3. Phased approach to varying restrictions
This route map takes an evidence-led and transparent approach to easing restrictions and sets out a phased approach towards the future. This will inevitably be a future which will not just pick up where we were before this pandemic but will be marked by the experiences we have been through. As we move forward over the coming months we will recognise that the impact of the virus has not been the same for everyone, although everyone has been affected. We will take an approach that takes us steadily towards the objectives and outcomes set out in the National Performance Framework.
The route map provides an indication of the order in which we will carefully and gradually seek to lift current restrictions, but does not attempt to specify dates for all of the different phases. Rather as we move beyond the first phase, future phases will be based on meeting particular criteria, including those set by the World Health Organisation (WHO).
We will continue to take a cautious approach that ensures that the virus remains suppressed, while seeking to restore as much normality as possible when it is safe to do so. We will continue to hold reviews every three weeks as a minimum, to ensure we are on track and to assess whether we can accelerate or need to decelerate elements within each phase.
The Annex provides a table setting out five phases ranging from Lockdown to Phase 4 - when the virus ceases to be a significant issue, though the need for some physical distancing and hygiene measures may remain for some time. The phases contain practical examples of what people, organisations and businesses can expect to see change over time. They also show some of the things that won't change for some time to come, such as the need for enhanced public health measures.
The examples set out in this table provide broad descriptions or examples of the types of changes we will make. They will be refined and augmented over time, including through additional guidance for people and sectors.
Our steps will be careful, gradual and incremental. Businesses, public services and the third sector will need time to plan and to prepare workplaces, processes, supply chains and logistics in order to introduce any changes safely and effectively. In doing so, they must recognise the importance of the role of trades unions and of undertaking risk assessments of workplaces conducted with staff and health and safety representatives. Communities, households and individuals will also need to adapt.
Our plans will need to include assessments of the steps needed to reverse each option should that prove justified, necessary and proportionate.
Conditionality and criteria for moving between phases
We will use clear criteria to move between phases as we ease the restrictions that have been put in place. Every three weeks, we will review and report on whether and to what extent we can move from one phase to another. It may be that not everything currently listed in a single phase will happen at the same time. It might be possible to lift some measures more quickly while some may take longer than we envisage now. A single phase may also span more than one review period.
To progress from Phase 0 to Phase 1, we will need to have seen evidence of transmission being controlled. This would include the R number being below 1 for at least 3 weeks and the number of infectious cases starting to decline. Evidence of transmission being controlled would also include a sustained fall in supplementary measures including new infections, hospital admissions, ICU admissions, and deaths of at least 3 weeks (WHO Criterion 1 – see Box 2 ).
Assuming no regression in our progress so far, we believe these conditions will allow a move into Phase 1 from 28 May. Our Test and Protect system will be in place at the end of May to support a move to Phase 1.
To progress from Phase 1 to Phase 2, we would need to have seen the R number consistently below 1 and the number of infectious cases showing a sustained decline. The WHO six criteria for easing restrictions must also be met. (We will work closely with the UK Government to ensure that the fifth criterion is met.)
Box 2: World Health Organisation: Six key criteria for easing restrictions
1. Evidence shows that COVID-19 transmission is controlled.
2. Sufficient public health and health system capacities are in place to identify, isolate, test and treat all cases, and to trace and quarantine contacts.
3. Outbreak risks are minimized in high vulnerability settings, such as long-term care facilities (i.e. nursing homes, rehabilitative and mental health centres) and congregate settings.
4. Preventive measures are established in workplaces, with physical distancing, handwashing facilities and respiratory etiquette in place, and potentially thermal monitoring.
5. Manage the risk of exporting and importing cases from communities with high-risks of transmission.
6. Communities have a voice, are informed, engaged and participatory in the transition.
To progress from Phase 2 to Phase 3, the WHO six criteria must continue to be met. In addition, R would require to be consistently below 1 and there must be a further sustained decline in infectious cases.
Progressing from Phase 3 to Phase 4 (the final phase in our transition), the virus must effectively have ceased to be a significant issue in Scotland. That might be because, for example, an effective vaccine had been developed and used on sufficient scale in Scotland and/or we have an effective treatment available across Scotland that essentially removed the health risk from the virus and/or transmission is so low that we are confident that the virus can be controlled without the restrictions of Phase 3.
As noted, a resurgence of cases may mean that we have to tighten restrictions again, potentially reversing back through the phases and their associated packages of restrictions. We are not planning for this to happen but will respond if necessary.
As part of our collective Four Nations approach, in time we may decide to make use of the assessments made by the Joint Biosecurity Centre that was recently announced by the UK Government to inform moving between phases. Scottish Ministers will retain decision-making over any formal movement between levels for Scotland and the associated package of responses required in moving to a new level.
Within Scotland, we are keeping an open mind on the potential for regional variation as we move through the phases of the route map, if that best meets the particular circumstances and needs of the geographies concerned. We would engage with the local communities concerned before taking any geographically differentiated approach to changing restrictions.
NHS capacity and monitoring
We have demonstrated during the Lockdown phase of the pandemic our ability to mobilise extra hospital and Intensive Care Unit (ICU) capacity across our country – precisely to stop the health system being overwhelmed. We will need to retain that ability, in the event of any second peak, and, crucially, ensure that our public health capacity – in particular, to Test and Protect – is mobilised and able to cope with the level of transmission in the forthcoming phases.
And at each one of these careful, gradual, and incremental phases we will monitor the impact of the transmission of the virus. As set out above, we monitor that on a daily basis on core national surveillance measures of cases, hospitalisations, ICU numbers and deaths. We will continue to monitor these core national measures. National surveillance will also continue to include our ongoing assessment of the reproduction rate of the virus – R – and, importantly, our estimates of the numbers of infectious people in the population and the daily number of new cases. Getting this latter measure as low as possible is important for maximising the effectiveness of our Test and Protect approach.
The Five Phases
This section sets out what people can expect in the five phases as we transition out of lockdown towards exit from the crisis. We know that our understanding of the epidemic and our responses to it will develop over time as we progress along the 'infection curve', consequently we will need to continue to ensure that the packages of measures in each phase remain appropriate.
The following descriptions of the measures and changes in each of the phases is therefore valid only at the point at which this document was published. However, the route map is intended to be a dynamic, living document and so readers will need to check on-line for the latest version. And it is intended to be consultative, reflecting our ongoing conversation with the people of Scotland about our response to the crisis.
If people, organisations or businesses tell us that something in the route map, or the phasing, does not look right – and this is both complex and uncertain territory – then we will listen and consider whether any change to our plans is appropriate.
We begin in the Lockdown phase that is currently in place. We set out in the update to the Framework to Decision-Making the various rules and restrictions, some set in guidance and some in regulation, that are working effectively during this phase to reduce the virus.
Please note that in each of the following phases, the rules of the previous phase continue to apply unless stated otherwise.
The description of the phases is summary rather than comprehensive: it will not include every aspect of the restrictions that is of concern.
And the location of changes within the phases is liable to vary as the evidence develops, for example, about the progression of the epidemic – and therefore what is safe to introduce at a given point in time – and about the impact of the changes themselves.
We are set to move to Phase 1 following the 28 May end-of-cycle review of the COVID-19 regulations, if the evidence supports that. In Phase 1, the virus would not be fully contained. There is a continued risk of overwhelming NHS capacity without significant restrictions remaining in place. To progress to Phase 1, R must have been below 1 for at least 2 weeks and the number of infectious cases starting to decline. There should also be a sustained reduction in new infections, hospital admissions, ICU admissions, deaths (WHO Criterion 1). Test and Protect capacity will be ramped up, with staff being recruited and digital systems being designed.
During Phase 1 a number of changes to the rules would be made – potentially over more than one review cycle (after 28 May, the next review cycle concludes on 18 June). Some of these changes would be to guidance and some to regulations. In addition, a number of public services that had either been paused or scaled back because of the crisis would now be resumed or expanded. The rules set out in the previous (Lockdown) phase apply except as set out below.
Seeing family and friends: We are planning in this phase to change regulations to permit people to use public outdoor spaces for recreational purposes, for example to sit in a public space. We are also planning for one household to meet up with another household outdoors, in small numbers, including in gardens, but with physical distancing required.
Getting around: Consistent with the reopening of workplaces set out in this phase, where home working is not possible businesses and organisations are encouraged to manage travel demand through staggered start times and flexible working patterns.
You will also be permitted to travel short distances for outdoor leisure and exercise but advice to stay within a short distance of your local community and travel by walk, wheel and cycle where possible.
International border health measures are set to be introduced.
Schools, childcare and other educational settings: We are planning in this phase to change guidance so that staff can return to schools and for an increased number of children to access critical childcare provision including the re-opening of child minding services and fully outdoor nursery provision. We are planning to make support available to pupils at key transition points, e.g. those due to start P1 or S1 where possible.
Working or running a business: In this phase we are planning for remote working to remain the default position for those who can.
For those workplaces that are reopening, employers should encourage staggered start times and flexible working.
We are also planning for outdoor workplaces to resume with physical distancing measures in place once guidance is agreed.
We are also planning for the construction sector to implement the first two phases in its restart plan with a decision to move to 'phase 2' of the construction sector's plan only after consulting with government to ensure it is safe to do so and in line with public health advice.
Preparing for the safe reopening of the housing market.
Workplaces resuming in the following phases can undertake preparatory work on physical distancing and hygiene measures in this phase.
Shopping, eating and drinking out: In this phase we are planning the gradual opening of drive through food outlets as well as the re-opening of garden centres and plant nurseries with physical distancing. Associated cafes (e.g. in garden centres) should not reopen at this stage except for take away.
Sport, culture and leisure activities: In this phase we are planning to allow unrestricted outdoors exercise adhering to distancing measures and non-contact outdoor activities in the local area - such as golf, hiking, canoeing, outdoor swimming, angling – consistent with the wider rules and guidance applicable to any activity in this phase.
Community and public services We are planning the gradual resumption of key support services in the community. We are expecting to restart face-to-face Children's Hearings and for there to be greater direct contact for social work and support services with at risk groups and families, and for there to be access to respite/day care to support unpaid carers and for families with a disabled family member. All of these would involve appropriate physical distancing and hygiene measures.
We are planning for the opening of Household Waste Recycling Centres.
Court and tribunal buildings open, with limited business and public access.
Gatherings and occasions: In this phase we are expecting no public gatherings except for meetings of two households and then only outdoors and with physical distancing.
Health and Social Care: In this phase we expect to begin the safe restart of NHS services, covering primary, and community services including mental health.
We are also planning on retaining COVID-free GP services and planning a further scale up of digital consultations.
We expect to roll out the NHS Pharmacy First Scotland service in community pharmacies and increased care offered at emergency dental hubs as practices prepare to open. We will also restart, where possible, urgent electives previously paused. And there will be a resumption of IVF treatment following the approval of Human Fertilisation and Embryology Authority.
There will be an increase provision of emergency eyecare in the community.
We will consider the introduction of designated visitors to care homes.
The Test and Protect system will be available across the country.
To progress to Phase 2, the virus must now be controlled, R must be consistently below 1 and the six WHO criteria described above must now be in place. Any signs of resurgence will be closely monitored as part of enhanced community surveillance but the risk of spreading the virus remains.
During this phase, further changes are made to ease the restrictions in place and further resumptions or expansions of public services are made. The rules set out in the previous phase apply except as set out below.
Seeing family and friends: In Phase 2, you would be able to meet outside with larger groups including family and friends with physical distancing. You would also be able to meet people from another household indoors with physical distancing and hygiene measures.
Getting around: In Phase 2, consistent with the reopening of workplaces set out in this phase, it is our plan that the default position is for people to work from home where possible. Where that is not possible businesses and organisations are encouraged to manage travel demand through staggered start times and flexible working patterns.
People will be able to drive locally for leisure and exercise purposes.
We are planning for public transport operating increased services but capacity would still be significantly limited to allow for physical distancing. Travel at peak times would remain discouraged as far as possible.
There may be geographical differences in approaches to transport depending on circumstances.
Schools, childcare and other educational settings: In Phase 2 we are planning for on campus university lab research to restart subject to physical distancing.
Working or running a business: In Phase 2, remote working should remain the default position for those who can. Non-essential, indoor non-office-based workplaces can resume, once relevant guidance has been agreed – including factories and warehouses, lab and research facilities – with physical distancing. We are planning for the construction sector to implement remaining stages of phased return.
We anticipate a relaxation of restrictions on housing moves.
Shopping, eating out and drinking: We expect that previously closed small retail units will be allowed to re-open with physical distancing in place. We are also planning on opening outdoor markets with physical distancing, hygiene measures and controls on numbers of people.
Pubs and restaurants can open outdoor spaces with physical distancing and increased hygiene routines.
Sport, culture and leisure activities: In Phase 2 we are planning a reopening of playgrounds and sports courts with physical distancing, and a resumption of professional sport in line with public health advice.
Community and public services: Scaling up of public services from phase 1 where it is safe to do so.
Gatherings and occasions: In Phase 2, we plan for registration offices to open for high priority tasks. Places of worship would be able to open for private prayer with physical distancing and hygiene safeguards. We are also planning to allow marriages, civil partnerships and other types of ceremonies to take place with a limited number of attendees.
Health and Social Care: In Phase 2, remobilisation plans will be implemented by Health Boards and Integrated Joint Boards to increase the provision for the backlog of demand, urgent referrals and the triage of routine services.
This phase will see the reintroduction of some chronic disease management, which could include pain and diabetic services.
Prioritised referrals to secondary care will begin.
We expect to expand the range of GP services, optometry and ophthalmology services and see an increase in availability of dental services.
There will be an increased number of home visits to shielded patients.
We will continue to plan with COSLA and Scottish Care and other national and local partners to support and, where needed, review social care and care home services.
Phase 3 will begin to feel closer to normal. The virus will have been suppressed and Test and Protect working across Scotland means we will understand where any additional local measures might be required. Many work places will already have adapted, with physical distancing the norm. Communities will be fully engaged and participating in the transition back to a more open life and economy.
This phase has a significant number of changes which impact many people, and the planned changes may need to happen over more than one review cycle of the regulations.
Seeing family and friends: By this stage, you will be able to meet with people from more than one household indoors with physical distancing and hygiene measures.
Getting around: In this phase you can drive beyond your local area for leisure and exercise purposes. Public transport will be operating full services but capacity will still be significantly limited to allow for physical distancing. Travel at peak times will be discouraged as far as possible. There may be geographical differences in arrangements depending on local circumstances.
Schools and childcare settings: We are planning for children to return to school under a blended model of part-time in-school teaching and part-time in-home learning. Public health measures including physical distancing will be in place. Subject to the evidence and progress of the epidemic we expect schools to open on August 11.
We are planning for all childcare providers to reopen subject to public health measures, with available capacity prioritised to support key worker childcare, early learning and childcare (ELC) entitlement and children in need.
We are planning for a phased return for universities and colleges with a blended model of remote learning and limited on campus learning where prioritised. Public health measures including physical distancing will be in place.
Working or running a business: In Phase 3 remote working remains the default position for those who can. Indoor office workplaces including contact centres can reopen, once relevant guidance has been agreed and with physical distancing.
Shopping, eating out and drinking: We are planning for larger retail to reopen with physical distancing.
Pubs and restaurants can open indoor spaces with physical distancing and increased hygiene routines. Personal retail services including hairdressers can open (with appropriate distancing and hygiene measures).
Sport, culture and leisure: Museums, galleries, cinemas, and libraries can open, subject to physical distancing and hygiene measures.
Gyms can open subject to physical distancing and hygiene measures.
Relaxation of restrictions on accommodation providers (including hotels, B&Bs and holiday homes).
Live events permitted with restricted numbers and physical distancing restrictions
Community and public services: Outside of health and social care, the main changes to public services will be a further resumption of justice system processes and services.
Gatherings and occasions: People can meet in extended groups subject to physical distancing. Places of worship can open to extended groups subject to physical distancing and hygiene safeguards.
We will relax restrictions on funeral attendance, marriages, civil partnership and other services to beyond close family.
Health and Social Care: We will see an expansion of screening services and adult flu vaccinations in care homes and at home. All dental practices will begin to see registered patients.
All community optometry will reopen with social distancing safeguards.
There will be a phased resumption of visiting to care homes by family members in a managed way.
In this, the final phase in our transition through the crisis, the virus remains suppressed to very low levels and is no longer considered a significant threat to public health, but society remains safety conscious. All WHO criteria continue to be met. A vaccine and/or effective treatment may have been developed. Test and Protect continues to be fully operational in all 14 Health Board areas. Scotland is open with precautions and the importance of hygiene and public health are emphasised. It could be many months, or longer, until we reach this phase.
Seeing family and friends: We will expect to see further relaxation on restrictions on gatherings and the continued importance of hygiene and public health will be emphasized.
Getting around: Public transport would be operating a full service. Physical distancing may remain in place, subject to scientific advice.
Schools and childcare settings: Schools and child care provision would be operating with any necessary precautions.
College and university campuses would be fully open - including key student services - with any necessary precautions
Working or running a business: Remote and flexible working remains encouraged. All types of workplaces would be open in line with public health advice.
Shopping, eating out and drinking: All types of outlets would be open in line with public health advice. Shop local still encouraged.
Sport, culture and leisure: There would be a further relaxation of restrictions on live events in line with public health advice.
Community and public services: Public services would be operating fully, in line with public health advice, with modifications and changes to service design, including increasing use of digital services where appropriate.
Gatherings and occasions: Mass gatherings could resume in line with public health advice.
All ceremonies could now take place with any necessary precautions.
Health and social care: The full range of health and social care services would be provided with greater use of technology to provide improved services to citizens.