards and others provided in January 2015 to determine the current status of each recommendation. Our initial analysis showed that work had already started on many of the recommendations in line with policies and programmes put in place either prior to or since the outbreak at the VOLH, much of which is evidenced throughout this response.

We know, however, that there is more to do. That is why we have asked NHS boards, in the interest of continuous improvement and quality assurance, to provide a progress update on their original assessment. We have requested that the progress report be considered and approved by their local area clinical forums, area partnership forums and public involvement networks.

The second action was to establish an Implementation Group and Reference Group to oversee the implementation process of all 75 recommendations. The Implementation Group, established in February 2015 and chaired by our Chief Nursing Officer, will work with a number of existing groups and quality, scrutiny and improvement organisations to take forward the recommendations. The Reference Group has representatives of patients and families affected by the outbreak whose role is to support and challenge the Implementation Group and ensure the recommendations are fully enacted.

The third action relates to how the Scottish Government, NHSScotland and other organisations will collaborate to go even further than Lord MacLean's recommendations. Examples include:

• the Chief Medical Officer working with the UK Government on a five-year plan to promote better antibiotic prescribing
• the Chief Nursing Officer working with Scotland's executive nurse directors to evidence and assure the quality of care provided in an open and transparent way
• the streamlining of our national HAI groups and development of a five-year strategy to 2020
• the introduction of a new uniform for our senior nurse leaders, making them easily identifiable for patients, families and carers.

5.2 Monitoring and reporting

Outputs from the Implementation Group and Reference Group, including an action plan with timescales to ensure the recommendations are fully implemented and progress updates, will be published on the Scottish Government website. We already have monitoring and scrutiny systems in place that inspect against a number of the recommendations, including the NHS board local delivery plans that are reviewed as part of the NHS board annual review process. The review this year will include questions on how well the recommendations are being implemented. The Healthcare Environment Inspectorate and older people acute hospital inspections currently inspect against a number of standards that are aligned to the report's recommendations.

5.3 Lessons learned

Finally, it is essential to ensure that the lessons of Lord MacLean's report are learned quickly across our healthcare system to prevent a tragedy such as that witnessed at the VOLH from happening again.

We have therefore introduced our national approach to assuring nursing and midwifery care to look at how nursing and midwifery can be improved in the light of the report. Quality of care reviews being developed jointly by Healthcare Improvement Scotland, the Scottish Government and NHSScotland will consider how the report's recommendations can be included as part of quality, scrutiny and improvement processes.

We are confident that robust arrangements such as these, operating alongside existing systems we have described in this response (such as the independent and rigorous scrutiny and assurance of NHSScotland hospitals by the Healthcare Environment Inspectorate and the monitoring of care provided to older people in acute settings by Healthcare Improvement Scotland) will alert us to problems early and trigger actions when things need to be put right.