Chamber and committees

SIGN Guideline 161 – ‘Managing the long-term effects of COVID-19’ provides healthcare professionals with recommendations on the monitoring of people with ongoing symptomatic COVID-19 and post-COVID-19 syndrome. The approach to monitoring will be tailored to each person, given the wide range of care needs that may be experienced.

NHS Scotland is delivering care tailored to the individual needs of people experiencing the longer term effects of COVID-19, with clinicians providing support based on presenting symptoms. This will continue to evolve as scientific understanding of the underlying mechanisms behind these longer term effects develops. In addition, we continue to explore the use of a digital tool to support symptomatic COVID-19 patients in higher risk groups to self-monitor their condition at home. A test of change is underway across a number of Health Boards that would provide them with support and advice on any possible deterioration in their condition using a pulse oximeter.

On 5 October 2020 the Scottish Government Chief Scientist Office launched a research funding call into the long-term effects of COVID-19 infection. Following an independent expert review process, 9 research projects have been selected for funding with a total commitment of around £2.5 million. These projects cover a wide range of approaches and address questions that will greatly increase the clinically relevant knowledge base on long-term effects of COVID-19 infection.

Further information is available from the CSO website: https://www.cso.scot.nhs.uk/outcome-of-the-funding-call-for-scottish-led-research-on-long-term-effects-of-covid-19-infection/

We are hugely grateful to the efforts of dedicated NHS staff as they continue to respond to the pandemic. On 30 November 2020, as a thank you for the outstanding efforts of NHS staff in these most challenging times, the First Minister announced a one-off pro-rata thank you payment.

I meet regularly with the Royal College of Nursing through their role in STAC Secretariat, most recently on the 30 December 2020, where all issues related to pay can be discussed. I remain absolutely committed to securing a pay settlement for 2021/22 that is fair, affordable, and sustainable and my officials are working with employers and staff side to agree an approach and timetable for securing a pay deal for NHS Agenda for Change staff in 2021/22.

Nurses in Scotland are the best paid in the UK. In 2020/21, nurses received a 2.95% pay rise as part of the current three-year NHS Agenda for Change pay deal, which has delivered a minimum 9% pay increase for most staff, and over 27% for some still moving up their pay scale. This is in excess of the 1.67% pay uplift for NHS England nurses.

The Scottish Government is doing everything it can to ensure we have sufficient numbers of staff on the ground who are well supported in these challenging times. Since September 2006, Qualified Nurses & Midwives (including Interns) have increased by 8.7%, or 3,564.5 WTE, from 41,026.2 WTE to 44,590.7 WTE. We continue to work with health boards to ensure that nurses receive the clinical professional support they require, and that psychological and wellbeing support is in place at both local and national levels. These measures include the National Wellbeing Hub and a National 24hr phone line for NHS and social care staff.

NHS Scotland does not supply staff with disposable hijabs, but staff are allowed to wear religious garments including hijabs, provided patient safety is not compromised.

These must be washed and/or changed between each shift or immediately if contaminated and comply with additional attire in, for example, theatre settings.

There is guidance for staff which explains how to properly and safely launder uniforms. There is also guidance on PPE included in the National Infection Prevention and Control Manual .

As we have indicated previously, the Neurological Care and Support Framework for Scotland 2020-25 is in place to improve support for people living with neurological conditions. This includes ensuring they are partners in their own care, improving co-ordinated health and social care and support, ensuring high standards of person-centred, and safe care and support, ensuring timely access to services and building a sustainable neurological workforce. £4.5 million of funding is being invested over 5 years to implement the Framework’s commitments. While the Framework is not condition specific, it covers common themes affecting people with all types of neurological conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and this condition is recognised as being covered by the Framework.

Under commitment 12 of the Framework, we are prioritising work to improve the recording of neurological conditions in people’s routine health and care records, which in turn will inform available data about the prevalence of neurological conditions. The incidence, prevalence and case definitions of ME remain contested worldwide, which presents a practical challenge in establishing the prevalence of ME. Our work takes account of difficult to diagnose conditions, such as ME, which is a factor contributing to the variation in their recording in health and care records. Improving digital platforms, including those used in primary care, form part of the Digital Health and Care Strategy being delivered and will be accompanied by training to ensure consistent recording of all neurological conditions. We are also looking to develop a data strategy across health and social care for the first time, which will benefit those living with ME/CFS.

In October 2020, we published a list of projects funded through the Neurological Care and Support Framework. One of which is to fund the creation of an online ME/CFS module for health care professionals. This work is led by a partnership of ME third sector/patient organisations and aims to support person-centred care, informed by good practice and current research.

The Scottish Public Health Network (ScotPHN) ME-CFS healthcare needs assessment: Briefing was published this month. We are considering the recommendations within this report alongside the Gathering Views report on ME/CFS by Healthcare Improvement Scotland Community Engagement; and the revised NICE guideline that is due to be published in April 2021. These form part of actions the Cabinet Secretary set out in evidence to the Public Petitions Committee (PE1690) on 19th December 2019 and in her written response on the 25 August 2020.

We are already taking action to ensure that people in Scotland receive the right care at the right time and place. Therefore, our ambition is for people living with ME/CFS to have access to the support they may need for assessment, diagnosis and care in a setting that is as close to their home as possible. At present, it is our belief that instead of setting up separate clinics, this can be best achieved by enhancing and better co-ordinating existing services in primary and community care, using the multidisciplinary and person-centred support that people may require. This further links to wider work involving the Rehabilitation and Recovery Framework.

My officials previously proposed a phased commencement of the Health and Care (Staffing) (Scotland) Act 2019 (the Act) and this remains the Government’s intention. Commencement of the Act will also require regulations to be made and there is very limited parliamentary time left in this session to progress secondary legislation. Due to pressures on that limited time caused by the priority of Covid-19 and EU Exit legislation, the current focus has been on critical legislation that requires to be progressed before the dissolution of Parliament for the 2021 election.

Prior to Covid, the Act Implementation Team were undertaking a programme of preparatory work to lay the way for implementation. This included the preparation of statutory guidance; a series of stakeholder engagement events to consult on the guidance, including visits to every Board and establishing 13 distinct working groups for specific guidance chapters; the instructing of regulations, and the preparation for detailed end to end testing of the Act’s statutory guidance at four Health Boards. Following on from this process a public consultation would take place.

This work had not concluded pre-Covid when the Act became one of a number of areas of policy/legislation to be suspended in order to prioritise the Government’s response to the pandemic. A significant amount of work was undertaken to draft guidance prior to the pandemic, however further work is still required. It will also be important to reflect on learning from Covid-19 and whether some redrafting of the current draft guidance will be required as a result.

Given that Covid-19 has considerably stretched resources within Boards and the wider health and social care sector, as well as the continuing uncertainty facing us, we believe it is not practical to establish a definitive implementation timetable for bringing the Act into force. However, the Scottish Government is resolute in its continuing commitment to the Act and its principles. Health and social care staff across Scotland have risen to the very significant challenges posed by Covid, showing incredible resolve and flexibility, and we will ensure this Act is implemented effectively to drive positive change for NHS staff and patients.

The actions that the Scottish Government has taken to develop its duties which correspond to the Health and Care (Staffing) Scotland Act 2019 (the Act) have, as with most aspects of health and social care policy, been significantly affected by our need to respond to the global pandemic emergency.

While the implementation of the Act has been paused, Boards have continued to use workload tools where there has been capacity to do so. Therefore, since the initial lockdown we have focused on supporting Boards with necessary workload and workforce planning as part of their response.

Scottish Government has been funding and overseeing the development of a range of resources in recognition that Covid-19 has required changes to staffing resulting from increased demand, reduced availability of staff and implementation of social distancing in clinical areas, including the development of:

• staffing models for intensive care units and the Louisa Jordan Hospital;
• professional judgement templates with associated specialty specific guidance for adult acute wards, maternity and neonatal services, mental health and learning disability services, community nursing and AHP services;
• a care management safety huddle tool and professional judgement template for use in care homes.

Additionally, Scottish Government has continued to provide funding for workforce lead posts in each Board to provide local leadership and expertise, in recognition of the importance of support being available to NHS Boards for staff at this time. The use of workload tools are not currently mandated in recognition that Boards may not have capacity, though they remain available to Boards should they wish to use them. Scottish Government also continues to fund the Healthcare Staffing Programme (HSP) within Health Improvement Scotland (HIS), which is responsible for work to support implementation of the Act, although understandably the focus this year has been on supporting workforce planning required as a result of the pandemic.

The epidemiology for the new variant of COVID-19 is being monitored by the Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland service for new confirmed variant cases and is being assessed for hospital onset status. As the validated data become available from Health Boards, new cases will be assessed for their hospital onset status. ARHAI are exploring other possible routes to determine the hospital onset status of new variant cases more rapidly should there be an ongoing need to track nosocomial transmission, in addition to extant monitoring (hospital onset surveillance and clusters reporting system).

Should cases of the new variant be identified, advice from Infection Prevention and Control (IPC) experts in Scotland, as well as the UK IPC cell, is that there is no change to the existing IPC guidance. Robust IPC measures remain of paramount importance for reducing nosocomial transmission. This includes the appropriate use of PPE, the extended use of face masks, physical distancing, good ventilation, increased environmental cleaning, symptom vigilance, good hand hygiene and good respiratory etiquette.

The Scottish COVID-19 Addendum in the National Infection Prevention and Control Manual should be followed, which can be found at: http://www.nipcm.hps.scot.nhs.uk/scottish-covid-19-infection-prevention-and-control-addendum-for-acute-settings/

The development of the guidance was divided into 13 work streams representing the 13 guidance chapters, each with an associated working group of external stakeholders and an initial draft document provided to each group. Thus far drafts of guidance have been developed on 8 of the 13 work streams.

Since 23 March, progress in drafting the necessary guidance in consultation with key stakeholders has been directly and severely impacted upon by capacity issues within Scottish Government, the Care Inspectorate and Health Boards. The suspension of preparatory work such as this for enactment was necessary due to the requirement to free up staff to work on Covid both at Government and Board levels. The work that was planned to develop guidance for care services was also paused. Accordingly, with significantly reduced capacity it has not been possible to progress work on the guidance as previously planned. However, Scottish Government is absolutely committed to directing resources and recommencing work on the development of the guidance with Healthcare Improvement Scotland, the Care Inspectorate and Boards as soon as is practically possible for us and our key stakeholders.

I refer the member to the answer to question S5W-34260 on 20 January 2021. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

Additionally, as I stated to the Health and Sport Committee in my letter dated 18 December 2020, it is not possible to be explicit on the date for the public consultation, given this is part of a wider process of engagement and input which has been placed on hold to prioritise resource for the pandemic. When capacity becomes available the public consultation will be an integral part of that process.

I refer the member to the answer to question S5W-34257 on 20 January 2021. All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .