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The Scottish Government is undertaking a detailed review of COVID-19 budget pressures across health and social care, and as part of this we will ensure that Integration Authorities have the resources that they need.

The Scottish Government has made available £50 million as an initial tranche of funding for Integration Authorities to meet immediate pressures, and has provided reassurance that further funding will be provided.

Public Health Scotland provides the Scottish Government with numbers of residents and staff tested in care homes, but it is not possible to disaggregate this further to provide a breakdown of the numbers of care home residents who were tested for COVID-19 during the delay phase. The move from the containment to the delay phase happened on 16 March and these data are only available from 20 April.

Principal responsibility for collecting data on deaths in hospital belongs to Public Health Scotland. However, the Mental Welfare Commission must be notified by Health Boards of deaths of people who are subject to detention in hospital or treatment in the community under the Mental Health (Care and Treatment) (Scotland) Act 2003.

I have asked the Chief Executive of the Commission to provide you with the figures requested.

We continue to work in close partnership with the BMA and other representative bodies, to ensure that we maintain the highest health and safety standards, and promote the health and wellbeing of NHS Scotland staff.

The Minister for Mental Health is working closely with partners across the health and social care sector, including NHS Boards, Health and Social Care Partnerships and local employers, to ensure a range of psychological and wellbeing support is in place for the workforce.

Clinical advice and available evidence suggests it is too early to determine exactly what the post-viral, long-term physical and mental health impacts will be for those who have had COVID-19. We are aware that some people suffer from post-viral syndrome following any viral infection and present with chronic fatigue and general malaise. We are also aware of the wider effects on mental health resulting from long-term isolation, reduced contact with family or friends and economic adversity. However the scientific evidence on post-viral physical and mental health impacts of COVID-19 specifically is still in its early days.

Access to pulmonary rehabilitation is already a key recommendation in national clinical guidelines which we expect NHS Boards to follow, that is why it will form an important part of the final Respiratory Care Action Plan for Scotland, currently out for consultation until 3 July 2020.

Once the final Plan is published, we will work with stakeholders to understand what clinical audits are needed for respiratory to support decision making both clinically and at a policy level in Scotland.

The Scottish Government on behalf of the NHS and other stakeholders have been working with Healthcare Quality Improvement Partnership (HQIP) since November 2018 to try and identify a way forward that will support Scotland’s continued participation in the National Asthma and COPD Audit Programme, specifically a mutually agreeable legal basis to support the financial payment for that participation.

So far we have not been able to identify one, although Scotland will continue to participate in NACAP until the end of this current contract, which is 28 February 2021.

We are continuing to work on how we collect auditing data of respiratory conditions going forward to ensure that any data collected meets Scotland’s needs, and supports decision making both clinically and at a policy level, including the implications of Covid-19. Options will include considering what the benefits of NACAP have been in terms of service improvement in Scotland and the possibility of contracting directly with the audit providers, rather than through a third party such as HQIP.

Information on staff to patient ratios in intensive care unit settings during COVID-19 outbreak is not centrally held by ISD or NES.

A joint statement on developing immediate critical care nursing capacity, produced by the four United Kingdom Chief Nursing Officers together with the NMC, critical care nursing organisations, professional bodies and trade unions was issued to Board Chief Executives and Nurse Directors on 25 March 2020. The statement can be found on the following link:

https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/joint-statement-on-developing-immediate-critical-care-nursing-capacity.pdf

To provide practical guidance for the delivery of this increased capacity an annex to this statement was also issued but not published online. Scottish Government officials are currently using the guidance in the annex to undertake further modelling in relation to the staffing required for the intended critical care expansion in Scotland. This will be issued shortly.

Haematologists across Scotland continue to advise that shielding for every patient with a diagnosis of Chronic Lymphocytic Leukaemia is not necessary. There are significant downsides to shielding, and it is not something we want to ask of anyone unless clinical advice deems it necessary. CLL affects a very diverse group of patients. Some are unlikely to ever need treatment in their lives as it has no immediate impact on their health and others will require treatment.

Clinicians have been working locally to identify patients with CLL who are at the highest risk of severe illness from COVID-19 and therefore should be shielding. This is a clinical decision which takes into consideration any treatment and the overall health of the patient . Many patients with CLL will not be required to shield. We do not wish to advise anybody to follow shielding measures unless absolutely necessary. This is because shielding is a severe intervention which may be difficult to adhere to for such a long period of time, and the additional benefit gained from this extra measure needs to be weighed against any impact on someone’s mental and physical wellbeing.

We are aware that there is emerging evidence that people from Black, Asian and Minority Ethnic backgrounds may be disproportionately affected by COVID-19. Further research and reviews are still underway and we await the results of these.

Analysts across the Scottish Government, National Records Scotland, Public Health Scotland and the NHS are working together to consider how we can better understand the impact of Covid-19 on those from all minority ethnic communities.

The health and wellbeing of our health and social care staff is a key priority and we are aware that many BAME staff may be feeling anxious and wish to discuss how best to protect themselves and their families at this difficult time. Guidance has been issued to help staff and employers by setting out best practice on risk assessments and support that is available for staff across health and social care.

Interim Guidance for health and social care employers on staff from Black, Asian and Minority Ethnic Backgrounds

Once the results of further research and review on ethnicity and COVID-19 are published, we will consider any changes that need to be made to this guidance, based on any new clinical evidence.