Chamber and committees

This question involves a broad range of policy areas and my answer focuses on Health & Social Care.

A range of measures are now in place to ensure Health & Social Care are well placed to respond to any second wave of the virus. This includes more digital tools, roll out of our test & protect system, and advance modelling to maintain our stock of PPE supplies.

NHS Boards and Health and Social Care Partnerships have developed local mobilisation plans in response to the COVID-19 emergency. We have also established a Care Home Rapid Action Group to monitor development in the care home sector.

‘Re-mobilise, Recover, Re-design: the framework for NHS Scotland' was published on 31 May. It sets out how health boards will follow national and local clinical advice to safely and gradually prioritise the resumption of some paused services, as well as ensuring we have the capacity that is necessary to deal with the continuing presence of Covid-19.

The biggest single factor in controlling the virus, will be how well we all continue to observe public health advice and we continue to take account of modelling and expert advice to ensure our plans are tailored. In addition, lessons already identified have allowed us to adapt our response and we are now better prepared than ever to manage any possible second wave.

(a) Care Inspectorate inspectors discuss infection control measures during weekly scrutiny and support calls with care services, and more frequently as required.

(b) Information collected from a Care Inspectorate weekly survey of care services is shared with the NHS NSS Triage Hub to provide an overview of any clinical consumables and PPE shortages across Scotland, to help resources to be appropriately directed.

(c) If there are to be admissions to a care home with a COVID-19 outbreak this must be discussed with local Public Health teams. The Care Inspectorate shares Health Protection Scotland (HPS) guidance updates when this is published, with all care services via national provider updates, Care Inspectorate website and social media.

In addition to the work undertaken by the Care Inspectorate, Scottish Government Care Home Action Group are pulling data from across the system, including Directors of Public Health, to provide the necessary assurances and drive national action.

The Care Inspectorate has changed their operating model in response to COVID-19 by establishing:

• daily notifications for suspected cases and deaths in care services
• a new system of red, amber green notifications for services to indicate if they were experiencing staffing difficulties
• a twice per day Gold command group and once daily Silver command group, deciding what action is required based on the intelligence gathered
• collaboration with Scottish Social Services Council (SSSC)/NHS Education for Scotland (NES) Hub to successfully route staff to services experiencing staffing difficulties
• training of inspectors on the use of 'Near Me' to utilise real time video footage to examine the circumstances within services, to provide further assurance, and to ensure that IPC and PPE are adequate in each service.

These data were published by National Record of Scotland on 3 June. Up to 17 May, there were 1,623 deaths where confirmed or suspected COVID-19 was mentioned on the death certificate either as the underlying cause or as a contributory cause. A further 154 care homes residents died in hospital with a confirmed or suspected COVID-19.

The 2014 Future of Residential Care for Older People in Scotland report made a number of important recommendations to help shape the future of the care home sector in Scotland. The Residential Care Task Force Implementation Group was established to take forward the report recommendations. Whilst many of the recommendations made were taken forward and were implemented relatively quickly, there were some longer term recommendations which required considerable development, planning and potentially funding. At the time the Taskforce anticipated that the integration of health and social care would open up opportunities for the care home sector to be developed through strategic commissioning based on local need, with an increase in intermediate care in care homes and at home, alongside a greater provision of extra-care housing as an alternative to care homes. In this context a number of significant recommendations, including the development of strategic commissioning plans, were made which are now being implemented by our Health and Social Care Partnerships (HSCPs). Some of the most significant recommendations were around support for the workforce, in particular with the implementation of the real living wage for all social care workers. As a result of this work, the Scottish Government has since October 2016 provided resources to enable all social care workers to be paid the real living wage for day time hours and that this was later extended to overnight support. However work to address the workforce challenges doesn’t end there. The Scottish Government has committed to working with national and local partners to take forward the recommendations set out in the Fair Work Convention’s Social Care Sector 2019 report to improve fair work practices for the workforce. Having reflected on progress within the care home sector five years on from the residential care taskforce report, the Scottish Government launched the adult social care reform programme last year along with COSLA. As part of that programme, the Scottish Government had started, prior to the COVID-19 outbreak, to look at ways to improve care home sustainability. While the current focus needs to be on supporting the care home sector through the COVID-19 crisis, it will be important to reflect on the lessons learned during this pandemic and identify what that means for the future of care home provision.

The Scottish Government is working closely with NHS Boards during the pandemic to monitor the impact of Covid-19 on demand and capacity. We wrote to NHS Boards on 14 May highlighting mental health as a clinical priority and asking them to set out plans for reinstating services and to work with partners to estimate the anticipated rise in mental health need in the population and their response. These plans will allow us to understand where Boards are now and what they need to do to address the mental health needs of their population as we move into the next phase.

Although clinical advice and available scientific evidence suggests that it is too early to predict the long-term mental health impacts of Covid-19, in anticipation of increased demand for mental health support, the Scottish Government has invested heavily in services, including more than £1 million to expand the Distress Brief Intervention (DBI) programme to help people in distress and £3.8 million to increase the capacity of NHS 24’s telephone and online services and extend digital therapies available through the NHS.

Clinical advice and available scientific evidence suggests that it is too early to determine exactly what the long-term physical and mental health impacts will be for those who have had COVID-19 or whose mental health has suffered as a result of long-term isolation, reduced contact with family or friends and economic adversity.

However, through the remobilisation process we have asked all territorial NHS Boards to provide a local assessment of demand for mental health services following the COVID-19 lockdown and their plans to respond to this. We will continue to work closely with Boards to monitor the impact of Covid-19 on demand over the coming weeks and months.

Our approach will also be informed by wider evidence. The Mental Health Research Advisory Group has been established to follow research developments to understand the medium and long term impacts of the Covid-19 pandemic on mental health. This will help us to put evidence-based services and support in place to help meet the mental health needs of the population.

Information on the number of publicly funded places in private care homes is not published. However the report on the Care Home Census for Adults in Scotland published by Information Services Division provides the proportion of care home places that are publicly funded. In 2017 70% of all care home residents were publicly funded. We do not have a breakdown of this by sector. However in 2017 there were 40,926 registered places in care home and of these 31,483 places (77%) were provided by the private sector.

More information can be found at: https://www.isdscotland.org/Health-Topics
/Health-and-Social-Community-Care/Publications/2018-09-11
/2018-09-11-CHCensus-Report.pdf .

We do not hold information as to which individuals attended the match.

The Business Support Grant Scheme is administered by local authorities, and they aim to make payment within 10 working days from receipt of a fully completed application and once all information and evidence in support of an application has been verified. Applications can be subject to delay if incomplete or incorrect details are supplied.

The Scottish Government does not hold estimates on the number of people that will be affected by mental health concerns as a result of domestic abuse during the COVID-19 crisis. However, we understand from regular discussions with key stakeholders that the mental health impact of lockdown continues to be a significant concern for organisations who support victims.

A Mental Health Research Advisory Group has also been established and will follow research developments closely to understand the medium and long term impacts of the COVID-19 pandemic on mental health.

Backed by £1.5 million of Scottish Government funding, support services have made changes to ensure they can still be accessed and are there to help people. National helplines are fully operational and also now with text and web chat functions.

Scottish Government published Coronavirus (COVID-19): guidance on domestic abuse which makes it clear that rules on staying at home do not prevent anyone from leaving their home to escape or keep themselves safe from domestic abuse.

We are also continuing to provide wider mental health support in Scotland through this time. The Scottish Government has provided funding to increase the capacity of NHS 24’s mental health services and digital therapies. These services will continue to be available throughout the COVID-19 pandemic for anyone who needs it.

Investment of more than £1 million has also been provided to roll out the Distress Brief Intervention programme on a national basis. The programme gives people over the age of 16, who are in emotional distress, the opportunity to speak to specially trained staff.