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Chamber and committees

Meeting date: Thursday, April 16, 2020

Leaders’ Virtual Question Time 16 April 2020

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


Questions to the First Minister

Covid-19 (Care Homes)

The high number of deaths, even as we see a stabilisation in the number of new infections, reminds us all how very real and tragic the impact of coronavirus is. Again, I extend condolences on behalf of everyone in my party to all those who have lost relatives over the past week.

It is clear this morning that care homes think that they are being treated as “second-class citizens”. The Scottish Government made some good announcements yesterday, but care homes have been an obvious risk since the start of the crisis weeks ago. One care home manager said:

“We are getting warm words from government but what we need is concrete action.”

Surely they are right.

They are right, which is why concrete action is being taken and will continue to be taken.

First, I want to be very clear that there are no second-class citizens in the fight against the virus. Every life matters, regardless of the person’s age, background, where they live—in their own home or in a care home—or whether they are in hospital. That is why the advice is so clearly focused on saving lives.

Since the start of the crisis, there has been clear guidance in place for care home providers about infection prevention and control, and public health directors in each of our health board areas, local health protection teams and the Care Inspectorate are working to ensure that that guidance is being implemented and followed. The Cabinet Secretary for Health and Sport and I are closely monitoring that situation, and we will continue to support care homes through the provision of the personal protective equipment that staff need to protect themselves.

As Jackson Carlaw said, we made an announcement yesterday on how we can continue to use testing effectively and strategically while taking care not to allow it to give false assurance, because the most important things are around infection prevention and control. That remains and will remain throughout the crisis an area of intense focus for all of us.

I understand that testing will now be given to every resident who displays symptoms in care homes. Frankly, it might have been a mistake to have limited it to just three tests per home.

We know that there are still issues with the scale of testing. A few weeks ago, the First Minister announced to Parliament that, by this point—mid to late April—we would be building up to 3,500 tests a day by the end of the month. How many tests does the First Minister expect to happen in care homes? Can she confirm whether every new resident who enters a care home—a potential unseen carrier of the virus—will now be tested before they are placed in the care home, which may have had no experience of the virus before?

I will take those questions in turn. I will be as brief as possible, but I want to address all of them properly.

On our testing capacity, we are on track to reach the 3,500 tests per day by the end of this month, and we intend to go beyond that as we go into May. It will continue to be important to build up that capacity, not least because of the role that testing will play in any exit strategy from the lockdown measures that there are right now.

On what we said yesterday about testing all symptomatic residents in care homes, let me stress again that that does not change the clinical management of residents or outbreaks of infections in homes. As my advisers tell me, whether one resident, five residents or all residents have been tested, once it has been established that the virus is in a care home, it is infection prevention and control measures that are important. What we announced yesterday was rightly about building the confidence and assurance of relatives who are worried and want more certainty about the conditions of their relatives in care homes, and building that public assurance. That is the right thing to do at this stage as we build up capacity.

In the case of new residents going into care homes, it is important that testing is used appropriately but that we do not run the risk of its giving false assurance. I remind Jackson Carlaw that testing is reliable only when a person is showing symptoms. If somebody is tested before they are showing symptoms and tests negative, that does not tell us for sure that they are not in the incubation period and will not develop the symptoms of the virus in the days ahead.

Therefore those who are in charge of people’s care and their admission to care homes need to carry out proper risk assessments. The experience of anyone who goes into such homes should be that the guidance that has been given to providers is followed fully. Unfortunately, as is the case for the rest of the population, the isolation measures that we are asking residents in care homes to follow—such as not to gather communally and to eat on their own—are tough. However, those measures are also very important—the most important things that care home providers have to do. As I have said, health protection teams and the Care Inspectorate will be working hard to ensure that those rules and the guidance will be followed and implemented fully.

Covid-19 (Shielded and Vulnerable People)

That final point on new admissions to care homes is helpful. Many of my constituents are concerned about new admissions to homes in which their relatives already reside. They wonder whether new residents might be bringing the virus in, and that is obviously causing them some distress.

Last week, the First Minister said that people who need to be shielded at home could register for a text service whereby their details could be passed on to supermarkets. This week, I have been contacted—as I am sure other members will have been—by a range of people who have had problems with that new service. I give the example of an 82-year-old lady with respiratory problems who registered for the text service but has had no response. She has not shopped for four weeks now and is relying on a local charity.

Will the First Minister say how many people have now had their details passed on through the text service and how many of them have now received deliveries?

I will give specific figures on that in a moment, but first I will say two things by way of introduction.

First, last week, there were problems with some mobile phone providers, which were quickly resolved. That was the reason for some people registering but not receiving a reply, but those problems have been fixed. If any member is being contacted by constituents who are still having such problems, I ask them to pass on the details immediately so that the Scottish Government can investigate such cases and resolve them.

Sixty thousand people have now registered through the SMS service, and 43,000 free food packages have been ordered and are being delivered through the national contracts. Many such packages have been delivered already and others are in that process. I have been contacted by people who have told me that they have got them and are grateful for them. Some 21,000 people have requested that we pass their details on to supermarkets so that they can then prioritise deliveries to them, and their details have been shared with those supermarkets.

All that has been happening and is still under way. As with any system that, for good reason, is put in place quickly and is complex and being carried out on a large scale, the system will have glitches and there will be individuals who will have difficulties. We want to hear about such cases so that we can fix them quickly. However, the system is working, as is evidenced by the numbers that I have just given.

So about 40 per cent have registered and about 15 per cent have—[Interruption.]

Scottish Conservatives have previously raised the issues of care homes and vulnerable people. I respect the First Minister’s assurance that progress is being made, but more people have been telling us that the system is not working for them. To give just one example of those, we have been approached by a constituent who has terminal lung cancer, chronic obstructive pulmonary disease and HIV but who has not yet received a letter confirming that he is considered a vulnerable person. Until he does so, he feels that he cannot leave his home, but he also cannot get a food package or register for priority treatment. That is an example of what some people are still telling us. I ask the First Minister whether she is now certain—or can say when she will be certain—that every vulnerable person is now getting the help that they need.

We are certain that everyone who has been identified by the clinical process has been. I am not a clinician, so I do not decide who should be in the vulnerable or shielded group; that is decided by those who are qualified to do so. Originally, we said that the figure would be up to 200,000 people, and then that it would be around 120,000. However, after further checks to ensure that everyone relevant has been captured, the figure has now been put at 157,000 people, all of whom have been notified.

I ask anyone who thinks that they should be in that category but who has not had a letter to contact their general practitioner to discuss whether they have been properly assessed or should be in that category, so that their situation can be rectified immediately.

As I have said, in a situation such as this there will be individual cases in which further investigation is needed. I give an absolute guarantee that such cases will be addressed as quickly as possible. I do not think that the suggestion that the systems are not working for growing numbers of people is true. We are making the systems work, and they are working. We will continue to ensure that the individual cases that remain to be resolved—however many of those there might be—are fixed as quickly as possible.

Covid-19 (Care Homes)

I want to return to the question of conditions in Scotland’s care homes. Yesterday’s figures showed that as many as one in four of the recorded deaths has been of a person who was a resident in our care home sector. People whom I speak to are afraid, but they are also angry. They cannot understand why, up until now, so few tests have been carried out in the care home sector, and why so many people who work in the sector still do not have the adequate personal protective equipment that they need. How can the First Minister justify that situation?

I would not justify that situation, even if I thought that that was a fair representation.

We are continuing to work to ensure, first, that PPE supplies are sufficient and that we get them quickly and efficiently to the front line, where they are needed. We monitor supplies literally daily—several times daily. We have streamlined and continue to streamline the distribution routes. This week, having set up the triage system and the local hubs, we have been in discussions about trying to get more of the supply directly to care homes. That is an on-going process that has absolute importance attached to it.

As we have built the capacity of testing, so, too, are we testing more people—care workers and residents, as well. Already, more than 12,000 health and care workers and, where appropriate, their families have been tested, and absence rates in the health service related to Covid-19 have been falling, which, I hope, is due partly to that. Just under 20 per cent of that total number are staff in the social care sector. Obviously, we want to get that percentage up; as we increase testing capacity, that will happen.

Those are areas of on-going progress. We are putting in place new systems quickly and, as we go, we are resolving issues, glitches and problems along the way. That is a daily process that will continue through the crisis that we are in.

Trade unions have described the situation in our care homes as a “crisis within a crisis”, and today’s newspapers report soaring levels of staff absenteeism in our care home sector.

The Scottish Government has repeatedly been asked how many workers have been tested, and we have been repeatedly promised that the figures will be published regularly. Does the Scottish Government know the figure for the number of care home workers who have been tested? If so, can the First Minister tell us today what that figure is? If not, why not?

With respect, I point out that I gave that figure in my previous answer, when I said that more than 12,000 health and care workers and, where appropriate, their families have been tested, and that just under 20 per cent of that figure is care workers and, where appropriate, their families. Remember that when it is a family member who is symptomatic, it is the family member who needs to be tested, not the worker. As I said, just under 20 per cent of the 12,300 health and care workers who have been tested are in the social care sector. I gave that answer in my first response.

More generally, in terms of the care home situation and Mr Leonard’s characterisation of it as a “crisis within a crisis”, we must recognise that Covid-19 is a virus that we know older people are more susceptible to becoming seriously unwell with, or dying from. We also know that in any institution, including care homes, there will be greater susceptibility to the spread of an infection such as Covid-19. That makes it all the more important that we treat care homes with particular care and attention, so that is what we are doing.

With the coronavirus, we see that there are issues about community transmission, that there are challenges around hospital-acquired, or nosocomial, infection—which we are looking at particularly—and that there is also risk of infection within care homes. All those issues are being treated seriously, but infection prevention and control, appropriate use of testing and, of course, ensuring that the staff have appropriate protection are all essential priorities, as we deal with the issue.

The expression, “crisis within a crisis” is not mine; it is the expression of the trade unions that organise in the care home sector.

Part of my question was about the regularity with which information is published. It is important that the Government is accountable, and that it regularly publishes the number of people who have been tested—national health service workers and those who work in the social care sector. People are saying to me that they feel that the Scottish Government is being too slow—the expression that they often use is “too little, too late”. There is real fear about that, and that is the warning that is being given to me. Does the First Minister disagree with that view?

Yes, I do. We are in an unprecedented crisis; the entire world is dealing with an unprecedented crisis. By its very nature, it is a rapidly evolving situation. Every day, all Governments are being challenged to make sure that the speed of our response is commensurate with the scale of the challenge. We are working incredibly hard to do that. As well as putting in place systems and responses, we are adapting and changing them, and we are responding to any flaws in them as we go. That is not easy, but it is our responsibility and we will continue to do it to the best of our ability.

I absolutely agree with the point about accountability. Right now, the Scottish Government is, I think, publishing more up-to-date information than any other Government in the United Kingdom. For example, the figures for the total number of Covid-related deaths that we published yesterday are more up to date than any such information from elsewhere in the UK. We are continuing to look at how we can break down as much as possible the information that we publish.

We intend to publish figures such as I have given to Richard Leonard more regularly, but some of the data that we are gathering now is not data that we have gathered previously; we are gathering it now for this purpose. Therefore, we must make sure that the systems for gathering it are producing data that is reliable and robust. As soon as we are confident that it is, we will—as we have done on many things—move to regular publication. That will apply to the figures that I have mentioned. At the moment, we publish daily figures on the number of tests that have been carried out; we will publish breakdowns of those figures as we become confident in the robustness of the information.

Covid-19 (Ending Lockdown)

I, too, would like to express my sincere sympathies to all those people who have lost a loved one. I offer my grateful thanks to all who are working in our national health service and in social care, in our public services, in our shops and beyond.

It is absolutely vital that lockdown carries on for as long as it needs to be in place and that it is not lifted a minute sooner than is safe. We know that people are feeling cooped up and that some people are feeling terribly isolated, and we cannot thank them enough for the efforts that they are making and the lives that they are saving. However, it is also important—I think that the First Minister alluded to this in her opening remarks—that people know that plans are being made for a clear exit strategy for ending lockdown safely when the time is right.

I have spoken to experts and the scientific advice seems clear: a test, trace and isolate strategy is needed to prevent further outbreaks in future. Is the Scottish Government committed to such a strategy? When might it be in a position to share more information on that with the Scottish public?

I will set out my thinking on that as briefly as I can. Unfortunately, lockdown will continue beyond this week. COBRA will meet later on and other Governments must reach their own decisions, but my clear advice is that we must continue the lockdown measures for at least another three weeks. Although we are increasingly confident that the measures are working, we are not yet confident enough that the virus has been suppressed sufficiently to lift any of the measures, because the risk of doing that is that there would be a resurgence that would be extremely damaging.

People want to know what the thinking is for the period beyond that. We do not yet have all the answers on that—no Government does—but it is important that we share the thought processes, the factors that we are taking into account and the framework for making such decisions. Over the course of next week, although we will not be able to announce all those decisions, I hope to set out the framework for decision making.

We must monitor the spread of the virus very carefully and assess the options for lifting the restrictions and what the impact of that would be on the virus, on the economy and on wellbeing more generally. Given that we will be living with the virus for some time to come, we must consider what will take the place of any measures that we lift, in order that we continue to suppress it. That is where test, trace and isolate comes to the fore. I am absolutely of the view that that must be a key part of any longer-term strategy to get life back to normal as much as it will be possible to do that while the virus remains a challenge. Next week, I hope that we will be able to set out more of the principles and the framework for that decision making.

Covid-19 (Testing and Tracing Capacity)

I appreciate that, and I can absolutely assure the First Minister that the Scottish Greens are wholly committed to ensuring that lockdown lasts as long as is required.

There are two aspects that we must consider. If we are to implement the test, trace and isolate strategy that we will be looking at in the future to ensure that we can safely exit lockdown, we need the capacity both to test every suspected case of the virus and to trace everyone who has come into contact with a confirmed case so that they can isolate and prevent the virus from spreading. You said that you hope to carry out 3,500 tests by the end of the month. Will that number be sufficient, will the testing be up and running when you need it, and how many trained contact tracers do we have? Has that training been put in place?

In the Scottish health framework, “contact tracer” is not a standalone professional designation. Many people in health protection teams and other parts of the health service will, when required, perform those tasks.

That approach might not be the only part of an exit strategy, but it will be a key part. It will mean expanding testing capacity beyond 3,500 by the end of the month, and that is why we have plans to take that further; we will be able to set out more about that in due course. It will mean expanding the network that we use to trace contacts, and technology could also have a part to play, although there are significant issues around privacy that we have to work our way through.

All that work is under way, and it is developing all the time. I want both the detail and the general principles that will govern our approach to be open to as much public discussion as possible. We all have to live with the virus and with restrictions on our lives, and some of those restrictions are likely to be in place for a considerable time. That means that we all have the right, as well as the duty, to understand the approach and to contribute to the discussion about how we best take ourselves forward in a way that balances suppression of the virus with having as much normality in our everyday lives as possible.

Covid-19 (Care Homes)

I will follow up on the earlier question about care homes and testing. I am still concerned that new residents with the virus are being admitted to care homes, which are full of vulnerable people. I think that we should be testing all potential new residents of care homes, and they should not enter if they test positive for the virus. This morning, one care home owner said to me that a test of all potential new residents is the most important test that we can do. First Minister, why can we not test all potential new residents of care homes?

I will try again to explain. I can understand the starting position that that is what we should do. Willie Rennie just used the phrase

“new residents with the virus”.

If somebody has been in hospital because they have had the virus, they will be tested before leaving the hospital to make sure that they test negative—that is in cases in which somebody has had the virus. If somebody is admitted to a care home today who shows no symptoms of Covid-19 and who tests negative, that does not mean that they will not show symptoms of the virus tomorrow, because they could be in the incubation period. Testing has a part to play, but it must be part of a properly risk-assessed approach.

It must be part of an approach that also prioritises infection prevention and control. Whatever the test status of somebody who is going into a care home, the guidance on isolation and the wider guidance on infection prevention must be followed. That is the most important thing to do. Yes, we must use testing where it is appropriate, but we must not allow testing, given its limitations, to give us false assurance that somebody going into a care home does not have the virus, when it might just be that they are in the incubation period and it does not show on a test.

Covid-19 (Reopening Non-essential Businesses)

I understand that, but I think that people find it difficult to understand that even people who do not show the symptoms are not being tested before they enter a care home. Care homes are full of vulnerable people, and new people should be tested in advance. I hope that the First Minister will look at that issue again.

We need a lockdown to save lives, but tension in the workplace is rising again, as companies say that they can operate within the public health guidance, but the Scottish Government is saying that non-essential businesses should stay closed.

The Walkers Shortbread factory plans to reopen soon; a factory in my constituency is planning to reopen in two weeks; and the construction industry has told me that, after the Easter break, many companies will start work again. What is the advice for non-essential businesses that can demonstrate that they can operate social distancing and good hygiene in line with public health guidance? Can they reopen, or must they stay closed?

Before I answer the question about businesses, I will briefly conclude my response to the question about testing, because Willie Rennie asked whether we would consider testing everybody who does not have symptoms.

I want to see testing used to the maximum where it will help us; that is not the issue. The problem with testing someone who does not have symptoms is that the test result is not necessarily reliable—it may tell you that they do not have the virus, even when they might be in the incubation period. It does not reliably tell you what you want to know. The danger is that it gives a false assurance that someone does not have the virus, when perhaps they do, but it is at a stage at which it is not showing up. That is why we must keep prioritising infection prevention and control.

The advice to businesses in Scotland stays as it has been. We have taken a tougher line than some other parts of the United Kingdom, which some people have criticised us for, but I think that it is appropriate. Some businesses have been told to close: shops, pubs and restaurants, for example. We know that others have to stay open because they are essential to keeping the lights on, and to delivering food supplies. However, to businesses in the middle, we have tried to give very clear precautionary guidance that if what they are doing is not essential, if they cannot allow their workers to work at home, and if they cannot be absolutely sure that they have safe social distancing, then on the precautionary principle—prioritising the health of workers—they should be closed. That guidance remains. We will continue to seek to speak to individual companies when they need more advice and to address any concerns that companies or workers have. However, right now it is about making sure that we are prioritising the fight against the virus and keeping people safe.

Thank you, First Minister and colleagues. That concludes today’s virtual question time. We hope to continue tomorrow at 2.30 pm with a virtual question time, with questions from party members to cabinet secretaries. Thank you for joining us.

Meeting closed at 13:01.