Meeting of the Parliament

Meeting date: Tuesday, May 5, 2020

Official Report 881KB pdf

---

Topical Question Time

We now turn to topical questions. Our first question this afternoon is from Alison Johnstone.

---

Covid-19 (Testing in Care Homes)

To ask the Scottish Government whether it plans to regularly test all staff and residents in care homes for Covid-19. (S5T-02138)

Since the weekend of 2 and 3 May, enhanced outbreak investigations are being carried out in care homes where there has been a confirmed case of Covid-19. In such instances, all residents and staff are offered testing whether or not they are symptomatic. The enhanced outbreak investigations include other homes if that facility is part of a group or chain. As part of our surveillance work, sample testing is also done in care homes where there have been no cases.

All of that is an advance on the previous position, where symptomatic residents were tested and, from 22 April, all admissions were tested with the exception of people who had been discharged from hospital to the care home having been in hospital with the virus, in which case they would had to have given two negative tests before discharge.

The outbreak of Covid in a care home on Skye is having a tragic impact on residents and staff, and my heart goes out to all those who are affected. I commend the efforts that are being made by all who are caring for the residents.

In Parliament last week, Professor Hugh Pennington said:

“the only way we can stop problems in care homes is to stop the virus getting into them in the first place because, once it gets into them, it is out of control.”—[Official Report, Health and Sport Committee, 28 April 2020; c 9.]

The Government’s job now is to ensure that everything is done to prevent further outbreaks. There is no doubt that regular routine testing alongside adequate personal protective equipment is a key to achieving that. Imperial College London published research concluding that weekly testing for at-risk workers such as carers could reduce the spread of Covid by one third. Can the minister confirm whether the Scottish Government accepts that conclusion? If so, why is it yet to introduce regular testing even though our daily testing rates continue to fall well below the capacity that we have?

Every incident in a care home is a tragic event. Members are, of course, particularly focused on Skye after this weekend, but we have had outbreaks elsewhere. In that respect, at least, Professor Pennington is absolutely correct about the key being first to stop the virus getting into care homes, then to ensure that transmission routes inside the care home are broken. That is why on 13 March we issued clinical guidance to all care homes, requiring them to ensure that residents were looked after in their own rooms and that there was appropriate infection prevention and control, which is a requirement of their Care Inspectorate registration; and it is why we stepped in when there were difficulties, as we continue to do to ensure the supply of proper PPE. In addition, visits to care homes were stopped as they were to hospitals.

Unlike our national health service, 70 per cent of care homes are run by private providers, 20 per cent by independent providers and around 10 per cent by local authorities. Our capacity to intervene directly is therefore limited, although we have done much more of that through the instruction to directors of public health to provide the additional clinical wraparound for our care homes. That work is under way, and some of it might appear in the emergency legislation that is yet to come before Parliament.

On regular testing, where asymptomatic individuals are tested or where test results come back as negative, although there is some debate around how often to continue testing, the accepted practice—broadly speaking—is that we would test twice a week until we concluded that there was no point in continuing testing. We will continue to do that with those care home residents and care home staff. Where the results come back negative, we will nonetheless continue to keep testing so that, should a positive result appear, we are alert to it straight away and not reliant on the care home advising us and are therefore able to act.

We know that asymptomatic and pre-symptomatic people can be infectious, which is why regular routine testing is so important. The predominantly female and low-paid social care workforce deserves every protection that we can give it. We are all aware of how those dedicated staff have gone above and beyond the call of duty throughout this crisis to support those whom they care for. However, Unison tells us that the workforce is terrified about passing on the virus between patients. Regularly testing those workers would ease anxiety, reduce the spread and prevent unnecessary isolation. Testing capacity continues to go unused every day; this week alone, thousands of tests that could have been taken up have gone unused. Why is the Government so reluctant to address this issue?

I need to make two points. It is correct, as Ms Johnstone asserts, that we know that asymptomatic individuals shed virus, but the level of virus is not clear at this point. At the start of the pandemic about 130 to 140 days ago, we did not know that asymptomatic individuals shed virus; at that point, it was clear from the scientific advice that asymptomatic people did not shed virus.

Our approach to how we handle the pandemic has to be evolutionary as our understanding—based on the scientific and clinical advice that we receive and on our understanding of how the virus is progressing elsewhere in the world—is evolutionary. We understand more as we go and we change our strategy and our implementation of it as we go. I am therefore not ruling out the regular testing of health and social care staff if the advice that we receive indicates that doing that more than we are doing in care homes at the moment is the right thing to do.

In relation to Unison’s position, we of course discuss issues through our leadership group with all the unions in health and social care—I think twice a week—including the British Medical Association, the Royal College of Nursing, Unison, Unite, and GMB. I am due to have a discussion with Union this week—I think that it will be tomorrow—at which I am sure we will pick up that point.

Like Alison Johnstone, I am deeply distressed for the residents and staff at Home Farm care home on Skye. A constituent who has a relative in the home told me that she raised concerns with senior management of the company about the lack of PPE for staff, and about temporary staff being taken in from other homes without a period of isolation.

I have written to the cabinet secretary and I have submitted a written question—on behalf of another constituent—about a protocol for care homes during the pandemic, to which I have had no response. When will there be a protocol available for care homes to prevent tragedies such as the one on Skye?

I assume that the first part of Ms Grant’s question is the one that we were asked by, I think, Sky News just a couple of days ago. It is a situation that we were unaware of, because, until today, Ms Grant had not advised me of it.

In relation to Ms Grant’s other question, I think that the answer to her parliamentary question will be with her shortly. [Interruption.] If I know the details of the constituent and the question that they raised, I will be happy to pursue that.

I am not sure what Ms Grant means by “a protocol”. The guidance to care homes is really clear. That guidance is that residents should be looked after in their own rooms; that there should be no communal socialising or meal times; that visits should be stopped; and that there should be no transfer of staff from one care home to another. All of that is about breaking the transmission route. I think that that is a type of protocol, but if Ms Grant wants us to add other areas into that, I will be happy to consider including additional areas.

However, I make the point that I have made previously: many of the issues that members are raising are about private care home providers—the majority of the outbreaks are in private care homes—which, in some instances, have not appeared to follow the guidance that we require them to follow. That is why the Government is now taking a more direct intervention route in those cases.

I will provide a little clarity: there are two separate constituents. One, who has a relative in Home Farm care home, told me that she has raised her concerns with the management repeatedly and has not been heard. The management have not dealt with the situation and her relative is very sick at the moment.

I also wrote on behalf of another constituent to request a protocol and was given a holding answer. If no protocol was available, why was I given a holding answer rather than an answer?

Rhoda Grant will have an answer to her PQ. With regard to her constituent’s question and their concerns about the management in a particular care home, if she tells me which one it is, I will intervene directly with that care home and get an answer to the question that her constituent rightly raises, because the management should be dealing with those concerns.

The cabinet secretary will be well aware of the particular circumstances that Inverclyde faces—population decline, a growing older population and 15 care homes. Following the publication of two sets of data by National Records of Scotland, we now have the unenviable figure of three times the level of Covid-19 deaths than any other part of Scotland. What additional actions and resources will the cabinet secretary introduce to help to reduce the level of deaths in my constituency and provide a focus on care homes, their residents and their staff?

As I said earlier, national health service directors of public health have now been given the authority to intervene directly in care homes in their locality. That will ensure that primary care is directly engaged with those care homes. If the care home providers agree, the NHS will provide staff to ensure that the right clinical interventions are made, and to help care home staff, who might want more training on infection prevention and control. In addition, checks will be carried out on the levels of personal protective equipment and to ensure that all the guidance from 13 March onwards is being followed.

All the directors of public health in all our territorial health boards are involved in that process. They have made contact with all 1,083 care homes and are paying particular attention to, and staying in constant touch with, those care homes that have active cases to ensure that the testing that I mentioned earlier is under way, if not completed. They also need to pay attention to those care homes that do not yet have active cases, because we need to shield those homes and make sure that they have everything in place to prevent an active case in as much as that is possible. If additional measures are required in Inverclyde or any other area, the directors of public health have the authority to introduce those.

I am happy to put specific questions to the director concerned in Mr McMillan’s constituency and to ask him to provide me with additional information for the member on exactly what the board in question is doing with the care homes in the Inverclyde area .

I understand that the reactive testing in our care homes is absolutely necessary. If I understood the cabinet secretary correctly, she talked about random sampling. If random sampling is taking place in places where there are not yet any instances of Covid-19, has that produced any positive cases?

Mr Rumbles is correct. Testing is undertaken in care homes that have no active cases at this point, providing that the residents and the staff agree—in that sense, it is randomised, because not everyone agrees to it. I do not have the information to give a direct answer to the member’s question about whether any positive cases have been uncovered as a consequence, but I am happy to look out that information and to provide it to him.

However, I know that in instances in which testing is under way and individuals have initially had negative test results, repeat testing has produced positive test results. In those instances, there are two additional ways in which we can support care home providers with regard to staff: one is to ensure that, if they are content with the arrangement, NHS staff are offered to supplement the staffing rotas in a care home; the other is through the 2,200 or 2,300 returners from our exercise in March and April, all of whom have experience in social care. We have already deployed some of those returners, and others are waiting to be deployed to care homes, should care homes ask for that to happen.

I am asking this question on behalf of the families and care staff in my region who have contacted me about cases that they have been involved in, and I declare an interest, as my mum is in a care home.

From the outset, the system of testing has been one of the greatest failings of the strategy to address the crisis. When so many non-Covid hospital wards are vastly underutilised—some are empty at the moment—why are we sending elderly and vulnerable people from hospital to care homes when their Covid status has not been determined, thereby risking their wellbeing and the wellbeing of other residents and the staff?

I will say two things. First, our hospital occupancy rate is growing as the work that we have done to remind people that the NHS is open for urgent care as well as Covid care becomes more successful. Secondly, we need to keep a degree of unoccupied capacity in our hospitals, because we cannot be confident at this point that we are past the highest number of Covid cases. The reproduction number that I, the First Minister and others refer to is under 1, but the results around the number are fragile and it is not sufficiently under 1 for us to release too much capacity at this point. However, that is one of our considerations as part of the work that we are undertaking to identify whether there can be any easing of the current lockdown restrictions.

In addition, we all know that the longer a person—particularly an elderly person—stays in hospital when they no longer require the clinical treatment of that hospital, the less mobile, less able and more open to other infections they become.

The guidance that we have put in place for admissions to care homes is very clear. If the person has been in hospital for Covid, if possible, they will need to give two negative tests before discharge. If that has not been the case, if it is possible to test before admission, that should happen; otherwise, they should be admitted to the care home and isolated for 14 days, but tested on admission. The test results come back from our NHS laboratory within between 12 and 24 hours, so we know very quickly whether an individual has Covid-19. If they do not have it, the degree of isolation and barrier nursing around them can be lessened. I think that that is a well-proven way of protecting both the individual and those who are caring for them. Like all residents in a care home, the individual should not be mixing with the other residents in any respect—that was a critical part of our 13 March guidance.

There are other questions on this matter, but we have to move on.

---

Social Distancing (Older People’s Health)

To ask the Scottish Government what assessment it has carried out of the impact of the lockdown on the mental and physical health of older people, in light of the views of the British Medical Association and Royal College of General Practitioners that age alone should not determine social distancing rules. (S5T-02133)

The framework, “COVID-19—A Framework for Decision Making”, which was published on 23 April 2020, is clear that the current lockdown measures are absolutely essential right now. However, we acknowledge that they have damaging consequences of their own for physical and mental health, including that of older people, for our economy and for our living standards.

We recognise the challenges that many older people face and we have provided a range of support, such as the national helpline and the £350 million funding package, to help local authorities and voluntary organisations assist where required.

Looking ahead, it is important that there are clear criteria to guide decisions on whether to maintain, tighten or relax the lockdown. As a Government, we will listen to the best scientific advice and to the people of Scotland as we make our judgments.

Does the minister accept that, in many cases, older people are well placed to make their own judgments on how best to shield or distance themselves while maintaining a healthy balance to protect their mental health and combat loneliness? Other countries have ruled out legally enforcing age-based restrictions. As decisions on the next phase are made, is it the Government’s view that age-based restrictions are discriminatory?

We have to differentiate between those who are shielding and the vulnerable groups that we are asking to adhere to the guidance that the general population is asked to adhere to, which includes washing hands frequently, staying at home and not socialising with people who are not part of one’s household.

The research so far shows that mortality from the disease is higher for the over-70s and that a large proportion of those suffering from the disease are in that age group, even when pre-existing conditions are taken into account. Although the risk is hard to quantify, we know that diseases that make people immunosuppressed, obesity and respiratory diseases all worsen outcomes.

We know that age matters with this infection, which is why we have taken the precautionary step of asking the over-70s to be particularly careful about physical distancing, hand washing and not mixing with other households.

I appreciate that this is a difficult time for everyone, and particularly for those of an older generation. My parents are in that age group and they find it really difficult not being able to spend time with their children and grandchildren. However, this is about protecting and saving lives and keeping our national health service safe.

As we go into the next phase, people want to understand whether the guidelines will be advisory or legally enforceable.

I turn to a related point. The minister will be familiar with the seniors together project, which represents older people in South Lanarkshire. Helen Biggins, the project chair, told me that the group is concerned about elder abuse, which can be physical, mental or financial in nature. She fears that it could become much worse as older people are stuck behind closed doors.

What is the Government doing to actively protect and support older people who are feeling more vulnerable and alone as a result of lockdown and who would feel more confident if they could have contact with people who they trust?

I am sure that Monica Lennon agrees that elder abuse is not acceptable. If anyone feels that they are vulnerable or that they have experienced abuse, help is there for them and they should reach out to get it. Domestic violence services and other abuse services are still available during lockdown; it is really important that we get that message out there.

We all have a responsibility to look after our communities. Right around South Lanarkshire, including in my constituency, there has been a fantastic local community response in reaching out to neighbours, supporting vulnerable people and providing food packages, as well as providing social support, listening ears and befriending services.

Although we still have to follow the guidance on maintaining social distancing, it is really important that we reach out to our communities, friends and families to ensure that people feel safe when they speak out.

Carers Scotland has warned that half of Scots carers face burnout because support services have been cut. When will the Scottish Government produce a plan for the safe return of respite care services?

I cannot give Mr Briggs a concrete answer to that. We will review all the services that support carers, of which there are a lot. There is no longer face-to-face support, but there is still online and telephone support.

It is really important that people realise that those services are still there during lockdown.

On respite, we would need to look at the available evidence and science around how safe it is to reintroduce the service, to ensure that residents who go into respite and the people who care for them are safe.

What additional support is the Scottish Government providing to key mental health services during the coronavirus pandemic, to help people to look after their mental health and wellbeing?

We recognise a range of possible effects on people’s mental health during this time. Some people might feel anxious or emotionally distressed. There might be escalating distress or mental ill health as a result of the pandemic, and effects might be exacerbated by unemployment, financial uncertainty, isolation or bereavement—and for many other reasons.

We want to ensure that people who are identified as needing support can get services that are appropriate to their needs. We have developed guidance to help individuals to maintain good mental health, through NHS inform. We have ensured that the NHS Covid-19 website carries advice on maintaining mental as well as physical health during the outbreak. In addition to the expansion of NHS 24 that has been announced, we will continue to explore the extension and development of mental health and wellbeing services that people can access from home should they need to do so.

It is important to note that mental health services are working just now. If people feel that they are becoming unwell, general practitioner and primary care services are there for them, and secondary care mental health services are available should people require referral to such facilities. In addition, over the past few weeks, we have opened—I think—17 mental health assessment centres across Scotland, so that people do not have to access accident and emergency to get a mental health assessment but can go to a special facility and access services more quickly.

Some of the most difficult pieces of correspondence that I get at the moment come from grandparents who are desperate to see and hold their grandchildren. Given that we are moving into a new phase, with mass testing, will the minister consider introducing a scheme that uses a combination of testing and voluntary self-isolation to enable family members safely to visit older relatives in self-isolation? Does she recognise that such a scheme would give much-needed help to some of our older residents right now?

I think that we all recognise just how difficult not being able to access parents or grandparents is—for all of us—and that it is particularly difficult for people who are shielding or who are over 70 and cannot access their grandchildren, which is absolutely heartbreaking. I have heard tales of people who have had a grandchild born during lockdown who they have not been able to see or hold as they would normally do. I have every sympathy for those people—and I think that we are all going through a difficult time in not being able to hug our parents.

The member makes an interesting proposition, and I am sure that all the science will be explored in that regard. We need to be careful and cautious in how we move forward; we have made a lot of gains in reducing the spread of the virus and we need to be careful not to lose them. We need to proceed with caution.

Lockdown can work only if everyone accepts its parameters. David Blunkett, the former Home Secretary, is leading a petition that calls for healthy older people to be treated in the same way as everyone else is treated when lockdown ends. What incentive is there for someone in their late 70s who is in good health to comply with lockdown long after everyone else has stopped doing so, if they feel that they have only a few years of life left and want to make the most of them? Surely such people should be given the same consideration as is given to any other healthy person of any age.

I refer Mr Gibson to part of my answer to Monica Lennon. We know that people in that age group are much more at risk, we know that the mortality rate is higher in that group, and we know that the measures that are currently in place are helping us to tackle the pandemic.

We are all responsible for our own actions, but we all need to follow the guidance, which is led by the science. I would caution anyone against going against that guidance. We all need to follow the Government’s guidance: to socially isolate, stay at home, not mix with other households, and wash our hands frequently.

---

Barnett Consequentials

To ask the Scottish Government when it will pass on £155 million in Barnett consequentials to councils. (S5T-02130)

The First Minister has already made clear in the chamber, and I am happy to confirm again, that we will pass on those consequentials in full to local government. We took action quickly and have already committed to providing £175.6 million to local government. That includes a £50 million hardship fund, a £45 million Scottish welfare fund top-up, £30 million for a food fund and £50 million for a council tax reduction scheme and social security top-up. That brings the total direct additional funding that we have committed to providing to local authorities to £330.6 million.

In a meeting with me, more than a fortnight ago, the Convention of Scottish Local Authorities agreed to supply details on cost pressures. That information is still awaited. It is absolutely right that that information from councils should inform distribution methodology, to ensure that we support the areas of greatest need.

I thank the cabinet secretary for that answer. It is the first time that I have heard her agreeing to give the entire £155 million to councils. She certainly did not want to do that when I questioned her last week.

Let us look at the cost collection exercise that the cabinet secretary is so keen to mention. The exercise started at the beginning of April. Templates were sent to council finance officers on 6 April. That was 12 days before Robert Jenrick’s windfall to English councils was announced, so it has nothing whatsoever to do with the consequentials from that. Does the cabinet secretary not accept that there is no link between the two and that councils should just be given the money—full stop?

It would be highly irresponsible to allocate money without carrying out the analysis that is necessary to understanding and determining where local authorities most require it. I agreed in good faith with COSLA, more than a fortnight ago, that we would need to see figures relating to additional pressures.

I accept, and have accepted all along, that local government has done an exceptional job in the response to coronavirus. I also accept that there are cost pressures. However, as Graham Simpson will have seen—and as I have seen—as individual councils identify what their cost pressures are, there is a variety of need. It is important that, in any spending decision, we decide in consultation with COSLA.

It is not for me to determine why that cost collection exercise has taken so long. I await it with interest; I look forward to receiving it; and I look forward to ensuring that local authorities get the funding that they need.

As I have already said, the cost collection exercise has nothing whatsoever to do with that £155 million. It sounds as though the cabinet secretary wants to decide for herself how that money is allocated. Perhaps she will confirm whether that is the case. If it is not the case, will she, as she should, use the normal distribution model that councils use—[Interruption.] I am being heckled, but perhaps members should listen. Failing to do that will lead to a war between councils and a battle within COSLA. I am old enough to have seen that happen. We have seen it before. The cabinet secretary would do best to avoid that and to use the normal system, rather than deciding for herself what each council should get.

It is within the job description of the Cabinet Secretary for Finance to deliver a balanced budget and to allocate funding. It is for COSLA to inform and influence the normal process that Graham Simpson has identified. His position is that he wants to use the normal distribution methodology; I would rather hear from COSLA how it believes that the funding should be allocated.

The cabinet secretary has set out how much additional funding is being provided to local government. She referred to a figure of £330.6 million. Will she outline the further financial flexibilities that the Scottish Government has provided to local authorities?

To support local authorities to respond to coronavirus, we have agreed with COSLA to front load our weekly grant payments by £150 million in May, £100 million in June and £50 million in July, and to keep the cash-flow position under review and make further adjustments if necessary. We have also increased the 2020-21 general revenue grant by £972 million and reduced business rates support by the same amount, reflecting the potential loss of business rates income resulting from our support for businesses. Lastly, we have provided additional flexibility linked to the previously ring-fenced funding for early learning and childcare, the pupil equity fund and the challenge authorities and schools programme funding.

The cabinet secretary said last week that local authorities should use their reserves while she decides how much support to provide them to enable them to deliver new services and support our communities to cope with significant reductions in their incomes. In her previous answer, the cabinet secretary did not appear to get the fact that we are in the middle of a pandemic—we are not in a normal budget round. Does she accept why COSLA and our council colleagues are increasingly unhappy with the lack of support that they have received to date and that she is micromanaging? Are our councils not equipped to carry out the necessary analysis to make the best use of those resources for our constituents across Scotland?

It is because we are in the middle of a pandemic that we moved quickly to provide local authorities with funding to begin with, before there were those consequentials from the UK Government; I have already mentioned the £175.6 million that we have provided to local authorities.

This issue appears to me to be a storm in a teacup. My letter made clear that I was awaiting confirmation from local authorities on funding in terms of their need; that was an agreed position with COSLA two weeks ago. I have committed once again, off the back of what the First Minister said a few weeks ago in the chamber, that we will pass on that funding in full, and I believe that COSLA and local authorities, and not just members in the chamber, should inform and influence how that money is allocated.

---

Covid-19 (Testing)

To ask the Scottish Government how soon it will begin to test asymptomatic people in the community as part of its test, trace, isolate and support strategy. (S5T-02136)

We are already testing asymptomatic people in care homes and those without typical Covid-19 symptoms who enter hospital and are over 70. That is in addition to on-going surveillance studies in the community, which test people who do not necessarily have Covid-19 symptoms. When the test, trace, isolate and support system kicks in in full, it will complement some of the current testing work that is under way but will not completely replace it. We will still have a specific focus on hospitals and care settings, where there are particularly high risks. Now, and in the future, when we test asymptomatic individuals as part of our overall testing strategy and they test positive, we will apply the same trace, isolate and support approach to their contacts.

The paper that was published yesterday says that symptomatic people will be tested initially. The models that test, trace and isolate is built on come from studies in South Korea, Iceland and the Italian town of Vò, where asymptomatic people tested positive. In Vò, 50 to 70 per cent of people tested positive. Given that research, some of which came to public attention in early March, can the cabinet secretary say what research exists that suggests that asymptomatic people should not be tested?

The paper that was published yesterday actually says that symptomatic individuals will trigger the trace and isolate strategy. That means that individuals whom the symptomatic person has been in contact with—who may not be symptomatic—will be traced and tested and, if they test positive, they will be asked to isolate while they wait for their test results and support will be provided to them. That is actually what the test, trace, isolate and support approach says. My understanding, from what I have read and what I hear from the group chaired by Professor Andrew Morris is that that particular approach matches what the World Health Organization tells us should be the approach on test, trace and isolate.

There will be a mix of symptomatic individuals and individuals with no symptoms who have been in contact in some way—there are criteria on the levels of contact in order to make the strategy work effectively. That is a central part of the work that we have already started. Contact tracing and testing was under way at the Home Farm care home in Skye at the weekend. That work has begun in some measure and will be ramped up as we look at ways to ease the current restrictions. However, in effect, test, trace, isolate and support will be one of our strategies for some time to come.

As we know, the UK Government has designed its own app, which it is trialling on the Isle of Wight. Does the Scottish Government have any plans to go down the road of most other countries of using the technology developed by Apple and Google, which is said to be more reliable and less intrusive in relation to sharing information?

As yesterday’s Government paper made clear, the core of our strategy primarily relies on contact tracers. That is the most reliable approach. We estimate that we will need about 2,000 individuals to work as tracers. That means using the health boards’ health protection teams, who do such work for other kinds of infections, and expanding them considerably. The work to expand those teams is under way and they will be assisted by digital technology. We are confident in using the technology that is being developed by our Digital Health and Care Institute, which is attached to the University of Strathclyde and has a track record of five years of work. It is building on an app that is already used in Scotland to trace contacts for other infectious diseases, primarily sexually transmitted diseases. That is now being scaled up to complement our strategy.

People will have heard in the media about the UK Government’s proximity app. I believe that that app is being trialled in the Isle of Wight. We have not yet taken a view on the app largely because we still await detailed technical information from the UK Government about it, assurance about the confidentiality and security of the data that it collects and assurance that what it identifies fits into the Scottish NHS system, so that the data transfer works well, allowing us to see it as an enhancement to our strategy. We have been asking for that information and I will have another conversation later today with Matt Hancock and colleagues from Wales and Northern Ireland. When we get that information, we will be able to take a measured decision about whether we believe that that particular proximity app will enhance our strategy.

What consideration has the Scottish Government given to the deployment of the proximity app that the UK is testing? Would it not be much more beneficial to have a cross-UK policy? That would tackle the issue much better. It highlights the lack of technology available in the NHS across the board.

I think that, by and large, I have already answered that question. Once we have the answers from NHS England and NHSX on the technical information—and, more important, on the assurance about data confidentiality and security and on whether, if people from Scotland download the app, the data will feed into our central approach of test, trace and isolate—then we can take a view. At this point, we cannot take a view because we do not have that information.

If we are to have a four nations strategy on any of those matters, we need the appropriate exchange of information so that all four nations can decide whether they want to go down a particular route. We have evidenced our willingness to do that so far, but we have also been clear, as have my colleagues in Wales and Northern Ireland, that we take the right decisions for the population for which we are directly responsible. In my case, that is the population of Scotland.

I am concerned about the prospect of confusion if we have two technology systems for different parts of the United Kingdom. I hope that the cabinet secretary is able to explain why she lacks the knowledge that she needs in order to have confidence in the app. On the Isle of Wight, people are already testing it but, up here, we do not seem to know what it involves. Can the cabinet secretary clear that up?

The reason why I do not know that is simple: the questions that we have repeatedly asked have not yet been answered. Willie Rennie’s question would be better directed to my counterpart in the UK Government. As do my officials, I continue to ask those questions and to hope for that information, because I want to make a decision about whether the proximity app could enhance what we are already planning. It is straightforward. At the moment, until I get my questions answered, I cannot make that decision. I do not know why I have not had that information; our questions are clear and we ask politely. We have managed to get to joint places on other matters but not yet on that. I remain hopeful that we will at some point.

As we move towards the test, trace, isolate and support strategy, can the cabinet secretary expand on the importance of following social distancing and personal hygiene measures, as set out by the Scottish Government?

I am grateful for that important question. Whatever else we do, including ramping up our early start with the test, trace, isolate and support strategy, and the considerations that the First Minister set out today about how we ease current restrictions and what that might do to our capacity in Scotland to suppress and control the virus, physical distancing and good hygiene will remain a central part of what we all need to do for some considerable time to come. We know the means by which the virus is transmitted. Physical distancing is there in order to prevent transmission, and good hand and respiratory hygiene are there to protect us as individuals and those we are with, including our families.

My final point is important. The whole exercise is about population health. The health decisions that I take as an individual impact on not only me and my family, but everyone in the chamber. We continue to say that we need to do this together, because our individual decisions have significant impacts on those around us.

---

Recycling Centres (Reopening)

To ask the Scottish Government when recycling centres will be designated as an essential service and reopened. (S5T-02144)

Local authorities are responsible for recycling centres and need to consider several factors before reopening them. Those include the ability to operate sites safely, the ability to ensure that physical distancing is maintained and the need to discourage the public from making unnecessary journeys.

We are working closely with the Convention of Scottish Local Authorities and local authorities on the development of a wider position statement regarding the prioritisation of waste services, and we are discussing what further guidance and practical steps on recycling centres might be required.

Of course, we are grateful to all those who are working to maintain essential waste collection services across Scotland.

I concur. We should thank all those front-line workers who have been delivering the refuse collection and health and safety services across Scotland.

This morning, I had a discussion with the co-leader of Fife Council, David Ross, who told me that council officials in Fife have been talking with the police and have in place a proposal to at least start to try to open some recycling centres, given the level of fly-tipping. He says that the stumbling block to moving that forward is the Scottish Government and that the Scottish Government would have to be clear that these are essential services that can be opened in a safe way.

There is no point in blaming local councils. We have a problem with fly-tipping, and councils want to get these centres open. Will the Scottish Government work with them to do that?

With the greatest respect to Alex Rowley, I say that that is exactly what I said we are currently doing. I am aware that a number of councils are looking at how they can manage the problem. It is not as straightforward as a single council choosing to reopen a centre, because impacts can begin to develop, as we have seen from some of the actions that have happened south of the border, which we do not want to be replicated here. It is very important that we understand how recycling centres will be managed.

One of the reasons why household waste recycling centres in Scotland were closed was workforce shortages. Average absence rates in waste services were between 15 and 35 per cent, but some were as high as 40 per cent. That situation still has to be worked through and managed.

It is not a question of just saying, “Yes, they can all be reopened.” They have to be reopened safely, we have to know that that is not going to incentivise non-essential journeys, and we have to make sure that the centres can be managed as well as possible. At the end of the day, this is about minimising the likelihood of continued transfer of the virus.

Roseanna Cunningham’s first answer was that councils are in charge of this and the decision is up to them, and her second answer was that it is up to local authorities, but the Government will not blindly give permission to open centres. With the greatest respect to her, I suggest that we need clarity and leadership.

The Scottish Environment Protection Agency has reported a 40 per cent increase in the number of reports of fly-tipping in April, compared to the figure for April last year. There is a problem that needs to be addressed, and councils want to address it. They are working locally to establish safe ways of doing so, and they want the Scottish Government to work with them and agree to get the centres reopened. The sooner we can do that, the better. I hope that the cabinet secretary will reflect on that.

I presume that the member does not want me to simply instruct all local authorities to reopen without regard to any other matters. That would be utterly wrong, and it would not solve any of the problems that would likely transpire. I am pretty sure that, if I did that, he would be the first here to tell me that I had no business in instructing local authorities to do anything of the sort.

The fact is that we have to discuss with local authorities what guidance will best allow them to manage reopening recycling centres. We must make sure that there are no unintended consequences of that, which the member does not seem to be particularly interested in.

The member talked about fly-tipping. A number of the fly-tipping examples that we have seen have involved commercial waste, which would normally be taken to a licensed disposal site. That material would not normally be disposed of through local recycling centres, so opening recycling centres will not necessarily fix the problem.

I caution the member to be careful about what he thinks he is calling for and to agree that, as I said at the outset, we are having a proper conversation with COSLA about how the situation can best be managed for everybody’s safety.

Coronavirus restrictions have meant that some councils have had to incinerate rather than recycle both kerbside waste and waste from recycling centres. When will the Scottish Government issue support and guidance to help maintain recycling rates?

Right now, what we are concerned about is ensuring that we can manage our waste collection services right across Scotland during this emergency. That is at the forefront of the conversations that we are having.

As we move forward, the continuing necessity to recycle will remain absolutely important—we do not want to take anything away from that—but, right now, we are trying to manage a situation that is not particularly easy to manage, given the nature of what we are talking about. I hope that the member agrees that conversation, collaboration, discussion and agreement are the best way forward.

Local authorities across Scotland will be affected differently and at different times by the coronavirus, and it is paramount that any waste management is carried out with the safety of employees in mind. We all have a part to play in reducing the spread of the coronavirus and, ultimately, in saving lives. Will the cabinet secretary outline what guidance is available to help households to manage their household waste during the coronavirus pandemic and where they can access more information?

Of course, we agree that the wellbeing of workers is paramount. We also recognise the importance of supporting households at this rather difficult and awkward time.

As part of our efforts, and working in partnership with local government, we have launched a national communications campaign that provides advice and support on arrangements for the management and collection of household waste. The campaign website, www.managingourwaste.scot, provides householders with a range of guidance and received more than 45,000 visits in its first week. Local authority websites continue to provide the very latest updates on local service changes. I hope that people will access local authority websites and the national campaign website in order to establish what best practice is in the current scenario.

The closure of the local recycling centre in Cambuslang, where I live, has resulted in an increase in fly-tipping and in householders holding excess waste within their properties. What routes exist for local communities to make their views known to councils and the Government on the safe reopening of recycling centres?

I probably answered that question by referencing the council websites. I anticipate that people will have regular discussion and conversations with local councillors and council officials to ensure that their views are heard and taken on board.

Some recycling centres might be easier to open than others, from council area to council area, for a variety of reasons. It is important that councils understand the general impact on, and response from, the public in relation to the closures that they have had to endure and the potential for reopening.

I remind everyone that commercial waste fly-tipping is on-going. Such waste would not normally be going to those recycling centres, which are household waste recycling centres, not commercial waste recycling centres. There is a danger of assuming that all the fly-tipping is of household waste, but that is not necessarily the case.

That concludes topical questions. I encourage all members who are leaving the chamber to do so safely.