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Patients are currently using several different ways to contact the NHS with the majority of consultations taking place by telephone. We are encouraging the use of video for consultations where it’s necessary to see the patient, such as for skin conditions or to view their general wellbeing. The monthly and weekly figures for Near Me video consultations are listed in the following table, with weekly usage figures only available from March.

Between 19 March (when the NHS National Services Scotland social care PPE triage helpline was launched) and 15 May, the following products have been distributed to residential care homes from the national stock. This is a daily changing picture, and the number of items will now be higher.

Aprons   4,564,502

Gloves   6,750,069

Masks   3,102,461

Eye Protection 156,935

FFP3     320

Visors   200

Total     14,574,487

Health Protection Scotland (HPS) has published infection control guidance for care homes which is updated regularly and most recently on 20 May. The HPS guidance is based on the National Infection Prevention and Control Manual and includes advice on how to prevent and manage the spread of all respiratory infections including COVID-19.

To supplement HPS guidance, the Scottish Government also issued clinical and practice guidance for care homes. This was first published on 13 March and updated on 26 March and 15 May. This guidance draws on the HPS guidance but provides more detailed information on some of the practical steps that are required to protect staff and residents. Both the HPS and the Scottish Government guidance are continually reviewed to take account of the emerging picture around COVID-19.

a)

Health Protection Scotland (HPS) has advised that it is not possible to say with the degree of certainty required, how many cases of hospital acquired COVID-19 there have been across Scotland. Healthcare Associated Infections (HCAIs) would usually be regarded as those infections, not present or incubating on admission, arising 48 hours after admission to hospital. Current estimates suggest a median incubation period from 5–6 days for COVID-19, with a range from 1–14 days. This means that COVID-19 arising before day 14 in hospital or other care settings may not be HCAI.

b) and c)

Health Protection Scotland has published quarterly data on both healthcare associated and community associated Staphylococcus aureus bacteraemias (SABs) at Board level since October 2017. SABs comprise MRSA and Meticillin-Sensitive Staphylococcus aureus, MSSA ); Clostridioides difficile infections (CDI); Escherichia coli bacteraemia (ECB); and Surgical Site Infections (SSIs) in Scotland.

Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) are not reported on individually due to small numbers of MRSA cases, but are part of the overall SAB data. The most recent quarterly report, published in April 2020, can be found on the Health Protection Scotland website https://www.hps.scot.nhs.uk/web-resources-container/quarterly-epidemiological-data-on-clostridioides-difficile-infection-escherichia-coli-bacteraemia-staphylococcus-aureus-bacteraemia-and-surgical-site-infection-in-scotland-october-to-december-q4-2019/ . The report for the next quarter, covering January to March 2020, will be published at the beginning of July.

Mandatory reporting of MRSA infections commenced across Scotland in 2003, with mandatory surveillance of CDI starting in 2006.

Since 2007, rates of MRSA infections have reduced significantly and, in their latest Healthcare Associated Infection Annual Report (published in May 2019), Health Protection Scotland reported a decreasing year on year trend (2014-2018) in the incidence rate of MRSA and CDI .

The Covid-19 Community Pathway was established to alleviate the pressure on GP practices by providing a pathway for those patients who were experiencing Covid-19 symptoms. Once assessed, those patients admitted to hospital will be tested. Patients who have been assessed either through the Community Hubs or at the Assessment Centres, and asked to manage their symptoms at home, are not routinely tested for Covid-19.

The only testing carried out through community assessment centres and community telephone hubs has been conducted by Health Protection Scotland for the purposes of community surveillance. This has involved testing a sample of people with mild to moderate symptoms. The number of tests carried out on a weekly basis is not published by Health Protection Scotland, but data is used to provide statistically robust estimates of the prevalence of the virus. This will allow the right strategies to be put in place to respond effectively to Covid-19.

Analytical partners across the Scottish Government, NRS, 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.

NRS recently published a note describing the limitations of ethnicity data collected via the death registration process (link here ). Ethnicity data is collected on a voluntary basis and is not known for 9% of registered deaths. This means that the true number of COVID-19 deaths broken down by ethnic group categories cannot be accurately ascertained from the registration data.

NRS are looking at how other datasets can be used to improve the quality of ethnicity data. They are testing whether ethnicity data from the 2011 Census can be used to improve the quality of the death registration data. If successful, NRS will add this to other key population data and carry out further analysis to ascertain whether there is a variation in the relative risk of mortality related to COVID-19 by ethnicity.

NRS hope to be able to confirm whether the data improvement work and associated analysis has been successful in the next fortnight. Should the work have been successful, NRS will then confirm a publication date.

Public Health Scotland also released preliminary analysis of COVID-19 and ethnicity data on 20 May. The analysis appears to show, based on the very limited data available, that the proportion of ethnic minority patients among those seriously ill with COVID-19 appears no higher than the proportion in the Scottish population generally. However, given the numbers involved are currently very low, PHS will continue to monitor the situation closely and improve the analysis as more data becomes available.

Other data will also become available in due course and will be published. For example, the University of Glasgow, with support from University College London (and in partnership with Public Health Scotland) are conducting an equity focused rapid review of published evidence on COVID-19, which includes ethnicity alongside other inequalities. This is expected to be completed within 6-8 weeks.

Across Scotland, there are 4 hospitals within the independent sector being utilised, delivering activity across a range of specialties. At week ending 17 May, 943 urgent surgical cancer procedures had been undertaken, and 1249 Outpatient appointments, which has provided support to 9 NHS Boards.

Prior to the current CV-19 situation, I had arranged to meet the BMA to discuss the report and recommendations.

The current CV-19 response has necessitated the pausing of many areas of work, as we focus on responding to this pandemic. It is vital that this important report and its recommendations are discussed in detail and in partnership with BMA Scotland.

As we start planning to return to routine business, I will arrange to discuss the report and its recommendations with BMA Scotland as soon as is practical to determine a way forward.

3,121 staff were reported as absent in adult care homes due to COVID-19, based on returns received from 813 (75%) adult care homes as at 12 May. Staff absent due to COVID-19 represents 7.3% of all adult care home staff (42,626) for whom a return was provided. Scottish Government has published this data and will be publishing updated data every week on our website: https://www.gov.scot/publications/coronavirus-covid-19-daily-data-for-scotland/