I refer the member to the timeline of events in my statement to the Parliament on 18 June 2008 and to the answer to question S3W-14337 on 15 July 2008. All answers to written parliamentary questions are available on the Parliament''s website, the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

In response to the recommendations arising from the publication of the Health Protection Scotland Report on Review of Clostridium difficile Associated Disease Cases and Mortality in all Acute Hospitals in Scotland from December 2007 - May 2008 and the independent review Report on the Clostridium difficile Outbreaks at Vale of Leven Hospital, I announced on 7 August 2008 that a new National HAI Action Plan and Action Plan for NHS Greater Glasgow and Clyde had been produced. Both plans are being led by our multi-agency HAI Task Force. The national action plan is available from the HAI Task Force website at:

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/19529/2005/actionplans.

Of the 55 patients at the Vale of Leven Hospital, 18 patients died either as a direct result of Clostridium difficile Associated Disease (CDAD) or had C. difficile recorded on the death certificate as contributory factor to their death. Further analysis of the death rate is required and is on-going as part of a separate exercise being undertaken by the board and Health Protection Scotland. Full details of the outbreak will be produced by the Outbreak Control Team in due course.

I refer the member to the answer to question S3W-15613 on 8 September 2008. All answers to written parliamentary questions are available on the Parliament''s website, the search facility for which can be found at http://scottish.parliament.uk/webapp/wa.search.

On 18 June 2008, I announced in the Parliament an independent review of procedures in place at the Vale of Leven Hospital over the period December 2007 to 1 June 2008, in response to information that 55 patients had developed Clostridium difficile Associated Disease (CDAD), 18 of whom had died.

The Independent Review Team (IRT) met and was briefed on 26 June 2008 with a remit to report by 31 July 2008. The IRT requested and reviewed all relevant documentation regarding cases of CDAD at the Vale of Leven Hospital over the six month time-frame and the circumstances contributing to these cases. The IRT visited the Vale of Leven Hospital on five occasions and interviewed a wide range of staff from the hospital and NHS Greater Glasgow and Clyde. An open invitation was made through the local press for patients and their families to submit written and oral evidence to the review and meetings were held with representatives from 10 families.

Full details of the process followed by the IRT are set out in the report, Independent Review of Clostridium difficile Associated Disease at the Vale of Leven Hospital from December 2007 to June 2008, which was published on 7 August 2008.

We have no plans to do so. The structure and content of the report was determined by the independent review team.

My officials were briefed by the Independent Review Team (IRT) and Health Protection Scotland (HPS) on 31 July 2008. They received Draft Reports from the IRT and HPS on 1 August 2008. The formal report was received on 4 August 2008 and published on 7 August 2008.

NHS Greater Glasgow and Clyde are in the process of implementing the recommendations arising from the Independent Review of Clostridium Difficile Associated Disease at the Vale of Leven Hospital. I understand that the board has already undertaken a review of the infection control structure, management and leadership arrangements.

To be confident that all of the actions are taken forward and have the desired outcomes, I have already asked, as recommended by the independent review team, that they review the actions taken by NHS Greater Glasgow and Clyde in six months time. The report will be made public.

NHS Greater Glasgow and Clyde has almost £1.5 million of capital funds committed in 2008-09 for the Vale of Leven Hospital. This includes a general provision of £1 million which will be used specifically to fund capital schemes aimed at strengthening the hospital''s capacity to control the spread of hospital acquired infection. The remaining £500,000 is earmarked for minor capital schemes of a more routine nature, which are carried out on a year to year basis.

Beyond 2008-09, the capital plan includes provision for ongoing investment in minor schemes on a year to year basis. There are proposals for Alexandra Health Centre to be re-provided on the Vale of Leven campus in the next five years, and there is an expectation that a firm timescale for the project would emerge subject to forthcoming public consultation on the wider future of the Vale of Leven Hospital.

The provisional estimate of capital expenditure required in relation to Alexandra Health Centre re-provision is £17 million but the NHS board have still to complete a detailed business case following public consultation which will consider the costs and delivery arrangements for the project.

If a medical practitioner knows the cause of death he/she can complete a death certificate. If not, the case should be discussed with the Procurator Fiscal who may decide there is enough information available to sanction the completion of a death certificate, or alternatively instruct further enquiry, which may include a postmortem. The NHS undertakes hospital postmortems with proper authorisation from the deceased person''s relatives, if a clinician wishes to learn more about the cause(s) of death. Postmortems very often reveal that a patient has more than one medical condition, some of which may not have been evident in life. Equally, the cause of death is still on occasion unknown, even following a postmortem. There is no legal requirement for a postmortem in cases of Clostridium difficile, and this condition is diagnosed by microbiological tests on stool samples in life.

All infection control managers report directly to the relevant NHS board Chief Executive.