Chamber and committees

Our national expert body, Health Protection Scotland, jointly with the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Public Health England and NHS England published updated PPE guidance in relation to COVID-19 on Thursday 2 April. The revised guidance is available at https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/

The guidance outlines what type of PPE frontline health and social care workers should be wearing in different settings and scenarios. The guidance itself recommends the safest level of PPE to protect health and social care workers and it specifies the type of PPE that should be worn in the various healthcare and social care settings where patients or residents could be cared for. Importantly, the updates reflect the fact that COVID-19 is now widespread in the community, meaning clinicians and care workers are more likely to see people with the virus, some of who will not have symptoms yet.

The guidance makes very clear (in table 2) that care workers who are providing direct care to, or visit, any individuals in the extremely vulnerable group or where a member of the household is within the extremely vulnerable group undergoing shielding should wear a face mask.

Given the recognised sustained transmission of COVID-19, table 4 of the guidance also includes detailed advice around risk assessing use of PPE, including aprons, gowns, Fluid-Resistant Surgical Masks and eye protection, in a range of different clinical and care scenarios, including community settings where the person being cared for is not currently a possible nor confirmed cases of COVID-19. The guidance also asks that organisations themselves undertake risk assessments to ensure that they provide the correct PPE for the safety of their staff.

Furthermore, I also published a joint statement on 9 April with COSLA and the Trades Unions which emphasised that social care workers can wear a Fluid-Resistant face mask along with other appropriate PPE where the person they are visiting or otherwise attending to is neither confirmed nor suspected of having COVID-19, if they consider doing so necessary to their own and the individual's safety.

We have not specifically evaluated this. I expect all employers to support their staff to follow the updated PPE guidance that was published on 2 April 2020, which includes the ability for staff to do an individual risk assessment of whether PPE is needed when they are providing direct care to someone who isn’t a possible or confirmed COVID-19 case.

I would also expect both public and private social care providers to ensure that all care workers are empowered and enabled to wear a mask alongside other PPE if they feel this is necessary, as was stated in the joint statement I made on 9 April with COSLA and the Trades Unions. The statement emphasises that social care workers can wear a Fluid-Resistant Surgical Mask along with other appropriate PPE where the person they are visiting or otherwise attending to is neither confirmed nor suspected of having COVID-19, if they consider doing so necessary to their own and the individual's safety.

If an employer disagrees with a care worker’s risk assessment, I would expect them to provide a clear explanation for this to the worker, and discuss this further with them.

Ultimately, the guidance states that where staff consider there is a risk to themselves or the individuals they are caring for they should wear a fluid repellent surgical mask with or without eye protection, as determined by the individual staff member for the episode of care or single session.

The Scottish Government does not hold the information requested. However, all employers should be supporting their staff to follow the updated PPE guidance that was published on 2 April 2020, which includes the ability for individuals to risk assess whether they require PPE when providing direct care to someone who isn’t a possible or confirmed COVID-19 case.

I reiterated this expectation in the joint statement on 9 April with COSLA and the Trades Unions which emphasised that social care workers can wear a Fluid-Resistant Surgical Mask along with other appropriate PPE, if they consider doing so is necessary to their own and the individual's safety.

We do not collect this information. It would also be almost impossible to determine whether the single factor in someone contracting COVID-19 is because a care worker didn’t wear a protective mask.

Our national PPE guidance https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe is very clear that all care workers who are providing direct care to, or visit, any individuals in the extremely vulnerable group, or where a member of the household is within the extremely vulnerable group undergoing shielding, should wear a face mask. This was also agreed in the joint statement between COSLA, SJC Unions and I on 9 April that this guidance makes clear that social and home carer workers can wear a fluid resistant face mask along with other appropriate PPE, if they consider this necessary to protect themselves and those they are caring for.

The recognised sustained transmission of COVID-19, table 4 of the PPE guidance also enables the risk assessment of use of PPE - including aprons, gowns, face masks and eye protection - when providing direct care and support to anyone who is not currently a possible nor confirmed COVID-19 case.

It is clear in my joint statement with COSLA and Trades Unions on 9 April 2020 that social and home care workers can wear a fluid resistant face mask along with other appropriate PPE where the person they are visiting or otherwise attending to is neither confirmed nor suspected of having COVID19, if they consider doing so necessary for their own and the individual's safety. They are professionals and we trust their professional judgement.

The PPE guidance that was published on 2 April 2020 recommends the safest level of PPE to protect health and social care workers and specifies the type of PPE that should be worn in the various healthcare and social care settings where patients or residents could be cared for.

The guidance contains 4 separate tables.

Given the recognised sustained transmission of COVID-19, table 4 of the guidance includes detailed advice around risk assessing use of PPE, including aprons, gowns, Fluid-Resistant Surgical Masks and eye protection, when health and social care workers are providing care and support to people who are not possible or confirmed cases of COVID-19. The guidance also asks that organisations themselves undertake risk assessments to ensure that they provide the correct PPE for the safety of their staff.

Importantly, in terms of shielding the extremely vulnerable in our society, the guidance advises that secondary, primary and community care workers should wear a surgical mask when providing care to any individuals in the extremely vulnerable group undergoing shielding; regardless if they have possible or confirmed COVID-19 or not.

Guidance on the personal use of face coverings during the coronavirus (COVID-19) pandemic was published on 28 April 2020 and can be found here:

https://www.gov.scot/publications/coronavirus-covid-19-public-use-of-face-coverings/.

Updated PPE guidance was published on 2 April 2020 for health and social care workers. This followed a review of the existing guidance against the latest evidence and WHO advice, on the safest way to protect health and social care staff. The guidance had input from Royal Colleges and was agreed by the Chief Medical Officers and Chief Nursing Officers in the UK. It outlines what type of PPE frontline health and social care workers should be wearing in different settings and scenarios.

Importantly, in terms of shielding the extremely vulnerable in our society, the guidance advises that secondary, primary and community care workers should wear a surgical mask when providing care to any individuals in the extremely vulnerable group.

In addition to this, the guidance also recommends that care workers providing direct care to patients or residents should risk assess sessional use of a fluid resistant face mask along with other appropriate PPE. Where staff consider there is a risk to themselves or the individuals they are caring for, they should wear a fluid repellent surgical mask with or without eye protection as determined by the individual staff member. This guidance was also outlined in the joint statement https://www.gov.scot/news/protecting-the-social-care-workforce/ , published on
‎ 9 April 2020, by the Scottish Government, COSLA and the Trade Unions.

The development of the UK-wide 4 nations COVID-19 Infection Prevention and Control (IPC) guidance was based on current evidence for droplet transmission.

The transmission of COVID-19 is considered to occur mainly through respiratory droplets generated by coughing and sneezing, and through direct and indirect contact from hands or contaminated surfaces/environment respectively. The UK-wide 4 nations COVID-19 IPC guidance, which includes PPE guidance, is therefore based on the current evidence for both droplet and contact precautions.

Currently there is no evidence of airborne transmission of COVID-19, however Aerosol-Generating Procedures (AGPs) have been associated with an increased risk of transmission through aerosolization when AGPs are carried out. Therefore, the IPC and PPE guidance reflects this associated risk with AGPs.

Current UK IPC guidance also recommends that, during this period of sustained community transmission, health and social care staff risk assess use of appropriate PPE when delivering direct care to people not considered to be COVID-19 positive.

The guidance had input from Infection Prevention and Control (IPC) experts from across the UK, the 4 UK nations Public Health bodies, the Royal Colleges, and was ultimately agreed by the four country Chief Medical Officers and Chief Nursing Officers.

Given the Scottish Governments considerable additional PPE provision to the hospital, primary care, pharmacy and social care sectors and to unpaid carers and personal assistants, it should be clear that this action was not driven by resource constraint.

The approach to testing for Health and Social Care staff also applies to staff working in the community and other residential settings. For those in community care and residents in residential settings other than care homes, the previous approach on testing, based on clinical assessment, remains appropriate. See the full guidance available on Health Protection Scotland here: https://www.hps.scot.nhs.uk/web-resources-container/information-and-guidance-for-social-or-community-care-and-residential-settings/ .