Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 3, 2020

Official Report 1015KB pdf

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Winter Preparedness in Social Care

The next item of business is a statement by Jeane Freeman, on winter preparedness in social care. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

16:02  

Every winter, our social care and health systems face significant pressures from seasonal flu and norovirus, but this year the Covid-19 pandemic magnifies those challenges as never before.

Last week, I set out how we will support our national health service to respond, and today I am publishing the interrelated plan for adult social care. Delivery of that will be backed by £112 million of additional investment to support the sector in providing care to some of the most vulnerable members of our communities.

Approximately 245,000 people in Scotland receive social care and support; that is one in 20 of the population. Of those, approximately 60,000 people are receiving home care at any one point in time.

People who use social care support in residential and community settings and in their own homes have felt the significant impact of Covid-19 this year. Many of them have lost their lives to the virus and many have become seriously ill. I again express my heartfelt condolences to all those who have been affected and to their families and their loved ones.

That impact has also been felt by the staff and the unpaid carers who provide care and support. Some of them have also lost their lives and some have become seriously ill, with long-lasting effects. I express my condolences to their families and loved ones, and my sincere gratitude to them.

The plan that was published today is supported by the evidence paper and the independent care home review that I commissioned using root cause analysis methodology. Both of those, together with the independent report from Public Health Scotland, the University of Glasgow and the University of Edinburgh, and the Care Inspectorate’s care-at-home inquiry, have informed the thinking and conclusions of the plan. The winter preparedness plan that is being published today supports safe care and protection by continuing the effective measures that are already in place and by applying learning from those published reports and from our direct experience and that of our partners to additional measures that we will introduce and require.

The plan is centred on four key principles: learning from evidence to protect people from the direct impact of Covid-19 and winter viruses; ensuring that people can benefit from good physical and mental health and wellbeing through the provision of high-quality integrated health and care services; supporting the social care workforce to deliver safe support and care and their own positive mental health and wellbeing; and collaborative working to both plan and deliver high-quality care.

The adult social care sector brings together organisations, providers and people from across the health and social care sectors from private, public and independent providers. The plan has been produced with their engagement and input, and I am pleased to say that it has the support of the Convention of Scottish Local Authorities, our key partner. I want to thank local government colleagues and others from across that wide sector for their constructive, pragmatic and positive approach.

The role of local government and health and social care partnerships in direct delivery and in commissioning from the third and independent sectors is critical to successful delivery. The NHS, health and social care partnerships and local authorities need to be able to take the lead in ensuring the successful delivery of the plan at a local level. We have set out shared values of communication, cohesion and collaboration, nationally and locally, and those must be in place and enacted if we are to have the positive impact that is needed on the lives and wellbeing of every adult who needs social care support.

I want now to set out briefly some of the key steps that are detailed in the plan against those principles. Of people receiving social care services or support, 77 per cent are aged 65 or over, and 90 per cent of people living in a care home are over 65 with one in two of that number aged over 85. We have already made significant progress with effective infection prevention and control, which protects not only against Covid-19 but against all winter viruses. However, we need not only to maintain that but to strengthen it, as the evidence tells us. We will issue new clinical guidance for care homes and community care through the clinical and professional advisory group, supported by an additional £7 million, to support increased infection prevention and control nursing support and training for social care providers.

All care homes are vulnerable to Covid-19 outbreaks, so our focus has to be threefold: preventing the virus from entering the home, early identification of cases and prevention of transmission. For older people in the population, we now understand that there are a broader range of Covid-19 symptoms, so we are asking providers to introduce a new daily review of Covid symptoms in care home residents and staff. To support that, the clinical and professional advisory group will provide and issue a checklist of those broader Covid symptoms and we will look to provide support to staff so that they can confidently undertake that daily review.

Minimising staff movement within and between care settings is also critical to reducing the risk of transmission. The evidence is clear that reducing the number of people in close contact reduces the risk, but we need to do that in a way that does not negatively impact on individual members of this vital workforce. Therefore, to support the sector to implement necessary limitations and restrictions on staff movement, we will make funding of up to £50 million available. We need to work together across the social care sector to deliver that, working through the practical steps that are needed and ensuring that our trade union colleagues are fully engaged with us in that work.

Public Health Scotland’s analysis of discharges from hospital to care homes reinforces the requirement that hospital discharge to home or to a care home is as safe as possible, so the current national testing requirements for people coming into hospital, and being discharged from it, remain and must be followed. Ensuring that that is the case is a responsibility that rests with boards, HSCP partnerships and providers, but also with Government.

Securing the physical and mental wellbeing of care home residents is critical, and I know only too well the impact that the early phase of the pandemic has had on many. Reintroducing health and care services for residents is vital. To do that as safely as possible, it is important to introduce testing for the professionals who are involved, and that will be implemented in the coming weeks.

We will continue to review visiting guidance. My aim is to maximise the quality time that families can safely spend together. We will apply additional protection through the introduction of testing for designated care home visitors and work to secure more localised, evidence-informed decisions that take into account the new strategic framework protection level arrangements, community prevalence, outbreaks and care home circumstances. We will increase our available wraparound care and continue to support social, community and primary care teams to work alongside each other.

Today, we are making up to £50 million available for the staff support fund and for sustainability payments for the sector this winter. We are committed to working with COSLA and wider partners immediately to support the development of effective and timely allocation mechanisms for those funds. I will say more about that in a moment.

There can be no doubt about the scale of the challenge that the adult social care sector has faced. At the forefront of that and in many ways bearing the brunt of it have been its professional, compassionate and skilled workforce. We owe them our thanks and the support that they need.

We will continue to improve weekly testing for care home staff by completing the transition of the programme to our NHS labs, which will build in greater certainty of fast turnaround times. That reduces the Covid risk to staff, their families and those they care for. We will prioritise testing for care-at-home staff, with the recognition that that might be phased in as capacity allows and targeted in the first instance at those who work in areas of high prevalence.

Testing is important, but infection prevention and control also critically requires the provision of PPE to the right standard and as set out in the guidance. The Government will meet the additional costs that health and social care partnerships and providers incur for PPE and will support the provision of and access to PPE for staff, visitors and—when necessary—care recipients over the winter period.

In May, we introduced increased collaboration and oversight across partners, which involves multidisciplinary enhanced oversight arrangements to support the delivery of adult social care during the pandemic. Those arrangements remain vital to supporting safety and improvements in care, and they will continue.

We have introduced the safety huddle tool for care homes, which 100 per cent of care homes have now signed up to. That provides care homes and local partners with the real-time information that they need to manage risk effectively, prevent issues from arising and seek support when they need it. In the coming months, we will look to expand that.

In the coming weeks, we will work with Scottish Care and the Coalition of Care and Support Providers in Scotland to identify opportunities to engage with providers on the plan.

Continuing to support technology and digital improvements is important. We have provided tablets to care homes and we now commit a further £500,000 to digital support, which will ensure that all care homes have access to digital devices, connectivity and support.

All that work and more requires our commitment, collaboration and—most of all—the skill and professionalism of staff, but it also requires money. I have agreed with COSLA that, for the month of November, we will continue the sustainability funding for social care at the level that was set for October. Over this month, we will work with COSLA and other partners to take a more targeted approach to sustainability funding to ensure that people get the support that they need, that organisations that need support can access it quickly, that services can be sustained and that value for money is secured. During November, with COSLA, we will engage intensively with commissioners and providers to ensure a smooth transition and clarity about financial support until March 2021.

This is the first national winter plan for the adult social care sector. Like all plans, it is not set in concrete and will have to adapt as circumstances change and new pressures and demands arise. That is all the more certain as we deliver on its requirements in the middle of a pandemic. However, the principles that it rests on will remain. The plan is built on partnership, and it can be delivered only in partnership, with collaboration, clear leadership, investment and pragmatism.

Our challenges are many, but our advantages are all that we have already learned, the developing and deepening evidence that informs our decisions, the relationships and leadership that we have at local level across the country and nationally, and—most of all—the skill, care and dedication of all who work in adult social care. I commend the plan and its supporting papers to members.

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 prior sight of her statement. I acknowledge and thank all our social care staff for their work in supporting some of the most vulnerable people in society throughout the pandemic. As we move into winter, we know that care settings are at risk from both Covid-19 and flu.

The cabinet secretary mentioned visiting guidance in her statement, and I wish to address that specifically. Earlier today, I participated in a call with relatives of people in care homes. Some of their stories were truly heartbreaking, in that they still did not have adequate contact. While we, of course, recognise the clear need to protect care home residents and staff from the virus, we must consider safe ways to reunite families with their loved ones. Given that winter makes all this even more complicated, I have three specific questions. Has the Government considered whether the designated visitor could be changed, so that more family members can see relatives in care settings at different times? Has the Government considered whether there could be a separate Covid-19-secure space in care homes, where visits could take place? Does the cabinet secretary recognise that there is a worrying lack of uniformity, given that care homes across Scotland are interpreting the rules differently?

I am grateful to Mr Cameron for those really important questions. I have met some care home relatives and am due to meet them again this week, I believe. I have heard some very distressing stories. I completely agree on the importance of finding a better way to balance safety with the necessary connections between many care home residents and family, loved ones and friends, noting the support that that brings. That often involves nutrition, or it can be support for those suffering from dementia, and it can absolutely help to address loneliness and isolation.

In answer to Mr Cameron’s specific questions, yes: we have considered and are considering whether the designated visitor might not always be the one person. In the normal course of things, if my mum was still with us and I was a designated visitor for her, I would not necessarily always be able to go every time, so I would want someone else to be able to go, too—a sibling or whoever it might be. We have that in place, with a designated visitor and back-up, although we probably need to be clearer about that.

A Covid-19-secure space is an excellent idea. Often, that is the individual’s own room. The new guidance on designated visitors—with visiting times of up to four hours and so on—includes touch. People should not be chaperoned, and there should be personal protective equipment. The additional testing will assist with that, too. Those arrangements should allow for the holding of hands, the kiss on the cheek or whatever.

It is not always possible in all care homes to have a designated Covid-secure space, other than the individual’s own room, so the arrangements have to be flexible enough to be applied in different care home settings, depending on the physical infrastructure that they have. Together with care home providers and Scottish Care, we are considering having a Covid-responsible officer to act as a link, which would help care homes to begin to implement some of those arrangements in a pragmatic way that gives their staff confidence that they are meeting what we need while being flexible enough.

That takes me to Mr Cameron’s last question, on lack of uniformity. There is a real lack of uniformity across the sector. As members know, services are provided by the public sector, the private sector and the independent sector. On balance, there is an understandable hesitancy on the part of many providers to take what they believe might be an additional risk. That is why we need to help them much more to understand how to assess risk, apply all those measures, and get a better balance, so that they feel confident that they will not be got at, or blamed, if they have a case of Covid. It is a really vicious virus—it sneaks in everywhere. Therefore, we have to put in place as many support measures as possible.

There are discussions to be had with our directors of public health, who have a key role in helping care home providers to assess the level of risk in the surrounding community, because that plays into the amount of risk that can be taken, and what additional measures need to be in place, in an individual care home in a particular location.

There is a lot to do with regard to the detail behind the plan, but those questions are important.

Scottish Labour called for a winter plan, so we welcome its publication and will review all the documents carefully. We have shown that we can work with the Scottish Government to achieve the right practical support and outcomes for people, such as the staff support funds, which I hope will continue to make a difference to front-line workers, to whom we are all grateful.

I am afraid that the Government is not yet in the right place on the issue of contact between residents and their family caregiver, and I think that families will be disappointed today. I welcome the practical points that Donald Cameron made—I am sure that others will make similar points—but people do not have time to wait. The cabinet secretary will be aware that a judge has ruled that care home residents in England are legally allowed visitors, and families are now having to think about taking legal action. We do not want that to be the case in Scotland, so I appeal to the cabinet secretary to work with us all on the issue.

It is not acceptable to have blanket bans in some parts of the country, which is the case right now. There are people in care homes who have not seen a member of their family or a close friend for several months. I therefore ask the cabinet secretary to work with us all so that we can get it right, and no one has to endure this winter on their own.

I am grateful to Monica Lennon for her comments and questions. I will make two points.

I know that the documents that were published today are detailed, but they are really important. I hope that members will take the opportunity to read them, and when they do, I will be happy to continue our meeting of Opposition health spokespeople to consider some of the detail, and bring some of the clinical advice and support to that discussion. I am happy to convene that meeting as soon as our diaries allow, in order to discuss exactly what Monica Lennon has asked for—that we work across the chamber to consider what more we can do to ensure that families and their loved ones in care homes can spend quality time together more frequently and for longer.

I cannot make care home providers do whatever I would like them to do, and I know that Monica Lennon understands that, but I want to make sure that we do not have blanket bans. That is why, in my statement, I talked about more localised decision making, so that it is not necessarily the case that, because a local authority is at level 3, for example, all care home or hospital visiting is automatically banned. If a local authority is at level 3, it is a risky area and we need to recognise that. However, we also need to consider whether the additional protective measures that I have announced, including testing for visitors and for visiting health and social care professionals, the PPE and all the other support will help providers to feel more confident about managing the risk, and directors of public health to feel more confident about giving tailored guidance to individual care homes.

I welcome the winter preparedness plan. I refer to the focus on the movement of staff between care settings as

“critical to reducing the risk of transmission.”

In home settings and care homes in rural areas such as my constituency, such movement will be difficult to reduce. Will guidance take account of rurality, and will funding be available to reduce what is currently necessary travel, or for suitably robust PPE when travel between care settings in rural areas is unavoidable?

That question is really important. As an MSP for a largely rural area myself, I completely understand the points that Christine Grahame is making.

Care-at-home staff are a particularly important group. That is why I am very anxious that, as soon as we can put it in place—in the coming weeks; not this time next year or at some time in the new year—we introduce testing for care-at-home staff, as a protective measure for them and those for whom they care, given that they will see more than one individual in any working session.

I am also keen that we make sure that there is no repetition of some of the difficulties of the first phase of the pandemic, in which care-at-home staff were given inadequate PPE supplies for the number of people for whom they were caring. With our health and social care partnerships, we will try to ensure that that is not repeated.

My commitment to provide PPE continues for the care home and the care-at-home sectors. The distribution routes remain, and all that has been made to work well continues. We will continue to discuss with the trade unions, and with COSLA, making sure that the guidance on the right PPE in those circumstances is well understood and implemented and that individual care-at-home providers have all the PPE that they need—I would prefer it if that was for the week, as opposed to being for individual shifts.

An essential part of preparing the social care system for winter will be ensuring that a robust testing scheme is in place for front-line staff. I am concerned that, although routine testing is taking place, Health Protection Scotland’s guidance states that staff who have previously tested positive for Covid are exempt from being re-tested, during those weekly cycles, for 90 days from the initial onset of their illness.

Given that we know so little about Covid-19 reinfection and that there has been at least one documented case of an individual being reinfected after 48 days, does the cabinet secretary believe that it is safe to exempt staff from routine testing for 90 days?

I am grateful for that important question. I am not clinically qualified, in any respect, to say whether it is safe, but I am very happy to ask HPS to review, and to continue to review, the guidance, in the light of emerging evidence. That is a constant exercise, but it is really important that we do it.

On the question of testing, I will have a detailed discussion this week in order to plan some of those additional areas of testing of individuals who are asymptomatic, as I mentioned in my statement—such as designated visitors, visiting health and care professionals, and care-at-home staff—into the scaling up of our testing capacity. I will be happy to return with a further statement on testing as a whole—and, of course, to discuss it with my colleagues in the Opposition parties—so that members can debate that.

Further to Donald Cameron’s questions, families still need closure after a devastating first wave, and many more will be wondering what this winter holds for the safety of their loved ones. After nine months of their not being able to have physical contact with their families and caregivers, the relaxation of visits for family carers is very welcome. However, I press the cabinet secretary on Donald Cameron’s question, about the fact that many care homes are still nervous of complying with those relaxations—sometimes for insurance reasons. What further measures can the cabinet secretary bring forward to ensure that, this Christmas, those residents are not deprived of physical contact with the people whom they love, and will care homes be part of the Scottish Government’s agenda as it prepares for the United Kingdom’s four-nations summit about Christmas?

The answer to the last part of Alex Cole-Hamilton’s question is yes. Care homes, care at home and adult social care—which goes much wider than elderly citizens, as it includes a range of residential settings, including supported accommodation and housing—will all be part of what we take into that summit, and I hope that we can have a productive four-nations discussion.

I completely understand the situation—as best I can—about care home relatives. I have met the care home relatives group, and I will continue to have discussions about what more we can do in addition to improving the visiting guidance and testing designated visitors, which I covered in my statement. What more can we do?

I have regular conversations with Donald Macaskill from Scottish Care and, of course, with colleagues from the Convention of Scottish Local Authorities about how care home providers are feeling and what they need. Not so long ago, I had a long conversation with the owner of the Balhousie Care Group and others, and I will continue to have such conversations.

I said in my statement that we need to have detailed discussions with Scottish Care and the CCPS, which represent the majority of providers, about how we can help to reduce the movement of staff between shifts and care homes and between care homes and other settings. We need to consider how we can help care home providers to feel more confident in applying the visiting guidance. We also need to have discussions with the directors of public health, so that we get closer to providing tailored guidance for individual care homes. That is what I meant when I talked about local decision making.

I encourage sharply focused questions and answers.

I warmly welcome the cabinet secretary’s statement. I should say that my mother is resident in a care home.

We have heard similar themes from Donald Cameron, Christine Grahame and Alex Cole-Hamilton. Most members are looking for consistency to be delivered, wherever possible, in what we can do for people who are in care homes and for those who are being cared for at home, regardless of where they are in Scotland. The cabinet secretary has been very good at emphasising her determination on that front, but I hope that she can say a wee bit more about that. We want to have consistency across the country.

The point about consistency is really important. I know that Mr Gibson appreciates fully the restrictions on my ability to secure consistency across the piece. The importance of COSLA, Scottish Care, the CCPS and our health and social care partnerships as key partners is critical, because those partners include the commissioners and providers of much of the care. Through the months of this year, we have developed much better working and practically focused relationships with all those groups.

We will continue that work in order to look at what we can do, in real time, to address inconsistencies and to consider how commissioners, as well as providers, can work together to give us greater consistency in the work that is undertaken, visits and all the protective measures. Our job is then to ensure that primary care wraps around that really well, that we provide the PPE, testing and support for the staff who are delivering the care and that I listen all the time, not only to members across the chamber who raise issues but to families and others—particularly trade unions—who raise issues directly with me. We will keep that approach going right until the end of this parliamentary session.

A consistent theme is running through a lot of the questions today. A constituent emailed me today to highlight that the care home that his father is in offers five half-hour appointments a day for visiting, which is a total of 35 visits a week for 47 residents.

I have pushed the cabinet secretary on this point previously, but does the Care Inspectorate have enough significant influence in private and council-run care homes? It can surely encourage a better visiting regime in indoor, Covid-safe environments. Can the cabinet secretary offer any funding to help care homes to establish such environments?

I am glad that Mr Whittle mentioned the Care Inspectorate, because it is a really important part of all this. The Care Inspectorate’s in-service inspections—in other words, when it undertakes inspections when inspectors are in the home—are now undertaken in consultation with, or directly alongside, Health Protection Scotland, so the infection prevention and control runs right through the inspections that are undertaken.

In doing that, the Care Inspectorate discusses the wellbeing of residents with care home providers. That is about not just protecting residents from infection but allowing, within the guidance, health and care services to come into the care home and provide care. It also relates to family visiting and so on. The Care Inspectorate is, and will continue to be, a key partner.

I repeat, though, that the only way that we can get consistency is if we can secure effective working between local government, the Scottish Government, commissioners and providers, and if we give providers the support that they need to deliver the kind of environment and safety that we require both for residents in care homes and for those who are receiving care at home.

I congratulate the cabinet secretary on the first ever adult social care plan for winter and welcome, in particular, the additional resources that are being made available.

As the cabinet secretary said, 77 per cent of people requiring social care in care homes in Scotland are over 65 and about half are over 85. That is precisely the age group that, if they catch Covid, are more susceptible to ending up in hospital, in an intensive care unit. Will the cabinet secretary ask her advisory group to look at trials going on in Edinburgh and Liverpool on early interventions that might prevent that age group catching Covid and therefore reduce the hospitalisation rate for Covid among it?

I am grateful to Mr Neil for that really important point. I am happy to ask the advisory group to do precisely that and will ensure that he and other members are fully aware of the response that I receive.

I have a couple of additional points, the first of which is the growing understanding of the range of symptoms with which older people present. We talk about the persistent dry cough and the loss of a sense of taste or smell, but for older people there are other symptoms that indicate that they might have the virus, which would trigger a test. The issue of widening our understanding of symptoms was a central part of my statement.

The second point concerns the roll-out of a service that I know Mr Neil is familiar with and very much supports, which is hospital at home. Hospital at home is not just at home but in a homely setting. NHS Lanarkshire has done fantastic work on that; it has been globally recognised for its effectiveness in providing hospital-level care in a person’s own home or a homely setting. The roll-out of that will be critical in supporting our elderly residents, wherever they are living.

Many of the findings in the recent inspection reports from the Care Inspectorate are concerning, with a high proportion of firms having received letters of serious concern or improvement notices, or having been graded weak. How confident can we be that those homes will be equipped to care and will act to protect residents throughout winter and the second wave?

That is another really important question. I completely agree with Ms Boyack that many of the Care Inspectorate’s reports are of concern. I meet the Care Inspectorate every two weeks and we discuss what it has found in individual care homes and on its return visits to those homes. In between, my officials are engaged in detailed discussions about how well the NHS is stepping forward to help those homes. Whatever the issue is—a staffing issue, an issue of understanding infection prevention and control and good practice, an issue of cleanliness or an issue of PPE—how well is the local NHS stepping forward to help? How close is the health and social care partnership to working with that home? In some instances, if the home is part of a group, the Care Inspectorate deals directly with the most senior level of management of that group.

In my discussions with the Care Inspectorate, we always ask, “If nothing changes in the next week, what are we going to do about it?”

There has been one instance so far of the NHS acquiring the care home to ensure that it can run properly and to the standard that protects the residents and gives them a quality of life; that was Home Farm care home in Skye. In another instance, the health and social care partnership ended its contract with a particular care home, because it was not getting the level of response from the provider that was needed, and worked with families and residents so that people could be moved to an alternative care home that they were happy with and confident in.

We are very focused on helping care homes to improve so that they meet what we need them to do, but we will not give them forever for that happen and will act if they do not come into line as quickly as we need them to.

The Public Health Scotland report that was published last week highlighted the issue of care home size in relation to the spread of infection. How will the winter plan help to minimise staff movement in and between care settings to reduce the risk of transmission?

The question of care home size was highlighted in that report; it is also in our evidence paper and has been in other papers on emerging areas, including by the Care Inspectorate. It is not a straightforward question to answer because a care home is the size that a care home is. We are about to enter discussions with providers of the larger homes about what they need to do to cohort their staff—sometimes those care homes are on two floors—so that there are bubbles of staff that do not move between one floor and another and, as we do in hospital, cohort individuals who are Covid-positive when there is an outbreak so that the mix is minimised between those residents who have the virus and those who do not, in order to provide clinical care and protection where it is needed.

Inevitably, that will produce an additional financial requirement, and that is part of the additional £112 million that I spoke about my statement; that is additional to the additional £150 million that I previously announced, so we are looking at £262 million in addition to what was already in the Scottish budget for social care. We need to work through with the care home providers of the larger homes exactly what they need to do and how we can assist them to address the concern about the size of care homes and the movement of staff between them.

The cabinet secretary touched on how vital for mental wellbeing it is to ensure that families can spend as much quality time as safely as possible with their loved ones. Could she expand on what additional protection will be in place in relation to testing care home visitors?

We will introduce regular testing of all care home visitors. We are looking at whether that will be through the polymerase chain reaction testing route or a quicker testing route, and at the logistics of how we do that, care home by care home. My preference is that we do it in such a way that it is the NHS labs that process the results alongside care home staff tests.

In relation to designated visitors and lengthier visits—those visits that open up the opportunity for touch and closer care by, in effect, caregivers in the family—and what PPE requirements will be needed, our national PPE procurement service is geared up to increase the PPE that we already provide to make sure that care homes have all the PPE they need, not only for their own staff but for those visitors, so that we can make it as protective as possible. I know for sure that those families who want that level of visiting will be dedicated and thorough in all the steps that we ask them to take to protect their loved ones; I have absolutely no doubt about that at all.

Can the cabinet secretary explain what further steps have been taken through the winter social care plan to enhance infection prevention and control in the care sector?

There are a number of steps. Obviously, the testing that I have talked about in care homes for additional groups of people who are not symptomatic, as well as care-at-home staff, is part of that. PPE is a central part of that; not only ensuring that the distribution and ordering routes continue to function well, but that people get the right PPE for their circumstances. There is continuing work to enhance infection prevention and control, so that care home and care-at-home staff feel that they have all the training and support that they need in order to know what to do, including the putting on and taking off of PPE, which is a critical element of infection prevention and control. Our Care Inspectorate, with its unannounced and planned visits—around the care home sector in particular—has a critical role to play in ensuring that infection prevention and control is of the highest possible standard. Our wraparound primary care and the involvement of our partnerships and directors of public health are also there, led by our nurse directors, to ensure that everyone has not only the kit that they need, but the training and support that they need to use it to the best effect.

Despite the Government’s announcements, for many families, when it comes to visiting, not a lot has changed and, eight months down the line, care-at-home staff are still not being tested. I have been contacted by people who have lost their jobs and have moved into that sector—or want to move into it—who cannot believe that they do not have routine testing, so it is putting people off joining. Many staff members in the NHS deal with patients every day and have Covid in their ward but are still untested. Cabinet secretary, that is not good enough. Those people are on the front line; they are the most key workers that we have, yet we are still not routinely testing them.

I do not disagree with Mr Findlay that it is critical that we test those individuals. As I said in my statement and in answer to a number of questions, we will introduce testing for care-at-home staff. As I also said, in answer to another question, the detailed planning for that testing will be taken further in a discussion tomorrow. As soon as I have details, dates and logistics of all the additional testing that I have described, I am happy to come back to the chamber and make another statement on testing and the roll-out of additional asymptomatic testing, so that members can scrutinise and question that. In advance, of course, I will brief our Opposition colleagues.

There is testing of some NHS staff and work is currently under way by the clinical advisory group on what additional testing we should introduce for NHS staff and in what settings. That might include emergency departments and other settings but, at the moment, it is there in oncology, as well as in long-term care of the elderly and of psychiatric patients. The clinical advisers identified that we should start in those areas, but work is already under way to look at further testing that we should introduce for NHS staff, including NHS staff in primary care, as well as district and community nursing and community hospitals. The logistics of planning all that have to be matched against the scale-up of our NHS capacity, as well as what we can secure from the UK Government’s Lighthouse lab.

That concludes questions on the statement on winter preparedness in social care. I remind members to observe the social distancing measures that are in place across the Holyrood campus when leaving or entering the chamber.