Publication - Strategy/plan

Coronavirus (COVID-19): allocation of levels to local authorities - 24 November 2020

Published: 24 Nov 2020

Outcome of the 3rd review of the allocation of levels to local authorities, alongside evidence and analysis informing these decisions.

Published:
24 Nov 2020
Coronavirus (COVID-19): allocation of levels to local authorities - 24 November 2020

Purpose

This document sets out the outcome of the third review of the allocation of levels to local authorities published (Annex A). It also sets out in summary form the reasons for changes in allocation.

An evidence paper setting out the data and analysis supporting these decisions has also been published.

See: Coronavirus (COVID-19): protection level reviews and evidence to ensure you are viewing the most up-to-date review information.

Decision-making process

On 29 October 2020, as part of Scotland’s Strategic Framework, we published the initial allocation of levels to local authorities. These allocations came into effect on 2 November 2020.

The allocation document makes clear that decisions have to be based firmly on the best available evidence, assessed through a process that is open, transparent and collaborative and frequently reviewed so that restrictions are not kept in place longer than is strictly necessary to achieve the aim of suppressing the virus.

The allocations are reviewed weekly and this document sets out the outcome of the third review. 

In line with the process set out in the allocations document, the National Incident Management Team (NIMT), chaired by Public Health Scotland and including representatives from local government as observers, met to discuss the latest analysis of data, which had been agreed with local partners including Directors of Public Health. The NIMT then provided advice to a group made up of the Scottish Government’s chief advisers and lead officials representing the “four harms” and observers from local government. This group helped form recommendations for Ministers on allocation of levels, which were discussed with the relevant local authorities, and then agreed by the Scottish Cabinet on 24 November 2020.

The critical indicators which inform the allocation of levels are:

a) the number of cases per 100,000 people over the past seven days

b) the percentage of tests that are positive over the past seven days

c) forecasts of the number of cases per 100,000 consisting of the weekly number of cases in two weeks’ time

d) current and projected future use of local hospital beds, compared with capacity

e) current and projected future use of intensive care beds, compared with capacity

The previous review on 17 November 2020 included a presentational change in how measures (d) and (e), relating to forecasts on NHS capacity, are reported in the section: local authority: allocation of level to each area and summary of indicators

The purpose of the hospital and ICU projections is to give early indications of concern.  Clearly any projection which shows that capacity will be exceeded would be of concern, however projections that show that capacity will be breached in 2 or 3 weeks would raise more urgent concerns. As such, the outputs from the indicators shown in the Local Authority tables are shown as “very high” where the projections show a breach of capacity within 2 weeks for ICU or 3 weeks for Covid hospital beds; “high” where the projections show a breach of capacity within 3 weeks for ICU or 4 weeks for Covid hospital beds; “of concern” where the projections show a breach of capacity within 4 or 5 weeks for ICU or 5 or 6 weeks for Covid hospital beds; and “low” if the projections don’t breach capacity within this time period.

The status of these indicators, including relevant trends for each local authority, is  set out in the accompanying evidence paper.  The data themselves do not determine the relevant level of any local authority, and they are considered alongside local intelligence and other local, regional and national factors.  As Scotland’s Strategic Framework  (p.23) says: 'These decisions require judgement to be applied to all the facts and considerations relevant at the time they are made, and in relation to the area directly affected and for Scotland as a whole.'

Summary of review

In announcing the initial allocation of levels to local authorities to Parliament on 29 October, the First Minister made it clear that the Scottish Government was taking a deliberately cautious approach.  This was not only to reflect the fact that we were introducing a new framework for the first time, but also the fragility of the situation we were facing. 

Eleven local authority areas moved to level 4 on 20 November. It is too early to make any judgements on the impact of that move.  In recognition of the considerable restrictions involved in level 4 protective measures, the position for these areas will be monitored particularly closely  as part of the weekly review process.

There is a significantly improved picture across Scotland with regard to projected pressures on NHS capacity.  Every local authority is now showing “low concern” for projected use of hospital and intensive care beds.  This is excellent progress, and it is vital that this is maintained if we are to meet the challenges of the winter season.

While there has been improvement in some areas, progress on prevalence is still slow.  The situation remains fragile with - as yet - no sustained evidence that we are changing the course of the pandemic. 

The specific outcome of this week’s  review is that no additional changes were recommended for this week. We have seen some areas improve, some remain broadly static and some showing signs of deterioration. For those local authorities in those latter two categories in particular we will continue to monitor very closely on a weekly basis, discussing the situation in depth with the local Director of Public Health and with the NIMT. The next scheduled review will be on  1 December.  We reserve the right to bring that forward for any one or more local authority as the situation requires.

The previous review recommended that Midlothian and East Lothian should move to level 2 on 24 November if the position there did not deteriorate.  This review confirmed that the move to level 2  for East Lothian should proceed. However since the last review there has been a concerning rise in both cases and test positivity in Midlothian.  Consequently the clinical and public health advise was that  it would not be appropriate to move Midlothian to level 2 at this point in time.  This will continue to be reviewed as part of the weekly process, and we will engage closely with the local authority on their plans to reverse this increase.

We remain confident that with local authorities allocated to the appropriate level, the measures in place within the levels will impact positively on the course of the pandemic. That, however may take some time. So while the decisions set out in this document are justified, necessary and proportionate for each local authority, the overall national impact of the measures has also to be considered as part of that assessment. That means that local authorities will not move down levels until there is sustained evidence of improvement, but may require to move up levels quickly in the event of a worsening position to mitigate the risk of deterioration and associated harms.

Local authority: allocation of level to each area and summary of indicators

 

Local authority*

Cases / 100k

Test Positivity

Cases / 100k forecast

Hospital forecast

ICU forecast

Present level

New Level

East Ayrshire

M

H

M

L

L

4

4

North Ayrshire

M

M

L

L

L

3

3

South Ayrshire

M

H

M

L

L

4

4

Scottish Borders

L

M

L

L

L

2

2

Dumfries and Galloway

L

L

VL

L

L

2

2

Fife

M

H

M

              L

L

3

3

Clackmannanshire

M

H

L

L

L

3

3

Falkirk

M

M

L

L

L

3

3

Stirling

H

M

M

L

L

4

4

Moray

VL

VL

VL

L

L

1

1

Aberdeen City

L

M

VL

L

L

2

2

Aberdeenshire

L

M

VL

L

L

2

2

East Renfrewshire

H

H

M

L

L

4

4

Inverclyde

M

M

M

L

L

3

3

Renfrewshire

H

H

M

L

L

4

4

West Dunbartonshire

M

H

M

L

L

4

4

East Dunbartonshire

H

H

M

L

L

4

4

Glasgow City

H

H

M

L

L

4

4

Highland

VL

VL

VL

L

L

1

1

Argyll and Bute

L

L

VL

L

L

2

2

South Lanarkshire

H

H

M

L

L

4

4

North Lanarkshire

H

VH

M

L

L

4

4

East Lothian

L

M

VL

L

L

2

2

Midlothian

M

H

VL

L

L

3

3

City of Edinburgh

M

H

L

L

L

3

3

West Lothian

H

H

L

L

L

4

4

Orkney Islands

VL

VL

VL

L

L

1

1

Shetland Islands

VL

VL

VL

L

L

1

1

Angus

M

M

M

L

L

3

3

Dundee City

M

H

L

L

L

3

3

Perth and Kinross

M

H

M

L

L

3

3

Na h-Eileanan Siar

      VL

VL

VL

L

L

1

1

*Ordered by health board

VL = very low
L = low
M = moderate
H = high
VH = very high

Summary of reasons for allocation of level

The following table sets out summary information only. Further data is contained in the supporting evidence paper. Broader information, including at the local level by the National Incident Management Team, has also been considered in reaching these allocation decisions.

Local authority

level

Summary of reasons for change in allocation of level

Aberdeen City

2

  • the sharp rise in cases observed last week appears to have stabilised over the past week but we will continue to monitor this
  • allocation unchanged

Aberdeenshire

2

  • there is some evidence that the rise in case numbers and positivity rates is slowing.
  • this will continue to be monitored closely over coming days
  • allocation unchanged

Angus

3

  • too early to say if move to level 3 has had desired effect but early signs suggest stabilising of numbers
  • allocation unchanged

Argyll and Bute

2

  • previous decreases in case numbers and positivity rates appear to have slowed
  • allocation unchanged but if positive trends continue may be considered for level 1 at next review

Borders

2

  • no consistent change
  • allocation unchanged

Clackmannanshire

3

  • some significant increases in case numbers and positivity rates over the last week
  • this will continue to be monitored closely over coming days
  • allocation unchanged

Comhairle Nan Eilean Siar

1

  • numbers continue to be low and will be monitored to see if recent changes to indoor socialising rules have any impact
  • allocation unchanged

Dumfries and Galloway

2

  • improvements in case numbers and positivity rates over the last week   
  • allocation unchanged

Dundee City

3

  • no sustained improvement in last week
  • allocation unchanged

East Ayrshire

4

  • some improvement in case numbers and test positivity
  • improved projections on NHS capacity
  • allocation unchanged

East Dunbartonshire

4

  • some improvement in case numbers and test positivity
  • improved projections on NHS capacity
  • allocation unchanged

East Lothian

2

  • some evidence of slowing improvement on case numbers, although these remain low compared to national average
  • some increase in test positivity rates
  • East Lothian to move to level 2

East Renfrewshire

4

  • Some slow improvement in case numbers and test positivity
  • improved projections on NHS capacity
  • allocation unchanged

Edinburgh

3

  • some evidence that improvement in cases and test positivity may be plateauing
  • allocation unchanged

Falkirk

3

  • no sustained improvement in last week
  • improved projections on NHS capacity
  • allocation unchanged

Fife

3

  • no sustained improvement in last week
  • allocation unchanged

Glasgow

4

  • improvements in case numbers and test positivity over the last week
  • improved projections on NHS capacity
  • allocation unchanged

Highland

1

  • cases remain low
  • allocation unchanged

Inverclyde

3

  • cases and test positivity decreasing over last week
  • improved projections on NHS capacity
  • allocation unchanged

Midlothian

3

  • Increase in case numbers and test positivity in last week
  • In view of these increases it was not appropriate to move Midlothian to level 2 as indicated in the last review
  • Midlothian to remain in level 3

Moray

1

  • cases remain low
  • allocation unchanged

North Ayrshire

3

  • some improvement in case numbers and test positivity over the last week
  • improved projections on NHS capacity
  • allocation unchanged

North Lanarkshire

4

  • cases and test positivity decreasing, but very slowly, both remain significantly higher than the national average
  • improved projections on NHS capacity
  • allocation unchanged

Orkney

1

  • numbers continue to be low and will be monitored to see if recent changes to indoor socialising rules have any impact
  • allocation unchanged

Perth and Kinross

3

  • Case numbers and test positivity have increased over the past week
  • allocation unchanged

Renfrewshire

4

  • no sustained improvement in case numbers or test positivity in last week
  • improved projections on NHS capacity
  • allocation unchanged

Shetland

1

  • numbers continue to be low and will be monitored to see if recent changes to indoor socialising rules have any impact
  • allocation unchanged

South Ayrshire

4

  • no sustained improvement in last week
  • improved projections on NHS capacity
  • allocation unchanged

South Lanarkshire

4

  • cases and test positivity decreasing, but slowly
  • improved projections on NHS capacity
  • allocation unchanged

Stirling

4

  • increases in case numbers over last week but improved test positivity
  • improved projections on NHS capacity
  • allocation unchanged

West Dunbartonshire

4

  • some improvement in case numbers and test positivity in the last week
  • improved projections on NHS capacity
  • allocation unchanged

West Lothian

4

  • no sustained improvement in case numbers or test positivity over the last week
  • improved projections on NHS capacity
  • allocation unchanged

Evidence paper