Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, November 11, 2020

Official Report 1142KB pdf

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Covid-19 Testing (Health and Social Care Workers)

The next item of business is a debate on motion S5M-23296, in the name of Monica Lennon, on routine Covid-19 testing for all health and social care workers.

15:25  

The motion in my name

“notes the ongoing threat to life and health posed by COVID-19”.

Today, the First Minister informed the country that a further 64 people who had tested positive have now died from coronavirus. On behalf of Scottish Labour, I send condolences to everyone who has lost loved ones in recent days and throughout the pandemic.

Staff working right across health and social care are on the front line. We are all grateful for the care and support that they continue to provide to our constituents and our own friends and families. My motion calls on the Scottish Government to

“introduce routine weekly COVID-19 testing for all health and social care workers immediately.”

Eight months into the pandemic, it is unacceptable that such widespread testing is still not under way.

Healthcare workers are often characterised as heroes, but they do not have superpowers—they are human and they are at risk, too. That risk is to themselves, to their families and, of course, to the people for whom they care. Scottish Labour does not claim that testing is a panacea. We have consistently called for a package of measures, including improvements to personal protective equipment.

Since the beginning of the pandemic, national health service and social care staff have been asking for widespread testing to be carried out. Members of the Scottish Parliament, including Scottish Labour’s leader, Richard Leonard, have echoed their calls. I pay tribute to colleagues from other parties who have done so—including Alison Johnstone, for her persistent and consistent calls for mass testing.

Back in May, I asked the Cabinet Secretary for Health and Sport how many people had died after contracting Covid-19 in hospitals. We know that, during March and April, Covid-19 outbreaks led to ward closures and, sadly, the deaths of patients. We are now experiencing a second wave of the virus, and hospital-onset Covid remains a serious issue. According to figures published today by Public Health Scotland, there have been more than 1,200 definite and around 360 probable hospital-onset cases. Therefore, identifying and containing the virus in hospitals is crucial if we are to protect patients and prevent such incidences.

Last week, we heard reports about a man whose father had apparently died after contracting Covid in Glasgow royal infirmary. He believes that his father had been exposed to Covid patients there. In a BBC interview, Professor Jackie Taylor stressed the need to control infections within hospitals. She said that

“testing all patients at the front door

is important

“because many don’t have typical symptoms.”

She also talked about the need for a

“coherent strategy for testing staff”.

Scottish Labour supports Donald Cameron’s amendment, which concerns a key measure on contact tracing. We are concerned about tracing performance times. Later today, my colleague Jackie Baillie will ask an urgent question, following on from journalist Chris Musson’s diligent reporting on tracing times. We will also be very interested in hearing the cabinet secretary give more detail on measures that would support not only the approach that is sought in my motion but the one that is set out in her own amendment.

I will mention a few issues that stakeholders have highlighted prior to the debate. The Royal College of Nursing Scotland has said:

“As a minimum, testing should be universally available to all staff, irrespective of whether they present with symptoms or have been caring for patients with COVID-19.”

Scottish Labour agrees that such tests need to be both available and accessible to staff where and when they need them.

Scottish Care has said that the testing of social care staff remains absolutely critical—most importantly, as a mechanism for identifying and minimising Covid-19 outbreaks. It also highlights the importance of testing availability and, crucially, turnaround times. Further, it recognises that testing can support loved ones to visit their families safely, keep staff safe and enable people to get the care that they deserve.

I make a plea to the cabinet secretary. We need to hurry up and connect family care givers with their loved ones, because people fear that they are running out of time. Like Scottish Care, we welcomed the commitments in the adult social care winter preparedness plan, and we need to see progress being made. The Coalition of Care and Support Providers in Scotland highlights that wellbeing is one of the health and social care standards that care providers are required to meet. A key element is that those who are being supported feel safe and protected from avoidable harm. Routine testing would help to support that element for both supported people and staff. That point was echoed in a recent Care Inspectorate report.

I recall that one of my constituents in North Lanarkshire who was receiving care at home before Covid and in the early part of the pandemic had different carers coming into her home and felt that it was a game of Russian roulette. People do feel frightened, cabinet secretary.

The CCSP also notes that testing of those who are being discharged from hospital into care settings other than care homes—to sheltered housing, for example—is not standard. Our motion would address that. Cancer Research UK again stressed the importance of having Covid-protected safe spaces in our hospitals, and I think that we all agree that that is a really important issue, because cancer is the leading cause of death in Scotland. We should have routine, frequent and rapid testing of all NHS staff in primary and secondary care.

I am out of time, but I hope that today’s debate is an opportunity to unite members in the chamber not just on the vital principle of expanding routine testing of all health and social care staff but on the need for urgent action. It is not enough just to praise our front-line healthcare staff; we need to protect them and the people they care for. Let us work together to make progress.

I move,

That the Parliament notes the ongoing threat to life and health posed by COVID-19 and the warnings of extreme winter pressures on the NHS, and calls on the Scottish Government to introduce routine weekly COVID-19 testing for all health and social care workers immediately.

15:31  

I will start by making it clear that I agree with Ms Lennon’s motion and Mr Cameron’s amendment, and that all I seek to do with my amendment is to clarify that we will deliver the roll-out of regular asymptomatic testing to front-line NHS staff and social care workers on the basis of clinical advice. As members know, since 25 May, we have been undertaking weekly testing of care home staff, and the most recent figures, which were published today, show that a total of 41,569 staff were tested in the period between 2 and 8 November.

Broadly speaking, the weekly figures are running somewhere between 39,000 and 41,000 per week. Since 8 July, we have been routinely testing front-line NHS staff in oncology and haemato-oncology wards and in day-patient areas, including in radiotherapy, as well as in wards caring for people over 65 years of age where the length of stay is over three months and in long-stay learning disability and mental health care.

Members will also know that we are actively scaling up our testing capacity to reach 65,000 tests per day, through a combination of NHS Scotland regional hubs and increased Glasgow Lighthouse capacity. I expect that capacity to increase still further as two additional measures come on stream.

I welcome what the cabinet secretary has said so far. Just so that we can get a sense of the scale of the challenge ahead of us, can the cabinet secretary say what proportion of NHS staff are being tested weekly at the moment, so that we have an idea of how far we still have to go?

I cannot quite do the maths. It is not a huge proportion, but I can tell you that the estimate we have of NHS staff in emergency departments, as well as surgical and medical staff and front-line paramedics, is 132,500. The estimate that we have of care-at-home staff, including in housing support, in residential settings for learning disability and in personal assistance, is 82,000. That is in addition to some of the other groups that we will talk about.

The two measures that I mentioned are, first, the use of new technology such as robotics in the processing of tests, which increases the number of samples that can be processed—[Interruption.]—I am sorry, but I need to make progress. Secondly, we have the increased use of new test types that do not require lab processes but that give on-the-spot results. Indeed, my colleague Mr Lochhead spoke about some of those test types earlier today, which we will use for students before they return home at Christmas.

Those new test types have lower levels of sensitivity and specificity than the PCR—polymerase chain reaction—test. That does not mean that they have no value or use, but it means that they are not appropriate in certain circumstances or for certain uses, such as in clinical diagnosis, where the PCR test is the right one to use.

In October, we published the clinical and scientific review of our testing strategy, which set out clear clinical advice on the priorities that are to be followed, the most important of those being the clinical care of patients and responding to symptomatic demand. The review also set out how we should prioritise routine testing to mitigate the risk of asymptomatic transmission, with the aim of protecting those who are most vulnerable to the harshest impact of Covid-19.

There are a number of groups to be included as a result. NHS and social care front-line staff are rightly there, alongside care home visitors, emergency admissions and professionals who visit care homes. As I have said in the chamber previously—I think that it was last week—I will come back before the end of this month to set out our clear plan with timescales, test type and test routes for the roll-out of asymptomatic testing to those groups.

I am acutely conscious of the importance not only of delivering on that clear commitment but of doing so in a way that is timely and sustainable. It is a significant logistical and planning exercise in which we need to ensure not only that we can test people but that our turnaround times in the lab processing channels that we use are as good as we need them to be.

I am aware of the time, so I will conclude. I do not think that we will find much disagreement between us in the debate. I am as impatient as everyone else is to have asymptomatic testing rolled out. However, I am as determined as I am impatient that we will do it properly and sustainably. I look forward to returning to the chamber with the plan.

I move amendment S5M-23296.3, to insert at end:

“, with prioritisation of staff groups to be guided by expert clinical advice.”

15:36  

During the pandemic, we have seen a heroic effort from all our NHS and social care staff to cope with the demands and pressures that have come to the fore as a result of this unpredictable virus. However, as we enter the winter months, the pressures on our NHS and social care sector will undoubtedly intensify. We must ensure that our health and care services are fully equipped and best placed to deal with what comes along.

As Monica Lennon rightly identified, we must make full use of our testing capacity. In particular, we must test weekly all those who work on the front line of our NHS and our social care sector, because we know that, by doing that, we will protect workers, patients and residents in care homes.

At this juncture, I should mention the issue of testing family care givers, given the crucial importance of enabling safe visiting of our loved ones in care homes. I hope that the Scottish Government is actively considering that matter.

It is right that steps are being taken to increase testing capacity from the existing capacity of around 30,000 tests a day in accordance with the Scottish Government’s strategy review on testing. We know that, although that capacity exists, it has not always been fully utilised. Between 26 May and 17 August, the daily average number of tests carried out was only 7,500 or so, which fell well short of the amount of existing capacity at any given time. The cabinet secretary mentioned the most recent figures. In the week that has just passed, only 41,569 care home staff were tested out of approximately 53,000 staff. That means that more than 11,400 staff remain untested, which we think is unacceptable.

Does the member accept that, in any given week, we will not have all 53,000-odd care home staff in care homes to be tested? Some will be off because they are unwell, some might be off because they are isolating, having been tested prior to that week, and some might be on holiday. Therefore, it is not possible to judge the success of care home worker testing by looking to see whether 100 per cent of staff are tested every single week. That is simply not reasonable.

If it is not reasonable, why did the cabinet secretary give assurances that all care home staff would be tested every week?

We know that that simply is not happening. In fact, the Scottish National Party Government has never met its target of testing all care home staff every week. According to the Coalition of Care and Support Providers in Scotland, none of the estimated 71,000 people who work in care at home are able to access routine testing. That simply is not good enough when we are talking about supporting our front-line workers and some of the most vulnerable people in our society, and it is a clear reminder of the risks that those on the front-line face every day while dealing with the virus.

In addition to increasing capacity and increasing the number of tests that are carried out, we need to be able to give people their results as quickly as possible.

Although regular and faster testing of staff is important, we must also ensure that our contact tracing capacity is able to cope with increasing demand during the winter months. That aim underpins our amendment. We learn in today’s Scottish Sun that test and protect is failing to meet current expectations and is performing up to five times worse than was previously claimed, with data showing that, in the majority of weeks in September and October, test and protect staff failed to contact about half of positive cases within 24 hours of being notified.

We still do not know whether we have enough contact tracers in place to meet the growing demand. We urgently need an assurance from the Scottish Government that the system will be able to meet winter demand and that it will be able to trace people quickly, so that we can reduce the spread of the virus. The system is meant to keep us safe, which is why our amendment says what it says about the contact tracing system.

We will support Scottish Labour’s motion and the Scottish Government’s amendment, and we hope that other parties will support our amendment. If we are to be able to control the spread of the virus, we must ensure that those who are most at risk—namely, our health and social care staff—are protected and that our contact tracing capabilities are sufficient to cope.

I move amendment S5M-23296.1, to insert after “on the NHS”:

“; recognises the need for the Test and Protect system to be able to provide rapid turnaround contact tracing and cope with increasing demand during the winter months”.

15:41  

On 24 April, I wrote to the Cabinet Secretary for Health and Sport and said that I considered routine testing for hospital and care workers who were on the front line of the Covid-19 pandemic to be an urgent imperative, and I still do. At the time, I pointed to a paper published in The Lancet that set out the case for screening of health and care workers to prevent transmission, which confirmed that University College London hospital was piloting such testing to

“further limit nosocomial transmission and ... alleviate a critical source of anxiety for HCWs.”

It said:

“A healthy, COVID-19-free workforce that is not burned out will be an asset to the prolonged response to the COVID-19 crisis.”

What an asset our health and care workforce is.

It was right that we loudly applauded the efforts of our health and care workers from our doorsteps, but we must do much more. We should, of course, pay those hard-working people more and, as I said last week in the chamber, we owe them the protection that testing provides.

This week, NHS England has made testing available to all patient-facing staff. Staff will receive home kits to test themselves twice a week. Although those lateral flow tests have a lower specificity, all positive results will be checked with a PCR test, as the Minister for Further Education, Higher Education and Science announced will be the case regarding students.

I wrote to the First Minister on 14 May, when I pointed to Imperial College London research that advised that regular screening of health and care workers, irrespective of symptoms, could prevent up to a third of transmission. Reducing transmission by a third is huge. It is no surprise that our proposal to test health and care staff enjoys widespread support, including from the Royal College of Nursing, Scottish Care and the Royal College of Emergency Medicine. Yet only last week, the First Minister said:

“the top priority for our testing capacity right now is people with symptoms, because that is how we ... break chains of transmission.”—[Official Report, 5 November 2020; c 11.]

However, that chain might have started with an asymptomatic carrier of Covid. We have known for months about the dangers of asymptomatic transmission, but we are still waiting for the virus to come to us.

Mark Woolhouse, the professor of infectious disease epidemiology at the University of Edinburgh, said in the press this week that we are still not finding out about half of the Covid cases in Scotland or the UK more generally, and that

“it’s like trying to control the epidemic with one hand tied behind our back.”

He welcomed the testing pilot in Liverpool that seeks to solve that problem. Slovakia tested two thirds of its population in two days. When I raised that last week, the First Minister said that the testing in Slovakia was antibody testing. That is not the case; it is antigen testing.

It is true that we should question the specificity and sensitivity of tests, but we must also question why Scotland seems so very unambitious when it comes to testing. I have asked many times for increased testing for those on the front line and more broadly.

I wrote to the First Minister on the issue of mass testing in September, when I cited the availability of quick turnaround, low-cost tests. The technology is improving, but our testing numbers are not. In fact, the total number of daily tests that are carried out in Scotland has barely changed since the end of August. A frequent response is that the Government is prioritising its testing capacity, so let us look at that. The Scottish Government aims to expand its overall testing capacity to 65,000 tests per day by winter, but in the past week Scotland processed an average of only 18,700 tests per day. Yesterday, 10,499 tests were processed.

Scotland has been too slow to implement the level of testing that is needed. Although routine testing for care home staff was introduced on 25 May, routine testing is still not available for staff in far too many settings including, as our briefings for today’s debate from the Coalition of Care and Support Providers in Scotland, Cancer Research UK and Scottish Care confirm, those in home care, those who support people with no homes or who are dealing with addiction issues, and staff who are involved in the diagnosis and treatment of cancer.

I said it last week and I say it again: here we are in November, and someone could still be working in a Scottish hospital with Covid-19 and not even know it. It is unacceptable for those staff, the families they return home to and the patients they look after. I hope that the issue will be progressed at a pace that has been sorely lacking up to this point.

15:45  

It is a great privilege to follow such an excellent speech from Alison Johnstone. I absolutely associate myself with her remarks.

The Liberal Democrats will support all the amendments to the motion and the motion itself. However, our acceptance of the Government’s amendment is guarded, because I am anxious that the terminology that is used could belie a business-as-usual approach. Why would we not support the prioritisation of testing in our hospitals and care sectors? However, that has been the Government’s default position since the start of the pandemic, and I do not believe that we can just continue as we have been. We are deep into the pandemic—

Will the member take an intervention?

I do not have much time, but I will take the cabinet secretary’s intervention.

If we do not use clinical prioritisation as the way to roll this out, what would the member suggest that we use?

I refer to the cabinet secretary to my remark a moment ago. We accept the Scottish Government’s amendment on that basis. We absolutely agree that, if the Government is rolling something out, it has to do it on a prioritised basis, but this Government has been prioritising things for months and we are still not testing everybody who needs to be tested.

Although there was a period of uncertainty at the start of the pandemic—in the foothills of the emergency—we now know that there are many who contract the virus but display no symptoms. They may never even know that they had it. That is why the best way to prevent a spike in infection in our hospitals, in our care homes and, crucially, as we have heard many times this afternoon, in care at home is to routinely test all staff, and with regularity.

Currently, a considerable number of health and social care workers are being tested, but there cannot be full confidence in the testing system until we know that that is happening with universality. We ask a lot of those workers, and the emergency has tested them like nothing before. They do not need the anxiety that they may be an asymptomatic carrier of the disease and, by extension, a danger to their patients or the people they care for.

People who work in social care but cannot currently access routine testing include staff who provide care at home, as we have heard; those in palliative care, where we would imagine that testing was critical; those in respite care and day care services; those who support children and young people or people without a home; and those who work in residential rehabilitation for drug addiction.

The Coalition of Care and Support Providers in Scotland has been pressing for an expansion of routine testing for a long time, particularly for care at home. As we have heard, the Care Inspectorate estimates that 53,000 people work in care homes for adults and 71,000 people work in care at home. That is a huge group of people who are coming into contact with our most vulnerable citizens, many of whom were asked by this Government to shield for much of lockdown on a daily basis.

The pausing of cancer screening programmes during the first wave meant that, in Scotland, more than 100,000 people every month were no longer being screened for bowel, breast or cervical cancer. Although those services have restarted, it will be some time before the backlog has cleared. Cancer Research UK has called for routine, frequent and rapid Covid testing of all NHS staff in primary and secondary care to ensure that the restarting of those vital programmes happens and that we get the care that is needed to the people who have fallen behind in the prognosis of their condition.

Liberal Democrats and members across the chamber have been calling for a wider roll-out of testing for some time. We are now into winter and time is running out to upscale testing before the busy winter period and the drain on resources hits with full effect.

Alison Johnstone was absolutely right to say that Slovakia tested millions of people on the same day—and that it was antigen testing, not antibody testing, which is fast-track testing. We need to be more ambitious for Scotland. There is a pilot of mass testing in Liverpool and we know that testing is one of the strongest defences against the spread of the virus; it has to start with the testing of the people in health and social care on whom we depend.

The Scottish Government expects to be able to process 65,000 PCR tests a day from December, which is welcome. However, the rate of expansion is not particularly fast.

I can see that I am running out of time. We know that the NHS is always under a lot of pressure in winter. We must do all that we can to mitigate that this year, more than ever. Testing all our health and social care staff is a good place to start.

We move to the open debate. We are tight for time; I ask for four-minute speeches, please.

15:50  

I put on record my thanks to all our NHS and care staff who continue to fight the virus on the front line, and I send my condolences and love to all those who have lost a loved one.

We have had good news this week, with the prospect of a vaccine coming soon. However, let us be honest. Eight months into the pandemic—eight months—we still have not fixed testing and we still have not fixed test and protect. The question now is whether we will have a vaccine or fix testing and test and trace first; that is the race. The vaccine was meant to be the end game, but it might well rescue us from failed testing and test and trace programmes.

Week after week, the Government has been asked about testing. Week after week, we have had promises. Week after week, people have been let down. Premiership footballers get tested every single week, but NHS staff, care home staff and care-at-home staff do not. We have all been sent images of NHS staff receiving bin liners to wear as aprons, as part of their PPE. That is not fair. The system is not working.

I have been constructive with the cabinet secretary, in public and in private, but we have to call a spade a spade. Testing and test and protect are not working. That is simply not good enough, and the Government has to get a grip.

We have heard tragic stories about cancer services—stories that would not have happened if testing was sorted. We have heard tragic stories about people not being able to visit loved ones in care homes—stories that would not have happened if we had sorted testing. Only now are we restarting dental services; we would not have those problems if we had sorted testing. We would not have the problems that we have seen on many university campuses if we had sorted testing.

We have to get testing sorted ASAP. I am talking about mass testing and rapid testing; if it is good enough for Liverpool, it is good enough for Glasgow and the rest of Scotland.

The Government keeps saying that test and protect is working—the First Minister said so when I spoke about the issue in the chamber a couple of weeks ago. I am sorry. There is a big difference between the claim that has been made in the chamber that three quarters of people are successfully traced and tested and the fact, which is that the proportion is less than half. Test and protect is not working. Too many people are not traced, too many people do not get the phone call and too many people are not given the advice that they need if we are to beat this virus.

As Monica Lennon said, what is happening in our hospitals is unacceptable. This week, I received an email from a distraught son, who said that his father had shielded for seven months—his family had stayed away from him for seven months and he could not see his children and grandchildren—after which he went to hospital for a heart scan, caught Covid in hospital and died. How is that acceptable? It is simply unacceptable.

Getting the test and trace programme and testing right can help us to fix the problems. I thank the Government for its communications exercise. We expect the Government to be brilliant at communications and we thank it for that, but we need it to be good at beating the virus, too. I ask the Government, please, to fix the testing system and test and protect, so that we can save lives in Scotland.

15:54  

I welcome this debate and what the cabinet secretary said about how she wants to work with others to ensure that we can solve the issue.

I think that we can all agree that the continued health and safety of all our front-line health and social care workers is a key priority right now. Since the beginning of the pandemic, I have expressed my on-going gratitude to all those who work in that sector. I want to take a moment at the beginning of my speech to once again thank our brave and committed doctors, nurses, carers, porters and everyone else who works in health and social care. My heart also goes out to those who have lost a loved one during these difficult times.

As the pandemic has continued and we have tried to limit the spread of Covid-19 throughout our communities, the Scottish Government has made testing a priority for key workers and the public. It continues to prioritise the expansion of the NHS’s testing capacity every day. It is important to note that Scotland’s maximum weekday lab capacity is now more than 10,000 tests and that, at the very beginning of the crisis, we had the capacity for only 350 tests. At that time, the 350 tests per day were split between Edinburgh and Glasgow. There has been an increase to 10,000 tests, with labs in all 14 health board areas alongside key partner nodes in academia and the private sector. All are operational and testing every single day.

Although the increase from 350 to 10,000 tests is exceptional, the Scottish Government is committed to building the lab processing capacity to at least 65,000 tests per day come winter. I know that all the new regional hubs that will go live between this month and next month will help us to move closer to that target and allow us to be less reliant on the United Kingdom Lighthouse lab network. [Interruption.] I do not have much time, so I cannot take an intervention. I am sorry.

Alongside massively increasing our national testing capacity to cope with the demand, weekly testing is already offered to all care home staff, regardless of whether they have symptoms or whether there is an outbreak in their home. Enhanced outbreak investigations are mandatory when cases are detected, and a test is offered to all care home staff. It is important that the Scottish Government continues to protect society’s most vulnerable by focusing on those who are most likely to bring the virus into homes in the first place.

The data suggests that the uptake of testing is already quite good. Statistics that were published on 4 November show that 41,767 care home staff were tested in the latest reporting period. That is an increase of 2,000 from the previous week. The percentage of available staff tested was at least 72 per cent. I know that many members across the chamber will ask why the remaining 28 per cent were not tested. It is important remember that testing can take place only with the explicit consent of the staff and that all the staff would need to be present for that to happen in the first place, as opposed to being on annual leave or otherwise absent. I am not one for filling a speech full of statistics, but it is important to remember those key points when we are dealing with such a serious issue.

I know that people are sometimes reluctant to be tested for fear of testing positive and then having to isolate and miss work. In light of that, the Scottish Government has advocated a supportive approach when staff decline a test. It encourages employers to get to the root of the reason for refusal.

It is crucial to highlight that the Scottish Government has implemented routine testing for healthcare workers when the evidence has suggested that it is appropriate to do so. The current policy is that all asymptomatic healthcare staff are tested for Covid-19 if there is an outbreak in a previously Covid-free ward. Since 8 July, that approach has been extended to include staff who work in the highest-risk areas of specialist wards, wards for the long-term care of the elderly and long-term psychiatric wards.

In order to combat the pandemic as safely and efficiently as possible, the Scottish Government has followed the advice of clinicians, scientists and professionals from the beginning. As we continue—we agree with one another today—we need to remember those specialists when we are dealing with the issue.

15:59  

I welcome the opportunity to speak in this important debate.

As many people have noted in recent weeks and months, the pressure on the NHS this winter will be unprecedented. On top of the regular challenges that are faced over winter, Scotland is continuing its battle against Covid-19. The virus has already put immense strain on the NHS over summer and autumn. That pressure will only intensify as we enter the winter months.

In Glasgow and the surrounding area, we have already seen how the impact of Covid-19 is putting pressure on Greater Glasgow and Clyde NHS Board’s flu vaccination programme, with many vulnerable people having to wait for their flu jabs much longer than was anticipated. That is why Conservative members believe that in order to mitigate the impact of Covid-19 and to ease pressure on the NHS during the next crucial few months, more testing and faster contact tracing are essential, as we look to slow down transmission of the virus in our health and social care system.

Therefore, in the spirit of the Scottish Labour Party’s motion, we urge the Scottish National Party Government to introduce routine weekly Covid-19 testing for NHS staff and social care workers who have been on the front line protecting the nation during this awful pandemic.

However, based on its record so far, I am seriously concerned that the SNP Government has a long way to go before it could realise that pledge. Since the crisis began in March, it has continuously failed to ramp up Scotland’s testing capacity. Only last month did the SNP Government’s review of its own testing strategy note that further work was required to speed up the pace of turnaround times, which could have allowed for quicker contact tracing and subsequent isolation of people who are considered to be close contacts. If that had been achieved, it would undoubtedly have reduced transmission. That important point lies at the heart of the Scottish Conservative’s amendment.

Furthermore, from the beginning of the pandemic we have repeatedly called on the SNP to address shortcomings in Scotland’s testing capacity, and we have offered constructive suggestions on how to do so. For example, we have called on the Government to increase the number of mobile testing units across the country, which would significantly bolster Scotland’s testing capacity. Take-up at testing sites has been low, largely because of the distance that key workers must travel to get to them; more are therefore required to support people in rural areas and care homes.

I have serious concerns in relation to care homes and regular testing of staff. In July, the health secretary pledged that all care home staff would be tested weekly, but data shows that between 26 October and 1 November, approximately only 79 per cent of Scotland’s care home staff were tested for Covid-19.

Warm words are all well and good, but action matters more. How are the Scottish people supposed to have faith in the SNP Government’s ability to ramp up testing this winter for care home staff when it continually fails to meet its pledges? The SNP must finally get serious and focus its efforts on ensuring weekly routine testing for all care home staff. It owes that to Scotland’s elderly and vulnerable population.

Let me take the opportunity to remind the SNP to abide by the vote in Parliament last week that called for the immediate establishment of a public inquiry to find out what has gone wrong in our care homes during the pandemic.

There is a strict four minutes for speakers, now.

16:03  

I first pay tribute to the scientists across the world who have been working night and day to find a vaccine, although we know that there is still a long way to go.

We can never repay the incredible efforts of our NHS staff and care workers, who have gone beyond the call of duty in looking after patients and saving lives, putting their own safety at risk through working in settings that have the sickest and most vulnerable patients, and where prevalence of the virus is high. Wearing the hard-fought-for PPE alone must be tiring for many NHS workers, but we are still calling for adequate regular testing for NHS and care workers. As the Royal College of Nursing has said, testing must be accessible to the workforce, so for them to be asked to take a test during their annual leave is disrespectful to that workforce.

More recognition is needed of the asymptomatic aspect of Covid-19 that enables it to spread so quickly. If that is not recognised in the system, we will be fighting a losing battle. Routine testing would be a recognition that the asymptomatic nature of Covid-19 might be why we are struggling to get it under control.

As we head into winter, there is a serious worry that our nurses and doctors are already at breaking point. A Unison report during the first wave of the virus highlighted that nearly 80 per cent of NHS staff said that were already tired, and 30 per cent said that they were very tired and were getting inadequate breaks. That is absolutely unacceptable. We must improve the conditions for our workforce in tackling the second wave, and we must keep them safe.

Particularly worrying is the suggestion that transmission of Covid-19 is not yet under full control in our hospitals. That is a failure of testing policy. Every other country in the world that has been successful against Covid seems to have signed up to the idea of mass testing.

Professor Jackie Taylor suggested that testing patients at the front door, irrespective of age and of whether they have typical symptoms, is an absolute must. That is the kind of ambition that we need. Not doing will impact more on delivery of non-Covid care. As Alison Johnstone said, other small countries including Slovakia have tested the entire population—two thirds of it in two days. Liverpool is doing mass testing, using the lateral flow system and lab testing. Here in Scotland, we seem to be behind the situation, and I would like to know why.

NHS 24 is also under pressure. We hear reports that staff have been absent for Covid-related reasons, and that those absences are critically impacting on service delivery, even as we rely on NHS 24 now more than ever.

The Royal College of Physicians and Surgeons of Glasgow and the Royal College of Physicians of Edinburgh have jointly called for a national strategy to safely manage

“the competing pressures of treating patients with COVID-19, and those without COVID-19 who need urgent care or elective work”.

This is where we are. As we speak, patients have had their consultations cancelled, many with no replacement dates and others with dates that are set well into the future. Patients who have managed their conditions through lockdown in anticipation of having an operation are now extremely worried that their care is being put off indefinitely.

Only with a Covid-free workforce that is well looked after will we have any chance of getting our NHS back into looking at physical care.

We need to go back to a system in which patients feel that they can challenge not having an appointment, or their critical care not being dealt with. The Government must give the positive clear message to patients that the NHS still serves them.

16:07  

I am pleased to speak in the debate. I was going to offer some statistics, but George Adam and others have done so, in regard to the Scottish Government’s 10,000 tests, and testing of health workers, which is very important.

The debate is about testing. I am going to talk from personal experience. I want to thank all the workers in the hospitals, from the cleaners and porters all the way through to specialists and nurses. I also thank care workers. It is a very difficult situation that everyone finds themselves in.

I know of one person who tested negative. Were they asymptomatic? I do not know. Unfortunately, that person did get Covid. At the time they tested negative, so although the debate is about testing, we have to look at other issues as well. I am quite anxious that if we say that everyone has to be tested every week, or even every couple of days, the other measures to keep the virus under control will be forgotten. I do not mean to say anything against testing, but I think that we need also to look at the other issues.

Care homes have been mentioned a number of times, including by Annie Wells. We have already seen the difficulties in huge care homes and the difficulties in private care homes. With regard to lack of hygiene, we know all about the situation that has been raised in press coverage in relation to a certain privately owned care home, which is one of the biggest privately owned care homes in Scotland and the UK. We need to take that part of the care homes situation out of the debate.

I do not know whether anyone in the chamber knows anyone who has had a test. If they do, they will understand that it is difficult to get an elderly person with dementia to take one, and we cannot force them. Any care home provider or assistant, or anyone who works in a hospital, will say how difficult it is. The test does not involve just a small swab in someone’s mouth; it goes right down the back of their nose and near enough into their throat. We have to remember that. I am not saying that we should not test—I am supportive of the motion and the amendments—but we have to consider the realities of the situation.

The only thing that will stop Covid is people listening to the expert guidance. Testing is important, but for me—not only for me, but for experts and others—testing is not a panacea. A vaccine will be a panacea, but we have to get through this situation until we get the vaccine.

We have to look at the guidance. We have to test, and we have to follow that through, but we must also be vigilant with regard to hygiene, shielding and looking after our older people, and we must not move people about from one care home to another. Testing will not stop infection if the people who provide care do not look after their workers and the people who are living in care homes. I wanted to get that point across, because it is important. Testing is not a panacea; it is a method that must be used along with other things.

16:12  

Given the excellent speeches that we have heard, I propose to keep my speech relatively short.

I always judge leaders on whether they would take the same risks as they ask people to take on their behalf. That is the mark of a good leader, and it is how I judge the difference between a good leader and a bad leader. The reality is that patient-facing health workers were three times more likely than any other working-age adults in Scotland to be admitted to hospital with Covid-19 during the first wave of the pandemic. We know that the risk of transmission is greater for health workers, so we must do everything that we can to reduce that risk.

Routine and reliable testing is a vital layer of protection that promises not only to limit the spread of the virus, but to protect the people who are protecting us. We simply cannot afford to have Covid outbreaks in our national health service, because it means that scheduled elective surgeries and other treatments have to be suspended. For example, we cannot afford an increase on the 4,355 operations that have been cancelled in NHS Highland in the past six months alone.

The SNP Government must ensure that all front-line health staff are given the urgent support, including routine testing, that will ensure that operations continue. That routine testing must also be rolled out to care home workers, as it is being, and to care-at-home workers. It is not just personal protective equipment that they need to protect themselves and the people whom they care for from the pandemic; they also need testing.

I want to give members an example that was given to me by a care-at-home worker. Imagine, for a moment, what it must be like to be a care worker who looks after an elderly lady who suffers from dementia and requires help going to the toilet, but who rails against her care workers as they get her undressed because she does not understand why they are doing it. In that moment of drama, which happens in the morning and in the evening, the care worker’s PPE is accidentally ripped off, so there could be transmission of the virus, either to the lady who is being looked after or to the care worker, and one of those people might well die as a result of it. The care worker might not know that they have been infected until the weekly test is completed—that is, if it happens at all.

Let us not forget that the SNP Government has never met its pledge on testing. Our care workers should not be put in that position and the Government must ensure that routine testing is made available to all care-at-home workers, whether it is done by the NHS or privately. It is not fair to ask private companies and employees to pay for testing over and above the routine testing that they are given.

We are now in the second wave of the pandemic. I believe that the Scottish Government has a huge duty to protect all our healthcare professionals, care workers and care-at-home workers from the pandemic. It cannot carry out that duty if there is no roll-out of routine testing. My simple message to the Government is that it should stop the warm words and the good public relations and instead get on with doing what we know is the right thing to do.

16:15  

I begin by acknowledging the incredible efforts of our NHS and care staff, who continue to be on the front line caring for patients with Covid-19 and working to prevent further spread in hospitals and care homes. This debate is not abstract for me; I have family and friends doing those crucial jobs, as do others in the chamber, and I am hugely grateful to them for all that they do under really difficult circumstances. Current estimates from the Care Inspectorate are that more than 53,000 staff work in care homes for adults, compared with more than 71,000 staff who work in care at home. As we have heard, weekly testing is offered to all care home staff, regardless of whether they have symptoms or whether there is an on-going outbreak in their care home.

The Scottish Government has implemented routine testing for healthcare workers where the evidence says that it is appropriate to do so, but there are social care staff who cannot currently access routine testing. They include staff providing care at home; supported living and housing support services; palliative care; support and care for children and young people; support for people with no homes or dealing with addiction issues; and respite and day services, although not all those services are running at the moment.

The safety of those workers, as well as of the people who are in their care, must be paramount. It is important to acknowledge, as the briefing from CCSP does, that third sector providers kept infection rates to a minimum from March through to the end of August without routine testing, through careful risk assessment and use of infection prevention and control. Routine testing is important, but it is only part of the picture. I understand and support the calls for it—it intuitively feels like the right thing to do—but it absolutely must be led by evidence. It is important to remember that testing provides a single-point-in-time assessment of whether someone has the virus; it does not mean that they will not go on to develop the virus.

The Scottish Government’s testing strategy and its nosocomial review group have recognised the importance of routine testing for healthcare workers, so I do not see why there is still a question of prioritising certain staff groups over others. Is it not long past time that we immediately got on and introduced it as a matter of urgency?

Alison Johnstone has consistently made those points, in her speech and before in the chamber, and she has done so again.

It is important to note that some staff who are eligible for a test decline to take it up and they cannot be forced to take a test. In the short time that I have, I want to talk about the barrier that losing income can be for people and how that can affect how they choose to act—if, indeed, it is a choice for low-paid workers. I welcome the fact that the Scottish Government has established a social care staff support fund to ensure that care workers who test positive for Covid-19 will receive sick pay above the current statutory level of £95.85 a week. That should go some way towards helping to ease the financial burden that having to isolate places on them.

It is absolutely crucial that employers also act responsibly and fulfil their duties with regard to the health and safety of their staff, and that workers are actively encouraged to follow guidance and are not pressured into coming in. I have heard about cases in which that has not happened right away and I urge workers to know their rights and speak up when they feel that things are not right. I reiterate that employers must fulfil their duties and must not put their staff in harm’s way.

I support evidence-led routine testing for all our health and social care staff.

We move to closing speeches.

16:19  

I remind members that I have a daughter who is on the front line in the Scottish NHS. As I rise to close on behalf of the Scottish Conservatives, I thank the Labour Party for using some of its debating time to bring this important debate to the chamber.

As one might imagine, there is much agreement among members on all sides of the chamber as regards the incredible debt of gratitude that we owe our NHS and our health and social care workers for their dedication and compassion. Those attributes have been highlighted specifically during the pandemic, but we need to remember that that is how those workers behave throughout their careers.

Members also agree that routine weekly Covid-19 testing for all health and social care workers would be a good thing, as it would protect not only front-line staff but the patients whom they look after. Monica Lennon began her speech by reminding members that Covid remains life-threatening, and I am sure that we would all want to send our condolences to all those who have lost loved ones to the virus.

The issue is not just testing capacity but the Scottish Government’s ability to deploy and utilise that capacity. For example, are there enough qualified personnel on the ground? It is also about the ability to turn the tests around and deliver the results timeously.

As has been pointed out in the debate, capacity has been ramped up too slowly, and capacity is going unused. As we all know, there are far too many messages from our constituents telling us that testing for our front-line health and social care workers is sporadic. The truth of the matter is that the Scottish Government was unprepared, despite all the warning signs from around the globe as the virus made its way towards us. We have been all too aware of the PPE shortages and the scramble to find ways to fill the gap.

Donald Cameron’s amendment highlights contact tracing as a key weapon in tackling Covid-19, as it offers the ability to isolate those who may have been in contact with the virus and thereby break the infection cycle. Donald Cameron also alluded to the fact that data from the Government are not necessarily always consistent and accurate; if the public is to have confidence in the programme, that will have to change.

We were all aware of the likelihood that a second wave was going to happen, and yet after eight months we still have not got the testing regime right. I would have hoped and expected that by now, the Scottish Government’s response would be a bit more sophisticated and comprehensive than it actually is. By now, we should have been making the case for testing all our teaching staff and our other emergency services. What about our military personnel abroad, especially those who will be coming home for Christmas? We could throw in students too, who are struggling just now in trying to get home for Christmas, and the family care givers who visit our nursing homes.

The reality is that there has been a lack of forward planning and that the Scottish Government is still too reactive, rather than proactive, in tackling the virus. The virus may have been unpredictable, but it is entirely predictable that we would need testing capacity and the ability to deploy it.

The cabinet secretary mentioned that we will require 200,000 tests per week in the health service before we start to consider testing for the groups that I mentioned. Anas Sarwar made the point that the vaccine could be here before the issues with testing and test and protect are resolved.

Not only should the Scottish Government introduce routine weekly Covid-19 testing for all our health and social care workers but it should have been done long before now. The problem is that I am not sure, even after all that we have learned about the virus in the past eight months, that the Scottish Government could do that even if it wanted to.

16:23  

To respond to Brian Whittle’s point, we not only can do it—we will do it.

I, too, express my thanks to all our health and social care staff and our emergency workers, and I offer my condolences in particular to the families of those health and social care staff who have lost their lives to the virus.

In my opening remarks, I said that I did not expect much disagreement in the debate. That has largely proved to be the case, but members have tripped over some inaccuracies and—I think—unreasonable assertions that I assume were made as a political point, so I will clarify some of those.

On test and protect, I point out that the World Health Organization’s target calls for

“At least 80% of new cases”

to

“have their close contacts traced and in quarantine within 72 hours of case confirmation.”

The most recent figures published by our independent statisticians to 8 November show that 95.8 per cent of contact tracing of all positive cases is completed within 72 hours.

It is not fair to test and protect staff to assert that they are not performing well—they are performing very well—nor is it accurate to assert that we do not have enough of them, because we have 2,221 fully trained contact tracers.

Let me clarify the routes for testing—and I think that we have done this before. Those routes matter—this is not a point made for the sake of it. We have two routes for testing: either through the United Kingdom’s Lighthouse lab or through the NHS labs. The route to the UK Lighthouse lab is through the regional testing centres, the mobile testing units and the local walk-through centres. Those are for symptomatic individuals.

We have a satellite route through the UK lab, which is the one that we have been using for care home workers who are asymptomatic. Although the turnaround times at the UK Lighthouse lab have improved for all other routes, the improvement has not been enough, or has not been sustained enough, for the satellite route and for home care. That is why we are moving care home worker testing to our own NHS labs. The other route is through NHS labs, which can cover asymptomatic individuals and where the turnaround times are consistently at or under 24 hours.

As members have indicated, roll-out by clinical prioritisation, for just two of the groups that we have mentioned, means totals of 82,000 or thereabouts for care-at-home staff and at least 132,500 for NHS staff if we prioritise that group—although we want to ensure that we include our paramedic workforce, too, along with care home relatives, visiting professionals and emergency admissions, which is particularly important for ensuring that, when an emergency admission comes into the acute setting, it will follow either the green non-Covid pathway or the red Covid pathway. That in itself contributes to a reduction in nosocomial infections. The roll-out of asymptomatic testing is undoubtedly important, and it is very important for that group, as well as the others. As I said earlier, I look forward to returning to the chamber before the end of the month to deliver our plan for just that.

The Government is happy to support both the motion and Mr Cameron’s amendment.

16:27  

SNP members who have spoken in the debate have been defensive, but I do not think that there is a need to be defensive. Monica Lennon is calling for all healthcare workers to be tested on a routine and weekly basis. Surely that is something that we would all want to strive for. Sandra White said that we need to consider the realities and that

“testing is not a panacea.”

Nobody is claiming that testing is a panacea, but let us remember that RCN Scotland has written to every MSP. This is not about party politics. The Royal College of Nursing has said:

“Routine Covid-19 testing for health and care professionals is an absolute must. Our members need this in order to do their job while keeping themselves, and their patients, safe.

We have previously called for wider routine testing of all health and care workers in order to improve the identification and containment of potential COVID outbreaks. As a minimum, testing should be universally available to all staff, irrespective of whether they present with symptoms or have been caring for patients with COVID-19. Without this, health and care staff cannot be safe nor can they be deployed safely or effectively.”

I say to the cabinet secretary that that is not playing politics; that is about ensuring that healthcare staff who are on the front line are properly protected. That is all that we are asking the Government for.

I accept that these times are very difficult, and I accept that the role of the Cabinet Secretary for Health and Sport is massive at this stage. I praise the cabinet secretary for the work that she has done and is doing throughout the pandemic but, when it comes to testing, the situation is simply not good enough, and it must improve.

The health secretary said that there are logistical and planning challenges. I have no doubt that there will be, but are we using all the resources that are available? The Prime Minister had a press conference the other day and I noticed that he had the head of the army there, who oversaw the logistics in Liverpool that had put in place all those testing centres. Do we ideologically oppose the use of the military or will we do the same as the UK Government and start to bring in all those who can help us to get the logistics right?

Anas Sarwar talked about the possibility of the Covid vaccine. The health secretary knows—because she intervened—that it was utter chaos in Fife when they tried to organise the flu vaccine: a letter was sent out and there was only one phone line to answer thousands upon thousands of calls, which unnecessarily worried loads of pensioners.

I agree that we need to get the logistics correct, which means that we need to be willing to reach out and consider where the best practice is across the UK and Europe that we could take and build on. The point that Alison Johnstone has repeatedly made is that we have seen—through the World Health Organization’s recommendations and the situation throughout Europe—that we need to test, trace and isolate, so why does Scotland seem to be behind most of Europe and England when it comes to testing? The clear message that must come from today is that we need to ramp up our testing.

Anas Sarwar made another point about vaccine and testing coming together. I made this point yesterday when I said to the First Minister that I, like everyone, welcome the potential of a vaccine by the end of this year, but I know that major hurdles are still to be overcome before we start to see the roll-out of the vaccine.

We should not take our eye off the ball; we need to massively improve our testing and our capacity to test. The health secretary’s job must be one of the toughest in Scotland right now so I will work alongside her, but the message from today is that we have to get better at testing.

That concludes the debate on routine Covid-19 testing for all health and social care workers.