- 19 Aug 2020
Today I want to set out work that is underway to remobilise our health services. In doing so I want to be clear about the factors that necessarily will limit our capacity to mobilise in the immediate term to the extent that we – and patients across Scotland - would wish.
But first, I want to acknowledge the incredible and selfless work of all staff in the NHS and the social care sector and offer them my heartfelt thanks and gratitude for all they have done often at great personal sacrifice - and all they continue to do.
I know that the necessary pause on NHS services in the first months of the pandemic and the experience of lockdown, especially for the 180,000 people who rigorously followed our shielding advice, whilst undoubtedly saving lives, also contributed to other harms to health.
Whilst we were on track to significantly reduce waiting times, now the numbers of people waiting for a range of tests and treatments is rising and will be added to by unexpressed demand from those who have either not felt safe to come forward or who did not want to add to the pressure on our health and care services during the peak of the pandemic.
This will be evident in mental health services as much – if not more – than in physical health. And it will be acutely felt by those who struggle with drug or alcohol addiction.
I want to see all of these services, and more, remobilised. But there are real limitations to that and I need to set these out clearly so they are recognised and understood.
In recent weeks we have seen real progress achieved in suppressing COVID-19 across Scotland. Numbers in hospital and intensive care have significantly reduced and there have been no deaths registered from confirmed virus cases since the 16th of July.
But there must be absolutely no doubt that the virus remains as virulent and as dangerous to life as it has ever been. Today we are managing a number of cases, clusters and outbreaks across the country. These are all at different stages; each one being actively managed through the exceptional work of our NHS test and protect teams led by tried, tested and highly skilled Incident Management Teams. But each one of them a clear reminder to every one of us that COVID-19 is an ever present threat.
Our aim is to vigorously suppress the virus to the lowest possible level. Full lockdown helped take us towards that. But full lockdown cannot last forever. So as restrictions are lifted we need other tools that we can use. A comprehensive set of public health measures of intelligence, anticipation, prevention, mitigation and response. No one intervention on its own will do the job we need done.
On Monday we published our updated Testing Strategy. It sets out our current priorities for testing, based on the work we have already done to increase capacity and improve availability. These priorities are: testing all those with symptoms; hunting down the virus through testing close contacts of people with Covid-19 and using testing to prevent or minimise new outbreaks; routine testing of people who work in high risk environments such as care homes. We are also using testing to ensure the safe resumption or continuation of NHS services, and, crucially, to assess the prevalence of the virus through a significant expansion in our testing for surveillance – both in our communities and in key sectors including schools and hospitals. This surveillance testing will add to our intelligence and early warning capability, critical for efforts to catch any outbreaks as early as possible, minimising wider transmission.
Our testing capacity continues to increase and we should have the ability to test 50,000 people per day by the end of August, with further contingency capacity of 15,000; taking us to around 65,000 by winter.
Today we have published on the Public Health Scotland website, the success rates of the National Contact Tracing Centre in making contact with those people testing positive and their close contacts. The new case management system (CMS) for Test and Protect began rolling out to health boards on 22nd June over a 30-day period. This report shows that, between 22 June and 16 August, 99.7% of all cases that were identified as requiring contact tracing in the case management system were successfully contacted. Based on that work, the teams also traced more than 5,000 contacts and they were successful in contacting 98.8% of those individuals. I would like to congratulate all involved in that achievement for their contribution to keeping us all safe.
As we approach winter, we plan for and deliver the seasonal vaccination programme for flu. But this winter, with COVID-19 still prevalent, the seasonal flu programme becomes even more critical. That is why we are planning a major expansion of that programme – to vaccinate just under 2.5 million people before the end of the year.
That’s 840,000 more than last year. To those already eligible we will add social care workers, NHS staff, household members of individuals who are shielding, and all those aged 55 and over, if not already eligible under another category. We will then look to vaccinate those aged 50-54 if vaccine supplies allow.
To vaccinate that number of people, across Scotland in 3 months and to do that safely with PPE and physical distancing in COVID protected environments is clearly challenging. Detailed delivery plans are being drawn up, multiple sites identified – all to be in place and staffed and ready to deliver – making it as easy to access as possible in our cities and towns and in our remote and rural communities. And knowing that we must also be ready for the COVID-19 vaccine so much effort is going in to producing and we all hope for.
Without doubt, we have reached this point in tackling the virus thanks in large measure to NHS and social care staff across Scotland.
But that has come with a cost to them. I fully recognise the impact this extraordinary period has had on their health and well-being. Health protection teams, who were amongst the first to mobilise in February, staff in primary and community care, in social care, in COVID wards and community hubs, in emergency and intensive care. In all professions and roles. And with very little respite so far this year.
Local hubs have been put in place to give members of staff the space to relax and recuperate away from their work environments.
The intensive provision of psychological support, for staff and carers will continue to be prioritised. Our National Wellbeing Hub is truly innovative, empowering staff and carers to address their physical and mental health like never before and we’ve established the new National Wellbeing Line for all health and social care workers, based within NHS 24; we’ve supported the provision of online coaching support and set up a network of 84 Wellbeing Champions across the country.
But our staff need time off, time with their families, time to recharge.
So we are working with our partners to develop a COVID-19 supplement to the Integrated Workforce Plan, with a particular focus on ensuring respite staff who have got us to where we are now.
In working to remobilise services, we must also remain alert to the need to provide and maintain safe living and working environments – whether that is in care homes, in GP practices, in assessment centres, in our hospitals and any other treatment spaces.
And we have to make sure that the necessary support is in place to respond to any future increase in COVID cases – whether that means staff training and development, securing supplies of key medicines or replenishing our PPE stockpiles.
And alongside this are the risks associated with a no deal or limited deal Brexit, where the end of the transition period lands right in the middle of flu season and may materially impact supply chains during this critical time.
So there are clear and significant operational challenges ahead. In recent years we have made significant progress under this Government’s £850 million Waiting Times Improvement Programme.
But when the waiting times for the period from March to June are published later this month, we can expect to see any progress wiped out; with a very significant increase in the numbers of patients waiting for routine appointments and treatments.
Boards have been cautiously resuming a wide range of routine services paused in the initial response and doing so in line with clinical priorities. But many will not be operating the same as before; nor in the same volumes.
The numbers of patients who can be seen, diagnosed and treated in the timeframes of before will clearly be reduced by continuing and necessary infection prevention and control measures, such as altered patient flows, appropriate bed spacing, physical distancing, PPE requirements, and time needed for additional cleaning between clinical sessions.
Early estimates are that up to 50% of operating theatre throughput could be affected in the coming months. We will augment local capacity by using national resources at NHS Golden Jubilee and NHS Louisa Jordan and there will, of course, be variation between Boards. But I want to be clear: this will have a significant impact on the time many patients have to wait for treatment.
I completely appreciate that further delays can materially affect the quality of life of many who will be waiting for care or treatment, with continuing pain and further anxiety.
I wish it was not so. And I regret that we cannot mobilise to the degree and at the speed we all wish for. But as we continue to deal with the virus and the aftermath of the first months, there is no choice. We have to continue to balance the competing demands and pressures, making the best decisions we can – none of which are easy and none of which are taken lightly.
So how do we determine what to remobilise and in what order? And how do we redesign to ensure we learn from and build on the hard-won lessons of the last few months?
What I can promise all patients, is that treatment will continue to be triaged and prioritised on the basis of clinical need, in line with advice and guidelines developed and agreed with the Royal Colleges and others.
We will be developing a National Cancer Recovery Plan to account for the changes to cancer services specifically and implement innovative solutions. This plan will be led by the National Cancer Recovery Group and published in early autumn.
The plan will focus on reducing the inequalities exacerbated by the pandemic and ensure patients are receiving treatment equally using a Once for Scotland Approach.
But there is also a need to strike a balance between urgent care and quality of life care which, if left not tackled, creates further long term problems.
So I want to repeat our commitment to resuming the full range of pain services as quickly as it is safe to do so. We will shortly publish a COVID-19 Recovery Framework for NHS Pain Management Services to continue to inform and guide our work.
This will sit alongside the Framework to Support People through Recovery and Rehabilitation I published last week and which targets work and services to better understand and help people who have been affected – often profoundly – in their physical and psychological health by their experience of the last months.
Deciding what we can remobilise, how we can build in the improvements in service delivery we have seen in recent months whilst also managing the limitations I have outlined is a continuous task. But it is informed by the experience and knowledge of all our key partners including the RCN, BMA, our trade union partners and colleagues in local authorities, Scottish Care and Integration Joint Boards; the third sector and clinical stakeholders, including the Royal Colleges.
The patient’s voice is important too and we are working with the Health and Social Care Alliance to make sure that we hear what matters most to patients.
Collectively, all of those voices feed into the Mobilisation Recovery Group, which I chair. The fourth meeting of the Group took place last week, the group has been meeting fortnightly with much detailed work in between and will continue to inform and guide our decisions.
Presiding Officer, There is much more to say and more detail to set out in the coming weeks on elective procedures, our approach to dealing with backlogs, the criticality of primary, community and social care, our plans for mental health support and more besides. As plans firm up, we will keep members fully informed.
But I want Members to be assured that learning, thought and effort is being applied nationally, regionally and locally – to give us as resilient and robust a response possible to the myriad pressures and risks we face in the coming months.