Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, October 7, 2020

Official Report 1169KB pdf

---

Urgent Question

The Presiding Officer has selected an urgent question. As a result, decision time will be at around 6.15.

---

Covid-19 Outbreaks in Lothian Care Homes

To ask the Scottish Government what action it is taking in response to the outbreak of Covid-19 at Redmill care home and Milford house care home in Lothian.

I have a number of points to make in my answer.

First, I express my condolences to the families who have lost loved ones in those two outbreaks. My thoughts also go to the families who have loved ones in the homes that are affected, to residents themselves, to staff who have tested positive, and to staff who are understandably upset and anxious for the residents for whom they care so much.

Neither of the homes has had previous outbreaks, nor have they been flagged as being either amber or red in assessments by the Care Inspectorate or the local director of public health. The Care Inspectorate will immediately conduct a root-cause analysis, as I have asked it to do, and will identify from that any further actions that we need to take in our winter preparedness work in the adult social care sector.

The local care home support and health protection teams are in direct contact with Milford and Redmill care homes to make sure that they have all the personal protective equipment that they need; to support them with their staffing, including use of NHS Lothian’s staff bank for staff who are self-isolating or who have tested positive; to make sure that that all relevant infection prevention and control measures are understood and are being implemented; and to make sure that both homes have the clinical care that they need for the residents who are affected.

I thank the cabinet secretary for that answer. Our thoughts are, of course, with those who have lost their lives, the families who are left behind, and the staff, who are doing their very best.

Over the past two days, I have been contacted by many staff members and by families of residents at the Redmill care home. I know that colleagues have had similar contact with Milford house. Staff and relatives need our 100 per cent support at this extremely difficult time.

Today, I spoke to HC-One Ltd about Redmill. It told me that the first positive test was on 25 September and that NHS Scotland was informed on that day but that the whole-home testing regime by NHS Scotland did not take place until six days later. Twenty-eight staff members are still waiting for results, and six staff members are waiting for a test. Some tests could not be given, because labels did not come with the kits. Twenty residents await results. Some people have not had results, despite having been tested on 28 September—nine days ago. One staff member received three sets of results, one received someone else’s results, and 20 results were returned as negative but with no information as to whom they belonged.

I really hope that the same has not happened at Milford house, because staff and residents deserve so much better than what appears, in this case, to be a shambles with the testing regime. If that is how it operates, how on earth can we get on top of the virus? The staff at the home deserve so much better than what they are being provided with through the testing regime. The owners of the home are not responsible for that. The staff and owners are doing their best; the testing regime is at fault.

I do not have the benefit of having the information that Mr Findlay has just provided, but I will look into the situation later today and give a detailed response tomorrow to him and other members who have a direct interest and concern.

The information that I have from NHS Lothian is that all the tests that were undertaken before the weekend have been returned and are in the test and protect system. That clearly differs from what Mr Findlay has told me, so we will pursue that in detail.

I know that, in Redmill, 37 staff and 18 residents have tested positive and that, in Milford house, 18 staff and 13 residents have tested positive. Results have come back, but Mr Findlay raises serious issues. I noted them as he spoke, but if he cares to send me the information directly so that I am absolutely sure about the facts as he understands them, we will investigate the matter urgently. If such problems exist, I will ensure that I understand exactly why they have occurred and what we are doing to resolve them. If the problems exist as Mr Findlay described them, we will ensure that they are not replicated across the system.

I am more than happy to provide the information. HC-One has been extremely helpful in providing me with updated information today, and with information yesterday, for which I thank it. Today, I sent that information to NHS Lothian and the local health and social care partnership, so they have it. I ask the cabinet secretary for an immediate inquiry into what has happened, because the situation cannot continue when lives are at risk.

What I am about to say is in no way whatever intended to cast aspersions on what Mr Findlay has told me, but I have not had such information from NHS Lothian. I was not given it by the Care Inspectorate, which I spoke to this morning, or by Scottish Care, which I also spoke to this morning, and both of those organisations have been in contact with HC-One and the other provider.

When I get the information from Mr Findlay—I thank him for sending it; I am sure that it will be waiting for me when I get upstairs to my office—I will look at the position in great detail and will have it investigated and then get straight back to him and other members who might be affected, so that we understand exactly what has happened and what the facts are. If there has been a problem, we must understand why it has occurred and, importantly, ensure not only that it is resolved for the two care homes but that it is not replicated anywhere else in the system.

I have two requests for supplementaries. I can take them both, if members are brief.

My thoughts are with the families and loved ones of the people at the care homes who have died from the virus.

Further to Neil Findlay’s questions, has NHS Lothian said that it believes that the Care Inspectorate’s guidelines have been met? Will the cabinet secretary investigate the ability to reopen the temporary laboratory at the University of Edinburgh, which has been put into hibernation? That would provide additional capacity for care home testing across east Scotland.

As I said, neither home has been flagged as being at the amber or red stage, either by the Care Inspectorate in its regular assessments or by the local director of public health. Assessments are made weekly and I get a report of them all. Neither home has appeared as amber or red.

As we know, neither home has had an outbreak before. Care home staff throughout the country are very concerned when their homes have positive cases, and, in the case of the two homes that we are talking about, I know how anxious and upset the staff are, because this has not happened before. The staff are very worried.

That is why the root cause analysis is so important. We need to understand what has happened in two care homes that have, as far as all the data that I have shows, been following all the guidance and all the procedures.

As, I think, the First Minister said in her statement, we are busy increasing national health service capacity across the country. The lab in Edinburgh to which Miles Briggs referred has been returned to its earlier work. We need to maintain increased capacity not only for Covid testing but for NHS testing, so that normal diagnostic and other tests can be done as we remobilise the service. We cannot give that up, because, if we did, we would not be able to do some of the procedures that we are doing.

We have scaled up NHS Scotland capacity and—as the First Minister said in her statement—we will report back on the review that we are doing as we scale up. We see that the UK Lighthouse Labs Network is also scaling up, so we will consider how we can strategically use that additional capacity for other areas of testing that are clinically advised. In regard to that last point, which related to care homes, we are incrementally transitioning all our care home staff testing away from Lighthouse labs and into NHS ones. That is partly to protect that testing from when Lighthouse has to deal with a UK-wide surge in demand, which can sometimes increase turnaround times.

Like colleagues, I associate myself with the comments about the devastating impact of the outbreaks.

Can the cabinet secretary tell us what enhanced infection prevention and control mechanisms will be put in place in the care homes, and about the lessons that can be taken from the outbreaks not only in Lothian but across the country? Has she seen the research from NHS Lothian about the correlation between the size of care homes and outbreaks?

I have seen that research, which is backed by data that the Care Inspectorate has produced.

The issue is partly about the size of care homes, but it is also about their configuration. For example, where a care home is configured in such a way that a whole floor can be put into isolation, responding to cases of infections that can break out in those settings—Covid, norovirus, flu or other infections—is more straightforward.

However, overall, it appears that the data is clear that the infection prevention and control work in smaller care homes is more effective in having an impact. There is more work to do on that, and there are obviously implications for the business models of some care homes that will affect how they go forward. All that is, of course, factored into the independent review that Derek Feeley is leading on.

Enhanced infection prevention and control is assisted by what we have now introduced, and the majority of care homes have signed up to that. It is called the safety tool. It, essentially, the same safety huddle tool that we have used so successfully in hospital settings as part of our patient safety programme. It has been transferred over, and is being applied appropriately for the care home setting. That allows the Government, the home, the Care Inspectorate and local directors of public health regularly to see not only PPE stock levels—we continue to supply that, where it is needed—but staffing rotas.

We want to open up visiting, where it is possible to do so safely, but it requires a certain level of staffing. The safety tool allows us to see, daily and weekly, where homes might need additional support, either from their local NHS or health protection teams.

The core—basic infection prevention and control—is the absolute standard that we need to ensure exists in all our care homes. The safety huddle tool helps us to identify where there might be difficulties in delivering that, so that we can intervene and offer support directly.