Coronavirus (COVID-19): Scotland's route map - supporting evidence for the 30 July 2020 Review

WHO criterion 6: Communities have a voice

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

Informing the Public

Public briefings continue, led by the First Minister and supported by Cabinet Secretaries and 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 focussed 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 motivate the population to comply)
• FACTS (protection messaging)
• 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 an almost constant 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 assets available for download on NHSInform.

Campaigns have additionally targeted a number of different demographics with specific messaging, including:

• General Population – NHS is Open (If it's urgent, it's urgent); Clear Your Head - supporting positive mental health; 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.
• BAME communities – specific Public Health messaging due to poorer cut through of general messaging.
• Renters – supporting tenants concerned about being evicted.
• Those with financial worries as a result of Covid – increasing awareness of benefits and wider financial 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) – 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.

A range of documents has been published as part of the Framework for Decision Making series, These outline the approach and principles that will guide us and the Route Map we will follow as we make decisions about transitioning out of the current lockdown arrangements. They also set out the supporting evidence and analysis which supports the framework and the decisions to move to Phases 1, 2 and 3.

Data on the pandemic has been published on the Scottish Government website daily, and is also available in Open Data format. Findings in modelling the epidemic have also been shared online as well as reports of research on public attitudes and behaviours. Work to improve access to data is continuing.

A dashboard which sets out a clear narrative and provides easy access to consistent data has been published. It brings together disparate elements of evidence to help the public understand the data as they relate to the harms caused by COVID-19.

As the drive to use data to better manage the COVID-19 pandemic increases through the Test and Protect system, there is work underway to bring together system-wide ethical, trusted, safe and effective access to the relevant public service data and intelligence.

Finding out about the public

Marketing activity has been developed following insight-gathering qualitative work 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:

• Campaign awareness for Health messaging has achieved high levels, ranging from 66% to 84%.
• Claimed action (among those who have seen the campaigns) is at very high levels of 85%+ for health related campaigns.
• Trust in advice and guidance has been maintained around 80% (from 73% 7-8^th April).
• Awareness of importance of hand washing/cleaning, physical distancing, and keeping hands away from face has been at 88% and over since tracking of these began.
• Levels of importance (as measured by the proportion saying 'very important') increased for physical distancing, wearing a face covering, avoiding crowded places and self-isolating and booking a test at the first sign of symptoms following the introduction of the FACTS campaign and have for the most part been maintained at higher levels since.
• Perceived importance and usage of face coverings had been increasing but following the new legislation, peaked last week, with 92% saying they wear a face covering at least sometimes (up from 66% the week before).
• Awareness of symptoms has been maintained at more than 80%.

The COVID hub has carried out a range of research, tracking the impact 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 also involved the production of weekly summaries of trends for wider policy/analysis and monthly summaries published for external audiences.

A consultation with stakeholders has been carried out 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. This helped to contextualise the findings from the polling and survey to provide a more rounded understanding of societal impact.

A commission of focused Social Research analysis has been carried out in the Scottish Government to improve the understanding of the impact of COVID-19, which 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, the 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 three times and is due to meet again on 6 August. The role of the ERG is to bring together academics and other experts to advise the Scottish Government in its response to any disproportionate impacts of COVID-19 on ME people. 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 subgroups to explore specific issues such as data, and systemic inequalities; the sub-groups met for the first time on 21 July.

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 the Scottish Government'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.

Across all areas of government, policy teams have continued to engage in discussions with stakeholders from their respective areas to 'take the temperature' regarding the impact of COVID-19 on different communities across the full range of Scottish Government's work to understand the immediate impacts and to better shape future actions.

Understanding the Impact on Children and Young People

Scottish Government teams have worked with partners and stakeholders to understand the impact of COVID-19 on children and young people. A COVID-19 Children and Families Collective Leadership Group has been established in collaboration with SOLACE, COSLA, Police Scotland, Scottish Children's Reporter Administration (SCRA), Children's Hearings Scotland, the third sector, organisations across education, health and social work sectors, and other key organisations. This Group is gathering data and intelligence about the adversities and challenges being faced by children, young people, and families and to progress local and national actions in response. Current key work-streams involve progressing actions on child protection, disabled CYP, domestic abuse, family support, and kinship families.

Additionally, a regular data collection has been established to understand the impacts of COVID-19 on vulnerable children and families, bringing together intelligence from the 32 Chief Officer Groups and national agencies and delivery partners including the third sector, Police Scotland, and the Health Service. The dataset includes key data on what is happening across children's services partnerships to support children and young people on the child protection register, those looked after and on the edge of care, those affected by poverty and those children and disabled young people. This data collection is being complemented by more detailed reports collating latest research evidence and feedback from service practitioners. Three reports have now been published by the Scottish Government to date, with the most recent available online (published 22 July).

Policy teams will continue to gather data on how Covid is affecting the public. Additionally, more qualitative research will be carried out to supplement the quantitative data we are already gathering. This will make links with existing National Performance Framework (NPF) indicators and measures where relevant. As an example, the Social Renewal Advisory Board is working with Poverty Truth Commissions and local community groups to ensure that the lived experience of those most negatively affected by Covid feeds into our work.

Engaging the public

An online public engagement exercise was launched on 5 May and was live until 11 May. In this time, we received more than 4,000 ideas and almost 18,000 comments relating to the Framework for Decision Making and Test, Trace, Isolate, Support strategy. In total, 11,692 respondents registered for this exercise, of whom 3,274 submitted ideas. All comments and ideas published can be viewed on the platform. A full overview of the engagement exercise has been published online. Outputs from the Dialogue exercise directly fed into the development of the Route Map portion of the Framework for Decision Making, published on 21 May.

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. The first meeting was held on 26 June and focussed on the needs for engagement in the short term to support people's participation in managing the pandemic. The next meeting is planned for the week commencing 3 August, and will focus on how best the public can be engaged and involved in the Renew process, looking ahead to the longer term.

Engaging to understanding the impact of Shielding

Up to 30 July, just over 180,000 people have been asked to shield for their own safety in Scotland. From the outset the team leading the work recognised the importance of being effectively connected to the citizens affected by this policy so that the impacts on them could be properly understood.

To do this they established a user design and research team to conduct both in-depth qualitative and quantitative work. As part of that work, they have now identified a citizen's panel of about 3,000 people who are shielding and who will be supporting the development of policy and delivery over the next weeks and months.

The User Centred Design Team engaged with people who are shielding or are caring for someone who is shielding (in-depth interviews – 32, survey – 2217); and six proxy users from third sector and support organisations. They were volunteers who had responded to the Framework for Decision-Making, Social Security Experience Panel members, policy and team member networks and via an external recruitment agency.

The work included both 1:1 in-depth telephone interviews and an online survey. This has meant Scottish Government teams working on delivering support and information to those shielding now have a deeper understanding of the lived experience of the cohort. Insights have informed service and policy design from a user centred perspective in a fast-paced environment.

Alongside this work, health and social care analysts have provided more detailed demographic information on the shielding cohort. This information allows policy teams to better understand the make-up of the group and their particular needs: clinical and wider social, economic, and non-Covid health needs. The analytical team have worked with external partners to ensure quality and up-to-date information is shared and analysed to provide support to policy decision-making.

Public Health Scotland have been commissioned to carry out an evaluation of the shielding programme. This has provided input to policy development, but will also provide a retrospective look at the critical initial stages of shielding, giving lessons learned. A survey undertaken by Public Health Scotland as part of the shielding evaluation received 12,700 responses. It covered questions about shielding behaviour, impacts and opinions and provides an invaluable source of information. A full report will be published in due course.

Engagement with Children and Young People

The First Minister and Scottish Government Clinical Director, Jason Leitch, supported by Young Scot, participated in a number of Q & A sessions, during which they have addressed a wide range of issues raised directly by children and young people in Scotland. Additionally, the Deputy First Minister met with a small group of pupils in June 2020 and he took part in a public "town hall style" online event with parents (reaching more than 4,000 people) to engage directly and hear their perspectives.

A Children, Young People and Families (CYPF) Advisory Group (AG) has been set up to ensure that the voices of those groups considered most vulnerable during the pandemic are able to share their lived experience and to participate in solution-based discussions. The group will support the work of the Covid-19 Children and Families Collective Leadership Group. The group has adopted a rolling chair model to support shared leadership and decision making with Children in Scotland taking on the role for the first three month period. The membership of the Group has been extended to include family focused organisations and representation from The Promise.

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 will 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 establishing 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 determine conditions on whether to re-impose 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. 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 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.

On the basis of the evidence summarised above the assessment is that this Phase 3 criterion continues to be met.