Chamber and committees

There is currently insufficient clinical evidence to conclude that people who have recovered from COVID-19 are protected from either a second infection or from infecting others.

Until such evidence exists the main public health benefits are for research purposes or in the clinical management of patients. The World Health Organisation and SAGE have warned there are potentially negative impacts on public health if individuals assume immunity from a positive result and adapt their behaviour in a way which could increase the risk of continued transmission.

On this basis, the CMO advised health boards on 23 rd June 2020 not to offer on-demand antibody testing. This applies equally to care or NHS staff.

Our approach is being kept under ongoing review. If clinical evidence around immunity changes we will swiftly roll out a national antibody testing programme in order to realise the potential health, social and economic benefits this would offer, and are preparing now for that prospect.

On 11th June 2020 the Association of Medical Research Charities (AMRC) published on their website an article entitled COVID-19: The risk to AMRC charities.

https://www.amrc.org.uk/covid-19-the-risk-to-amrc-charities .

The published AMRC figures do not distinguish between cancer and other medical research charities.

On 30 th March Cancer Research UK released a press release that referred to an estimated 25 percent drop in fundraising income in FY 2020-21

https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2020-03-30-cancer-research-uk-estimates-25-per-cent-drop-in-fundraising-income-due-to-coronavirus?_ga=2.60513902.2117832912.1593763662-1469902633.1572445696

The impacts of COVID-19 on medical research are being considered by the UK Office for the Strategic Coordination of Health Research Board, which includes representation from the AMRC and the Scottish Government’s Chief Scientist Office through the Chief Scientist for Health as well as from the other UK Health Departments, and UK research councils.

The UK Government has announced on 27 June that, from this autumn, UK universities will be able to access a series of UK Government grants and long-term, low interest loans covering up to 80% of each institution’s income losses caused by a decline in international students, up to the value of non-publicly funded research activity in that university. In addition, around £280 million UK Government funding will be made available to universities and research organisations for costed extensions of UK Research and Innovation and National Academy research projects impacted by the pandemic.

We welcome the recent announcement by the UK Government which builds on the Scottish Government’s commitment last month to provide an additional £75 million to ensure our universities can protect their world-leading research against the financial impact of COVID-19. However, we are concerned about the emphasis on loans in the UK Government’s stabilisation package, as not all universities will be in a position to take advantage of those. We will work with the UK Government not only to agree how this package will be implemented in Scotland, but also to address the long term sustainability of our sector to ensure it plays a key role in Scotland’s economic and social recovery.

The Data requested by the member is not held centrally by the Scottish Government.

Whilst the majority of cancer treatments have continued throughout this pandemic, some patient’s treatment plans may have changed to minimise their individual risk. Those that require changes will always be done on a clinical basis and will be in discussion with the patient and clinical team.

It has been made clear that vital cancer services should remain where clinically agreed during the Covid-19 pandemic, this includes the use of private hospitals to treat these NHS patients. By utilising the private sector capacity we are able to provide a COVID free environment for urgent cancer procedures. The Golden Jubilee is also supporting the treatment of urgent cancer patients.

Targeted clinical guidance has been issued to support decision making in a range of areas including clinical prioritisation. This includes:

• Clinical and patient guidance disseminated to clinical and oncology teams on the 30 April which has been kept under constant review.
• The Framework for Recovery of Cancer Surgery to assist NHS Scotland prioritise those most in need of cancer treatment.
• Clinical guidance has been published on q(FIT) testing to specifically support decision making for those colorectal cancer symptoms.
• Published Re-mobilise, Recover, Re-design: The Framework for NHS Scotland on 31st May to support clinical decision making as NHS Boards begin to restart paused services. This Framework sets out how NHS Boards will follow national and local clinical advice to safely and gradually prioritise the resumption of services while maintaining COVID-19 capacity, resilience and providing appropriate support for social care.

Throughout the pandemic we have been clear that urgent, emergency, Maternity and Cancer services should continue to be available and that the NHS is open for those who require medical attention.

The Covid-19 Clinical Guidance Cell has been established by the Chief Medical Officer to rapidly develop and revise guidance on clinical management of COVID-19 for the NHS.

The purpose of the Clinical Guidance Cell is to rapidly prepare guidance for the health and care system in Scotland on the clinical management of COVID-19.

Membership is drawn from key organisations and professional communities across Scotland who have a direct interest. This includes the Scottish Academy of Medical Royal Colleges and Faculties and Health Protection Scotland.

The Scottish Government is also advised by the COVID-19 Advisory Group, which was established to address the need for additional scientific analysis of the impact of COVID-19 in Scotland, based on regularly updated advice and modelling from the UK Scientific Advisory Group for Emergencies (SAGE), and other emerging scientific evidence.

The group is chaired by Professor Andrew Morris, Professor of Medicine at the University of Edinburgh, supported by vice chair, Professor David Crossman, Dean of Medicine at the University of St Andrews and Chief Scientist (Health) at the Scottish Government. Members are public health experts, clinicians and academics spanning the disciplines of epidemiology, virology, public health, behavioural sciences, global health, medicine and statistical modelling. Full details of the group’s membership are available on the Scottish Government’s website at https://www.gov.scot/groups/scottish-government-covid-19-advisory-group/

As part of the Scottish Government response to the COVID-19 pandemic, on 25 th March 2020 the Chief Scientist Office (CSO) launched a call for rapid research in COVID-19. The call attracted 139 individual research project proposals. CSO convened an independent expert panel to review the applications. This panel, which met virtually on 21 April 2020 to consider the applications, comprised 35 expert members from the medical and wider health and social care research sectors and 3 lay members and was co-chaired by Professor Eleanor Davies from the Univeristy of Glasgow and Professor Shaun Treweek from the Univeristy of Aberdeen.

The outcome of the review was that 56 research projects were funded, led by 15 different research institutions from across Scotland. The work funded through this call involves researchers from the medical and wider health and social care research sector. This includes research to:

• Better understand the effects of COVID-19 infection in order to inform treatment and management of disease

• Develop and test new diagnostics and therapeutics

• Investigate novel disease surveillance approaches

• Inform interventions to prevent transmission of infection

• Support the resilience and mental health of frontline health and social care workers

• Understand the physical and mental health implications of social distancing and other restrictions and their impact on the general population and also a number of vulnerable groups

Details of the funded projects are available from the CSO website. https://www.cso.scot.nhs.uk/rapid-research-in-covid-19-programme/

We have been clear that throughout this pandemic, the NHS is there for those who need it. Our NHS is Open campaign was launched 24 April and we have seen a steady increase in the number of people presenting to their GP practice with symptoms that could be suspicious of cancer – now 86% pre COVID levels.

Our Clinical Director for Scotland, Jason Leitch also made a statement urging patients who have an appointment to attend hospital for these as it will have been deemed clinically safe to do so.

We are working hard to ensure vital and urgent care remains, including the use of private hospitals to treat these NHS patients. By utilising the private sector capacity we are able to provide a COVID free environment for urgent cancer procedures. The Golden Jubilee is also supporting the treatment of urgent cancer patients.

Our national expert body, Health Protection Scotland (HPS), jointly with the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Public Health England (PHE) and NHS England published updated PPE guidance in relation to COVID-19 on Thursday 2 April (updated 12 June). The guidance is available here .

The guidance outlines what type of PPE frontline health and social care workers should be wearing in different settings and scenarios, including where a two-metre social distance is not possible. The guidance contains tables which clearly explain the PPE required for different common clinical and care scenarios. The first table relates to acute hospitals and the second and third are for primary care, outpatient and community care, ambulance staff, paramedics, first responders and pharmacy.

Given the recognised sustained community transmission of COVID-19, the guidance importantly includes detailed advice (table 4) around risk assessing use of PPE, including aprons, gowns, Fluid-Resistant Surgical Masks and eye protection, in a range of different clinical and care scenarios, including where a two-metre social distance is not possible.

Additionally, on 23 June recommendations on the wider use of face masks by staff within residential healthcare settings, such as acute adult (including mental health) and community hospitals and care homes for the elderly where staff are unable to physically distance were announced. The guidance recommends that staff working in a clinical area of an acute adult or community hospital, or in an care home for the elderly should wear a face mask at all times throughout their shift. Additional advice was also announced on the requirement for visitors to wear face coverings when attending adult hospitals or care homes for the elderly.

The Scottish Government continues to participate in the four nations approach to the procurement of tests and, subject to clinical recommendations and the availability/approval of an effective antibody test, can draw-down an allocation of the UK procured COVID-19 antibody tests for use in Scotland.

The exact information requested is not available centrally. Public Health Scotland collect social care information directly from Health and Social Care Partnerships; however, it is not possible to identify from this if social care packages have been withdrawn or the reason why a package may have been withdrawn or reduced.

It is possible to estimate the number of people receiving home care services each month and how many hours of home care were received. Table 1 provides this information for January to March 2018. Information for 2018-19 is not yet available.

Table 1. Number of people receiving home care 1 services and total number of hours 2,3,4 of home care by month and Health and Social Care Partnership 2,3,4 , January to March 2018

Scotland’s testing capacity fluctuates on a daily basis and for this reason, and given daily fluctuation in NHS capacity, it is not possible to give a definitive figure for the proportion of testing capacity that comes from UK regional testing facilities.

We are working hard to ensure we maximise use of our daily capacity, as we expect the number of daily tests to increase as we roll out Test and Protect. NHS lab capacity is currently around 10,000 tests a day and around 8,000 at the weekend, and is supported by non-NHS labs including: University of Edinburgh, University of Aberdeen, and the Scottish National Blood Transfusion Service.

In addition to this, we have further capacity through the Lighthouse Laboratory in Glasgow (run by the UK government), which has capacity to process approximately 20,000 tests a day. The Glasgow Lighthouse Laboratory may however process tests taken from across the UK.