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Chamber and committees

Meeting date: Tuesday, August 18, 2020

Meeting of the Parliament (Hybrid) 18 August 2020

Agenda: Time for Reflection, Topical Question Time, United Kingdom Internal Market, Business Motion, Decision Time


Topical Question Time

Care Homes (Covid-19 Hospital Patients)

To ask the Scottish Government what its response is to reports that 37 hospital patients were transferred to care homes after testing positive for Covid-19. (S5T-02313)

Before I start, I take this opportunity to welcome Mr Cameron to his new responsibility.

Discharge decisions for individual patients are made by clinicians, based on each patient’s needs. If somebody is discharged to a care home, that should be because that has been assessed as the best place to meet that person’s needs.

As has happened in other parts of the United Kingdom, guidance on discharge and admission to care homes has evolved since the start of the pandemic as our understanding of the virus has developed. Current guidance sets out the steps that are to be taken to ensure that patients are screened clinically, so that people who are at risk are not transferred inappropriately.

Any individual who is being placed in a care home must be subject to an appropriate risk assessment and be isolated for 14 days. A testing regime is also in place to ensure that all care home staff are offered routine testing, and that people being admitted to a care home from either a hospital or the community are tested appropriately.

We have worked to make as much data available as is practical on a range of issues related to Covid-19, which is why I have today asked Public Health Scotland to work with boards to produce validated statistics and analysis on the number of patients who tested positive for Covid-19 and were subsequently admitted to a care home. That includes examining how many were assessed as being discharged when they were considered to be infectious, and the rationales that were in place for such a discharge, for example in the case of palliative care concerns.

I thank the cabinet secretary for her words of welcome at the start. However, I have to say that it has taken months for the Parliament and the Scottish public to learn about those 37 patients who were sent to care homes. The First Minister has a broadcast every day and she did not mention it. We heard about those appalling mistakes—mistakes that possibly cost lives—only because of a newspaper investigation, which did not even include responses from every health board in Scotland.

How many Covid-infected patients did the Government send to care homes? More important, how many people were infected second-hand as a result of those colossal and potentially fatal mistakes?

The Government did not send people to care homes. As the First Minister and I have repeated, those are clinical decisions. Our national clinical director and our chief medical officer have consistently been crystal clear that the decision about where an individual goes on discharge is a clinical decision, following a risk assessment and in conversation and co-operation with a care home, if that is the place to which the individual is being discharged. It is entirely wrong to say that the Government sent people to care homes. We did not.

It is for individual health boards to determine whether they can respond, given the limits and cost of freedom of information provisions. Clearly, some boards decided that they could not. The work that I have commissioned today from Public Health Scotland will look across all health boards and will cover the robust validated statistical output and analysis that I have described. It will provide additional information about whether individuals were considered to be infectious at the point when they were discharged and, if they were, what the rationale was for that discharge decision.

I am afraid that the cabinet secretary’s answers are wholly unacceptable. Nearly 2,000 people have died in care homes in Scotland from coronavirus—every single one of them an unspeakable tragedy. The Scottish Conservatives wrote to the Lord Advocate weeks ago, but we have still not heard whether he will investigate. Why do 2,000 bereaved families not deserve answers? Does the cabinet secretary agree that a public inquiry into the scandal should start immediately?

It is not for me to comment on the Lord Advocate’s area of locus; I would simply say that, as I would have hoped that the member would know, the Crown Office has set up a unit to look at deaths in care homes. It will receive information and, where it considers it appropriate, it will investigate. The Crown Office will get on and do that job independently, as it should.

The First Minister has been clear, as indeed have I, that in due course there should be a public inquiry into all aspects of the handling of the pandemic, including, importantly, the issue of care homes. An inquiry would consider whether the guidance that was produced at various stages, based on the information and evidence that we had at the time, was appropriate and was implemented, and whether that guidance was properly updated as new evidence emerged, based on growing understanding of the virus, which is of course new.

These questions have been answered. There can be no doubt that I and this Government take very seriously the situation in our care homes, but I hope that, equally, there is no doubt that we have, at all times, acted with the best of intention and based on the information that was available at the time.

A large number of members want to ask questions on the issue.

Is no one accountable for this public health disaster, which I believe is due to neglect? The reality is that they could not get people out of hospital quickly enough. Many of those people had been in hospital for months and months, as long-term delayed discharge cases. The issue was not about the best clinical care but about clearing the decks of all those elderly people—our loved ones. I ask the cabinet secretary: who is responsible for that?

I have to disagree completely with Mr Findlay. I would never be so offensive as to describe clinical decisions as “clearing the decks”. I would never undermine the professionalism, skill and compassion of every one of the clinicians who work in our health service and, indeed, those in our care homes who are also party to the decisions about whether someone is admitted from hospital. I really wish that Mr Findlay would not characterise individuals in that way.

I have made it clear that I am accountable for the decisions that I have taken as the health secretary. This Government is accountable for the decisions that it has taken throughout the pandemic, and, in the proper time, a public inquiry will look at all those decisions and judge whether we took the right decisions, based on the information that we had at the time, in the right way and updated them accordingly and whether the guidance and the decisions that we took were implemented appropriately. That is the right way to do it. It does not assist anyone to impugn the motivation of those who work in our health service and in care homes, all of whom are doing the best job that they can.

Is the Scottish Government aware of hospital patients in other parts of the UK being transferred to care homes after testing positive for Covid-19 from early on in the outbreak?

The answer is yes. In the four-nation discussions that I have with my colleague health ministers from the other three nations of the United Kingdom, we have discussed the issue and the guidance and its updating. Across the United Kingdom, we have wrestled with those challenges, as, indeed, have individuals and our counterparts in Europe and elsewhere. I will write today to my colleagues in Wales and Northern Ireland, and to Matt Hancock in the UK Government, setting out what I have asked Public Health Scotland to do and asking them to consider initiating a comparable exercise so that we can look across the UK’s four nations, learn from that and have comparable data across the country.

In its response to this issue, Scottish Care said that there has been “a breakdown in relationships” between hospitals and the care sector because the “eagerness of hospital discharge” has resulted in individuals being placed in care homes when it was clear that they needed nursing rather than residential care. How does the cabinet secretary respond to that statement? What will she do to repair, strengthen and support those relationships and to ensure that the relationship between the care and hospital sectors is an equal one?

The first thing that I will do in response to what Ms Johnstone has said is ask Mr Macaskill from Scottish Care why, in the many meetings that he and I have, he has never raised that difficulty directly with me. I will then seek to understand what concerns him and what he and I together can do to resolve the matter. Looking forward, what we can do, should there have been a breakdown in the relationship between an individual hospital and a care home, is ensure that both understand their responsibilities. The care home has a responsibility to be confident that it can receive a resident into its care and meet that resident’s needs. If it does not believe that it can do that, it has a responsibility to be clear that it cannot, and alternative care must be found for the individual until it or another care home is ready.

Mr Macaskill is—helpfully and productively—a member of the recovery group that is working with me and a range of stakeholders on how we not only remobilise our health and social care services but ensure that the proper lessons are learned from the early days of the pandemic and that the proper planning is in place should we see an upsurge in cases as we enter autumn and winter.

I find it unbelievable that, all these months later, the Scottish Government still does not know the full extent of the tragedy. That is a devastating revelation. We now know that the Government was accelerating the movement of Covid-positive cases into care homes at the same time as the international community was screaming about asymptomatic transmission. We did not know how the virus was moving around in hospitals and our care homes had no PPE.

When the cabinet secretary talks about lessons learned, does she recognise that the only way for the Parliament and the country to learn those lessons is through an independent public inquiry, which she must commission now?

I believe that I have already answered the question about the need for a public inquiry. The First Minister has made it clear that there should be a public inquiry into every aspect of the handling of the pandemic and that, when the time is appropriate, she will commission such an inquiry. It will carry on and do the job that it is supposed to do.

I must correct Mr Cole-Hamilton in respect of PPE. In our care home sector, it is the responsibility of the private, independent and public sector providers to acquire PPE. When we knew, on 19 March, that their private supply lines were experiencing difficulty, the NHS and our national procurement service stepped in to ensure that there was a direct supply of the appropriate PPE, in volume and quantity, to care homes, and we have continued to do that where it is necessary. We will continue to do that for as long as it is required by the care home sector and other health and social care sectors.

I have listened carefully to the cabinet secretary, and I am disappointed that she has used the clinicians as a shield instead of taking responsibility for her Government’s guidance.

Care staff, the majority of whom are working class, low-paid women, were ringing the alarm about safety in care homes from the very beginning of the pandemic. Before the pandemic hit, the Government was well aware that there was a crisis in social care, especially in many privately run care homes that had had really bad reports from the Care Inspectorate. Why was it deemed safe to discharge Covid-19 patients to care homes that were not able to keep them and other residents and staff safe?

Does the cabinet secretary now accept that any patient who is known to have Covid-19 should not be discharged to a care home setting with other vulnerable people? Does she regret not acting sooner on the concerns of care staff and their unions?

I dispute completely the statement that I am using clinicians or anyone else as a shield. I have said more than once in Parliament—including today—that I am accountable for the decisions that I have taken. However, it is clear that the 13 March guidance—which was issued before the virus was in full community transmission—says very clearly that patients discharged from hospitals should be screened clinically. It is not me who screens them; it is for clinicians to screen those patients and to have those conversations. That is a simple statement of fact. It may not suit the argument that Ms Lennon wants to promulgate, but it is a statement of fact. I am certain that patients would not want me or any other politician to be screening them. That is not our job, and it is not the job that we are qualified to do. I am not using clinicians, care home staff or anyone else as a shield.

I am clear about my accountability and about the facts of the matter, which include that, from 2012, care homes were expected to abide by the “National Infection Prevention and Control Manual”, which includes basic infection prevention and control measures. We assumed that that was happening—the Care Inspectorate has a role in ensuring that that is the case. The guidance and PPE that we introduced were additional to that, to deal with the pandemic. As Ms Lennon now knows, residents are tested before entry into care homes, whether they are coming from the community or from hospital. That is a step to ensure that no one who is Covid-positive enters a care home unless there is a clinical reason—agreed between the hospital or the community and the care home—why that is the best place for that person to be. In those circumstances, as in others, they should be isolated for the appropriate length of time.

The fact is that the cabinet secretary today has been hiding behind clinicians. She has repeatedly used the phrase “clinical judgment” and she is, in effect, saying that it was down to them. If people thought that it was okay to send patients who had tested positive into care homes, that was because of the guidance that was issued. Why will the cabinet secretary not take responsibility for that?

Quite simply, because Mr Simpson is wrong. It is a very long time since I had clinical training, but I am not shielding behind clinicians or using clinicians. It is a statement of fact that clinical assessment—whether it is about delayed discharge, what happens to someone who pitches up at A and E, or treatment once someone is suspected of having cancer—is a clinical decision, and rightly so. I will defend that on and on, and I will support clinicians in taking those decisions. That is what they are qualified to do, and that is where their expertise and compassion lie. That does not mean that I am not accountable for the Government’s decisions in these matters; it is a statement of fact, and I am very sorry that Graham Simpson does not like it.

Schools (Covid-19 Positive Tests)

To ask the Scottish Government whether it will provide an update on the return of schools and the number of pupils and staff who have tested positive for Covid-19. (S5T-02318)

As a direct result of the collaboration between all partners, and the commitment shown by the public in adhering to the measures in place to suppress coronavirus, I can confirm that the vast majority of our schools were able to reopen as planned last week for the new term. That was a significant milestone in our recovery from Covid and a recognition of the importance of having our children and young people back in school.

However, being back at school is not the same as going back to normal. School life will feel very different for pupils, parents and staff. Regrettably, there are now a number of community clusters of coronavirus cases among school-age children and young people. As far as we can determine, in all cases the transmission relates to out-of-school activities rather than to transmission within schools. As a result of the community transmission, and to protect others, affected pupils and staff have been asked to self-isolate.

Managing the situation is exactly why we have implemented a series of measures under our enhanced surveillance and testing programme for schools. The surveillance and testing is an essential component of our joint planning to ensure a safe welcome back for pupils and staff. The data will provide important information on levels of infection in our school communities.

I also confirm that the severe weather last Tuesday night meant that several schools were unable to open due to storm damage, but by Monday 17 August only one school, in Aberdeenshire, remain closed. I am glad to report that it reopened today

I have been contacted by parents wondering whether the right precautions are in place, and the Educational Institute of Scotland has today called on the Scottish Government to “do more” on school safety. Young people are used to wearing face coverings in shops and on public buses, so will the Scottish Government now mandate the wearing of face coverings on school transport?

The Government has worked closely with our local authority partners, professional associations and other stakeholders in formulating the guidance that has been issued to all schools in relation to the reopening after the summer break.

That guidance must be followed in all circumstances. Within the guidance, there are a number of measures to mitigate any risk that is experienced by young people and staff, and to create a safe environment for all. It is vital that the guidance be followed at local level.

I have made it clear to Parliament that the Government will continue to review the guidance that is in place, to ensure that it remains appropriate for the challenges that we face. The EIS has written to the Government with its suggestion about face coverings. We will take further clinical advice on that point, because the guidance is consistent with the clinical advice that we have received to date. Further discussions on that question will be held in the education recovery group, which is responsible for production of the guidance.

There is logic to wearing face masks on school transport. Pupils who get a Lothian Buses or First Group bus—or indeed a ferry, in Shetland—to and from school have to wear masks, and wearing a face covering on school transport would not be an impediment to children’s education in the way that doing so in a classroom would be.

The Scottish Government has been clear that this is about balances and trade-offs. Would not face coverings on school transport be a sensible precaution to help to minimise transmission and allow schooling to stay on track?

On Beatrice Wishart’s comment about keeping schooling “on track”, I reiterate—on the basis of the information that is available to us today—that although some pupils have tested positive for coronavirus, there is no evidence that any of that transmission has happened in schools. It has all been about community transmission. That provides me with the opportunity to reiterate the fundamental point, which is that suppression of community transmission is crucial to maintaining school opening arrangements.

Our clinical advisors have expressed to us the view that dedicated school transport should be considered as an extension of the school estate, in which the wearing of face coverings is not mandated. I appreciate that that is a significant question for a number of stakeholders, not least the EIS, and I assure Parliament that we will take further advice on it and discuss it with the education recovery group, to ensure that we can properly address any issues that are of concern for pupils, staff and parents, as part of the safe resumption of schooling in Scotland.

If an individual pupil tests positive, the response is that that pupil should go home and isolate, with test and protect measures kicking in.

However, the biggest fear for many parents is about what happens if a large number of teachers test positive and school transmission occurs. What pre-emptive work has been done to ensure that staffing levels in schools are adequate, so that whole schools or classes do not have to revert to blended learning and to reduced face-to-face contact? How many additional teachers have been recruited in the past few months? If the Deputy First Minister does not know the answer, why not?

The answer is held by local authorities, which are currently recruiting, because—as I have had to remind Mr Greene on several occasions—the Government does not recruit teachers.

The Government is putting in place the resources to enable recruitment of 1,400 additional teachers to the schools of Scotland. We will wait to hear from our local authority partners, who have democratic and statutory responsibility for employment and recruitment of teachers locally. We have put those resources in place to try to boost the school teaching population, in order to address exactly the issue that Mr Greene raised. I hope that that reassures him that appropriate action has been taken to address the issue.

I am sure that other members will, like me, have been contacted by the parents of children who live with conditions such as diabetes and who have returned to schools in which few, if any, pupils and teachers are wearing face coverings. Those parents just cannot understand why their sons and daughters are protected in supermarkets by everyone wearing face coverings, but not in classrooms.

I heard what the Deputy First Minister said about the clinical advice, but for the life of me I cannot explain the logic of that to parents. Will the Deputy First Minister have a go?

The logic of the advice, which is, of course, published, as Mr Gray asked us to do and which we have done, is that the risk of transmission among young people is judged to be very low, and that provided that staff maintain physical distancing from pupils within schools, the risk of transmission between them and staff is low. Of course, physical distancing also exists between staff within schools. Provided that those rules are being followed, the risk of transmission in schools is low. That is the foundation of the advice that we have had.

However, as I said to Beatrice Wishart, the Government is taking further advice from our clinical advisers. That advice will be reflected on by the education recovery group, in which all our stakeholders are participants, to make sure that we can address the legitimate issues that Mr Gray raises.

There is, of course, the need for young people who have been shielding because they have diabetes, for example, to have their circumstances individually assessed by their schools, in order that they can be assured of their safety.

I recognise that the phrase “school cluster” can be thrown around a bit too much and is ambiguous—it does not necessarily reflect whether infection of pupils has taken place in the school or in the community. However, the Government seems to be relying on the assumption that infections of pupils will reflect community transmission and will not drive community transmission in the future. It is too early to have picked that up already, given how recently schools have reopened, and none of us wants to be in the position, in a few weeks or months, of realising that that judgment was just a wee bit wrong.

I have also heard from teachers, who share the concern of parents and pupils, which Iain Gray asked about. They want greater emphasis on distancing and they want wearing of face coverings to be expected inside schools. Does not the cabinet secretary recognise that there is a case for erring on the side of caution?

Fundamentally, the Government has erred on the side of caution in all our actions in relation to Covid. Indeed, we have been criticised on many occasions by many Conservative members for erring too much on the side of caution, so I am not paying particular attention to what is being muttered behind my back on that side of the chamber today.

I hope that I have adequately set out to Parliament that we are considering the substantive point that Mr Harvie raises. There will be arguments about whether the measures are appropriate at present. We have sought clinical advice, and we will continue to seek clinical advice, to inform the judgments that we make.

However, based on the evidence that I have so far, none of the positive cases appears to have emanated from within schools. It is the other way around—they have emanated from the community and the virus has gone into the school with a pupil. We must concentrate our efforts on ensuring that we have a safe regime within schools, but we also have to ensure that we are doing all that we can to suppress community transmission, because suppressing community transmission will give the best prospect of our school hygiene measures being as effective as I hope they will be.

Aberdeenshire Train Derailment

To ask the Scottish Government how it is assisting in the aftermath of the train crash near Stonehaven. (S5T-02314)

Our thoughts and condolences are with the family and friends of those who have lost their lives and those who were injured in the tragic rail incident near Stonehaven.

Scottish Government officials within Transport Scotland are liaising closely with investigating bodies and the rail industry. In addition, I have met with Network Rail and Abellio ScotRail, the Office of Rail and Road, the Rail Accident Investigation Branch, and the emergency services and agencies that dealt with this tragic event.

Transport Scotland has also supported Abellio ScotRail to ensure that connectivity to Aberdeen is maintained by replacement buses. Transport Scotland senior officials also participate in regular calls with industry partners to discuss the derailment situation and the recovery arrangements.

I put on record my condolences to the families of those who lost their lives and those who were injured and my thanks to the emergency services.

An assessment of the condition of the line and the surrounding area will be of the highest importance and passengers and railway staff will want to have full confidence that everything is being done to ensure the safety of the rail infrastructure and the embankments along the line. Can the cabinet secretary give more detail of what work is being carried out in that regard?

In addition to the on-going investigation by the Rail Accident Investigation Branch, Police Scotland, the British Transport Police and the Office of Rail and Road, Network Rail has been asked to provide an immediate assessment of similar risks across the wider Great Britain network, with an interim report expected by 1 September and a full report later this year. Additionally, from my discussions with the lead investigators of the incident at the RAIB and the ORR I understand that any factors identified during the course of their on-going investigation that they believe need to be brought to the attention of the rail authorities will be identified early and brought to the authorities’ attention in order that immediate action can be taken.

The events of last week continue to be extremely traumatic for survivors and the families of those affected and will also have been difficult for the emergency services personnel who attended the scene. In addition, a few of my constituents who work on the railway have got in touch with me to say how upsetting they found the approach to the reporting of the tragedy in The Sun newspaper, and the insensitive door-stepping of the victims’ families very soon after they received the devastating news. What support are those affected being given to help them?

I am aware that insensitive approaches have been made to families and victims affected by last week’s rail incident. Such approaches are completely and utterly unacceptable and the Scottish Government does not condone that behaviour in any shape or fashion. I hope that those involved in making such insensitive approaches take a long, hard look at themselves and recognise the sensitivity of the matter. I advise Gillian Martin that Abellio ScotRail has met the families of both Brett McCullough and Donald Dinnie and has offered support. In addition, I understand that the rail authorities’ arrangements to offer support to passengers’ families affected by the incident are well advanced.

This tragic accident, which is nothing short of a disaster, has had a massive impact that extends well beyond the toll last Wednesday. How is the Scottish Government assisting third sector organisations to deal with the friends, families and colleagues across the north-east and beyond who have been affected by the incident?

As I mentioned in my response to Gillian Martin, the rail authorities are already taking forward work with appropriate agencies to provide support to those families who have been affected by this tragic incident. However, if the member has in mind a particular third sector body that has been involved in the matter and requires assistance, I am more than happy to give consideration to that. I can assure the member, though, that assistance is being provided where it is sought and that the rail authorities have put arrangements in place to ensure that.

The cabinet secretary will know that the men and women of the railway family across the network will be marking one week since this disaster with a one minute silence at 9.33 tomorrow. Those affected will be in all our thoughts at that time. Does the cabinet secretary agree in principle that the rail disaster near Stonehaven should lead to accelerated investment in improving the safe running of trains between Aberdeen and Dundee and must not result, however inadvertently, in any avoidable delay?

The member has raised an important issue, but it would be wrong for me to pre-empt the outcome of any of the investigations that are taking place across four different agencies.

The member will also appreciate that the operation, maintenance and renewal of the rail network is regulated by the Office of Rail and Road, which makes determinations every five years as part of its periodic review process of any operational, maintenance and renewal matters that need to be taken forward, including safety, within a control period. Clearly, depending on the outcome of the various investigations being taken forward, it would be for the ORR to look at whether determinations need to be made to Network Rail for further enhancement, maintenance or renewal works to be undertaken on the particular line. However, at this stage, it is too early to say what the exact causes of the incident were and what measures need to be put in place to prevent an event of this type from occurring again.