Meeting of the Parliament

Meeting date: Tuesday, December 8, 2020

Official Report 1042KB pdf

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Topical Question Time

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Covid-19 (Care Home Visiting)

I declare an interest, as my mum is a resident in a care home. To ask the Scottish Government what action it is taking to ensure that safe care home visiting can take place. (S5T-02571)

We continue to take a number of steps to support safe visiting. On 3 December, we issued guidance for care homes and visitors over the festive period, which reiterates that care homes should support indoor visiting where it is safe to do so. We are introducing asymptomatic testing for designated visitors as an added measure alongside personal protective equipment and infection prevention and control. The roll-out of 14 early adopter care homes started this week, and lateral flow testing kits will be delivered to all care homes across Scotland during the course of next week. Where a home cannot make initial use of the lateral flow devices, polymerase chain reaction—PCR—tests will be made available.

In addition to that, in consultation with directors of public health, Public Health Scotland and the chief medical officer, we now recommend that the period of closure to new admissions and to visitors following an outbreak is reduced from 28 to 14 days.

At the weekend, families of care home residents, health and social care workers, trade union representatives, MSPs from all the Opposition parties, lawyers, journalists, and public figures wrote to the First Minister about the lack of contact between families and their loved ones in care homes. Despite assurances that we can have regular visits of up to four hours and close contact including holding the hands of our loved ones, for the overwhelming majority of families, that bears no relation to reality. Families have even less contact than they did before the cabinet secretary’s announcements. This situation cannot continue.

Families have had enough of press releases about enhanced visiting and they are not prepared to tolerate being separated any longer. The cabinet secretary has claimed that she is powerless to act and that only care home owners and Public Health Scotland can do so. Will the cabinet secretary agree to immediate all-party talks so that we can consider whether we need to bring emergency legislation before the Parliament in order to facilitate safe and regular contact with our family members in care homes?

I am always willing to talk to all parties and do so regularly. I am happy to have the conversation that Mr Findlay talked about. The latest information that I have—before we roll out the lateral flow devices—is that about 40 per cent of care homes in which there is no outbreak are facilitating indoor visits, and a number of them will be facilitating four-hour visits.

As Mr Findlay said, however, what I can do is issue continually improving guidance. The guidance that we issued for Christmas and new year is significantly improved in making it really clear what care homes can do, what visitors can do, and what precautions people need to take along with the roll-out of regular asymptomatic visitor testing. All of that is designed to give care homes that are unsure about the risks that they might be taking more confidence in following the guidance on visiting. We also intend to continue our work with Scottish Care and others to look at specific care homes that have specific problems. Nonetheless, as I said, I am very happy to meet members from across the chamber to discuss that further.

That is excellent—I am delighted that the cabinet secretary has accepted that. I hope that her office can facilitate that meeting later today or tomorrow morning, because this is an absolute emergency for families. The cabinet secretary quoted a 40 per cent figure. Perhaps she could provide us with evidence of that at the meeting, because care home residents who have done surveys report fewer than 10 per cent of care homes providing that type of access.

We heard in October that indoor visits would be extended from 30 minutes to up to four hours. However, I know nobody who has had anything like a four-hour visit. We also heard about outdoor visits with up to six visitors and increased personal interaction, including hugs and hand holding, as long as PPE and infection prevention and control measures are met. That is fantasy for most families. I certainly dream of that happening.

Question!

I will ask a question when I get around to it. Do not be so ignorant. This is an extremely important issue.

Excuse me. Order, please.

If he thinks that this is not an important issue, he needs to have a word with himself. Clown.

Order, please. Let us not have bad-tempered comments or exchanges across the chamber. That goes for you in particular, Mr Findlay. You are on the floor and you have the microphone—nobody else has the microphone. Please continue.

Absolutely, Presiding Officer.

It is really important for families. Over the weekend, I have spoken to families who are prepared to take action that they really do not want to take, including legal action and the withholding of care home fees. I ask the cabinet secretary not to force families into doing that. We should have those talks, this afternoon or tomorrow, to see how we can remedy the situation, because it is absolutely critical.

I do not disagree for a minute with Neil Findlay on how important it is to families and to residents. I hear it when I meet the care home relatives group, as I did, most recently, last week. I also hear it from my constituents and from my family, so I absolutely understand it.

I am very happy to see what more we as a Government can do, but we should also be straight with people about the limitations regarding timeframe and action. I am happy to discuss that, but in circumstances in which care homes do not wish to follow the guidance and open up for visiting, we must not pretend that we could force them to do that, as that would need to be considered. Nor can we pretend that if we wanted to do it, we could do it quickly.

I am happy to look at and discuss that, but we must not set it up as some kind of binary position, in which people are on either the right or the wrong side. I think that Mr Findlay and I are on the same side. I might not be moving fast enough for him and I might not be doing everything that he wants, but we should have the discussion to see what more is possible.

Stuart McMillan joins us remotely.

We know that testing is no substitute for other vital layers of protection against Covid-19, the most important of which is following the FACTS guidance. In the light of that, will the guidance that is published following the trial phase include specific instructions for visitors on how to follow infection prevention and control measures?

The guidance already includes that, as well as information for care homes and their staff about how to help visitors follow the right procedures on personal protective equipment and hand hygiene. As Stuart McMillan knows, the point about PPE is not just about the PPE that is used; it is about the safe way to put it on and, in particular, to take it off, and the setting in which that should be done. He is absolutely right: testing is an important additional measure, but is not sufficient on its own. It needs to be surrounded by all those other aspects, such as PPE—absolutely—and good quality infection prevention and control in the care home or hospital setting.

I spoke to a group of care home relatives yesterday. It is clear that, as time goes on, their anguish and frustration grow. One issue that they mentioned was delays in the processing of risk assessments from care homes by health boards’ public health departments. Does the cabinet secretary acknowledge that problem? What can she do to solve it?

Care home relatives have raised directly with me two issues on risk assessment. In some instances—it would not be fair to think that this is the case across the whole country—the risk assessment takes a bit too long to be completed. In other instances, people feel that the guidance that they receive on a comparable issue is inconsistent between areas.

We have begun and we continue conversations about what we can do to address those issues with our directors of public health, bearing in mind that they are senior clinicians and have to exercise their professional and clinical judgment on individual circumstances. They need the room and the flexibility, within the overall approach, that allow them to do that. That discussion is under way in order to see whether there is anything more that we can do to improve that position.

Care home managers and operators are scarred by what happened in March. That is why it is really important that all members stand with them as they seek to make that difficult decision about allowing residents to meet their families in the care homes.

A person’s being safe and well is about not just the normal things that we think about to do with the virus but quality of life, which is why I want residents to meet their families as often as possible. I am sure that the health secretary agrees. What more can we do to build the confidence of care home operators and managers to make those difficult decisions?

I have consulted Scottish Care and I have met a number of care home providers directly, to hear what more they think that they need. They all said that they needed two things: additional support for the additional administrative work that they need to do, such as when they book in visitors or use our safety huddle tool, which gives them more work to do, and testing for visitors. I have responded to both requests. We have provided additional financial support so that staff can be recruited to take on additional administrative and other work, and we are rolling out lateral flow devices to provide testing.

Now that care homes have answers on what they said would help them to feel safer and more confident about people visiting—and longer visits—including in the circumstances that Mr Findlay described, we will follow that up, to see whether that comes to pass or there is more that they need to do or that we need to do to support them.

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Covid-19 Vaccination Programme

To ask the Scottish Government whether it will provide an update on the roll-out of the Covid-19 vaccination programme. (S5T-02576)

The first vaccinations began across all mainland national health service boards today. NHS Orkney will begin tomorrow, NHS Western Isles will begin on 10 December, and NHS Shetland will begin on 11 December.

Initial vaccinations are for national health service and social care staff, as I set out in my statement last week. Those vaccinations will take place in 21 sites, close to the vaccine deployment centres. From next week, we will begin to vaccinate care home residents and people aged 80 and over who are in-patients.

Three webinar training sessions, led by our deputy chief medical officer, Dr Steedman, have been held for the Pfizer vaccine. There were 4,035 attendees, who were a mix of vaccinators, pharmacists and other clinical colleagues.

The vaccine management tool went live from Tuesday 1 December and all cohort data for over-80s, care home residents and health and social care workers has now been community health index—CHI—matched and shared with boards, so that we can manage the data flow as people are vaccinated.

The freephone Scottish Covid-19 vaccination helpline went live today, on 0800 030 8013.

I thank the cabinet secretary. Last week, she and the First Minister committed to publishing the Covid-19 vaccination plan that was reviewed at Cabinet, as well as a national list of vaccination centres and information on how many storage freezers are in each health board. Can the cabinet secretary give a fixed date for the publication of that information? If not, can she give an indication of when the data will be published?

I can, indeed. The information will be sent to all members of the Scottish Parliament and lodged with the Scottish Parliament information centre tomorrow. It will include other information that I hope will assist members in answering their constituents’ questions about the safety of the vaccination, the regulation process and so on. We will follow that iteratively.

A point that I want to make, which I ask members please to hold on to, is that, as supplies arrive and as new vaccines are approved, as they might be, the information that we send them will need to be updated. We will be very clear in the information that we give members and the timeframe that it covers. Members should expect updates as more information becomes available to us.

We know that we have enough vaccine to vaccinate approximately 32,000 people. Approximately how many people will be vaccinated this week? Will the 32,000 number be reached by the end of December? Will the Government commit to publishing a rolling update on the number of people who are vaccinated each week?

We hope that, towards the end of this week, we will be able to give an indication of the number of people who have been vaccinated in this first week. Members should remember that the first week will not be comparable to any other week, because our vaccinators are handling a new vaccine and need to be sure about how they do that, which, in part, is why vaccination is taking place in centres near the deployment sites.

We are considering the frequency with which, thereafter, we will publish data that is robust and therefore publishable. I am happy to let members know the timeframe in which we will operate that. Again, information will be sent to members once we are confident about its robustness and accuracy.

As I heard Matt Hancock say this morning on “Good Morning Scotland”, although we have an indication of the volume of supply, we need to remember that Pfizer’s 174 approval for the vaccine—the approval to supply—means that every single batch needs to be batch tested. That will streamline over time, but, initially, that will create an extra element in the delivery chain. We therefore need to be confident that, as the vaccines arrive in the United Kingdom, are tested and so on and are on their way to us, we can say at that point how many additional doses we have. As we get to those various points throughout this month and into the next, we will make sure that members are aware of that.

I am going to squeeze in a couple of supplementary questions, if the questions can be brief.

What plans does the Scottish Government have to encourage maximum uptake of the vaccine by eligible groups?

A number of plans are in train, not least to supply proper information for informed patient consent. As I said last week, information will go to every household in Scotland at the beginning of March. There will be other aspects of marketing and public information. As we finalise the overall information plan over this month and the next, and probably into February, we will make sure that it is issued to members so that they know what to expect. However, in order that members can answer constituents’ questions, I would say that a lot of the initial plan concerns safety, the regulatory process, what to expect and so on.

I thank all the staff involved in the vaccination programme.

I was concerned to hear that some staff phone lines were jammed yesterday with front-line workers trying to book appointments for their vaccine. I know that NHS Lothian has apologised. What resources are in place to ensure that we do not get jammed phone lines? Will all the helplines and phone lines be free of charge? NHS Lothian has said that it will reimburse workers who had to queue for a long time for an appointment.

We are talking about one board out of 14 that had that difficulty. As Ms Lennon said, that board has apologised and has ensured that it has additional resources.

Boards are more likely to issue appointments and information to staff by email, because we prioritise within the patient-facing group of NHS employees to ensure that we see those NHS employees first who are most at risk from the virus. Understandably, perhaps, NHS staff are enthusiastic about the vaccine—that is good—and are contacting their board to book an appointment.

We ensure that the phone lines, which are the right source for staff or anyone else, are adequately resourced. Our national helpline certainly is.

It is important that NHS staff know that patient-facing NHS staff, particularly in Covid red areas—I am talking about intensive care units, high-dependency units, Covid wards and so on, and also primary care and our ambulance service—will be contacted first. That will often be by an email to their work account. In the initial stages, that may be done at relatively short notice, when we know that supplies are arriving. Boards need to know for sure that a supply is arriving before they issue appointments.

All of that will smooth out over the coming weeks. Initially, we will have those glitches and interruptions, but we will make sure that, every time that we have supplies of the vaccine, we are ready to vaccinate those who need it, in the order of priority that the Joint Committee on Vaccination and Immunisation has set out for us.