Coronavirus (COVID-19): Scotland's Route Map - supporting evidence - 20 August 2020 review

WHO criterion 6: Communities have a voice, are informed, engaged and participatory in the transition.

Summary

This update report provides information which illustrates the actions taken in Scotland since the previous report date (30th July) to ensure that 'communities have a voice, are informed, engaged and are participating in the transition'. It is not a comprehensive list of every interaction with stakeholders or the public, rather it is intended to demonstrate the Scottish Government's commitment to work with partners, stakeholders and the wider public to inform and engage them in mitigating the harms caused by the Covid-19 pandemic and to maintain public trust.

The report demonstrates that actions have been taken to ensure that the existing partnerships and interactions to deliver the Programme for Government and the National Performance Framework have been effectively focused to take account of the impact of the pandemic. It has a strong emphasis on being transparent in sharing information, listening and learning about the experiences of communities - particularly those badly affected by the pandemic - so that future work to ease the emergency actions are taken with the best information available.

Informing the Public

This work ensures the public is aware of the public health measures in place, is able to access support if they require it, and has trust in the Government's decision making and advice.

Ministerial briefings to the public continue. These are generally led by the First Minister supported by medical and scientific advisors. They continue to provide clear and consistent messaging and are followed by Q&A with journalists. This regular briefing has also been used to launch and direct the public to new publications and information on the government's actions to mitigate the harms of Covid-19.

The messaging provided by the daily briefing has been supported by marketing campaigns, primarily focused on increasing awareness of and compliance with public health measures and support for those who need it (including for domestic abuse, mental health and managing finances). Messages have evolved as restrictions have lifted, but now, with frequent changes to restrictions, marketing activity focuses on three main areas:

• Compliance (We Are Scotland - an emotive overarching campaign designed to empower the population to comply);
• FACTS (protection messaging); and
• Test & Protect (Scotland's approach to implementing the test, trace, isolate and support strategy).

These campaigns direct people to the nhsinform.scot and gov.scot websites for further information. They are supported by other channels which cover the more nuanced, audience-specific information that is being updated and changed on a regular basis (ongoing changes to restrictions). Through our Partnership Team we also engage regularly with various stakeholders, partners and third sector bodies by providing assets via stakeholder toolkits or for download on NHSInform.

Paid-for-media campaigns have additionally targeted a number of different demographics with specific messaging, including:

• General Population – NHS Redirection campaign (to encourage people to check where the best place is to go for medical help depending on the concern; Clear Your Head - supporting positive mental health, with phase 3 of this to launch soon; Scotland Cares – encouraging volunteering and communitarianism;
• At Risk Audiences (adults 70+, adults at increased risk of Covid complications) encouraging additional precautions and offering additional support if required
• Victims of Domestic Abuse – encouraging access to support services during Covid;
• Minority Ethnic communities – specific Public Health messaging due to poorer cut through of general messaging;
• Those with financial worries as a result of Covid (including renters) – increasing awareness of benefits and wider financial/other support available
• Young people (18-24 year olds, 13-24 year olds) – demographic-specific public health messaging;
• Parents (of children 0-16 years old, of children 2 - 9 years old, school-age children) – range of messaging and support products.

Advice and Guidance has been published on a wide range of issues on the Scottish Government website to support individuals and businesses through this period. Recent publications have included information for people who are asked to self-isolate, guidance for care homes around visiting, and guidance around international travel.

We continue to share information around Scotland's Route Map, including supporting evidence for each review (most recent on 30th July).

Data on the pandemic has continued to be published on the Scottish Government website daily, and is also available in Open Data format. Public Health Scotland launched their improved dashboard at the end of July. Findings on modelling the epidemic continue to be shared online as well as reports of research on public attitudes and behaviours. Data on the Four Harms continue to be published on the dedicated dashboard.

Finding out about the public

The purpose of this work is to develop a clear understanding of how COVID-19, and the response to it, are impacting different sectors of the public and to gain an understanding of the attitudes and beliefs held by the public at this time.

Marketing activity has been developed following insight gathering qualitative groups among different audiences in Scotland. Creative work has been co-created and tested in qualitative research for effectiveness ahead of production. Impact of paid-for-media campaigns has been closely tracked, to ensure that marketing campaigns have been effective. Findings include:

For We Are Scotland compliance campaign (at 23-26 July):

• Campaign awareness of 57% (against a target of 43%);
• Claimed action (among those who had seen/heard the campaign) at a very high level of 79%;
• 81% agreement among those who had seen/heard the campaign that it is supportive; and
• 83% agreement among those who had seen/heard the campaign that it helps me understand that we are all responsible for keeping Scotland safe.

For FACTS campaign (at 23-26 July):

• Campaign awareness of 79% (in line with target);
• Claimed action (among those who had seen/heard the campaign) at a very high level of 83%;
• 82% agreement among those who had seen/heard the campaign that it is supportive;
• 89% agreement among those who have seen/heard the campaign that it makes clear what I need to do on an ongoing basis to help stop the spread of coronavirus.

For phase 1 of the Test & Protect campaign (2-6 July):

• Just over 5 weeks after launch, the campaign achieved 67% awareness, rising to 83% with the inclusion of the door drop (in line with target);
• Among those who had seen the Test & Protect campaign 92% agreement (63% strongly) that 'the advertising makes clear what I need to do next if I have coronavirus (Covid-19) symptoms'; and
• Among those who had seen the Test & Protect campaign, 75% said that if they personally had symptoms they would request a test, 66% said they would stay at home and not go out for 7 days (the timeframe advised at that point) and 57% said they would provide details to the NHS if asked to do so for contact tracing.

The COVID hub has carried out a range of research, tracking the impact of Covid on communities to support effective action to mitigate the harms of the pandemic. This has included:

• Polling to monitor public attitudes, behaviours and some of the harm indicators (trust, loneliness and health). This has involved the production of weekly summaries of trends for wider policy/analysis, and monthly summaries published for external audiences, with the most recent published on 5 August. Recent findings have indicated that:
  • Compliance with rules and guidance has been high, with majorities trying to keep 2m distance from others when out (72%) and avoiding non-essential use of public transport (60%). However, there have been gradual declines in the proportions avoiding meeting with family and friends inside and avoiding gatherings with friends and family (43% and 44% respectively), which likely reflect guidance about changing lockdown restrictions. (10-13 July);
  • The virus has impacted on personal and societal wellbeing, with 33% reporting high levels of anxiety, 64% feeling worried about coronavirus and 44% reporting feeling lonely. (28-30 July);
  • Trust in Scottish Government advice and guidance is strong, with 75% viewing the Scottish Government as doing a good job to help Scotland deal with recovery following the pandemic (4-6 August) and 78% trusting the Scottish Government to work in Scotland's best interests. (28-30 July);
  • There have been increases in people's levels of comfort in resuming activities, with 59% feeling comfortable going to their usual place of work in the next month and 59% feeling comfortable with children going back to school. (4-6 August).
• A more detailed telephone survey to supplement the polling work has also been undertaken, which focused on the impact of Covid on people's wellbeing and provided breakdowns for key groups in society, as well as a consultation with stakeholders, to explore how community-level organisations responded to the pandemic and their views on the impact of the virus on the people they work with.

A commission of focused Social Research analysis deployed to improve the understanding of the impact of Covid-19 on the identified more than 50 pieces of targeted research and rapid reviews of evidence across a wide range of policy areas where harms have been identified. This includes impact on:

• Emerging labour markets;
• Student hardship;
• Mental health;
• Remote court hearings on justice system;
• Use of drugs and drug deaths;
• Impact on migrant populations;
• Review of the impact of Covid-19 funding streams on wellbeing and resilience.

Recognising that the impact of Covid-19 affects certain areas of the community disproportionately, Scottish Government has worked with partners and stakeholders to understand the impact of Covid-19 on their work. This includes work to improve understanding of the existing data and to identify gaps in the data to help manage risks for both the population and the workforce as lockdown is lifted.

To further this work, an Expert Reference Group (ERG) on Covid-19 and Ethnicity has been established to assess and understand impacts for Minority Ethnic (ME) groups in Scotland. The ERG has met four times and is due to meet again on 20 August. The role of the ERG is bring together academics and other experts to advise the Scottish Government in its response to any disproportionate impacts of COVID-19 on ME groups. The Group will feed into the Race Equality Action Plan (REAP) Programme Board, which continues to have the overarching remit for advancing race equality in Scotland, and will also link in with other relevant bodies such as the SG's COVID Advisory Board, the Social Renewal Advisory Board and the Economic Recovery Group. In comparison to the broader role of the REAP, the ERG's work is focussed on specific issues arising from COVID-19 in relation to data, inequality, racialized health inequalities, and other identified inequalities in this context. To support the range of its work, the ERG has established two subgroups focussed on data, evidence and risk, and systemic issues. The ERG is expected to provide its initial advice and recommendations shortly.

In addition there has been continued wider engagement with race equality stakeholders, the Scottish Government's race equality team meet with a range of stakeholders on an ongoing basis. For example, policy officials met with the Ethnic Minority National Resilience Network (run by BEMIS) on 11 June to outline SG's actions and listen to concerns. The Network shared the priorities that they and their users have, including immediate anxieties and longer-term recovery issues.

Engaging the public

Our intention is to give the public the opportunity to give their opinion on decisions which are being made, or problems which we face.

In recognition of the evolving approach to Public Engagement across Government, an expert group has been formed to provide advice and guide our public engagement work. Following the first expert group meeting, planning is now underway to develop the next online engagement exercise which will focus on aspects of the management of the pandemic and the maintenance of public trust.

The second meeting was held on 4th August, and focussed on how best the public can be engaged and involved in the Renew process, looking ahead to the longer term.

Initial public engagement is already underway within the Renew Process. For example, the Social Renewal Advisory Board has commissioned a series of community-based listening events, to ensure that lived experience informs their work. These events are already underway, and will allow the board to hear from at least 30 local authorities across Scotland. Feedback from the first round of discussions with Poverty Truth Commissions have already been received.

Complementing these events, deep dives with communities of interest are also planned, intending to use existing groups and networks as "sounding boards" for the longer term recommendations of the board. An exercise will also be run to allow interested organisations to submit responses, questions and ideas on the Social Renewal work, with thematic analysis of these responses feeding into the board.

In conclusion, on the basis of the evidence summarised above, the assessment is that this criterion has been met at this review point.

Any signs of resurgence are closely monitored as part of enhanced community surveillance

As Scotland transitions to the next phase of the COVID-19 pandemic, a responsive system of community surveillance for COVID-19 is essential. The national level measures that have become the mainstay of tracking the pandemic need to be supplemented by local active surveillance. We expect to see less community transmission, followed by clusters of cases, then more sporadic cases (one or more cases, imported or locally detected). These need to be carefully monitored, including outbreaks in special settings.

The Scottish COVID Data and Intelligence Network is working to provide an effective pandemic response at national, local, and sectoral levels, and to support public trust by publishing data. That includes the ability to identify potential new clusters of COVID infections at a near real time and on a small area geographical basis.

Data from Test and Protect will be critical to establish the efficacy of the system and contribute to active surveillance. This includes demonstrating that most new cases are translating into index cases and establishing that high proportions of contacts are traced within 48 hours.

Alongside this, modelling of the pandemic will also continue and will provide an ability to look at the effect of any new cases on the country as a whole and whether this may lead to additional cases that would need to be acted on e.g. around re-imposing lockdown restrictions.

We can set conditions for consideration of whether to re-impose lockdown restrictions (based on our understanding of the impact on transmission risk of the various changes we have made). Re-imposing restrictions should be considered when key measures cross certain thresholds (or meet specified criteria). This could include the estimated levels of R, infectious people, estimated new infections and observed data.

Other lead indicators are now being tracked to identify any resurgence of the virus as part of enhanced community surveillance efforts in Scotland. Maps showing areas of Scotland with higher than expected positive cases, NHS24 calls for respiratory symptoms, and trends in symptomatic patient surveillance at Community Hubs are shown in the SG Situation Report. Data, maps and insights of NHS24 calls and positive tests in local areas are now shared across Scottish public bodies.

Further development is planned for the coming weeks, in particular, we are

• assessing a forecast of new Covid cases that looks 7 days forwards. This is based on travel patterns. We are currently assessing its predictive power for local authority areas and neighbourhoods.
• undertaking a survey that started on 10 August that asks where people have gone and how many people they have met/spent time with. This uses a standard approach that is used across Europe that translates changes in people's contacts to likely changes in new cases. This should give good forecasts of new cases for Scotland.
• analysing waste water for signals of Covid. This will report on 26 areas around Scotland. Early indications are that it can pick up indications when there are Covid spikes.
• discussing potential additional early warning indicators with UK Joint Biosecurity Centre.

There are well established multi-tiered, multi-agency coordinated approaches to managing any public health outbreaks in Scotland. The procedures used are set out in very well established and effective guidance: The Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams. This guidance is well known and well understood by local health partnerships. It was updated and published again on 14 July to reflect COVID legislation and the introduction of Public Health Scotland. To support the publication of the refreshed guidance, officials have developed a position statement that sets out six steps to surveillance and response. To support the publication of the refreshed guidance officials are developing a position statement that sets out six steps to surveillance and response.

On the basis of the evidence summarised above, the assessment is that this criterion has been met.