Chamber and committees

The Scottish Government is greatly concerned at this report. NHS Greater Glasgow and Clyde is unaware of any shielding issues relating to lung cancer patients and are unable to investigate the issue raised in the question with the information provided. The Scottish Government has asked Ms Baillie to contact NHS Greater Glasgow and Clyde directly to provide further details. People who have undergone radical radiotherapy for lung cancer or are receiving active chemotherapy treatment for any type of cancer are advised to shield. The vast majority of people in these categories were sent letters of advice in the week commencing 30 March. People who have started treatment since then should have been advised that they will need to shield before they began their treatment.

In common with other UK regulators and counterparts in Ireland, the Care Inspectorate took the decision early in our response to the pandemic to scale down, recognising that this may put an unnecessary burden on the care sector, may contribute to spreading COVID-19, and put their inspectors at risk.

Additionally part of the continuous review in their response to the Covid-19 outbreak, the Care Inspectorate has put in place a programme of increased unannounced site inspections.

The Care Inspectorate has been very active in monitoring services and has been making regular contact with care homes and their parent companies, often daily. They are also actively working with Health Protection Scotland, local Public Health teams, Health and Social Care Partnerships, local authorities and others in order to monitor, direct and guide services.

The Care Inspectorate changed their operating model in response to Covid-19 by establishing:

• daily notifications for suspected cases and deaths in care services
• a new system of red, amber green notifications for services to indicate if they were experiencing staffing difficulties
• a twice per day Gold command group and once daily Silver command group, deciding what action is required based on the intelligence gathered
• collaboration with Scottish Social Services Council (SSSC)/NHS Education for Scotland (NES) Hub to successfully route staff to services experiencing staffing difficulties
• training of inspectors on the use of 'Near Me' to utilise real time video footage to examine the circumstances within services, to provide further assurance

Under the Coronavirus (Scotland) (No2) Act 2020 the Care Inspectorate has new duties to report on inspections and deaths in care homes. These reports will be laid in Parliament accordingly.

Under the Coronavirus (Scotland) (No2) Act 2020 the Care Inspectorate has new duties to report on inspections and deaths in care homes. These reports will be laid in parliament accordingly.

In March 2019, 110 inspections were carried out at care homes. In April 2019, 99 inspections were carried out at care homes. In March 2020, 71 inspections were carried out at care homes. In April 2020, no inspections were carried out at care homes, but the work noted above was undertaken.

(a) Care Inspectorate inspectors discuss infection control measures during weekly scrutiny and support calls with care services, and more frequently as required.

(b) Information collected from a Care Inspectorate weekly survey of care services is shared with the NHS NSS Triage Hub to provide an overview of any clinical consumables and PPE shortages across Scotland, to help resources to be appropriately directed.

(c) If there are to be admissions to a care home with a COVID-19 outbreak this must be discussed with local Public Health teams. The Care Inspectorate shares Health Protection Scotland (HPS) guidance updates when this is published, with all care services via national provider updates, Care Inspectorate website and social media.

In addition to the work undertaken by the Care Inspectorate, Scottish Government Care Home Action Group are pulling data from across the system, including Directors of Public Health, to provide the necessary assurances and drive national action.

The Care Inspectorate has changed their operating model in response to COVID-19 by establishing:

• daily notifications for suspected cases and deaths in care services
• a new system of red, amber green notifications for services to indicate if they were experiencing staffing difficulties
• a twice per day Gold command group and once daily Silver command group, deciding what action is required based on the intelligence gathered
• collaboration with Scottish Social Services Council (SSSC)/NHS Education for Scotland (NES) Hub to successfully route staff to services experiencing staffing difficulties
• training of inspectors on the use of 'Near Me' to utilise real time video footage to examine the circumstances within services, to provide further assurance, and to ensure that IPC and PPE are adequate in each service.

Data on testing is published on a daily basis by both the Scottish and UK Governments. The only like for like comparison available across the four nations is the Pillar 1 NHS/Public Health England (PHE) lab data.

As at 2 June, 1,731,901 tests had been carried out at NHS and PHE labs across the UK, giving a testing rate of 25,927.90 per million.

In Scotland as at 2 June, a total of 175,180 tests had been carried out in NHS labs, giving a testing rate of 32,064.87 per million.

Therefore Scotland has a higher testing rate from NHS lab testing than the overall UK figure.

Additional testing is carried out by commercial partners in Scotland including Regional Testing Centres and Mobile Testing Units. This data is collected by the UK Government and is not broken down into totals for the four nations to enable any valid comparisons.

Capacity continues to increase in Scotland to support the delivery of the Test and Protect programme.

Clinical advice and available scientific evidence suggests that it is too early to determine exactly what the long-term physical and mental health impacts will be for those who have had COVID-19 or whose mental health has suffered as a result of long-term isolation, reduced contact with family or friends and economic adversity.

However, through the remobilisation process we have asked all territorial NHS Boards to provide a local assessment of demand for mental health services following the COVID-19 lockdown and their plans to respond to this. We will continue to work closely with Boards to monitor the impact of Covid-19 on demand over the coming weeks and months.

Our approach will also be informed by wider evidence. The Mental Health Research Advisory Group has been established to follow research developments to understand the medium and long term impacts of the Covid-19 pandemic on mental health. This will help us to put evidence-based services and support in place to help meet the mental health needs of the population.

The Scottish Government is working closely with NHS Boards during the pandemic to monitor the impact of Covid-19 on demand and capacity. We wrote to NHS Boards on 14 May highlighting mental health as a clinical priority and asking them to set out plans for reinstating services and to work with partners to estimate the anticipated rise in mental health need in the population and their response. These plans will allow us to understand where Boards are now and what they need to do to address the mental health needs of their population as we move into the next phase.

Although clinical advice and available scientific evidence suggests that it is too early to predict the long-term mental health impacts of Covid-19, in anticipation of increased demand for mental health support, the Scottish Government has invested heavily in services, including more than £1 million to expand the Distress Brief Intervention (DBI) programme to help people in distress and £3.8 million to increase the capacity of NHS 24’s telephone and online services and extend digital therapies available through the NHS.

The 2014 Future of Residential Care for Older People in Scotland report made a number of important recommendations to help shape the future of the care home sector in Scotland. The Residential Care Task Force Implementation Group was established to take forward the report recommendations. Whilst many of the recommendations made were taken forward and were implemented relatively quickly, there were some longer term recommendations which required considerable development, planning and potentially funding. At the time the Taskforce anticipated that the integration of health and social care would open up opportunities for the care home sector to be developed through strategic commissioning based on local need, with an increase in intermediate care in care homes and at home, alongside a greater provision of extra-care housing as an alternative to care homes. In this context a number of significant recommendations, including the development of strategic commissioning plans, were made which are now being implemented by our Health and Social Care Partnerships (HSCPs). Some of the most significant recommendations were around support for the workforce, in particular with the implementation of the real living wage for all social care workers. As a result of this work, the Scottish Government has since October 2016 provided resources to enable all social care workers to be paid the real living wage for day time hours and that this was later extended to overnight support. However work to address the workforce challenges doesn’t end there. The Scottish Government has committed to working with national and local partners to take forward the recommendations set out in the Fair Work Convention’s Social Care Sector 2019 report to improve fair work practices for the workforce. Having reflected on progress within the care home sector five years on from the residential care taskforce report, the Scottish Government launched the adult social care reform programme last year along with COSLA. As part of that programme, the Scottish Government had started, prior to the COVID-19 outbreak, to look at ways to improve care home sustainability. While the current focus needs to be on supporting the care home sector through the COVID-19 crisis, it will be important to reflect on the lessons learned during this pandemic and identify what that means for the future of care home provision.

Information on the number of publicly funded places in private care homes is not published. However the report on the Care Home Census for Adults in Scotland published by Information Services Division provides the proportion of care home places that are publicly funded. In 2017 70% of all care home residents were publicly funded. We do not have a breakdown of this by sector. However in 2017 there were 40,926 registered places in care home and of these 31,483 places (77%) were provided by the private sector.

More information can be found at: https://www.isdscotland.org/Health-Topics
/Health-and-Social-Community-Care/Publications/2018-09-11
/2018-09-11-CHCensus-Report.pdf .

These data were published by National Record of Scotland on 3 June. Up to 17 May, there were 1,623 deaths where confirmed or suspected COVID-19 was mentioned on the death certificate either as the underlying cause or as a contributory cause. A further 154 care homes residents died in hospital with a confirmed or suspected COVID-19.

Public Health Scotland provides the Scottish Government with numbers of residents and staff tested in care homes. The Scottish Government is working with Public Health Scotland to quality assure this information.

Initial data was published on the 10th of June together with information that will be included in future weekly publications.