Chamber and committees

The National Clinical and Practice Guidance for Adult Care Homes during COVID was first published on 13 March 2020 and updated on 26 and 15 May. It is based on Health Protection Scotland (HPS) infection control guidance for care homes but provides more detailed practical advice around adoption of measures to protect staff and residents. It has been updated each time to reflect the extent of the outbreak, emerging evidence on ways to protect staff and residents and subsequent announcements, for example on testing. The guidance was updated by the Care Homes Clinical and Professional Advisory Group (CPAG), a multidisciplinary group of stakeholders established to provide clinical and professional advice for the care home sector during COVID. This group had approved the guidance, however it had not had final sign off from the Chief Medical Officer (CMO) and the Health Secretary so was published in error on 8 May. The guidance was therefore withdrawn from the website on 10 May. It was updated to take account of HPS advice on testing outbreaks and following approval from the Health Secretary and CMO, was published on 15 May. The guidance will continue to be kept under constant review by the CPAG.

At all times, the Scottish Government’s actions in response to COVID-19 have been guided by the best and most up to date expert scientific and medical advice from the Scientific Advisory Group for Emergencies (SAGE), Public Health Scotland and our Interim Chief Medical Officer.

It was announced on the 12th of March that the four nations of the UK were moving from the contain to the delay phase of the outbreak at which point contact tracing was stopped. This was an appropriate decision at the time as based on the evidence available at the time.

The Gartnavel centre has been closed temporarily as the number of health and social care staff who are self-isolating and referred for testing has reduced. The testing staff have been moved into an additional mobile testing team as there are a number of staff without transport unable to attend the drive-thru centres.

The situation at the Gartnavel centre is reviewed on a daily basis and it can be stood up quickly if the number of symptomatic health or social care staff requiring tests increases again. Symptomatic care home staff are still being tested through the staff testing programme either at the other sites or by the home testing teams.

Public Health Scotland advise on their website that the release of the 2018 edition of the Scottish Care Home Census publication had been delayed due to Information Governance issues.

https://www.isdscotland.org/Health-Topics/Health-and-
Social-Community-Care/Care-Homes/Previous-Publications/index.asp

The information governance arrangements to enable the data to be sent to Public Health Scotland have recently been agreed and Public Health Scotland will soon receive the data and prepare it for publication once it is analysed. A date for publication of both the 2018 and 2019 data will be announced via the Public Health Scotland Statistical Publication Schedule in due course.

Since 1 May, Scottish Government policy has been to test residents and staff in care homes with a confirmed case of Covid-19, and in linked homes where staff work between homes run by the same operator following an outbreak in one. Sample testing should also take place in care homes where there are no cases.

From the week commencing 25 May Scottish Government policy has been to offer all care home staff weekly testing regardless of symptoms or whether there is an ongoing outbreak in their care home.

An independent, multi-disciplinary, multi-agency group Incident Management Team (IMT) with responsibility for investigating and managing the Nike conference incident was established. The IMT provides a framework, response and resources to enable the NHS board and other statutory agencies to fulfil their remits.

Contact tracing was carried out by the Health Protection Teams within the NHS Board of residence for each of the cases identified. This process was supervised by the IMT.

The Health Protection Teams would have followed the Health Protection Scotland (HPS) guidance for contact tracing. This includes contacting individuals, obtaining information on any symptoms they had, arranging testing as appropriate, and providing advice. Contact tracing is a clinically led activity and I can confirm that the relevant NHS health board deployed the level of contact tracers they felt appropriate to support the IMT response.

Those who had contact with the initial international case were contact traced and the contacts of those who subsequently tested positive in Scotland were also traced. Through this process a total of 8 Scottish residents were identified, 2 of which were secondary cases linked to the 6 primary cases, who subsequently tested positive for Covid-19 in association with the conference.

Risk of deductive disclosure leading to a breach of patient confidentiality means that data about the number of people tested in any specific health board area in Scotland at that time cannot be released. However, any case that tested positive, whether related to this event or not, has always been included in our daily COVID-19 updates.

68 individuals were identified in Scotland and around 50 others in England and traced from these cases based on a clinical assessment of being a contact. It is not for the Scottish Government to comment on the actions taken elsewhere. The number of people who were tested outwith Scotland by respective agencies outside those countries is not available.

*Contact tracing was carried out by the Health Protection Teams within the NHS Board of residence for each of the cases identified.

Decisions undertaken on how best to respond to COVID-19 are continually assessed against the evidence and as this evolves, so too does our response. Whilst testing for COVID-19 is most reliable in individuals experiencing symptoms it is recognised that in some circumstances there is value in broadening the eligibility criteria.

The risks associated with care homes is an example of this and why decisions were taken to expand testing to include residents on admission to a care home, all staff and residents regardless of symptoms as part of enhanced outbreak management and as announced on 18 May 2020, all staff regardless of whether COVID-19 infection has been detected.

The information is available at https://www.nrscotland.gov.uk/statistics-and-data/
statistics/statistics-by-theme/vital-events/general-publications/weekly-and-
monthly-data-on-births-and-deaths/deaths-involving-coronavirus-covid-19
-in-scotland/related-statistics

Spreadsheet entitled “Weekly deaths by location of death, age group, sex and cause, 2020”.

The figures requested for each NHS Board area is as follows:

Testing capacity of 350 tests per day was available in Scotland from early February 2020. Since then NHS testing capacity has grown significantly and is now over 6,000 tests per day, and adding in capacity from the Glasgow Lighthouse laboratory brings this to over 15,500 tests per day at the end of April.