4. To ask the Scottish Government what its response is to research by the University of Edinburgh suggesting that more than half of severe Covid-19 cases were as a result of transmission in hospital during the second wave of the pandemic. (S5O-05149)

The research study makes an important contribution to our consideration of all those matters. However, it is limited in that it uses a wider nosocomial definition than has been agreed internationally. That extended timeframe overestimates nosocomial Covid-19 from the “indeterminate” category. That reduces the opportunities that we have to identify areas for improvement.

However, it is an important piece of work and it adds to our overall knowledge of nosocomial infection and the additional steps that we need to take on top of those that we have already taken to reduce it as far as possible.

As we remobilise the national health service from the grip of the pandemic, can the Cabinet secretary explain how the Government will prevent it from happening again?

In answering that question, I need to add a touch of realism about things happening again. As one of the report authors notes,

“The reality is that there are a number of constraints on the ability to have complete infection protection in hospital settings. The reasons for that are multifactorial and complex. One is the built environment. Some of the older hospitals do not have a lot of single rooms.”

We need to be careful in comparing wave one and wave two, given that, in wave two, we were dealing with a virus strain that was significantly more infectious than the strain that we were dealing with in wave one.

All that said, however, a number of additional steps have been taken on top of the world-renowned Scottish patient safety programme. There is additional personal protective equipment. There is now testing of all admissions to hospital settings from emergency right through to planned, including maternity. Testing of our patient-facing staff is now extended to other NHS staff, as well as social care staff. There is also, of course, the constant monitoring that our clinical advisers do, led by our chief nursing officer. The nosocomial group brings in additional academic and clinical experts to identify from looking internationally and elsewhere in the UK whether there is more that we can do, in addition to the steps that I have already outlined.

Hospital transmission of Covid-19 remains an issue, with data for the week of 28 February showing at least a further 30 cases. Staff have been raising their concerns for several months now, and the Scottish Government needs to safeguard staff. What is being done to ensure that enhanced PPE is being provided?

Presiding Officer, I take this opportunity to wish the Cabinet secretary well in her retirement and thank her for her co-operation over the years.

My thanks go to Ms Baillie for those kind words.

She is right. Nosocomial infection of any virus in a hospital setting and in other institutional settings is really important. We have listened carefully to what staff have said to us about PPE. Our clinical advisers continue to look at the issue to see whether more can be done about the PPE that staff are clinically advised to use.

In a recent communication with staff, we have also stressed the importance of individual staff members undertaking their own assessment of the risk that they believe that they face and exercising their professional judgment. Guidance is important, as is the provision of PPE. At this point, I record my thanks to the NHS’s procurement exercise that ensured that we never ran out of PPE at any point during the pandemic. However, it is important to leave room around the guidance for the professionals to make their own judgment and for management to enable that clinical judgment. When there are difficulties with that, I am happy to intervene and ensure that professional judgment takes first place.