Chamber and committees

The guidance for whole households of close contacts to self-isolate was local guidance as part of the local restrictions in place in Greater Glasgow and Clyde and Lanarkshire Health Board areas from 01 September to 02 November. The National Incident Management Team considered the proportionality of this measure on 24 September, and recommended that requiring entire households of close contacts was, on the balance of evidence, no longer proportionate to the risk posed. The local guidance was therefore withdrawn on 29 September in the relevant Local Authority areas in the West of Scotland.

Whole-household close contact isolation advice can still be issued if local Health Protection Teams believe this is necessary to contain an outbreak. People should always follow their local Health Protection Team’s advice – doing so is essential to breaking the chain of transmission of the virus.

The Scottish Government does not hold information on how many people have self-isolated as a result of local whole household isolation guidance.

The advice from Infection Prevention and Control (IPC) experts in Scotland and the UK IPC cell is that the current evidence does not support a change to the existing PPE requirements.

Evidence has shown that COVID-19 is predominantly transmitted via droplets and contact with contaminated hands or environment. Therefore, IPC guidance recommends that all health and care staff providing direct patient care should wear Type IIR Fluid Resistant Surgical Masks (FRSMs) at all times throughout their shift as they protect against droplet transmission. Airborne precautions, including the use of FFP3 respirators, are required for the medium and high-risk pathways where Aerosol Generating Procedures (AGPs) are undertaken. However, in Scotland, following an individual risk assessment, staff can also choose to wear an FFP3 respirator when undertaking AGPs in the low-risk pathway, as set out in the Scottish COVID-19 IPC addendum for acute settings.

The guidance is continually reviewed in line with the latest evidence and advice.

The advice from Infection Prevention and Control (IPC) experts in Scotland and the UK IPC cell is that the evidence does not currently support a change to the type of PPE we currently use in response to this new strain.

The Scottish Government continues to review international research and data to ensure that IPC measures and facemask guidance for hospitals and other care settings are in line with the latest evidence and advice. We already have strong measures in place to protect patients, such as the extended use of face masks and coverings, physical distancing, risk-assessed patient care pathways, testing and the appropriate use of PPE, to minimise nosocomial transmission as far as possible. All staff should exercise the risk assessment process when donning PPE in line with the transmission-based precautions for COVID-19.

The extant IPC and PPE guidance can be accessed via the Scottish COVID-19 Infection Prevention and Control Addendum for Acute Settings. The guidance is continually reviewed in line with the latest evidence and advice.

The Scottish Government procures sufficient vaccine to vaccinate all those who are invited to receive the seasonal flu vaccine, in line with uptake planning assumptions. For the adult flu programme, vaccines are procured nationally and as part of the contractual agreement, the Scottish Government receives an end of season credit for the unused vaccine, therefore would not constitute as wastage.

The HPV vaccine is procured centrally and the stock is managed through NHS Board Vaccine Holding Centres. The vaccines are procured in a manner that minimises wastage by placing orders regularly and only holding sufficient stock for programme requirements each month. Holding Centres work closely with school immunisation teams to ensure the correct amount of HPV vaccine is delivered to schools for each setting.

Research work undertaken by the University of Edinburgh and Marie Curie in 2019 found that on average 69% of people had a KIS in place at time of death. The study reported that this was an encouraging improvement on previous years but that more work was needed.

For people to get the care that is right for them, it is important that medical professionals have early and sensitive conversations about their care wishes should the worst happen. That is why from the outset of the pandemic, we encouraged GPs to contact those registered with their practice who may be vulnerable and required to shield to help ensure that appropriate care planning was in place and recorded. Our guidance emphasised the importance of completing a KIS following such discussions to help ensure people get the care that is right for them.

We have also produced further resources and guidance on having Anticipatory Care Planning conversations which we believe will be helpful to GPs in having successful discussions with patients for whom this is appropriate, and allowing them to record the outcome in their KIS.

The Palliative Care Research Forum has been unable to meet in 2020 due to the challenges associated with the Covid -19 pandemic. The Scottish Government remains supportive of the Forum and will work with Forum leads over the coming months to learn from our experiences in the pandemic, and reflect on the role and work of the Forum going forward.

This information is not collected centrally.

The Key Information Summary (KIS) is a collection of information, extracted from a patient’s general practice record, that may be helpful to attending medical professionals in providing treatment. As this information is stored via GP systems, it is not possible to centrally collect information in the manner described.

We want people to be able to receive high quality end of life care in the setting that is most comfortable for them. For most people this will be at home or in a homely setting.

However, there are significant challenges associated with gathering views from those who have had a loved one supported by palliative care services to support further improvement work. These include the difficulty in gathering a suitable sample size to make the findings useful for service improvement, the need to put in place support arrangements for those contacted, and most significantly the ethical requirement for the benefit of those findings to outweigh the distress caused by surveying the families of the recently deceased. This a particularly important consideration during the pandemic.

As part of our wider work to learn from experiences during the pandemic, we are working with Public Health Scotland and other key stakeholders to identify options on how best to establish a more coherent picture of the quality of end of life care, which can also be used for improving future service delivery.

We want people to get the high quality palliative and end of life care and support that is right for them. For most people this will be at home or in a homely setting.

Due to the challenges associated with the pandemic, we are seeing more people being cared for in community and homely settings. That is why throughout this year we have provided additional resource to Integration Authorities to help ensure that those being cared for in community settings can get the care that is right for them.

Most recently, in November 2020, we published our Adult Social Care Winter Preparedness Plan which includes a focus on supporting people to get the care that is right for them when time becomes short. To support this work, we provided Integration Authorities with an additional £72 million to help ensure that those being cared for in the community, including those with palliative care needs, have access to the right services at the right time.

The Scottish Government remains committed to ensuring that people get the palliative and end of life care that is right for their unique circumstances.

Over the coming months, we will be working with key stakeholders to reflect on our experiences during the pandemic and focus on the lessons learned to inform any future palliative and end of life care service development work. Ministers will communicate any decisions regarding service development work to Parliament in due course.