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The Scottish Government has already announced a record level of investment of £54 million over three years to tackle all healthcare associated infection, including Clostridium difficile.

In addition, all NHS boards have been instructed to ensure that they have an antimicrobial management team in place, and £520,000  has now been released to enable NHS boards to establish antimicrobial pharmacist posts which will support high quality prescribing.

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.

This is a matter for the Crown Office and Procurator Fiscal Service (COPFS). COPFS has issued guidance to doctors on the categories of death that must be reported to the Procurator Fiscal. This guidance is available on the Crown Office website, www.copfs.gov.uk. Clostridium difficile is not a cause of death which doctors are currently obliged to report in terms of this guidance.

The Scottish Government regularly reviews and updates the information that is made available on their website. Information about Clostridium difficile was last reviewed and updated following the publication of the independent review on 7 August 2008.

The review report was referred to the Lord Advocate because she is responsible for the investigation of deaths in Scotland. The Procurator Fiscal has a duty, on behalf of the Lord Advocate, to investigate all sudden, suspicious, accidental, unexplained and unexpected deaths, as well as deaths which give rise to serious public concern.

The majority of these deaths were not reported to the Procurator Fiscal at the time but when the full extent of the situation at the Vale of Leven Hospital became known, I ordered a review. In the circumstances, it was appropriate for the Procurator Fiscal to await the outcome of the independent review before considering what further action was necessary. However, the number of deaths at the Vale of Leven hospital has clearly given cause for concern within the community and it is therefore appropriate for the area Procurator Fiscal to conduct an independent inquiry into the circumstances of those deaths in the first instance.

The Scottish Ambulance Service (SAS) have advised that they intend to take forward the recruitment of an additional member of staff for the Arrochar station. In addition, this additional crew member will support the elimination of single-rostered crewing in this area.

The Scottish Government is committed to ensuring that the SAS continues to provide sage, efficient and effective services to patients across Scotland, including those in remote and rural area. It is also important that patients have confidence in the SAS''s ability to respond to emergencies.

While this presents particular challenges in remote and rural locations, the service seeks to improve performance for all patients and remains keen to seek local solutions that meet the needs of those communities. In addition, the SAS has appointed a first responder co-ordinator in this area to develop and support first responder schemes.

It is important to ensure that performance targets are challenging but deliverable. On that basis, the national performance target for responding to category A calls was revised to be achieved across mainland Scotland by March 2009, rather than within each individual NHS board area.

We recognise that achievement at a Scotland-wide level will mean that there may be some communities where this target is not routinely being met. That is why the Scottish Government is looking for the Scottish Ambulance Service (SAS) to demonstrate that across all parts of Scotland it is working to secure continuous improvement, particularly in remote and rural areas.

The Scottish Government and the SAS are committed to ensuring safe, efficient and effective health services across all parts of Scotland, including remote and rural areas. The SAS will continue to work with local partners to achieve this.

Tendering for the central heating programme was undertaken in 2006. The contract was for two years, with the option of a further two extensions of up to 12 months each. The first extension is currently being used from April 2008 to March 2009.

The Scottish Fuel Poverty Forum is currently considering the long-term future of the programme and is expected to report back in early autumn. Once the forum has provided its recommendations the necessary decisions on the programme''s future will be taken.

The specific statutory requirements which relate to NHS boards are available via the Office of Public Sector Information website, www.opsi.gov.uk.

The Scottish Government is committed to ensuring that the Scottish Ambulance Service (SAS) continues to provide safe, efficient and effective services to patients across Scotland, including those in remote and rural areas. It is also important that patients have confidence in the ambulance service''s ability to respond to emergencies.

While this presents particular challenges in remote and rural locations, the service seeks to improve performance for all patients and remains keen to seek local solutions that meet the needs of those communities. In addition, the Scottish Ambulance Service has appointed a first responder co-ordinator in this area to develop and support first responder schemes.