Meeting date: Thursday, May 21, 2020
Meeting of the Parliament (Hybrid) 21 May 2020
Agenda: Covid-19 Lockdown: Next Steps, Members’ Question Time, Urgent Question, Decision Time
Untested Patients in Care Homes (Inverclyde)
To ask the Scottish Government what its response is to reports that the health secretary authorised the purchase of 50 beds in order to move untested patients into 10 care homes in Inverclyde, which has the highest Covid-19 death rate in Scotland; how many of these homes have experienced a subsequent outbreak of the virus, and how many deaths there have been.
As part of our planning for Covid-19, we asked all health boards and, jointly with the Convention of Scottish Local Authorities, all health and social care partnerships, for their mobilisation plans in order to make sure that we were ready for the worst-case scenarios that were being suggested by the scientific advisory group for emergencies and the associated modelling. Our plan was to create a capacity in the health service of 3,000 beds and to double the number of intensive care unit beds at that time.
Inverclyde regularly has the lowest levels of delayed discharges anywhere in the country, but the health and social care partnership anticipated more people coming through the system more quickly, with high levels of care and support needs. As part of its advance planning, Inverclyde secured an additional 50 care home places to be called upon if required. Forty places have been used to date, covering eight care homes. There are 14 care homes in Inverclyde and the total number of deaths in those 14 homes is 35. As part of the Scottish Government’s commitment to testing, all the homes will have been fully tested by this coming Monday 25 May. To date, my understanding is that three staff have tested positive.
With regard to the number of those eight homes that have experienced one or more Covid-19 case, I apologise to Neil Bibby that, in the time available, I have not been able to get robust data on that. However, I commit to writing to him very shortly, as soon as I have the data, so that he will have that additional answer to his question.
It is vital that the full facts about outcomes of Scottish Government decisions are in the public domain, and I look forward to receiving that further information from the health secretary. It is particularly important given that there has been some confusion about figures in answers that ministers have given in recent days. It has at times appeared that ministers have tried to avoid giving figures or have been unclear about what the accurate figures are. No one questions that ministers believe that they have acted with the best of intentions, but does the health secretary regret authorising the purchase of beds for hospital patients in unprepared care homes without testing, and does she believe that that and the known problems with personal protective equipment were likely contributory factors to the failure to protect care home residents in Inverclyde and West Scotland?
I will make a number of points in response to that supplementary question. I am grateful to Mr Bibby for his question and for the way in which he asked it. Those were decisions that I made, but they were made on the basis of the plans that local health and social care partnerships had come forward with, because they know their areas best. All those health and social care partnerships anticipated what they believed would be the demand coming in their direction at that time and what they thought they needed to do in order to best meet it. I am not trying to absolve myself of accountability. I signed off on those final plans—absolutely—but they came from those partnerships, which of course involve both health and local government.
With regard to whether those patients should have gone into care homes, or indeed their own homes, in the absence of testing, I think that I have said before that I am sure that, as we look back we will think that there are many decisions that we would perhaps have made differently, if we had known at the time what we know now about the nature of the virus, the way in which it transmits itself and so on.
At that point, as I am sure the member recalls, not least from the four nation plan that was published, we were facing what we anticipated to be a significant surge in demand on our health service. In order to ensure that we minimised the number of deaths there, we took a number of decisions to protect capacity for that health service. As it has turned out, largely on the basis of how the public responded to the restrictions that we asked them to abide by, we have fortunately not reached a position where that full capacity has ever been used.
In our care homes, testing is not the only precautionary measure in terms of controlling the introduction and the spread of the virus. All our care homes should have proper infection prevention and control for previous infectious diseases, such as winter vomiting and flu—the member will know them as well as I do. Infection prevention and control and adequate PPE—including knowing how to use it, with proper training given to support staff—are critical.
As Neil Bibby will recall, when private and public care homes’ own PPE supply chains became disrupted, the Government stepped in to ensure that PPE was supplied to care homes in Inverclyde, as elsewhere.
I thank the health secretary for that further answer. As I said before, it is vital that we have the full facts about the outcomes of Scottish Government decisions. Almost 1,000 patients across Scotland now appear to have been discharged from hospitals to unprepared care homes without testing—that we know about.
Has the cabinet secretary seen or asked for, and will she publish, any report that details the specific homes across Scotland that received such patients and that went on to experience a Covid-19 outbreak, as well as the number of residents and staff who became ill, tested positive or died in each case? In addition, were new care home units established for that purpose?
I share with Mr Bibby the desire that there is as much transparency as possible and that accurate information is given to members. As I hope he knows, this morning, I wrote to his party leader and others to clarify things to address some of the concerns that have been raised around that matter in recent days.
In relation to the information that he asked whether I will publish, I commit to go away and look at that in detail, to publish as much of the robust data as I believe we can, and to advise him and other members of my response to that particular part of his question.
The only caveat that I add is that I have a little anxiety around the idea of naming specific care homes. I need to take advice on whether naming particular care homes to which there has perhaps been only one admission from hospital means that there is any risk of identifying that individual.
As I said, I will take advice on that and, in as much as I can do so, I will publish the response to Neil Bibby’s questions. I will certainly write to him to let him know whether I believe that I can answer all those questions and publish all that information, or whether there are areas where I do not think that I can produce that information, with an explanation of the reasons for that.
I would like to be able to call all the members who have requested to ask a question. I therefore ask for more succinct questions and answers, in which case I may well be able to do so.
The cabinet secretary highlighted the importance of effective prevention and control measures in care homes and hospitals to ensure the clampdown on Covid-19 and to protect lives. I would be grateful if the cabinet secretary could set out what steps the Scottish Government has taken to support those integral activities in the 14 care homes in Inverclyde, and across Scotland.
As I hope that Stuart McMillan and colleagues know, we first issued guidance to care homes on 13 March, which was subsequently updated. Part of that guidance states, as we have always said, that the critical steps that need to be taken absolutely include quality infection prevention and control measures alongside the appropriate use of PPE for any particular setting. That guidance also asked care homes to reduce significantly the amount of communal activity—including communal dining—and to reduce visiting, with one or two exceptions around palliative care and support where it is needed for residents with dementia.
Since then, as I hope that Stuart McMillan knows, we have charged our directors of public health, who are working with our board directors of nursing and medical directors, to directly engage and work with every care home in their area to assess the levels, extent and effectiveness of infection prevention and control and to provide additional support if that is required; to ensure that staffing levels are as they need to be and, if they are not, to ensure that we can provide additional NHS staff to those areas if employers have not taken staff from our returners portal; and to make sure that there is direct clinical engagement from local primary care practices and general practitioners.
As I believe the member also knows, the Care Inspectorate has taken the decision to provide direct inspections of care homes, working on the basis of the red, amber or green status that it gave the homes in previous inspection reports.
It has taken 10 weeks for the cabinet secretary to provide the most basic information on when, from where and to what setting almost 1,000 hospital patients were discharged, and the information that she provided to me on Tuesday was inaccurate. The Scottish Government still has not revealed how many patients were discharged over the whole of April to care homes from a hospital setting. Families want answers. This is a matter of competence, honesty and transparency, and the cabinet secretary has failed on all three. Given all that we now know, does the cabinet secretary not realise that she has lost the confidence of the public?
Before we go any further, I say to the chamber that I expect courtesy at all times. There is certain language that I think we all recognise as being very discourteous, and perhaps all members should reflect on that. [Interruption.] I ask everyone in the chamber to please be quiet. I think that I have made the position very clear. I will be listening carefully from now on. I ask everyone to reflect on how they are dealing with certain issues and to do what most people would believe to be the right thing.
With regard to what I said on Tuesday and subsequently, as Mr Briggs knows, I have written to his party leader, Jackson Carlaw, and I believe that a copy of that letter has gone to Mr Briggs. It sets out the factually correct position and apologises for any mistake that I made in the language that I used in the chamber. I have also written to the Presiding Officer with that apology and asked for the record to be corrected.
The April figures will be published once we have gone through the proper process of assuring their accuracy for all the partnership areas and all our hospital settings. As soon as they are published, Mr Briggs will be able to see them.
On whether the public has confidence in the job that I am doing, that is, in my view, for the public to decide. I am focused on doing what I believe to be the right thing: making the right decisions based on the information that I have at the time that I have to make them. That does not mean—and I would never claim—that there might be decisions that have been made that would have been different had I had the information then that I have now. However, I do not think that there can be any doubt about the focus that I am giving to the job that I have to do, or about my intent to get it as right at the time as it is possible to do.
Mr Briggs, you might wish to take the opportunity to accept the apology.
In this whole debate, members across the chamber are doing our utmost to—
Mr Briggs, I asked you whether you wish to take the opportunity to accept the apology. If you do not wish to take that opportunity—
Yes, I do, Presiding Officer.
Thank you very much.
The cabinet secretary is more than aware that bed blocking occurs because there is no care home place or home care package available to people who are in hospital. In the past year, we have had record delayed discharges because of that.
However, in March, 1,000 untested people were discharged from hospital to care home places or home care. I am trying to understand and get my head around how we were able to find those additional 1,000 places. Was that capacity always there, or was extra capacity suddenly built, or were jobs created overnight, with additional funding? If the capacity was always there, were people kept in hospital not because there was no care home place or home care available but simply because local government and integration joint boards have been underfunded?
There were two primary reasons for the improvement in reducing the number of delayed discharges. At least one of those reasons is reflected in our health service, where we have secured improvements, for example in the use of digital technology, in a shorter period than we had been able to manage up to the point when we were charged with dealing with the pandemic.
Regarding one improvement, there has always been a minimum-to-zero level of delayed discharges in some of our partnership areas. In fact, Inverclyde was one of those areas. Those partnership areas had adopted particular aspects of practice that involved planning for discharge at the point of admission and ensuring that any care package that was needed—if one was needed—was available to the individual at the point when they were clinically fit to leave the hospital setting.
That spread of practice was secured much more quickly by all the partnership areas through an absolute focus on that being what we needed them to do. As I know the member is well aware, having people stay longer in the hospital setting than their treatment requires risks causing them harm. For some time, all of us in the Parliament have shared a desire to achieve a reduction in the number of delayed discharges, and the position was achieved partly through that focus of effort, with the spreading and uptake of good practice.
Additional funding was made available to partnership areas to ensure that existing social care packages were not depleted. The member will have heard me speak about my concern regarding some areas where that happened, without, I believe, good reason.
It has also been a matter of meeting additional demand for support at home for short or long periods. Further, in some cases, intermediate step-down beds were created, sometimes in a care home and sometimes elsewhere in more of a community setting, in addition to care homes places.
There were a number of reasons why that position was achieved. As we look back over the journey of dealing with the pandemic and as we consider what improvements we would want to make and what lessons we would want to learn, we will conclude that some of them will be improvements that we want to continue into the future.
Minutes of the Covid-19 advisory group meeting that was held on 2 April record a number of priorities, but two stand out. One was to understand the problem of virus transmission in hospitals, and the second was to support the mobilisation of patients from those same hospitals into social care. It seems that the group could not understand how the virus was spreading in hospitals, yet it still sent more than 1,000 patients into care homes without a Covid test.
We know that those homes were raising concerns about PPE and access to testing at the time, so what risk assessment was made prior to that mass movement of patients? If one exists, will the cabinet secretary now publish it?
By 2 April we had already set up the additional support to provide PPE to social care, and to the care home sector in particular. That support was active by that date to ensure that there was appropriate PPE, and an appropriate level of PPE, in care homes as elsewhere.
Guidance is clear that individual risk assessments are undertaken for the discharge of elderly patients from hospital—whether or not they were in hospital because of Covid-19—that look at the appropriate support that they need and the appropriate place to which they should be discharged. Those individual risk assessments are part of the work that is undertaken. It is not possible to publish individual risk assessments; however, risk assessments have always been undertaken when discharging from hospital patients who require additional support, be that for a short period or a longer period.
I apologise to Angela Constance, Jamie Halcro Johnston and George Adam for being unable to take their questions.