Clarity urged over inspectors power to close hospital wards

Health boards are concerened about the new powers given to health inspectors

The Royal College of Nursing (RCN) Scotland has also expressed reservations that the proposed change in the law, brought in after the inquiry into the deadly Vale of Leven C. diff outbreak, could be subject to political influence.

The Scottish Government has laid regulations before the Scottish Parliament that would allow Healthcare Improvement Scotland (HIS) inspectors to close wards as a last resort to protect patients.

The move will fulfil a key recommendation made by Lord MacLean, whose inquiry found that C. diff was a factor in the deaths of 34 out of 143 patients who had tested positive for the infection at the West Dunbartonshire hospital in 2007 and 2008.

But some health boards have warned that ward closures could in themselves have an impact on patient safety as services struggle to cope, and have called for clarity on how it would work in practice.

NHS Shetland points out that its local hospital has only four wards with a total of 57 beds.

In a submission to Holyrood’s Health Committee, the health board said: “In this context the decision to close a ward, while obviously only being taken for serious safety reasons, would in itself have significant safety issues in relation to overall bed capacity and the need to transfer a significant number of additional patients from Shetland to Aberdeen or other mainland hospitals.”

NHS Lothian said: “NHS Lothian does not have capacity to quickly absorb a full ward of patients. Nor does it have capacity to sustain current performance against targets if a ward/wards were closed.

“It may also be that depending on the function of the ward under the threat of closure there is not a facility that provides the same level of specialist treatment.

“So although it’s important that HIS have the ‘potential’ power of closure we would again stress the need for an escalation process and an element of pragmatism in relation to how such an order would be enacted.”

RCN Scotland raised questions about the independence of HIS, which has both a scrutiny and improvement function in NHS Scotland.

The Organisation for Economic Cooperation and Development (OECD) recently said HIS risked “marking its own homework”.

RCN Scotland said: “The RCN has repeatedly said in the past that HIS’s dual improvement and scrutiny role can present a conflict of interest.

“If HIS is granted the power to close wards, will this increase the conflict of interest further and, if it does, how will this be mitigated?

“Given the current proposals, how will HIS be protected from situations where there may be political resistance or pressure to close wards?”

MSPs will take evidence on the proposal from Public Health Minister Maureen Watt at the next meeting of the committee on Tuesday.

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