Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, November 4, 2020

Official Report 1007KB pdf

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Care Homes

The next item of business is a debate on motion S5M-23226, in the name of Donald Cameron, on care homes.

16:04  

I am grateful for the opportunity to open this important debate, particularly in light of last week’s delayed report by Public Health Scotland.

I pay tribute to all Scotland’s care workers, who have been at the forefront of protecting some of the most vulnerable people in our society. We thank those who work in a care home, those who deliver care at home and those who simply look after a relative or friend for all that they do and all that they continue to do.

The unpredictable nature of Covid-19, especially in the early stages of the pandemic—in March and April this year—has created significant challenges for the care sector, but those at the front line have been quick to adapt to the new reality that we face. Protecting those who receive care must always be at the forefront of our minds, but I am afraid to say that it is clear that significant and costly mistakes have been made during the year. The Scottish National Party Government has made mistakes that may have cost lives.

At the heart of the detailed report from Public Health Scotland that was released last week was confirmation that 113 Covid-positive patients were sent from hospitals to care homes and 3,061 patients were discharged into care homes without being tested at all. We also know that, since the start of the pandemic, there have been, as of today, 2,048 deaths from coronavirus in our care homes, and that, as of 28 October, 134 adult care homes had a current case of suspected Covid-19.

Those are serious and concerning figures. Every death from the virus is, of course, a terrible tragedy. However, there is a lot that remains unknown. We do not yet know the number of positive tests from care homes that suffered outbreaks after receiving a Covid-positive patient or the number of positive tests from care home staff. We do not yet know when precisely the First Minister became aware that Covid-positive patients were transferred from hospitals to care homes and what action she took to investigate that. Those are serious questions that require serious and urgent answers.

Politicians of all political stripes have demanded clarity on numerous occasions from the First Minister, the Cabinet Secretary for Health and Sport and public bodies such as Public Health Scotland. It is regrettable that those answers have not often been forthcoming. The Government’s failure to protect Scotland’s most vulnerable people is a scandal—I do not shrink from describing it in that way.

It is clear to us and to others in the chamber that only an immediate public inquiry will hold ministers to account and give grieving families the answers that they deserve. I know what the cabinet secretary will say to that call—indeed, it is in her amendment. She says that it is not the time and that we must wait until this is over and it is reasonably practicable to do that. However, the simple reality is that we do not know when this will all be over. We are currently experiencing a second wave, and we may—regrettably—have a third wave. That could be a matter of months or another year from now—we do not know. While we wait, the families of those who died in our care homes will get no answers and no closure. We owe it to them to get those answers now, not later. It is precisely because the virus has not gone away that we need to get to the bottom of what went wrong.

There is no reason to delay. We can set the wheels in motion today. We can decide terms of reference and appoint key personnel. Crucially, we can start to in-gather evidence. All that takes time. If committees of the Parliament or the chamber can operate virtually or in a hybrid function, so can an inquiry. If court trials in Scotland can now—as of today—operate as they used to do before the pandemic, so can an inquiry operate.

I want to cover a few other aspects that the report covers. The report provided particularly damning evidence on the guidance that led to Covid-positive patients being transferred into our care homes. We know now that the SNP Government did not change that guidance until 26 April. Its original guidance of 13 March advised that, although

“long term care facilities have expressed concern about the risk of admissions from a hospital setting ... the priority is maximising hospital capacity”

and

“steps should be taken to ensure ... that flows out from acute hospitals are not hindered and where appropriate are expedited.”

We know that it was not until 21 April that the cabinet secretary announced to Parliament that Covid-19 patients who were discharged from hospital should have given two negative tests. It then took almost another month before any mention was made of the testing of non-Covid hospital patients.

Mention is often made of hindsight. I have always accepted that in March and April we needed the capacity in the national health service to deal with an influx of Covid-19 admissions. However, even then, any movement of hospital patients into care homes had to be done safely, especially given the virulence and speed of Covid-19 infection and particularly because care homes are the abode of many elderly people who are especially vulnerable. That had to be done safely, but it was not.

I am grateful to the member for taking an intervention and for his comment about the importance of what was, at that point, a shared agreement across the chamber to protect our NHS.

Does the member also accept that to safely discharge patients from hospital to any setting, the guidance on 13 March—notwithstanding his point about testing—was clear that there should be a clinical risk assessment? From memory, the guidance on 26 March was not only clear that that should happen but put in place particular infection prevention and control steps that have been there since 2012. That guidance also required the isolation of individuals in their own homes and placed significant restrictions on communal and other activities for the purpose of safety.

We do not have a lot of time in hand, but Mr Cameron will get all his time back.

The cabinet secretary mentioned the guidance on 26 March. That guidance also stated that individuals who were being discharged from hospital did not routinely need confirmation of a negative Covid-19 test. We cannot pick selectively from the guidance, despite its terms.

Yesterday, I participated in a virtual meeting with Scottish Conservative Party leader Douglas Ross and relatives of care home residents from across Scotland. Some of their stories were heartbreaking. It is clear that the inability of families to see their loved ones for months on end has taken its toll. One participant talked about a father in a care home who has not been told that his wife has died. Every member in the chamber will have experience of constituents who have come to them with those stories, which are a stark reminder of the human cost of the virus and the dilemma that we face in keeping care home residents safe, but also trying hard to maintain their quality of life.

That underpins why an inquiry is necessary now. The quicker we can learn lessons, the better. That will allow us to understand what happened and to move on to a better, safer and more humane system. It is just as much about the future as it is about the past.

There have been significant failings that have probably led to deaths in our care homes. Every death is a death too many. The affected families deserve answers. They have waited too long. Now is not the time for delay; now is the time to take meaningful action. The only way that that can be fulfilled is through an urgent, judge-led public inquiry. It is a simple request.

I call on the Scottish Government to support the motion in my name.

I move,

That the Parliament notes the publication of Public Health Scotland report, Discharges from NHSScotland Hospitals to Care Homes between 1 March and 31 May 2020; further notes with serious concern the report’s analysis of the transfer of COVID-19 positive patients from hospital to care homes during this time; recognises the risk that this might have posed for vulnerable and older care home residents, and calls on the Scottish Government to hold an immediate public inquiry to find out what happened in Scotland’s care homes during the course of the pandemic, which resulted in the deaths of more than 2,000 residents.

16:13  

Covid-19 is a cruel virus that is particularly dangerous for the most elderly and vulnerable in our society. In the first wave, as we have heard, the lives of over 2,000 care home residents were lost. That is devastating for their loved ones and for the staff who cared for them, and I will never be able to adequately express my sorrow and condolences to them all.

In moving the amendment in my name, I want to be very clear. As we have said repeatedly, the Government wants and will welcome a public inquiry into the response and handling of the pandemic. There is no dispute about that between us and any other party in the chamber. A public inquiry will be critical for a number of reasons, not least for the lessons that it will draw out for any future Government response to a global pandemic, and the critical improvements to any part of the health and social care infrastructure that will be introduced, or aspects that will stay the same, in preparation for that.

The only disagreement may be about the timing of such an inquiry. Right now, as the number of cases, the rate of test positivity, the number of people in hospital and the number who have died must make crystal clear to all of us, we remain in the middle of a global pandemic. If our ultimate responsibility as a Government is to do all that we can to save lives, then that, without question, must remain our focus.

That is why my amendment sets the timeframe for a public inquiry after the country is through the immediacy of dealing with the pandemic. I would welcome the engagement of all parties in working with us on its remit and scope.

One aspect that we should consider together is whether the inquiry should or could be held on a four-nations basis, because I am conscious of the experience of families who have been affected by blood-borne infections. After Scotland’s Penrose inquiry had reported, the United Kingdom Government instigated a UK-wide inquiry. That meant that people who had been affected by that tragedy had to face reliving it twice.

A public inquiry rightly takes time to reach its conclusions; for example, the Penrose inquiry lasted for almost seven years. Put bluntly, however, we do not have time to wait. That is why we have commissioned a range of independent, expert investigations to get us the recommendations now that we need to act on for this winter.

Members will be familiar with the information that I published yesterday that supports the adult social care winter preparedness plan: the evidence paper and the result of the root cause analysis of outbreaks in care homes. Those were in addition to last week’s independent Public Health Scotland report and the recent Care Inspectorate inquiry into care at home, which will both teach us lessons and which fed into the winter plan.

I turn first to Public Health Scotland’s independent report. It found that, although it could not exclude hospital discharge as a factor associated with outbreaks, that was not the major factor; the key factor was the size of the care home. I am not dismissing either.

Given the highly infectious nature of the disease, any person who comes into a care home carries a risk of infection. That is not to blame anyone—it is simply a statement of fact, just as it is a fact that any one of us who comes into this chamber carries a risk of infection. By the very nature of care homes, the larger one is, the larger the number of people who come into it, whether that is through admissions or whether those people are staff, visitors and others providing essential supplies.

We need to learn and work out how we can help providers work with that finding. Members know that I have agreed with the Convention of Scottish Local Authorities that we will continue sustainability funding for social care at October levels and work with providers and others during this month to ensure that people get the support that they need, that organisations that need support are able to access it and that services can be safely sustained. That will include making the changes that we need to make to learn the lessons.

Does the cabinet secretary accept that at the same time that hospital patients were incautiously discharged into care homes, many other hospital patients were discharged into the community, thereby seeding Covid-19 into the community as well as care homes?

I can give you only 30 seconds back, cabinet secretary, so you are nearly in your final minute.

I do not agree with the member’s characterisation of that as incautious. I believe that we did what we believed to be right at the time with the resources that were available to us, and we changed that. Yes, about two thirds of individuals who were discharged went into the community.

The Care Inspectorate’s recent inquiry into care at home and housing support services could not have been clearer about the hard work and flexibility of care at home staff in meeting the needs of people during the pandemic. They, along with others, of course have my grateful thanks for all that they do.

Families rightly want answers. If I were one of those families, I would want answers, too. Therefore, I welcome the actions of the Crown to establish a dedicated unit to receive and investigate the reports of Covid-19 deaths, whether through employment or as a resident in a care home. The findings of that work, which investigates individual cases, will also provide vital information to help make improvements for the future.

A public inquiry is undoubtedly important—we have no disagreement on that. However, right now—in the middle of the pandemic, when all the resources in care homes and the national health service are stretched severely—is not the time to divert any resource to setting up an “immediate” public inquiry, as the motion demands.

I move amendment S5M-23226.2, to leave out from “calls” to end and insert:

“also notes the report’s conclusion that care home size has the strongest association with outbreaks of COVID-19, and that this association persists after taking account of other care home characteristics, including discharge from hospital; further notes the publication of the rapid Independent Care Home Review, which through root cause analysis reviews the factors in four care homes, which were relevant to the management of COVID-19 within the homes; welcomes the Care Inspectorate’s inquiry on delivering care at home and housing support services during the COVID-19 pandemic; recognises that the recommendations of these reports have helped lead to the development of the Adult Social Care Winter Plan; believes that a public inquiry into all aspects of the response to the COVID-19 pandemic, including in the tragic loss of the lives of over 2,000 care home residents, should be held as quickly as is practicable, once the country is through the immediacy of dealing with the pandemic; considers that expert input and review must continue to be sought as the response to COVID-19 continues to evolve in light of emerging evidence on the virus, and believes that all of this evidence should be shared with the Independent Review of Adult Social Care, together with the views of those receiving social care and their families, in order to best shape the development of a National Care Service for Scotland.”

I must say to members that, in these short debates, there is no time in hand, so I have to be very strict with the timings. I call Monica Lennon to speak to and move amendment S5M-23226.1. You have a strict four minutes.

16:19  

Care homes have been at the centre of the Covid-19 crisis and, unfortunately, the crisis is far from over. Today, it was confirmed that, sadly, six of my constituents from Caledonian Court care home in Falkirk have died in the past few days following an outbreak. On behalf of Scottish Labour, I send my sympathies to their loved ones and to everyone who has lost someone special to them during this awful pandemic. I also pay tribute to healthcare workers who have lost their lives, those who have become ill in the line of duty, and all the workforce for their on-going efforts.

It is vital that Parliament pays proper attention to the impact of the pandemic response on care home residents and the workforce, so I am grateful to Donald Cameron for lodging the motion and for the opportunity to give these vital matters our attention. We will support the motion, because we believe strongly that getting a public inquiry under way is in the public interest. My amendment calls on the Government to commence cross-party talks on the inquiry’s remit, and I think that the cabinet secretary has made fair points about the four-nations context. We need to have a discussion about that.

My amendment also calls for a human-rights-based approach to such an inquiry. The Scottish Human Rights Commission recommends that, and I am pleased that ministers have already made a commitment to that approach. However, we are not minded to support the Government’s amendment today, because it does not commit to getting the preliminary work under way, which risks an inquiry being kicked down the road, possibly until after the election. We recognise that Scottish Care and others would prefer the work to begin later, but many others have added to the compelling case for action beginning now, including Age Scotland, GMB Scotland and other unions, and Covid-19 Bereaved Families for Justice UK.

Cross-party work should be being done now, so that we can agree the terms of reference, identify where there are gaps in the data and research, and fill those gaps quickly.

Donald Cameron touched on this point. The voices of families are really important, but so, too, are the voices and experiences of people who live in care homes. We are not hearing enough about them and they do not have time, so we have to capture their views. We need to discuss who will lead the inquiry and so on, but we can agree those things.

What has happened in our care homes this year has been a national scandal. I thank Neil Findlay for bringing a debate on the Amnesty International report “As If Expendable” to the chamber last night. That report contains findings and lessons that are applicable to the whole of the UK, including Scotland, and Amnesty International recommends a full independent public inquiry without further delay.

We should never again find ourselves in a situation in which older people are discriminated against on the basis of their age. The Amnesty International report concludes that we have had policies during this pandemic that have threatened older people’s right to life, their right to health and their right to non-discrimination. Never again can we have a situation in which people who test positive for Covid-19 are discharged into care homes and an environment with other vulnerable people.

My amendment also says that an inquiry should consider the role of Scottish Government guidance in relation to Covid-19 outbreaks in our care homes. I am afraid that, last week, the Scottish Government sounded very defensive when questioned about the Public Health Scotland report that is referred to in the motion.

No one is looking for a blame game to happen here, but we need transparency and openness. I urge that we work together to agree the terms of the public inquiry and show collective willingness to act swiftly in the interests of public safety.

I move amendment S5M-23226.1, to insert at end:

“; believes that such an inquiry should take a human rights approach and consider the role of Scottish Government guidance in relation to COVID-19 outbreaks in care homes, and calls on the Scottish Government to commence cross-party talks on the inquiry remit, in the interests of transparency and public safety.”

Thank you. It is very hard to keep to four minutes in this debate, so well done Ms Lennon. I call Alison Johnstone—you, too, have four minutes.

16:23  

I, too, thank all those who work in care and in our care homes. The clapping might have ceased, but they should be in no doubt that we appreciate the great value that they bring to us all.

Calls for public inquiries are not made lightly, and I appreciate that each and every party in the chamber agrees that there should be a public inquiry. Colleagues who have spoken have outlined their differing views on when such an inquiry should take place. I make it clear that, if the Conservatives had brought this motion to the chamber earlier in the pandemic, I would have resolutely opposed it. However, we now know that 2,048 people have died from Covid in Scotland’s care homes, that 44 per cent of the total deaths from Covid have occurred there and that families across Scotland are grieving. With loss of life on that scale in that specific setting, the case for a separate public inquiry on the issue is clear.

I appreciate that the Government’s amendment seeks an inquiry into all aspects of the response to the pandemic. I do, too, but including care homes in that essential endeavour—an inquiry of such scope—would lead to greater delay. I am gravely concerned for those people from whom we need to hear, who must be given every opportunity to ensure that we can hear from them. If we delay, there is no guarantee that we will have learned all the lessons. We may continue to put lives at risk due to a lack of complete understanding of what happened.

As we know, public inquiries investigate issues of serious public concern. They seek to prevent a recurrence of events that we would always wish to avoid. They need effective information gathering and management, and we need to know now that the necessary information is stored securely. There will be a requirement to ask for and gather evidence, to analyse documents and testimonies and to establish roles and responsibilities and the terms of reference. That must, of course, involve consulting residents and their families, bereaved families and the people who are working to look after them.

All of that will take time. Elderly spouses or partners and the families of people who have lost their lives may not be able to wait, nor should they be asked to. Our shared aim is to save lives and protect people, and the sooner that we understand all the contributory factors to the truly harrowing death toll in our care homes, the better. I believe that an inquiry is an important step to take now to ensure that we are doing all that we need to do in order to prevent avoidable deaths among our oldest citizens.

I welcome the fact that the Scottish Government commissioned Public Health Scotland to carry out work to identify and report on discharges from NHS hospitals to care homes during the first wave of the Covid-19 pandemic, and I welcome the care homes review. As has been said, the PHS report states that,

“after accounting for care home size and other care home characteristics, the estimated risk of”

hospital discharge may reduce and

“is not statistically significant”,

but that will provide no comfort to people who have lost loved ones. It also raises questions about the mitigations that are being put in place in larger care homes.

We now understand what is appropriate personal protective equipment in specific settings, why testing must include asymptomatic people and why masks are important, but do we understand all the interlinking factors that have led to the devastating loss of life in our care homes? I do not believe that we do, and we need to learn them now. The opportunity to do so should not be delayed.

16:28  

What has happened in our care homes is the tragedy of Scotland’s pandemic story. While it certainly did not do it out of malice, by sin of omission and commission the Government has failed some of our most vulnerable residents.

If we cast our minds back to the foothills of the emergency, our public health priority at the outbreak of the pandemic was to manage the spread of the virus in a way that allowed our front-line health services to cope. We all subscribed to that and absolutely understood it. In early spring, in those weeks of high infection, the Government frantically prepared for the tsunami of Covid cases with the construction of the NHS Louisa Jordan hospital and the rapid decampment of older people from our hospitals into our care homes.

The minutes from the Scottish Government’s Covid advisory group meeting on 2 April cover several topics, but two points stand out. First, our scientists were struggling to understand how the virus was moving around in Scottish hospitals despite infection control measures; secondly, the Government wanted to speed up the movement of elderly patients into care homes. The international health community had been screaming about asymptomatic viral transmission since January, yet the Government accelerated the movement of more than 1,500 hospital patients whose Covid status was unknown into care homes that had precious little PPE at the time.

In that decision lay what may well come to be regarded as one of the biggest public health disasters led by policy in this country. Our rate of care home deaths is much higher than the rates that have been recorded elsewhere in these islands. To make matters worse, we now know that the Government was releasing into care homes patients who had tested positive for Covid-19, which put a time bomb at the heart of the most vulnerable homes in our country. For me and my party, that is unforgivable.

Beyond the early death of care home residents, which could and should have been avoided, another misery that has been visited on the residents of this nation’s care homes and their families has been the isolation that they have experienced. For the best part of nine months, tens of thousands of Scottish people living in care homes have had to go without the physical contact and presence of those whom they love the most. That has caused untold harm to the mental wellbeing of people who were struggling in any case.

Many family members made an appropriate point to the Government in a demonstration outside Parliament that I and other members, including Monica Lennon, attended. They highlighted that family members are not just sightseers nor do they come to a care home just to have a cup of tea. They are there because they care and they want to be part of the physical care of their loved ones. They are unpaid family carers and, as such, they take health and infection control measures as seriously as any agency or in-house staff would. In fact, they go further, and they made this point to us at the demonstration. Family members who go into care homes act as informal inspectors—they pick up on problems, things that have been missed or corners that have been cut. That function has been lost to our care homes for the time that we have been denying those families access.

I am grateful to the Scottish Government for moving on the matter. I very much hope that we will start to see life being breathed back into our care homes. That is not to denigrate the very hard work of our care home staff, who have worked tirelessly to make the situation as bearable as possible. We need to ensure that that continues. However, we also need a public inquiry, so that we can learn from the mistakes at the start of the pandemic in order to avoid the future mistakes that may still come.

We move to the open debate. I ask members for tight four-minute speeches.

16:32  

I, too, thank care home workers for the compassion that they have shown during the pandemic.

This is a really important debate: 2,000 people have died from coronavirus in Scotland’s care homes, which is 47 per cent of coronavirus deaths in Scotland. The facts speak volumes, and delay, spin and sleight of hand cannot gloss over SNP mistakes that led to the highest rate of care home deaths in the UK.

Would the member like to elucidate on what delay, spin and diversion—I think that that was the other term that she used—I, as cabinet secretary, have engaged in?

As I make progress through my speech, I shall engage with the cabinet secretary on the delays and the publishing of guidance that was removed from the Government website.

We cannot begin to imagine the anguish that has been experienced by the families who have lost loved ones in care homes. The Scottish Government knew that older people were vulnerable, but it threw a match on a petrol-soaked problem, with guidance stating that elderly patients could be discharged from hospital before their test results came back, risking the introduction of yet more infected patients into care homes.

When she was questioned, the Cabinet Secretary for Health and Sport admitted that she had “not seen absolutely yet” guidance before it was revealed that that guidance had been published in error and removed from the Scottish Government’s website. Families have been let down, and—as my colleague Donald Cameron pointed out—that is nothing short of a scandal.

It is upsetting to know that constituents of mine were potentially put in danger by the Government’s actions, but the Government’s failure to take proper action to investigate why that happened really rubs salt in the wound. Furthermore, the Scottish Government report was delayed, and the First Minister has still not answered the question about when she knew that Covid-positive discharges to care homes were happening. Why was that allowed to happen? Families across Scotland have been left speechless, and now, during these difficult times, they are grieving without knowledge of the full picture. The Scottish Conservatives will fight to ensure that they get those answers.

We need to see more data on what has happened over the past eight months. We know that 3,000 patients were transferred without a test and that 113 Covid-positive patients were knowingly sent from hospitals to care homes across Scotland. Between 1 March and 31 May 2020, 137 people were discharged from Borders hospitals into 20 of the 26 care homes across the Borders. We do not know, however, how many Covid-positive patients were discharged. That is causing significant concern—a point that the Cabinet Secretary for Health and Sport can perhaps address immediately. It is imperative that the Government provides clarity on the statistics at a local level. In my constituency of Ettrick, Roxburgh and Berwickshire, people want answers, and that is the least that the SNP can do.

The Government has demonstrated a complete lack of ownership of the problem, which happened entirely on its watch. The First Minister has still not answered the question about when she first knew about the Covid-positive discharges to care homes and what action she took to investigate the situation. The SNP’s tactic has been to blame others for mistakes. Both Nicola Sturgeon and Jeane Freeman blame clinicians, yet we know that the SNP Government had the policy in place. It ignored advice and chose to make dangerous decisions.

When it comes to the detail of Public Health Scotland’s report, the SNP Government fails to take proper ownership. It claims that the report does not show a statistical link between the transfer of patients and the further spread of the virus. Public Health Scotland states in its report that it

“cannot exclude a moderate to large excess risk from a care home receiving a discharge where the last test was positive.”

It will not bring back our loved ones, but we need a full public inquiry into this national tragedy now.

16:36  

Covid-19 is the biggest public health crisis that we have faced in our lifetime, and the impact on care homes across the world has been profound. Every life lost to the virus is a tragedy and a loss that will be deeply grieved by loved ones. I send my condolences to anyone who has experienced the loss of a loved one to this serious virus. I also thank care home staff for their valuable work.

As I listened to the speeches so far, I reflected on where I was, and where we all were, at the start of the pandemic. We did not know a lot about the virus. I was one of those folks who was eager to return to the NHS front line and to help with what Alex Cole-Hamilton has just called the “tsunami of Covid cases” that we expected to receive in hospitals across Scotland.

I am clear that the Public Health Scotland analysis does not find statistical evidence that hospital discharges were associated with care home outbreaks. As a direct response to the Conservative motion, I can say that the First Minister and the health secretary have confirmed that a public inquiry will be held that will look into every aspect of the crisis, including what has happened in care homes. However, we are in the midst of an increase in cases—a second wave of the virus—and right now is simply not the time for a public inquiry, although I agree that one is needed and I welcome the commitment that it will happen.

It is important to note the point that we have got to. The health secretary commissioned the Public Health Scotland report in August

“to identify and report on discharges from NHS Hospitals to care homes during the first wave of the COVID-19 Pandemic.”

The report was commissioned because it is right that residents, families, staff and the Parliament have accurate data on and independent analysis of the transfer of patients to care homes and the impact on care homes.

The report states on page 42 that

“The analysis does not find statistical evidence that hospital discharges of any kind were associated with care home outbreaks.”

It also states that PHS

“cannot statistically exclude the presence of a small risk from hospital discharge. By comparison though, the risk of an outbreak associated with care home size is much larger than any plausible risk from hospital discharge.”

The cabinet secretary has already described that.

The report notes that 3.7 per cent of care homes with fewer than 20 registered places had an outbreak over the period. In comparison, 90.2 per cent of care homes with more than 90 places had an outbreak over the same period. The report noted that hospital discharge was

“associated with an increased risk of an outbreak when considered on its own. However, after accounting for care home size and other care home characteristics, the estimated risk”

was not “statistically significant.”

The Scottish Government will take forward the recommendations that PHS makes in its report, and PHS will now carry out further work to give a more detailed understanding of Covid-19 outbreaks in care homes. The Scottish Government will act on the areas in which the report’s conclusions highlight the need for additional measures.

I welcome the steps that the Scottish Government has already taken to ensure that additional safeguards, such as testing when clinically appropriate, are in place when discharge from hospital into care homes takes place.

Guidance has been clear—

You must conclude.

I will conclude, Presiding Officer.

I welcome that the Scottish Government will continue to—-

Conclude means conclude, wherever one is on the planet.

16:40  

I declare an interest as my mum is a resident in a care home and my wife and daughter work in the NHS.

I have never worked in a care home and have never been a resident in one. With that in mind, I have to relay what carers and those for whom they care have told me and try to put myself in their position.

Imagine that it is March of this year and that you are an 81-year-old patient in hospital. You have been there for six months and have been ready to go home for 12 weeks but have been told repeatedly that the reason why you cannot leave the hospital is that there is no care home place or package to support you. Imagine then being told at short notice that a place has become available and that you are moving today, although not to your own community, among the people you know, but many miles away, and that you have to move there, as it is the only place that is available.

Imagine watching TV on that same day and hearing that a virus that results in the deaths of hundreds of thousands of older people just like you is sweeping the world. You see the news bulletins that show multiple deaths at care homes across Europe, and the haunting image of undertakers removing bodies. Imagine then being discharged alone, with limited family contact and without an assessment of your needs and without being tested.

Imagine working in a care home on minimum wage, in a place that is regularly short staffed and has been for years. Imagine that you have to take in more residents and that the company that you work for cannot provide you with appropriate and safe PPE to protect you, keep your residents safe and allow you to do your job. Imagine that that company is registered in a tax haven, pays negligible corporation tax and posts regular, healthy profits. Imagine going home at night—every night—to see the news headlines of more and more people dying in care homes just like the one you work in.

Imagine reading newspaper reports of multiple care home deaths—such as happened on Skye—and wondering, “Are we next?” Imagine listening to politicians who claim that we have the best testing capacity in the world at a time when neither you nor the residents you care for have ever been tested. Imagine caring for Covid-positive people who have become seriously ill and then being told that they must not be admitted to hospital for treatment.

Imagine being Covid-clear as a patient in hospital but finding yourself ill from Covid a few days after you are moved to a care home. Imagine realising that, as you worked and tried to keep people safe, you were inadvertently spreading Covid because you had never been tested.

Imagine being vulnerable, living among new people you do not know and seeing the Covid crisis growing. Feeling scared and alone, you are unable to hold the hand of your son and daughter or even to speak to them. Imagine being asked to agree to a do not resuscitate order without a discussion with your general practitioner or your closest family. Imagine seeing your friends and neighbours—other residents—die without their family around them and being laid to rest with a handful of mourners.

Too many of our mums, dads and grandparents, our friends and our family have no need to imagine those things—they happened to them in Scotland in 2020, and that is to our eternal shame.

16:44  

I welcome this short debate, and I thank the Conservatives for securing it. I agree with Donald Cameron’s comments regarding the activities of staff in care homes throughout the Covid pandemic.

In preparation for the debate, I spoke to my staff to clarify how many of my constituents have been calling for an immediate public inquiry, as per the Conservative motion. The answer is none. Some constituents have contacted me to raise issues and concerns about PPE and about access to local care homes but, in the main, constituents who have contacted me—

Will the member take an intervention?

Let me finish my point.

Most constituents who have contacted me about care homes have been fairly positive about their experiences. Not one person has called for an immediate public inquiry, as the motion does.

Incredible! Absolutely incredible! How many constituents have contacted your office asking for a hate crime bill or an independence referendum while all this is going on? I honestly cannot believe that you have the gall to stand up and say that in Parliament. It is shameful. [Interruption.]

You are all wasting your debating time.

Mr Findlay, I know that it is a teacherly thing to say, but please do not use the word “you” in the chamber. I have said over and over again that I like things to be proper.

I am telling members about the number of constituents who have contacted my office. I am sorry if Mr Findlay does not appreciate the fact that not one constituent has contacted my office asking for an immediate public inquiry. I am sorry if members do not accept that, but it is a fact.

Members rose—

I am sorry, I have already taken an intervention.

I want a public inquiry to take place, but I genuinely do not think that it is right to have one according to the timing that is set out in the motion. The families of the 2,048 residents who have passed away as a result of Covid-19 deserve answers about what has happened, so it is absolutely correct that an inquiry should happen. However, I believe that attempting to have an immediate inquiry is the wrong thing to do. We are in the midst of a second wave of Covid-19, so we need to focus on dealing with the pandemic that we face. We do not know what will happen after the second wave; members need to appreciate that.

On multiple occasions, the First Minister and the Cabinet Secretary for Health and Sport have confirmed—we heard it again today from the cabinet secretary—that a public inquiry will be held that will look into every aspect of what has happened. That is the right thing to do—it is vital for accountability, and in order to ensure that lessons are learned, going forward. However, our attention must be on the crisis at hand so that we ensure that we are as prepared as possible for dealing with a second wave of the virus.

I am conscious of time, so I will conclude. I want a public inquiry—but not at this time, as per the motion.

16:48  

I am pleased that we have been able to have the debate, because it is vital.

Since the outbreak of the Covid-19 pandemic, some of our most vulnerable constituents have faced conditions and dangers that should cause enormous concern to members across Parliament. We are all well aware of their plight, and we all have a responsibility to make sure that the problems are addressed quickly.

However, too often in the chamber, we have heard warm words about our older population—words such as “respect”, “choice” and “dignity”, while the reality has been quite different. Too often, the Scottish Government has substituted rhetoric for real action.

Our social care system remained low on the Government’s agenda. The consequences of that have been apparent for a long time, but are now even more clear because earlier this year our care homes faced a new virus that disproportionately affects elderly people and those with underlying health issues. However, instead of action from the Scottish Government to support efforts to protect those residents, care homes saw their residents being put at risk through discharge into care homes of untested patients from hospital. The result is that those care homes, which should have been some of the most shielded settings and sanctuaries for their elderly and vulnerable residents, have been battling Covid infections since the start of the pandemic. The cost of that is stark: more than 2,000 residents have lost their lives, so far.

I spoke recently in a debate about social care staff and acknowledged again their remarkable efforts and commitment. However, those staff, while they have been on the front line in the fight against Covid, have often been left at the back of the queue for help. They were late in getting vital supplies of PPE and late in being provided with adequate testing.

In my region, I have seen directly how the testing regime that was promised by SNP ministers simply was not working. When one care home in Moray identified a confirmed case of Covid, getting testing for staff and residents—testing that we were assured, by the health secretary and the First Minister, should be routine—was an almost impossible struggle. Despite the case being raised with the First Minister and the health secretary in the chamber, it took two weeks for testing to start and three weeks from identifying the first case for all results to come back. What did they find? They found three more cases—two of which were asymptomatic and both of them staff. Residents and staff were put at further risk while Government ministers here in Edinburgh gave assurances that bore no relation to what was happening on the ground.

Care home residents, their families and the staff who work in the care homes still have deep concerns. As we enter the early stages of the second wave, they remember the experiences of the first.

Although we have to protect the physical health of care home residents, we must not ignore the importance of also protecting their mental health. Too many have been unable to see family and friends, and have been left isolated because safe visiting options have, for many, been completely absent. The impact that that is having on their mental health and wellbeing is enormous. There are too many stories of people coming to believe that life is not worth living or—most heart-breaking of all—dying alone without their loved ones around them. The Scottish Government must work with the social care sector to ensure that the guidance and resources are in place so that care homes can allow residents safely to see their families.

We do not know for how long the virus will continue to be a threat, or for how long it will continue to separate families, and we still do not know that all our care home residents are safe, but we do know that too many have lost their lives already and that lives will continue to be lost. I therefore fully support the view that there is a need for an urgent judge-led independent inquiry. That inquiry would look in more depth at the challenges that the sector faced and the response of the Government and its agencies, and—so that lessons can be learned to prevent more loss of life—find out what went so badly wrong.

16:52  

I wanted to take part in the debate because I hope to provide some reassurance and clarity for the families and loved ones whose relatives have tragically lost their lives in care homes throughout the pandemic.

None of us in the chamber is a stranger to the devastating statistics that we saw about care homes at the beginning of the pandemic. Constituents have contacted me after losing loved ones; I continue to offer them my deepest sympathies and condolences. I also believe that the families of those care home residents have a right to know what happened, and to know whether hospital discharges to care homes were to blame. After all, those who have lost members of their families are the most important people in the process.

That is why I am glad that the Cabinet Secretary for Health and Sport, Jeane Freeman, commissioned the report on hospital discharges from Public Health Scotland. It has been acknowledged from the start that the Scottish Government might get things wrong, so it is important that the circumstances were investigated and that we learned from the report.

What we learned is that hospital discharges into care homes had no significant impact on the risks of an outbreak in care homes, but other factors, including the size of the care home, did. We know that the more residents, staff, visitors and community admissions there were, the higher was the risk of a Covid outbreak. Larger care homes have increased healthcare requirements and more people interact with them in order that they can run smoothly in all their operations.

Only 3.7 per cent of care homes with fewer than 20 places had an outbreak between March and June, while 90.2 per cent of care homes with more than 90 places had an outbreak during that period. That dramatic difference is significant—the size and capacity of care homes are playing major roles. There are many large care homes throughout Scotland. We need to investigate further to ensure that we get things right and to ensure the safety of residents, staff and their families in those environments. We might have to look at different and radical ways of tackling the issues that have been highlighted by the pandemic. Those decisions will be made in due course.

Countries throughout the world have similar findings, so we are not tackling the issue alone—and tackle it, the Scottish Government has. It did not waste time on generating guidance to hospitals and care homes that anyone leaving hospital or a care home should be tested. For those who tested positive, there was clinical interest in their discharge, with a mandatory risk assessment and 14-day isolation.

The cabinet secretary has said time and again that the wellbeing of staff and residents in care homes is one of her top priorities. As everyone else in the debate has done, I congratulate and thank care home staff for their on-going work. They are working with Health Protection Scotland, local public health teams, health and social care partnerships and others to monitor, direct and guide services.

The Care Inspectorate has been given an enhanced role with enhanced duties, including on reporting. There is at least weekly, and sometimes daily, contact. Public Health Scotland is immediately told of Covid outbreaks in care homes, which allows it to provide specialist infection-control advice, guidance and support. I have confidence that the Government will work with them and learn from the findings in the new report.

Although I support the call and acknowledge the need for an inquiry into what has happened, I do not think that now is the best time. We need more information, more evidence and more time. We are going through a worldwide pandemic. We must ensure that, when we hold an inquiry, we do it properly, and that there will be a legacy for care home residents.

16:57  

This has been an important debate, and I am grateful to all members for their contributions. In her opening remarks, the cabinet secretary said—I am paraphrasing—that we are all committed to holding a public inquiry. I accept that. She also said that her disagreement is only about the timing. However, the timing is crucial. Alison Johnstone made a considered contribution in which she said that, if we delay, there is no guarantee that we will learn all the lessons that we need to learn and we could put lives at risk.

I acknowledge and welcome the fact that the Government has made important commitments in recent weeks and days. George Adam touched on that. However, we need to go further. We cannot afford to be slow and to be reactive.

I welcome the adult social care winter preparedness plan, which was published yesterday. However, I also reflect that GMB Scotland wrote to the First Minister back in March asking for a national plan for social care.

We have been hearing people say a lot that, with the benefit of hindsight, we could have done X, Y and Z. I pay tribute to low-paid and front-line workers who have been speaking out since the beginning of the pandemic. We owe it to them to act now.

There are immediate issues that need to be raised. For example, in a briefing today, the Royal College of Nursing Scotland asks where the workforce will come from to cover sickness absence and to support care homes during the winter. We went into the pandemic with about 3,600 nursing and midwifery vacancies in the NHS. We know that we have big challenges to address now.

The clinical guidance for nursing home and care home residents that was published on 13 March, and updated on 26 March, has been referenced today. It also says:

“It is not advised that residents in long term care are admitted to hospital for ongoing management but are managed within their current setting.”

We have still not had sufficient explanation as to why that guidance was in place, or a reassurance that, as our NHS buckles again under pressure, those same decisions will not be made. Members have mentioned the pressure that has been put on people to have in place “Do not attempt to resuscitate” orders. Hospital beds are filling up. We cannot have a situation again in which care home residents are denied access to hospitals.

I point out that we are still seeing blockages in data coming through—for example, members from across the chamber are struggling to get responses to freedom of information requests. I was pleased that, last night, the Minister for Social Security and Older People gave me a commitment that she would get me answers from NHS Lanarkshire on issues that I have raised about whether particular care homes received patients who were positive for Covid. The health board has said that it cannot provide those answers, so how can we have confidence in the report that Public Health Scotland published last week?

I have a few seconds left, so I will pick up on other points that have been raised in the debate. As Alex Cole-Hamilton said, the role of family care givers is crucial. There are other areas in which we need to do more. Infection prevention and control should be an enabler to families having contact; it should not be a barrier. I also appeal to the Scottish Government to take on board the suggestion—made not just by me but by campaigners for older people—that in Scotland we should have an older people’s commissioner. That is not a new idea—I think that Alex Neil raised it back in 2005 or 2006—so let us get it done.

If the motion is agreed to, Scottish Labour will work constructively with the Government and will participate fully in cross-party efforts to shape the terms of a public inquiry, build public confidence and do everything that we can to protect lives.

I call the cabinet secretary, Jeane Freeman, to close the debate on behalf of the Scottish Government.

17:01  

There is no question but that a public inquiry should take place. However, I want to be clear about the requirements for the holding of a statutory public inquiry—and such an inquiry should be statutory.

As I have said, I welcome discussion from members across the chamber on the draft remit and scope of such an inquiry. As Ms Lennon has said, it should also take a human rights-based approach. I agree with her, and the Scottish Government will support the amendment in her name. However, it would be for the judicial lead in such an inquiry to make a final determination on its remit and scope, on the information and evidence that he or she would require, and on how the inquiry would proceed.

I am sorry, but I do not believe that people can examine the Scottish Government’s response to the pandemic—and get the answers that they seek and which we need to learn from and apply—by focusing solely on one aspect of that response, as the motion suggests.

Alison Johnstone set out clearly exactly how a public inquiry goes about its business. I believe that, in doing so, she proved my point precisely. Such an inquiry is not an immediate exercise; rightly, it takes the time that is required to do its job properly. [Interruption.] No, I am not taking any interventions.

As case numbers rise, as we battle to suppress the virus again and as, after an already very tough year, our NHS and social care staff gear up for a long and difficult winter, now is not the right time to divert their resources to respond to the rightful demands of a public inquiry.

I refute absolutely the suggestion that the Government is hiding, spinning or avoiding any issues or demands on how we have already responded to the pandemic or how we will do so in the weeks ahead.

Will the cabinet secretary take an intervention?

No; I will not.

Why will you not take my intervention?

Mr Findlay—no.

You are not avoiding anything?

No, I am not avoiding anything, Mr Findlay.

Excuse me, everyone. You cannot hold your own little debate across the chamber. If the member is not taking interventions—

My apologies, Presiding Officer.

Excuse me, cabinet secretary. Please sit down for a second.

My understanding is that, when a member says that they are not taking interventions, they mean that they are not doing so—end of.

I call the cabinet secretary.

Thank you, Presiding Officer.

I have only one final point to make. The issue here is all about timing. We must ask what is the right thing to do, right at this moment, and what is the right focus not only for the Government but for our NHS and social care staff. It is how we continue to suppress the virus and steer a safe course through the coming winter months. Winter is always difficult; in the context of the Covid pandemic it will be even more so for every single one of us but mostly for our front-line NHS and social care staff.

Therefore I do not believe that this is the right time to divert that resource away from the important work that they do so very well, in order to set up an immediate public inquiry. There will be such an inquiry, and I will work with colleagues from across the chamber to agree its draft remit. We will go ahead and do that when we are through the immediacy of the pandemic.

I ask members to support the amendment in my name.

17:04  

I am pleased to be closing this important debate on behalf of the Scottish Conservatives. As others have done, I thank the incredible staff and carers who have looked after our most vulnerable in such difficult times with such dedication and professionalism. There are so many stories of compassion and dedication and it is important, when we have these debates, that we always caveat our comments by acknowledging the debt that we owe our care staff and our NHS staff.

We are all aware of the difficult decisions that no Government would want to have to make. It is clear that Governments across the world have struggled to create a route out of this crisis and that is why, when the Scottish Government called for cross-party support for its efforts to tackle Covid-19, the Scottish Conservatives put party politics aside, as did all other parties in the chamber, recognising the seriousness of the situation. That does not mean that Opposition parties waive their right to scrutinise the Scottish Government.

The subject has returned to the chamber because it is so important. Moreover, it is the lack of satisfactory answers to consistent parliamentary questions and scrutiny that ensures that we will continue to seek answers to the many questions that we continue to be asked by constituents on the continuing care home tragedy.

Let us be absolutely clear—all Government responses, including those in the other UK nations, have been seriously flawed. This is no time to hide behind party politics. However, it is our job, in this place, to scrutinise and question Scottish Government decisions and I know that I and many of my colleagues continually raise the care home crisis with the Scottish Government on behalf of our constituents. Hardly a day goes by without care homes being the subject of emails and phone calls to my office. It seems increasingly clear that there has been mistake after mistake in the handling of the most vulnerable in our society. As has been said, in Scotland, there have been 2,048 tragic deaths from Covid in care homes since the start of the pandemic—some 45 per cent of all Covid deaths. A Public Health Scotland report revealed that over 113 patients were sent to care homes, despite testing positive for Covid, and some 3,061 patients were discharged into care homes without being tested.

The cabinet secretary recognised the risk of patients being transferred into care homes, but citing clinical decisions or advice surely cannot be acceptable. I listened to Neil Findlay’s speech, which I thought was very good, and I am sure that he would agree with me that although he and I are not clinicians, we do not need to be clinicians to work out for ourselves that transferring positive Covid patients into a care home environment is extremely dangerous, especially given that the reproduction number is estimated at over 10 in that environment. I say to George Adam that the reason why care homes with the greatest capacity have the greatest Covid outbreaks might be because they accepted most of the Covid positive cases into their homes.

It was acknowledged and accepted right at the start of the crisis that mistakes would be made; the main and recurring issue that I have is with the Scottish Government’s continual attempts to hide the truth—to hide from simple parliamentary scrutiny. Take the simple question, “When did you know that Covid positive patients or patients who had not had a test were being transferred into care homes?” How many times has that question gone unanswered? Had it been answered the very first time with a degree of honesty, it would not be the issue that it has become.

The biggest question to my mind has been about the Scottish Government’s initial response and its lack of learning since. We watched the virus begin in China, move across the world, and move across Europe towards us with devastating effect on countries such as Italy, Spain and France, especially on the most vulnerable, yet we were still caught unprepared. I asked the cabinet secretary about that and her response was that we did the same as everybody else. Why did she do the same as everybody else? What different outcome did she expect? The wise learn from their mistakes and the truly wise learn from other people’s mistakes. Protection of the most vulnerable in our society should have been better than it has been.

Even now, after nine months of the pandemic, with all that we have learned, the care home sector is still being let down by the Scottish Government. Not only have too many care home residents tragically lost their lives to Covid, too many are still being denied contact with loved ones during the twilight of their lives.

I have raised the point many times in the chamber that the Care Inspectorate, under the guidance of the Scottish Government, has significant influence over the way in which private and council care homes are run, so surely it was not beyond the wit of the Scottish Government to ensure that Covid-safe indoor environments were created in all care homes. Instead, we have heard over and over about short meetings with loved ones, outdoors, in poor conditions.

That tells me that the Scottish Government is not looking ahead or planning ahead and that it is not learning the lessons that must be learned, which is exactly why a public inquiry is essential now. As Alison Johnstone said in her speech, lessons have not been and cannot be learned if the Scottish Government refuses to accede to proper parliamentary scrutiny or to answer straight questions.

As I said, it was accepted that mistakes would be made and that advice would be ever changing as we learned more about the virus, but keeping the Parliament from effective scrutiny only increases the Parliament’s suspicion. The virus is not going away, despite what many of us thought would have happened by now. The response across the world, including from the Scottish Government, has been far less sophisticated than it should have been by now.

It is time to take a breath. We all recognise that terrible decisions have been placed in front of Governments, but the Scottish Government must own its poor decisions and mistakes. It must instruct a public inquiry now that will answer the public queries from those who have lost loved ones. Then we will be able to map a more cohesive and compassionate route out of the crisis in which we can all have confidence. Care home residents and staff, and families and their loved ones, deserve that at the very least. I ask members to support the motion in the name of Donald Cameron.