Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, August 19, 2020

Official Report 701KB pdf

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Health

I note that the front benches around the chamber are generally empty, and remind members that business carries on from one item to the next; there are no set timings.

The next item of business is a statement by Jeane Freeman on health. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:53  

Today I want to set out work that is under way to remobilise our health services. In doing so I want to be clear about the factors that will necessarily limit our capacity to mobilise in the immediate term to the extent that we—and patients across Scotland—would wish.

However, first I want to acknowledge the incredible and selfless work of all the staff in the national health service and the social care sector, and offer them my heartfelt thanks and gratitude for all that they have done—often at great personal sacrifice—and all that they continue to do.

I know that the necessary pause on NHS services in the first months of the pandemic, and the experience of lockdown, especially for the 180,000 people who rigorously followed our shielding advice, while undoubtedly saving lives, also contributed to other harms to health.

Although we were on track to significantly reduce waiting times, now the numbers of people waiting for a range of tests and treatments is rising and will be added to by unexpressed demand from those who have either not felt safe to come forward or did not want to add to the pressure on our health and care services during the peak of the pandemic. That will be evident in mental health services as much as—if not more than—in physical health, and it will be acutely felt by those who struggle with drug or alcohol addiction.

I want to see all those services, and more, remobilised. However, there are real limitations to that, and I need to set those out clearly so that they are recognised and understood.

In recent weeks, real progress has been achieved in suppressing Covid-19 across Scotland. Numbers in hospital and intensive care have significantly reduced, and there have been no deaths registered from a confirmed virus case since 16 July.

However, there must be absolutely no doubt that the virus remains as virulent and dangerous to life as it has ever been. Today we are managing a number of cases, clusters and outbreaks across the country. Those are all at different stages, with each one being actively managed through the exceptional work of our NHS test and protect teams, which are led by tried, tested and highly skilled incident management teams. However, each one of them is a clear reminder to every one of us that Covid-19 is an ever-present threat.

Our aim is vigorously to suppress the virus to the lowest possible level. Full lockdown helped to take us towards that, but full lockdown cannot last forever. So, as restrictions are lifted, we need other tools that we can use: a comprehensive set of public health measures of intelligence, anticipation, prevention, mitigation and response. No single intervention will do the job that we need to be done.

On Monday, we published our testing strategy, which we have updated since the early days of the pandemic. It sets out our current priorities for testing, based on the work that we have already done to increase capacity and improve availability. Our priorities include testing all those with symptoms and hunting down the virus by testing close contacts of people who have Covid-19 and by using testing to prevent or minimise new outbreaks. There will be routine testing of people who work in high-risk environments such as care homes. We are also using testing to ensure the safe resumption or continuation of NHS services. Crucially, we will also assess the prevalence of the virus through a significant expansion in our testing for surveillance—both in our communities and in key sectors including schools and hospitals.

Our testing capacity continues to increase. We should have the ability to test 50,000 people per day by the end of August, with a further contingency capacity of 15,000, taking us to around 65,000 tests per day by winter.

Today, on the Public Health Scotland website, we published the success rates of the national contact tracing centre in making contact with those people who test positive and with their close contacts. The new case management system for test and protect was rolled out to health boards over a 30-day period from 22 June. Today’s report shows that, between 22 June and 16 August, 99.7 per cent of all cases that were identified in the case management system as requiring contact tracing were successfully contacted. Based on that work, the teams also traced more than 5,000 contacts and were successful in contacting 98.8 per cent of those individuals. I congratulate all who were involved in that achievement for their contribution to keeping us safe.

As we approach winter, we plan for and deliver the seasonal flu vaccination programme. This winter, with Covid-19 still prevalent, the seasonal flu programme becomes even more critical. That is why we are planning a major expansion of that programme: we plan to vaccinate just under 2.5 million people before the end of the year. That is 840,000 more people than last year. To those who are already eligible we will add social care workers, NHS staff, household members of individuals who are shielding, and all those aged 55 and over who are not already eligible in another category. Then, if vaccine supplies allow, we will look to vaccinate those aged 50 to 54.

To vaccinate that number of people across Scotland in three months and to do so safely with personal protective equipment and physical distancing, in Covid-protected environments, is clearly challenging. Detailed delivery plans are being drawn up and multiple sites identified. Those must be in place, staffed and ready to deliver, making vaccination as accessible as possible in our cities and towns and in our remote and rural communities. We know that we must also be ready for the Covid-19 vaccine that we all hope for. Much effort is going into producing that.

Without doubt, we have reached this point in tackling the virus thanks in large measure to NHS and social care staff across Scotland. That has come at a cost to them. I fully recognise the impact that this extraordinary period has had on their health and wellbeing. Health protection teams, who were among the first to mobilise in February, and staff in primary and community care, in social care, in Covid wards and community hubs, in emergency and intensive care—in all professions and jobs—have had little respite so far.

Local hubs have been put in place to give members of staff the space to relax and recuperate away from their work environments.

The intensive provision of psychological support for staff and carers will continue to be prioritised. Our national wellbeing hub is truly innovative, empowering staff and carers to address their physical and mental health as never before. We have established the new national wellbeing line, based in NHS24, for all health and social care workers, supported the provision of online coaching support and set up a network of 84 wellbeing champions across the country.

However, our staff need time off—time with their families and time to recharge—so we are working with our partners to develop a Covid-19 supplement to the integrated workforce plan, with a focus on ensuring respite for staff who have got us to where we are now. In working to remobilise services, we must also remain alert to the need to provide and maintain safe living and working environments, whether in care homes, general practitioner practices, assessment centres, our hospitals or any other treatment spaces.

We have to make sure that the necessary support is in place to respond to any future increase in Covid cases, whether that means staff training and development, securing supplies of key medicines or devices or replenishing our PPE stockpiles. Alongside that are the risks associated with a no deal or limited deal for Brexit, where the end of the transition period lands right in the middle of the flu season and may materially impact supply chains during that critical time.

There are clear and significant operational challenges ahead. In recent years, we have made significant progress under the Government’s £850 million waiting times improvement plan. However, when the waiting times for the period from March to June are published later this month, we can expect to see any progress wiped out, with a very significant increase in the numbers of patients who are waiting for routine appointments and treatment.

Boards have been cautiously resuming a wide range of routine services that were paused in the initial response and are doing so in line with clinical priorities, but many will not be operating in the same way as before, nor in the same volumes. The numbers of patients who can be seen, diagnosed and treated in the timeframes of before will clearly be reduced by the continuing and necessary infection prevention and control measures, such as altered patient flows, appropriate bed spacing, physical distancing, PPE requirements and time needed for additional cleaning between clinical sessions.

Early estimates are that up to 50 per cent of operating theatre throughput could be affected in the coming months. We will augment local capacity by using national resources at NHS Golden Jubilee and the NHS Louisa Jordan hospital and there will, of course, be variation between boards. However, I want to be clear: there will be a significant impact on the time that many patients have to wait for treatment.

I completely appreciate that further delays could materially affect the quality of life of many people who will be waiting for care or treatment with continuing pain and further anxiety. I wish that it were not so. I regret that we cannot mobilise to the degree and at the speed that we all wish for, but, as we continue to deal with the virus and the aftermath of the first months, there is no choice. We have to continue to balance the competing demands and pressures, making the best decisions we can, none of which are easy and none of which are taken lightly.

So how do we determine what to mobilise and in what order? How do we redesign to ensure that we learn from and build on the hard-won lessons of the past few months? I can promise all patients that treatment will continue to be triaged and prioritised on the basis of clinical need, in line with advice and guidelines developed and agreed with the royal colleges and others.

We will be developing a national cancer recovery plan to account for the changes to cancer services specifically and to implement innovative solutions. The plan will be led by the national cancer recovery group and published in early autumn. It will focus on reducing the inequalities that have been exacerbated by the pandemic and ensure that patients are receiving treatment equally using a once-for-Scotland approach.

There is also a need to strike a balance between urgent care and quality-of-life care which, if left not tackled, creates further long-term problems. I repeat our commitment to resume the full range of pain services as quickly as it is safe to do so.

We will shortly publish a Covid-19 recovery framework for NHS pain management services to continue to inform and guide our work. It will sit alongside the “Framework for supporting people through Recovery and Rehabilitation during and after the COVID-19 Pandemic”, which I published last week, which targets work and services to better understand and help people whose physical and psychological health has been affected—often profoundly—by their experience over the past months.

Deciding what we can mobilise, and how we can build in the improvements in service delivery that we have seen in recent months while managing the limitations that I have outlined, is a continuous iterative task. However, it is informed by the experience and knowledge of all our key partners, including the Royal College of Nursing; the British Medical Association; our trade union partners and colleagues in local authorities; Scottish Care and the integration joint boards; the third sector; and clinical stakeholders, including the royal colleges. The patient’s voice is important too, and we are working with the Health and Social Care Alliance Scotland to make sure that we hear about what matters most to patients. Collectively, all those voices feed into the mobilisation recovery group, which I chair. The group’s fourth meeting took place last week; it has been meeting fortnightly, with much detailed work being done in between, and it will continue to inform and guide our decisions.

There is much more to say and more detail to set out in the coming weeks on elective procedures; our approach to dealing with backlogs; the criticality of primary, community and social care; our plans for mental health support; and more besides. As plans firm up, we will keep members fully informed. However, I want members to be assured that learning, thought and effort is being applied nationally, regionally and locally to give us the most resilient and robust response possible to the myriad pressures and risks that we face in the coming months.

Before we move on, I repeat what my colleague Ms Fabiani said from the chair. This item is follow-on business—at this stage in the parliamentary session, members should be aware that they must be in the chamber before the statement begins, and today too many members came in late. We are beyond the time for not knowing. When you see that something starts at 3, and you know that it is follow-on business, you should be in the chamber.

The cabinet secretary will now take questions on the issues raised in her statement. I intend to allow 45 minutes for questions, after which we will move to the next item of business. It would be helpful if those members who wish to ask a question would press their request-to-speak buttons now.

Presiding Officer, I apologise for being one of those members who arrived late to the chamber.

I thank the cabinet secretary for advance sight of her statement, and for the update. I too pay tribute to our incredible NHS staff and social care staff for all that they have done and continue to do. As the cabinet secretary rightly acknowledges, the virus has not disappeared and we must remain vigilant as we continue to fight it.

In her statement, the cabinet secretary referred explicitly to routine testing of people who work in care homes. We on the Conservative side of the chamber remain concerned that levels of testing of care home staff for Covid-19 remain unacceptably low. In July, the cabinet secretary said on several occasions that weekly testing of care home staff was in place, and yet the weekly figures that her Government has published show that thousands of care home staff are still not being regularly tested. Indeed, figures that were published today show that around 16,600 care home staff had not been tested. That is completely indefensible, and it is a failure that lands squarely at the feet of the cabinet secretary.

With that in mind, I have two questions for the cabinet secretary. First, why are thousands of care home workers still not being tested, despite her promises that they were? Secondly, what urgent action will she take to fix that and ensure that every care home worker is regularly tested?

We are doing two things. First, in working out how many care home staff should be tested, it is unrealistic to expect 100 per cent of them to be tested every week, for two reasons. First, staff may be on annual leave, sick leave or maternity leave, or they may be on different rota patterns. From discussions with Scottish Care and others, the percentage that we look to is 70 per cent or more, and in recent weeks we have overshot that target.

Secondly, there are some staff who refuse to be tested. Testing is not mandatory. Working on a real-time basis with colleagues in the Coalition of Care and Support Providers in Scotland, Scottish Care and the Convention of Scottish Local Authorities, my officials are working through all the issues that may be preventing staff from agreeing to be tested, and are trying to address and remove those as we go.

We have already addressed some of the issues with the help of Ms Lennon and the amendment that she lodged on the special fund to address those staff who were reluctant to be tested in case they were positive because their terms and conditions were such that they would receive only statutory sick pay. That would represent a significant decrease in their weekly income for many staff who were on low pay in any event.

We continue to work that through. However, I note the most recent figure that I have for the current programme—I do not have the one that was published today, but in the previous week, 76 per cent of the total number of staff employed in the care home sector were tested, and we should bear in mind that 100 per cent is an unrealistic target. We continue to drive the figure up, but we are seeing the positive impact of that testing in the number of cases that we are seeing in our care homes across the country.

If I may, I will make a quick final point about the easing of visiting restrictions. I am sure that Mr Cameron has studied the subject carefully and will know that one of the criteria for a care home to be able to ease visiting restrictions is that it is fully and actively participating in the weekly care home staff testing programme. That is one of the ways in which we are trying to make sure, with encouragement, that all our care homes are taking part.

I, too, put on the record our thanks to and appreciation of all our healthcare workers, and I thank the cabinet secretary for advance sight of her statement.

Back at the end of May, we welcomed the framework to remobilise, recover and redesign our NHS. We appreciate that a bit of time is required and, of course, that staff need some time off. They are burned out. They were burned out before Covid, but that has got a lot worse. However, I say to the cabinet secretary that progress has been very slow. For many of our constituents and many patients, it feels as if the NHS is still in lockdown, and the easing of that lockdown has, sadly, come too late for some patients.

Will the cabinet secretary give us a bit more detail on what the Government is doing to address the chronic understaffing levels and underfunding that were problems even before Covid? Our NHS was running hot, but now people are really struggling.

I also want to pick up on the issues around the winter flu vaccination and preparedness for winter, using my health board as an example. NHS Lanarkshire has said of the ability to deliver the expanded flu vaccination programme that it is a high risk, and other health boards across the country have the same worries. If we are worried about delivering the flu vaccine, how are we going to deliver a Covid vaccine when we get one?

I would be grateful if the cabinet secretary could address those points, because health workers are very worried about them, and so are our constituents.

I thank Ms Lennon for those very important questions. She is right: no part of the NHS is restarting as fully and as quickly as any of us would want.

Part of the reason why I set out in my statement all the things that we need to do right now—test and protect, managing clusters and outbreaks, the flu programme, the reduction in productivity because we need our NHS to be safe, and the additional testing programmes that are under way—is that those things are all staffed by NHS staff. If we have them all doing those things, they cannot also be free and able to do other jobs in the health service that they are now being redeployed to do, albeit that we are actively engaged in bringing people back in through our health returner portal, and some of them can most certainly help us with the flu vaccination programme.

I understand the frustration and disappointment, particularly from patients and people who have been waiting. Our health boards were asked to produce mobilisation plans to the end of July in order to get going, and they did that. They have now produced, as we asked them to, mobilisation plans to the end of March next year. They have been asked to make sure that they build into that the wellbeing, respite and care of staff, and that they join that up with health and social care integration so that they are focusing on primary and community care and not solely on acute care.

Part of the mobilisation recovery group that I chair is to work through those and ensure, with the input of the royal colleges, that we set clear, clinically determined priorities for the whole of the country that boards will then follow. We need to try as best we can to achieve equity of access and approach, regardless of where people live in Scotland. A particular example of that is the recently published framework for prioritising cancer surgery with that clinical lead. We will follow that up in other areas, particularly in elective care and elsewhere.

On the flu vaccine, Monica Lennon and NHS Lanarkshire are absolutely right that it will be a significant challenge to vaccinate 2.25 million people before the end of the year. On the upside, it will be an excellent dry run for the Covid vaccine so we are determined to get it right. It will be an all-system delivery, so we will engage as many parts of the primary and community care sector as we can. Pharmacists, dentistry, or other clinical teams could be involved, as well as those who have been brought back in to help us.

Two things need to happen to help that process. First, the UK Government needs to pass a piece of emergency regulation to change the reserved act about who can give a vaccination. Secondly, we need to enact a part of our coronavirus emergency legislation on the administration and control of vaccinations. Those two need to go hand in hand so that we have a range of people who are clinically qualified and able to vaccinate. That will allow us to carry out the programme. It will be a national delivery flu vaccination plan that boards will feed into, but it needs to be national and all-system if we are going to do it as well as being ready for the Covid vaccination.

I certainly do not want to curtail questions and answers but I have 40 minutes and 20 questioners, so please bear that in mind when you are asking your questions and when you are making your responses.

Will the cabinet secretary outline how the Scottish NHS can ensure that a consistent approach is taken to service remobilisation across the country, including in NHS Dumfries and Galloway in my South Scotland region?

I think that I have, in large measure, answered that question. That will be done partly through the board mobilisation plans and through ensuring that the recovery group takes a collective view that is informed by trade union colleagues who represent staff, by the royal colleges and by other key stakeholders in local authorities, the third sector and so on.

We want to ensure that we have a consistent framework for prioritising on the basis of clinical need, and for ensuring that services are started and followed through across all health boards so that we achieve equity of access, and so that we have a national approach with local delivery.

I have previously raised the issue of chronic pain patients with the cabinet secretary. For many, it has been five months since they were able to attend a chronic pain clinic or access appropriate treatment. Some have taken the drastic action of travelling to England for treatment, so desperate have they become.

I note that the cabinet secretary has repeated her commitment to resuming the full range of pain services as quickly as possible. A report from clinicians—“IMPACT-Restart report for orthopaedic elective arthroplasty”—has suggested that it has been entirely possible to restart such treatments quite safely, so why, despite that, has the plight of people who are suffering from such conditions remained largely unheeded?

I completely agree with Mr Whittle, which is why I made a particular point of mentioning in my statement what I described as quality-of-life health issues. They are not life-threatening, as such, but have a hugely debilitating impact on people’s capacity to live as freely, independently and fully as they wish, and as we want them to. Pain services must be central in that. I have made an absolute commitment to ensuring that we restart all the pain services that are needed so that people can access them.

I also referred to holistic services, with a combination of medication, physiotherapy and lifestyle management—all things that are very much bespoke to each individual. I do not subscribe to the view that medication is entirely wrong in these instances; it absolutely has a role to play. We want to see that happening.

I have asked my officials not only to produce a framework, but to provide me with a delivery plan that will show me how pain services can be restarted across Scotland, and how quickly we can do that.

Recent stats from the Office for National Statistics indicate that the number of adults who are experiencing depression has almost doubled during the coronavirus pandemic. How will the NHS prioritise resumption of one-to-one personal mental health support for those who need further psychological support because of the coronavirus crisis?

I am grateful to Mr Torrance for asking a very important question. My colleague Ms Haughey, who is sitting beside me, has been busy producing and agreeing a remobilisation plan for our mental health services, in order to build on some of the innovative ways of delivering mental health services to adults and young people that have been adopted during the pandemic, and to increase our capacity to deal with additional areas of demand that have arisen because of the pandemic, as Mr Torrance described.

Both because of people’s experience of the lockdown restrictions and because of the significant psychological trauma that has been experienced by individuals who have contracted and have survived the virus, and who have long-term psychological and physical health demands, we are making specific use of the expertise of our national trauma network, which has taken innovative psychological steps to help patients who have suffered trauma.

Like hospital and social care staff, general practitioners have been working particularly hard during the pandemic, in providing online, email and phone consultations for their patients. However, those are not substitutes for face-to-face consultations. I have constituents who have suffered significant deterioration in their conditions because they have not been seen. Will the cabinet secretary ensure that there is, as part of NHS remobilisation, much greater access to face-to-face consultations with GPs?

Yes, I will. I have spoken before about the innovative steps that have been taken in response to the pandemic, and about the need to create Covid-safe pathways throughout our health service. Much use has been made—very successfully—of NHS near me services, for example, as well as of other digital methods. However, I know that in many cases, as GPs and other clinicians tell me, that that is absolutely not a substitute for actually seeing the person—their body language, their facial expressions and the things that they are not saying, which practitioners need in order to question patients a bit more if they are to get to the bottom of things.

In considering the mobilisation plans, I have asked that a very particular focus be applied to primary, community and social care. For me, those form the bedrock of our NHS. We have talked with the British Medical Association, particularly on the GP side, and we will take particular measures in response to what it and the Royal College of General Practitioners are saying to us, as we consider what more we might do to assist general practices to remain safe places—Covid-free spaces—so that GPs can pick up on their face-to-face consultations.

I, too, apologise for missing the beginning of the cabinet secretary’s statement.

The cabinet secretary has advised that people who work in high-risk environments such as care homes will continue to be routinely tested, but that routine testing will not yet apply in schools and hospitals. That is an issue of on-going concern to many people. Can the cabinet secretary confirm whether that differentiated approach is subject to continuous review by the Scottish Government?

Yes, it is. What Ms Johnstone said is not quite accurate, however. We have introduced testing in hospitals for NHS staff in specific areas: in long-term care of the elderly, in cancer treatment and in one or two others. I will be happy to let Ms Johnstone know the detail of that.

That was done on the basis of advice that was given to us by our chief medical officer’s advisory group and our very particular nosocomial review group. That is clinical and scientific advice, and it continues to be reviewed. For example, one of the areas of review is emergency department admissions. People aged 70 and over who are admitted to our hospitals are subject to routine testing, but one of the things that are currently being looked at is widening of that to include all emergency admissions.

In relation to schools, there is test and protect and there is surveillance work, and we have also made sure that all school staff can access testing if they are concerned that they have been close to someone who might have the virus. They might not be symptomatic, but a portal has been opened up so that they can access testing, as well. On whether more needs to be done, the expert group that is working with the Deputy First Minister on the safety of schools will continue to consider whether testing can be used in other ways in order to provide safety and assurance for schools, so that we can continue to keep them open and keep young people learning.

During the pandemic, people with dementia in care homes have been deprived of the social and emotional contact and the advocacy that family visits bring. The Scottish Government’s guidance on care home visiting has as its first principle that a person-centred approach must be taken at all times. What more can be done to ensure that that is the case in each and every care home in Scotland, so that we can be sure that our older people get the contact with their families that we know is crucial to their health and wellbeing?

That is another important area. Throughout the pandemic, and from the very outset when we said that visiting to care homes needed to be stopped, we have made exemptions. One of the groups of residents for whom there has been an exemption is residents with dementia for whom the absence of seeing family and friends was causing additional distress. Care homes were clearly advised of what to do in relation to ensuring infection prevention and control and safety in those circumstances, and to permit that visiting. I regret that in some instances that has not happened; individual cases have been raised with me and we have investigated, intervened and, I hope, resolved them.

I hope that the increase in visiting—it has gone from one designated visitor outdoors to up to three visitors outdoors and, provided the right plans are in place, a designated visitor indoors—will further assist that group.

I am also currently considering guidance on safely increasing communal activity, and on reintroduction to care homes of other health and support services that are especially important to residents, but which they have not been able to access face to face up to now. Again, that will be slower and will take longer than before, because we need to have in place the proper PPE provision and so on.

However, I hope that step by step, with all the safety precautions in place and with care homes that are Covid-free participating in care home worker testing, we will be able to reintroduce greater levels of normality for residents in our care homes.

Before the pandemic there were only just enough beds in Raigmore hospital; now there are not enough. Given that that is one of the main factors that are limiting the amount of operations that can be carried out, will the cabinet secretary commit to providing additional temporary accommodation to allow the backlog of in-hospital treatments and operations in the Highlands to be carried out?

Additional accommodation is not just a case of going to the nearest Premier Inn, opening it up and buying all the bed spaces. We are talking about accommodation that needs to be clinically safe for patients and staff to work in. That is an important caveat to make, before I respond to Mr Mountain’s question.

Every health board is considering what it can do to maximise its space and use of its theatres, while bearing in mind the necessary infection prevention and control measures, one of which is distancing. That is happening in Raigmore and other hospitals, as they consider the space between beds and so on.

However, NHS Highland is actively considering what more it can do to increase the number of patients whom it can see and treat, while remembering that it has other demands—not least in working to continue to keep the virus under control and in allowing staff time to recover before we ask them to do even more than we have asked them to do up until now.

Can the cabinet secretary give an update on the review of domiciliary eye care and say when she thinks it may be safe for that service to resume face to face in some capacity?

That is one of the areas of service that are currently being considered for reintroduction to care homes, for example. There is also domiciliary eye care that is provided in people’s homes, and that will be wrapped up in the same piece of guidance. I hope that we will be able to approve that and that those services will be reintroduced shortly, but all that depends on how the prevalence rates of the virus run across the country, the levels of infection, what happens to the R number and the numbers in hospital, intensive care units and so on. Those are important NHS services and it is important to restart them, but they sit in that context and they must be restarted safely.

In the cabinet secretary’s statement, there are positive references to remobilising the NHS and enabling patients to receive equality of treatment. There are two main issues for Highlands and Islands constituents: provision of a positron emission tomography—PET—scanner for cancer treatment in the region, and dynamic and effective pain clinics. Does the cabinet secretary agree that those two issues would be consistent with a once-for-Scotland approach?

Certainly, it is the case that we need to do as best we can to increase patient access to those healthcare services in our island, remote and rural communities. We have just agreed to additional investment in diagnostic equipment. Standing in the chamber, I do not know where that investment is going, but I am very happy to investigate that and make sure that Mr Stewart knows about it. If there is a particular issue regarding the PET scanner, he is welcome to take that up with my officials.

I agree that we need to have equity of access as far as we can manage it across the country for the services that we can remobilise.

On the important issue of the plans for a significantly enhanced seasonal flu vaccination programme, how will the NHS manage the balance between providing seasonal flu vaccinations to such a significantly increased cohort of people and, at the same time, working to prevent the spread of Covid-19?

That is an important question. It is important for those who will be eligible for the flu vaccination to know that where we are asking them to go to be vaccinated will be as Covid-19 free as we can assure them it will be, just as we did when we created the Covid-19 pathway in the community, started the Covid-19 assessment centres and hubs and took that stream of work out of the GP practices.

We are looking to replicate that for the flu vaccination programme, which will mean that, across the country, all our health boards and Public Health Scotland are looking at other locations where people can go to be vaccinated. Some of those will not be healthcare locations, so we need to make sure that they are accessible and have all the levels of cleanliness and infection prevention and control measures that we need, so that we can vaccinate large volumes of people. Those locations need to be accessible not only in a physical sense but in the sense that they should not require long car journeys for people to get to them. That work is well under way, because we want to be able to start the flu vaccination programme in time to have it completed by the end of the calendar year.

In April, the cabinet secretary announced a much-needed pay rise for care workers, but she did not announce any additional funding. Given that the Edinburgh integration joint board has been underfunded since its inception, there is now an unacceptable choice between cutting services that are desperately needed for pandemic recovery and funding that vital pay rise. Will the cabinet secretary fully fund the pay rise that she announced in April?

I am afraid that I do not accept the premise of Sarah Boyack’s question. There is additional funding. In fact, not only is there additional funding to pay for the pay rise, there is £100 million of additional funding available to social care to make good the additional cost to it of responding to the Covid pandemic. That is in addition to the PPE that we have been providing free of charge to that sector.

The Edinburgh IJB is alone among IJBs in not paying that wage rise—other IJBs are paying it. Clearly, the funding is available. IJBs have to make political choices, the same as Governments do. The money is there, and I assure Sarah Boyack that I intend to have even more discussions with the Edinburgh IJB about why it consistently refuses to make the right choice and pay those workers the money that they are due, and to back pay it to 1 April.

The cabinet secretary’s statement drew heavily on the Covid-19 statistical report. It is disappointing, however, that she left out the update on quarantine checks for international travellers, which is deeply troubling. Humza Yousaf told Parliament that 20 per cent of people who are expected to quarantine would be contacted, yet we now know that the tracers are following up only half that number. More worryingly, the report reveals that tracers are unable to find a large proportion of people who are supposed to be in quarantine. How are we getting this so wrong?

I am looking to see the most recent data that I have, and I apologise for not instantly laying my hand on it. However, my understanding—I will correct both the record and Mr Cole-Hamilton if I am wrong in this—is that, through Public Health Scotland, our officials are reaching that 20 per cent target. The position is that, if they cannot reach an individual who should be quarantining by either the second or third phone call or by email, they will then pass on that information to Police Scotland, which will take whatever operational decisions it thinks fit. That is the right thing to do, because quarantining is critically important. Contacting the 20 per cent of people who should be being contacted—the numbers involved in that will vary from week to week, depending on the numbers of travellers coming in from the countries that are not exempt from quarantine—is a very important part of what we are doing.

My understanding is that the number of people who are being checked is meeting the 20 per cent target. I will check the figures and ensure that Mr Cole Hamilton knows what they are. If I am incorrect, I will correct the parliamentary record.

Will the break-up of Public Health England have any impact on Scotland’s response to the pandemic?

I am afraid that the short answer to that is that I do not know for certain whether it will make a difference, or whether, if it makes a difference, that will be a good difference or a less than good difference.

On Monday night, I had a conversation with Matt Hancock, the Secretary of State for Health and Social Care, in which he informed me and my colleagues in Wales and Northern Ireland of his intention to make those changes. His assurance was that there would be no difference in terms of who acted on what reserved and devolved responsibilities. We need to look further at the detail of that and at what it means in operational terms. This is not just about who has responsibility for what; it is about my officials knowing who they are talking to south of the border in the new organisation, given the relationships that they have established with people in Public Health England, which are very important with regard to the speed of transfer of information and so on.

We need to continue to consider the detail of the matter. If there are issues that I think will adversely affect Scotland, the member knows that I will raise them in my very regular call with Mr Hancock and my colleagues in Wales and Northern Ireland.

For the future, we should learn from the past. A patient who tested positive and was then allowed to be released from hospital into a care home was the first care home Covid death in Angus in my region. How will the cabinet secretary ensure that she is better informed to take decisions in the future than perhaps she was in the past?

In a number of ways, we are learning lessons as we go, partly informed by the growing knowledge and understanding of coronavirus of our leading scientists and clinicians—not just those who work in Government and from academia in an advisory role, to whom I am grateful—but others who are working hard in Scotland, the rest of the UK and Europe.

As the understanding of the virus develops, we aim to change our guidance and approach accordingly. We started off well with our national procurement service and its stockpile of PPE, but its modelling work has improved significantly, so I am confident in the modelling that it is doing in estimating demand for PPE, along with Ivan McKee’s significant work in securing domestic supply of PPE. We know what we need and where and how we are going to get it. For example, we have continued with our orders of ventilators, so that we will have ready quadruple the number that we started out with, should we need them, but stockpiled if we do not and ready to replace existing ventilators when they need replacement. Our testing strategy has been updated in direct response to that growing knowledge of the virus and to learning the lessons and improvements that we need to make as we go.

Will the cabinet secretary outline how the NHS Louisa Jordan hospital is being used and can be used to help the delivery of NHS services?

As the member knows, 400 patients have received orthopaedic and plastic surgery consultations at the NHS Louisa Jordan hospital. We are now looking at key diagnostics such as X-rays, CT scanning and ultrasounds, as well as at special dermatology outpatient appointments and continuing orthopaedic and plastic surgery consultations. The NHS Louisa Jordan hospital remains a significant resource, as does the Golden Jubilee hospital, as I said in my statement, which has restarted all its services, particularly in the area of elective surgery. That Covid-free national resource deserves huge congratulations for the fact that, since 1 April—right through the middle of the pandemic—it has undertaken 10 heart transplants.

We will continue to look at how we can maximise the use of the NHS Louisa Jordan hospital, bearing in mind that we always need to be able to return it quickly to cope with any surge in Covid patients that our long-term estate cannot cope with. However, my expectation is that our NHS will be able to cope with any upsurge in numbers, provided that we continue to hunt down and suppress the virus and retain the trust and confidence of the population of Scotland in following the measures that we ask them to follow.

In her statement, the cabinet secretary said that she could promise all patients that treatments would continue to be triaged and prioritised on the basis of clinical need, in line with guidelines agreed with the royal colleges. Many doctors have preferred clinical judgment over waiting time targets. How regularly could those arrangements be reviewed? Am I right in saying that, in effect, waiting time targets would be on hold? In view of that, can the cabinet secretary offer any assurance to patients that there will be transparency in clinical decisions about when they are seen by doctors?

Clinical judgment is critical, which is why I keep going on about the importance of our engagement with the royal colleges and point to the example—which we will repeat in other areas—of the national clinical framework for cancer surgery, which is led entirely by the clinicians and their judgment on what the priorities are. I agree with Pauline McNeill in that regard.

In relation to elective work and our waiting times, as I said towards the end of my statement, I intend to return to the chamber with more detail once we have worked with all our boards and the relevant clinical teams—because it involves whole teams, not just doctors—on what is possible and how it will be delivered. Pauline McNeill is right to say that part and parcel of that work is providing absolute clarity and transparency for patients about what they can expect and when they will hear from their board about their times and dates. This time, we will make sure that it is clearly a nationally led exercise. Boards will do the work, as they know their patients, their numbers and how to get in touch with people and tell them what they need to know; however, I need to be sure that all boards are giving their patients clear information in language that is easy to access and understand.

The cabinet secretary will need to correct the record, because she is wrong about the number of people in quarantine who have been contacted. It is supposed to be 20 per cent, but in the past week it was 14 per cent, and since the end of June it has been 10 per cent. That is just not good enough. Quarantine contacting is very important, so what is the cabinet secretary going to do about the matter?

I will look at the numbers that Mr Rennie and his colleague Mr Cole-Hamilton have given us, and at the numbers that I have here, and if I am wrong—I have no reason to gainsay Mr Rennie at this point—I will correct the record, as I promised to do. If Mr Rennie is right, I will talk to Public Health Scotland about the exact issues and problems that are preventing it from meeting the 20 per cent target and what steps we can take to ensure that it does. I will then advise members of what I have done.

The cabinet secretary will be aware of the interest in the testing of workers in the oil and gas sector. In my constituency, there have been Covid-19 cases relating to returning offshore workers, and, as the cabinet secretary knows, the recent outbreak in Aberdeen will naturally heighten concerns around those. In the light of the situation in Aberdeen, will the Scottish Government consider taking any further steps to test more returning offshore workers?

I am grateful to Dr Allan for his question. As he knows, it is not currently the advice of Public Health Scotland to routinely test asymptomatic offshore workers, largely because testing those who are about to travel offshore would not remove the risk of people incubating the disease and becoming symptomatic while offshore. However, as I have said more than once today, our clinical advisory group, the chief medical officer, the national clinical director and others continue to assess and review our testing approach. I will return to the issue with them and ask for their current advice on whether that approach has changed. If it has not, I will ask in what way the rationale for the absence of change is best set out, so that I can return to give Dr Allan the answer.

NHS boards and IJBs insist that the eradication of delayed discharge almost overnight in February was due to improved joint working and the sharing of best practice. I presume that they will continue to work jointly and share best practice now. If that is the case, will the cabinet secretary confirm that there will be no return to the huge numbers of people who were stuck in hospital and misled into believing that they were still there because no care home place or care package could be found for them?

I think that NHS boards and IJBs are correct in what they have said. In the regular meetings—I think that they are fortnightly—that I have with my colleague Councillor Currie, who is the social care spokesperson for COSLA, the number of delayed discharges is among the areas that we continue to look at. His officials and mine are working with the IJBs and the boards to consider what more we can do on sharing best practice.

Among the groups in the remaining delayed discharge cohort are adults with incapacity and people who have complex mental health, learning disability and social care needs. A great deal of work is under way in that area. Not every health board experiences difficulty when it comes to adults with incapacity who no longer need to be in a clinical setting, but some boards do, and we are working with those boards to find out what their difficulties are and to overcome any obstacles.

With regard to people who have a high volume of highly complex social needs, we are continuing to take forward the work that we began before the pandemic on the reform of adult social care with Councillor Currie and his colleagues in local government. We want to identify in what way we can assist with the provision of social care packages for those who have the most complex needs but who do not need to be in a clinical setting and who should be able to live in the community as independently as possible and as independently as they wish.

The last question is from Miles Briggs.

I welcome the restarting of the pain services, but throughout the Covid scandal, families have not had the opportunity to be given advocacy. When I raised the issue with the First Minister a few weeks ago, she said that she would write to me, but she has still not done so. Therefore, I would be grateful if the cabinet secretary could look into the establishment of a fund for families.

Does the cabinet secretary support the establishment of a patient commissioner? Will she agree to consult on that and report back to Parliament?

I have two things to say to Mr Briggs—it is nice to see him back. First, there is no “Covid scandal”. I do not know exactly what he is referring to, but if I was an NHS worker or a social care worker who was watching these proceedings, I think that I would be pretty appalled that all the efforts that I had put in were being described as a scandal. If Mr Briggs wants to be critical of the Government, he should feel free to be, but he should make it clear that it is the Government that he is being critical of.

As far as what needs to be done is concerned, I will be happy to look at where we are as regards the advocacy point that Mr Briggs raised with the First Minister.

On the issue of a patient commissioner, I assume that Mr Briggs is referring to the Cumberlege report. As I said to his colleague Mr Carlaw, to Mr Findlay and to Mr Neil in a previous discussion, I am very sympathetic to the idea of a patient commissioner but we need to look at how that would fit with our overall patient safety programme, which is recognised globally as an exemplar. I will return to the issue in due course, in the Government debate that I have committed to holding on all the measures in the Cumberlege report and our response to it.

That concludes questions on the statement. I thank all members, because—yet again—we managed to get through all the questions.

There will be a slight pause before we move on to the next item of business.