Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, June 9, 2020

Official Report 881KB pdf

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Topical Question Time

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Covid-19 (Publication of Figures)

To ask the Scottish Government for what reason it did not immediately publish details of the number of patients who have contracted Covid-19 in hospital. (S5T-02243)

Details of the total number of Covid-19 cases and deaths in each national health service board are published daily. Last week, we published initial unvalidated data on the number of suspected nosocomial Covid-19 incidents. The challenge is that, in all the data on nosocomial infection, it is not yet clear whether the individuals involved contracted the infection in the community prior to admission or in hospital.

The unvalidated information, which is a compilation of reports from health boards, shows that there have been 125 Covid-19 incidents, which are associated at the moment with a potential 901 patient cases, of which 870 are confirmed Covid-19 cases and 31 are suspected, and—sadly—218 deaths. In addition, the same unvalidated information indicates 894 staff cases, including both confirmed and suspected Covid-19 cases. However, that position is very far from being definitive at the moment, not least due to the long incubation period of Covid-19, as is recognised by the European Centre for Disease Prevention and Control.

I want to make available as much information as I can, as soon as I can, and information that is as accurate as possible. I will continue to do that. However, as I said in my letter of 4 June to Ms Lennon and in my response to the Government-initiated question on the same date, these are suspected transmissions, and to suggest otherwise would be wrong.

I am sure that the cabinet secretary will want to apologise to the families for the misleading picture that has developed around the spread of the Covid virus in hospital wards. The fact that she has referred to 125 incidents when we know that the number of deaths—[Interruption.] I hear SNP back benchers heckling me about the deaths that we have seen from Covid-19. It is important that we get clarity from this Government—[Interruption.]

Order. Let us hear the questioner, please.

Why did ministers decide to define almost 1,000 people as incidents? Will she now commit to publishing more accurate figures so that Parliament can have the true picture of what is happening in hospitals?

In publishing unvalidated data, I was attempting to be helpful. It is a lesson that I have now learned.

I say to Mr Briggs that I apologise to every single person who has lost a loved one as part of the pandemic. I think that we should all do that. Every single day, when we announce the numbers, we recognise that they are not just numbers but unique human beings who have been lost to their loved ones. If Mr Briggs thinks for one minute that I do not spend just about every minute of my day thinking about the impact of the pandemic, he is very much mistaken.

I will continue to publish validated data. Although it has been clear all the way through—in the GIQ, in the letter and in what I have just said to Mr Briggs—that these are suspected transmissions, suspected cases and suspected deaths linked to them, and that the validated data will be published—by the end of the month, I hope—Mr Briggs has chosen to take unvalidated data and pretend that it is validated. That is inexcusable. If anyone needs to apologise to the people of Scotland for sending them off with unvalidated nonsense, it is Mr Briggs. It is certainly not me.

The information was provided to The Herald by the cabinet secretary.

At the weekend, she admitted that hospital staff are not yet being tested regularly. Even more worrying is the fact that no plans have been published on how that testing is to be carried out. Today, surgeons have warned that a fifth of the patients who were treated for broken hips in March and April have gone on to contract Covid-19 while in hospital, and all of that is happening at a time when only a third of our testing capacity is being used. We have known for months that routine testing is vital to stopping the spread of the virus. Will the cabinet secretary finally accept that the Government’s failure to test staff has also created this situation?

In respect of the comments about orthopaedics that Mr Briggs has just made, that figure is estimated—the key word is “estimated”. When we validate the data, we will know how many of those cases—including among staff—and deaths came about as a consequence of hospital-acquired Covid-19.

As Mr Briggs should know well, Covid-19 has an incubation period of up to 14 days. We needed to reach a definition of nosocomial infection for this particular infection, as we have done for all other infections that might be acquired in hospital or healthcare settings. Now that a four-nations definition has been reached that complies with what the European Centre for Disease Control needs, Health Protection Scotland will work through the data against that case definition, and it will publish the results. In that publication, we will be able to see whether the estimate is accurate, but it will be an estimate—it will be suspected transmissions and estimated cases. If we are going to lead the country through this pandemic properly, and if—I gently suggest—the Opposition is going to scrutinise the Government properly, we will not take estimates and suspected data as fact; we will take what is fact and use it appropriately.

I have already covered Mr Briggs’s point about the testing of NHS staff. I need to know whether the chief medical officer’s scientific advisory group and the nosocomial group that involves the chief medical officer and scientists from outwith the Government, as well as the chief nursing officer, take the view that we should test all NHS staff on a seven-day repetition or that we should test all NHS staff in particular clinical settings such as cancer and outpatient departments.

It should be remembered that Governments across the UK have said from the outset that we will be informed by the science and clinical advice. Once we have that information, I will make the decision about how we will institute the testing. I have already asked for a delivery plan to be prepared for that information. Once that is done, I will make sure that Mr Briggs and members of Parliament are advised of what is happening.

We are now three months into this crisis. Cancer services need to have this testing in place. After three months, that is not happening. Scotland has a capacity of 15,500 tests a day but barely one third of those tests are being done. That is a national scandal and ministers should be taking action to ensure that the tests are utilised.

That failure has meant that people have entered hospital without coronavirus and have caught it there, and they have died when the testing could not be provided.

In terms of where we are today with the development of test and protect, where has test and protect been for patients in Scotland?

Mr Briggs should please, please, please not assert what he does not know. He asserts, yet again, on the basis of suspected transmission, that people have caught the virus in hospital and have died. He does not know that and neither do I. When the data is validated—[Interruption.]

Mr Briggs is mumbling at me; he should be listening. When the data is validated Mr Briggs will know it, I will know it and we will deal with the facts at that point.

On using testing capacity, we have increased testing from a starting point of 350 tests per day in two NHS labs to 15,500. There is a point about using the testing for a purpose. Tomorrow, we will publish the data that I promised we would publish on the use of testing in our care homes of asymptomatic staff, and residents and staff in care homes where there has been a case. We will publish that data every week, and so we will see the progress that is being made by health boards against national policy. When I have the clinical advice that I have asked for, that will match the delivery plan that has been commissioned on testing NHS staff.

The other area of testing, which is under way, is for all over-70-year-olds who are admitted to hospital. Surveillance testing is also under way and there are plans to expand it.

The final area is that of those individuals who are symptomatic, whom we ask to go for a test straight away. At the moment, I do not expect that number to be high, because—Miles Briggs will understand this—we know from the R rate and the published data that the level of transmission in Scotland at this point is much lower than it was.

We might see that particular number increase as we release lockdown measures, so test and protect is a vital tool. Miles Briggs needs to understand, do the homework and pay attention before making such assertions.

The cabinet secretary and Miles Briggs need to understand that arguments in the chamber will not bring back the people who caught Covid-19 in hospital and went on to die. Let us stick to some facts: I spent an hour on the phone today with a constituent who is absolutely heartbroken. Her mother was in hospital for several weeks, saw no one, was shielded from family and all visitors, was in a room on her own and died from Covid-19—it is on the death certificate.

Families such as that of my constituent need answers. In this case, my constituent wrote to the First Minister weeks ago and got a reply from an official who told her to go to the ombudsman if she was not happy. That is not good enough. Families deserve answers and an apology; they need an independent inquiry to get to the bottom of this and, most important, we need such an inquiry to have confidence that, as we restart our national health service, people, patients and staff will be safe.

WIll the health secretary grant the public an independent inquiry?

I absolutely agree with Ms Lennon that none of this arguing back and forth will bring back people who have died as a result of the pandemic, whether as a result of nosocomial infection or of the impact of the virus on them in another regard. That is a huge matter of regret.

I also agree that people need answers. When the data is validated, we can have a conversation on two matters. First, we can talk about the actual numbers. Secondly, we can discuss why we think those cases happened, what the nosocomial group is doing and what it is telling us—me and members, too—because we will make that information available about how the virus was transmitted in that hospital setting. There are a number of possibilities on which I will not speculate—I am sure that Ms Lennon knows them as well as I do.

We can talk about the group’s view on how the virus could be transmitted and its views therefore about the additional steps that we should take. I have asked the group, now and once the data is validated, to consider not only in what way it thinks it possible that the virus has been transmitted in a hospital setting, but what more we need to do—other than what we are doing currently with red/green or hot/cold zones, infection prevention and control and the supply of personal protective equipment—with regard to additional environmental cleans, the testing of staff, which is absolutely part of the matter, and the wearing of masks in all clinical as well as non-clinical settings, including in staff canteens and so on.

All that information will come to me shortly. I am very happy to share it with Ms Lennon and others. Let us see then whether we can do more, first, to try and give an answer to her constituent as well as mine—who wrote to me last night on exactly this matter—and to all those families and, secondly, to be sure that we are doing everything that we need to do. I want us to focus on that. Whether an inquiry is held into any aspect of how this pandemic has been handled by any party, and whether that happens in the near future or at a more distant time, will be a decision for another day.

What I need to do right now, as I am sure that Ms Lennon agrees, is focus on what we need to do to ensure that we mitigate and minimise the possibility of nosocomial infection in our hospital and healthcare settings. That is what our next conversation should be about.

Five more members want to ask a question.

There are scores of examples in the academic literature of blanket testing having detected a large number of asymptomatic individuals. Imperial College London researchers advise that transmission from those tested can be reduced by a third by routine testing, and the Organisation for Economic Co-operation and Development now advises regular testing for at-risk groups. Scientists are calling asymptomatic transmission

“the Achilles’ Heel of Current Strategies to Control Covid-19”.

While we ask questions in this chamber, asymptomatic carriers could be walking around hospitals, with the potential to infect patients and high-risk staff such as black and minority ethnic doctors and nurses. Does the cabinet secretary agree that the on-going absence of routine regular testing in our hospitals is indefensible?

I agree that it is self-evident that the information and evidence have now taken us to a place where testing of asymptomatic individuals in particular settings makes sense and is the right thing to do. That is why testing of asymptomatic care home workers in care homes that have no cases is now part of the policy—and data on performance in that regard will be produced tomorrow and in subsequent weeks.

It is also evident that I agree that that makes sense in the healthcare setting, as I think that I set out to Mr Briggs and Ms Lennon. In particular settings, where the clinical advice points me to this, the testing of individuals, particularly staff, who do not have symptoms, is the right precautionary measure for us to take, along with other precautionary measures.

In doing that, we need to ensure that we have the right delivery plan. I have commissioned the delivery plan and I am waiting on advice from the CMO and chief nursing officer, which will be with me shortly. At that point, we will begin to do exactly that—I expect in particular clinical settings; as to whether there should be a wider approach, the advice from the CMO and CNO will tell me what they think I should be doing.

What additional steps are being taken to better understand and address the impact of nosocomial transmission of Covid-19?

As with all healthcare-acquired infection, we needed to reach agreed definitions of probable and definite healthcare-acquired cases. By and large, that relates to the incubation period of a particular infection.

The agreement across the four nations—so that we all do this in exactly the same way—is that it is a probable healthcare-acquired Covid case when a positive sample is taken when an individual has been in for more than seven days but fewer than 14 days, and that it is a definite healthcare-acquired Covid case when a positive sample is taken more than 14 days after admission. Now that we have that definition, we will use it to validate the data, which will involve looking at dates of admission and discharge for all cases, including staff.

In addition, as Ms Harper knows and as I said, there are at least two patient pathways in hospitals, as has been the case since we repositioned the national health service to deal with the pandemic; we also have protective personal equipment, infection prevention and control—a central feature of our acclaimed Scottish patient safety programme—and additional environment and equipment cleaning.

I expect that the advisory group will suggest to me the testing of staff in particular settings, additional environmental and equipment cleaning, and the wearing of masks by healthcare staff in clinical and non-clinical settings—for example, as I said, in staff canteens. All of that is designed to protect staff and militate against transmission, particularly as, increasingly, there is recognition of asymptomatic transmission—albeit that not every asymptomatic individual who is known to have the virus will shed the virus. A great deal of scientific work is still going on to refine that, so as to be sure about which symptomatic and asymptomatic individuals are infectious to others, and which are not.

The Cabinet Secretary for Health and Sport knows that I have sought to be constructive throughout the pandemic. However, I have to say that this whole episode—125 outbreaks turning into 908, and, tragically, 218 people dying—has shaken my confidence in what the Government is telling us. What does it mean for restarting non-urgent operations in hospitals? Is the Government on top of this, or will those people have to wait even longer?

I will explain. Health boards report suspected hospital-acquired infections on the basis of incidents. An incident is two or more cases. There was no attempt to dissemble; that is how the information comes in, and that is what was reported. As soon as the question was asked as to how many people that might have involved, the information was given straight away; again, there was no attempt to dissemble.

Mr Rennie is absolutely right, and I am grateful to him, that he and his colleagues have consistently attempted to engage constructively. I hope that he feels that he has had a constructive response. However, I do not think that, when we are talking about a number of suspected cases and unvalidated data, as has been made crystal clear in every answer on the subject, it can be described as that number “turning into” the number of cases and deaths that he referred to, because we do not know that yet. We will know it only when the data is validated.

On what this means for nosocomial infection and how patients might feel about the restart of the national health service, when I spoke in the debate last week on the framework for decision making, I recognised Cancer Research UK’s example and its request that patients should feel that they have a safe space, and said that that would in part be met by the testing of staff. Clinicians also have discussion under way on asking patients for elective surgery to self-isolate for 14 days before the date of admission. That work is under way to ensure that we offer patients and staff the safest possible route in the remobilisation of our NHS. In what was said in the framework, and in the debate, I talked about doing it safely for staff and for patients, and that will involve all the measures that I have outlined.

No one underestimates the efforts or commitment of ministers, but it is our job to hold them to account for their actions and decisions. It is a fact that the information has been withheld and delayed. It is a fact that advice from senior advisers has been kept secret, that freedom of information requests have been blocked and that parliamentary answers have been evasive.

The cabinet secretary tells us not to assert. However, the First Minister asserted that we have the greatest testing capacity in the world, yet we are still miles behind. The national clinical director asserted that we had more than enough personal protective equipment, when people were crying out for it. The cabinet secretary herself asserted that 300 people had been discharged untested from hospitals into care homes, when in fact the number was 1,300. Is it not a bit rich for the cabinet secretary to lecture MSPs who are doing their job in holding Government to account, or to claim that they are making unvalidated assertions, when the Government has been making such assertions all the way through?

I completely agree with Mr Findlay that it is entirely the job of every member of the Parliament to scrutinise what the Government is doing and to question our decisions. However, I will quote from an earlier exchange that took place on 17 March:

“It is not the time for Opposition parties to exploit our situation or to use partisan and pejorative rhetoric against the efforts that are being made.”—[Official Report, 17 March 2020; c 9.]

Scrutiny is one thing, but lumping together a series of unconnected incidents and claiming that they are connected is, to me, partisan and pejorative, and—this might be my view alone, perhaps—saying that something is a fact when all the information that has been given has been clear that what has been issued is unvalidated data and that we are talking about suspected cases and suspected transmission is not proper scrutiny. Proper scrutiny is based on factual information, and no one could say that this Government has done anything other than put out the maximum amount of information—increasing week on week, with more information coming out this week—on the testing programme in care homes and on the test and protect system. That approach has been repeated every week so that, every week, there is more and more information.

The data goes out when it is robust and when we are confident it in it. In this instance, to be helpful, I published unvalidated data. I will not do that again because, clearly, all the caveats that surround unvalidated data are ignored and the numbers are taken as fact, which is entirely wrong.

The cabinet secretary is absolutely right to say that we are not experts, but we should be listening to the people who are. She has already referred to the story regarding orthopaedics, which involved Alastair Murray, the chair of the Scottish Committee for Orthopaedics and Trauma in Scotland, saying that the green pathways in hospitals should have “nowhere near” the level of infection that has been reported. In another story that was reported over the weekend, a senior cardiologist whose mother was refused admission to hospital because her care home said that it was unable to transfer her on the basis of guidance described those policies as “immoral”. I ask the cabinet secretary to respond to those assertions by senior and experienced doctors who are raising serious questions regarding infection control and admission procedures, some of which are being followed on the basis of Scottish Government policy and guidance. Further, will she ask for a rapid urgent independent investigation into the policies and practices regarding infection control and admission procedures?

The nosocomial group is independent, because, although it reports to the chief nursing officer and the chief medical officer, it involves epidemiologists, viral specialists and others from our academic institutions and elsewhere. It is independent of Government, as is Professor Andrew Morris’s scientific advisory group on emergencies. Therefore, the information and the advice that we receive are independent.

I take seriously what the group of orthopaedic surgeons have said, and I believe that I have answered those concerns. When the data is validated, we will see how the estimated number sits against the validated data and we will have discussions with that group, as we are having with all clinical groups, about the safe remobilisation of the health service. The fact is that, unless those senior clinicians agree that it is safe and proper to restart any of the procedures in primary or secondary care, it is not possible to do that—not only would it be wrong to do that; it would be impossible.

On the issue of the cardiologist’s concerns, we have responded to that issue before. The care home’s interpretation of what was in the guidance was wrong. No one who has been clinically assessed as requiring to be treated in hospital should be denied that hospital treatment. The First Minister and I have been consistently and emphatically clear on that point and the chief medical officer has taken steps to ensure that that is clearly understood. Those decisions are not for politicians or for managers of any description; they are for clinicians to take, and if a clinician says that the right place for treatment for a patient is hospital, hospital is where that patient should go.

I apologise to the members whom I was not able to call.

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Guidance for Travellers from Abroad

To ask the Scottish Government whether it will provide an update on the guidance for passengers arriving in Scotland from abroad. (S5T-02247)

I announced on 7 June that the Scottish Government would be introducing public health measures—[Inaudible.] Those measures will apply to international arrivals to Scotland, whether they are residents or visitors. These temporary measures, taken as part of the four-nations public health approach, require arriving passengers to provide contact details and travel information, as well as self-isolating for 14 days.

There will be a very limited number of exemptions, including for those working on critical infrastructure in transportation. The measures have been taken to support a continued effort to suppress the virus and will be reviewed on a three-weekly basis.

Further guidance on what to do when travelling to Scotland is available from the Scottish Government’s—[Inaudible.]

We have seen reports in the media in recent days about so-called travel corridors between the United Kingdom and other countries. Has the UK Government consulted the Scottish Government on that?

There has not been any consultation or discussion with the UK Government as yet on any air corridors. I should make it abundantly clear that any exemptions or any air corridors that were to be developed would have to come under the Scottish regulations. Therefore, that is not something that the UK Government could implement unilaterally; it would have to be done by the Scottish Government via the Scottish regulations.

Perhaps I can ask the cabinet secretary to elaborate on how the guidance issued in Scotland might differ from that in the other UK nations.

Generally speaking—[Inaudible.]—between the four nations, but there has also been the ability to create differentiation, where that is appropriate to the circumstances here in Scotland. There are minor differences in relation to the exemptions, I would say.

Reflecting Scotland’s needs, there are differences reflecting seasonal soft-fruit workers, for example. There are some differences when it comes to enforcement measures, but they reflect the different legal jurisdiction that we have here. All of the exemptions that are different here in Scotland have been discussed with the appropriate stakeholders, including Police Scotland, Public Health Scotland, the Crown Office and Procurator Fiscal Service and, indeed, business and industry. A full list of the exemptions that apply in Scotland is available on the Scottish Government website.

The sound quality is not the best, but we will persevere.

Does the cabinet secretary agree that allowing people to travel without quarantine from Ireland, where almost 1,700 people have died of Covid-19, while imposing a quarantine on people travelling from Norway, Iceland or Singapore, which have a fraction of Ireland’s death rate—to name just some countries—is just daft? I understand that visitors cannot just stop off in Ireland for a day or two on their way here to avoid quarantine restrictions, but can the cabinet secretary advise the Parliament as to how that will be monitored?

[Inaudible.]—Ireland are exactly, as Kenny Gibson describes in the sense that anybody attempting to—[Inaudible.]—quarantine will not be able to do that. Even coming into Scotland via Ireland, they would have to self-isolate for 14 days, minus any period of self-isolation in Ireland.

As for how that will be enforced, there will be spot checks by Border Force. As regards any further enforcement, Police Scotland officers will, if in the normal course of their duties they come across anybody who is breaching self-isolation, have the ability to enforce that with a fixed-penalty notice of £480. If necessary, they can escalate the matter to the procurator fiscal.

Regarding the differences that we discussed earlier, the maximum fine for breach of quarantine is £1,000 for the rest of the UK, but only £480 in Scotland. The cabinet secretary is on record as saying that the lower fine is because of our distinct fines system, but an exception could quite easily have been carved out in legislation, as has been done for several issues since the outbreak began. Will the cabinet secretary confirm that that was a policy choice by the Scottish Government? Can he justify it?

[Inaudible.]—was done in collaboration and conjunction with Police Scotland and the Crown Office and Procurator Fiscal Service—[Inaudible.]—with the Scottish Government, but in consultation with important partners.

If we had imposed a fine of £1,000 in Scotland, I think that reporting people to the procurator fiscal as a first step in response to any breach of self-isolation measures would have had a disproportionate effect and would have been a very heavy-handed measure.

I think that we all appreciate that there is a bad connection and the volume is quite low. I ask members not to mutter in the background, because others will want to listen to Mr Yousaf’s answers. We will take the next question, from James Kelly.

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Covid-19 (Prisoners) (Family Contact)

To ask the Scottish Government what arrangements are being made to enable prisoners to have contact with their families during the Covid-19 outbreak. (S5T-02245)

Before I answer the question, Presiding Officer, I can, if you wish, try reconnecting to a mobile phone hotspot for the remaining time to see whether that provides a better link, because I do not want to deny members any opportunity to ask questions. I will leave that—[Inaudible.]

To answer James Kelly’s question, I recognise the value and importance of family links and the impact that the restrictions, and the suspension of visits in particular, can have on those who are in custody and, importantly, on their families too. The Scottish Prison Service has been working hard to introduce a variety of different initiatives to enable contact between those in custody and their families during the Covid outbreak.

From next week, virtual visits will go live at a number of sites, which will allow those in custody and their families to have video calls. The scheme will then be rolled out across the prison estate in the coming weeks.

In addition—[Inaudible.]—phones are being introduced across the prison estate as another way of—[Inaudible.]—during this difficult time. Directions to the prison rules to allow that to happen are being laid before Parliament next week, with the roll-out of phones starting thereafter. The email-a-prisoner service is available in all prisons, as is prison voicemail, which allows those in custody to listen to messages from friends and family.

Thank you, Mr Yousaf. With Mr Kelly’s permission, I will end it there. We will try to reschedule the question if possible, but it is quite clear that the reception is getting worse rather than better. I could hear most of the answers, but I appreciate that the broadcasting system was not coping and most members could not hear. I hope that those who are listening on the channel will have heard it a bit better.

I thank the cabinet secretary very much—we will conclude topical questions on that point, although we might reschedule Mr Kelly’s question for another time.

On a point of order, Presiding Officer. It is very important for members of Parliament to be able to scrutinise Scottish Government ministers in this way and, if we cannot hear the answers to some very important questions, that scrutiny falls on its face. I think that you already covered the matter in your intervention, Presiding Officer.

Thank you, Mr Cole-Hamilton.