Official Report 1262KB pdf
The next item of business is a statement by Mairi Gougeon, providing an update on Scotland’s testing strategy. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.
15:26
Since the Cabinet Secretary for Health and Sport last updated Parliament, in November, we have made significant progress in rolling out our testing strategy and programme.
The strategy that was published in August last year gave five rationales for our priorities for testing for Covid-19 in Scotland: testing to diagnose anyone with symptoms of Covid-19; testing for clinical care of patients; testing to protect those who are most vulnerable to harm from Covid-19; proactive testing to find cases among people without symptoms; and testing for surveillance, to monitor prevalence and understand disease transmission.
I will say more about progress on each of those rationales, but a key aim of the strategy was to increase the daily capacity for polymerase chain reaction testing in Scotland to at least 65,000 by the winter of 2020. That has been achieved.
Since the beginning of December 2020, our focus has been on expanding the coverage of our testing programme and the available testing capacity in Scotland into the areas where we believe it can have the greatest impact as part of our response to the pandemic. That has been aided by the availability of new types of testing technology, including rapid result lateral flow tests, which has allowed us to significantly expand the coverage of people with and without symptoms.
Under our test to care scheme, we have now extended testing to all those who have been admitted to hospital emergency departments, acute assessment centres, maternity units and emergency mental health units, as well as to all medical and surgical elective admissions.
As part of test to protect, all healthcare workers in patient-facing roles in our hospitals, in the Scottish Ambulance Service and in community-based Covid assessment centres, the healthcare professionals who visit care homes and staff working in hospices are now offered twice-weekly testing. The extension of testing to our primary care workforce—including our general practitioners, dentists, optometrists, pharmacists and pharmacy technicians—is also well under way and is on track to be completed by the end of this month. I can announce today that we will now implement testing of all remaining healthcare workers, including those in non-patient-facing roles, providing access to regular testing for more than 170,000 people who are employed by NHS Scotland.
We have also extended testing in social care, offering testing for up to two designated visitors a week for our 42,000 care home residents across Scotland. We have supplemented existing PCR testing of care home staff by providing additional lateral flow testing. We have also completed—a month ahead of schedule—the roll-out of testing to the care-at-home workforce, who are critical to supporting and caring for people so that they can continue to live as independently as possible in their own homes.
Proactive case finding remains a key part of our response to the pandemic. Since 18 February, all close contacts of index cases have been able to book a PCR test between days three and five after exposure to a confirmed positive case.
At a community level, test to find is a core part of the rationale for targeted community testing. Proposals are developed with local partners to address problems of stubbornly high transmission, rapidly rising transmission or specific transmission risks in communities, and I can advise Parliament that proposals for targeted community testing have now been agreed with 20 local authorities across eight health board areas. We have 28 asymptomatic test sites and 12 mobile testing units providing access to community testing, with more sites planned to open soon.
As well as continuing to offer campus testing to students at times of large population movement, we have now extended access to PCR testing to students prior to their travelling to accommodation at university or college. Plans are also being developed to roll out regular testing for university and college students and staff.
To manage the risk of importation of the virus from abroad, from 15 February, quarantine testing was introduced for people arriving in Scotland from outside the common travel area. All such people are tested twice during their quarantine period, on day 2 and day 8 of the 10-day quarantine, with all day 2 positive test results being sent for sequencing in order to detect any possible variants of concern.
The most recent expansion, which was announced in February, extended routine testing to support the maintenance of essential services, to mitigate wider social and economic harms and, crucially, to provide an additional protective layer to support the easing of restrictions for key groups and sectors.
To support the safe return of schools, we have introduced twice-weekly at-home testing for all staff in primary, secondary and special schools and for all secondary school pupils, with the secondary 1 to 3 cohort due to commence testing after the Easter break. Staff in school-based early learning and childcare settings can also receive testing as part of the offer, and I can announce today that, from the end of this month, access to testing will be extended to all stand-alone facilities in the public, private and third sectors that provide early learning and school-age childcare services.
Further roll-out of regular asymptomatic testing is also now available to food production and distribution businesses, whose workplaces, by their nature, can present a higher risk of transmission due to factors such as low temperatures, high humidity and limited ventilation. More than 60 businesses are now registered with the scheme and are undergoing the relevant training and induction processes.
In the public sector, to support the continued safe running of essential services, we have now implemented regular testing in the control rooms of the Scottish Ambulance Service, Police Scotland and the Scottish Fire and Rescue Service, as well as in NHS 24 call centres.
In the early part of this year, we have seen the emergence of new and more transmissible variants of the virus and outbreaks in closed settings. To help to address those, we plan to introduce testing of staff who are working in prisons to reduce the risk of asymptomatic prison staff importing the virus into the prison environment. That will start with three prisons, so that we can assess the operational feasibility and public health impact of that type of testing.
We have made rapid and significant progress across all five priority areas for testing, and it is therefore appropriate that we now publish an updated and refreshed strategy. The fundamental purpose of our strategy and testing programme will not change. Testing on its own is not a panacea. It does not stop transmission in and of itself; it gives us information to help us to take action to stop that spread and to enable us to take the right decisions at the right time. That purpose will become even more important as we determine how best to integrate and deploy our testing strategy and programme to support the safe easing out of lockdown restrictions in the next phase of the pandemic.
The activity that I have just set out will continue. We will continue to test to diagnose people who are ill so that, if they have Covid, they isolate to stop the spread. We will test for the clinical care of people in hospitals and to protect those who are most vulnerable to the worst harm. We will keep testing to find cases wherever we are most likely to find them, whether or not the person has symptoms. We will test to support our essential services and the people who work in them and to mitigate the wider social and economic harms that are caused by the pandemic. We will also continue to test to monitor prevalence, which is crucial to safeguarding the progress that we have made through all our efforts to do the right thing and adhere to the protective measures that are in place and through the success of our vaccination programme.
As transmission continues to reduce, as we hope it will, the next phase will mean a return to more sporadic outbreaks and there will be a continuing risk of importing new variants that could undermine our progress. Whole-genome sequencing improves our ability to address both of those threats. We also need to be ready for the threats of the future, not just for the next three months but for the next three years and beyond. Health threats will continue to emerge, so we must build a legacy that will help us to prepare for those future threats and that will help to build a world-class public health system in Scotland.
Today, the First Minister has announced that, next year, we will invest more than £13 million in developing a truly world-leading Scottish whole-genome sequencing service. Sequencing has already proven to be a powerful method of detecting new variants that are of concern and of investigating links between strains in outbreaks. It helps us to understand transmission better and to design treatments, it gives us early warning of new strains, and it builds a legacy for the future. Scotland’s sequencing science is already world leading. With the investment, we will build on that science to create a service that can help in our next critical stages of responding to the pandemic, that can sequence up to 1,000 cases a day if necessary, and that helps us to deal with the risks of today and tomorrow. The service will underpin our updated approach to testing. That approach will continue to be refreshed as we adapt to the pandemic conditions that we face and seek to incorporate and deploy emerging technologies.
There are two core messages that we want everyone to note from the updated strategy that we have published today. The first is how far we have come. At the start of the pandemic, before test and protect was launched, Scotland had a daily testing capacity of 350 tests. By the end of this month, the daily testing capacity across the entire system will be at least 250,000 tests a day. We now have eight drive-through regional test sites, 42 mobile testing units, 33 walk-through local test sites and 21 small-scale test sites located across the country. I say a heartfelt thank you to everyone who has helped to design, develop and deliver the sites and all our testing capacity—there are literally thousands of workers and volunteers all over Scotland involved in that shared national endeavour.
The second message is that we all need to know when, how and where to get a test. As we learn to live with the threat of the virus and seek to return safely to our everyday activities and lives, we must keep testing and must test more and in more circumstances. Put simply, testing must become part of our everyday lives, offering an important layer of protection in the months ahead, alongside vaccination and other measures including social distancing, self-isolation, hand washing and face covering.
Testing will help us to return to activities that have been largely restricted over the past year, and it will help us to increase social contact, which is vital for our mental wellbeing and relationships. In short, testing will help us to move on from the present and into the future.
We have around 20 minutes for questions. I ask members who are present in the chamber and who wish to ask a question to press their request-to-speak button. Members who are contributing remotely should type R in the chat function.
I thank the minister for the advance copy of her statement. This week, we passed the one-year point from when the United Kingdom first entered a nationwide lockdown. On a more positive note, as of today, 26.5 million people in the UK have received their first dose of the vaccine, which is almost half the adult population, with nearly 2 million people in Scotland having received theirs. However, we must remain vigilant, and it is critical that we continue to utilise testing as much as possible, given its crucial role in combating the virus.
I welcome the various announcements that have been made today, although they have been a long time in coming. For example, community testing was first announced in December, three months ago. Why has it taken so long to put community testing in place?
The Scottish Government currently has access to testing capacity of around 77,000 tests a day. We have just been told that, by the end of March, the daily capacity across the entire system will be at least 250,000 tests a day. Can the minister explain why only 17,000 people were tested yesterday? That shows that the Government is nowhere near making full use of the existing testing capacity.
I thank Donald Cameron for raising those questions. He asked about community testing and why we have not been able to roll that out sooner. We had the first pilot for community testing last December. Of course, like any such projects that we undertake, it was really important that we evaluated the lessons to see what we could replicate as quickly as possible.
A really important aspect of our targeted community testing is the fact that we have done it in conjunction with health boards and local authorities. As I said in my statement, we have managed to roll out community testing to 28 local authority areas, which is no mean feat, given that we are only into March.
The engagement has been really important in making sure that we are testing in the right places and where that is most appropriate for local circumstances. I hope that the member recognises those points and accepts them.
In his second question, about the utilisation of capacity, the member makes an important point. As I outlined in my statement, we have seen a huge increase in our capacity, including in relation to our PCR testing and lateral flow devices. The strategy document that we have released today is vital in that respect, because it outlines how we intend to use that capacity. I also highlight the importance of retaining an element of that capacity, especially in the next few stages as we ease out of lockdown. Should there be other outbreaks for which we need to utilise that testing resource, it is important that we have that capacity. We have set out today in our plan how we intend to utilise the capacity.
I thank the minister for the advance copy of her statement.
Scottish Labour has long called on the Government to take seriously the need for more testing, so I welcome much of what the minister has announced. The vaccine has been great news, but the experts are clear that the virus will be here for some time yet, so we need robust testing and tracing to find and isolate outbreaks.
The Scottish Government’s own Covid-19 advisory group has said that
“It would be desirable to test more people ... even if this increased test positivity”
and that that expanded testing and community testing could be “a game changer”. However, community testing is still too small in scale. Last week, fewer than 6,000 asymptomatic tests were carried out at community sites. They uncovered 155 positive cases. How many more are going undetected?
Does the minister accept that there is a need to expand community testing even further and to advertise it to local people, especially as restrictions lift? After all the effort to scale up Scotland’s testing capacity, why is the Government content to let more than 50,000 gold-standard PCR tests go unused every day, as asymptomatic cases go untested?
Finally, from November to January, only 30 per cent of self-isolation support grant applications were awarded. That is woeful, and I am worried that some people will refuse tests and not self-isolate as a result. It would be very helpful if the minister outlined what she will do urgently to rectify that problem.
Jackie Baillie has raised a number of really important points.
We want more people to take part in community testing. We want to roll it out throughout Scotland and ensure that we work with local authorities and health boards to do that in an effective way that will work.
The advertising element is absolutely critical. We need people to know that community testing facilities are available in their communities and that they can access them. We have worked with health boards on communications to ensure that they are doing all that they can locally, and the Government is doing what it can to advertise community testing and to encourage people to take part in it, when it exists in their areas. We are more than happy to look at the matter to see what more we can do to push the message even further out.
Jackie Baillie talked, as Donald Cameron did, about our PCR capacity and the fact that not all of it is being used. The prevalence of the virus has fallen in recent weeks, thanks to the efforts of everybody who has been sticking to the restrictions and guidelines, and thanks to progress in our vaccination programme. Prevalence falling means, of course, that there are fewer people with symptoms isolating and booking tests, because there are fewer people who are ill with Covid. As I said in my previous response, we know from experience that that can change. We need resilience in our testing system so that we can respond if demand increases again.
PCR testing is only one aspect of our testing programme. There is also extensive lateral flow testing for people without symptoms in schools and workplaces throughout the country. We will continue to use all our testing capacity as effectively as possible.
Jackie Baillie’s last point was about self-isolation, which is absolutely critical in relation to all the areas that we are looking at in tackling the pandemic. It is critical alongside vaccination, our testing programme and all the other non-pharmaceutical interventions, including social distancing and the wearing of face coverings. Self-isolation is key to the approach.
On the figures that we have for people who are self-isolating, a UK-wide survey showed that 80 per cent of people were adhering to self-isolation advice. We are undertaking our own work to identify exactly what the situation in Scotland is.
We need to ensure that people are aware of the support that is available to them, and it is crucial that we get that right. However, we have significant packages in place, and we are trying to help as many people as possible and to get the message about the support that is available out as much as possible.
There are 12 minutes left, and 10 members want to ask questions. That tells members how short their questions should be. There must be single questions and short answers, please.
The virus has adapted, there are new variants of concern, and no doubt others will emerge in the coming weeks and months. How will the genomic sequencing scheme help us to detect new variants?
There is use of surge testing in England where there are community or localised outbreaks that are linked to new emerging variants, but that approach did not feature in today’s statement—
No—that is not a short question. Can we have an answer to the first bit, please, which I think was about genomic sequencing?
Our expert advisers on genomics have told us that there is no scientific rationale for mass testing to try to find cases in order to eliminate new variants of concern. If a variant is identified through whole-genome sequencing, local health protection teams carry out enhanced contact tracing. That case is then reported through the four-nations twice-weekly publication on variants of concern. Our approach—which involves extending the circles of investigation and testing for positive cases of a variant of concern—has a clearer scientific rationale than mass testing of entire geographies. Essentially, it is also a quicker way of controlling and containing outbreaks.
Thank you. Now, let us have short questions from now on. Mr Whittle, you will set an example. You will be followed by George Adam.
An outbreak at Kilmarnock prison involved almost 200 cases of Covid. Those included 40 staff, 18 of whom were asymptomatic. Why does the Scottish Government therefore still feel the need to assess operational feasibility and the impact on public health when the evidence is already clear?
Our whole approach to testing and where it is carried out has been based on the best clinical advice. We take a risk-based approach to the testing that we roll out, which we try to do as best we can, guided by such intelligence. That is the key to what has been set out in our strategy, including our approach on targeted community testing, working with local health boards and local authorities to see where testing can best be utilised and focusing it on areas in which there is high prevalence.
I will try to be quick and to set an example, Presiding Officer.
From the minister’s statement, it appears that the updated testing strategy suggests that testing will become part of everyday life. Will she explain further how that will work in practice? What role does she envisage testing playing in helping us to continue to respond to and suppress the virus?
Right from the beginning, test and protect has been an absolutely critical part of our response to the pandemic. It will continue to be vital as we cautiously ease restrictions and move out of lockdown.
Of course, we must remember that the virus has not gone away. Anyone with symptoms should still isolate and book a test as soon as possible. Extending asymptomatic testing, including through community testing, will help us to find cases that might otherwise be missed. Finding such cases and supporting people who are affected to isolate and to break the chains of transmission will really help us to suppress the virus.
Will the Scottish Government support lateral flow testing as a way of allowing people to fly from our airports safely? If not, given the undercapacity in PCR testing, would the Government prefer that? Will it allow some testing at airports in order to save our connectivity?
Again, our strategy sets out the rationale for the types of tests that we use and where we use them, whether they be PCR tests or tests that use lateral flow devices. When it comes to opening up areas, including areas of the economy, those are all factors that we take into active consideration. We will look at all those aspects and consider them further.
Today’s news about the expansion of testing is certainly welcome. However, how will the data on testing be gathered and reported? How will it be used to inform our approach to testing and to managing the virus in the future?
Data on testing is absolutely vital and will continue to be reported in the usual ways. Daily data on confirmed results of PCR testing will be published on the Scottish Government’s website, and data on all aspects of lateral flow testing will be published in Public Health Scotland’s weekly Covid-19 statistics report. New data will be added to that from today and will be built on with additional data in the period ahead.
As we have set out in our strategy update, work is also continuing on development of an evaluation framework for the testing strategy, drawing on routine testing data, national surveys and local evaluations. Monitoring and evaluation across the whole testing programme will be used to inform our on-going approach to testing and managing the virus in the future.
I welcome the extension of asymptomatic testing for early learning and childcare settings, but what has been announced today falls way short of a workplace testing strategy for Scotland. Why will food businesses receive asymptomatic tests for their staff but people who work in waste management centres or bus depots will not, despite the fact that such settings have experienced serious outbreaks of Covid in recent months?
As I outlined in my statement, there are particular reasons for our rolling out of testing to food production and distribution, which are to do with the types of environment that exist there and the fact that the incidence of outbreaks has been high there. We therefore felt that that was the most appropriate area to look at first.
We must consider the situation by looking at the capacity that we have and how to best utilise it, so that we roll out workplace testing in accordance with our strategy. We essentially take a risk-based approach so that we can make sure that we use our capacity in the most effective way, and so that we can open the economy in a sustainable way.
I am more than happy to look at all the other areas that Mark Ruskell talked about. As part of our targeted community testing, we have been discussing with health boards and local authorities whether there are particular sectors in their regions that we can consider for the roll-out of testing. I would not say that anything has been ruled out, but we must take that risk-based approach and make sure that we make the best and most effective use of the capacity that we have.
We have heard several times this afternoon that we are using only a third of our daily testing capacity. Although I understand that the Government will not prioritise key workers such as front-line police officers in the vaccine roll-out, perhaps it can prioritise them in the testing roll-out. We are testing control room staff—that is understandable—but when can we start testing our vital front-line police officers?
Alex Cole-Hamilton raises another important point, but that is not to say that we do not think that testing should not be done in those important areas. As I outlined in my statement, in rolling out testing to the call centres of all the emergency services, we were guided by the clinical advice on where the most appropriate use of testing would be and what type of testing that should be. We keep that under review. We are in constant discussion with the emergency services and other key sectors about where testing could best be used. Therefore, I would not rule anything out; the situation is one that we are monitoring constantly.
I welcome the expansion of testing to workers in food processing, as they have been critical during the pandemic.
How will the minister ensure that we reach agency or temporary workers who might be reluctant to take up the offer of testing because of the potential impact on their earnings if they have to self-isolate?
I want to elaborate on the response that I gave to Mark Ruskell when he asked about the food sector. The aim of the testing programme in that area is to contribute to the reduction of coronavirus-related risk in high-risk settings and, in doing so, to enhance the resilience of critical food supply. That will help to reduce the risk of the significant impacts on businesses and their employees that can occur when there is an outbreak.
We are engaging directly with all companies that have expressed an interest in testing to help them to understand the guidance and the practical steps that they need to take to proceed, and to ensure that they are aware of the importance of supporting any employees who are required to self-isolate as a result of a positive test. As I said to Jackie Baillie, that includes making companies aware of the extensive package of measures that are available to support people who need practical and financial support to self-isolate. We recently expanded eligibility for that and, as I said in my statement, 60 companies have registered an interest. Their average employee number is around 200 people, and they are located across 26 different local authorities in Scotland.
Testing patients who attend hospital, especially those who go to accident and emergency, will reduce the need for red and green routes. Is the minister confident that the proposed testing is robust enough to make red and green routes redundant?
I believe that the testing that we have put in place is robust. If the member wants to raise any particular concerns with me about that, I will be more than happy to correspond with him.
I welcome the expansion of testing to all emergency service control room staff. Will it also be extended to all front-line emergency service workers?
Did you get that, minister?
I think that I picked it up, so I will respond to David Torrance as best I can.
The Scottish Fire and Rescue Service and Police Scotland identified their operational control rooms and command, control and co-ordination functions as being business critical for the delivery of emergency services. Therefore, asymptomatic testing of that group of staff is a vital part of business continuity, as it will ensure that any potential cases of Covid-19 are quickly identified in those critical operations of our emergency services.
We have also implemented regular testing for all Scottish Ambulance Service staff as part of our roll-out of healthcare worker testing, and we are actively considering expanding testing in the police and fire and rescue services to specific staff groups where other Covid mitigations such as physical distancing or working outside are challenging. That includes areas such as driver training and staff who carry out wellbeing assessments.
As I have said in previous responses, our approach is driven by the expert clinical and scientific advice that we receive. We continue to monitor the situation and keep it under review.
I thank members. We got in all the questions in the time. I also thank the minister—I put you under a bit of pressure, but you got through it.
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