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Since the weekend of 2 and 3 May, enhanced outbreak investigations are being carried out in care homes where there has been a confirmed case of Covid-19. In such instances, all residents and staff are offered testing whether or not they are symptomatic. The enhanced outbreak investigations include other homes if that facility is part of a group or chain. As part of our surveillance work, sample testing is also done in care homes where there have been no cases.
All of that is an advance on the previous position, where symptomatic residents were tested and, from 22 April, all admissions were tested with the exception of people who had been discharged from hospital to the care home having been in hospital with the virus, in which case they would had to have given two negative tests before discharge.
The outbreak of Covid in a care home on Skye is having a tragic impact on residents and staff, and my heart goes out to all those who are affected. I commend the efforts that are being made by all who are caring for the residents.
In Parliament last week, Professor Hugh Pennington said:
“the only way we can stop problems in care homes is to stop the virus getting into them in the first place because, once it gets into them, it is out of control.”—[Official Report, Health and Sport Committee, 28 April 2020; c 9.]
The Government’s job now is to ensure that everything is done to prevent further outbreaks. There is no doubt that regular routine testing alongside adequate personal protective equipment is a key to achieving that. Imperial College London published research concluding that weekly testing for at-risk workers such as carers could reduce the spread of Covid by one third. Can the minister confirm whether the Scottish Government accepts that conclusion? If so, why is it yet to introduce regular testing even though our daily testing rates continue to fall well below the capacity that we have?
Every incident in a care home is a tragic event. Members are, of course, particularly focused on Skye after this weekend, but we have had outbreaks elsewhere. In that respect, at least, Professor Pennington is absolutely correct about the key being first to stop the virus getting into care homes, then to ensure that transmission routes inside the care home are broken. That is why on 13 March we issued clinical guidance to all care homes, requiring them to ensure that residents were looked after in their own rooms and that there was appropriate infection prevention and control, which is a requirement of their Care Inspectorate registration; and it is why we stepped in when there were difficulties, as we continue to do to ensure the supply of proper PPE. In addition, visits to care homes were stopped as they were to hospitals.
Unlike our national health service, 70 per cent of care homes are run by private providers, 20 per cent by independent providers and around 10 per cent by local authorities. Our capacity to intervene directly is therefore limited, although we have done much more of that through the instruction to directors of public health to provide the additional clinical wraparound for our care homes. That work is under way, and some of it might appear in the emergency legislation that is yet to come before Parliament.
On regular testing, where asymptomatic individuals are tested or where test results come back as negative, although there is some debate around how often to continue testing, the accepted practice—broadly speaking—is that we would test twice a week until we concluded that there was no point in continuing testing. We will continue to do that with those care home residents and care home staff. Where the results come back negative, we will nonetheless continue to keep testing so that, should a positive result appear, we are alert to it straight away and not reliant on the care home advising us and are therefore able to act.
We know that asymptomatic and pre-symptomatic people can be infectious, which is why regular routine testing is so important. The predominantly female and low-paid social care workforce deserves every protection that we can give it. We are all aware of how those dedicated staff have gone above and beyond the call of duty throughout this crisis to support those whom they care for. However, Unison tells us that the workforce is terrified about passing on the virus between patients. Regularly testing those workers would ease anxiety, reduce the spread and prevent unnecessary isolation. Testing capacity continues to go unused every day; this week alone, thousands of tests that could have been taken up have gone unused. Why is the Government so reluctant to address this issue?
I need to make two points. It is correct, as Ms Johnstone asserts, that we know that asymptomatic individuals shed virus, but the level of virus is not clear at this point. At the start of the pandemic about 130 to 140 days ago, we did not know that asymptomatic individuals shed virus; at that point, it was clear from the scientific advice that asymptomatic people did not shed virus.
Our approach to how we handle the pandemic has to be evolutionary as our understanding—based on the scientific and clinical advice that we receive and on our understanding of how the virus is progressing elsewhere in the world—is evolutionary. We understand more as we go and we change our strategy and our implementation of it as we go. I am therefore not ruling out the regular testing of health and social care staff if the advice that we receive indicates that doing that more than we are doing in care homes at the moment is the right thing to do.
In relation to Unison’s position, we of course discuss issues through our leadership group with all the unions in health and social care—I think twice a week—including the British Medical Association, the Royal College of Nursing, Unison, Unite, and GMB. I am due to have a discussion with Union this week—I think that it will be tomorrow—at which I am sure we will pick up that point.
Like Alison Johnstone, I am deeply distressed for the residents and staff at Home Farm care home on Skye. A constituent who has a relative in the home told me that she raised concerns with senior management of the company about the lack of PPE for staff, and about temporary staff being taken in from other homes without a period of isolation.
I have written to the cabinet secretary and I have submitted a written question—on behalf of another constituent—about a protocol for care homes during the pandemic, to which I have had no response. When will there be a protocol available for care homes to prevent tragedies such as the one on Skye?
I assume that the first part of Ms Grant’s question is the one that we were asked by, I think, Sky News just a couple of days ago. It is a situation that we were unaware of, because, until today, Ms Grant had not advised me of it.
In relation to Ms Grant’s other question, I think that the answer to her parliamentary question will be with her shortly. [Interruption.] If I know the details of the constituent and the question that they raised, I will be happy to pursue that.
I am not sure what Ms Grant means by “a protocol”. The guidance to care homes is really clear. That guidance is that residents should be looked after in their own rooms; that there should be no communal socialising or meal times; that visits should be stopped; and that there should be no transfer of staff from one care home to another. All of that is about breaking the transmission route. I think that that is a type of protocol, but if Ms Grant wants us to add other areas into that, I will be happy to consider including additional areas.
However, I make the point that I have made previously: many of the issues that members are raising are about private care home providers—the majority of the outbreaks are in private care homes—which, in some instances, have not appeared to follow the guidance that we require them to follow. That is why the Government is now taking a more direct intervention route in those cases.
I will provide a little clarity: there are two separate constituents. One, who has a relative in Home Farm care home, told me that she has raised her concerns with the management repeatedly and has not been heard. The management have not dealt with the situation and her relative is very sick at the moment.
I also wrote on behalf of another constituent to request a protocol and was given a holding answer. If no protocol was available, why was I given a holding answer rather than an answer?
Rhoda Grant will have an answer to her PQ. With regard to her constituent’s question and their concerns about the management in a particular care home, if she tells me which one it is, I will intervene directly with that care home and get an answer to the question that her constituent rightly raises, because the management should be dealing with those concerns.
The cabinet secretary will be well aware of the particular circumstances that Inverclyde faces—population decline, a growing older population and 15 care homes. Following the publication of two sets of data by National Records of Scotland, we now have the unenviable figure of three times the level of Covid-19 deaths than any other part of Scotland. What additional actions and resources will the cabinet secretary introduce to help to reduce the level of deaths in my constituency and provide a focus on care homes, their residents and their staff?
As I said earlier, national health service directors of public health have now been given the authority to intervene directly in care homes in their locality. That will ensure that primary care is directly engaged with those care homes. If the care home providers agree, the NHS will provide staff to ensure that the right clinical interventions are made, and to help care home staff, who might want more training on infection prevention and control. In addition, checks will be carried out on the levels of personal protective equipment and to ensure that all the guidance from 13 March onwards is being followed.
All the directors of public health in all our territorial health boards are involved in that process. They have made contact with all 1,083 care homes and are paying particular attention to, and staying in constant touch with, those care homes that have active cases to ensure that the testing that I mentioned earlier is under way, if not completed. They also need to pay attention to those care homes that do not yet have active cases, because we need to shield those homes and make sure that they have everything in place to prevent an active case in as much as that is possible. If additional measures are required in Inverclyde or any other area, the directors of public health have the authority to introduce those.
I am happy to put specific questions to the director concerned in Mr McMillan’s constituency and to ask him to provide me with additional information for the member on exactly what the board in question is doing with the care homes in the Inverclyde area .
I understand that the reactive testing in our care homes is absolutely necessary. If I understood the cabinet secretary correctly, she talked about random sampling. If random sampling is taking place in places where there are not yet any instances of Covid-19, has that produced any positive cases?
Mr Rumbles is correct. Testing is undertaken in care homes that have no active cases at this point, providing that the residents and the staff agree—in that sense, it is randomised, because not everyone agrees to it. I do not have the information to give a direct answer to the member’s question about whether any positive cases have been uncovered as a consequence, but I am happy to look out that information and to provide it to him.
However, I know that in instances in which testing is under way and individuals have initially had negative test results, repeat testing has produced positive test results. In those instances, there are two additional ways in which we can support care home providers with regard to staff: one is to ensure that, if they are content with the arrangement, NHS staff are offered to supplement the staffing rotas in a care home; the other is through the 2,200 or 2,300 returners from our exercise in March and April, all of whom have experience in social care. We have already deployed some of those returners, and others are waiting to be deployed to care homes, should care homes ask for that to happen.
I am asking this question on behalf of the families and care staff in my region who have contacted me about cases that they have been involved in, and I declare an interest, as my mum is in a care home.
From the outset, the system of testing has been one of the greatest failings of the strategy to address the crisis. When so many non-Covid hospital wards are vastly underutilised—some are empty at the moment—why are we sending elderly and vulnerable people from hospital to care homes when their Covid status has not been determined, thereby risking their wellbeing and the wellbeing of other residents and the staff?
I will say two things. First, our hospital occupancy rate is growing as the work that we have done to remind people that the NHS is open for urgent care as well as Covid care becomes more successful. Secondly, we need to keep a degree of unoccupied capacity in our hospitals, because we cannot be confident at this point that we are past the highest number of Covid cases. The reproduction number that I, the First Minister and others refer to is under 1, but the results around the number are fragile and it is not sufficiently under 1 for us to release too much capacity at this point. However, that is one of our considerations as part of the work that we are undertaking to identify whether there can be any easing of the current lockdown restrictions.
In addition, we all know that the longer a person—particularly an elderly person—stays in hospital when they no longer require the clinical treatment of that hospital, the less mobile, less able and more open to other infections they become.
The guidance that we have put in place for admissions to care homes is very clear. If the person has been in hospital for Covid, if possible, they will need to give two negative tests before discharge. If that has not been the case, if it is possible to test before admission, that should happen; otherwise, they should be admitted to the care home and isolated for 14 days, but tested on admission. The test results come back from our NHS laboratory within between 12 and 24 hours, so we know very quickly whether an individual has Covid-19. If they do not have it, the degree of isolation and barrier nursing around them can be lessened. I think that that is a well-proven way of protecting both the individual and those who are caring for them. Like all residents in a care home, the individual should not be mixing with the other residents in any respect—that was a critical part of our 13 March guidance.