Chamber and committees

All symptomatic health and social care workers, and symptomatic household members, are eligible for testing through local NHS facilities.

As of 8 July 2020 there has been routine testing of NHS and social care staff working in; Specialist Cancer Wards and Treatment Areas, Long Stay Care of the Elderly and Long Stay Old Age Psychiatry and Learning Disability Wards. Scottish Government is working closely with Health Boards to develop management information on the testing of NHS staff.

Scottish Government is working closely with Health Boards to develop management information on the testing of NHS staff.

All social care staff employed in care homes will be routinely offered testing regardless of whether they are symptomatic

In the latest available week 24 – 30 July 2020, over 36,000 care home staff were tested.

Currently information on deaths by suicide are published yearly by National Records Scotland (NRS), usually in June for the previous calendar year. At the moment the most recent figures held are up to 2018. The report for 2019 has been delayed as NRS has not received some of the information it relies on to categorise these deaths. It is not possible to produce reliable statistics without this information.

In relation to deaths by suicide in 2020, usually this data would not be available as official statistics until June 2021. However as part of our response to the pandemic the National Suicide Prevention Leadership Group along with Public Health Scotland are looking at ways to extract reliable real-time data from other sources to inform local and national suicide prevention in Scotland.

I refer the member to the answer to question S5W-29910 on 31 July 2020. 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

The principles of the Adults with Incapacity (Scotland) Act 2000 should be given effect to in any intervention in the affairs of an adult lacking capacity. One of these principles is that the views of interested parties should be taken account of when determining if an intervention is to be made and what intervention is to be made. This includes those who are acting as power of attorney.

Our Integrated Adult Policy on Cardiopulmonary Resuscitation (CPR) makes clear that if a patient does not have capacity to make a decision related toCPR, then the principles of the Adults with Incapacity (Scotland) Act 2000 apply. WhereCPRmight be successful in achieving sustainable life, a decision about whether the benefit ofCPRwould outweigh the harms and burdens for that patient must be discussed and agreed between that healthcare team and the patient's relevant others. Where there is a legally appointed proxy decision-maker (welfare attorney or welfare guardian) they must be involved in the decision-making process. It is for the clinical team responsible for the patient's care to determine the most appropriate way of having such discussions and ensure that they are conducted in a safe and timely manner.

Additionally, visiting guidance in health and social care settings recognises that visits to those nearing the end of life are deemed essential and as such we would expect those working in clinical settings to accommodate such visits where it is safe to do so. This provision has been in place since restricted visiting was introduced.

Dr Calderwood was an NHS Lothian employee at the time she was seconded to the Scottish Government as Chief Medical Officer. Questions regarding her NHS employment should be directed to NHS Lothian.

I refer the member to the answer to question S5W 28663, which gives all the information held by the Scottish Government in relation to the number of people contacted via contact tracing following a patient testing positive for Covid-19 since 1 February 2020. The Scottish Government does not hold data on the number of people contacted via contact tracing following a patient testing positive, prior to 28 May 2020.

As of 31 March four contracts were procured through National Services Scotland for the use of private hospital facilities throughout the COVID19 pandemic. These facilities provide a COVID-19 free environment for patients to receive urgent cancer surgery, outpatient appointments and radiology tests.

The total value of the contract will be dependent on the variable costs associated with the procedures being undertaken. However, these contracts are on a non- profit basis with NHS Scotland only meeting the overhead costs incurred in operating the facilities.

The activity undertaken is performed by NHS surgical teams on NHS patients, and the private hospitals have been responsible for the provision of nursing services.

As at 12 July there have been 3,954 outpatient appointments, 2,471 surgical procedures and 2,468 radiology tests delivered across the four hospitals.

I refer the member to the answer to question S5W-29295 on 2 July 2020. 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.

The basis of infection control in Scotland has been, and continues to be, the National Infection Prevention and Control Manual (NIPCM) (here:

https://www.hps.scot.nhs.uk/guidance/nipcm/

The NIPCM was first published in 2012 and is updated in real time to ensure that the information on infection prevention and control is current and up to date. It provides guidance on infection prevention and control practices and procedures required to support to all those involved in care provision, including care homes. In addition it contains information to assist staff to prevent cross contamination of specific infectious agents via different routes, including those that are droplet based. It is in use in all hospitals in Scotland, and care homes are encouraged to use the manual as a basis for their infection prevention and control information and for managing incidents and outbreaks.

The Scottish Government’s position on discharging patients from hospitals to care homes was set out in National Clinical and practice guidance to support those working in adult care homes in Scotland during the Covid-19 pandemic, issued on 13 March, and subsequently updated on 26 March and again on 15 May (to be found here:

https://www.gov.scot/publications/coronavirus-covid
-19-clinical-and-practice-guidance-for-adult-care-homes/ .

Guidance at each time was based on the latest scientific and epidemiological evidence available. A summary is given below:

13 March guidance

Our guidance at this time advised that care homes should continue to take admissions and screen for symptoms, in line with Health Protection Scotland guidance.

Patients discharged from hospital: our initial priority was to ensure that patients were screened clinically so that people at risk were not transferred inappropriately, while flows out from acute hospital were not hindered.

Patients suspected of having symptoms of COVID-19 were to be supported in line with Health Protection Scotland guidance and specifically isolated in their own room.

Where a long term care facility had a resident who had tested positive for coronavirus, further admissions were to be halted.

We also took steps to reduce communal activity. Residents were advised to remain in rooms as much as possible, with meals served in rooms where possible.

It was recommended that communal activities should be reduced by 75%

We also took steps to reduce visitors, with essential visitors only with allowances for end of life care and distressed situations, eg, in the case of those with dementia.

It was recommended that the number of external visitors was to reduce by 75%.

26 March guidance

We updated our guidance on 26 March.

This advised that care homes should continue to take admissions if it was clinically safe to do so.

The advice focused on assessing for symptoms and managing on this basis.

Admissions known to have contact with COVID patients were required to isolate for 14 days. All other admissions were required to isolate for 7 days.

HPS guidance advised that admissions from the community should be screened for symptoms and a discussion held with clinical staff in the community prior to admission, to assess whether there was a need for isolation measures

The HPS guidance stated that people being admitted from home and the community did not need to be tested for COVID-19 and should be managed based on symptoms.

Advice on admissions from hospital confirmed there was no need for confirmation of a negative COVID test and that care homes should be advised of recommended infection prevention and control measures on discharge.

Advice at this time also recommended a documented clinical risk assessment for COVID-19 and a screening form was provided.

For care homes with cases of Covid-19 the advice stated that they could take admissions if they had 1-2 confirmed cases but should seek advice and risk assessment from the local Health Protection Team (HPT).

If a cluster of cases was identified then homes were advised to close to new admissions and visitors unless the layout of the facility allowed for partial closure.

Advice on communal activity and visitors was enhanced.

26 April guidance

I announced on 21 April that all Covid-19 recovered patients discharged from hospital to a care home should have two negative tests before discharge, and that any patient being discharged for any reason unrelated to Covid-19 from hospital to a care home should have one negative test. Those admitted from the community should also have at least one negative test. On 26 April Health Protection Scotland published new guidance to reflect these changes, Covid19: Information and Guidance for Care Home Settings,

(here : https://hpspubsrepo.blob.core.windows.net/hps-website/nss/
2980/documents/1_covid-19-information-and-guidance-for-care-homes.pdf

15 May guidance

The most recent iteration of National Clinical and practice guidance to support those working in adult care homes in Scotland during the Covid-19 pandemic confirmed that everyone being admitted to a care home should have a negative test before admission, unless in the clinical interests of the person to be moved - in such cases a full risk assessment should be carried out.

The guidance included the introduction of 14 day isolation for all admissions.

In the event of the admission of COVID-19 recovered patients from hospital, they should be isolated for a minimum of 14 days from symptom onset (or first positive test if symptoms onset undetermined) and absence of fever for 48 hours (without use of antipyretics).

Two negative tests were required before discharge from hospital.

For the admission of non Covid patients, a single test is required within 48 hours prior to discharge.

Patients can be discharged to the care home prior to the test result being available and should be isolated for 14 days from the date of discharge from hospital.

All admissions from the community should have at least one test performed before or on admission, and be isolated on admission for 14 days.

The advice continued previous guidance on communal activity and physical distancing - Residents remain in rooms as much as possible and in all care homes meals are served in rooms but particularly where there is an outbreak.

The current guidance may be found here:

https://www.gov.scot/publications/coronavirus-covid
-19-clinical-and-practice-guidance-for-adult-care-homes/

Infection Prevention and Control

Current scientific evidence suggests that using PPE correctly and undertaking correct Infection Prevention and Control (IPC) practice, should mitigate against the risk of transmission from asymptomatic staff to patients and vice versa. Nurses and other care home staff should follow the UK wide COVID- 19 IPC Guidance:

https://assets.publishing.service.gov.uk/government/uploads/
system/uploads/attachment_data/file/886668/COVID-19_
Infection_prevention_and_control_guidance_complete.pdf

- to prevent spreading infection to those in the care home setting.

The Scottish Government and its agencies provides a wide range of different forms of business support. This includes the funds to support businesses through the COVID-19 crisis which were managed by Local Authorities and Enterprise Agencies. Recognising the urgent need to provide support financial support to business, specialist skills or support from external providers may on occasions be required to ensure the fastest, most effective way for funding to reach businesses. We are Umi was procured by Scottish Enterprise to assist in the delivery of the Pivotal Enterprise Resilience Fund and the Hardship Fund. Grants administered by local authorities are not considered to be outsourcing.