Dr. Tracey Cooper:

I will answer the second question first. I certainly have not come across any. I was surprised at the question. We have not had experience of any waivers, not even a suggestion or whisper of them, which is good.

I agree absolutely that people should be held accountable for persistent poor compliance. I have a problem with people who say their target for hand hygiene is 80%. In my view that equates with people deciding actively not to clean their hands for one in five patients. That is the reality. This goes back to what I said about team level. There are different levels of accountability. Somebody said, and I agree, that everybody is accountable and everybody has responsibility for doing it right. That does not mean that when people persist in poor compliance everybody ignores them. I would like to know that at team level, at ward level, consultants and senior nurses are setting examples.

Someone responded to a report last week by saying that doctors are really busy. I do not care if someone is a doctor, a porter, a pharmacist or a nurse. It makes no odds. Everybody is responsible. In answer to the Deputy’s question, the leadership at facilities must address people who are reportedly non-compliant. If a ward has had a persistent number of health care associated infections I want to know who the repeat people are and how to support them because this involves remedial action and training. If there are persistent problems it should be part of a disciplinary process for a hospital if a member of staff persists in offending. There is an opportunity and we persist in raising awareness to persuade people to do something different tomorrow when they go to work and have their colleagues challenge them.

Deputy Conway felt uncomfortable about empowering patients but patients can tell who has not washed their hands when coming towards them. I have been in that position. If I was sitting in an emergency department with my child and I was watching a nurse, pharmacist or doctor going back and forth in a clinical environment to patients without washing their hands I would not let that person touch my child.