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Chamber and committees

Meeting date: Thursday, April 9, 2020

Leaders’ Virtual Question Time 09 April 2020

Agenda: Covid-19 Update, Questions to the First Minister


Questions to the First Minister

Covid-19 (Personal Protective Equipment)

I express the heartfelt sympathies of all Scottish Conservatives to all those who have endured loss, as many families have over the course of the past week.

I thank the First Minister and politicians from around Scotland for their good wishes to the Prime Minister as he recovers from the virus. Boris, if you are watching, we all urge you to get well soon and back into number 10.

Presiding Officer, I applaud the first virtual meeting that we are holding.

I will begin by asking the First Minister about personal protective equipment, or PPE, as it is commonly called. Unions say that the PPE guidelines are confusing; front-line staff say that the equipment is not robust enough; and care homes say that they do not get the kit until after the virus has entered the care home. Further, it has emerged that the new PPE distribution hubs that the Scottish Government has set up might be shut at Easter. For several weeks, we have been told that supplies are adequate and that the problem is with distribution. However, members are getting emails and calls from front-line staff and care homes. They have been told that they have the equipment, but they phone us to tell us that that is not the case.

At what point will the First Minister be able to say with absolute confidence that the effective distribution of PPE is in place? If necessary, will she use logistics experts from the private sector, many of whom are currently doing nothing, or from our armed forces, which have helped elsewhere already?

We have army logistics support based here in St Andrew’s house who are already helping us with many issues. I am deeply grateful to them for that. We will draw on support in logistics and other areas when we need it and from wherever we need it.

PPE is fundamental; it is of paramount importance. We have been working hard to resolve people’s concerns, which roughly fall into the following categories: the adequacy of supplies; the distribution of those supplies to where they are needed; the guidance that we are issuing to workers about what types of equipment they should be using in which circumstances; and the quality of the PPE.

We have adequate supplies, although we are not complacent about that, as there are global pressures on supply. We have taken significant steps to improve distribution and we continue to do that, addressing glitches and concerns as they arise. At the briefing that Jeane Freeman and I did yesterday, we commented on our work to ensure that distribution centres will be open over the Easter weekend, just as GP practices and pharmacies will be.

Jackson Carlaw might not yet have had the opportunity to see the joint statement on guidance that was issued this morning by the Scottish Government, the Convention of Scottish Local Authorities and trade unions, which all took part in a meeting that was convened yesterday by the Deputy First Minister and the Cabinet Secretary for Health and Sport. The statement endorses the four nations guidance as being good-quality guidance, but it also makes it clear that whenever a health or care worker on the front line feels that they should be wearing a mask, they should do so, as their professional judgment should be the guiding factor. The Scottish Government will continue to work hard to ensure that adequate supplies get to the front line.

Yesterday, medics wrote a letter on PPE quality, and the chief medical officer is engaging with its signatories. When the guidance that was issued last week was drawn up, there was input from experts and from the royal colleges. There has also been Health and Safety Executive input on the quality of PPE that is being provided.

We treat these issues as hugely important and we will continue to address any concerns that arise. There is an email address that anybody in the front-line workforce can use if they have concerns that they want to be brought immediately to my attention and that of ministers.

Covid-19 (Shielding)

I accept, of course, that the First Minister is taking the issues incredibly seriously. I am pleased that engagement is taking place; I am pleased about her response on the quality issues and I am pleased that distribution centres will be open over the Easter weekend.

However, I am concerned about the on-going issue with distribution, because so many people are still contacting members directly to say that they do not have PPE. I am not sure that I heard the First Minister say that she was confident about when a permanently successful distribution strategy will be in place. However, I know that she will come back to that.

I raise the issue of the shielding of vulnerable people. Yesterday, Sainsbury’s said that it was still waiting for a list of those who are vulnerable and, last night, we were told by a council that it does not know when food boxes will be delivered.

I expect that online delivery will not be the only way to help vulnerable people. There are many who, where online delivery is available, cannot get a spot for several weeks ahead. Again, in Scotland, it seems as though the situation has been rumbling on for weeks, whereas it is being resolved elsewhere. I know that people in my constituency and people who are emailing me from elsewhere in Scotland are getting incredibly frustrated.

When will it be fixed? When will supermarkets have the names of those who need to be supported and prioritised?

I will come to that question in a moment, but before I do, I will briefly round off the issue of PPE. Jackson Carlaw asked me whether I can be confident about when distribution will be improved. We have improved and we continue to improve distribution, and we now have an effective system in place. However, I am not going to predict that no glitches or problems will ever arise, such is the scale and magnitude of what we are trying to achieve. We will continue to quickly and effectively resolve distribution issues. The systems are in place and I believe that they are, in the main, working effectively, but we want to hear, on an on-going basis, from anybody on the front line who is not getting what they need.

I have said before that I am overseeing the coronavirus response as First Minister, but—this will apply to many of us, not just to me—I have family on the front line of the national health service. We all want those workers to have the protection that they deserve, and I take that hugely seriously.

I will give an update on shielding. The shielded group, as we call them, are people in certain medical groups that were carefully considered by medical professionals and experts. We originally said that up to 200,000 people in Scotland would be in that group. We then thought that that would be closer to 120,000. The final figure, after further discussion with doctors, is 136,000.

Those people have all now had letters and they have been given a text message service to register with if they need help getting food or medicine. As of now, 21,000 of them have registered with the service. Just fewer than 6,000 food packages have been ordered. We have in place a national contract with two supermarkets for the delivery of food boxes—free of charge, I should say—and 4,200 have already been delivered. That is under way.

We are also working with supermarkets for people who want to get deliveries via their choice of supermarket. A text will go out from the service, I hope later today, to people who have registered with it, asking them if they want their details to be passed to supermarkets. The supermarkets will then deliver a priority service, which we expect to be up and running in the early part of next week.

We have taken some time to make sure that the system and the service is reliable and robust, and I stress that people do not have to rely on normal supermarket slots. The national contract that is in place with Brakes and Bidfood means that people who have registered with the service will get food boxes delivered free of charge.

Covid-19 (Business Support)

I am conscious of time, so I will move swiftly on, but there was some very helpful information in there and I hope that all of that can be put in place quickly.

When grants were announced to help businesses get through these tough times, Fiona Hyslop, the Cabinet Secretary for Economy, Fair Work and Culture, told the Scottish Parliament on 18 March that grants would be issued per property. Businesses were assured that “every penny” of support funding would be passed on, and they planned on that basis. It then emerged that, in Scotland alone, grants would be given on the basis of one per business, not one per business outlet. That puts any firm in Scotland with more than one outlet at a huge disadvantage compared to those in England and Wales.

Businesses on our high streets are dealing with the reality, not the theory, of the crisis. They are saying to us that they need the support if they are going to be there at the end of the crisis. They are asking me to ask the First Minister to think again. Will the First Minister do so?

We are thinking carefully about the support that we give to business. Every single penny of the consequential funding that is coming from the United Kingdom Government is being passed on to businesses.

We have designed the support in a way that allows more businesses to benefit. By limiting the grants to one per business, we have enabled more businesses to benefit. There are properties with rateable values of between £15,000 and £18,000, for example, that get a grant in Scotland but would not get that grant if they were in England.

We are also providing a range of support in Scotland that is not available elsewhere. We are providing help for businesses that have difficulties with water charges. We have provided a financial support package for the bus industry. We have provided £5 million for the seafood sector and another £10 million for seafood business resilience. We have provided funding through Creative Scotland for artists and those in the creative sector. We are providing money for a range of sectors, which is support that is not available elsewhere. Every penny is being passed on, but we are trying to do that in as fair a way as possible that captures and provides assistance to as many businesses as possible.

However, I am acutely aware—this will be true in the United Kingdom and in Scotland—that businesses will require further support in the period to come, so we are continuing to talk to business organisations, individual sectors and businesses about what more we can do to support them.

Covid-19 (Lockdown)

The Cabinet Secretary for Economy, Fair Work and Culture told businesses that they could expect to receive funding that was parallel to what would be available in England and Wales, and many of them spoke to their banks on that basis. The danger is that, if people have two or three small outlets and get support for only one of them, the other two might no longer be open, which could mean a loss of jobs and viable businesses.

Finally, everybody wants to know when the crisis will end. We realise that the key thing is to flatten the curve and reduce acute pressure on the NHS, and we know that, for the moment, as the First Minister said in her statement, it is vital that we all stay at home, protect the NHS and save lives. However, people want to look to the future as much as they can and today’s newspapers are full of reports that we might—understandably—live under the lockdown for some weeks yet. Will the First Minister confirm that, although that is first and foremost a public health decision, it will be taken in lock step as part of a four-nations strategy across the United Kingdom and that we can all hope, as a country, eventually to come out of this together?

I certainly hope that the UK will be able to come out of the lockdown measures in an orderly and unified way that protects health and is mindful of the other impacts, although, across the different parts of the UK, we have to be mindful of the spread of the virus in the different nations and regions. This morning, I had a call with the other First Ministers and the mayor of London in which we discussed our different experiences, and there will be a COBRA meeting later today.

Let me be very clear: I do not want the measures to be in place for a single minute longer than they have to be. Equally, I do not want us to come out of the measures prematurely in a way that would do damage and would mean that we would see the virus spiral out of control, our NHS potentially be overwhelmed and more lives lost. It is right and proper that we stick with the measures for as long as necessary.

I want to be clear, because there is a lot of media speculation: there is no likelihood or prospect of the measures being lifted after the Easter weekend. I think that COBRA is likely to meet again later next week—I would certainly support that—to start to think about the exit strategy and what it might look like, but it is likely that restrictions and measures will be in place for some weeks to come yet.

Again, I appeal to people to stick with this. We are not asking people to change their lives in such a fundamental way for no reason. I do not want to do it, but it is vital, for health reasons that we all understand.

I do not have my gavel to hand and it is difficult to make eye contact, but I ask everyone to be conscious of the time. We will try to finish the session by 1 o’clock.

Covid-19 (Personal Protective Equipment)

I offer the Scottish Labour Party’s condolences to all those families who have lost loved ones over the past few weeks, and not least to the families of Catherine Sweeney and Janice Graham, two front-line workers in Scotland who have lost their lives to Covid-19 over the past few days. We applaud the efforts of all those front-line workers who are, in the end, saving lives and at times putting their own lives at risk in so doing. It is a national collective effort, but they are very much leading it.

That is all the more reason why I want to return to the issue that has arisen over the past few days about the guidance issued by the chief nursing officer on personal protective equipment, which has caused a good deal of concern among people working on the front line. Those who are working in the community providing home care or district nursing services, for example, are already under pressure and are being put under even more stress and pressure. Can the First Minister give a categorical reassurance that workers in the community on the front line will receive the right and adequate personal protective equipment that they need?

Richard Leonard raises an important issue. The issue around the guidance is not so much about the supply of PPE—we continue to work hard to maintain that supply and to distribute PPE, although, as I said, there are pressures globally on those supplies, so there is no complacency there—as it is about the guidance and its interpretation.

In short, the chief nursing officer’s letter, which was intended to simply interpret and articulate the UK-wide guidance, said that care workers should not feel the need to wear a mask if someone is not confirmed to have the virus or suspected of having it, unless they risk assess that they should wear a mask. In the joint statement that I referred to, which I would encourage everybody to read—it has been agreed with the Convention of Scottish Local Authorities and with the trade unions—we have flipped that on its head and said that every care worker should feel that they can wear a mask unless, in their professional judgment, they do not need to do so. It is a much more precautionary-based statement, and I hope that it builds the confidence of care workers who are on the front line, doing incredibly difficult jobs.

As I said, that statement, which endorses the guidance but is very clear about that interpretation of it, has been agreed by the Scottish Government, COSLA and the unions, which all took part in a meeting yesterday. I hope that that resolves that issue. Of course, we continue to focus on the supply and distribution of PPE.

Covid-19 (Testing)

The other question that I want to touch on is that of testing. The World Health Organization continues to advise, “Test, test, test.” In an interview this morning, the national clinical director told the BBC that 5,000 health and care workers have been tested in Scotland. How many health and care workers have requested to be tested? Out of those 5,000 people, can we get a breakdown of how many of them are care workers and how many are national health service workers? What are the current rates of absenteeism in the NHS and in our care services?

The absenteeism rate in the NHS related to the virus has been around 6 per cent. We continue to monitor that carefully.

On a daily basis, we are increasing the numbers of healthcare staff—and, where appropriate, their family members and close contacts—that we are testing. We hope to update the 5,000 figure that we have given in the next couple of days and I would obviously expect it to be higher at that point.

We are building testing capacity with every day that passes and, by the end of this month, we will have the capacity to do 3,500 tests per day. The capacity is more than 2,000 tests per day right now but we will go higher than that. That testing capacity is simply within the NHS; we are also seeking to bring on stream academic and commercial testing capacity.

Testing is really important. It is important now and it will become really important when we have an exit strategy as a way of going back to the contain phase of the virus, where we test, isolate and trace contacts.

However, I want to be clear about the limitations of testing. The current diagnostic test that we are using can tell us whether somebody has the virus while they are symptomatic. That is important but it does not tell somebody who is in the incubation period that they have the virus, nor does it tell people once they have recovered that they have had the virus. There are quite narrow windows in which that test allows us to say whether a health worker or another worker would be fit to return to work. They may test negative one day, but they may be in the incubation period and may show up positive the next day.

The current test is an important tool and we will use it to the maximum capacity, but we also have to understand its limitations and therefore the importance of having in future, we hope, antibody testing, which will allow us to tell whether somebody has had the virus—assuming that that confers an element of immunity.

The First Minister spoke about maximum testing, which is important, but I also want to raise the question of compassionate testing.

Will the First Minister commit to look at the case for testing those people who have lost somebody through Covid-19, so that they are not grieving alone? Will she also consider the case of those who are receiving end-of-life treatment in our hospices or hospitals and who, frankly, do not want to die alone? Is she prepared to agree to the testing of immediate family members of people in that situation? We talk a lot about statistics in discussing this issue but, in the end, it is about human beings.

I ask the First Minister to look favourably at those compassionate grounds for extending testing.

I will, of course, look at that carefully. I do not challenge the premise of the question, which concerns the importance of compassion in every aspect of our response to this crisis, but I would say two things. First, we need to ensure that we are using our testing capacity in the best and most strategic way possible in order to give us the best chance of beating the virus. Secondly—although I do not want to negate what I said about the fact that I will look at the issue carefully—there is an effectiveness in testing somebody only when they are symptomatic. There is no point testing somebody before they display symptoms or after they have stopped displaying symptoms. I come back to that relatively narrow window of opportunity just to illustrate the point that, although there might be many people who want to be tested to show that they do not have the virus or perhaps have had it, the current test is not capable of doing all that. Therefore, we continue to use the test where we think that it is most appropriate to do so and where it will help us with the wider efforts against the virus. However, of course, I will always look at suggestions that are made and I am happy to come back to that issue once there is an opportunity to do so.

Covid-19 (“Do not Resuscitate” Notices)

Like everybody else, my first thoughts and those of the Scottish Green Party are with those who have lost a loved one, those who are currently affected by the virus and those who are working to care for them across our health and social care services. However, as well as wanting the people who are providing those services to be safe, people across Scotland are also concerned about the quality of care that their loved ones are getting.

As the First Minister is aware, one of the issues that has been raised with me and other MSPs is that of instructions not to resuscitate a patient in certain circumstances—DNR notices, for short. We are all conscious that, in medical care, difficult decisions need to be made about the appropriate form of care for people if the worst happens. However, those decisions need to be taken in the context of a respectful discussion with patients and their loved ones, and in a way that respects the dignity and control that people expect to have in those circumstances.

Does the First Minister recognise that, at the moment, that is not always happening in all circumstances, and that some people have been concerned at the perception, at least, that DNR notices are being issued on a blanket basis and without that respectful and calm discussion with individual patients and, where appropriate, their relatives?

I have heard those concerns from some people, and I think that there are some cases of professionals trying to do the right thing but perhaps not doing so in the best way. Discussions will be taken forward between the medical professionals who advise the Government, including the chief medical officer, and—in this case—general practitioners, in particular.

Coronavirus aside, we encourage health professionals to talk to individuals and patients about anticipatory care—about what all of us as individual human beings would want, or not want, if we were in the final stages of our lives. These are important conversations and they should be held sensitively and properly. They might ultimately come to the point of asking somebody whether they would or would not want to be resuscitated if they got to that stage.

However, let me be clear: no one should receive a DNR form out of the blue without those sensitive discussions having taken place, and absolutely nobody should feel under any pressure to complete such a form. I want to be absolutely emphatically clear about that.

We must continue to give people the best care that is available for them and the care that they would think is right for them. Sometimes, that will mean respecting people’s wishes about not wanting continued medical intervention, but those conversations must be held sensitively and we must always respect people’s wishes.

I am grateful for that clarity. Can the First Minister give an assurance that care homes, for example, and the medical professionals who work with them, will be reminded of the absolute need to continue to respect, as we normally do, the requirement for those long-term and sensitive discussions with individuals to take place? Can she give any advice to anyone who is concerned that their family member or loved one has not been treated in the way that they should have been in relation to the notices?

My main piece of advice is that nobody should feel under pressure to sign something of that nature if they do not feel comfortable signing it, or they feel that they have not had the right advice about it. If people feel aggrieved that they have received letters like that, they can take that up through their health board. We will take steps to disseminate that advice and information more widely to GPs and care homes.

There is one other issue with care homes that I will mention. It has been suggested to me that, almost on a blanket basis, people in care homes contracting the virus will not be taken to hospital. I want to be clear that people—anybody, of any age, no matter where they are living—should get the care that is right for them, and if that means their being in hospital, that is where they should be.

It will often be the case for an older person that the best and right place for them to be cared for is in their homely setting, but if they need to be in hospital, they should be in hospital, because the NHS is there to provide the appropriate and best-quality care for everyone.

Covid-19 (Care Homes)

I will be on my front doorstep this evening clapping for NHS, social care and other key workers, and I am sure that all the other leaders will be doing exactly the same.

I want to thank the First Minister for the work that she is doing to keep us safe. We know that she has many challenges, and I think that I can speak for us all in saying that we are determined to help her to overcome them.

I am concerned about the situation in care homes that the First Minister has been talking about. Residents are vulnerable, and the staff are essential, so we owe it to them all to get it right. Even though care homes are in lockdown, people are still being admitted to them. Some care homes are under considerable pressure to admit new residents from hospital without the necessary information to determine whether they are free from the virus. How can we ensure that care homes get the information and the support that they need from the NHS, to keep all our residents safe?

Secondly, if a care home resident catches the virus, the best place to treat them might still be in that home. That should not mean that they are deprived of the right healthcare—everyone else gets that. Does the NHS have the capacity and the capability for primary and secondary care to be delivered in care homes to give people the best chance of recovery?

I thank Willie Rennie for his initial comments, and for the questions.

I will start with the second question. Yes, the NHS is equipped to deal with the situation. The NHS is under incredible pressure—it will be increasing pressure—but we have been reorganising how it works in order to ensure that it can deal with the coronavirus challenge. That is about caring for and treating patients when they need it and in the best way possible.

On care homes, it is appropriate for them to admit residents if it is safe for them to do so. The Care Inspectorate is working closely with care homes to make sure that they have the right advice and support, and that any issues or concerns are flagged up and can be addressed.

What matters most are the infection control measures that are in place in care homes. At a very early stage of the epidemic, guidance was sent to care homes about how they should be caring for their residents. Unfortunately, for a lot of residents in care homes right now, that involves isolation in their own rooms and not having the communal activities that they are used to. The situation is really tough for them, as well as for the population generally.

We are looking to the Care Inspectorate to have an on-going supportive dialogue with care homes to help them manage through the crisis as well as they can.

Covid-19 (Exercise)

Those are very helpful and clear answers.

The virus and the lockdown have knock-on effects. On the one hand, people are finding new ways to connect with each other and help in their community, and many are enthusiastically embracing their daily exercise. On the other hand, I am concerned about the impact on people’s mental health from isolation and the trauma that our health and social care workers are being exposed to. We cannot wait until all this is over before we start to address those issues. Can we put in place mental health counselling for all NHS and social care staff right now? Is that possible?

On a lighter note, I am prepared to predict that Willie Rennie is embracing his physical exercise responsibilities better than the rest of us are right now.

It is an important question. From the outset, I have been acutely aware of the impact on people’s mental health from the stresses of living through a situation such as the one that we are in, the changes to people’s lives and the fact that people cannot see others who they are used to seeing, such as grandkids, grandparents and other family members. There are additional burdens, challenges and stresses on our front-line health and care workers.

We are mindful of the issue. A couple of weeks ago, I think, we announced additional funding to expand the NHS 24 telephone and the online services that people can access, and we have given additional funding to expand the Breathing Space service. We are trying to build up the capacity of the services that already exist.

I give an assurance that the issue is high on our priority list because, not just in the immediate phase of dealing with the current situation but, I suspect, for a long time afterwards, we will be dealing with a mental health legacy, and we need to ensure that there are services to provide the help that people need. It is a question of expanding access to counselling now and looking ahead to ensure that there are appropriate services in future.

Thank you very much, First Minister, and thank you to all our party leaders for participating this afternoon. We went slightly over time, but we are dealing with a serious matter that deserves serious consideration. I thank everybody for watching.

Meeting closed at 13:06.