2. The marked decline in the number of deaths from Covid-19 gives us hope, but we should never forget the lives lost and the families left grieving because of the pandemic.

As we look to the future, safely restarting national health services is a national priority, but our NHS is stuck. The restart of services cannot begin unless we are sure that our hospitals are safe. We now know that there have been almost 1,800 suspected cases of hospital-acquired Covid-19. That raises questions again about personal protective equipment and testing. Families and NHS staff need answers.

We understand that a Scottish Government review group is now examining the data, but families who lost loved ones as far back as March and April feel that the process has been too slow and too secretive. For the sake of public confidence, ahead of the reopening of our NHS, will the First Minister agree to publish details of the group’s work, including its minutes and all its recommendations? Will she agree to appoint an independent chair to review that work urgently?

I absolutely agree with Richard Leonard’s first comment: we should never forget the human lives lost behind the statistics that we report on every day. Speaking personally, I never, ever will forget—every one of the numbers that I have had to read out daily will be engraved on my heart forever, and I think that that will be true for all of us.

Our NHS is not “stuck”, to use Richard Leonard’s word. It is currently preparing remobilisation plans so that it can safely, but as quickly as possible, resume services that had to be postponed—for reasons that I think that everybody understands—during the Covid crisis.

I turn to the issue of nosocomial infection, which is infection that may be acquired in hospitals. Let me be very clear about this, just as the Cabinet Secretary for Health and Sport has been very clear about it. We have published unvalidated data, and we did so in an attempt to be open and transparent about the data. As an aside, I note that no equivalent data has yet been published for any of the other United Kingdom nations.

However, it is very important that we understand the limitations of that data before it is validated. I welcome the fact that Richard Leonard used the word “suspected”, because it would be wrong to say that we know that all those infections were acquired in hospital. Many of them may well have been acquired in hospital, but it is also possible, given the incubation period for the virus, that some were acquired in the community but were diagnosed only when a patient or member of staff was in hospital. It is very important to understand that.

There is now a process under way to validate that information. NHS Scotland is working to apply the European Centre for Disease Prevention and Control international case definitions for hospital-associated Covid-19. When that work is complete and the information is validated, it will be published in a validated form. As the health secretary has said, we hope that the work will be completed by the end of this month, and the data will be published.

The nosocomial review group was established in early May. It is an expert group that is currently chaired by Professor Jacqui Riley, who is nurse director and healthcare-associated infection executive leader with NHS National Services Scotland; I think that she is an appropriate chair for that work.

The group is looking at a range of things just now, including the extension of routine testing of care home staff—as we have just been talking about—to front-line NHS staff. It will also develop further proposals and recommendations to ensure that everything possible that can be done in hospitals is being done to reduce the possibility of hospital-acquired Covid-19. We will look at what we can publish from that work and make sure that the group’s recommendations are publicly known so that we can be very clear about how they are being taken forward.

I thank the First Minister for that answer, but I know that many families and NHS staff will be disappointed that she is not prepared to consider the case for greater independent scrutiny of what has happened.

Scottish Labour first called for an NHS recovery plan five weeks ago. When we did so, we called for a guarantee of access to both testing and PPE for all NHS and care workers in every part of Scotland. I thought that the First Minister agreed to that.

Today, we have again been told that phase 2 of the easing of the lockdown is likely to start as early as next week. However, the health secretary admitted in Parliament just yesterday that there is still no plan for testing NHS staff, and still no plan to ensure the standard and supply of PPE across different NHS settings.

I have been raising workers’ concerns about PPE since March. We know that, as far back as 2018, exercise iris concluded that:

“Amongst frontline staff there is unease at the lack of clarity on PPE availability, training and testing.”

We are two years on from that planning exercise, but now the pandemic is real and that unease remains.

Staff tell me that their PPE is sub-optimal and that they are still being instructed to use PPE that is out of date, including critical equipment such as FFP3 respiratory masks. Will the First Minister give NHS and care staff a guarantee that PPE guidance and supplies will be enhanced, that out-of-date PPE will be withdrawn immediately, and that regular and routine testing will be rolled out without further delay?

The First Minister:

Those are important issues, and I will take them one by one—I will be as brief as possible, Presiding Officer.

I will start with PPE. Very clear guidance is in place across all four UK nations on the circumstances in which PPE should be used. That guidance was informed by clinical groups and expert organisations. Ultimately, it says that if any member of staff—the member of staff themselves, not Government or their bosses—risk assesses that they should be using PPE, they should use PPE.

We have also been working extremely hard to make sure that we have adequate supplies of PPE, and at no point during this crisis has Scotland run out of any pieces of PPE kit—in fact, we have been able to give mutual assistance in some respects to England. We have ensured those supplies and we are working to make sure that the distribution lines are as quick and effective as possible. We have put in place additional distribution lines—not just for healthcare workers but for social care workers. Thanks to the work that the Minister for Trade, Investment and Innovation, Ivan McKee, has been leading, we have also been building a domestic supply chain for PPE, so that we have greater resilience for the future.

To be clear on expiry dates—because we have covered the issue before on several occasions—the only circumstance in which PPE that has gone past its expiry date should be used is if it has been revalidated by the relevant authorities as being safe to use. If that has not been done, it should not be used.

All those arrangements are in place. The health secretary speaks to trade unions regularly and if any concerns are raised, they are acted on.

On testing, in his first question Richard Leonard rightly and properly asked me about the nosocomial review group. He said that it was really important that it was independent and expert led and that we listen to its recommendations. In my answer, I said that one of the pieces of work that that group is looking at right now, on which it is about to give us recommendations, is the extension of routine testing to front-line healthcare workers. However, in his second question, he seemed to think that I should disregard all of that and take the decision regardless of what the nosocomial review group says.

We will continue to take clinically and expert-led decisions, and when such decisions are taken, we will make sure that the resources and processes are in place to implement them. That is the responsible way for any Government to deal with a crisis situation such as this one. It is the approach that we have taken so far and the approach that we will continue to take.

I am bound to say that, with 10,000 tests going unused daily and with new stocks of FFP3 masks due in the next few days, it is disappointing that the First Minister cannot give a firmer guarantee.

I began by saying that safely restarting the NHS is a national priority. NHS lockdown has resulted in thousands and thousands of patients going without treatment and at least 80,000 waiting for surgery. Many are waiting anxiously and many are waiting in pain. We will need to use every available resource to get people booked in for procedures, taking social distancing measures into account and putting safety and saving lives first. People want guarantees that they are going to be treated in a Covid-free space. One resource not yet used but readily available is the £43 million NHS Louisa Jordan. Can the First Minister update us on her plans for the NHS Louisa Jordan? Will the lease be extended? If so, what role does she see it playing in easing pressure as the national health service begins to restart in the weeks ahead?

The First Minister:

I will come to the NHS Louisa Jordan in a moment, but before I do I will expand on, or close off, the first part of Richard Leonard’s question. He asked me to give a guarantee about routine testing for NHS workers, because symptomatic NHS workers already have access to testing. If the nosocomial review group recommends that, I give a guarantee that we will implement that recommendation, but we will do that on the basis of expert advice that we have asked for. I hope that Richard Leonard accepts that that is the right and responsible way to proceed on such matters.

I am delighted and relieved that, so far, we have not had to use the NHS Louisa Jordan. Had we required to do so, it would have meant that the existing capacity of our hospitals, including their surgical capacity, had been overwhelmed, which would have meant many more people becoming ill and, unfortunately and undoubtedly, many more people dying—even more than has been the case. We should all be very thankful for the fact that the hospital has not had to be used so far.

We will ensure that the NHS Louisa Jordan is there for as long as we may need it, and I can confirm that, as part of the remobilisation plans, we are considering whether and to what extent we could use the Louisa Jordan to do some elective treatments. We have to be careful in the judgments that we make about that. I fervently hope that this is not the case—and we are doing everything possible to avoid it—but if we face an autumn or winter resurgence of coronavirus, we will need to ensure that those facilities are there to deal with it. That goes for overall NHS capacity: we have to protect some capacity to deal with any surge in the virus, while getting the NHS back to normal.

The NHS Louisa Jordan is part of our considerations, and the Cabinet Secretary for Health and Sport will keep Parliament updated.