Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, June 23, 2020

Official Report 982KB pdf

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Topical Question Time

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National Health Service (Covid-19 Transmission)

To ask the Scottish Government what steps it is taking to reduce the transmission of Covid-19 as NHS services resume. (S5T-02293)

As we remobilise our NHS, the chief nursing officer’s expert group on nosocomial transmission has made three important sets of recommendations. First, in addition to testing all staff connected to a suspected nosocomial outbreak, we will now test on a weekly basis staff working in specialist cancer units, in long-term care of the elderly and in long-stay mental health wards. Boards will be asked to start that additional testing from 8 July.

Secondly, in hospitals and care homes for adults, face masks will now be worn by staff who have contact with patients or residents—that is, all staff who have contact with patients or residents—and out-patients, day-case attendances and visitors will be asked to wear a face covering. That new measure is designed to reduce the risk of transmission from the person who is wearing the mask or face covering. Guidance on that for health boards and employers will issue this week and will be effective from 29 June.

Thirdly, enhanced cleaning and maintenance regimes will be implemented in areas of high patient volume and in areas in which surfaces are frequently touched. Again, that will be implemented from this week, and across our health boards from 29 June.

In the interest of the safety of patients and staff, understandably, not all health services can be resumed at this stage. Will the cabinet secretary outline the best way for members of the public to access reliable health information?

We have published on the Scottish Government website a list containing “Coronavirus (COVID-19): framework for decision making” and “Re-mobilise, Recover, Re-design: the framework for NHS Scotland”, which gives an indication of the phases of that exercise. The first meeting of the recovery group, which I will chair, will take place this coming Monday.

In addition to that, there is information across all our health boards about all the initial phase 1—that is, until the end of July—services that are being restarted or increased until the end of July, and boards will be commissioned to produce additional remobilisation plans that will run from the beginning of August right through to the end of March next year. The recovery group will consider that, and those board plans will also be published as they are agreed.

Will the cabinet secretary confirm that the face coverings that visitors to health and care settings will be expected to wear are simply coverings and not medical-grade masks?

Mr Torrance is absolutely right. Staff in health and social care will wear medical-grade masks, and out-patients attending for day-case procedures and visitors will wear face coverings along the lines that have been recommended most recently for those using transport and entering other areas where physical distancing is difficult.

I thank the cabinet secretary for her response to Mr Torrance. Given that we know that those carrying Covid-19 can be asymptomatic while contagious, at what point does the Scottish Government intend to widen testing to all staff working in our NHS facilities such as hospitals?

I am grateful to Ms Johnstone for that additional question. The nosocomial group, which is chaired by Professor Jacqui Reilly, is a group of experts including Professor Tom Evans—who is part of our chief medical officer’s Covid-19 advisory group—and other experts in antimicrobial resistance and infection prevention and control. At this point, their recommendation is not to widen testing to other areas of our NHS but to introduce it in the areas that I have described—that is, in areas in which they believe that the risk of nosocomial infection is higher and in areas in which there are particularly vulnerable groups or cohorts of patients, such as specialist cancer units. However, the group also recommends that we continuously review that; so it may be that, in time, its advice will change and it will recommend widening the testing to other cohorts of our NHS staff. At this point, however, the group’s expert and clinical advice is to focus it in the way that I have described.

What measures will be used to screen patients for Covid-19 prior to and on admission?

The polymerase chain reaction test will be used. Health boards are working out how far in advance of the admission date for, for example, elective surgery people will be asked to self-isolate, as well as the detail of how to get the test to the individual, and at what point, in advance of their planned elective procedure. Once the boards have agreed the national position across our health service, I will make sure that Monica Lennon, other party spokespeople and, of course, the Health and Sport Committee know.

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Test and Protect

To ask the Scottish Government whether it will provide an update on the number of people tracked through its test and trace system, and the availability of its digital tool to the public. (S5T-02299)

Test and protect was successfully rolled out across health boards in Scotland on 28 May this year. Between 28 May and 14 June, that being the latest date for which data has been published, 992 cases were recorded, from which 1,239 contacts have been traced. Data is published on Public Health Scotland’s website and is updated every Wednesday. The data to 21 June will be published tomorrow.

We are on track to provide an initial public-facing digital tool by the end of June, as we intended. We will then take a decision on how quickly we will roll it out across the system, taking into account how our test and protect service has developed, international evidence that might be available and the volume of cases that are being experienced.

The Sunday Post reported that between the start of test and protect on 28 May and 14 June, Scottish Government tracers identified an average of 1.2 contacts for each positive Covid test result, whereas in England, tracers identified 8.5 contacts for every positive test over the same period. Why is the gap so striking? If the tracing in Scotland does not include special outbreak tracing in health and social care settings, why not?

That is a good question, and I am grateful to Mr Cole-Hamilton for it.

There are two main reasons for the difference. To a degree, the first reason is that some aspects of lockdown measures have been eased in England a little ahead of their being eased here in Scotland. Given that people in England are less locked down—I cannot think of another way of describing it—we expect them to have been in contact with more people.

The other reason, as Mr Cole-Hamilton indicated, is how we in Scotland deal with complex cases compared with how it is done in England. In England, all cases are handled by the centralised national contact tracing centre; in Scotland, complex cases are handled by expert local health protection teams. The data from those complex cases is gathered and reported separately from the data from test and protect. However, we are now looking at how we can bring the data together such that the test and protect data that is published includes data from the complex cases. The position of Scotland and England would then be more comparable.

A complex case is defined as a case in a complex or high-risk setting for which the expertise of the local health protection team is needed, such as an educational establishment, a homeless hostel or shelter, or a prison. We will continue to deal with complex cases separately, but will work to bring the data together, so that it can be migrated into a single system.

If the cabinet secretary is confident that the tracing process is rigorous, but it is still turning up just one contact for each new case, is she equally confident that the current definition of “contact” is catching everybody that it needs to catch?

We know how important test and protect is to beating the virus, because we know how infectious the virus is. We also know the multitude of ways in which the virus can be passed on, including via hard surfaces. Has there been an update to the science that suggests that 15 minutes at 2m is the right threshold for contact tracing?

If a patient identifies that they have visited a public space before testing positive, what deep cleaning protocols are then followed?

There has been no update to the science that would change the definition of “contact”. However, the chief medical officer’s expert advisory group and our advisers elsewhere, not least those in Health Protection Scotland, continually monitor whether there should be an update at any point. Based on their expert advice, I am confident at this stage that the process is proceeding and that test and protect is a system that is operating well across the whole of Scotland.

The concern that might exist about the difference between the number of contacts reported in England and the number reported in Scotland is explicable in the way that I have set out. As we see our data merge, we will get proper comparison of what is happening in Scotland and England.

I apologise, because I should have said earlier that it is important for me to be clear that although we deal with complex cases in a different way, contacts are traced through those complex cases. The number of contacts is therefore followed through in complex cases and in those in the test and protect programme.

As of last night, over 452,000 tests that had been made available through the combined United Kingdom and Scottish Government facilities had not been utilised. The cabinet secretary made a pledge to test every member of staff in care homes across Scotland. Is it now the case that all staff working in care homes where there has been no Covid-19 cases are being routinely tested?

Yes, that is the case, and it should be clear when we publish the data tomorrow. As Mr Briggs will know, I issued what can only be described as an instruction to all health boards that the national policy is not open to local interpretation. We therefore now receive weekly their plans for that testing.

The care home portal, through which the bulk of the testing is accessed, has increased the numbers available to us, which is a significant help. The last figure that I had, which might have increased since, is that 700 of our 1,083 care homes had registered for the portal and would be receiving test kits and returning them as appropriate. The testing of care home workers not only in care homes in which there are no active cases, but across the care home sector, is therefore well under way, and the figures in that regard will be published tomorrow.

The UK Government failed to include devolved Administrations in consideration of the tracing app that was being developed but has been abandoned. Now that the UK Government has stated that it will switch to an app-based system using the Google and Apple application programming interfaces, can the cabinet secretary tell us whether the devolved Administrations have been given an opportunity this time to be involved meaningfully in development of the replacement app?

My understanding is that my officials in that area have had some initial information, but I would not describe that as active involvement. I have had no information yet from my counterpart, Mr Hancock, but I am sure that that will be coming. It is not clear to me exactly where the Secretary of State for Health and Social Care and NHS England are with that Google and Apple app, but we will raise the matter and discuss it again with Mr Hancock in the weekly four-nations call this week, to see where they are and to find out whether there will be a proximity app from NHS England.

Meanwhile, our test and protect programme is not reliant at all on a proximity app, and never has been. I am pleased that we took that decision, given what has happened with the proximity app south of the border, but we will always look at the option of a proximity app as an enhancement to our test and protect programme.

Thank you. That concludes topical questions.