Chamber and committees

The latest data cut of 22.07.2021 showed 262 active Cancer Clinical Trials in Scotland. On that date there were 22 Covid-19 suspended Cancer Clinical Trials.

The primary aim of the Scottish Government throughout the pandemic has been to protect people in Scotland against the direct and tragic harm to health which the virus causes, including against long-COVID as we know that the virus affects people’s health in different ways.

Every phase of easing COVID-19 restrictions is considered on a “Four Harms” basis – namely (1) the direct harm caused by the virus; (2) the impact of the virus on broader health and wellbeing; (3) social harms arising from measures necessary to suppress the virus; and (4) damage to the economy. A consideration of the impact of lifting restrictions on the number of people developing long-COVID is at the core of “Harm 1”.

Throughout the pandemic, we have published evidence in support of our decision-making. Impact assessments have been published to accompany regulations since the Strategic Framework was first introduced. They will continue to be a key publication where appropriate whenever regulatory changes are made.

Our initial plan for moving of all of Scotland to Level 0 was delayed in order to allow more people to be fully vaccinated and also to assess the impact of the Delta variant on case numbers and hospital admissions. We have now moved to Level 0 but with an added degree of caution. These decisions have prioritised a careful and gradual approach and taken into account the high prevalence of long-COVID especially amongst young people. This is a concerning trend which we are closely monitoring and, therefore, justifies the cautious easing of restrictions we are pursuing.

The Scottish Government’s Primary care Directorate meets weekly with the Scottish General Practitioners Committee of the BMA to discuss a range of issues including Covid related issues such as long Covid.

NHS Boards are developing pathways according to local services and the needs of their respective populations, to support people with long COVID. We continue to invest in and expand multidisciplinary teams in primary care consisting of health and care professionals that play a key role in the provision of rehabilitation services.

Since the publication of the rehabilitation framework in August 2020, we have established a National Advisory Board to oversee its implementation.

The rehabilitation programme is currently undertaking a significant scoping exercise through a self-assessment process to understand the current status of rehabilitation services in Scotland, from the perspective of the staff working in them.

The self-assessment tool has been circulated to all NHS Boards, Health & Social Care Partnerships, third sector organisations, and Leisure Trusts as part of Local Authorities.

The outputs from the self-assessment tool along with demand and capacity data will help us shape priorities, understand challenges and opportunities and inform funding decisions.

This information is not currently available. Weekly updated data on the proportion of the NHS workforce reported absent for all COVID-19 related reasons in total is available at:

https://www.gov.scot/publications/coronavirus-covid-19-daily-data-for-scotland/

The most recent long COVID statistics published by the Office for National Statistics on 1 July 2021 state that, over the four-week period ending 6 June 2021, an estimated 962,000 people living in private households in the UK reported experiencing long COVID (symptoms persisting more than four weeks after the first suspected coronavirus (COVID-19) episode that are not explained by something else). Of those people, an estimated 81,000 lived in Scotland. Detailed estimates by age are available for the UK at Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK - Office for National Statistics (ons.gov.uk) .This detail is not available for Scotland.

We do not currently have for Scotland a breakdown of people experiencing symptoms of long COVID by age, or according to whether or not they were originally hospitalised due to the virus. We are working with the EAVE II project, on which the University of Edinburgh and Public Health Scotland collaborate. Funded by the Medical Research Council, this project used pseudonymised GP and other patient data to track the COVID-19 pandemic as it unfolded across Scotland. This dataset is now being used in a separate project funded by the Chief Scientist Office to investigate long COVID, and will generate analysis of people assessed as having long COVID. Early results will be available later in 2021.

In October 2019 the Scottish Health Technology Group (SHTG) recommended that: “Where patients understand and are willing to accept the demands, risks and uncertainties of treatment, autologous haematopoietic stem cell transplant (AHSCT) should be considered as a treatment option for patients with relapsing-remitting multiple sclerosis (RRMS) who have evidence of significant inflammatory disease activity that has not responded to adequate treatment with licensed high-efficacy disease modifying therapies (DMTs).”

Following comprehensive clinical assessment, relevant diagnostic testing and consideration by a specialist multi-disciplinary team, AHSCT can be offered to MS patients from Scotland where they meet this criteria and when it is clinically judged that the benefits of treatment outweigh the risks. In these circumstances such patients can be referred by their NHS Consultant for this specific treatment at a specialist centre in England.

Stem cell transplantation is currently undertaken in Scotland for other clinical reasons, however specific expertise in its use for the treatment of MS is still developing. In order to ensure that patients receive the highest level of safe, patient-centred care, clinical consensus is that this is currently best delivered by one of the most experienced centres globally, located in Sheffield. Although delayed by the need to focus resources on COVID-19, key stakeholders within NHS Scotland are continuing discussions regarding a potential Scottish pathway for this treatment.

AHSCT is an intensive treatment which carries a very high risk of infection for many weeks, due to severe immunosuppression as part of the treatment pathway. In March 2020 the Association of British Neurologists (ABN) recommended postponing this treatment in patients with MS until the risk of coronavirus receded, due to the potential for severe illness in those with compromised immune systems. As of November 2020, the ABN advises its use only in exceptional cases of relapsing disease.

Following the publication of the review of the Cervical screening standards in March 2019 NHS Boards should ensure that individuals referred to the colposcopy service with an abnormal screening test are seen within the nationally agreed time frames:

• no later than 2 weeks for urgent referrals (glandular, suspicion of invasion)
• no later than 4 weeks for high grade referrals, and
• no later than 8 weeks for low grade referrals that do not require urgent assessment.

On the 30 March 2020 the Cervical Screening Programme was temporarily paused to due to impact of the COVID-19 pandemic with services resuming on 29 June 2020. However, the need for additional infection control measures, including physical distancing and the use of PPE, continue to pose challenges but the Scottish Government are working with Health Boards to monitor and address these. During the screening programme restart, the Scottish Government provided £1 million to support capacity in sample-taking and colposcopy.

Further information regarding the standards for this procedure and the wider Cervical screening standard can be found in the Healthcare Improvement Scotland publication linked below.

https://www.healthcareimprovementscotland.org/our_work/standards_and_guidelines/stnds/cervical_screening_standards.aspx .

I refer the member to the answer to question S6W-01751 on 6 August 2021. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers .

Please find the requested information set out in the following table:

Initial estimates suggest that 5,786 invitations have not yet issued to people affected by the pause, but it should be stressed that this will be for a range of reasons, including participants being excluded from the programme after it restarted, or taking the opportunity to be screened at their GP ahead of their scheduled prompt to make an appointment. Data on patients who had their routine cervical screening test delayed and have (a) now received a test, (b) referred for further investigation is not routinely available at present.

Public Health Scotland will release their annual statistical report on the cervical screening programme on 1 September 2021.