Chamber and committees

It is vital for the current COVID-19 vaccination programme to reach everyone and that no one is left behind, both for individual health and our collective community wellbeing.

In order to achieve this, we have embedded inclusion as a key aspect of our national programme, working alongside Health Boards and other partners to encourage uptake, remove barriers and respond to evidence of low uptake in certain communities, including those from more deprived areas.

We have worked with Health Boards to map the locations of our vaccination clinics, ensuring that they are accessible for those in more deprived areas, and local partnerships with transport providers has supported people with free travel to appointments, if required.

Health Boards have also adapted their delivery models to ensure they are reaching communities with lower uptake. For example, mobile outreach units have been provided by the Scottish Ambulance Service (SAS) and some Health Boards have partnered with local transport providers to use their vehicles to take out into community settings. Pop-up and drop-in clinics are now being used across the country for those who are unable or unwilling to access the mass vaccination clinics. Health Boards plan the locations of these to suit the needs of their populations, and respond to evidence of lower uptake in certain areas.

The Coronavirus (COVID-19): vaccine deployment plan provides further information on our approach to delivering the vaccine to everyone in our society.

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.

Special Advisers are appointed in accordance with Part 1 of the Constitutional Reform and Governance Act 2010 by the First Minister as a Special Adviser for the purpose of providing assistance to the Scottish Ministers.

Their specific responsibilities are as follows:

The Scottish Government currently only allows travellers returning from green and amber list countries to use NHS Covid-19 tests.

These home PCR kits are sold at a fixed price and can be booked through CTM, the UK Government’s booking portal for international travel.

Wales currently also only allow use of NHS Covid-19 tests, booked through CTM and have the same fixed pricing structure as offered in Scotland.

The Scottish Government held a meeting with key stakeholders, including Scottish Swimming, on 11 August to discuss water safety.

Discussions included the provision of lessons and also water safety education.

More discussions on how to move forward are scheduled for the coming weeks.

We have reviewed the border health measures closely over the last 28 days and have assessed that there continues to be a requirement for the regulations to remain in place to reduce the risk of imported transmission and safeguard public health in Scotland. The regulations continue to be an important and proportionate part of the Scottish Government response to managing the pandemic.

The regulations will expire on 20 September 2021, and, whilst the regulations are of course subject to review, it is anticipated that restrictions imposed by the regulations will still be required at that stage. Where possible, it is my intention to lay a new instrument at that time revising and consolidating all amendments to the existing regulations since they came into force in June 2020.

By the end of July, all Health Boards had completed the audit of cases where individuals have been excluded from the cervical screening programme despite their records indicating they may have had subtotal hysterectomies before 1997. Further work was then carried out to collate and analyse the findings. By Wednesday 18 August, around 174 letters were issued by Boards to all those who have been identified as requiring to be re-instated in the programme, or to be offered a gynaecological appointment either because it is not clear from their records if the exclusion is appropriate, or because their age means they are no longer eligible for cervical screening.

In total, 484 records were reviewed. Of these:

• 204 individuals were found to have been correctly excluded and no further action is necessary.
• 39 individuals have been wrongly excluded and are still in the eligible age range for screening. These patients will be re-instated to the programme and asked to contact their GP practice to make an appointment for screening.
• 46 individuals have been wrongly excluded but are now no longer eligible for screening due to their age. These patients will be offered an appointment at a gynaecology clinic.
• 89 individuals’ records did not allow a determination to be made on the appropriateness of their exclusion. These patients will also be offered an appointment at a gynaecology clinic.
• A small number of individuals are no longer resident in Scotland. Efforts will be made to trace them, and they will be re-instated in the screening programme so that they will be invited again for screening should they return to Scotland.
• 100 individuals are now deceased. As noted in the statement given to Parliament on 24 June, a review is being carried out into the deaths of anyone who may have been excluded in error from the programme to verify whether cervical cancer was a main or contributory cause of death.

The care pathways in place for anyone written to in August are the same as for all those written to at the end of June. Jo’s Cervical Cancer Trust also continue to offer support through their helpline services. The helpline can be reached by calling 0808 802 8000 or emailing [email protected]. If anyone believes they have had a subtotal hysterectomy and therefore thinks they should have received a letter, Jo’s Trust will also be able to redirect them to a Health Board contact.

We recognise the anxiety anyone receiving a letter will almost certainly feel, and we are sorry for that. It is important to stress that the risk of developing cervical cancer is extremely low – less than 1 in 100 women will develop it in their lifetimes.

As we have stressed throughout this incident, anyone who is experiencing symptoms of cervical cancer – that is anyone experiencing unusual discharge, or bleeding after sex, between periods or after the menopause – should make an appointment with their GP practice. More information on symptoms is available on NHS Inform.

I will provide a more detailed update to Parliament on this issue after recess.

There are voluntary agreements in some parts of Scotland around the use of jet skis, including duration of use and timings. We are not aware of a specific agreement covering Wardie Bay. These agreements are not a statutory requirement.

Our natural geography brings the benefit of increased opportunity to access both freshwater and our unique coastline and we will continue to promote and ensure the safe enjoyment of Scotland’s diverse landscape.

The Scottish Government works closely with Water Safety Scotland (WSS) and other partners, including local councils, Police Scotland and Scottish Fire & Rescue Service to implement and support initiatives that can help raise awareness, this includes providing grant funding to The Royal Society for the Prevention of Accidents and the Scottish Community Safety Network to help promote a co-ordinated and preventative approach to water safety across the country.

WSS has produced a guide on Water Safety Policy in Scotland which is available online.

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, so we are unable to influence the cost of these.

Currently, we are not using private test providers for international travellers arriving into Scotland from green and amber list countries.

We are having on-going discussion with the UK government on using private test providers, particularly about the speed and reliability of the flow of data from private companies. We are keen to understand fully the key performance indicators (KPIs) that have been recently set for these companies and the process should these not be met.

Transport Scotland does not hold data on the percentage of passengers wearing face coverings while using public transport. However, ScotRail advise that the most recent observed levels indicate between an average of 80% and 90% of passengers wearing face coverings. The Confederation for Passenger Transport (CPT), who represent bus operators, advise recent observed levels indicate an average of around 80% of passengers wearing face coverings. In relation to ferries, operators have advised that they estimate that observed levels indicate around 85-95% of passengers wearing face coverings whilst using their services.

The recently observed levels do not include those who may be exempt from wearing face coverings on account of age and health conditions and so the levels of compliance with the regulations will be higher than the observed average percentages of passengers wearing face coverings.