Meeting of the Parliament

Meeting date: Tuesday, April 21, 2020

Official Report 894KB pdf

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Covid-19 (Health)

The next item of business is a statement by the Cabinet Secretary for Health and Sport, Jeane Freeman, on Covid-19. The cabinet secretary will take questions at the end of her statement.

14:06  

It is no exaggeration to say that the effort and sacrifice of the people of Scotland in complying with the restrictions that are in place has helped to save thousands of lives. I know that it has not been easy, but I cannot stress enough how much it matters and how much it is appreciated.

We want to be clear with the public on what the future might look like and the principles that will shape any future decisions on easing any of the restrictions that are currently in place. Later this week, we will set out the principles that will guide us, the evidence that we will use and the framework for our decision making. However, it will not—yet—be a hard and fast plan with dates, because it is simply too early to be able to set out that level of detail.

Once again, I thank the people of Scotland for complying with the rules and for their patience and continued support. Our aims now, and as we look to shape the steps that we need to take next in order to find different ways to live with this virus, are to minimise the impact of the virus, to continue to protect our national health service and social care services and to protect lives.

As at 9 o’clock this morning, 8,672 positive cases had been confirmed, which is an increase of 222 on the numbers reported yesterday. A total of 1,866 patients are in hospital with Covid-19, which is an increase of 57 from yesterday. Last night, a total of 166 people were in intensive care with confirmed or suspected Covid-19. That is a decrease of three since yesterday. However, in the past 24 hours, 70 more deaths have been registered of patients who have been confirmed as having Covid-19, which takes the total number of deaths in Scotland, under that measurement, to 985.

As always, we remember that behind those numbers are human beings—fathers, daughters, mothers, cousins, friends—who all meant so much to those they have left behind. Again, I extend my condolences to all those who have lost loved ones.

The work that our national health service has undertaken to treble intensive care unit capacity and to increase bed availability has ensured that so far, we have kept the number of cases below our capacity to cope. To ensure that that capacity is in place, we completed the construction of the NHS Louisa Jordan hospital in Glasgow over the weekend. In just over three weeks, we have planned, developed and constructed a hospital that now stands ready for patients. We continue to hope that that temporary facility will not be needed, but its creation gives us greater certainty that our NHS will have the capacity that it needs in all circumstances.

The effort and support from the army initially and the significant efforts of front-line NHS staff, construction and support staff and SEC staff has been awe inspiring, and I am sure that everyone in the chamber shares my gratitude for their remarkable achievement, the pride with which they have worked and the continued effort that they make to be ready.

This virus is a particular and serious threat to the most vulnerable in our society. Among those are our oldest citizens and those with underlying conditions. That means that protecting the residents of care homes is vital—just as it is during flu season and when they experience outbreaks of norovirus.

Guidance on isolation in care homes has been established for some time and requires clear social distancing, active infection prevention and control and an end to communal activity. However, to provide clarity, today I am setting out a series of tailored additional steps that we are taking to support staff and residents.

I have required NHS directors of public health to take enhanced clinical leadership for care homes. For the first time, NHS directors will report on their initial assessment of how each home is faring in terms of infection control, staffing, training, social distancing and testing and on the actions that they intend to take to rectify—and rectify quickly—any deficits that they identify.

To supplement that new clinical oversight, we are establishing a national rapid action group, comprised of the key partners with operational responsibility in the area, recognising that care homes are primarily operated by independent providers. The group will receive daily updates and activate any local action that is needed to deal with issues as they emerge, as well as co-ordinate our wider package of support to the sector.

In addition, we are equipping the Care Inspectorate for an enhanced role of assurance across the country, including greater powers to require reporting.

Testing for staff and residents is being expanded, including testing of all symptomatic residents of care homes. Covid-19 patients who are discharged from hospital to a care home should have given two negative tests before discharge. I now expect other new admissions to care homes to be tested and isolated for 14 days, in addition to the clear social distancing measures that the guidance sets out.

I make clear that testing is not an alternative to following the guidance on social distancing, ending communal activities and enhancing infection prevention and control. However, it can and does provide necessary assurance to the families of people who are in or being admitted to care homes, which is important. Of course, it also provides assurance to staff.

We are working to get students and social care retirees and returners into the system as quickly as possible and we are supporting care homes to recruit additional staff. Employers now have direct access to the Scottish Social Services Council recruitment portal, to enable the quick and effective redeployment of care workers. More than 80 staff have already been matched for work in care homes or care at home under the new portal; more will join them in the coming weeks.

I have spoken to a number of stakeholders in recent days and I thank them for their support. In particular, I am pleased that Scottish Care, which represents the majority of care homes in Scotland, agrees that this strategy and approach is the right one.

We owe enormous gratitude to workers who are safeguarding our most vulnerable loved ones in care homes and at home.

To ensure that staff have the personal protective equipment that they need, we are increasing care homes’ access to NHS PPE. Although care homes have their own PPE supply route, as before, we have undertaken to supplement that, recognising the additional demand on care homes at this time.

More than 16 million items of PPE have been distributed to social care since we launched the triage helpline for the sector on 19 March. This week, we began delivery of a week’s supply of aprons, gloves and fluid-resistant surgical masks direct to every single care home, prioritising those with known outbreaks; delivery of all that will be complete by the end of this week.

The demand for PPE is a huge global challenge, but we are doing all that we can to ensure continued supply and distribution. On top of the supply of NHS PPE to care homes, we have delivered more than 80 million items to Scottish hospitals and provided eight weeks’ supply to general practitioners and primary care in Scotland.

Global demand as a result of the pandemic is huge and we continue to run what is now a 24/7 operation to procure the supplies that we need for Scotland. In addition, we are working on a four-nation basis with our colleagues in the rest of the United Kingdom.

We are continuously updating our guidance in line with the science, as our understanding develops, so that workers have clarity on the type of PPE that they should wear and in which setting or scenario.

However, I should be clear that the guidance that Public Health England issued last week on actions to undertake in the event of shortages did not apply to Scotland. We continue to have sufficient stocks of PPE. However, we continue to have to work hard, every single day, to ensure that orders arrive on time, that delivery volumes are as ordered, and that we source new suppliers into the market. As always, if staff have concerns, we need to hear about them. They can contact us through the direct dedicated PPE email address, which I will give again: [email protected].

Work has also been continuing on increasing our NHS testing capacity, and we are on track to meet our target of 3,500 by the end of this month. By that time, every health board will have local testing capacity, and we are working across academia and the independent sector to increase that capacity further. In addition to our own efforts to increase testing, we—again—work on a four-nation basis to increase testing capacity in Scotland as part of the UK effort.

Increasing our polymerase chain reaction testing capacity and looking forward to other emerging forms of testing—if they are validated—will be essential to plans for the future. Our work on testing now matters now, but we are also building the testing infrastructure that we will need as we move to the next phase. Our capacity to test, trace and isolate will be critical to controlling the virus.

We are witnessing the most significant transformation of health and social care in a generation. Tripling our intensive care unit capacity, massively scaling up and extending our procurement service, creating a new hospital in three weeks, protecting hundreds of thousands of our most vulnerable, and welcoming thousands of NHS and social care returners, student nurses, midwives, allied health professionals and medics to support our communities and our NHS are just some examples of what has been undertaken.

All that is testament to the professionalism, dedication and sheer hard work of those who work in, and lead, our NHS and social care. In addition, the people of Scotland have stuck by the rules and stayed at home, maintained social distance, and sacrificed the contact with family and friends that means so much and the pleasures that they otherwise enjoy.

That transformation and those sacrifices are impressive beyond words. However, alongside that, our NHS remains open. Services from GPs to accident and emergency and urgent care are all open and ready to care for those who need it. I say to everyone: please do not hesitate to come forward if your condition, or that of your child or family member, concerns you. If you have symptoms, seek help by contacting your GP, calling NHS24, or by attending A and E for urgent symptoms. The NHS is ready to cope—and is coping—with Covid-19, and it remains open for all those other important and urgent health issues, in relation to which it cares for people so well. The NHS and our social care services continue to scale up and to work to protect the health of people in Scotland, and we continue to do all that we can to support them.

As the cabinet secretary will imagine, a large number of members wish to ask a question. I hope that we will have relatively concise questions and similarly concise answers.

I thank the cabinet secretary for advance sight of her statement.

Ministers have stated that delayed discharges will be reduced by a further 500 this month. How many of those patients are still in hospital today? In addition to that, given the concerns that have been raised regarding current staffing levels in care homes across the country, how many of those patients is it envisaged will be moved to care homes?

From memory—if I am wrong, I will correct this later—delayed discharges have reduced by 62 per cent since 4 March, and just over 600 individuals who clinically no longer need to be in hospital are still there. Regarding those who have been discharged, I do not have with me the number of individuals who have gone to care homes or into care at home over that period. However, we will get those figures from health and social care partnerships as best we can, and we will ensure that Miles Briggs and other members have them.

I should also make the point that, as we work hard in relation to delayed discharge—in which there has been significant achievement—it is being revealed that there are particular issues around the support that is needed for adults with incapacity, and with significant mental health or behavioural issues. We are working to introduce what is needed in that respect not only for this time, in relation to the pandemic, but for the longer term, so that we can continue to deliver to those individuals the care and support that they need.

The latest data says that around one in four Covid-19 deaths has happened in a care home, and there is persistent evidence that care workers are working in a precarious environment without the basic equipment—masks, gloves and so on—that they need.

The cabinet secretary mentioned the email address that the Government uses. How many people have emailed that account about PPE? Although I welcome the creation of the national rapid action group, I recall that the cabinet secretary put the NHS on an emergency footing on 17 March. Is the care sector now on an emergency footing? If not, why not?

Let me take those questions—I think that there were three—in turn.

Since 1 April, when the email address was initiated, we have received 1,636 emails. Emails that are considered to be urgent are turned around and dealt with within 12 hours. Next are emails that are dealt within two to three days. Others take longer, as we try to work through exactly what needs to happen and check the question against the information that we get back from health boards on social care, or on particular care homes.

I am currently considering whether we need to increase staffing for that. It needs to be an around-the-clock—although not necessarily overnight—operation, because of how people email in their concerns. As I said, as those concerns come in, there is ministerial engagement, and some of the concerns are acted on quickly. Boards now have single points of contact for PPE. Those individuals meet virtually at least once a week, and the minister concerned joins the meeting as often as possible in order to try to understand exactly where there might be particular issues.

As Monica Lennon will know, the majority of our care homes are private enterprises: from memory, I think that about 20 per cent are run by local authorities, so there is a mix of public and private sector provision. The Government’s oversight of social care is not as direct and clear as it is for our national health service. However, I have outlined a significant increase in clinical intervention and oversight. I said in my statement that I had worked with partners—importantly, including Scottish Care—to secure their agreement, so that we have much greater direct intervention in, control over and support for individual care homes.

The guidance that went out in the second or third week of March was specifically established in order to break possible transmission of the virus. It was harsh guidance about residents having to stay in their own rooms and all communal activity ending, and it covered infection prevention and control support for staff, PPE and training, and staff confidence in that. If all that had been put in place and was active, we should not have seen the level of transmission that we have seen in care homes.

We now need to increase our clinical oversight and the Care Inspectorate’s inspection of care homes, and we need to ensure, through direct delivery of PPE and other measures, that we are offering to care homes the maximum support that we can offer. Members should bear it in mind that, for the most part, care homes are private enterprises, so we need to agree levels of intervention and support with them, notwithstanding the standards that they are required to meet for their Care Inspectorate registration.

I have spoken with scientists, including Professor Debby Bogaert, who is an expert in infectious disease who strongly advocates a test, trace and isolate strategy—the response that has been urged by the World Health Organization. Will the cabinet secretary explain why our testing capacity in Scotland continues to be underused? Indeed, we are close to the bottom of the European Union testing table.

The cabinet secretary will be aware that, as well as testing, we need capacity to trace. What action is under way in that regard?

I am sure that Alison Johnstone will remember that, at the very start of this period, when we were in what we described as the containment phase, we undertook the strategy of testing, tracing and isolating cases. At that time, generally the process was carried out in people’s own homes. The NHS in Scotland at that time had two labs that were capable of undertaking a total of 350 tests per day. However, that capacity has been increased significantly; all boards now have access to laboratory facilities. As Alison Johnstone said, our testing capacity has increased to the current level. I emphasise that it will increase further to meet the target of 3,500 tests per day because of the additional capacity that I spoke about in my statement.

We set out that we would in this phase, as we significantly increased capacity over a very short time, use testing for patients in hospital, for surveillance purposes and to help critical key workers to return to work. Such workers are not only in the health and social care sectors, but extend to prison, police, ambulance and fire and rescue services. However, we have seen low uptake of testing among them. Members will recall the three categories of key workers that we published; we are now looking at extending availability of testing to workers in other key areas.

The point of the significant increase in testing to the target of 3,500 tests per day and beyond is in order for us to be as ready as possible to carry out the strategy of testing, tracing and isolating cases as we move, in any respect, from the current severe restriction measures to easing of them, depending on where the evidence takes us and when the decisions that I mentioned at the start of my statement are made. Whatever we do at any point, the test, trace and isolate strategy will be critical to ensuring that we retain control of the virus’s spread, and that we continue to keep case numbers within the NHS’s capacity to cope with them.

That will all become clearer as we increase testing capacity—on which we will update Parliament as we do so—and as we increase the capacity of our local health protection teams, which lead the tracing process and provide advice on isolating.

Thirteen members still wish to ask questions, so I urge the cabinet secretary to be slightly more concise in answering, if possible. I know, however, that these are difficult matters that involve a lot of detail.

I welcome the announcement on testing in care homes. Willie Rennie and the Lib Dems have been asking for that for several weeks. That shift in policy will keep people safer.

This week, Colin Millar voiced his anger at the Scottish Government’s failure to end continued exposure of personal assistants to the risk of infection transmission. He said that the telephone support line refuses calls from social care workers because they are not registered with the Care Inspectorate. Those who deliver care in people’s homes, as personal assistants, are in as much danger as care home staff. Will the cabinet secretary intervene to ensure that they are no longer stonewalled by the PPE helpline?

Yes, I will. Before I do, however, I say here—and I will later write to the Scottish Personal Assistant Employers Network, SPAEN, to say this—that I apologise for the fact that we have not resolved that issue before now. Social care workers are a very important group, as are the people for whom they care. At this point, there is no good reason for their being unable to access PPE.

With that apology, I also offer my assurance that, before I leave Parliament to go home tonight we will have resolved that issue. There is no reason why it should not be resolved. Alex Cole-Hamilton and, more important, the personal assistants whom he mentioned, have my personal assurance that we will resolve the issue by the end of the day.

As the member for Cowdenbeath, I take this opportunity to thank all NHS Fife staff and care sector workers in Fife for their unstinting dedication.

Over the past few weeks, we have witnessed unimaginable, yet hugely commendable, community buy-in to lockdown. How does the cabinet secretary plan to build on that in planning for the next steps, while recognising at all times the hugely different circumstances that pertain in communities in villages, towns and cities across Scotland?

The answer to that is, in part, what the First Minister set out only a few days ago. We plan to publish a document later this week that will set out the approach that we intend to take to making such decisions. The document will set out not what the decisions will be, but the criteria and the evidence that we will use, and how we will make all that as transparent and as public as possible. The document attempts to engage us in hearing what communities want to say to us about the approach that they want us to take, and about easing of various measures that might be possible while we control spread of the virus.

It is important to remember in all this that we are looking—from a situation in which there are severe restrictions on people’s everyday lives in order to control the virus—to identify in what way any of those restrictions can be eased while we continue to live with the virus. It is not going away; it is still with us and we need to continue to manage the virus as best we can. That is why test, trace and isolate is so important, but we will set out the other steps, the balance of evidence that we will consider and the decisions that we will reach as clearly as possible, because that is the best way for people to understand the rationale for anything that we decide to do, and for us to secure their support and commitment to continuing to work with us as we try to manage the virus and minimise loss of life.

Last Friday, I asked the cabinet secretary about the procurement process for Scottish companies that have offered to manufacture or supply PPE. I recognise the need for due diligence, as the cabinet secretary indicated in her answer on Friday, but, on behalf of companies that are in that situation, I ask why is it taking so long for the initial engagement with them—sometimes as long as three weeks—and whether there is a way for that delay to be tackled.

As I said to Mr Whittle on Friday, much of that work is a collaboration between me and Mr McKee and the group that he leads with Scottish Enterprise and others. I do not have a direct answer to Mr Whittle’s question now, but he has my commitment that I will work with Mr McKee to look at all the companies that have come forward, what has happened with them, what the process is and whether there is room to speed it up. I will return to the member in the next few days with that answer.

According to National Records of Scotland, in 2018, 3,400 people died from contagious diseases in Scotland, including 364 from influenza and 1,670 from pneumonia. Does the Scottish Government have any information yet on the lockdown’s positive impact on reducing the number of deaths from infectious diseases other than Covid-19, such as pneumonia and influenza?

No, we do not have detailed information on that yet, although it will be an interesting piece of information. We have an indication that some of the infections that generally arise because we do not wash our hands well enough are declining. That should be a spur to us all to continue to pay attention to the important public health message about washing our hands.

I welcome the cabinet secretary’s additional measures for care homes. The 15 deaths at Crosslet house care home have now become 16, following the death of a resident yesterday. As late as yesterday, senior managers were claiming that the home is Covid-19 free. That is despite at least two local GPs diagnosing residents with Covid-19, five staff testing positive and one member of staff now in hospital.

In a shameful piece of spin that, frankly, would make most politicians blush, West Dunbartonshire Council claims that it is following guidelines and is giving the impression to families that it is testing residents, but it has not tested a single resident—not one. The council is not even being accountable to its local councillors, who are being refused information. Will the cabinet secretary instruct an urgent investigation and tell West Dunbartonshire Council that it must test its care home residents and not allow older people to be treated as second-class citizens?

The situation that Ms Baillie has just outlined is utterly shameful and completely unacceptable. This afternoon, I will ask the relevant director of public health to immediately take steps to look at what is happening in that care home, to ensure that residents who are symptomatic are tested and to advise me on what additional steps should be taken with that particular care home, as we are now asking all directors of public health to do with every care home across Scotland.

The cabinet secretary will be aware of concerns raised by essential workers, including those caring for the most vulnerable in our communities, such as care workers, who have previously been told that they will be entitled only to statutory sick pay should they self-isolate rather than the 80 per cent of salary that has been offered to non-essential workers. Can the cabinet secretary provide more detail on the funding agreement that was reached between the Scottish Government and the Convention of Scottish Local Authorities for sick pay in cases where care workers are ill or self-isolating?

The funding agreement was that we would meet any additional costs required by local authorities or others to ensure that the sick pay of care workers who are off sick or isolating because of Covid-19, or who are at home looking after someone else for whom they have caring responsibilities, is met in full.

Macmillan Cancer Support is concerned about the lack of clarity around the guidance on visiting someone at the end of life who is dying at home. Macmillan says that leaving the house for such visits is not listed in the Government guidelines as an exemption. Will the cabinet secretary set out guidance on that with regard to all settings, including home and non-home settings, so that people can say goodbye to their loved ones safely, regardless of where that might be?

It may be sensible to repeat that, in the guidance that we set out on the various media platforms that we use, in which we said that visiting people in care homes, hospitals and other settings would end, there were a number of exemptions, one of which was to be with a loved one at the end of their life. Another exemption is birthing partners—-when someone is a partner for someone giving birth. A third exemption is when a loved one suffers from dementia and it would increase their anxiety and distress not to have someone visit. There is a fourth one—forgive me, but I cannot remember it. I will make sure that members are informed of all four exemptions, and we will look again at whether we need to make those more public so that people are clear that, at end of life and in the other situations that I have described, there are exemptions to the current ban on visiting.

Several weeks ago, it emerged that 17.5 million or so antibody tests bought by the UK Government were found to be unreliable by scientists at the University of Oxford. I am aware that work is on-going to identify reliable testing kits. Can the cabinet secretary update us in relation to the Scottish Government’s work on sourcing such tests? Does she continue to believe that antibody testing will be a useful tool in helping to beat the virus and ease the lockdown?

So far, a successful antibody test has not been developed. The evidence is not clear on the degree to which someone who has Covid-19 develops antibodies and immunity, or, if they develop immunity, for how long that lasts. All those factors make the development of a test more complicated. A great deal of work is going on, a lot of which involves researchers and others from Scotland, as part of a UK and European exercise and, in some instances, a global exercise. However, although work goes on to try to develop a successful and clinically robust antibody test, at this point none exists.

What are the cabinet secretary’s plans for opening the new department of clinical neuroscience facility at Little France in Edinburgh in May, in light of the concerns of senior medical staff that that could be a dangerous distraction at a time of our greatest need and their view that the DCN move should be delayed until the pandemic is over, when it can be carried out in a safe, orderly and sensible manner?

It is a positive that the DCN part of the new site is ready and on track, as we had hoped it would be. However, some of the senior clinicians that Ms Boyack refers to wrote to me to express those concerns and since then there have been a number of discussions between them and others with the medical director for NHS Lothian on whether any level of service can safely be moved to the new site without compromising the work of staff who are currently dedicated to addressing the Covid-19 pandemic. I believe that they have reached a view on out-patient services, but that is still to be finalised and those discussions continue.

The clinicians are right to prioritise what needs to be done now, but it is important that, if there is any level of service that can be moved that does not compromise those efforts, steps are taken to do that. Any such move would need to minimise disruption to the work that those clinical teams are undertaking now.

Today’s Evening Times raised concerns about agency staff in care homes being moved across the care home estate, potentially increasing the risk of infection. I am also aware of staff being deployed across various units within the same care home setting due to significant staff shortages as employees have to self-isolate. Will the new national rapid action group review and clarify guidance in that area and ensure that it is rigorously enforced in case it could save lives? Does the cabinet secretary agree that, once testing of symptomatic staff is routinely conducted, staff absences will be reduced, fewer will need to be redeployed and fewer agency staff will be required?

Staff should not move from one part of a care home or one care home that has Covid-19 positive patients to another that does not—that is basic infection prevention and control. Directors of public health will be looking to ensure that, if that is happening, it stops. It should not be happening in any circumstances and certainly not in the current circumstances. Increasing the availability of testing for social care staff or their family members if they are engaged in household isolating may help.

Some parts of Scotland have been successful in ensuring that numbers go through at pace. There should be no need for agency staff to be used, given that we have 20,920 individuals in total who are returning to the health and social care workforce and that NHS Education for Scotland, NHS Greater Glasgow and Clyde, NHS Lothian and the SSSC portal are working at pace to deploy them. As I said in my statement, 81 staff have been deployed, another 126 are ready and available for social care services and more will be coming forward, including 1,854 student nurses who have been placed in community settings. We need to ensure that care home owners and managers understand how to access those skilled clinical workers with experience and commitment to make up any shortfall that they have in their permanent staffing numbers.

I apologise to Anas Sarwar, Andy Wightman and Neil Findlay, but I am afraid that we have to move on to the next item of business. I remind members to be careful about social distancing measures when leaving or entering the chamber.