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Chamber and committees

Meeting date: Tuesday, April 28, 2020

Meeting of the Parliament 28 April 2020

Agenda: Time for Reflection, Business Motion, Covid-19 Legislation, Health (Covid-19), Transport (Covid-19), Topical Question Time, First Minister’s Question Time, Business Motions, Parliamentary Bureau Motions, Decision Time, Point of Order


Health (Covid-19)

The next item of business is a statement from Jeane Freeman on health and Covid-19. The cabinet secretary will take questions at the end of her statement.


Thank you for the opportunity to update Parliament on several key areas around our response to Covid-19 and to say something about our future planning.

Today is international workers memorial day and, across Scotland, many people observed a minute’s silence to honour the health and social care staff who have tragically died during this pandemic. A number of our colleagues in Scotland have lost their lives to Covid-19. My thoughts and those of members across the chamber are with their families and loved ones.

In the past 24 hours, 70 deaths have been registered of patients who were confirmed as having Covid-19, taking the total number of deaths in Scotland under that measurement to 1,332. As always, it is important to remember that behind each of those numbers is the loss of people who were loved and are now much missed. I offer my sincere condolences to their families and friends.

Notwithstanding all of that, we are starting to see promising signs that the efforts and sacrifices that the overwhelming majority of people across Scotland have made are having an impact. In recent days, the number of patients in hospital with confirmed or suspected Covid-19 has been broadly stable, and there has been a decline in the number of people with Covid-19 in intensive care units. We should not read too much into all that yet—these are early days—but those trends are welcome and we are cautiously hopeful about them.

As of today, 50 per cent of adult care homes have reported an outbreak of suspected Covid-19. Last week, I set out a series of additional steps to support those who live and work in our care homes. Those steps increase the clinical support that is focused on preventing Covid-19 infection and transmission in care homes. Our national health service directors of public health are providing enhanced clinical leadership and have contacted every care home in Scotland. They are assessing how each home is managing infection control, staffing, training, physical distancing and testing.

We have provided a direct delivery of personal protective equipment to care homes and have worked with local partners to significantly improve the operation of local PPE hubs. Although in the private and public sectors the supply of PPE is primarily the responsibility of care home providers, we will continue to provide top-up and emergency provision to ensure that staff have what they need and that they and the residents have that protection.

Work is also under way to ensure that all Covid-19 patients who are being discharged from hospital provide two negative tests before discharge and that all new admissions to care homes and all residents who are symptomatic should be tested. Those new admissions should be isolated for 14 days. Social care and care home staff continue to be priority key workers for testing. I have written to all care homes to remind them of that and to ask them to make sure that, as employers, they follow through where that testing is required.

As members know, we also have more than 21,000 returning health and social care staff alongside student nurses, student midwives, allied health professionals and newly graduated doctors, who are all willing to apply their skills and experience to the collective effort. Many of them are able to work in the care and primary care settings. As of today, 185 applicants have been matched into roles in care homes and care-at-home services, and a further 218 are ready and available. In the coming weeks, I expect the number of matches to increase rapidly.

As well as those who work in care homes to protect our most vulnerable people, many carers—paid and unpaid—support people to stay in their own homes, and they, too, must be protected. Therefore, we have extended the provision of PPE to personal assistants and unpaid carers.

From the start of this week, the local PPE hubs for the registered social care sector are receiving enhanced supplies and support, so that they can distribute to the whole of the social care sector where normal supply routes have failed. We have published advice for unpaid carers on the appropriate use of PPE and how to access it, and we will shortly publish equivalent guidance for personal assistants. I have asked the national carer organisations and local carers centres to discuss with carers their needs, and, when they need PPE, to help us direct them to their local hub.

We will ensure that hub locations are clearly signposted on the Scottish Government’s website and that health and social care partnerships are working with local carers centres to make it clear how individuals can get the necessary personal protective equipment.

Throughout this difficult time, it is critical that social care support is maintained, to ensure the safety, dignity and human rights of people who already receive that support. I reached agreement some weeks ago with the Convention of Scottish Local Authorities that, in addition to providing the funding that is directed towards social care in the 2020-21 budget, we will meet additional costs that are incurred because of the impact of the pandemic. That agreement was reached specifically to ensure that existing and new demand and need could be met. Alongside that, the additional returning staff whom I mentioned a moment ago are also available for deployment to those services, to ensure staffing resilience.

So, it is not acceptable to me that care packages are being cut—in some instances, by 100 per cent. I expect people to follow the steps that I have already taken. If more needs to be done to ensure that existing packages are not cut and that new demand is met, I hope that colleagues in the sector know that my door is always open and that I expect them to come to me with those additional requirements.

I now turn to testing. By 22 April, 17,800 health and social care staff and symptomatic members of their households had been tested. Twenty-one per cent of those tested were social care staff. By the end of April, all 14 health boards should have local testing capacity. We are on track for testing capacity to reach at least 3,500 tests available per day by the end of this month, having made steady progress from the start of the pandemic, at which point capacity was 350 tests per day from two laboratories.

We also continue to work with the United Kingdom Government on its testing programme, which is expanding both capacity and access in Scotland. Four UK Government drive-through testing facilities are already operational, with a fifth due to open in Perth this Thursday. Five mobile testing units, manned by Army personnel, are going live in Scotland this week, and it is anticipated that a further eight units will be live in Scotland within the next week or two.

The increased capacity in our own NHS laboratories and through our participation in the four-nation testing exercise has ensured that we are able to expand the areas and the groups that are being tested. Thus we have increased availability to key workers beyond the health and social care sector, using the categories that we outlined before, and we have today also extended testing to all people aged 70 years and above who are admitted to a hospital setting. Access to the UK four-nation exercise is controlled through the queueing system and digital portal managed by the UK Government.

Before I conclude, I will touch on research and on-going changes to healthcare delivery. The pandemic has required fundamental change to how healthcare and care are accessed and delivered. That has involved a significant reorientation of resources and the incredible support and efforts of local leaders, planners and clinicians—in fact, of the entire workforce. The work has included preparing to quadruple the number of ICU beds and ensuring that there is sufficient hospital bed capacity; significant increases in digital access to health services, with around 60 per cent of general practices now using NHS near me, and the number of weekly digital consultations increasing from around 300 to over 9,000; the reshaping of primary care to support Covid-19 hubs with 24/7 access; shielding almost 150,000 clinically vulnerable people and focusing multidisciplinary teams to work on anticipatory care planning with them; and expanding mental health support by moving towards a 24/7 NHS 24 mental health hub and digital therapies.

It is clear that, in line with our framework for decision making, which was published last week, we need to achieve a careful balance in managing our healthcare capacity, including our commitment to continue to treat emergency, urgent and maternity cases.? Therefore, we will continue to work closely with health boards and our partners to ensure that there are robust plans in place to safeguard local resilience and responsiveness while considering how and when we can increase the business-as-usual work of our NHS.

The incredible level of compliance with social restrictions that we have seen shows a clear willingness on the part of the people of Scotland to think beyond individual health to population health. As we introduce the test, trace and isolate measures that are required, we will need that focus on population health to continue.

In concluding, I will update members on the research proposals for Covid-19 that we launched on 25 March. One hundred and thirty-nine proposals were received from across Scotland’s universities and research institutes, and, following an independent expert review process, 55 projects have been selected for funding. That has resulted in a pan-Scotland portfolio of research, with 15 different institutions leading on projects. In summary, the outcome of the call is a programme of projects that meet the aim of establishing a broad Scottish programme of high-quality research on Covid-19 that will be delivered rapidly and that will inform policy and clinical practice in responding to the pandemic.

I continue to be grateful for the tremendous resilience of our health and social care staff, our key workers and, most important, people all across Scotland. Together, we are making progress, we are suppressing the virus, we are saving lives and we are showing that we can continue to rise to the challenges of this pandemic.

The cabinet secretary will now take questions on the issues raised in her statement. I intend to allow about 20 minutes for questions, after which we will move on to the next item of business.

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

I would like to raise two specific issues. More than 900 dentists have written to the Scottish Government to express concern about the future sustainability of the sector. Many dental practices that have a mixed NHS and private patient list are expressing concern that they are on the brink of collapse. What support and plans do ministers have to support dentists to get through the outbreak?

Many charities across Scotland are reporting that they have lost 20 to 25 per cent of their income during this period. The UK Government has announced that £30 million in additional funding will come to the Scottish Government to help to support Scotland’s charitable and hospice sector, which is very welcome. When will ministers consult hospice associations across Scotland on how the funding will be distributed?

We have provided additional emergency funding to the NHS general dental services budget, which will provide additional support to dental practices for the temporary loss of patient contributions. Following today’s session, I am happy to advise Mr Briggs of the exact amount of that funding, but it has already been issued and is in place.

It is for my colleague Ms Campbell to respond to matters relating to charities in the wider sense, but I can confirm that we will pass on all the consequential funding for hospices that we receive from the UK Government. We are in discussions with the hospice network on how best that funding can be apportioned.

Last night, the BBC’s “Disclosure” programme, which featured journalist Sam Poling, covered the issues relating to PPE in great depth. She described the fear among some NHS staff, but when she put that to the Scottish Government’s national clinical director, Jason Leitch, he said that that is not what he hears when he walks the halls and speaks to front-line staff.

Today is international workers memorial day, and we remember that some health and care workers across the UK have died in the line of duty. Does the cabinet secretary recognise that people are scared, that they are right to raise issues about PPE and that lack of access to PPE and testing is a widespread and collective issue for front-line workers? What is her advice to workers who remain concerned? Can she give an up-to-date figure on how many social care staff have now been tested?

I recognise that fear. This is entirely anecdotal, but I think that the fear is diminishing, as a result of the many additional steps that we have put in place to ensure that we have a continuous through-flow of PPE and, more important, that it is distributed quickly to areas that require it and the guidance is clear. However, I would never underestimate that fear and I completely understand it. Thinking back to my own time, many years ago, I would have wanted to have the right PPE for the clinical or care situation that I was working in. Therefore, I understand.

Notwithstanding everything that we have done—and everything more that we need to do, when issues are raised with us—I genuinely do not think that, throughout this pandemic, I will ever be able to stand here and say that the situation around PPE is resolved once and for all. It will be a constant exercise to ensure that people receive the PPE that they need when they need it, and that they have the confidence and training to know how to use it. It is not only about knowing how to put on PPE; it is about the momentarily risky position that a person is in when they take it off.

Staff are very right to raise concerns and issues, and they should continue to do so. They should raise those issues with the member and other colleagues in the chamber, who should then raise them with me directly. Members should expect us to act as quickly as we can, in order to assure that those issues are resolved. That is entirely right and proper.

Health and social care workers have always been a priority for testing. I gave the latest overall figure that I have about the number of health and social care workers who are being tested, and I said that 21 per cent of that number work in social care. Those numbers are about a week out of date and will be updated later this week. There is a clear route for key workers to be tested, and for members of their households to be tested too, if that is the reason why a key worker is staying at home. As we expand capacity, we will continue to ensure that we are testing those key workers and that we are widening testing to include key workers across the public and private sectors. However, the testing capacity and the exercise of ensuring that demand is flowing through for that testing is a piece of work that—like the situation with PPE—continues all the time.

As the First Minister said at today’s lunch time briefing, later this week and into next week we will say more about testing: on our capacity, how it is used and, importantly, all the work that we have under way to enable us to scale up and deliver the test, trace and isolate operation that is so critical to the next steps.

We move to open questions. I ask members for succinct questions and answers, to allow as many members to ask questions as possible.

The cabinet secretary said that she has written to all care homes to ensure that, as employers, they follow through when testing is required. We know that people can be infectious when they are pre-symptomatic or asymptomatic; that has been shown by an increasing body of evidence. Therefore, will the cabinet secretary ensure that all health and care staff will be tested as a priority, and can she confirm that the 3,500 test capacity will be fully utilised by the end of this month?

As Ms Johnstone said, there is growing evidence that pre-symptomatic and asymptomatic individuals shed degrees of the virus that make them infectious to a greater or lesser extent. That is new, emerging evidence that was not there at the start of all this. It continues to emerge and, with our chief medical officer and other clinical advisers—including the Scottish Government Covid-19 advisory group, which is led by Professor Andrew Morris—we are continuing to consider expanding testing to all health and care staff, and whether that is the right thing to do.

Having expanded testing to all patients over the age of 70 who are admitted to hospital, for whatever reason, we must recognise that testing will happen every four days, for as long as they are in-patients. That would also apply in the case of health and care staff. It is an iterative process. The test tells us only whether the person has Covid-19 on the day of the test, so testing has to keep being repeated.

On making use of the 3,500 capacity that we have set, we will meet that by the end of this month. We are working hard to ensure that demand is flowing through in order to use that capacity, and we intend to be at least as close to 3,500 as we can get in the next few days.

I am concerned about the ability of key workers in rural and remote areas to access a test. That includes large areas of the Highlands and Islands and the north-east, as well as the south of Scotland. What is the maximum amount of time for which someone might have to travel to get a test in those areas? How long will it take for key workers in remote and rural areas to have access to a local and speedy test?

Willie Rennie is right. That area has exercised us for some time. That will be assisted in part by the mobile units, of which there will be five this week; that number will scale up until we have 13. The units, which are being deployed in more remote areas—not only in the Highlands but in the south of Scotland, in some parts of Perthshire and so on—will enable us to take testing closer to the individuals who require it.

If those individuals are health and social care workers, their health boards will ensure that testing is available close to them. If Willie Rennie is referring to the drive-through centres, he is right about the distances that people have to travel.

As part of the four-nation exercise, we are also trialling home-testing kits. That initiative has been proven to be clinically robust, and it too will be rolled out, which will make ease of access to testing much simpler.

What advice can the cabinet secretary give to my constituents who may have to access their GPs during the May public holidays? What support is being made available to them?

George Adam will recall that we provided additional investment to ensure that GP surgeries and community pharmacies were open over the Easter holiday period. We have done that again to ensure that GPs and community pharmacies are open over the May public holidays. We have made a total of £8.2 million available to NHS 24, community pharmacies and GP practices so that they can stay open over the May holiday weekends.

We are all acutely aware that our front-line NHS staff and social care workers are delivering the highest-quality care in the most demanding circumstances. They worry every day about the danger that they are putting themselves in and about potentially taking that home to their families. They worry about levels of patient deaths, about having to inform families about a loss, and about working long hours and extra shifts. The situation has been described as similar to one that can lead to post traumatic stress disorder.

What is the Scottish Government doing, or considering doing, to support our front-line staff in these unprecedented times, to allow them the time to decompress and look after their own health and wellbeing?

I am grateful to Mr Whittle for that important question. A number of our health boards have taken specific action to create wellbeing spaces near the working environment where people can have a breather, make a cup of tea and so on. They have also made use of digital technology to provide mental health support to their staff.

However, what Mr Whittle is referring to is about more than that: it is about trauma. That can particularly affect social care staff who become very close to the people they work with in the person’s own home or in care homes. It is very hard for many staff in health and social care when individuals die of Covid-19.

We are working with Marie Curie, Scottish Care and clinical colleagues and others. In the next week to 10 days, we will be able to announce a package of additional support for health and social care staff, including access to counselling. We will provide details of that to members nearer the time.

Can the cabinet secretary tell us how much the consequentials are for Scotland from the UK hospice fund? In light of the financial challenges facing hospices in Scotland, including St Andrew’s Hospice in Ayrshire, which is in my constituency, and its sister hospice, St Margaret of Scotland Hospice in Clydebank, which Gil Paterson supports, once the cabinet secretary has agreed the distribution formula with the hospices, will she consider sending the funding direct from the Scottish Government to the hospices, rather than sending it through third parties such as the integration joint boards, which would slow it down and possibly put it at risk of top slicing?

It is not yet confirmed, but our expectation is that there will be consequentials of £19 million for hospice work from UK Government funding. As I have said, all the consequential funding—whatever the final level—will be passed directly to the hospices through the hospice network. We are discussing with hospices how that will be apportioned.

I am very happy to take away the question of direct funding and to consider further whether that is something that we could sensibly do.

I do not need to tell the cabinet secretary how many lives cancer screening services have saved. Breast cancer screening in Scotland is a gold-standard service, and it has saved many women’s lives. It is the speed with which tumours are identified and acted on, and surgery is carried out, that characterises our wonderful service. Have there been any discussions about how and when safe screening services can return? Has there been any discussion about or assessment of how many men and women have missed out on screening during the short period in which we have been in lockdown and what the consequences of that might be?

I am grateful for that important question: the unintended consequences of pausing some of the business-as-usual programmes in our NHS and the health harms that may be caused are of significant concern to me. Mr Russell spoke about a range of harms that are being caused as a consequence of dealing with the pandemic.

One difficulty with the breast screening programme is the inability of those involved to maintain any level of social distancing, as Ms McNeill and all the women in the chamber will know.

As I said in my statement, if the number of cases, the number of patients in ICU and, indeed, the number of deaths continue to decline, we will create headroom in our NHS. That headroom is fragile and needs to be protected. We need to maintain a level of protection as we go through the next stages, lest we see the number of cases increase.

If we ease any of the restriction measures, we will need to consider, across Government and with colleagues, what that may do to case numbers and to that headroom, and therefore whether there is any room to restart any of the paused NHS business-as-usual programmes.

Our screening programmes are a very important preventative health measure, particularly in relation to cancer. They will be factored into our consideration. If it is at all possible, we will prioritise restarting those screening programmes. Ms McNeill has my assurance that we will do that as soon as we can. If it cannot be done soon, we will certainly set out to members why we do not believe that it can be done soon.

In Denmark and Germany, Covid-19 deaths per capita are about a third of the rate in Scotland and a quarter of the rate in the UK; in Greece and Cyprus, the rates are a twentieth. In the Faroe Islands, 187 people are known to have caught the virus, of whom 181 have recovered, and not one person has died. Portugal’s deaths per capita is a sixth of the rate in neighbouring Spain. What is being learned from nations outwith the UK that might help Scotland through the crisis, particularly as thoughts turn to how we can lift the lockdown safely?

As I am sure that Mr Gibson knows, our clinical teams and senior leaders on health matters are in constant dialogue with their counterparts not only in the four nations of the UK but especially in Europe and, in some instances, more widely elsewhere in the world. Attention is paid to all the learning from that process, including the tracking of data and what is being said in those countries, and the experiences there. That is all fed into both the scientific advisory group for emergencies operation at the UK level and the scientific advisory group that we now have in Scotland, which, as I said, is led by Professor Andrew Morris. All those countries’ approaches and the ways in which they have faced the challenge that are either comparable to or different from what others have done have been brought into that process. That learning will continue, with particular reference to our consideration of how we might phase out or ease the current restrictions.

I ask for even shorter questions and answers, please.

I turn to the subject of primary care. As recently as today, I have been contacted by constituents who are very concerned about the looming closure, in July, of the Abbey general practice in Arbroath, which has about 6,500 patients. I understand that resources are being focused on tackling the coronavirus, but can the cabinet secretary offer my constituents any comfort that they will still have a viable general practice service after July?

The right thing for me to do is to ask Mr Bowman to write to me with details of that practice. We will then investigate its situation and reply to him fully.

I was pleased to hear that, at her briefing today, the First Minister announced guidance on the wearing of face coverings. The cabinet secretary will know that I have been calling for the issuing of advice on that matter. Will she outline the Government’s current thinking on making the wearing of face coverings mandatory when people are outside, as other countries have done, and especially as we begin to consider any easing of the lockdown measures?

As members who have seen the First Minister’s lunchtime briefing will know, the Government’s position is not to make the use of face coverings mandatory. That is partly because the science on the benefits of doing so is not unequivocal, although it is sufficiently strong to lead us to consider that it is right to provide the advice that the First Minister has set out and which is now widely available.

It is important to say that the guidance refers to face coverings and not to face masks—especially not the surgical masks that we need for health and social care. The guidance states that people should use such coverings in situations in which social distancing is not possible or is more difficult. However, the really important point that I must make is that the use of such coverings should not in any sense be a substitute for following all the measures that are currently in place—especially those on social distancing, hand hygiene and staying at home with the exception of periods in which the limited activities that have been outlined may be carried out.

Every Thursday evening we rightly applaud the work of health and social care staff. However, they need more than our applause. I hope that, in the fullness of time, their contribution and service will be recognised through their salaries, because they represent a predominantly low-paid, female workforce. I invite the cabinet secretary to take an immediate step towards offering such recognition by paying the registration fees of nurses and social care staff this year, which the GMB campaigned for prior to the pandemic.

I am sure that Ms Baillie knows that I completely share the sentiments behind her question. I will be happy to look at her request, consider how we might respond to it and let her know the response in early course.

That concludes questions on the cabinet secretary’s statement. My apologies to Stuart McMillan, Anas Sarwar and Jamie Halcro Johnston that we are unable to accommodate their questions, but we must move on to the next item of business.