Meeting of the Parliament

Meeting date: Tuesday, March 10, 2020

Official Report 1009KB pdf

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Covid-19 (Update)

The next item of business is a statement by Jeane Freeman on nouvelle—why did I call it “nouvelle”? I am not French—on novel coronavirus Covid-19. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:22  

Covid-19 presents a profound and escalating challenge to countries around the world. The situation is extremely fast moving, but I want to try and keep this chamber as up to date as is practicable.

As of 9 o’clock this morning, there have been a total of 27 confirmed cases of Covid-19 infections in Scotland, which is an increase of four since yesterday. All the cases that have been identified in Scotland either have a relevant travel history or are infections through contact with known cases. Nineteen cases are related to travel to category 2 countries—northern Italy, in the majority of cases—and eight involve infection through personal contact.

We are also carrying out enhanced surveillance in the community, through our general practitioner sentinel network; in intensive care units; and in our acute hospitals. However, to date, no cases have been identified through that means. Therefore, we have no evidence yet of community transmission, which means that we remain in the containment phase.

As I set out last week, following the publication of the United Kingdom-wide coronavirus action plan, it is important that our approach continues to be guided by clear scientific and clinical evidence, routed through the chief medical officers via the scientific advisory group for emergencies, SAGE.

As members will recall, there are three distinct phases to managing any outbreak: containment, which is the phase that we are in now; delay, which involves the steps that need to be taken to flatten the peak number of cases and protect the most vulnerable; and mitigation.

Yesterday, the First Minister and I attended a Cobra meeting at which those matters were discussed across the four nations, and there will be a further Cobra meeting tomorrow. The First Minister has also been chairing our Scottish Government resilience room meetings to ensure that we have a cross-Government response that goes wider than simply the health service and involves all of Scotland’s public services and business and tourism sectors.

As I have said, like England, Wales and Northern Ireland, we remain in the containment phase, but we can expect to move relatively soon to the delay phase, when we begin to see cases transmitted in the community. Our goal is to protect life, not least the lives of the most vulnerable in our society. All of our actions—those that we have taken to date, and those to come—are taken with that goal in mind. The timing of moving into the delay phase and judging what measures are the most effective in that phase must be and are driven very firmly by scientific and clinical advice.

Understandably, people will look to the situation in other countries and question why some of the moves that they are taking are not yet being taken in Scotland or in the United Kingdom. No measure has been ruled out, and the actions that we take might develop over time and be added to as we seek to manage the impact of the infection and protect life. If the actions that we take can flatten the infection curve, we will give our national health service the best chance to be able to treat the sickest patients to the very best of its ability. The timing of actions, guided by the scientific evidence, is being tailored to have the maximum impact in flattening the infection curve. Timing is critical: if we take those measures too soon, we will not have the impact that we need; if we take them too late, we will not reduce demand to the level required.

It is no exaggeration to say that continuing with simple measures such as hand washing and sneezing etiquette could help reduce the spread of infections and, as a result, help save lives. Preventing the worst impacts of the virus will need action across not just our Government but our society. However, we all need to be clear that, although the virus will cause mild symptoms for the vast majority, for many it will be a serious illness that is potentially life threatening. I am aware that steps that we might have to take in the coming weeks will have an impact on the normal day-to-day lives that we lead, but anything that we do will be carefully considered, in line with the evidence, and backed with clear guidance and support. The steps will also be clearly explained in the chamber and to the wider public.

Work is already in hand to ensure that the health and social care sector is as ready as it can be for any increase in the number of cases. That includes work to scale up NHS 24 to enable telephone consultation should restrictions be placed on people’s ability to visit their GP or practice nurse. We are working with the professional regulators to ?establish urgent arrangements to allow us to bring back recently retired nurses and others, if they are willing. Work is also in hand to explore how students who are close to finishing their training in nursing and medicine can be registered temporarily to support our efforts, if that is needed.

We are accelerating our NHS near me provision, with immediate investment of £1.24 million, to ensure that we can support the video consultations that will be essential to help us to reduce face-to-face contact, which will be necessary should there be a significant increase in the need for self-isolation. That is a rapid scaling up of services that have previously been used largely in rural areas but which will now become more common in our urban settings too.

I have also taken the decision to postpone the annual NHS event, not because it is a large event but because our hard-working front-line staff need to be able to focus their collective efforts on responding to the virus. The postponement is simply about not placing an additional demand on our staff.

Again, I put on record my sincere thanks to and appreciation of all the staff in the health and social care sector who have worked and continue to work incredibly hard in responding to the evolving and dynamic situation and who are continuing to discharge the high-quality care that NHS Scotland is renowned for. I also thank all members of the public for their support in following the advice on hand washing and use of tissues, and on contacting NHS 24 or their GP if they have symptoms. They are acting to protect themselves and their families, but they are also acting to protect all of us. The response has to be a societal one.

I am grateful to members for the support that they have shown so far and I will continue to update the chamber as quickly as is practically possible. I am very happy to take any questions.

The cabinet secretary will now take questions on her statement, for about 20 minutes.

I thank the cabinet secretary for providing advance sight of her statement, and for the manner in which she has been keeping Opposition parties briefed on this important matter.

I have two specific questions. First, what further progress has been made in the past week to increase bed capacity in every NHS hospital across Scotland? Secondly, have ministers received any concerns from NHS staff or from unions about equipment or capacity?

A lot of work is going on to consider the steps that we might take to increase bed capacity in our health service, not only in acute settings but in secondary and community settings. That includes considering what we need to do, and what it is possible to do, to increase capacity in our intensive care units.

As Mr Briggs will know, the primary treatment for those who are most ill from coronavirus is high-flow oxygen therapy, which will be administered either externally or through ventilator systems. The evidence from elsewhere appears to be shifting as to the proportion that is needed of one or the other. All of that is being factored in.

The work that is under way directly involves all our NHS boards, and the boards are involving all their area partnership forums. We have been in direct contact with the senior Scottish representatives of all unions that are involved in our NHS, and I co-signed a letter from the chair of the national partnership forum to staff, because it is vital that they continue to be involved.

There will be a need for additional equipment. The scaling-up of the attend anywhere scheme involves the provision of additional equipment, and we have authorised expenditure on that. The additional equipment is a UK-wide issue, so we are looking to address it on a UK-wide basis, and not to get into some kind of competition. The four-nation approach has been effective so far, and we are keen to continue with it.

I thank the cabinet secretary for providing advance sight of her statement and for her regular updates in and outwith the chamber, which are appreciated.

Concerns have been raised with me about testing for the virus. I have heard that people who have a relevant travel history have presented with symptoms but been told that they are not viewed as a risk and do not need to be tested. Will the cabinet secretary provide further clarity on when people can expect to be tested for Covid-19 and on whether further work is on-going to ensure that testing will be widely available to those who need it and on a consistent basis?

The cabinet secretary will recall that, last week, I asked about NHS 24 capacity, so I appreciate the announcement about scaling up NHS 24. Will she say more about that and whether it will include overtime or redeployment?

What discussions are taking place with the Scottish drug deaths task force and others to look at the particular needs of people who have substance misuse issues, who might be sleeping rough or homeless and who need access to medication and so might struggle to self-isolate?

Testing for the virus is a clinical decision that is taken through a conversation between a clinically qualified individual and the person concerned. They go through a number of questions, and the clinician decides whether the individual’s description of their symptoms meets the case definition for Covid-19, at which point testing is instigated. Testing is widely available where those clinical decisions indicate that it is required.

As members know, there are two testing centres in Scotland, in Glasgow and Edinburgh, with Tayside ready to scale up should that be needed. Glasgow has now taken on confirmatory testing, in addition to Colindale down south.

If individuals have concerns, there are two NHS 24 numbers. The first is 111, which is for use out of hours, if a person believes that they may have symptoms and wants to go through that exercise with a clinician at the other end of the line. The other is a free helpline number—0800 028 2816—which is for individuals who are a bit worried or unsure about the best thing to do, as it can be confusing. I will write to all MSPs later today and will include that number in the letter.

The scaling up includes recruiting additional staff as well as working with existing staff to look at working patterns, additional shifts and so on. However, we are mindful that we are in this exercise for the long haul, so we need to take care of our staff as well as them taking care of others.

There are vulnerable groups in a health sense and, as Ms Lennon said, other vulnerable groups. This morning, the Minister for Public Health, Sport and Wellbeing, Mr FitzPatrick, had a meeting specifically with respect to how we get that health reach to those suffering from drug addiction.

Eleven members wish to ask questions and we have about 15 minutes. Everyone deserves to ask their question, so I ask members to be disciplined.

Will the cabinet secretary confirm that the experts who are providing the scientific advice to the Scottish and United Kingdom Governments are learning from experiences elsewhere, not least Italy, which is clearly seeing the impacts of a significant infection outbreak?

Thank you, Ms Harper—that is how to do it.

Yes. The modelling that I described in my statement last week was, at that point, primarily using data from China. That modelling is a continuous exercise and now factors in more data from Italy and elsewhere in Europe.

I previously asked the cabinet secretary what action was being taken to support people who are on insecure contracts and who may receive no payment at all if they are forced to self-isolate. The UK Government has advised that people apply for universal credit if they find themselves in that situation. However, considering the assessment process that must be completed, not to mention the five-week wait—which the cabinet secretary will be only too well aware of from her previous role—that will not be practical.

Ask a question, please.

What further assurance can the cabinet secretary provide that people who are on zero-hours contracts or in insecure work will not be forced to take that course of action and face not being paid?

I do not know whether that is one for you, cabinet secretary.

In the Cobra meetings, and with colleagues at that level of the UK Government, discussions have been on-going with the Department for Work and Pensions with specific reference to universal credit and how it can be altered in order to avoid individuals being forced to choose between what is right for their health and that of their families, and their income.

In addition, my colleague Ms Somerville, who is, as Ms Johnstone will know, the Cabinet Secretary for Social Security and Older People, is engaged in active thought along with Social Security Scotland about those benefits for which we are responsible and what additional work can be done there. She is also looking at what more the Scottish Government could do to help to mitigate financial problems for people in relation to the insecure contracts to which Ms Johnstone referred.

Will the cabinet secretary say more about how, in the coming weeks and months, the Scottish and UK Governments will maintain regular dialogue on developments with Covid-19, and about how the important information that is discussed in that forum will be communicated regularly to the public?

The primary way in which that happens is through the Cobra meetings, which are now chaired by the Prime Minister. Recently, there have been two each week, although the second one is often chaired by the Secretary of State for Health and Social Care, Mr Hancock. That is the primary way in which the two Governments, along with our colleagues in Wales and Northern Ireland, are discussing the issues, based on the scientific and clinical advice, and reviewing what more we collectively believe needs to be done.

In addition, our officials—including our deputy chief medical officer, our chief medical officer, our chief pharmacist and others—are of course in daily contact with their counterparts elsewhere in the United Kingdom in order to ensure that we are as aligned as possible on the decisions that we take.

With regard to communicating information to the wider public, the chief medical officer, our national clinical adviser, our First Minister and myself are regularly taking up all the opportunities that are offered to us through national broadcast and print media. We will continue to do that, and I will continue to look for every possible opportunity to update the Parliament, members directly and the party spokespeople and leaders, as we have done until now.

Given that Covid-19 seems to affect older people disproportionately, in terms of infection and severity, and that many older Scots live alone without access to the internet and the NHS near me service, what provision for treatment and testing is the Government making for older Scots, who might already be socially isolated, if they become sick?

The evidence so far indicates that those who are most at risk of contracting the virus and experiencing a serious illness are people in their 70s and 80s and individuals who have particular vulnerabilities in terms of their health—largely speaking, those who are immune suppressed. As we move into the delay phase, we will set out very clearly what those conditions are and what we are asking people to do.

Scotland’s resilience approach includes our regional resilience partnerships, which have now been stood up for some days. They include local government, as well as fire, police and health. Local government is critical in the support that it can offer to older people, as is our third sector. My colleagues Ms Somerville and Ms McKelvie are actively looking at what more we can do to ensure that the necessary steps are put in place to support older people, particularly those who live alone and who are isolated in terms of either their social contact or their geography.

The cabinet secretary has made clear that people have a vital role to play in helping to contain any outbreak by following the latest health and travel advice. Will she reiterate the best places for the public to access advice on travelling at home and abroad?

There are two places that are key to advice on travel and travel restrictions. The Foreign and Commonwealth Office website will keep people up to date on its very specific advice on travel. With regard to our response and a whole range of other questions that people might have, the NHS inform website and the free helpline number are where people should go for continuously updated advice that also relates to the travel advice from the FCO.

I have a constituency issue about a pharmacy that has told me that, when it replenished its stock, it was charged three times the usual cost for medicines such as paracetamol. Is the cabinet secretary aware of other instances like that? What can the Scottish Government do to ensure that ethical practices—if I can put it that way—continue during this crisis?

I would be very grateful to know the detail about that instance from Mr Whittle, and about any other such instances that arise, from any member. Mr Whittle and I discussed this morning in the Health and Sport Committee the interrelationship between devolved and reserved powers, which he will understand. Once I have the details, I will make sure that my officials raise them with their counterparts south of the border to see what we can do to ensure that unethical practices—quite disgraceful practices, if that is the case—are prevented, as far as that is possible for us to do.

Presiding Officer, I take this opportunity to factually update the chamber; I understand that the Cobra meeting will now take place on Thursday, not tomorrow.

Can the cabinet secretary outline the Scottish Government’s strategy for the final stage of dealing with the coronavirus, which is the mitigation phase, particularly with reference to intensive care beds, which are in short supply relative to our European neighbours, such as Italy?

The number of our intensive care beds is proportionately the same as that across the UK. As Mr Stewart quite rightly identified, the evidence tells us that some of the people who will be more seriously affected are likely to require intensive care beds. Part of the work that we are undertaking to look at bed capacity across the whole estate, which I described to Mr Briggs, aims to double the number of intensive care beds and ensure that we have the right trained staff and the right equipment to be able to do that.

We will continue to look at what more we can do to maximise our capacity to respond, at the same time as we take steps to flatten the peak so that we give ourselves the best possible chance of being able to do so. Nonetheless, all of us must understand that the situation is serious and that although many people will be mildly affected, this will be a serious infection for some and for many it will potentially cause their death.

Can the cabinet secretary set out the approach that residential care homes should take to protect residents and staff and the precautions that they should take with visitors?

Residential care homes should ensure that visitors, as well as their staff and residents, follow the straightforward public health advice that we have encouraged people to follow as part of the containment phase and beyond. The advice includes hand washing, using tissues and making sure that anyone who has any symptoms that they are concerned about calls a local general practitioner surgery or NHS 24.

Our future planning is undertaken directly with our colleagues in the Convention of Scottish Local Authorities. We are looking, with the residential care sector, at what additional clinical expertise the sector might need in the community and at what additional training staff might need to deliver what I would describe—I accept that this is an old-fashioned term—as barrier nursing. Most people will understand what that means: it is basic nursing precautions to prevent the spread of infection. That work is under way with COSLA and the care home sector, to make sure that we are planning and putting in place what we need at the right time.

What measures can the Government take to support our more vulnerable adults and young people, who might not be able to read some of the information or comprehend it as other people can?

That is an important question. My colleague Clare Haughey tells me that we are looking at the matter, particularly for people with learning disabilities.

We are also, through colleagues elsewhere in Government, reaching out to ensure that carers have the support that they need. This is an anxious time for carers: there is anxiety about those for whom they care as well as anxiety about who will care for the individuals for whom they care if they become ill themselves.

All that work is under way. I intend to come back to the chamber and update members on all of that, as soon as it is possible and practical to do so.

Yesterday, in response to a question on testing at airports, the UK Government health secretary said that the evidence from other countries that have tried temperature testing at airports shows that it is not effective and can actually be counterproductive because it leads to a lot of false positives. Does the Scottish Government’s scientific advice concur with that view of airport testing, and is the cabinet secretary content with the approach that is currently being taken at Scotland’s airports?

We are content. Only a third of those who are infected by the coronavirus demonstrate that by way of a spike in their temperature. One difficulty with screening arrivals at airports is that people will be missed because they are not showing an increase in their temperature, which then gives false reassurance. That is why, based on the scientific and clinical advice that we have, screening at airports is not the right precaution for us to take.

I am grateful for the update on the increase in intensive care beds. Can the cabinet secretary assure us that additional intensive care staff will be in place as bed capacity increases?

That is an important question. Although I am not bringing absolute conclusions here, I want members to be assured that that work is going on daily and has been going on for some time. We are looking at the skilled staff that we have who are not intensive care staff but who could, with some additional training, take on some of those roles, leaving our highly specialised intensive care staff to do the things that only they are qualified to do.

In practical terms, that means that, as far as is possible within the bounds of patient safety and good clinical care, the current model for delivering care in an intensive care unit in normal times will have to shift a bit. That will allow us to cope with having more people in intensive care beds with the maximum clinical input and the maximum patient safety.

Thank you. That concludes questions on coronavirus. I thank the cabinet secretary and all members, because we managed to get in all the questions, due to your self-discipline.