Chamber and committees

I can confirm that from 14 August 2020, the automated, web based Turas Care Management safety huddle tool will go live across Scotland. Data collection from the tool will commence from the week beginning 17 August 2020. I expect all care homes to be registered and using the automated safety huddle tool by 24 August.

The original Excel version of the safety huddle template was developed with the care home sector and other key stakeholders including representatives from the Care Inspectorate, Health and Social Care Partnerships, Scottish Care, Scottish Social Care Services Council, Scottish Government representatives from across Directorates, Scottish Executives Nurse Directors, Community Lead Nurses, Health Protection Scotland and NHS Board Public Health Directors. This has been used by care homes across Scotland, and we have continued to work with these stakeholders to ensure that the automated safety huddle is fit for purpose and meets the requirements of the staff who use it, both for the inputting of data at a care home level and on the reviewing of the data.

This work is incredibly important, not only now in our response to COVID-19 but beyond. This will enable more consistent national reporting of the data originally captured through the excel version of the safety huddle returns and will also help to reduce the data burden on our care homes, whilst supporting improved reporting and better analysis of the information on a local and national basis. It will also enable our Health and Social Care Partnerships, NHS Boards and oversight groups undertake their assurance roles which are so important at this time and to ensure that the necessary support is given to the care home sector when it is required.

The tool has been developed so that it is futureproofed, to allow for changes to be made in the future, post COVID-19. Suggestions for future additions to the tool include the addition of quality indicators, including number of complaints, critical incidents, falls, pressure sores, medication errors, no of initial referral discussions relating to adult support and protection etc, which would allow trend reporting for quality improvement. Furthermore, future amendments to the tool could also align with the data collected under the Care Inspectorate legislative framework through the e-form reporting and annual returns. The web based tool has the capacity to add links to the Care Inspectorate e-forms for ease of completion and the data from the safety huddle could be used to provide real time reporting for the Care Inspectorate going forward and support the delivery of evidence based in scrutiny visits.

Public Health Scotland (PHS) this week, 1 July, published validated statistics on the number of nosocomial Covid-19 infections in Scotland, based on the agreed definitions of the European Centre for Disease Control (ECDC).

Scotland is the only country in the UK to have published this data to date. The data provides a detailed picture of hospital associated infections.

The information is not directly comparable to previously published unvalidated management information. The validated statistics cover a longer time period, week ending 1 March to week ending 7 June. The new statistics also capture each individual laboratory confirmed case, rather than only those in a HAI infection cluster.

These statistics will be published weekly on the PHS website as part of the wider information already published. In addition, the National Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Unit within NHS National Services Scotland are working on a statistical process to produce further information relating to COVID-19 Healthcare Associated Infection deaths where possible.

The data and supporting methodology is available at: https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/hospital-onset-covid-19-cases-in-scotland/

On 31 May we published Re-mobilise, Recover, Re-design: the framework for NHS Scotland ( https://www.gov.scot/publications/re-mobilise-recover-re-design-framework-nhs-scotland/ ).

The Framework sets out how NHS Boards will follow national and local clinical advice in order safely and gradually to prioritise resumption of some paused services over the coming weeks and beyond, while retaining sufficient capacity to deal with COVID-19.

NHS Boards have continued to protect key services throughout the pandemic and are now gradually resuming services across key specialties including cardiology, urology, trauma and orthopaedics, as well as endoscopies and other diagnostic services. Patients will be seen on the basis of clinical need, and anyone who has been offered an outpatient or diagnostics appointment or a date for surgery should attend in order to ensure that they receive the treatment and care that they require.

We know that COVID-19 is likely to be with us for some time to come, so we will have to continue to balance the safe and effective resumption of services with the need to keep the virus under control; continuing to protect the NHS and ensuring that there is capacity to deal with any cases of the virus that need hospital treatment.

Whilst Scotland has moved to Phase 2 of the route map, we should not forget that our NHS is still on an emergency footing. Health Boards and their planning partners will continue to work on safely resuming services whilst protecting COVID-19 capacity, as informed by the evidence, clinical priorities and associated national frameworks and guidance.

As we move into Phase 2, I am pleased to report that NHS Boards are making good progress in planning the safe resumption of paused services. Boards are continuing to review how services are delivered so that treatment can be effectively provided whilst ensuring that staff and patients are safe. This work will take time and, in some cases, will mean that how patients access services will look and feel different.

Resuming services safely will mean additional use of PPE, environmental cleaning and physical distancing in clinical areas which will reduce the number of patients who can be seen during a clinical session.

A summary provided on services which are planned to be resumed, by territorial Board area prior to the end of July, was published on 19 June ( https://www.gov.scot/publications/coronavirus-covid-19-mobilisation-of-key-clinical-services/ ).

There remains further work to be done to resume elective treatments. We are working with NHS Boards to resume these services as soon as possible, including examining all resources, such as the Golden Jubilee National Hospital and NHS Louisa Jordan.

People who are on the shielding list have been sent a letter today confirming that the shielding period will continue until at least the end of July and that support which is in place will remain in place for at least that period. The letter contains updated advice to enable outdoor exercise provided strict physical distancing is followed. This advice is in place from 18 June, subject to infection rates in Scotland remaining at a sufficiently low level. The updated advice, along with the future steps on shielding are available here: https://www.gov.scot/isbn/9781839608100

Evidence from the progress of the COVID-19 pandemic highlights that there is a risk of the virus spreading where people are grouped together in enclosed spaces, like hospitals.

The NHS has been alive to this risk and has taken steps to minimise risks of transmission. These steps have included strict adherence to Infection Prevention and Control (IPC) guidance, the wide use of appropriate PPE, frequent hand washing, decontamination of the care environment and physical distancing between staff, where this is possible. Efforts have been made in particular to establish and enforce separation between COVID-19 and non-COVID-19 areas of hospitals, and the direction of patients to different routes has been adapted to take account of developing evidence in relation to symptoms.

Visits to patients have also been restricted to those that are considered essential. These include a birth partner during childbirth; to a person receiving end-of-life care; to support someone with a mental health issue such as dementia, a disability or autism where not being present would cause the patient to be distressed; and, to accompany a child in hospital. Visiting times are managed to ensure social distancing and prevent accumulation of visitors in the ward, and visitors must adhere to strict hand and respiratory hygiene.

Work also continues to enhance the effectiveness of action taken to minimise risks of hospital transmission. A sub group of the Chief Medical Officer’s COVID-19 Advisory Group is examining domestic and international evidence to consider new steps that might be taken. The Government expects to make an announcement shortly about the additional circumstances in which health care workers might be tested for the virus. Consideration is also being given to how to enhance measures to limit transmission in non-clinical areas of hospitals. The group is also developing recommendations in relation to wider patient admission screening.These efforts will be of particular importance as the NHS seeks to both continue suppressing the virus but also begin to re-commence elective surgery and other activity that was paused as priority was given to ensuring sufficient capacity existed to cope with patients suffering from COVID-19.

Where outbreaks have occurred steps are taken quickly to seek to determine the source of transmission and to curtail it, and management of incidents can often involve the temporary closure of wards, or part of a ward. Infection prevention and control has been and remains a priority for NHS Scotland, in all settings.

NHS Boards have been reporting incidents that have involved COVID-19 appearing outside the dedicated ward areas. Reports of incidents first arose in mid-March (from 18 March) and increased in line with the trend of the community outbreak. Reports of incidents have been declining since the beginning of May.

In the period up to 3 June, Health Boards reported to Health Protection Scotland (HPS) a total of 125 incidents involving COVID-19 cases outside the COVID-19 wards. Of these incidents, 120 are now classified as closed. Incidents are classified as closed by Health Boards when there is no evidence of continuing transmission taking into account possible contacts and the incubation period of the virus. Some incidents are also closed where there are sufficient isolation facilities or where COVID-19 positive patients are transferred to COVID-19 wards.

These reports constitute incidents of suspected transmission in hospitals. Because of the varying incubation period of COVID-19 it will have been the case that some patients admitted have not presented with symptoms on admission but will have already acquired the virus in the community.