The Cabinet Secretary for Health Jeane Freeman MSP has provided the following update to MPs and MSPs on the impact of the Covid-19 pandemic on Scotland’s Health & Social Care Services.
Read the letter in full (published 1st April 2020) here: Cab Sec Covid-19 letter to Holyrood Health Committee.
ICU capacity and ventilators
As you know, we set out to double our ICU capacity and to free up 3000 beds across our hospital estate. We continue to work with suppliers, and the Scottish Critical Care Network, on the supply and early delivery of additional ventilator capacity. We have ordered this equipment and additional medical devices from a range of manufacturers and continue regular contact with them to monitor delivery timelines and press for these to be met and where possible brought forward. The first of these orders has arrived and delivery will continue over the coming weeks. Alongside this equipment delivery we are carrying out the relevant training and preparation with staff.
In addition, we are participating in a joint procurement with the health services in England, Wales and Northern Ireland for further ventilators. To bridge any gaps between the estimated increase in case numbers indicated by the iterative modelling of the virus spread and the delivery timelines, rapid and effective work has been undertaken with the engagement of the Scottish Critical Care Delivery Group and the Scottish Intensive Care Society, medical physicists and clinicians to increase ventilation capacity through repurposing Anaesthetic Machines. That means that by the end of this week we will have trebled our ventilation capacity to just over 560.
This, together with our own orders, the active monitoring of delivery timelines and our 4 nation work on ventilator and other medical equipment supply, means we are moving as swiftly as we can to quadruple our ICU capacity across the country.
There are currently approximately 13,000 beds in NHS hospitals across Scotland and Board mobilisation plans which have included the temporary pause in non-urgent work including elective surgery and procedures, means we have now freed up the 3000 beds required for Covid-19 patients.
With the hard work of our IJBs across Scotland the number of beds occupied as a result of delayed discharge has reduced by 554 in March and work is underway to secure a further significant reduction over April.
We have also taken the decision as part of our contingency planning to secure the Scottish Events Campus (SEC) IN Glasgow as the site for a temporary hospital. With the support of the army and Balfour Beatty as the main contractor work has begun on the build on 31 March. The temporary hospital, NHS Louisa Jordan, will have an initial capacity of 300 beds but with the capability to expand to 1000 patients if needed. The temporary hospital should be available for use in 2 weeks and Jill Young, former Chief Executive of the Golden Jubilee Hospital at Clydebank, has been appointed Chief Executive.
Community Health and Social Care
We are mobilising our community services, with a new community pathway for Covid-19. From 23 March we have had a unique Hub and Assessment Centre pathway in Scotland.
All Boards have set up Community Hubs and Assessment Centres with Highland Hubs covering Orkney, Shetland and the Western Isles. NHS 24 has made the necessary adjustments to its systems to connect with Community Hubs.
Patients with symptoms of Covid-19 are asked to call 111. Callers to 111 will be assessed and if it is clinically required, called back by a senior clinical decision maker from their local Community Hub. If further assessment is needed patients will be asked to attend their local Assessment Centre where they will be further assessed and decisions made on the next clinically appropriate step. There are now over 40 Assessment Centres across Scotland with Health Boards continuing to plan for up to 50. These are specific to local conditions and allow safe face-to-face consultation between a clinician and members of the public referred to them by their local Hub.
In the first week the new service has worked well but further work is required to ensure Covid-19 patients are aware of the service, call 111 and not their local GP or NHS24 standard number. NHS 24 are working closely with SG to identify and implement ways to ensure resilience in their workforce through the redeployment of NHS returnees and other clinical staff.
This innovative new approach ensures both a clear, nation-wide clinical pathway for Covid-19 patients and that GPs are freed up to continue to deliver non Covid-19 healthcare to those who need it.
I am very grateful to all those who have worked hard and with pace to ensure this innovative service is established.
I am also pleased to confirm that we have released additional financial support to GPs that will allow them to continue to provide this critical service including over the Easter Weekend.
As you know there are other critical services in our primary care provision and we are providing direct financial support to these other independent contractor professions – community pharmacy, dentistry and optometry – to enhance capacity where needed and maintain critical services.
Alongside this we are actively engaged with our partners in COSLA and SOLACE in the mobilisation of social care across the country. I have agreed additional financial support which is needed by Councils, in order to meet increased social care demand and together with COSLA, we monitor on a weekly basis the increase in provision to meet demand and to ensure additional resilience. This is the work that delivered the significant reduction in delayed discharge numbers over March and continues that work into April. Alongside this we are working actively with the IJB Chief Officers to maintain existing social care packages and contribute to the ‘shielding’ work covered later.
Improved Distribution of PPE
The safety of our health and social care workforce is a priority and it is vital that workers have absolute clarity on which PPE they should wear in which setting or scenario. The latest COVID-19 PPE guidance is available on the Health Protection Scotland website and is continually updated following any changes or revisions.
We monitor our supply stock, orders and delivery timelines daily and against growing demand and I can confirm that our stock supply remains adequate at this time. Additional orders are continuously placed with the most recent being a further supply of FFP3 and IIR masks.
From the 30 March we introduced a number of additional steps to ensure the swift delivery of PPE to those who need it. We now have 4 delivery and distribution routes covering hospital, primary and community care, social care and the SAS. PPE supplies for pharmacy are delivered through the medicine distribution network.
We have a new dedicated email address for staff, MSPs or members of the public to raise specific supply issues. This is covid-19-health-PPE@gov.scot It will be monitored continuously and allow us to act to resolve any specific supply issues more quickly.
All of the supply and distribution of PPE follows the clinical guidance on what is required in which clinical situation or caring scenario. HPS and our Chief Nursing Officer have produced further clear information and info graphics which will be published this week and communicated directly with staff through a number of different platforms.
We are continuing to work alongside carer organisations to make sure carers have access to the right advice to help protect them are and their loved ones during this challenging period. We also know that some carers may require protective equipment should the person they are caring for be symptomatic of coronavirus. We are currently working to identify the most effective routes to direct them to the support they need.
The diagram in Annex A shows the supply routes for the four categories of health or social care provider.
Hospital – A Single Point of Contact (SPoC) within each health board is managing co-ordination of PPE available on site, and ordering more as required. This system appears to be working well with decision making being quicker due to having a SPoC in place. There is a daily call with the health board contact, National Procurement and Scottish Government where issues can be raised.
Primary Care – Currently GPs contact their local Health Board SPoC to order more PPE or arrange delivery of orders. To supplement this, a new supply route is being set up to do a proactive delivery of 8 weeks’ worth of stock to each GP practice. This will be delivered to 8 hub locations, and then direct deliveries to c. 1,000 GP practices. This will begin on Monday and all deliveries will be complete by 3 April.
Social Care supply – A social care triage hub has now been operational for one week, and this is being scaled up to improve delivery to social care providers. A range of measures have been put in place from 26 March including, additional pickers to prepare orders and additional drivers in both volume and extended delivery hours.
Alongside boosting capacity within the social care triage hub, a proactive approach is being developed in parallel. This will be deliveries of PPE to local cluster points for onward distribution or collection by social care providers. This will be in place from week commencing 30 March. The supplies will be accessible to all Care Inspectorate registered social care providers, unpaid carers, personal assistants, non-registered services providing a social care support service with roles that have a need for PPE, and hospices. There will be up to 70 cluster points across the country – these are being identified and may be schools, community centres, or other appropriate locations.
The SSSC and NES have developed a core PPE training package for social care for those who are being redeployed to care roles, and for volunteers.
Scottish Ambulance Service supply – Deliveries are made direct from National Procurement to two agreed locations in the central belt which a SAS SPoC manages. This process has not changed from the previous approach and has continued to strengthen as it beds in.
Testing for key workers
Health and social care staff are on the frontline of our response and it is vital that they know whether they, or someone they live with, has the virus, or if they are healthy and able to return to work. We welcome the new UK Government programme with industry, charities and universities to increase testing capacity for health workers and we are working closely with the UK Government to support implementation, including from a site in Glasgow, so that the new tests can be introduced as quickly as possible in Scotland.
In the next few weeks we expect to increase the volume of key workers who can benefit. We are working with Health Protection Scotland and National Services Scotland to rapidly increase our NHS laboratory capacity in Scotland. This has now increased to around 1900 test capacity daily and will continue to increase to around 3400 at the end of April. Consideration is also being given to additional capacity from our academic institutions and the private sector.
Guidance has been published for the NHS to support the use of the testing capacity in laboratories, in so far as it is not needed for essential care, in order to enable health and social care staff to be back at work when that is safe. Boards are being asked to prioritise testing the symptomatic household members of health and social care staff who are not experiencing symptoms themselves, but are in isolation because of those household members.
As our testing capacity increases we will be able to extend our testing of key workers incrementally.
The health professional regulators with emergency registration powers have written to experienced professionals who left their registers in good standing in the past three years. We have appeared to those whose contact details may have changed since they left a register to get in touch with their regulator – further information is available on their websites.
NHS Accelerated Recruitment Portal
Working with NHS Education for Scotland, a new Health and Social Care Covid19 Accelerated Recruitment Portal has been created, accessible through the NHS Careers website. This will facilitate emergency registrants across professional groups to provide their details. The portal went live 29th March 2020.
The portal is the gateway to accelerated employment across health and social care. It will enable those with relevant skills and experience to come forward and support health and social care services at this time of national emergency. It will support applications from returners and students to priority areas in health and social care across acute, primary, community and social care settings, and applies to those who are registered, whose registration has lapsed, or who are enrolled on a healthcare profession qualification with a university or a college. Applicants will provide information on location, sector (health or social care), skills and any previous experience.
Where local recruitment discussions are already underway for returners, those processes already started will continue to completion. However, all undergraduate students will be directed to the Portal. To create a robust single set of data, all future applicants will be routed through the Portal. Any and all future campaigns for returners and students from across all Health and social care disciplines will clearly direct applicants towards the Accelerated Recruitment Portal.
Deployment within health and social care will be handled at local level, though consistent with service and workforce priorities associated with Covid19, as identified and communicated through the Scottish Government. NHS Education for Scotland will employ returnees and students deployed to NHS Boards. Students will be employed for a maximum of 6 months initially, dependent on when they will be ready to apply for normal registration. The Scottish Social Services Council (SSSC) will work with key partners to oversee employment and placement across social care organisations.
NHS staff – terms and conditions
The Scottish Government is working closely with NHS Scotland Employer and Staff Side representatives to ensure that the service has the terms and conditions flexibility it needs to respond to the current crisis. Staff have full access to enhanced overtime pay and all staff working for NHS Scotland who are sick due to COVID-19, irrespective of their length of service, will receive sick leave on full pay until they have recovered from their illness for as long as they are contracted to NHS Scotland. We continue to engage with employers and staff side organisations on a daily basis to identify how we can support our staff throughout this challenging time.
Death in Service for Locums
We have committed to offering a death in service benefit to those NHS Board and Special Health Board employees on permanent or fixed term contracts who are not in the NHS Pension Scheme, and therefore are not covered by these provisions. Officials are working on the detail of this, but the benefit will be similar to that which is available to pension scheme members, equivalent to a payment of 2 x pensionable pay. If needed, the benefit can be applied retrospectively. Locum and bank staff will be encouraged to take a fixed term contract to allow access to this benefit
Indemnity for clinicians at HUBs/CACs
The Clinical Negligence and Other Risk Indemnity Scheme (CNORIS) will, under the powers provided by the Coronavirus Act, cover all persons providing care or treatment to those who have or are suspected of having the coronavirus (whether or not in respect of that disease), to those who have been, or are suspected of being, infected or contaminated with the coronavirus, as well as diagnosing or determining whether a person has been infected or contaminated.
Cover will also be provided to persons who are providing diagnosis, care or treatment in consequence of another person who usually provides such a service being unable to do so in consequence of providing the above services or for other reasons relating to coronavirus.
GPs working in the new COVID Community Hubs and COVID assessment centres will be covered by CNORIS for their service in the hub and assessment centres.
Placing of current medical students in the NHS workforce
Pre-registration nursing and midwifery students have been sent an open letter by the Chief Nursing Officer inviting all, apart from first year students, to register with the NHS Education for Scotland (NES) Health and Social Care COVID-19 Accelerated Recruitment Portal : https://www.careers.nhs.scot/coronavirus-covid-19-recruitment/ The students will be paid according to the work that they do, and will continue to receive the nursing and midwifery student bursary.
The Chief Medical Officer is also writing to all medical students to encourage them to register their expressions of interest with the NES Portal to apply for roles to bolster the healthcare workforce. Those students who are in their final year of study and who are about to graduate/have graduated are being encouraged to seek provisional registration from the GMC and then to apply for interim Foundation posts within Boards through the portal.
Those students who wish to volunteer their skills, knowledge and expertise but who are either further away from graduation or who do not wish an interim Foundation post have been asked to register to apply for other roles, such as Healthcare Support Workers. However, there is no compulsion to apply for roles – and any roles will not form part of their formal training although they will be paid employment for the duration.
NES is co-ordinating work with all NHS Boards and private sector health care organisations to ensure that students (and returnees who register through the portal) are suitably placed to address local needs and the national priorities. Our priority remains ensuring frontline workforce resilience and safety on the clear understanding that there are posts into which those who register can be safely and effectively deployed to both ensure their welfare and ensure patient safety. Nobody will be asked to undertake a role which is beyond the level of their competence
NHS car parking and television charges
I recognise the importance of NHS staff getting to and from work as easily as possible during this extremely challenging period. I have therefore removed all car parking charges at the three PFI car parks in Ninewells, Edinburgh Royal Infirmary and Glasgow Royal Infirmary over the next three month for staff, patients and visitors.
I also acknowledge that being in hospital can be a lonely time, and even more so when visits are significantly restricted. On Friday 27 March, free access to all 3,400 terminals across six hospitals with a contract with Hospedia entertainment services was agreed for the next three months.
The six hospitals benefitting from this arrangement are Raigmore, Crosshouse, University Hospital Ayr, Aberdeen Royal, Edinburgh Royal and Monklands. All other hospitals will continue with existing TV arrangements which will continue to be provided free of charge.
Shielding and contact with those at greatest risk
The UK Chief Medical Officers have identified six conditions which place people at the highest risk from covid-19 and these people have been asked to stringently self-isolate for 12 weeks. These are conditions such as specific forms of cancer, severe respiratory conditions, rare diseases which leave a person vulnerable to infection, people who have received solid organ transplants, are on immunosuppression therapies or women who are pregnant and have congenital heart disease. It is estimated that there are 150,000 – 200,000 people in these groups and letters are being issued to them to advise them of the steps that they should take to keep themselves safe. Over 90,000 letters have issued so far and the vast majority of letters will have been issued by today. There are smaller groups, such as those with a specific rare disease or on immuno suppression therapies, which are requiring us to work with clinical networks to correctly identify those affected; we do not want to write to people or include people who do not need to undertake such stringent shielding measures. Therefore some of these smaller groups are taking longer to work through and we expect this to be completed by Tuesday 7 April at the very latest.
The letter also offers further advice and support, to ensure that those who are self-isolating have access to the grocery and medicines supplies that they need. A mechanism has been established for that through text messaging or local phone line service to request assistance. For those who may not have internet or mobile phone provision, this can be accessed through their local authority. These ‘shielding’ measures are designed to support people in these groups to self-isolate, to protect them from serious illness as well as taking pressure off the NHS providing the most acute care. We are working closely with Local Resilience Partnerships and other partners to deliver this support and to ensure the people who need it have the appropriate support they require. We will be sending a further letter to those identified with further information about the support being offered, including details of the shielding support phone numbers for each local authority. We have also provided funding to Age Scotland to enhance their ability to support and signpost older people via their Helpline (0800 12 44 222).
Infection control and clinical guidance for care homes and care at home services
Health Protection Scotland published updated infection control guidance for Social or Community Care & Residential Settings on 26 March.
In addition the Chief Medical Officer, Chief Nursing Officer and Chief Social Work adviser issued a letter on 26 March about clinical care guidance for social care settings which should be read in conjunction with the HPS guidance above. The letter also covers:
- Updated Guidance for Nursing Home and Residential Care Residents – updated to take account of further advice from HPS on visiting and care home admissions:
- Guidance on Care at Home, Housing Support and Sheltered Housing:
We are also looking to provide support for mental health in this difficult period. Advice on supporting wellbeing during the current restrictions is now available on the NHS Inform website and is being widely promoted by partner bodies.
Last week, the First Minister also announced a significant injection of funding to develop mental health services in response to current demands. A further £3.8 million is being provided to begin to increase the capacity of NHS 24’s telephone and online services.
This includes £2.6 million to expand the NHS 24 Mental Health Hub and Breathing Space telephone helpline and web support service; and £1.2 million to provide extra capacity for Computerised Cognitive Behavioural Therapy. NHS 24 are gearing up recruitment over coming weeks to enable the Mental Health Hub to operate 24 hours a day, 7 days a week. The capacity of Breathing Space will be expanded, providing those who struggling with their worries support to talk them through.