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We are not aware of any evidence from worldwide literature that we are aware of that suggest that air conditioning systems spread COVID-19, however we recognise that our understanding of COVID-19 continues to grow and expand and we will continue to review new evidence as it becomes available.

Air conditioning and ventilation systems in hospitals are designed and operated to reduce the spread of airborne infection of many types. The guidance followed across the NHS is published on the Health Facilities Scotland web site:

http://www.hfs.scot.nhs.uk/publications/1475762746-
SHTM%2003-01%20V2%20Part%20A.pdf.

Information on all admissions to care homes is not held centrally; data on how many people have been admitted to local authority care homes will instead be held by each local authority.

We have published the ‘Re-mobilise, Recover, Re-design, The Framework for NHS Scotland’ that sets out how Health Boards will follow national and local clinical advice to safely and incrementally prioritise the resumption of services paused during the current public health emergency. This is in the context of maintaining COVID-19 capacity and resilience, where many of the specialist pain workforce was re-deployed to, and providing appropriate support for social care.

As part of this, the Interim Chief Medical Officer and National Clinical Director have provided an outline of services that could be prioritised including:

• cancer services, especially referrals and postponed treatments
• expanding treatments for non-cancer urgent inpatients and outpatients
• outpatient therapies where delay will increase the risk to patients, such as management of macular degeneration, paediatrics and respiratory services
• mental health support
• treatment room services such as blood monitoring and B12 injections

The above is in line with the Faculty of Pain Medicine guidance of 15 May, which refers to a letter issued by NHS England advising the initial focus should be on urgent and time critical work.

Our approach is driven by clinical priorities, as well as what matters to people’s quality of life. We are therefore engaging with Health Boards and stakeholders to stimulate a national discussion to inform local and regional planning to resume hospital pain management services as quickly and as safely as possible, and to evolve the Scottish Chronic Pain Service Model to improve access to care and support for pain management in the community.

In May 2020, Health Protection Scotland carried out a Rapid Review of Literature: 'Assessing the infection prevention and control measures for the prevention and management of COVID-19 in health and care settings', which identified that, currently there is no clear evidence of airborne transmission of SARS-CoV-2 (COVID-19).

This is published on the HPS web site, https://hpspubsrepo.blob.core.windows.net/
hps-website/nss/2985/documents/1_covid-19-rapid-review-ipc-for-covid-19.pdf .

The current view of the UK experts considering such matters is that air conditioning may reduce potential risk through dilution of contaminants, rather than contribute to the spread of COVID-19. Ventilation (air conditioning) has very limited effects on short-range aerosol/droplet and contact transmission, which are believed to be the main transmission routes. No specific research is planned on the contribution of air conditioning to the spread, however, emerging literature is being monitored.

The Scottish Government does not centrally collect information or data relating to the use of Do Not Attempt Cardiovascular Resuscitation (DNACPR) forms in hospitals.

As with all other clinical treatments, decisions about CPR should be based on the individual clinical circumstances and wishes of the patient, recorded appropriately and updated when medical circumstances change. This recording is done in hard copy on a DNACPR form, the existence of which is then recorded on an individual’s Key Information Summary. Such information is only shared for the purposes of direct care and is therefore not centrally collected.

On the 10 April, the Chief Medical Officer, Chair of the Scottish General Practitioners Committee of the BMA and Chair of the Royal College of General Practitioners (RCGP) wrote to GPs to provide advice and support on having anticipatory care planning conversations and to make clear that there is no requirement for health professionals to have a DNACPR discussion as part of this conversation, unless the patient wishes to discuss it or clinician feels strongly it is necessary to raise in conversation for the patient’s wellbeing. On the 17 April, a further joint letter from the Scottish Government’s Chief Medical Officer, BMA and RCGP was sent to GPs to reinforce the advice already provided.

There has been no change to the guidance on the use of Do Not Attempt Cardiopulmonary (DNACPR) forms during the Covid 19 outbreak. As such, the Scottish Government has not formally consulted with professional representational organisations on the existing DNACPR guidance during the Covid 19 outbreak.

The Scottish Government continues to work closely with a wide variety of professional groups and organisations in responding to the challenges posed by the Covid 19 outbreak.

The Scottish Government has made available additional funding for frontline Boards of £333 million through the Scottish Budget, and this has now been allocated in full to support our health and care services. This funding is detailed in the table below and will be prioritised towards responding to Covid-19 and will ensure that patient safety remains the top priority.

The Scottish Government has published in its Summer Budget Revision the details of the £620 million in health and social care COVID-19 consequentials that have been received so far, and that have been allocated in full to support our frontline health and care services. In addition, we remain in close contact with the UK Government to ensure that the NHS receives whatever resources it needs, in line with the commitment made by the Chancellor of the Exchequer.

Clinical advice on admitting people with suspected or confirmed COVID-19 to hospital is included in a range of clinical guidance that has been published on the Scottish Government website - https://www.gov.scot/publications/coronavirus-covid-19-clinical-advice/ .

A relaxation of restrictions on home moves is anticipated in phase 2 of the recovery plan, as set out in Scotland’s route map through and out of the crisis , published on 21 May. Restrictions will only be relaxed if the virus remains suppressed and the evidence allows us to do so. During phase 1, surveyors should continue to follow the Scottish Government guidance published on 31 March: https://www.gov.scot/publications/coronavirus-covid-19
-guidance-moving-home/ .

We are working with a wide range of stakeholders through our Home Moves in Scotland Working Group, including the Royal Institution of Chartered Surveyors, to develop revised guidance for phase 2.