Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, November 25, 2020

Official Report 1068KB pdf

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Covid-19 (Roll-out of Testing Programme)

The next item of business is a statement by Jeane Freeman on the roll-out of a testing programme. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:54  

Last week in the chamber, I updated members on our plans to deliver Covid vaccinations. Today, I am grateful for the opportunity to provide an update on our plans to significantly expand testing. The further expansion is possible because of increases in our testing capacity, which is coming from the three new national health service regional hub laboratories, from Lighthouse laboratories and from new testing options.

Yesterday, the Glasgow Lighthouse laboratory reached the remarkable milestone of having processed 5 million tests.

Work on our three new regional hubs in NHS Scotland is progressing and I thank our microbiology, virology and healthcare science workforce, who have built the largest diagnostic capacity and are a critical part of Scotland’s Covid response. New options come from innovation in testing outside our labs—notably, the new lateral flow devices—bringing us significantly greater capability to test more people, more often.

I will come on to how we will use that capability, but I will first say a few words about the new tests. Lateral flow devices are rapid turnaround tests whereby samples are processed on site with no lab required and results being available in less than half an hour. The type that we are using first in our expansion—the Innova lateral flow test—has had extensive clinical validation by Public Health England and the University of Oxford. That validation found that the Innova lateral flow test has an overall sensitivity of 76.8 per cent, meaning that it will identity more than seven in 10 positive cases of Covid. That rises to more than 95 per cent of those with high viral loads—those who are likely to be the most infectious.

Understanding that matters, because, as we have said consistently from the outset, no test is 100 per cent accurate, and testing on its own does not reduce transmission. It helps to stop transmission only through the actions that are taken following the result: to isolate if positive and give contact tracers all the information about where we have been during the period when we may have been infectious so that close contacts can be identified and told to isolate—all of which is aimed at killing off the chain of transmission.

Testing is one layer of protection. All the others—from reducing contacts and keeping our distance, to wearing face coverings, enhanced infection prevention and control in our NHS and care settings, and vaccines, when they come—work to greatest effect only when they work together. Our senior clinical and scientific advisers recently reviewed our testing strategy and their advice was clear and unanimous: test people with symptoms, test for clinical care and, when capacity allows, prioritise to protect those who are most vulnerable to the worst harm. We now have that increased capacity and we will extend testing to many more people.

By the start of December, we will extend testing to all hospital admissions to emergency departments, acute assessment centres, maternity units, and emergency mental health units. By mid-December, we will extend that testing to all medical and surgical elective admissions. We will extend our routine testing of healthcare workers. Everyone who works in patient-facing roles in our hospitals, in the Scottish Ambulance Service and in Covid assessment centres in the community, and the healthcare professionals who visit care homes, will receive twice-weekly testing. The scale of that challenge is not to be underestimated: NHS Scotland employs more than 170,000 people and although not all are in patient-facing roles, the number who are is considerable.

We know that our front-line NHS staff are at the highest risk of being exposed to Covid-19 and we know that when community transmission rises, so, too, does the risk of outbreaks in our hospitals. We will therefore phase in that extension from the start of December, to be completed by the end of that month. I know that all those NHS staff who continue to deliver an extraordinary service, and who understand so well all that they need to do to protect themselves and the patients whom they care for, will welcome that additional layer of protection.

We will extend testing in social care. There are up to 42,000 care home residents across Scotland, all of whom are entitled to a designated visitor. We will use lateral flow testing on the day of the visit so that, if that test is positive, family members can take immediate action to isolate and avert the harm that could have arisen. We will roll out lateral flow testing to up to 12 early-adopter care homes across four local authority areas from 7 December. Learning from that, we will roll out to a further number of homes across an additional seven local authorities before 21 December, with full roll-out across all homes completed over January and early February.

Although that is positive progress and—I hope—good news, I am mindful of the approaching Christmas period and I do not want any resident or family member to be disadvantaged. For those not included in the lateral flow early adopters before Christmas, we will therefore provide access to PCR testing in the weeks beginning 21 and 28 December and 4 January.

Family and loved ones know better than anyone else that testing provides an additional layer of protection. On its own, it does not give risk-free visiting; however, combined with appropriate personal protective equipment and strict hand hygiene, I hope that it allows more relatives to visit their loved ones, reduces isolation and loneliness for care home residents and gives providers the additional confidence that they need in order to facilitate more visits.

There can be no question but that the home care workforce do a most critical job in supporting and caring for people so that they can continue to live as independently as possible in their own home. From mid-January, we are extending our testing programme to them, including permanent and visiting staff and personal assistants in a person’s home, covering residential settings, sheltered housing and day care.

This is a large group of people, who are doing very important jobs, but the very nature of the jobs that they do means that they work individually in a number of different homes and settings. The logistics of this are not straightforward, so we will phase in the testing for care-at-home staff also from mid-January, starting in the local authority areas that have the highest virus prevalence at the time, and expanding from there to cover the whole sector by March.

With the significant capability now available to us, we are also extending asymptomatic testing to entire groups and communities, to help us find positive cases even before a person develops symptoms. As members know, we are doing that, first, in partnership with our universities, so that tens of thousands of students can travel to their family homes safely at the end of this term. All students who are leaving their term-time address will be offered two lateral flow tests, three days apart, from next week, and, as part of the details that are to be set out shortly for the staggered return of university students in the new year, testing will again be put in place for them.

All school staff can currently access testing if they are concerned that they have been at risk of infection. In addition, enhanced surveillance in schools has been undertaken by Public Health Scotland. However, I know that, as transmission has risen or stayed stubbornly high in some of our communities, especially those that are now in level 4, school staff may have had concerns about risk. We will maintain the current access to asymptomatic testing, but, last week, the Deputy First Minister also gave a clear commitment to exploring the further extension of testing, and I am pleased to confirm that, from the return to school in January, we will undertake a number of pathfinder programmes to test deliverability in the school environment, with the objective of establishing a sustainable programme of asymptomatic testing among school staff.

Our testing capability now enables us to work with local partners to trial whole-community testing in exactly those areas where transmission has stayed stubbornly high. Next week, we will be deploying up to six additional mobile testing units and 20,000 home test kits to support work in five local authority areas: Glasgow City, Renfrewshire, East Ayrshire, South Ayrshire, and Clackmannanshire.

We will also set up an asymptomatic test site using lateral flow testing in Johnstone in Renfrewshire, which has one of the highest numbers of new cases per 100,000 people of any local authority in Scotland. That centre will have capacity to test up to 12,000 people a week. We are also actively planning wider targeted deployment for early January, including further asymptomatic test sites.

In deploying mobile units and home test kits, and in trialling the asymptomatic test site, we will work closely with local communities to harness their expertise in order to encourage high participation.

Testing is undeniably important, but it is just one layer of protection. Many layers are needed to fight the virus. Our increased capability to test more people, more often, is potentially powerful as we navigate our way through the coming months as safely as we can, alongside our nationwide vaccination programme.

With the plans that I have set out, we will move to testing hundreds of thousands of people without symptoms, in order to actively find the virus, and, with the continuing co-operation of people across Scotland, to prevent and break down chains of transmission before Covid-19 can cause the harm of which we know it is capable.

The cabinet secretary will now take questions on the issues raised in her statement. We are pushed for time, but I will allow around 20 minutes for questions.

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

We strongly welcome the further clarification of the expanded testing programme that has been provided. It is right that these actions are rolled out swiftly, so that we can continue our efforts to suppress the virus. The positive news about vaccines in recent weeks needs to be complemented by a robust and accurate testing regime—both are critical tools.

I want to return to testing in social care—care homes and home care. Given the very difficult and emotional issues that arise for relatives and friends, especially at this time of year, which the cabinet secretary acknowledged, will she clarify whether designated visitor testing will be mandatory in all instances?

Will the cabinet secretary set out what support will be given to care homes to implement the new policies, given the importance of having a uniform approach throughout Scotland? One of the hardest issues for relatives is having different rules in different care homes.

I thank Mr Cameron for his important questions.

As Mr Cameron knows, we do not make testing mandatory. It is not mandatory for our NHS staff. There is a very straightforward reason for that: we want people to undertake testing voluntarily—particularly the lateral flow testing, which is much more straightforward and much less intrusive and difficult for people—because they understand the importance of and rationale for testing. At this point, we do not intend to make testing mandatory for care home visiting.

We need to continue our discussions with care home providers, through Scottish Care, to ensure that providers feel that testing—which they have asked for—gives them greater confidence about opening up more visiting for their residents.

There will be support for all care homes. The pathfinder approach allows us to work directly with care homes to provide training so that people understand how lateral flow devices work and to make sure that we get the logistics of kit delivery accurate and smooth. We will then use those homes’ experience to roll out the approach to colleagues who run other care homes. Training and support will be provided to all care homes as the lateral flow devices are provided to them. Of course, PCR testing is done through our NHS.

On the surface of it, there is quite a lot to welcome in the statement, but the devil is in the detail. People have been promised a lot already when it comes to testing.

The cabinet secretary recognised that our front-line workers are at higher risk and do really important jobs, but I see from the statement—I listened carefully and wrote this down—that it will be the end of March before everyone who works in home care has access to testing. That will be a year after we went into the pandemic, which seems completely unacceptable to me and to Labour colleagues.

It is worrying that we are seeing nosocomial infections in our hospitals and infection spread in the community and into care homes. It is a worrying time for our front-line workers. Why has it taken so long to roll out testing?

I welcome the update on whole-community testing. Given the high number of cases in Lanarkshire and our level 4 status, why has Lanarkshire not been selected for whole-community testing? What criteria have been used?

I do not think that I promise a lot and then do not deliver. The reason why members are getting this update today and not at any other point—when it would have been entirely possible to make an announcement, but it would have been an announcement with no substance—is that today we have a detailed delivery plan and I am confident that the dates that I am giving are those on which we will deliver. I think that that gives the public in Scotland and, more important, the people who need testing the respect that they deserve.

As I said, all patient-facing NHS staff will undergo routine weekly testing by the end of December—in a month’s time. The nature of the job that home care staff do means that they do not conveniently gather in one place on a regular basis before they go and do their job. We need to work out the logistics of that. If we can deliver routine weekly testing to them before March, we will do that because the work that they do is vital. The fact is that they will often visit five or possibly more homes in any one day, and they have arrangements for PPE.

The other point about home care staff—the First Minister explained this yesterday—relates to authorisation for non-clinical use of the lateral flow test. The lateral flow test is the best test to use in those circumstances because of the speed of the result, but there is not yet across the UK authorisation for anyone who is not clinical staff to use that test. We can make sure that it is used in care homes, where we have nursing staff, and by our NHS staff, given all the admissions to hospital, but home care workers are different. To make the testing go smoothly as part of their shift and not be something that they have to get on their day off, we need to get that authorisation, which will help us to roll the testing out further.

The two areas of complication are the nature of the home care job—including the fact that we do not conveniently find home care staff in a ward or a care home—and the need for authorisation for the widespread use of the lateral flow test among non-clinical workers. Those are the difficulties. As I have said, if we can do the testing more quickly, we will do that, but our current estimate, which is based on those two issues, is that it will—starting in January—take us until March to complete it.

We really are pushed for time, so I must insist on concise questions and answers.

I, too, add my welcome to the significant expansion of the testing programme. What discussion has the Scottish Government had with NHS Fife and Fife Council to ensure that health and social care staff in my constituency of Cowdenbeath can access testing close to their community?

NHS staff will be able to access testing directly in their workplace or as close to their workplace as the health board and the Scottish Government can organise it. For example, in some places it may be in one community setting where everyone needs to go to get it, but I am keen that it is part of the shift pattern and not something that people have to do on their days off. I have already explained to Ms Lennon some of the issues in relation to social care, but where we have social care staff directly employed by local authorities—in my opinion, that does not happen often enough, unfortunately—the testing is logistically easier to organise. We will be talking to Fife Council and others to make sure that we test those individuals in shifts and as close to the workplace as we can.

I would like some clarification of the cabinet secretary’s answer to Donald Cameron’s question. I appreciate that she cannot make it mandatory for everyone to take a test, but will the cabinet secretary make it mandatory for all care homes to offer testing to staff, residents and visitors?

I cannot really do that either. At the minute, care homes have to meet certain criteria before different levels of testing are permitted by the local directorate of public health, so my clinical adviser team is looking at what we can say about the requirement for testing—both the offer and the taking of it—for the four-hour visits, for example. In relation to the latter, we need to be careful that we are not discriminating against residents or visitors for whom taking the test is not possible, which is why we must get that bit of it right.

Nevertheless, I completely understand and agree with the sentiment behind what Mr Whittle and Mr Cameron have asked, and, as soon as the position is clear, I will make sure that they are aware.

After eight months, this is progress, but—I am sorry—it is not good enough. Full care home testing will not be done until the end of February. That will be almost a year since the beginning of the pandemic. Care home staff are not celebrating today. They feel broken. Care home residents and their families feel broken. This situation is not good enough. We are breaching their human rights and ignoring basic decency. Almost a year until full testing—

Please get to your question.

Will the cabinet secretary offer testing care home residents and their families to allow them to have loved ones close to them at Christmas, so that they can, at least, have some close contact, given the year that they have gone through and the fact that those might be the final moments that they have with those loved ones?

If Mr Sarwar would like to read my statement, he will find that it answers his question.

I will make another point. In February last year, NHS Scotland was capable of delivering 350 tests at day. I think that the expansion that our staff, our virologists, our healthcare scientists and all of our policy and delivery staff have secured and achieved in the face of a pandemic, now with new innovations in testing, is quite remarkable. They should be considerably thanked for that and we should not look at this situation as if the glass is half empty.

I am delighted that all front-line NHS staff working in health and social care are finally going to be giving given weekly testing, which is something that my Green colleagues and I have been calling for since April, and it is the least that our doctors and carers deserve. However, it has taken seven months to get to this point, and I am slightly concerned about that.

Last week, Parliament voted for the Green motion calling on the Scottish Government to introduce routine testing for asymptomatic staff and senior pupils in Scotland’s schools and, in her statement today, the cabinet secretary made a tentative commitment to trials in January. I would be grateful if the cabinet secretary could tell us whether we will have to wait another seven months before our schools can benefit from regular testing.

The commitment is not tentative. We have given a commitment that, in discussion with the Deputy First Minister, from the return of schools in January, there will be pathfinder lateral flow programmes, precisely so that we can ensure that we have smooth deliverability, taking account of the point that I made earlier to Ms Lennon about the authorisation of the non-clinical use of lateral flow tests. That is the reason—it is a straightforward reason and I am not hiding anything. That is what we will do and, as soon as we can roll it out, we will do so.

The news that lateral flow tests will be offered to students to confirm their Covid status before the journey home for Christmas will be a welcome reassurance for families. However, I want to ask the cabinet secretary about the return to campus in the new year. Her statement hints that testing will be made available for that, but will it be made available to students while they are still at home, so that they can self-isolate there if need be, or are we going to test them on campus, risking a repeat of the chaos that we saw this freshers week?

I think that I must have done something wrong when I was delivering my statement, because I did not hint at that at all; I said pretty clearly that testing would be part of the plans for the return of students after the Christmas break. Those plans have to be worked through between the Deputy First Minister and Mr Lochhead and the university sector. As they work those through, we will provide them with clinical advice about the most effective way of delivering that testing. However, of course, we can deliver that testing only in Scotland. If students are travelling from elsewhere in the UK or beyond the UK, we will not be able to deliver that testing for them.

We need to reach a sensible approach to this, in a way that minimises the risk as far as possible. I have every confidence that the Deputy First Minister will set out those plans once he has completed his necessary and perfectly proper discussions with Universities Scotland and the National Union of Students.

I welcome the cabinet secretary’s statement on the routine testing of healthcare staff. Will that testing also include maintenance staff who may be required to enter wards or rooms with Covid-19 patients? That issue has raised with me by a constituent.

Yes, it will include estate staff, who undertake a number of roles and all of whom, at various points in their jobs, have to enter wards and other areas where there are patients. It will include maintenance as well as other staff who are non-clinical.

I welcome plans for rapid testing to get students home for Christmas. However, other young adults, many of whom have disabilities, live in other forms of residential care during term time, and they have been told that, if they want to go home for Christmas, they must self-isolate for 14 days. Surely that is unacceptable to us all. Can the cabinet secretary provide reassurances that her commitment to get students home for Christmas through the use of testing will be extended to other young adults, who deserve the dignity and respect that is afforded to the rest of society?

The commitment that I can give is that I will talk to my colleagues the Deputy First Minister and Maree Todd to see whether there is anything that we can do in that regard and, once we have reached a view, I will update Mr Greene.

The cabinet secretary knows that I have been calling for the testing of carers in order to protect people with learning disabilities, who have a high rate of mortality from Covid. Many people with learning disabilities are in supported living, where the risks are similar to those in care homes, but the cabinet secretary did not specify them today. The staff in those settings, unlike home care staff, are in one place and are often employed by local authorities, so they are not difficult to identify. Therefore, can the cabinet secretary offer reassurance on how soon those staff can be tested? Given that they are easy to identify, why can we not roll out the care home programme to cover them?

I apologise if that was not clear in the statement either, but that work will begin from mid-January for the staff that Ms McAlpine referred to.

I welcome the plans for a system of two lateral flow tests, three days apart, for students leaving their term address, but why has the Government so far rejected that solution for passengers who arrive at Scotland’s airports, especially given that the airports would provide the tests? What is the science that says that it is a safe thing to do for students but not for airline passengers?

Our clinical advisers continue to talk with the airport authorities in Scotland. They have not yet reached a final view or agreement on that, but that work is under way and, as soon as we have that advice, we will take steps to introduce whatever we are advised to do.

Many of my constituents work in the oil and gas sector and they are typically asked to get tested before going offshore. However, because they cannot access testing privately in the islands, they often have to get tested in Aberdeen, which adds days on to the length of their journey. Although I understand the reasons why the testing machine in Stornoway is only for people who are symptomatic, is there anything that can be done to improve things for people who are caught in that situation?

I appreciate the points that Dr Allan made; he has made them before and I understand them. Two things are under way that might be of assistance in resolving that issue. The first is that we will look at what more we might do where there is underuse of existing capacity, either through the UK portal sites or directly through our NHS labs, although, to a large extent, our NHS labs will now be fully utilised by what I have announced today.

Secondly, we will now continue to look at sectoral arguments for asymptomatic testing, which include the particular circumstances of the oil and gas sector, in which individuals work offshore. Whether that offshore testing could be undertaken depends, again, on the authorisation of the non-clinical use of lateral flow testing. However that consideration and that work are under way, and we will make sure that we keep Dr Allan and other colleagues who represent islands and the north-east of Scotland updated as we make progress.

The city of Glasgow has a high transmission rate and we are in tier 4. Does the cabinet secretary agree that it would make sense to extend asymptomatic testing to Glasgow, as she has done in Johnstone, which is a very small part of the country, or does that indicate how far behind we are with asymptomatic testing? Why can people from Glasgow city—and wider Glasgow—not get a test, particularly after the five-day Christmas period, when it would make good sense for people to volunteer to have one, in order to fight the virus?

First, I apologise to Monica Lennon; I missed answering part of her question on Lanarkshire, so I hope that I cover it now. The introduction of the community asymptomatic testing that I described, which will happen from the start of December, is done in direct negotiation and consultation with local authorities. We have not excluded Lanarkshire—I am not excluding anybody. Lanarkshire will come forward with its proposals, but at this point they are not finalised, so I am not going to announce them. I am not confident yet about what exactly they will be. They will come, but we do not have them yet.

Following discussion with the local authority and health board, a particular part of Glasgow will be designated for community access asymptomatic testing at the beginning of December.

As I said in my statement, we will continue to look at whole-town and whole-city testing as we move into the early part of 2021. We have worked out how to do community access asymptomatic testing with local authorities and other partners. That will happen in the early part of December. We have the Renfrewshire site, which will give us a great deal of learning, as will what eventually comes through to us from Liverpool. All of that will help us to look at running asymptomatic testing—depending on the prevalence of the virus—in other parts of the country, either at community level or at the wider town or city level.

That concludes questions on the roll-out of the testing programme. I apologise to Rona Mackay for being unable to reach her question.