Coronavirus (COVID-19) - testing strategy update: Public Health Minister's statement - 17 March 2021

Presiding Officer, since the Cabinet Secretary for Health last updated Parliament in November, we have made significant progress in rolling out our testing strategy and programme.

That strategy that was published in August 2020, centred on five rationales for our priorities for testing for COVID-19 in Scotland – testing to diagnose anyone with symptoms of COVID-19; testing for clinical care of patients; testing to protect those vulnerable to the most harm from COVID-19; testing to proactively case find among people without symptoms, and testing for surveillance to monitor prevalence and understand disease transmission.

Now I will say more about progress on each of these rationales in a moment but a key aim for the strategy was to increase daily PCR capacity in Scotland to at least 65,000 by winter last year. That has been achieved.

Since the beginning of December last year, our focus has been on expanding coverage of our testing programme and available testing capacity in Scotland, into areas where we believe it can have the greatest impact, as part of our response to the pandemic.

This has been aided by the availability of new types of testing technology, including the use of rapid result lateral flow tests, allowing us to significantly expand coverage for people with symptoms and for those without.

Under Test to Care we have now extended testing to all hospital admissions to emergency departments, acute assessment centres, maternity units, emergency mental health units and to all medical and surgical elective admissions.

As part of Test to Protect, all healthcare workers in patient-facing roles in our hospitals, in the Scottish Ambulance Service, in Covid assessment centres in the community, and the healthcare professionals who visit care homes and staff working in Hospices are now offered twice-weekly testing.  

The extension of testing to our primary care workforce – including our GP’s, Dentists, Optometrists, Pharmacists, and Pharmacy Technicians – is also well underway, and on track to be completed by the end of this month. 

And I can announce today that we will now implement testing for all remaining healthcare workers – including those in non-patient facing roles – providing access to regular testing for more than the 170,000 people that NHS Scotland employs.

We have also extended testing in social care – offering testing for up to two designated visitors a week for our 42,000 care home residents across Scotland.

We have supplemented existing PCR testing for care home staff to provide additional lateral flow testing,  and we have completed – a month ahead of schedule – the roll out of testing to the Care at Home workforce, who are critical to supporting and caring for people, so that they can continue to live as independently as possible in their own home.

Proactive case finding remains a key part of our response to the pandemic. Since 18 February, all close contacts of index cases can book a PCR test between days three and five from exposure to a confirmed positive case.

At a community level, test to find is a core part of the rationale for Targeted Community Testing – with proposals developed with local partners to address problems of stubbornly high transmission; rapidly rising transmission; or specific transmission risks in local communities. 

I can advise Parliament that proposals for Targeted Community Testing have now been agreed with 20 local authorities across eight health board areas and we have 28 Asymptomatic Test Sites (ATS) and 12 Mobile Testing Units (MTUs) providing access to community testing with more sites planned to open shortly. 

As well as continuing to offer campus testing to students at times of large population movement, we have now extended access to PCR testing to students prior to travelling to accommodation at university or college.  Plans are also being developed to roll-out regular testing for university and college students and staff.

To manage the risk of the importation of the virus from abroad, quarantine testing was introduced for people arriving in Scotland from outside the Common Travel Area from 15th February.  All are tested twice during their quarantine period – on day two and day eight of the ten day quarantine, with all day two positive test results being sent for sequencing in order to detect any possible variants of concern.

The most recent expansion announced in February extended routine testing to support the maintenance of essential services, mitigate wider social and economic harms and crucially, provide an additional protective layer to support the easing of restrictions for key groups and sectors.

To support the safe return of schools, we have introduced twice-weekly at-home testing for all staff in primary, secondary and special schools, and to all secondary school pupils – with the S1-3 cohort due to commence testing after the Easter break. 

Staff in school-based early learning and childcare settings can also receive testing as part of this offer and Presiding Officer, I can announce today, that from the end of this month, access to testing will be extended to all standalone facilities in the public, private and third sectors, providing early learning and school age childcare services.

Further roll out of regular asymptomatic testing is also now available to food production and distribution businesses, whose workplaces, by their very nature, can present a higher risk of transmission due to factors like low temperatures, high humidity and limited ventilation. 

We now have over sixty businesses now registered with the scheme and undergoing the relevant training and induction processes.

In the public sector, to support the continued safe running of essential services, we have also now implemented regular testing in the control rooms of the Scottish Ambulance Service, Police Scotland, Scottish Fire and Rescue Service and NHS24 call centres.

In the early part of this year, we’ve seen the emergence of new, more transmissible variants of COVID, and also of outbreaks in closed settings.   To help address these, we therefore plan to introduce testing of staff working in prisons to reduce the risk of asymptomatic prison staff importing COVID into the prison environment. 

This will start with three prisons to assess the operational feasibility and public health impact of this type of testing.

Presiding Officer, we have made rapid and significant progress across all five priority areas for testing, and it is therefore appropriate that we now publish an updated and refreshed strategy. 

The fundamental purpose to our strategy and testing programme will not change. 

Testing on its own is not a panacea.  It doesn’t stop transmission in and of itself – it gives us information to help us take action to stop that spread, to enable us to take the right decisions at the right time. 

That purpose will become even more important as we determine how best to integrate and deploy our testing strategy and programme to support the safe easing out of lockdown restrictions in the next phase of the pandemic.

The activity that I have just set out above will continue.

We will continue to test to diagnose people who are ill, so if it is COVID, they isolate to stop spread.  We will test for the clinical care of people in hospitals, and to protect those most vulnerable to the worst harm.

We will keep testing to find cases, where we are most likely to find them, whether the person has symptoms or not.  We will test to support our essential services, the people who work in them and to mitigate the wider social and economic harms caused by this pandemic.

We will also continue to test to monitor prevalence, which is crucial to safeguarding the progress we’ve made through all our efforts to do the right thing and adhere to the protective measures in place, and through the success of our vaccination programme. 

We know the next phase, as we hope transmission continues to reduce, will mean a return to more sporadic outbreaks.  And there will be the continuing risk of importing new variants that could undermine our progress. 

Whole Genome Sequencing improves our ability to address both these threats.

But we also need to be ready for the threats of the future  - not just for the next three months, but for the next three years and beyond.  Health threats will continue to emerge, so we must build a legacy that will help us prepare for these future threats and that will help build a world class public health system in Scotland.

Today the First Minister has announced that we will invest over £13 million next year in developing a truly world-leading Scottish Whole Genome Sequencing Service. 

Sequencing has already proven to be a powerful method to detect new Variants of Concern and to investigate links between strains in outbreaks.  It helps us understand transmission better, helps us design treatments,  gives us early warning of new strains, and builds a legacy for the future.

Scotland’s sequencing science is already world-leading. With this investment we will build on that science to create a service that can help in our next critical stages of responding to this pandemic.

A service that could sequence up to a thousand cases per day if necessary.  One that helps us deal with the risks of today, and tomorrow. 

Presiding Officer, this service will underpin our updated approach to testing.

That approach will continue to be refreshed as we adapt to the pandemic conditions facing us and seek to incorporate and deploy emerging technologies. 

And there are two core messages that we want everyone to get from publishing this updated strategy today.

Firstly, look how far we have come.

At the start of the pandemic, before Test and Protect was launched, Scotland had a daily testing capacity of 350 tests. 

By the end of this month, daily testing capacity across the entire system will be at least 250,000 tests per day.

We also now have eight drive-through regional test sites, 42 mobile testing units, 33 walk-through local test sites, and 21 small scale test sites located across the country.   

And I want to say a heartfelt thank you to everyone who has helped to design, develop and deliver these sites and all of our testing capacity – there are literally thousands of workers and volunteers all over Scotland involved in this shared national endeavour. 

And the second message is this – we all need to know when and how to get a test, and where to get a test.

So as we learn to live with the threat of the virus and seek to return safely to everyday activities and lives, we must keep testing, and test more and in more circumstances.

Put simply – testing must become part of our everyday lives, offering an important layer of protection – alongside vaccination and other measures, including social distancing, self-isolating, hand washing and face covering, in the months ahead.

It will help us return to activities that have been largely restricted over the last year. It will help us increase social contact, so vital for our mental wellbeing and relationships. 

In short, testing will help us move on from the present and into the future.