Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, May 19, 2020

Official Report 846KB pdf

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Care Homes

The next item of business is a statement by Jeane Freeman on supporting care homes during Covid-19. The cabinet secretary will take questions after her statement.

14:45  

Today I want to set out the steps that we have taken, including the additional action that we set out at the weekend and yesterday, to support residents and staff in care homes across Scotland as they deal with the impact and challenges of Covid-19.

Although the majority of people who contract the virus experience mild to moderate symptoms, for our most vulnerable citizens Covid-19 is a vicious virus. Among those who are most vulnerable to its impact are people who are older, who are frail and who have existing health conditions. Many live in care homes. Care homes are not just institutions, of course—they are people’s homes.

Not all care homes are the same. The care home sector in Scotland is provided primarily by private sector businesses, with a smaller proportion of owners from the independent and third sectors and public authorities.

However, there can be no doubt that the staff who work in all care homes and in community social care are, like our staff in the national health service, committed to doing their very best every day, and they are being sorely tested by the risks and challenges with which they are dealing as they care for their residents in the face of this pandemic.

In early March, we issued clinical and practice guidance for care homes that set out what we believed to be the risks and the resultant clinical and practical steps to be taken, including the ending of communal activities, communal dining and unrestricted visiting. That guidance was updated on 26 March and again on 15 May. Each iteration is a reflection of our growing understanding of the virus and the situation on the ground in some of our care homes.

As global supply chains for personal protective equipment became increasingly challenged and the normal private supply routes to the care home sector were disrupted, the NHS National Services Scotland social care triage helpline was launched on 19 March, so that, at national level, we could step in and respond to urgent requests for PPE from social care providers, including care homes. We increased our NSS order volumes to make sure that we could cope with the additional demand from the social care sector and primary care and pharmacy, as well as the additional demand from acute care.

To make sure that we could get the right PPE to the right people, we created direct distribution routes, including local PPE hubs for social care providers—which covered care homes—and direct distribution, where that was needed. That was and continues to be a remarkable logistical achievement by the people who were involved and I thank NSS and local health and social care partnerships for their considerable and continuing work in the area.

For care homes, as for the NHS, an area of concern was the sustainability of the workforce. Alongside NHS staff, social care workers have been the priority group for testing from the outset. In many cases, staff were absent because a member of their household had Covid-19 symptoms, so the testing was designed to ensure that a positive confirmation or not of the presence of the virus would either confirm the need for absence or allow staff to return to work. That must also mean that there is availability of a back-up workforce, to ensure that rotas are stable. Following the call to social care and NHS staff who had left the profession to volunteer to return, the Scottish Social Services Council national accelerated recruitment portal went live on 29 March, so that people with relevant skills and experience could come forward and be ready for deployment.

By yesterday, 18 May, 895 individuals had been cleared to work in a variety of social care settings, including care homes. Of those individuals, 254 have been matched with employers so far. Several hundred additional checked, cleared and skilled employees are ready to begin work. Today, as I have already been doing, I am urging providers to make full use of that significant additional resource.

We also recognised that it was inevitable that the pandemic would impose additional costs on the social care sector, as it has done on health. Working with the Convention of Scottish Local Authorities, the trade unions, Scottish Care and the Coalition of Care and Support Providers in Scotland, we were able to announce a national uplift of 3.3 per cent in the total hourly contract rate for adult social care providers, starting from 1 April.

We also reached agreement with COSLA to meet other additional costs incurred, including additional payment to third sector and independent care providers who are working on local government contracts, to cover sick pay, in line with terms and conditions, for all staff who are off work because they are ill or self-isolating.

On 12 May, I announced an initial £50 million to support social care provision that is commissioned by health and social care partnerships in care homes and for care-at-home services, to provide resilience in the sector and to deal with increased need as a result of Covid-19.

As I have said, social care workers have been in the priority 1 group of key workers from the outset, and to date, around 30 per cent of key workers tested have been from social care. However, I am also aware that there are social care workers who, because of their employment contract, are anxious about being tested, because if they test positive and go off work—as they should—their weekly income will be reduced to the level of statutory sick pay. For those workers, that is an intolerable position to be in. It is a terrible choice between their commitment to the care of residents, their own health and that of their family, and the risk of a significant and unmanageable reduction in their income. That arises solely from the contract that the employer has put in place, so it is not the case for all social care workers. For those who are affected, however, it is an impossible choice that we need to resolve.

Yesterday, I spoke to Donald Macaskill from Scottish Care, and I know that he and COSLA are meeting today to discuss how the matter can be resolved. I have asked for an update following that meeting, but I have been clear to him and to the unions that have raised it with me that I will help to resolve the matter where I can.

On 15 April, the First Minister announced that all symptomatic patients in a care home would be clinically assessed and offered testing for Covid-19. Two days later, the chief medical officer wrote to ask all health boards to make testing available to all residents and staff in a care home that has an active case of the virus. We have taken steps to ensure that admissions to care homes are tested in advance of admission and, in the case of community admissions and admissions from hospital when the patient was not in hospital for Covid-19, residents are also isolated for a period of 14 days on admission.

Yesterday, I announced that all care home staff will be offered testing, regardless of whether the care home in which they work has a Covid-19 case. That will be an iterative process, with testing undertaken every seven days. We will begin that work from next week, and are working now with our NHS testing capacity, senior NHS staff and Scottish Care to plan the implementation of the process, including the prioritisation of care homes for testing. Every effort will be made to ensure that testing can be undertaken as close to a care home as possible.

Just as the virus is new to scientists and clinicians around the world, it is also new to the social care sector. Like us, they are having to learn, adapt and improve their response as their understanding grows. That includes increasing the level of clinical oversight and practice expertise that we provide to ensure the welfare of residents and staff during this time. We already have an effective system of inspection for social care in Scotland, and the Care Inspectorate, now with its partners in Healthcare Improvement Scotland, is actively engaged in the direct inspection of individual care homes and providing support and guidance, as well as escalation when that is required.

From 20 April, NHS directors of public health took on enhanced and urgent clinical leadership for care homes in their board area, working closely with the Care Inspectorate, local authorities, general practitioners and district nurses, and being supported by the care homes clinical and professional advisory group, overseen by the chief medical officer and our chief nursing officer, and by the care homes rapid action group.

On 17 May, I set out a further enhancement of those arrangements, including the requirement that each board’s medical director and nursing director, each local authority’s chief social work officer, and the chief officer of each health and social care partnership should work to provide direct and frequent engagement with each care home in their area. That was to ensure effective infection prevention and control practice; testing in the way that I have set out; the adequacy of PPE, and its appropriate use; and the robustness of staff rotas. It was also to ensure the provision of direct NHS staff support where that was required. Such arrangements are not about medicalising the provision of care in care homes, which, as I said earlier, we should remember are people’s homes. Rather, they are a necessary response to a national emergency that has to be centred on public health and clinical need.

Members will be aware of the important amendments to the coronavirus emergency legislation at stage 2 that will be considered by the Parliament today and tomorrow. I will not encroach on that debate, but I will say, firmly, that I consider those amendments to be necessary to provide the necessary level of safety by taking immediate action in particular circumstances to secure the safety, wellbeing and continuity of care of care home residents.

I have set out, as best I can, all the key steps that we have taken to ensure the safety, protection and wellbeing of residents and staff in our care home sector. This is not the end of our work by any means. I am certain that we will have more to do and more improvements to make. When that is the case, I assure members that that is what we will do.

The cabinet secretary will now take questions on her statement.

From the outset of the outbreak, ministers were pressing health boards to discharge vulnerable patients into care homes. Will the cabinet secretary say how many patients have been transferred from NHS facilities to care homes since the start of the outbreak when they were untested for Covid-19, or whose results were unknown at the time of transfer, or who had positive tests without those being followed by clear results?

Given that ministers’ most recent clinical guidance suggests only that, ideally, patients should have given two negative tests before they are discharged from hospital, will the cabinet secretary now accept that we have seen a dysfunctional approach to testing in care homes across Scotland? If not, where does she believe that the management of the spread of the coronavirus across Scotland’s care homes has gone so wrong?

As of last week, the percentage of delayed discharge patients going to care homes was 38 per cent, so 62 per cent of people who were discharged from hospital went to their own homes with appropriate social care packages. [Jeane Freeman has corrected this contribution. See end of report.]

I refute the idea that we were forcing people out of hospital in order to clear the way for Covid-19 patients. Actually, the 3,000 bed spaces that we cleared came primarily from the key areas of healthcare that we took the very difficult decision to stop—not least, elective procedures.

From time to time, all members will have made the perfectly legitimate point that our delayed discharge figures need to be reduced. What happened in response to the Covid-19 pandemic, as in many other areas of healthcare, is that we managed to attain changes and improvements that we had spent many years trying to achieve. The use of digital tools is one example of that and the incredible expansion of the NHS near me service is another. The focus of our health and social care partnerships was to reduce the number of delayed discharges in order to ensure that individuals had the best possible care and were not in hospital when they no longer needed the clinical care that is provided there.

I do not accept that our response has been dysfunctional. Mr Briggs has quoted selectively from the guidance. We all know that the right clinical decision for elderly and frail individuals is for them not to be in hospital when their clinical care no longer requires that they be there—it is not the best place for them. Some clinicians, including geriatricians, will go so far as to say that hospital is positively a bad place for such individuals to stay in. When clinical care in hospital is no longer required, moving people to their home or into a care home is the right thing to do.

We have said that, while a test can be done—48 hours before discharge from hospital if someone is a Covid patient, or 24 hours if they are not, with 14 days in isolation—testing is not the single silver bullet that will prevent transmission of the virus. Quality infection prevention and control, which should exist in our care homes in any circumstance, is the primary way by which we can prevent transmission.

The announcement of regular testing for care home staff is very welcome, albeit that it should be happening on a much greater scale. I have continually requested an emergency protocol for care homes. I lodged a written question on 4 April and I subsequently wrote to the cabinet secretary hoping for a faster response, but all that I have received is an acknowledgement and a holding response.

The lack of a clear single protocol has been disastrous. When testing eventually took place at Home Farm care home in Skye, it showed that there had been an overwhelming level of infection. Since the very beginning of the crisis, Scottish Labour has repeatedly highlighted the need for testing in care homes, on the advice of experts in Scotland, the World Health Organization and other international agencies.

Will the cabinet secretary outline exactly what scientific advice has changed? Will the Government now accept the need for regular testing of staff in care homes? The roll-out will start next week, but when does she expect that level of testing to be available in every one of Scotland’s care homes?

I am grateful to Ms Grant for her question, and I start with an apology for the delay in responding to her. In advance of her receiving a proper response, I am very happy to meet her to discuss what she thinks an emergency protocol should contain, and to consider whether that is something that we can usefully do in addition to what has already been done. My office will be in touch with her to ensure that we have that meeting as soon as possible.

There has been a recent change to offer testing to staff regardless of whether there is a Covid case in the care home in which they work. I will outline what has changed to allow that to happen. As I am sure Ms Grant and other members will recall, at the outset, our understanding of the virus—and indeed the understanding of our scientists and clinical advisers—was that, if someone was not symptomatic, they were unlikely to be infectious, and that the test was not reliable. That view has changed over the piece and there is now increasing evidence on and debate in the scientific community about the degree to which asymptomatic and pre-symptomatic individuals may be infectious.

Although the test is not as reliable in asymptomatic individuals as it is in symptomatic individuals, the advice has nonetheless changed. It now says that, given that there is a growing debate about the level of infectiousness of individuals who are asymptomatic or pre-symptomatic, use of the test for preventative purposes in a contained area such as a care home—bearing in mind that the test must be repeated every seven days to be sure—is, on balance, the right thing to do. That is why we have changed our position.

I welcome the introduction of regular testing in care homes, for which the Greens have long been calling, but it must be expanded to include national health service staff.

Public Health England’s research on care homes in London has shown that, in some cases, workers who transmitted Covid-19 had been drafted in to cover for others who were self-isolating. HC-One, which operates Home Farm care home on Skye, has admitted that it brought in temporary staff from outside. Personal protective equipment and regular testing significantly reduce the risk of transmission and are hugely important, but they do not eliminate the risk entirely. What action is the Scottish Government taking with the sector to minimise the movement of staff between care homes?

Both areas that the member asks about are important. On the situation in hospitals, our chief nursing officer is, with her clinical colleagues, working through some additional advice that she intends to give on what more we can do in the hospital setting to minimise transmission of the virus there. We already have red and green zones, but there are other steps that it might be wise and useful for us to take, including to minimise as far as possible transmission between staff from one zone to another. Once we have that advice, I will update members on it and on any subsequent decisions.

Alison Johnstone is also right about the importance of not transferring staff from one home to another, and certainly not without testing to ensure that the new staff that are introduced are clear of the virus at that point, bearing in mind that the test tells people only whether they are positive on the day that they are tested.

Another thing that is really important, which is why we have now involved not only our directors of public health but our nurse directors and medical directors, is to ensure that we can offer NHS staff to those homes rather than have them move their own staff from one care home to another, not least because, in doing that, they might make the home that they take staff from vulnerable in terms of its staff rotas and therefore its capacity to do effective infection prevention and control.

The chief nursing officer has been clear that NHS and care home staff should be tested before they first go into a home. A number of our health boards have already provided NHS staff to care homes in order to backfill their rotas and, in some instances, to increase the level of staffing in a care home where there is an active case.

New residents from the community could still be admitted into care homes without first getting the results of a negative test. Can the cabinet secretary fix that? Why is it necessary for the testing of all staff to be iterative? Why not test everyone immediately?

The situation at Home Farm care home in Portree is terrible, and an application has been made to cancel its registration. Is the cabinet secretary planning to cancel the registration of other homes?

I apologise to Mr Rennie; I think that I am about to miss the first question that he asked. I will start with the last question.

It is not for me to cancel the registration of any care home. That is a very serious matter. The Care Inspectorate has applied to the court to consider the deregistration of HC-One as the owner and provider of Home Farm care home on Skye. Because the issue is now in the court, it is not appropriate for me to say anything more about it—except to repeat that it is not for ministers to cancel registrations. The Care Inspectorate approves registrations and, if it wants to cancel them, it needs to go through that court process.

The fact that testing is iterative should not be taken to mean that it does not happen now. It means that, if I were to test negative today, that would tell us that I do not have the virus today. However, if a person wanted to be sure that their continued work in a care home was not risking bringing the virus into that care home, they would need to be tested every seven days to make sure that they continued to be negative for coronavirus. The seven-day period relates to the clinical advice on how often the testing should happen. If we went into care home X, it did not have a case, and all the staff tested negative, we would need to go back in seven days’ time, otherwise it would be a one-off. My understanding is that our position on that differs from the approach that Public Health England and the NHS in England are taking.

I apologise if I missed the first part of Mr Rennie’s question. If he wants to give me it later, I will ensure that he has the answer.

I ask the cabinet secretary to expand on what she said earlier. Do the NHS and local authorities have staff available to support care homes that have insufficient staffing due to Covid-19? Have any been deployed to care homes in recent weeks?

George Adam will recall that we made a call to NHS and social care staff who had recently left the profession to volunteer to return. If they are deployed back into the health service or social care, it will be under a proper contract of employment. We had 1,916 expressions of interest for social care roles. In my statement, I provided the number who have gone through all the pre-employment and other checks that are required, and the number who have been deployed into care homes.

The decision about whether those individuals are deployed into care homes rests with care home providers. I cannot tap an individual on the shoulder and send them into a particular care home. That is why, in my statement, I urged care home providers that, if their rotas are fragile or if they need to increase the ratio of staff to residents because they have an active case, there are expert people who are ready, willing and able to be deployed. However, what I can do—I have done this—is ask NHS staff to volunteer to be deployed to provide cover if providers are not coming forward to request returning individuals with social care experience.

The Care Inspectorate instigated an unannounced inspection of Home Farm care home on Skye, which, as the cabinet secretary said, resulted in the Care Inspectorate applying for the NHS to take over the running of that nursing home. Unfortunately, there are many tragedies throughout Scotland that have not led to similar action. What are the protocols for such interventions by the Care Inspectorate and the Scottish Government in care homes?

The Care Inspectorate is independent, and it is largely responsible for determining which care homes it wishes to inspect, either announced or—this is important—unannounced. It has taken the view that it should do what I would call live inspections of care homes, in which it physically goes to the care home, with the appropriate PPE and so on, and undertakes an inspection. In doing so, it largely looks at two things: the care homes that it has already assessed as having a red-amber-green status of red or amber; and the care homes in which there is an active case. Whether the inspection is announced or unannounced is for the Care Inspectorate to decide. It has a means by which it did does that, and it is largely independent in acting in that way.

In recognition of its particular role, the Care Inspectorate is actively engaged with us in all the care home work that I described in my statement. For care home inspections, it has formed a partnership with Healthcare Improvement Scotland, which has very particular expertise in infection prevention and control. In many cases, those inspections will be joint inspections by the Care Inspectorate and HIS.

I welcome the cabinet secretary’s announcement on testing, but it is months late. We have witnessed a lack of testing for staff—there was really nothing in place until the third week in April—the reluctance of care homes to send their staff for testing because of concerns about staff absence, and a lack of PPE, with PPE locked in cupboards while coronavirus raged through care homes. Why was none of that done sooner? Why have we had a patchwork approach to care homes, with constantly changing guidance? Where has the Care Inspectorate been? The truth is that it has been posted missing. Instead of stepping up to the plate, it has stepped back and taken a light-touch approach at a time when people are dying in their hundreds in care homes. Did the Scottish Government agree to the Care Inspectorate stepping back?

Part of the difficulty—I mentioned this early in my statement—is that the care home sector is primarily delivered by private business. Some 70-odd per cent of care homes are private businesses, whether they are individual small businesses or part of a much larger chain. There are also, of course, independent, third sector and public authority care homes, but they are in the minority. In such circumstances, my capacity—or any health secretary’s capacity—to direct and instruct is limited in a way that it is not in the health service.

As Jackie Baillie will recall, some time ago—in early March, I think—I put the national health service in Scotland on an emergency footing in order to ensure that, regardless of individual board opinion, I could be sure that it was doing the things that I thought that it needed to be doing in a consistent way across the country. The care home sector is not like that, so there is, of necessity, a different approach. Whether that is the right place for us to be and whether we want to be in a different place in the medium to longer term are important issues for debate for a different day. I have to deal with the current reality of the sector.

I would not dispute any of the points about the reluctance of providers to send staff for testing and PPE in cupboards. The point of the significantly enhanced clinical guidance, direction and intervention is to overcome those problems as best I can.

The Care Inspectorate took the view—as it was entitled to—that, in the face of the pandemic, it was safest for residents of the care homes for it to undertake inspections and engagement with care homes that did not involve its directly appearing in the home. It has now changed that position in order to directly inspect what is happening in those care homes, and I am glad that it has done that. That is a welcome change of decision.

Yesterday, HC-One care homes reported 1,002 suspected cases and 207 Covid-19 deaths in its care homes. Considering the number of homes and beds that HC-One has, those numbers seem to me and others to be disproportionately high. Will there therefore be a review of the practices of large care home operators, and does the cabinet secretary agree that the future of elderly care must be a priority for change?

The Covid-19 advisory group to the chief medical officer and, obviously, to the Government, which is led by Professor Andrew Morris, is focusing on that area. That involves consideration of emerging views from the Care Inspectorate about whether there is a difficulty in large care homes—that is, physically large care homes as opposed to groups of care homes—compared to small care homes in relation to effective infection prevention and control, and in relation to proper support, training and guidance for staff who work in those care homes. It is important to make clear that that question is not yet decided and that there is not a concluded view. Members need to be aware that the debate has begun, and that some aspects of both sides of that argument are backed by data and evidence.

In relation to whether there should be a review of large care home operators that have more than one care home, as I said to Ms Baillie, there is an emerging and genuine need for consideration in the medium to longer term—by the Parliament and the Government—of what our care home sector should be, how it should be funded, who should provide it and what we require of it in providing care to our older and more vulnerable citizens, which many of us will be at some point.

However, that is for the medium to long term. My focus just now has to be on dealing with the reality that I face given the way in which the sector is constructed as it stands. I need to navigate my way as best I can through that to ensure that, where possible, we maximise the wellbeing, care and support for residents and staff in the current circumstances.

I encourage members to keep their questions brief and ministers to keep their answers concise. There are still a dozen members to go.

I will be very brief. I want the cabinet secretary to clear something up. Have people been moved from hospitals into care homes without knowing whether they had Covid-19 or whether the virus was in the care home?

I cannot give the member a definitive answer to that question. I can give an answer with respect to the date from which we required the two negative tests before someone could leave hospital to go to a care home if they were a Covid patient and the single negative test if they were not, and the requirement on community admissions. I will give Mr Simpson details of that after this statement. However, I cannot give him an answer on the situation prior to that.

With your indulgence, Presiding Officer, I will restate the point about why those tests are not always undertaken before the individual moves to the care home. The main reason for that is the clinical view on the balance of risk: that the risk in staying in the hospital is greater than that of moving to the care home, and that the move to the care home can be mitigated while waiting for the test results by the requirement for 14 days of isolation.

Why does the cabinet secretary applaud care home workers on Thursday evenings, only to instruct MSPs on the COVID-19 Committee today to vote against amendments that would have made those workers safer and would have improved their terms and conditions?

I disagree with those amendments and do not believe that that is what they would do. There are other approaches. I will not get into a debate about that emergency legislation, as that would not be appropriate at this point, but the amendments that we have lodged are the correct ones and I hope that members will support them.

I am sure that my colleague Mike Russell is more than capable of setting out our clear reasons for opposing certain amendments. I do not think, as the member appears to be implying, that there is any contradiction between my long-standing support—from before I was health secretary—for care home workers and NHS workers, having been one myself many years ago, and the occasions when I may disagree with Mr Findlay.

I, too, welcome the changes to the testing criteria in care homes. How will that work in practice? Will test kits be sent out to care homes, particularly those in rural areas, so that a nurse in the home can carry out the testing or will someone from the health board or social care partnership still be required to visit the home to carry out the tests on staff and residents, thereby causing a delay in the process?

That is an important point. Much of our country is remote and rural and requires travel over considerable distances in order to reach places. Depending on what will give us the quickest answer, which will vary, there will be a mix of both approaches. On occasion, if the clinical staff in a care home have been trained to undertake the sampling, they will be able to do that, whereas in other circumstances, testing will be carried out through the deployment of the mobile testing units, of which we have 12 in Scotland. In other circumstances, local NHS staff, such as district nurses or local staff from a nearby acute or primary care setting, will be used.

It has taken nearly three weeks from when a resident of the Glenisla care home in Moray was confirmed as a Covid-19 case for full testing of residents and staff to be undertaken and the results to be processed. Some of the test results took five days to process. So far, that full testing has identified a further three cases, but the management have told me that they will not be offered secondary testing because it is being focused on priority cases. Will the health secretary confirm that the delay of nearly three weeks is unacceptable and that it will have put the safety of residents and staff at further risk? Will she confirm that Scottish Government guidance is clear that secondary testing should happen when there are confirmed cases and that, if NHS Grampian is not offering that testing, it is in breach of that guidance?

If the member cares to give me the details of that particular instance, I will investigate it directly this afternoon and tomorrow and get back to him. It is not acceptable for that to take three weeks and it is certainly not acceptable for tests to take five days to process. I need to know which lab was processing those. Our NHS labs are working to a maximum of 24 hours. They do not always meet that at the moment, but they need to get there by the end of this month and they are actively engaged in doing that.

Twenty-four hours is the right time period for us to move into test, trace, isolate and support. In some instances, it takes longer than that, but five days is completely unacceptable, as is the situation that the member described with secondary testing. I do not understand why that view was given by NHS Grampian or reported by the manager. I will want to look in great detail at what that was and why anybody thought that it was the right thing to do, because it is not.

Residents and families must be assured that they will receive the highest quality of care and that robust action will be taken when that does not happen. How will new powers that are proposed in the Coronavirus (Scotland) (No 2) Bill help to bolster the work of the Care Inspectorate to ensure that that happens in practice?

I will focus on one of the amendments that we have lodged, as a way of—I hope—explaining why we believe that the powers are necessary.

I preface my comments by saying that we would use these powers as a last resort, but if the Care Inspectorate’s view is that a care home that it has inspected is of such poor quality that it intends to apply to the court to deregister the provider, I do not believe that we can wait for the court to go through its due process—although I am not criticising how long the court may take—before we can step in to ensure that the residents are safe and that infection prevention, cleanliness and the ratio of staff to residents are of the standards that we need.

In those extreme circumstances, it is important that we can provide that additional safety net and, regardless of the provider’s view or the fact that the court decision is still to be made, move in straight away to protect the residents in the care home. As the member knows, the amendment will then require us to apply retrospectively to the court for its permission to do what we have done.

Given the tragedies that are occurring in care homes across the north-east of Scotland, what amount of the £58 million that was pledged last week from the United Kingdom Government will go to the north-east, and how will it be distributed?

I am not entirely sure what additional funding the member is talking about. I apologise to him—I did not hear clearly what he said. If he is referring to the additional resource that the UK Government has committed to care home work, the consequentials for that will go to care home work in Scotland.

I declare that my mother lives in a care home.

Even before the pandemic, many care homes were struggling to survive. In my constituency, care homes have closed in Arran, Largs and Saltcoats in recent years. Financial support from local authorities for those whom they place has struggled to keep up with the rising costs. Now that the additional costs of personal protective equipment, higher wages and a higher staff-to-resident ratio have arisen, what steps will the Scottish Government take to ensure the continued viability of our care homes as the pandemic recedes?

As I am sure that the member knows, many of our care homes survive financially on the same basis as some of those that do not. The standards that are required are the standards that are required, and we have already discussed what needs to be done in circumstances in which care homes fail to meet those standards.

Care homes are subject to a national contract that they negotiate with COSLA through Scottish Care, which sets out the amount that will be paid for each resident whom the local authority asks to be placed in a care home, which is currently done through the health and social care partnerships.

I am sure that, in addition to the continuing discussions between COSLA and Scottish Care on statutory sick pay and ensuring that care home workers are not put in an invidious position as a result of their employer’s contract of employment, further discussions will take place between those two parties on the national contract, and that not only will I be advised of what those are, but I will hear from both parties what more they think needs to be done.

As we go through this pandemic, we will be actively engaged, not only on the additional resources that are required to get through the pandemic, which I have touched on and which the Scottish Government has made available, but on the continuing sustainability of the care home sector. Some of that engagement will pick up on questions that Ms Baillie and others have raised.

Does the cabinet secretary accept that simply adding new categories to the list of those who can be tested is, in itself, not enough? We know from our communities that many people who are already eligible—such as carers and residents in homes with an outbreak, and carers who are being told to travel miles to access tests—are simply not being tested.

Will the cabinet secretary consider regularly publishing the numbers of people who are tested by category of eligibility and by health board for each category, so that we can properly scrutinise delivery on the ground? Will she ensure that no one has to travel an excessive distance to access a test?

I will commit to publishing what data we have, as best I can. The reason for that caveat is that we do not have all the data on testing that takes place when an individual accesses UK Government mobile or drive-through testing through the employer or employee portal, which is processed at the lighthouse laboratory in Glasgow. If a care home worker, an NHS worker or an oil and gas worker goes through that route, we do not get the absolute data of every category that has been tested. There is a limit to what I can publish, which is the data that comes through our NHS testing.

We have been consistently clear that NHS and social care workers should be tested by the NHS and their tests processed in NHS labs, which are quicker at turning around test results—notwithstanding the issue that was raised earlier, which I will look at. We have much more direct control over what those labs are doing.

No one should have to travel miles to access tests through NHS labs. That situation happens when an individual goes through the UK Government employer or employee portal and is directed to one of the drive-through testing centres if a mobile testing unit is not nearby. That is why we want health and social care workers to go through the NHS route.

I agree with the member that there is no point in adding testing categories or capacity if we do not use that capacity. The capacity that I can control is that of our NHS labs. Work is under way right now to ensure that we can maximise that for all the groups that we have said are priorities for testing, including care home residents, care home workers, NHS staff, over-70s who are admitted to hospital, and others.

I, too, would like to hear the answer to Graham Simpson’s question about test results, as many of us are concerned about that.

It is welcome that the Government is finally adopting the testing advice of experts such as Sir Harry Burns and Professor Hugh Pennington. The latter also suggested that the R number in care homes was likely to be high. Can the cabinet secretary give us an update on the current estimated R number in care homes?

No, I cannot. As I am sure that the member knows, there is a range of experts in this area, in addition to the two that she mentioned. Our advisory group, which is chaired by Professor Andrew Morris, has been asked to look at what the R number might be in certain settings, including care homes. It is working on that.

The difficulty that the advisory group has is that not every care home has an active case and not every care home has had an active case since the outset of the pandemic. Looking at the sector as a whole is a difficult exercise. Some care homes have significant numbers of cases, some have only one and many have none, so it is difficult for the group to look at the R number with any confidence in its modelling. However, it has given us the assurance that it will continue to work on it and see what it can pull in from experience elsewhere.

The R number should be a range, and I, too, would find it very useful to know what it is. At the moment, the advisory group’s response is that it is not possible for it to give us an answer with any confidence in its robustness, but we will continue to look at that.

Highgate care home, in my constituency, was one of the first to declare the presence of Covid-19. Many of my constituents want testing to safeguard their loved ones. I have to declare that my brother is a resident of Highgate, and his daughter and grandchild, if they were here today, would surely thank the cabinet secretary for her announcement, as I do.

How often will staff and patients in care homes where Covid-19 is present be tested? Will it be every week?

Where there is an active case of Covid-19, all the staff and residents in the care home should be tested. Staff who test positive should stay at home following the guidance that any of us should follow if we test positive, and residents should receive the clinical care that they need, through their primary care provider, which will be the GP practice. All of that is now overseen by the medical and nurse directors of the health board. Under infection prevention and control measures, care homes are actively scrutinised to ensure that any possibility of transmission from one resident to another is broken, as far as that is possible.

The member will know that for many residents in our care homes who suffer from dementia, that degree of isolation in their room is particularly distressing. In those circumstances, a degree of clinical guidance is needed that supports care home staff to minimise that distressing situation while other mitigating measures are taken to prevent infection transmission.

In my statement, I announced that care workers in care homes that do not have an active case will be tested, and that process will repeat every seven days. If, in the first round of testing, any member of staff tests positive, they will be asked to go home and follow the appropriate isolation and clinical guidance that we have spoken about. We would then begin to test the residents in that care home, because we would need to be sure that none of them had contracted the virus.

According to the Financial Times, the rate of excess deaths due to Covid-19 stands at 65 per cent in Scotland, which is exactly the same rate as that in Italy and is among the worst in Europe. At the same time, in Scotland, the use of intensive care unit beds peaked at 208 on 12 April, which was just 18 more than the pre-Covid-19 capacity. It is hard to avoid the hypothesis that people have not been admitted to ICU in Scotland who would have been in other countries. The situation in our care homes raises the suspicion that that is even more true for those who are resident in those homes.

What steps is the cabinet secretary taking to interrogate the data, examine the policy and practice, and ask the question whether people have been refused admission to ICU who should have been, and would have been, admitted elsewhere?

As the member said, he is talking about a hypothesis. I would be very careful about suggesting that our clinicians at any level in primary or acute care chose not to provide any patient with the appropriate clinical care for any reason at all. Our chief medical officer has been clear in supporting our GPs and primary care practitioners, as have the BMA GP group and the Royal College of General Practitioners, that individuals should be given the right clinical care for them, regardless of their location. I have no reason and no evidence to suggest that that has not been the case.

That applies, too, in the hospital setting, when an individual is admitted. We have clear guidance from the Royal College of Emergency Medicine about the balance in decision making that is undertaken in any circumstance, and not just in the current pandemic, in considering invasive and intrusive treatment that causes pain and may cause long-lasting harm. We have seen some emerging data about the potential long-lasting harm that is caused to individuals who are admitted to ICU and ventilated for any length of time during the pandemic. Clinicians always have to balance the benefits of the care that could be delivered against the risk of damage and the failure of that care. That is a constant balancing judgment that all clinicians have to make. It is a very difficult place to be, and not one that I would wish to occupy.

Our group that is led by Professor Andrew Morris, along with the National Records of Scotland and our senior statisticians, are looking at the excess death numbers here and in the rest of the UK in order to interrogate those numbers further so that we know as best we can exactly what lies behind them. As they reach conclusions on that, we will of course ensure that members and others are made aware of those conclusions.