Seòmar agus comataidhean

Estimated numbers of people affected by the pause to bowel screening were published when the pause to the programme was announced on 30 March. The figures, which are based on the most recent information available to Information Services Division at the time of the pause, indicate that 248,177 people may have had a faecal immunochemical test (FIT) delayed as a result of the pause to the bowel screening programme over the past three months.

The resumption of screening services is taking place safely, carefully and in a series of stages, as part of the remobilisation of the NHS in Scotland. Bowel screening colonoscopies are now resuming in all Boards, including for bowel screening participants who returned a positive FIT test before or during the pause.

Local boards will be provided with numerical FIT values, to help them prioritise bowel screening participants alongside symptomatic patients.

During the pause to the screening programmes we have continued to emphasise that anyone who is concerned about any signs or symptoms of cancer should not wait for their next screening test and should seek medical advice.

Estimated numbers of people affected by the pause to breast screening were published when the pause to the programme was announced on 30 March. The figures, which are based on the most recent information available to Information Services Division at the time of the pause, indicate that 46,596 people may have had their breast screening appointment delayed as a result of the pause to the breast screening programme over the past three months.

The resumption of screening services is taking place safely, carefully and in a series of stages, as part of the remobilisation of the NHS in Scotland. The breast screening service is currently assisting acute services to prioritise high-risk familial clinics and post-treatment surveillance screening, while preparing for the resumption of the national programme.

In the meantime, it is absolutely vital for those in between screening appointments or awaiting a rescheduled appointment to be aware of any symptoms or signs of the conditions screened for. Anyone having these symptoms should contact their GP practice.

Estimated numbers affected by the pause to the screening programmes are based on the most recent information available to Information Services Division at the time of the pause. This indicates the following numbers of people may have had their appointment delayed in the three month period since the programmes were paused on 30 March:

• 248,177 bowel screening participants.
• 46,596 breast screening participants.
• 101,963 cervical screening participants.

The cancer screening programmes that were paused on 30 March (breast, bowel and cervical) are now beginning to restart – safely, carefully and in a series of stages.

The Scottish Government were concerned to read the findings of this tragic incident. NHS Lothian have accepted the findings of the Fatal Accident Inquiry and have confirmed that a number of actions have taken place since 2014 to improve the number of staff incorporated within ward establishment figures. Firstly, the Royal Edinburgh Hospital was given an uplift in budget of £3 million which allowed it to review establishment levels. In addition, when the new Royal Edinburgh Building was built, it allowed for an improved number of nursing staff per bed ratio.

NHS Lothian has produced a draft action plan in response to the FAI which includes implementation of the standards within Healthcare Improvement Scotland’s (HIS) "From Observation to Intervention" 2019 guidance. This is being taken to the NHS Lothian Health Care Governance Committee for discussion on 24 th July 2020.

On December 16 2019, the Scottish Government published the first Integrated National Health and Social Care Workforce Plan in the UK. Developed in partnership with COSLA, the Integrated Plan sets out how health and social care services will meet growing demand to ensure the right numbers of staff, with the right skills, across health and social care services. Covid-19 has led to widespread disruption to Health Boards' models of service delivery and we are carefully considering the Integrated Plan to ensure its content and associated guidance are, going forward, reflective of the full range of current and developing planning requirements on Boards and the changing circumstances regarding Covid-19.

In addition, implementation of the Health and Care (Staffing) (Scotland) Act, which is the first multi-disciplinary workload and workforce planning legislation in the UK, will support the wider workforce planning process by enabling a rigorous evidence based approach to staffing decisions. Health Boards have also been supported in planning their nurse staffing in response to the pandemic by the development of a professional judgement decision making template, including for mental health.

The Scottish Government will also shortly reconvene the National Mental Health Quality and Safety Board. This Board will be considering all issues that impact upon the quality and delivery of safe and effective services, including inpatient and community settings.

The Scottish Government continues to participate in the four nations approach to the procurement of tests and, subject to clinical recommendations and the availability/approval of an effective antibody test, can draw-down an allocation of the UK procured COVID-19 antibody tests for use in Scotland.

The exact information requested is not available centrally. Public Health Scotland collect social care information directly from Health and Social Care Partnerships; however, it is not possible to identify from this if social care packages have been withdrawn or the reason why a package may have been withdrawn or reduced.

It is possible to estimate the number of people receiving home care services each month and how many hours of home care were received. Table 1 provides this information for January to March 2018. Information for 2018-19 is not yet available.

Table 1. Number of people receiving home care 1 services and total number of hours 2,3,4 of home care by month and Health and Social Care Partnership 2,3,4 , January to March 2018

Our national expert body, Health Protection Scotland (HPS), jointly with the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Public Health England (PHE) and NHS England published updated PPE guidance in relation to COVID-19 on Thursday 2 April (updated 12 June). The guidance is available here .

The guidance outlines what type of PPE frontline health and social care workers should be wearing in different settings and scenarios, including where a two-metre social distance is not possible. The guidance contains tables which clearly explain the PPE required for different common clinical and care scenarios. The first table relates to acute hospitals and the second and third are for primary care, outpatient and community care, ambulance staff, paramedics, first responders and pharmacy.

Given the recognised sustained community transmission of COVID-19, the guidance importantly includes detailed advice (table 4) around risk assessing use of PPE, including aprons, gowns, Fluid-Resistant Surgical Masks and eye protection, in a range of different clinical and care scenarios, including where a two-metre social distance is not possible.

Additionally, on 23 June recommendations on the wider use of face masks by staff within residential healthcare settings, such as acute adult (including mental health) and community hospitals and care homes for the elderly where staff are unable to physically distance were announced. The guidance recommends that staff working in a clinical area of an acute adult or community hospital, or in an care home for the elderly should wear a face mask at all times throughout their shift. Additional advice was also announced on the requirement for visitors to wear face coverings when attending adult hospitals or care homes for the elderly.

The information is not held centrally. Data on the number of people admitted to hospitals from care homes is not recorded systematically in the data submissions from NHS Boards to Public Health Scotland (PHS). PHS have analysed and linked a suite of their management information data sources in order to identify people admitted to hospitals from care homes. This analysis was unable to produce reliable answers.

PHS will now work with NHS National Services Scotland, local Health and Social Care authorities (NHS Boards and IJBs) and the Care Inspectorate to improve national information so that these types of questions; as well as ones in relation to patients discharged from hospital to care homes; can be answered in future.

The Scottish Government has been working with partners to explore options for transparent masks and face coverings. Currently, there are no commercially available transparent masks that are certified for use in clinical settings. However, £50,000 of funding from the Scottish Enterprise’s Pivotal Enterprise Resilience Fund (PERF) was recently awarded to an Edinburgh based company to expand its production of face coverings to include coverings with transparent panes, which enable lip-reading. This company is also being supported by the National Manufacturing Institute for Scotland (NMIS) to upgrade these face coverings to type IIR masks suitable for use in clinical settings.

The Scottish Government is aware that when face coverings and face masks are worn there may be additional challenges for those who are deaf or have hearing loss, as well as others with different communication needs. Guidance is being continually updated as to when face masks and face coverings should be use in health and social care settings. The latest guidance on the extended use of face masks recommends that staff working in clinical areas of an adult acute, community hospital or care home for the elderly should wear a medical face mask at all times. However the guidance also stipulates that where necessary and when safe to do so, staff can lower or remove their mask to allow for lip-reading, but must maintain 2m physical distancing. Where physical distancing is not possible, other communication methods should be used.

Digital consultations have played an important role in allowing people to continue to access appointments during Covid-19 with nearly 17,000 consultations being held each week across Health and Care services. Feedback on using our Near Me video consulting service remains extremely high and in mobilisation plans we have now asked for Health Boards to maintain and build upon this. We would expect a video consultation to take place whenever it is clinically appropriate to do so.

To support its wider uptake and awareness of the service, we are currently in the middle of a public engagement exercise to ensure that we gather feedback on areas where the service is particularly beneficial or where it may not be appropriate for such a consultation and we will use this feedback to adjust our approach to scale up once we have collated the information. The survey can be found here - https://www.nearme.scot/views .