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The Scottish Government convened the National COVID19 Cancer Treatment Response Group (CTRG) on 18 th March to form national clinical consensus in Scotland on changes to cancer treatment in response to the new risks associated with COVID-19 ensuring those most urgent cases were prioritised.

The group has produced clinical advice on an ongoing basis and throughout the pandemic the majority of cancer treatments have continued.

We have now established a National Cancer Recovery Group which has been established to offer national arbitration on overall clinical priorities. It will also oversee national data and modelling work in relation to cancer recovery and advise on patient and public communications.

Any cancer patient worried about symptoms should call their existing cancer treatment helpline or the national cancer treatment helpline. Individuals with serious or worrying signs or symptoms are encouraged to use the NHS as normal and contact their local GP practice.

A safe and effective COVID-19 vaccination is dependent on success in at least one of over 170 vaccine trials underway worldwide in terms of both development and manufacture. When a vaccination might be available, and considerations about delivery and prioritisation, will depend in part on which vaccine candidates are successful.

While there is no guarantee of success in any of the trials, it is prudent that we plan on the basis of a vaccine becoming available. In Scotland we already deliver nearly 2 million doses of vaccine routinely every year and we have a comprehensive vaccine delivery infrastructure in place. We are currently working to upscale this in order to deliver a COVID-19 vaccine in the event that a safe and effective vaccine does become available.

Prioritisation and eligibility decisions will be founded on clinical evidence and advice.

Urgent and emergency care has been maintained throughout this pandemic to ensure those with life threatening conditions were and continue to be seen as a matter of priority.

Through the Re-mobilise, Recover, Re-design: The Framework for NHS Scotland , Health Boards will follow national and local clinical advice to safely and gradually prioritise the resumption of some paused services whilst continuing to protect emergency, urgent, Cancer and maternity care. Health Boards will plan to resume services while maintaining COVID-19 capacity and resilience and providing appropriate support for social care, and also protecting the safety of all patients and staff. Health Boards are taking a careful and considered approach to this, balancing the treatment of COVID-19 patients with the all potential impacts of longer waiting times, including assessing the impact of this on excess death rates.

Patient safety will be at the forefront of NHS Boards plans as they restart previously paused services, and a number of different steps to mitigate the impact that two-metre physical distance are being put in place. This includes extended working days including evenings and weekends to provide more clinics and see more patients.

The Golden Jubilee providing national support to territorial Health Boards in specialties such as Ophthalmology and Orthopaedics, and continue to support with Cancer surgery.

The Private Sector is supporting NHS Boards by providing a COVID free environment for urgent and Cancer surgery. This provides a safe environment for both staff and patients.

In addition, in order to increase access to diagnostic testing, NHS Boards will be deploying six mobile MRI scanners and three CT scanners, across Scotland. This will enable Boards to ensure patients have appropriate access to diagnostic services while also ensuring physical distancing measures and PPE requirements are followed.

We are also exploring options for further pathways for the NHS Louisa Jordan with the possibility that the facilities can be used to provide outpatient appointments and access to diagnostics testing.

There is currently insufficient clinical evidence to conclude that people who have recovered from COVID-19 are protected from either a second infection or from infecting others.

Until such evidence exists the main public health benefits are for research purposes or in the clinical management of patients. The World Health Organisation and SAGE have warned there are potentially negative impacts on public health if individuals assume immunity from a positive result and adapt their behaviour in a way which could increase the risk of continued transmission.

On this basis, the CMO advised health boards on 23 rd June 2020 not to offer on-demand antibody testing. This applies equally to care or NHS staff.

Our approach is being kept under ongoing review. If clinical evidence around immunity changes we will swiftly roll out a national antibody testing programme in order to realise the potential health, social and economic benefits this would offer, and are preparing now for that prospect.

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 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.

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 Scottish Government does not hold this data however vital cancer services have remained throughout the COVID-19 pandemic where clinically agreed. We have been clear that throughout this pandemic, the NHS is there for those who need it most.

To ensure patients are seen based on their clinical priority Health Boards clinical teams have weekly Multi-disciplinary team meetings where patients are reviewed based on clinical risks and individual treatment requirements.

To support Health Boards in treating these urgent cancer patients capacity has also been identified within the Private Sector and the Golden Jubilee National Hospital providing a safe environment for both patients and staff.

A list detailing the title of Clinical Trials which were paused due to the Covid-19 pandemic can be found at NHS Research Scotland’s website: http://www.nhsresearchscotland.org.uk/uploads/tinymce/NRS%20Non-COVID-19%20Suspended%20Study%20Sites.pdf .

This identifies the Clinical Trials and the NHS Scotland Health Boards involved. As will be seen from the link, a number of Clinical Trials have since been reopened or terminated (e.g. because the trial was close to ending in any case). It should be noted that the Scottish Government’s Chief Scientist Office has created strategic and operational groups to lead efforts to re-open all research in NHS Scotland as quickly and safely as possible.