Meeting date: Tuesday, September 15, 2020
Meeting of the Parliament (Hybrid) 15 September 2020
Agenda: Time for Reflection, Topical Question Time, Migration and Care Workers, Decision Time, World Suicide Prevention Day 2020
- Time for Reflection
- Topical Question Time
- Migration and Care Workers
- Decision Time
- World Suicide Prevention Day 2020
Topical Question Time
To ask the Scottish Government what its response is to recent figures showing that Scotland’s daily Covid-19 cases are at a four-month high. (S5T-02386)
As we remove restrictions from the lockdown period, we expect to see an increase in the number of positive cases, because the virus has not gone away. As we are freer to go about a more normal life, the virus is freer to move about, too. We see that here, in the rest of the United Kingdom and across Europe.
That is why our public health messages, including FACTS, are so important, and it is why, in addition, we make sure that our test and protect system and our local public health teams are resourced to the levels that we need, and are in place to act on any cluster or outbreak. Last week, our proximity app went live, and there have been 950,000 downloads to date.
The objective remains the same—to suppress the virus to the lowest level possible. Alongside that, we continue monitoring to ensure that protective and preventative measures in care homes and the care and health sectors remain in place.
In the past few days, there have been a number of worrying developments with regard to Covid-19. Daily cases have hit a four-month high, there was a rise in the number of positive cases in care homes, and Scotland’s reproduction number and Covid growth rate are now the highest in the UK. We cannot afford to risk Scotland’s response to the virus going off track. Given those developments, will the Scottish Government now implement additional measures, such as mass community testing, airport testing and home testing kits in schools?
All those measures are continuously reviewed by our chief medical officer’s clinical advisory group and, for example, by the clinical and professional group that works with us on care homes.
I have obviously read his news release; I need to correct Mr Cameron. In the past seven days—from 7 to 13 September—none of the cases in care homes were care home residents. In terms of the other measures that he has asked about, such as airport testing and mass testing, I want first, along with my colleagues in the UK Government, to make sure that the current UK testing system, of which we are part, is working as efficiently as we require, and at the speed that we require, before we consider adding pressures to it.
The efficacy of, and the clinical guidance on, widening the groups that we test is constantly being considered by the CMO advisory group, as was outlined in the updated testing strategy that we published in August.
The cabinet secretary is right to say that testing is essential if we are to tackle the virus. I will ask her about testing in Scotland by national health service boards, given the ultimate responsibility that her Government has for the NHS. What is the Government doing to increase the testing capacity in NHS Scotland, especially in the light of the developments that I mentioned and the possibility of a surge in cases over the winter?
The capacity that is controlled by the NHS boards in Scotland, and, through them, by the Scottish Government, also includes capacity in our academic nodes. We are quickly putting in place arrangements to cover the difficulties that the UK network of Lighthouse labs is currently facing, including interim arrangements that involve use of some private labs.
We are also scaling up to create three regional hubs from October, although we are looking at whether we can introduce some of the additional capacity later this month, and therefore earlier than October.
The reason why we are doing all that is, in part, because it is what we committed to, but it is also to ensure that there is significant additional resilience in the testing programmes that contribute to protection of the people who are most vulnerable. That includes care home testing; we have already begun to transition care home worker testing away from the Lighthouse labs to our NHS labs, so that we can be more confident about the speed of turnaround and more in control of the system. We will continue and complete that migration, so that all care home worker testing is run through the NHS labs. That also includes testing of NHS workers in healthcare areas that have been initially designated as requiring testing for staff in order to protect the most vulnerable patients.
Finally, I did not answer Mr Cameron’s earlier question about the R number. I hope that we are all watching the First Minister’s daily briefing. Those who do so will hear her make the point—as the chief medical officer and our national clinical director have done—about understanding the importance of the R number in and of itself, particularly when we have low prevalence. We still have low prevalence across Scotland, so the R number is important but is not the only factor. There are several other factors to consider, all of which are published weekly by the NHS and the Government.
As the number of cases and the R number are rising, thousands of families, such as mine, are very worried about what that means for visiting loved ones in care homes. At the moment, we are reduced to one visit a week—outside. That is very undignified, both for the person who is being visited and for the family, because it is cold, wet and windy. I plead with the cabinet secretary to move forward on this and to allow families to meet their loved ones in a dignified setting. What is going on just now cannot continue into the autumn and winter.
I will make a couple of points in response. First, I completely share the sentiment that Mr Findlay’s question expresses. I am constantly concerned about striking the balance between protecting residents in care homes from the virus and recognising that some of the measures that are taken to do that are harming them and their families, particularly in relation to family contact, residents’ cognitive functions and so on.
Right now, it is possible for care homes to have indoor visiting by a designated visitor. There are certain criteria that the care home needs to meet. It must have been Covid-free for 28 days and participating in the weekly test programme, and it must have a plan that shows that it has everything in place, including the right number of staff, available personal protective equipment, provision for taking details and so on. If the care home has all those things, the local director of public health will sign off that plan and indoor visiting can take place.
That is the case largely because I completely recognise that, on a day like this, an outdoor visit is not the kind of visit with their loved one that people want, and that if a loved one in a care home has dementia, window visiting does not work very well because they might not recognise the visitor through the window.
I assure Mr Finlay that we are looking constantly at what else we can do to normalise the situation in our care homes, which are, at the end of the day, individuals’ homes. The clinical and professional advisory group is looking again at what more we can do as we enter winter to strike a better balance between family and visitor contact for residents, activities for residents and healthcare services for residents, and protecting them from introduction of the virus into their homes.
Constituents have contacted me expressing their frustration that they cannot download the Protect Scotland app because their phone is not the latest model or they do not have the latest software. Those people still want to do their bit. Is the Scottish Government working to include people who currently find themselves unable to use the app on their mobile phones? Will the cabinet secretary confirm that anyone who is unable to download the app will still be contacted by the test and protect service if they come into contact with someone who tests positive and is unknown to them?
On the latter point, if someone who tests positive has come into close contact, for more than 15 minutes and closer than 2m, with someone whom they do not know, the only thing that they can do is to give information to the test and protect team and tell them where that happened—it might have been in the shop or on a bus—and the team will try to track that individual down. That is why the app is very useful, and is in addition to the test and protect programme.
The people who have developed the app, along with colleagues at Google and Apple with whom we have been working, are working to ensure that we can add functionality so that individuals with older phones can download it. When we get progress in that area, I will ensure that Beatrice Wishart and, indeed, all members are aware of it.
The cabinet secretary touched on the interim arrangements to help the UK Government. Will she give further information on the discussions with the UK Government regarding the capacity for processing Covid-19 tests and whether progress has been made on finding a long-term solution?
Members will be well aware that the Lighthouse lab in Glasgow is part of a network of UK-wide Lighthouse labs. People book tests through the UK portal and are asked to go to a mobile testing unit, a regional testing centre or one of the new walk-through centres, the second of which will open in Glasgow at the end of this week.
In relation to our agreement with the UK Government, the Glasgow Lighthouse lab should, as a minimum, give access to tests that are taken in Scotland at a level that is based on our population share. The figure fluctuates day to day, but it is anywhere between 13,000 and 14,000. On the basis of the information and data that we get, that meets the demand from those routes on most days. There have been a couple of days—when schools went back, for example—when the system was stressed above that level, but that level should be sufficient, provided that we have in place all the other facilities that I have just talked about.
However, in recent days—from about the middle of last week to now—there has been a growing backlog of tests in the Glasgow Lighthouse lab, because the network as a whole is being stressed by significant additional demand outwith Scotland. The Glasgow lab is part of that network. Care homes and others have raised the issue, which is why we are moving care home tests out of that route and into NHS labs.
I was in contact with Matt Hancock over the weekend. Our discussions were about not constraining the number of sample slots that people could access over the weekend. Yesterday, I and then the First Minister were in contact with Matt Hancock and Dido Harding about the arrangement, and we looked at measures that could be put in place to get rid of the backlog while not creating a new one. Their officials and our officials are busy working on what such measures could be, and on how we can be assured that we have, as a minimum, access to a level of capacity in the Glasgow Lighthouse lab that is based on our population share, as the memorandum of understanding says.
Parallel to that, there is the work that I touched on earlier on scaling up the testing processing capacity that we have at our own hand through regional hubs, the academic nodes and our own laboratories.
A83 Rest and Be Thankful (Closure)
To ask the Scottish Government what mitigation measures are being considered to deal with the continuing closure of the A83 at the Rest and Be Thankful. (S5T-02387)
I understand the frustration that closures to the A83 bring to local communities and drivers. However, safety remains our key priority. Overnight on Saturday, nearly 80mm of rain fell, bringing approximately 5,000 tonnes of material down on to the road. Recovery work commenced quickly thereafter and the old military road opened this morning. Work has begun on a further catch pit, with an additional one to follow, as well as a new geotechnical survey of the hillside.
To accelerate work to consider alternative infrastructure options for the A83, a dedicated project team has been established. Design and assessment work is now under way and engagement on the 11 route corridor options will commence in the coming weeks. A preferred route corridor will be announced in March 2021.
Members will know that the A83 at the Rest and Be Thankful was first closed due to a landslip on 4 August. The diversion route through the old military road has been closed for part of that time, too. One week after it reopened—just last week—it has been closed due to another landslip.
Therefore, I share the cabinet secretary’s frustration, as do local people. I know that he will want to join me in thanking all those who are working to clear the road. However, the mitigation is frankly no match for Scottish weather. What will the cabinet secretary do to protect not only the A83 but the diversion route on the old military road?
I recognise the concerns that Jackie Baillie raised. She will acknowledge, though, that the landslip that took place on 4 August is on a new area of the hill where mitigation measures have not previously been installed because they were not anticipated to be required.
Jackie Baillie will also be aware that in places where mitigation measures have been put in on the Rest and Be Thankful there have now been around 48 occasions on which the road has remained open because the mitigation measures have protected it. Therefore, we know that where mitigation measures are put in place they offer protection to the road and help to keep it open.
Jackie Baillie will be aware that a further catch pit is being installed on the road at present. Work was started on 1 September. It was postponed at the request of the local authority and other interested stakeholders to avoid any delay during the summer months. The work commenced on 1 September, and a further catch pit is being designed at present for the area where the new landslip took place. That work will be undertaken once the present catch pit is completed, so that the workers can move to the new site.
We are determined to do everything we can to ensure that we have the appropriate mitigation measures in place while at the same time doing the appropriate work to identify an alternative route for the A83, to ensure that we have a long-term solution to this problem.
I add my thanks to the workers who have worked through very difficult conditions in a very challenging environment to ensure that we continue to repair the damage that has been caused on the A83 at the Rest and Be Thankful.
The A83 task force met at the end of August, and I understand that the cabinet secretary is exploring 11 options for a permanent replacement, as he referenced. I am sure that he will agree that a replacement is urgent—there is cross-party agreement on that between me, Mike Russell and Donald Cameron, and also by Argyll and Bute Council. What can the cabinet secretary do to accelerate that process, and when will the options be published along with the minutes of the task force meeting?
I want to pick up on a point that Jackie Baillie made in her second supplementary question. I am sorry that I did not touch on it. It was about protection for the OMR. The member will be aware that some mitigation measures have been put in on the OMR as a result of the most recent landslide. However, the OMR is largely dependent on the mitigation measures that we have on the Rest and Be Thankful, which is why it is important that we continue the work on that.
In relation to accelerating the process and looking at the 11 different options, the member will be aware that I have accelerated that process as quickly as I can. I hope that we will be able to start the public consultation on the 11 different options by December. I have also put a project team in place now, in order to start the process of dealing with the responses that we received during the consultation to try and accelerate the process as we get to the end of the consultation exercise. That is all aimed at trying to speed up the process as quickly as we can.
I assure the member that I am trying to do as much as I can to ensure that the local community and interested stakeholders have an opportunity to give us feedback on the 11 different options as quickly as they can in order to ensure that we have a long-term solution in place as early as we reasonably can.
Yesterday, I was in discussions with BEAR Scotland about the relief road situation on the A83 at the Rest and Be Thankful in respect of the adverse weather during the coming winter. Could I advise the cabinet secretary to consider a northbound relief route on the south-side forestry track at Glen Croe and a southbound relief route on the old military road, as it is now, to be open 24/7 so that we basically have two roads of one-way traffic?
The member might be aware that the forestry road on the other side of the glen is not up to the necessary standard for carrying traffic flow of that nature. The second particular difficulty with his suggestion on the OMR operating 24 hours a day is that it is dependent on safety assessments. A blanket 24-hour operation on the OMR is not always safe. Safety audits are carried out in the morning and evening in order to make sure that the OMR is operating safely.
I can assure the member that we will continue to do everything we can to try to address the local frustration that I know is caused when that major road is closed as a result of landslips. The work that I set out in my response to Jackie Baillie demonstrates our determination to make sure that we do all we can to resolve the issue.
Covid-19 Testing (Social Care Workers)
To ask the Scottish Government what its response is to the call by the director of Enable Scotland for routine testing of all front-line social care key workers in all settings. (S5T-02384)
As we have moved through the pandemic, and as our understanding of the virus grows and our testing capacity changes, we constantly review how we make best use of that capacity.
We published an updated testing strategy on 17 August. To demonstrate that changing understanding and use of testing capacity, and as we safely remobilise our national health service, we have introduced NHS staff testing in areas of particular patient vulnerability. Further introduction of NHS staff testing and of admission testing is now under consideration.
We continue to expand our testing capacity and to review its most effective use, including what more we can do to protect those who are most vulnerable to the virus and its health impact. In doing that, we will of course take account of the views expressed by the director of Enable Scotland.
Epilepsy Scotland has also asked for the routine testing of carers of people with learning disabilities in supported accommodation and has asked for more data on the mortality rates for that vulnerable group. Will the cabinet secretary update Parliament on the work that was commissioned on mortality among learning-disabled people?
The Scottish Learning Disabilities Observatory has approval to link to data sets controlled by National Records of Scotland and the NHS. That enables the observatory to investigate the impact of Covid-19 on the learning disabilities population in Scotland. Once the observatory receives the data sets—a process that is underway—it is linked and analysed. We expect the evidence to be available this month. Provided that we can meet statistical quality thresholds, it will then be published. If there are any glitches with that, our statisticians will engage with the individuals concerned to ensure that the data can be published as soon as possible.
I welcome that. Yesterday I met parents connected with the charity PAMIS. They are now cut off from the lives of their learning-disabled adult children as some health and social care partnerships still do not allow any visiting or trips outside, or allow only very limited visits. The families of those young adults say that their adult children’s physical and mental health has been impacted. They suggest that close family members who were previously providing high levels of support should be treated as part of the care team.
Will the cabinet secretary examine those suggestions from PAMIS and will she encourage all health and social care partnerships to allow appropriate visiting?
Yes, I will. The chief executive of PAMIS, Jenny Miller, has written to me to express those concerns. I understand that that situation is not only concerning for the families but that it is often heartbreaking for them and for their loved ones.
The guidance about access is interpreted differently in different local areas. I need to get to the bottom of that. I would be grateful to know, either from PAMIS or from the member, which health and social care partnerships are not allowing visiting. Guidance about outside visits by individuals has recently been produced. I need to understand where the difficulties are and why those health and social care partnerships believe that their advice is superior to the clinical advice on which our guidance is based. Then we can seek to resolve that. In the meantime, I need consistency, but I also need to hear directly from Ms Miller about the specific concerns that PAMIS has so that we can try to move to assist.
I attended the same meeting as Joan McAlpine yesterday morning, along with Jackie Baillie. Interpretation is not good enough. We have families who have not seen their children or other family members since March. Some of the most vulnerable individuals have not been able to cuddle their mum or dad.
I urge the cabinet secretary to look at the matter urgently. It is not good enough for people to say, “It’s how we interpret it.” We need to allow those families to have access to their children. It is not possible for some of them to do that outside, so it needs to be inside. If that means testing, let testing happen. However, for the sake of the most vulnerable members of our society, let us not let officers hide behind interpretation.
Actually, I could not agree more. There is not the room for, and health and social care partnerships do not have the locus for, reinterpreting guidance that is introduced and sent out by us from Public Health Scotland and is soundly based on that balance of risk between clinical judgment and the other non-health harms that can be brought about by people’s isolation.
I will most definitely look at the matter urgently and I am happy to ensure that members are kept up to date with progress.