Chamber and committees

As I noted in my statement to Parliament on 24 June, a single NHS Board first discovered in December 2020 that a small number of women who had subtotal hysterectomies had been wrongly excluded.

In 2016, a review was carried out of all individual records on the Scottish Cervical Call-Recall System (SCCRS) which had both a subtotal hysterectomy entry and also an open exclusion on the record. This was prompted by an IT error that had led to ‘no cervix’ exclusions being automatically added to the system when a subtotal hysterectomy was recorded together with recommended management of ‘no follow up’ or ‘no further recall’. This error was swiftly addressed.

In the course of addressing the issue, a number of other cases were identified, where a subtotal hysterectomy had been recorded on SCCRS and a manual exclusion had subsequently been opened. As soon as this was discovered, a process was initiated to identify all records on SCCRS with subtotal hysterectomies and open exclusions.

Following a rigorous review of affected records, it was established that some exclusions had been opened in error. Anyone affected was re-instated to the screening programme, and provided with a full explanation. Recommendations were made for safeguards to be put in place to prevent further instances of inappropriate manual exclusions.

At that time, it was believed that the records review had captured all affected patients, and there was no evidence to suggest further widespread errors in the recording of subtotal hysterectomies or the general application of exclusions.

It should be noted that, in 2006, in preparation for the migration to SCCRS, a data cleansing exercise was carried out. GP practices were provided with a list of women where there were discrepancies between the exclusion status and screening history and asked to resolve these before the transfer to SCCRS was complete.

This data cleansing exercise was standard good practice prior to the migration to SSCRS and did not uncover significant coding or data issues that gave rise to widespread concerns. Once the inconsistencies were resolved, the migration to SCCRS was carried out. A decision was made to migrate total hysterectomy information and all exclusions but not subtotal hysterectomy information, as individuals with subtotal hysterectomies would continue to be screened.

Although the actions taken in response to the issues detected in 2006 and 2016 were reasonable in light of the available evidence, we will consider whether there were opportunities to detect the wider issues now identified, and, if so, what lessons can be learned to strengthen monitoring and auditing going forward.

I refer the member to the answer to question S6W-01898 on
‎ 23 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.

As we see children return to school after summer I understand how important it is for families to feel involved, especially where children are attending school for the first time. However, as we monitor the impact of important changes to self-isolation policies amongst children and young people, it is also important that we continue to minimise the risks of infection and transmission in the school environment.

Updated guidance, published on 3 August, makes clear that visitors to schools should be agreed in advance and arrangements appropriately risk-assessed. Parents/carers may accompany children onto school premises where this is agreed with the school and strictly necessary to support children and young people, for example where there are concerns about individual children making a successful transition from Early Learning and Childcare to P1. Otherwise, where virtual arrangements for parental engagement are already in place and working well, these should continue to be used.

The updated guidance is available at the following link: https://www.gov.scot/publications/coronavirus-covid-19-guidance-on-reducing-the-risks-in-schools/ . These arrangements will be kept under careful review, and are expected to be in place for up to six weeks at the start of the new term.

The Scottish Government currently only allows travellers returning from green and amber list countries to use NHS tests, delivered through the UK Government’s contract with the travel management company CTM. These tests are the highest quality with established data flows into NHS boards and samples are sequenced to ensure early detection of variants of concern.

The Scottish Government currently only allows travellers returning from green and amber list countries to use NHS tests, arranged through the CTM booking portal, as they are the highest quality with established data flows into NHS boards and samples are sequenced to ensure early detection of variants of concern.

Travellers arriving in other parts of the UK can access the NHS tests, however those arriving in England and Northern Ireland are also able to access private test providers who charge a range of prices.

The Scottish Government is exploring ways to allow private testing for travellers coming to Scotland provided we are confident in the flow of data into contact tracing services and that all positive test results are analysed to identify any variants of concern.

The Covid-19 test kits are home PCR kits provided by NHS Test & Trace. The cost of the kits is set by the UK Government and the process managed through its contract with the travel management company CTM.

Currently, the Scottish Government does not allow use of private test providers for international travellers arriving into Scotland from green and amber list countries.

We are having on-going discussions with the UK government on using private test providers and exploring ways to allow private testing for travellers coming to Scotland provided we are confident in the flow of data into contact tracing services and that all positive test results are analysed to identify any variants of concern.

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 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.

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.