Meeting date: Tuesday, June 2, 2020
Meeting of the Parliament (Hybrid) 02 June 2020
Agenda: Time for Reflection, Topical Question Time, Resuming National Health Services , Economic Recovery, Point of Order, Decision Time
- Time for Reflection
- Topical Question Time
- Resuming National Health Services
- Economic Recovery
- Point of Order
- Decision Time
Topical Question Time
To ask the Scottish Government what the daily average number of Covid-19 tests carried out last week was. (S5T-02218)
During the week commencing Monday 25 May, an average of 4,624 tests were carried out on the Scottish population each day. That figure does not include the numbers for home testing.
That figure falls well short of Nicola Sturgeon’s promise that we would have 10,000 tests per day by the end of April, which was subsequently revised to 15,000 tests per day by 26 May. Indeed, yesterday saw the lowest number of tests being carried out—only 2,729—and only 937 new people being tested, which are the lowest figures for months. Further, only 2.1 per cent of the population has actually had a test.
Will the cabinet secretary therefore explain why testing is not being done at even a third of the capacity that is available in Scotland, but at a level that is considerably less than 10 per cent of the number of tests routinely carried out by the national health service in England? Will she also explain why we have one of the worst testing rates in Europe, if not in the world?
I thank Ms Baillie for her supplementary question, but before I respond to it I will correct a couple of points. The First Minister did not say that 10,000 tests per day would be carried out. What we said—and delivered on—was an initial increase in capacity to 8,000 tests and a further such increase last week, to the end of May, of 15,500 tests. Those figures are for capacity and not for the number of tests being carried out per day. In both cases those capacity commitments were delivered on.
Such testing capacity is used in two ways. The first is largely demand led. It is led by key workers, which now includes people across a range of sectors, and anyone over the age of five who has symptoms, going for a test. That is done primarily through the United Kingdom Government’s regional testing centres and the tests are processed by the Lighthouse lab.
The NHS labs are delivering on tests taken for those over the age of 70 who are admitted in hospital settings. At the moment, the number of such cases is reduced, given the pause that we have put on so much of the NHS’s work. It is delivering on tests for patients in intensive care units—whose numbers are, fortunately, reducing, as Ms Baillie will know—and also those in hospital for Covid-19 and those in care homes. Testing in care homes is being rolled out. Many of our board areas have now completed their testing in homes in which there have been cases, and they are working through tests for care workers in homes in which there are currently no active cases.
The capacity that we have created, and we need to go further, is to ensure that we have the capacity in our NHS system to cope with the demands that might come as a consequence of easing lockdown measures and seeing an increase in the transmission of the virus, which we will then deal with through the test and protect system.
I thank the cabinet secretary for her further response. However, I am surprised at her defence, because I am sure that she would agree that there is absolutely no point in having capacity unless we are actually going to use it.
As the cabinet secretary has outlined, she has made a number of announcements about extending testing. She did so twice in March, three times in April and twice in May. That suggests that the eligibility criteria were far too narrow to start with and remain so now.
The World Health Organization told us months ago that asymptomatic people were carriers too, and that the more of them who were tested the better. Given that we are now moving to the test and trace phase, in which testing will be critical to managing a return to work, will the Scottish Government finally follow the advice of experts at the World Health Organization whose mantra is “test, test, test”, or are our clinicians more expert than those world experts?
I will make a number of points. First, what I said in response to both of Ms Baillie’s questions was not a defence but an explanation. Secondly, eligibility for testing was increased as the evidence emerged suggesting that it was possible to do so.
More importantly, let me quote the World Health Organization on the subject of asymptomatic individuals. We have consistently taken a precautionary approach in relation to asymptomatic or pre-symptomatic transmission. On 2 April, the World Health Organization’s statement said:
“there has been no documented asymptomatic transmission”.
As both the First Minister and I have said, in the early days of the pandemic the clear advice that we received from our scientific and clinical experts was that there was no transmission from asymptomatic individuals.
That advice has changed over time. There is still no set view on the part of the scientific or clinical community on that or on the difference between being infected and being infectious in relation to those asymptomatic individuals. Nonetheless, we are taking a precautionary approach; that is why we have introduced testing for care workers in care homes where there is no active case and those care workers have no symptoms. We will continue to consider, as we look to remobilise our health service, in what way further testing can assist us to do that safely.
Cabinet secretary, given the need to get the reproduction numbers down, would it not make sense to focus all that spare capacity where the biggest impact from Covid-19 is being felt and where the highest R number now resides—in our care homes?
That is precisely what we are doing—we are testing in our care homes. In those care homes with an active case, all residents and all care workers are being tested, and we are also testing care workers in care homes where there is no active case. That is precisely our focus, as well as the work that is under way in the hospital setting. As I have said, as we remobilise the health service, which is the subject of the debate that we will have later, there will be further consideration of whether testing can assist us to do that safely for both patients and staff.
However, I remind members that the test tells us only whether someone is symptomatic of Covid-19 on the day on which the swab is taken; it does not tell us whether someone will be symptomatic two days later. It tells us whether they are symptomatic on the day of the test. If someone is asymptomatic and tests negative, the test has to be repeated, and that is precisely what we will do in those care homes that have no active cases. Testing care workers will be an iterative process, repeated every seven days.
As I highlighted to the First Minister last month, giving people access to information on the level of testing that is taking place locally will be key to building public confidence and securing compliance as we move ahead with test and protect.
The First Minister appeared to agree, yet there is still no sign of the data being made available to people in Orkney or across Scotland. When can the public expect to be able to access that data and other relevant information relating to test and protect?
We will be able to provide information on the tests that are conducted through our NHS-controlled facilities—that includes not just our NHS labs but our partners in three of the major universities and in the Scottish National Blood Transfusion Service—over the coming days, once we are sure that the evidence and the numbers that they are giving us through Public Health Scotland are robust and make sense.
We should bear in mind that a test may sometimes be taken in a particular board area but processed through a lab in another board area, in order to ensure that we meet the timeline that we need to meet, of as close to 24 hours as can possibly be managed.
However, we will not be able to break down the number of tests that go through the Lighthouse lab by area, because we get the figure for Scotland as a whole, not necessarily for different parts of the country. We are working to give as clear and robust data as we possibly can, and, as soon as we are ready to publish that data, I will certainly make sure that Mr McArthur knows that, as well as the frequency with which we will update it.
The cabinet secretary mentioned the importance of flexibility in scaling up contact tracing, depending on demand. Can she outline how the Scottish Government will assess demand?
The assessment of the testing capacity that is needed comes from pulling together all the information that we have. For example, we know the number of 70-year-olds who are being admitted to hospital whom we need to test, and we will be able to project that number as we look to restart elective care in our NHS. We know the number of health and social care key workers that will come through, although that number is declining, and we know what care home demand will be as we test care homes with active cases and, increasingly, as we test care workers in care homes that do not have active cases.
We also get information on demand from the modelling estimates that produce the R number and the anticipated number of individuals across Scotland who have the virus. There is also the work on the test and protect approach, through which the message that we are sending to the public is different from before—the message now is that, if people have symptoms, they should please get in touch with NHS Inform or NHS 24 and book a test.
All of that is factored into the modelling that shows how much more than a capacity of 15,500 we need for testing in Scotland.
On 18 May, the Scottish Government widened access to testing so that anyone with symptoms could get a test, and it introduced routine testing for 53,000 members of staff in care homes. Before those changes, 5,000 tests were being carried out each day; however, as we have just heard, since then, the number of tests has actually decreased. To test staff in care homes weekly, some 7,000-plus tests would have to be carried out each day. Can the cabinet secretary confirm that it is the Scottish Government’s intention to carry out that testing? If so, when will it start?
It has started. Before I go into that, I should say that the drive-through test numbers—in other words, the numbers from the regional test centres, which now largely involve that wide eligibility group of anyone who is over the age of five and who has symptoms—have declined in the recent period. To a degree, that is not a surprise, because the R number is reducing and the level of the virus in Scotland at the moment is low, so we can reasonably expect a lower number of individuals to have symptoms and to seek tests.
The work on care homes has begun. All boards have now produced plans that identify the priority with which they are going round care homes in their areas to undertake testing, including those where there are no cases and where they are testing care workers. There have been a number of glitches in that path. Up until a week ago, one of those related to care workers who were reluctant to be tested because their terms and conditions from their employer were such that their weekly income would reduce significantly if they tested positive. The Government has now acted to resolve that impossible dilemma for them.
Of course, individuals have to consent to be tested, and we cannot expect 100 per cent of people to give that consent. In some instances, particularly with care home residents, consent is not possible because of the conditions that they suffer from, and the clinical decision might be made that the particular test involved would cause too much distress to force it on the person—although, of course, we cannot force a test on any individual. However, testing is by no means the only route by which care homes should be preventing the transmission of the virus between one resident and another. Care homes should be following the clear guidance that has been issued and reissued from 13 March onwards.
Care Home Deaths (Covid-19)
To ask the Scottish Government what its response is to reports that there have been around 600 more deaths in care homes from Covid-19 than officially recorded. (S5T-02220)
Every week, National Records of Scotland publishes the number of registered deaths where Covid-19 has been recorded by a medical professional on the death certificate. NRS figures show that, up to the publication of the figures last week, there had been 2,350 excess deaths in care homes during the pandemic. Of those, 74 per cent had Covid-19 recorded on the death certificate as either a suspected or a probable factor in the death. In the case of the remaining 601, the doctor who certified the death did not record Covid-19 on the certificate as either a cause or a suspected cause of death. The Scottish Government is working with Public Health Scotland and NRS to explore excess deaths as part of wider work to understand the impact of Covid-19 on the population.
For several weeks, the First Minister has repeatedly suggested that the United Kingdom Government was undercounting the number of care homes deaths, but that now appears to be the case in Scotland. Can the cabinet secretary say how many deaths there have been in care homes where people have been removed from a care home to a hospital setting? Does she know that figure? Also, does she now accept that, in at least some of those cases, excess deaths in care homes that have not been recorded as Covid-19 related could be Covid-19 related?
In response to the latter part of the question, neither I nor Mr Briggs is clinically qualified, so I would not gainsay the professional reputation, competence or expertise of the medical practitioners, who take exceptionally seriously the signing of death certificates—nor would I have the audacity to question whether they have recorded those matters properly.
Secondly, the First Minister did not suggest or state anything to do with how other countries in the UK record their figures. She simply spoke in detail about how we record our figures. The member will know that very clearly. With regard to where deaths are recorded as happening, there is of course no gap here. NRS figures—I am sure that Mr Briggs is as familiar with those weekly publications as I am—give the location of the death. If the individual who died was not at home but was in hospital, it would be recorded as a death in hospital. It would not be a missing death but would be recorded as a death in hospital. If the individual was in hospital and not in a care home, the death would be recorded as in hospital and not in the care home. There is no suggestion, I hope, that there is any dubiety in the figures that NRS records and publishes to the professional standards that it is required to meet.
Last week, I asked the First Minister how many patients in hospital without a power of attorney have been placed in care homes. The First Minister has still not responded to me, so can the cabinet secretary provide that information today? Also, has she investigated any of the individuals who may have had a “Do not resuscitate” order placed on them? What legal framework are the Scottish ministers using in both of those cases?
On the question of individuals who are clinically able to be discharged from hospital but who are there because of adult with incapacity legislation, under that legislation it is not the Scottish ministers who decide, as a decision will be taken primarily by the designated mental health officer of the local authority. There are various processes that individuals have to go through.
Without advance notice of the member’s supplementary question, I do not have the numbers that he asks for. I am sure that the First Minister will respond to Mr Briggs, as she has committed to do.
I am sure that Mr Briggs will be aware of the actions that the former chief medical officer, the current CMO and the Royal College of General Practitioners took to ensure that our general practitioners across the country and our clinicians in hospitals understood the proper process to go through to agree with a patient whether a DNR notice should be placed. There have been instances where that decision appears to have been taken inappropriately and, in all those instances, the CMO has contacted the board or practice and ensured that the individuals in those circumstances understand the way in which DNR and advanced care planning need to be undertaken.
Can the cabinet secretary provide some detail on how excess deaths in recent weeks in Scotland compare with those in other parts of the UK?
Two figures may help. Between week 11 and week 21 of the pandemic, excess deaths were 39 per cent higher in Scotland than in the equivalent period against which they are compared, and 50 per cent higher in England and Wales. In week 21, which is the most recent week for which figures are available, excess deaths in care homes were 63 per cent above the five-year average in England and Wales and 42 per cent above it in Scotland.
Those are the figures, but I must point out that we are not engaged in some kind of competition. Any one of those deaths is to be regretted and, of course, leaves the family and loved ones of the deceased devastated and grieving. Every day—whether at the daily briefing or here in the chamber—we make it very clear how seriously we take those numbers, but it is important, as I said, to view all such matters in a clear perspective and to be accurate.
In a written parliamentary question, I asked the Scottish Government
“how many people have been discharged from hospital to care homes since 1 February 2020, and how many have subsequently died.”—[Written Answers, 18 May 2020; S5W-28698.]
Mr Briggs asked a similar question, which I noticed that the cabinet secretary did not answer. Will the Government pursue that and collate and publish the relevant information? The answer that I received was that that information “is not held centrally.” It is an extremely important point.
Mr Findlay is correct: the answer is that that information is not held centrally. However, we are working with the various teams concerned to establish how much of that information we can gather. I cannot commit to being able to gather in 100 per cent of it but, as that work progresses, I undertake to make sure that Mr Findlay is updated on how far we have got and how robust we think that information is. As with all information, we will publish it at the point at which we believe it to be robust.
Last week, I was contacted by a constituent whose daughter works in a care home in the north of Scotland. She recently processed the arrival of a resident who had been transferred from the Home Farm care home on Skye. That resident subsequently died of Covid-19 within a week. How widespread is the transfer of residents out of Covid outbreak homes? What infection control measures are put in place to allow that happen safely?
I do not have the answer to Mr Cole-Hamilton’s first question. I am not sure whether it is possible for me to acquire those numbers, but I am certainly prepared to undertake to consider that, to look to see whether we can do so and to let him know.
Mr Cole-Hamilton’s second question, which was about infection prevention and control measures, is very important. At all times—before the pandemic and since it began—all care homes should have adequate infection prevention and control measures in place. We all know that, every winter, people in care homes suffer from norovirus to varying degrees, that flu is a seasonal occurrence in winter and that older residents are particularly vulnerable to both of those. Therefore, all care homes should have very clear and up-to-date infection prevention and control measures.
In addition, in the current situation, the guidance that was issued on 13 March was very clear, and every piece of guidance that has been issued subsequently has been very clear. Individuals should be isolated in their own rooms for 14 days if they have symptoms of Covid-19 or have come from a Covid-19 setting. That should happen even if they had tested negative, in order to be sure that no symptoms emerge. There is growing knowledge of the range of symptoms in older people, in particular, which appear to differ from those of people in different age groups.
As well as all the guidance on the ending of communal activity, communal dining and so on, in recent weeks our directors of public health and our national health service clinical teams have been directly involved in ensuring that all care homes are meeting the requirements that they should have been meeting for some considerable time. In addition, as Mr Cole-Hamilton will know, the Care Inspectorate is undertaking a number of on-site inspections of care homes across the country.
Shielding Advice (Covid-19)
To ask the Scottish Government whether it plans to update its advice for people who are shielding from Covid-19. (S5T-02232)
We plan to update that advice. That should not be taken at this point as an indication that it will necessarily change, but we recognise that those people who are shielding, who are the group of whom the most has been asked recently, want to know what will happen next and what it will mean for them.
We need to ensure as best we can that the approach that we take is the right one, and in doing that we are led by our chief medical officer and his advisory group of clinicians. They are working through whether they believe that there is any possibility of easing the current restrictions on the group as we come to the end of the first period in which we asked people to shield. The chief medical officer and his advisory group are working through that in order to provide clinical advice.
We will make sure—and they are working to a timetable that will ensure this—that individuals in the group are given clear advice in advance of the end of the current shielding period. That advice will cover the level of risk that the clinicians believe individuals face, what we are asking people to do to shield themselves against that risk and what they can do individually. Importantly, there will also be advice for those who are supporting such people, which will cover what they need to do in order to ensure that they mitigate risk. In addition, we will of course continue to offer support to individuals in the group to ensure that they have access to medicine, food and other support that they might need.
I thank the cabinet secretary for that response. Given that advice in England has diverged from that in the rest of the UK and people in the shielding category in England are now being advised that they can meet other people despite the medical and scientific evidence suggesting that it is too early for that course of action, can the cabinet secretary assure those who are shielding that that step will be taken in Scotland only when the advice and evidence suggest that it is safe to do so?
Yes, I can. That is why we have not made any pronouncement so far. I understand that that can be difficult for people in Scotland who are in the group, who see apparent changes in England and Wales but, so far, none here. That is why we have made such an effort to continuously say, “We have not forgotten you—you matter, and we are working on this because you are so important.”
We are also making sure that we hear from those who are shielding. Since 29 April, we have been undertaking research interviews with such people, and until 14 June people can respond to a Public Health Scotland survey, which they can find at surveys.publichealthscotland.scot, so that we can hear from them about what matters most to them and try as best we can to weave that into the advice and guidance that we give.
Over the weekend, we saw reports of vulnerable people in England being told via text message that they had been removed from shielding lists without even the knowledge of their general practitioners. The cabinet secretary talked about the advice that is being given to people who are shielding. How will the Scottish Government communicate any changes in the guidance to those people? Will there be flexibility for people to adapt their behaviour in consultation with their clinicians?
As I am sure that Ms Harper and others will recall, the shielding list was drawn up in the first place in agreement between the four CMOs of the nations of the United Kingdom. My understanding is that the removal of some clinical groups from the list for England was not agreed between the four CMOs. We do not intend to do that at this point. The clinical group that I mentioned is looking carefully not at removing people from the shielding group but at whether advice should vary depending on the condition or whether it is too early for that to happen.
As the member knows, the clinical groups that are on the shielding list have altered over time, and it remains possible for an individual GP or consultant clinician to add someone to the list if they feel that they should be on it. As an example, the splenectomy group was recently added to the list.
Once we have that clinical advice, we will communicate with people as we did at the outset, which will be through a very detailed, clear letter that specifies the route to take if they have further questions, whom they should speak to about their personal situation and where they should go to get that locally delivered support—there may be people who did not register for support the first time around but will need it now.
We will repeat all that and we will give people that information, advice and guidance in advance of any change that we introduce, so that they have time to ask questions, understand what any change involves and arrange how they will accommodate that into how they are living, if that is what they wish to do.
There are those in the over-70 group who are unclear about what the guidance is for them. Some have been following the shielding guidance even though they are not on the shielding list. When the new shielding guidance comes out, will there be a revision to guidance for the over-70s?
It is fair to say that, precisely because of the points that Mr Rennie made, there will be clarification for people who are not on the shielding list but are over 70 years old or are currently eligible for the flu jab about how they not only have the same restrictions imposed on them as everyone else, but need to take additional care, in terms of being outside, maintaining 2m distance, wearing face coverings and so on.
We will look to ensure that people no longer feel that the shielding advice applies to them but have clarity about what advice does apply to them, including additional advice that says, “These are the reasons why we believe you need to take additional care to that taken by your 20-year-old grandson or 40-year-old daughter. This is why you need to take a bit of additional care and here’s what that additional care should be.”