Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 1, 2020

Official Report 872KB pdf

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Care Homes

The next item of business is a statement by Jeane Freeman on care homes. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

I will touch on a number of issues regarding care homes and will say more about the commitment that the First Minster has outlined in the programme for government.

We have discussed and debated the situation in our care homes many times during the months of the Covid pandemic. It is right to do so. From the outset, in the Covid-19 update statements made to Parliament by the First Minister and by me, we set out the plan that we were putting in place to prepare our national health service in the face of evidence that, at that time, suggested significant hospitalisation and demand for intensive care. We set out our intention, among the other work then under way, and at pace, to ask health and social care partnerships to focus on reducing the level of delayed discharge. That reduction has been a long-held ambition of this and previous Governments.

Over the weeks and months since then, we have updated the initial guidance to care homes, strengthened primary care support and increased testing. However, there have been many deaths in our care homes, and it is right that we and Parliament should use accurate data and analysis to look at the decisions that were taken and the actions that followed, so that we can see—with the increased knowledge that we now have—what more could be done. That is not only the rightful purpose of scrutiny; it will aid our planning for the weeks and months ahead.

The loss of a loved one is a weight that stays with every one of us for the rest of our lives. It is a loss that is made heavier if we have not been able to be beside our loved one in their final hours, and one of the deep cruelties of Covid-19 is that, at a time when we would look to friends and family to help shoulder the weight of grief, we have been forced to stay apart. The weight of the loss of so many of our fellow citizens to this brutal virus will never leave me or, I know, many others.

As I set out last month, I have commissioned Public Health Scotland to report on discharges from hospital to care homes and what the Covid-19 status was for those who were discharged at the time of their discharge. That should also include information on the outcomes experienced by those patients, and that work should be ready to be published by the end of the month.

As I set out in the Parliament in March and April, we set a clear goal of reducing delayed discharges and, as we have considered many times, the guidance made it clear that any such discharges should continue to be subject to clinical risk assessment. The United Kingdom Coronavirus Act 2020 allows local authorities to undertake partial needs assessments by dispensing with particular social care assessment duties, but only where it would not be practical to carry out those duties or where they would cause unnecessary delay in providing community care services to any person.

The powers are designed to allow local authorities to provide urgent care without delay, protecting the lives of those who are most vulnerable while ensuring that safeguards are in place. I gave evidence to the Health and Sport Committee on the legislative consent motion on 24 March, and the regulations came into force on 5 April. Those powers have not been widely used in Scotland. In the monitoring period to 2 July, seven out of 32 local authorities used the powers in the specific circumstances that I have described.

In recent days, we have seen reports of delays in the care home testing carried out through the UK Government’s testing portal. As members are aware, there have been issues with the UK’s network of three lighthouse labs. We are in daily contact with the Department of Health and Social Care to address those issues and ensure that we can continue to access the capacity that we need at the same time as we continue the work to bring more NHS Scotland processing capacity on stream, to increase resilience and mitigate any issues with the UK’s portal. Those recent challenges have seen some test results delayed, but, having looked at that in detail, I am pleased to advise members that those delays have not been as extensive as recent reporting suggests. Even so, delay beyond 48 hours must be minimised, and we are working with our UK colleagues to improve that even more.

I well understand the upset and dismay that have been caused to both residents and families by the restrictions on visiting, and I hope that the steps that have been taken since early July to return visiting, both indoors and outdoors, in a phased way have been helpful. We are now finalising guidance for care homes, to support the return of in-reach health and social care services and the safe reopening of communal areas. Caveats apply here, as members would expect, in that the care home must be free of Covid-19 and be participating fully in the testing programme. However, with that proviso and the necessary health and safety measures in place, those activities should be able to return, and I hope to publish the relevant guidance shortly. It will, however, remain the case, as we have seen in Aberdeen and in Tayside, that, where we have a higher prevalence of the virus in an area, that may necessitate the restriction of care home visiting in order to protect residents while an outbreak is brought under control.

The pandemic has seen a pace of change in the delivery of many aspects of our healthcare service that was previously unimaginable. It is a pace of change that is necessary for our adult care sector. As the First Minister set out in our programme for government, I have commissioned an independent review to examine how adult social care can be most effectively reformed to deliver a national approach to care and support services. I have made no secret of my sympathy for a national care service, and that will be part of the review’s considerations. The scope of the review will include how adult social care is organised, commissioned, regulated and funded.

I am pleased to inform the Parliament that Derek Feeley has accepted my invitation to chair the independent review. Many members will know Derek from his time as our director general for health and social care and the chief executive of NHS Scotland. He will be ably supported by an advisory panel that will draw on expertise from Scotland and beyond: Caroline Gardner, who was until very recently the Auditor General for Scotland; Malcolm Chisholm, a former Minister for Health and Community Care and a former member of the Parliament; Anna Dixon, the chief executive of the Centre for Ageing Better; Göran Henriks, the chief executive of learning and innovation in Jönköping county, in Sweden; Councillor Stuart Currie of East Lothian Council and the Convention of Scottish Local Authorities; and Ian Welsh, the chief executive of the Health and Social Care Alliance Scotland and also a former member of the Parliament. Their task is not an easy one, and I am very grateful to each of them for agreeing to be involved in and to lead this work.

The review will build on the reform of adult social care that was under way, in conjunction with COSLA, before the pandemic. That reform had at its core the views of those receiving social care, and it was previously examined by the Health and Sport Committee.

I believe that, across the Parliament, we have a shared view that we need both to improve outcomes for people who use services and to ensure a good working environment for a key workforce whose criticality has been emphasised in recent months. I have agreed with the independent chair that the review will take a human rights-based approach, with a strong emphasis on the needs, rights and preferences of people who use services, their carers and their families.

Social care services and supports are enormously varied, covering everything from care homes and care at home to day services, befriending and supported employment. Those services touch the lives of a very wide range of people: disabled people, older people, people with mental health problems and people with drug and alcohol problems. We must consider the needs of all of them equitably, fairly and respectfully. People who are using services and supports should be consistently and routinely informing the process of improvement and should be involved in co-designing services.

Derek Feeley and his colleagues are ready to begin immediately, and they will report in January 2021. That is a very tight timescale, but it will ensure that the Parliament has the options before it straight away at the start of the next session, so that it can take any steps—legislative or otherwise—that are necessary to put in place the reforms that our adult care sector needs.

I know that the care that many people receive is already good and that people who work in care in Scotland are beginning to feel more valued, and certainly more recognised, for the work that they do—but not enough yet. I am determined that we should go further, so that positive experiences are consistently the norm, by design and with intent. My hope is that the outcome of the review will give us a blueprint for the future that can secure consensus across the chamber.

Our adult social care sector is a vital service for very many people, helping them to live as independently as they want and as well as they can. Those who work in the sector are every bit as caring, compassionate and dedicated as those who work in our NHS. The experience of the pandemic shows us that very clearly. It has also shone a light on the pressing work that we need to do to improve services and to support those who need them and those who work in them. The independent review will offer us real solutions and, I suspect, difficult choices, but its work is vital.

Right now, as the review begins its work, there is more for us to do in applying the lessons learned so far from the pandemic in our mobilisation plans, in supporting the sector, in working co-operatively and in providing fast responses to problems and issues that arise. The Parliament has my commitment that we will continue to do just that.

The cabinet secretary will now take questions on her statement. I intend to allow until around 5 to 5 for questions, after which we will move on to the next item of business. I make my usual plea for succinct questions and answers.

I thank the cabinet secretary for advance sight of her statement. I acknowledge the announcement of the establishment of a national care service. Scottish Conservatives await more details of that and will comment further when concrete proposals emerge.

Thanks to various newspaper investigations, we now know even more about the decision to send patients who had tested positive for Covid-19 into our care homes. We have already found out that as many as 37 such patients were transferred to care homes, that having been sanctioned by clinicians—and several health boards are still to report their figures. Just this weekend, it was reported that at least one care home provider took in a person whom the local health board said had tested negative for Covid when in fact the opposite was true.

The First Minister has repeatedly been asked when she first learned that patients who had tested positive for Covid-19 were transferred into our care homes, but she has repeatedly refused to answer. Therefore, I ask the cabinet secretary directly to say when she first found out that that was happening.

I am grateful to Mr Cameron for his question and his comments.

Once the independent review has developed its work plan—including how it will hear evidence and information, and, in particular, how it will hear from those involved in the sector—I intend to ensure that colleagues from across the chamber are made aware of that and of the timescale involved.

I turn to Mr Cameron’s question. As the Scottish Government has said more than once, he will know that I have commissioned Public Health Scotland to undertake a piece of work that will consider all discharges. It will determine whether individuals were Covid positive on discharge. It will also determine the point at which they had been tested, so that we will know whether they were infectious at the point of discharge.

As we worked through the information on care homes, we became concerned that some individuals might be in that situation, because they could test positive for Covid even after they had previously tested negative. We also became increasingly concerned about the numbers of cases in care homes, which was when we not only updated our guidance—on more than one occasion—but introduced testing. Of course, testing is one of the elements that are critical to preventing infection from spreading, and other such elements include isolation and proper infection prevention and control, as was set out in our guidance from 13 March onwards.

As we understood more about the virus and how it transmits—including in those who might be asymptomatic and the fact that, particularly in some elderly people, different symptoms from those that are normally present in the rest of the population can indicate Covid—we also understood that there might be a risk that individuals who had not been tested but who needed to be were going into care homes. It was at that point—I do not have the exact date in front of me, but it will be in my papers—that we introduced testing as a requirement before admission to care homes. However, the critical elements—isolation; infection prevention and control nursing; the clinical decision that a patient was ready for discharge; and the clinical risk assessment about where that person should go—have been there from the very beginning.

Care homes have been at the epicentre of the crisis, but it did not need to be that way. On too many issues, the cabinet secretary and the Government have failed to listen to front-line staff and the families of residents. On personal protective equipment, on testing and on what happened when people were discharged from our hospitals to care homes, the Government was too slow to act.

Scottish Labour welcomes today’s commitment to establishing a national care service. I look forward to getting around the table with the cabinet secretary and Opposition parties to discuss that. However, I point out to the cabinet secretary that the advisory panel does not include anyone from the front line, so we need to get that sorted. There is no trade union representation and no one else is representing the voices of workers. That needs to change, because if we had listened to workers at the start of the crisis, we would not have seen the tragedies that we have seen to date.

On visiting, it is really important that residents and their families do not pay the price for this Government’s mistakes, with paralysis and fear preventing families from being reunited. I need to hear a commitment about when families can be reunited. Too many people are having to sit with elderly loved ones in car parks in wet conditions; in some cases, I have seen older people having to sit in underground car parks that are covered in pigeon mess. It is not safe, it is not hygienic and it is a betrayal of people’s human rights.

Finally, we must have an independent, judge-led public inquiry, because the public have lost a lot of trust and confidence. Will the cabinet secretary indicate when she thinks that that will happen? We all wish her well in her retirement, but the public need to know that the people who have made key decisions will be around for the inquiry.

Ms Lennon asked a number of questions, which I will try to answer. I thank her for her good wishes and, just for the record, I will say that I am no away yet. I have a lot of work still to do, and a lot of energy to give to it.

I do not accept that we have failed to listen. I talk to trade unions and Scottish Care regularly. It was thanks to some of the discussions with Unison in particular that we managed to address the PPE issue. The issue was raised first by Scottish Care, which advised me that its private supply lines for PPE were not working as well as it needed them to work. We therefore introduced direct support to the social care sector, including to care homes, in relation to supplies of PPE.

However, it was the unions that raised issues about the quality of some of the PPE, and it was thanks to them that we could then address those issues. We reached agreement with COSLA and all the unions involved on 2 April about the right of care home workers to determine for themselves whether, for example, they believed that it was professionally important that they wear a mask.

Therefore, I do not accept that we have not listened to staff. We continue to listen. I continue to meet and discuss things with staff, and the trade union voice is involved in the recovery group on mobilisation that I chair.

The advisory panel will undoubtedly reach out and hear from all the unions involved. Members heard the First Minister say that she fully expects that the advisory panel will want to hear from every Opposition party in this chamber, as well as from other voices, including families, relatives and so on.

Indoor visiting is already possible. I accept, and I genuinely understand, the difficulties around visiting, but our clinical and professional advisory group advises me about the right steps to take in order to stage a step-by-step return to more normal living for people in our care homes. I know that people’s care homes are their homes, but I also know that we need to protect them and we need to have time in between each step to ensure that we have not caused unnecessary harm in those situations.

We now have more outdoor visiting. As the weather changes, we need to increase indoor visiting and, importantly, communal activity, and to ensure the return of in-reach care and health services. I hope to be able to make an announcement on that shortly.

We have had this discussion before about a public inquiry. The First Minister has been clear that we consider that having a public inquiry on the entire handling of the pandemic is the right thing to do; that level of scrutiny is important. When we think that it is right for that to begin, we will come back to the chamber with the details of the arrangements.

However, one of the things that I will do tonight is attend a resilience meeting at 5 o’clock to discuss the increase in the number of cases that the First Minister announced. The pandemic is still here, and all the focus and energy must be on that as much as it is on anything else right now.

I would warmly welcome the commencement of that public inquiry as soon as possible. I have previously raised concerns that congratulating health and care partnerships for achieving a delayed discharge target at this time might create a culture in which targets inadvertently affect actions and outcomes.

I welcome the announcement of the independent review and the commitment to consider establishing a national care service—the Greens whole-heartedly support that—but there have been significant outbreaks in our care homes during the pandemic, and the shocking number of deaths reveals the toll that it has taken. However, we do not yet understand the long-term effects. Large numbers of residents might require more complex care as a result of Covid infection. Can the cabinet secretary therefore advise what steps are being taken to prepare for a potential surge in the number of people experiencing more chronic health problems in our care homes?

That is an important question. Our clinical and professional advisory group is working on what more we need to do to introduce increased rehabilitation services and support for dementia in care homes, and how we can most effectively deliver that. My colleague Ms Haughey, who is sitting beside me, is leading on our work on dementia overall but with a particular focus on what more we might need to do in care homes and in relation to people who receive care at home, who may have been isolated from their families because of the lockdown restrictions. We are giving careful thought to that. Once we have a clear plan about what additional work needs to be done, I will ensure that the member is made aware of that.

I add my voice to the calls for the immediate commencement of a public inquiry.

It is troubling to learn that, in the testing surge that went with the return to school, care homes were forced to play second fiddle to 17,000 children who had the sniffles and who were probably fine. Care homes had to operate blind for several days while they waited for delayed test results and kits to come back. Unquestionably, the human tragedy of the pandemic is in our care homes, so what assurance can the cabinet secretary give that, should there be another spike in demand for testing, care homes will be protected and that their results and test kits will be turned around in short order?

That is part of the work that I set out in the statement. We have daily contact with the UK Department of Health and Social Care. The delays were caused in the UK Lighthouse Labs Network, which is made up of three laboratories across the UK and which experienced that surge. Actually, the Glasgow lighthouse lab is further advanced on the number of tests that it can process and the speed with which it does that, but it is part of that UK-wide network, so it has to play its role in handling that work overall.

We continue to work with colleagues in the Department of Health and Social Care to ensure that we can access the number of tests that we need in Scotland and that we control the mobile testing units, the regional testing centres and the walk-through testing centres that are being introduced—the first one opened in St Andrews on Monday. We want to ensure that we can control the level of slots so that the centres do not close down unnecessarily. We are also trying to increase the pace of work on the three regional hubs that we have always planned to introduce from October and to bring those forward where we can. Today, I agreed additional expenditure on equipment for that, and for our NHS and for partner nodes, so that we build more resilience sooner in our NHS capacity.

However, I do not believe that our care homes played second fiddle. It is a difficult balance. The labs process the tests as they come in and do not make decisions based on where a test came from or whether it involves an old or young person. That is not how the process works. We do not want to discourage parents from having their child tested; we want to help them to understand the symptoms of Covid as opposed to the sort of common or garden-variety bug that children inevitably get when schools open up again, and especially after such a long time. That is why the national clinical director sent out a letter to help with that, which I think that all parents have now received from their schools.

In the week up to 20 August, the number of care home staff who were tested was 36,986, so the figure did not dip. My understanding is that the numbers that will be published this week will show that there has been a dip, but it is very small. Therefore, it is not fair to characterise the situation as care home tests coming in very late. I have looked at some of the detailed reporting extremely carefully, and I can say—with no disrespect to the journalists concerned, who worked with the information that they were given—that it has not been entirely accurate. I am happy to put the accurate picture on the record for those journalists or, indeed, for anyone who has a concern.

For understandable reasons, I have let the front benchers have longer questions and longer answers, but 10 members want to ask questions in the remaining 15 minutes, so I will be very firm. I want questions.

Has any comparison been done between infection control practices in privately run care homes and those in local authority-run care homes to ensure that best practice is being shared across the board?

In the course of its job, the Care Inspectorate has been collecting a range of data across a number of areas. An early indication that it has brought back is on different sizes of care homes and different layouts. However, at this stage, it is too early to be definitive about infection prevention and control measures, size and layout of care homes, and which part of the sector they are in. What is clear, though, is that many of those care homes that have gone through the entire pandemic without any Covid cases so far have been small, single-standing care homes. They are to be commended on the work that they have so successfully done.

Before Covid-19 took hold in Scotland and had the devastating impact that we have witnessed on the most vulnerable in our care homes, the evidence was there from across Europe that, if the virus got into a care home, it could have horrendous consequences for residents, with an R number of greater than 10. Surely it was not outwith the wit of the Scottish Government to have recognised that and to have acted on that information to ensure that the most vulnerable in our society were protected. The cabinet secretary has now recognised that better decisions could and should have been made.

What I have recognised is that, if I knew then what I know now, different decisions would have been made, but I did not know that then—indeed, neither did the Parliament when it heard statements from me about delayed discharge, nor did the committee concerned when it accepted the additional powers for local authorities. Nobody queried any of that; nobody challenged it or questioned it. All of us, including Mr Whittle, have been on a bit of a learning journey throughout the pandemic.

I will not accept that, somehow, the Scottish Government wilfully ignored compelling evidence and chose to do something different. Absolutely nothing could be further from the case. Hindsight is a marvellous thing, as is being in opposition, but I remind Mr Whittle that the challenges that the Scottish Government faced are exactly the same as those that now confront every Government across the four nations of the United Kingdom. We are learning together and working together; being able to do that across this chamber would be a bit of a step forward.

My brother was in Highgate care home, which was the first care home to have Covid-19. Sadly, he died, although not from Covid-19. I thank the cabinet secretary for her work and the commitment that she made in her statement.

Will the cabinet secretary report back to Parliament when the recommendations from the review have been published? Will that review set out the next steps for how we can make lasting improvements in the quality of care that is provided in our care homes for all our loved ones?

I thank Mr Lyle for that and, for the record—I have done this in person—I offer him my condolences on the loss of a much-loved brother.

I will report back to Parliament. I will make sure that members know what the work plan is for the review and how those involved will go about their work and how they will reach out and hear opinions and views from everyone who has an interest in the matter. When the recommendations of the review have been published, I will come back to Parliament to give the Government’s initial response to those.

In the meantime, we will continue to work with Scottish Care, the Convention of Scottish Local Authorities, our trade union partners and others to identify improvements that we can make now in our work with the care sector—in relation to care at home and care homes—to ensure that we are learning the lessons and applying them, particularly as we plan for a potential increase in the number of cases as we enter autumn and winter, which I hope does not happen.

I recognise the need to increase bed capacity and reduce delayed discharge, but that does not mean sending Covid-positive patients into care homes. Will the cabinet secretary confirm when she knew that Covid-positive patients were being sent into care homes? Does she accept that that act helped to contribute to 2,000 of our fellow citizens losing their lives in a care home setting?

I say to Mr Sarwar that I have already answered that question. On whether I accept that those individuals who may have gone from hospital into residential care were Covid positive and the impact that that had, I have commissioned Public Health Scotland to undertake detailed work on the data so that it is validated and we have that analysis. That will be at the end of the month, and I am sure that we will come back and look at that in detail. That will tell me and the Parliament whether Covid-infected patients who were still infectious transferred into care homes and what the impact was in those care homes. We will then know that, and we will know it on the basis of validated data from across all of our health service in Scotland.

I understand Scottish Government caution about the resumption of care home visiting, but I also keenly feel family members’ concern about the impact of loneliness and isolation on their loved ones’ health. What criteria will individual care homes have to meet to allow them to increase the number of people who can visit a resident?

There are two critical criteria for a care home to be able to introduce any kind of visiting. The first is that they need to be Covid free for 28 days, and the second is that they need to be fully participating in the care home worker testing programme—not all are at this point, although the number that are is increasing.

Thereafter, care homes need to have produced a plan, which the local director of public health or his or her nominee signs off, for proper infection prevention and control. That includes ensuring that there are adequate supplies of PPE—of course, we have a role in helping with that—and that the staffing rota is of a sufficient size to ensure that staff are there to assist residents and visitors. The new safety huddle tool, which members will recall has been published, will greatly assist care homes with being able to work out exactly what their staffing rota needs to be in those instances.

Those are the primary areas of concern. The director of public health is also involved—the reason why it is the director of public health is that they understand the prevalence of the virus in their local area—and from time to time, as they did in Aberdeen and Tayside, they will restrict visiting beyond what is possible elsewhere in the country in order to provide additional protection while an outbreak is being managed and controlled.

The cabinet secretary talked about the vital importance, when tests for Covid are taken, of getting results quickly. She said that delay beyond 48 hours must be minimised and that she is working with her UK colleagues to improve that. What steps, precisely, is she taking to ensure that such delays are minimised? How is she working with her UK colleagues to improve the situation?

It is important to say that the total turnaround time remains under 24 hours for 95 per cent of our NHS-processed tests. The problem that we have encountered with the lighthouse lab is precisely the problem of it being part of a three-lab UK network. When there is a surge in one area, all three labs have to respond, and at this point not all of them are at the same level of processing capacity. The Glasgow one is ahead.

The work that we undertake involves, on a daily basis, my senior officials talking with their counterparts in the Department of Health and Social Care, anticipating what the demand is likely to be from one day to the next, and discussing how they can flex the processing capacity to deal with that. As I said, from Monday, direct control is being introduced for us here in Scotland over the availability of testing slots and sampling slots in the regional testing centres, mobile testing units and walk-through centres.

We had already planned to increase our NHS capacity. It was always part of the plan to introduce three regional hubs to the existing NHS labs. The first of those was to come on stream from October, but we are working to see whether we can bring that forward, and we are standing up many of the academic nodes that we contracted. We are increasing the capacity that we have at our own hands through the NHS and those other measures, which will include discussions that are now under way with two of the private labs in Scotland.

Can the cabinet secretary inform us whether the UK Government has advised of its intention to undertake a similar independent review of the adult care sector in England, and whether it has indicated whether it is commissioning any analysis of hospital discharges to care homes?

On the latter part of that question, I have written to all my colleagues—Matt Hancock; Vaughan Gething, the health minister in Wales; and Robin Swann, the health minister in Northern Ireland—advising them of the work that I have commissioned from Public Health Scotland on discharges from hospital and asking them whether they wish to do similar. I have not yet had a response from any of them.

I am not aware that any of the Governments in the UK intends to follow what we are doing with the independent review of adult social care , but if they are, we will be very happy to co-operate with them on that.

During this crisis, we have seen older people discharged untested, discharged Covid positive, pressured into “Do not resuscitate” notices, not admitted into hospital for care and not assessed before going into care homes. What has been the response from the cabinet secretary for older people during the crisis? Absolutely nothing. Today, during this important statement, she spends her time in the tea room, blethering to her pals. [Interruption.]

Let me hear the question, please. [Interruption.] Dr Allan, I want to hear the question.

What is the point of having a cabinet secretary for older people when, during the biggest crisis affecting older people in decades, she is posted missing?

I am not posted missing, and neither is Ms McKelvie. If Neil Findlay understood the way that Government works—I appreciate that it is not something that he has experienced—he would know that Ms McKelvie and I, and other Cabinet colleagues, are constantly in touch with each other, hearing what we are doing and asking how we can contribute. Ms McKelvie has contributed a great deal to our understanding and thinking, particularly from the perspective of older people, and she will undoubtedly do the same in the independent review.

If that is the sum total of the questions that Mr Findlay can ask when we are debating something as important as care homes, the next time he tries to pretend that he cares deeply about this issue, I am afraid that his credibility will be pretty weak.

On a point of order, Presiding Officer.

I sincerely—[Interruption.] Excuse me, Mr Findlay. Do not speak over me. I hope that it is a point of order. Let us hear what it is.

The cabinet secretary might know that my mum is in a care home, and I will see her on Friday for the first time in six months. I take great offence at that answer.

I feel sympathy for your personal circumstances, Mr Findlay, but that is not a point of order.

I welcome the routine testing of asymptomatic care home workers and the recent figure of more than 36,000 that the cabinet secretary shared today. Has the Government been able to assess how effective that measure has been in stopping the spread of the virus? I understand that it is early days, but if that has not been done, are there plans to do it?

That is a very important point. There are figures—I do not have them to hand, but I would be very happy to ensure that Ms McAlpine gets them—that show that, as we test care home workers, the number of positive tests from any care home among care workers or residents is declining hugely, but the balance is from care home workers. I know that many of them appreciate the fact that there is now that testing, because they care very much about protecting the residents whom they look after.

While we await the conclusions of the care review, can the cabinet secretary commit to ending insecure care work, increasing pay for staff and abolishing the registration fees that low-paid staff currently have to pay to be able to work in the care sector?

Ms Boyack knows full well that care is delivered by a private, public and independent mix. Each of those sectors has its own terms and conditions. In my opinion, too few of those services negotiate those terms and conditions properly with trade union representation. It is not in my power to interfere directly in that, but it is in my capacity to try to ensure that the fair living wage is paid and to put in place resource to try to ensure that that happens. That is what I have done.

I fully expect the independent review, as it looks at how adult social care should be designed with the individual in mind, how that can best be delivered, how it can best be regulated to ensure consistency of quality and standards, and how it should be funded, to have quite a lot to say about the terms and conditions that should be awarded to those who work in the sector, because the work that they do is so valued.

In the meantime, I will continue to have discussions with COSLA and Scottish Care about the national contract and the commissioning measures that they can put in place in order to try to deliver better across the whole sector on the fair work principles which, as Ms Boyack knows, the Government has signed up to.

I thank members for their co-operation. All members got their questions in, and that is what we always want to happen.

There will be a short pause before we move on to the next item of business.