Coronavirus (COVID-19): Scotland's Strategic Framework update - June 2021

The components of our strategic response

1. Vaccination

Progress

Progress on the COVID-19 vaccination programme has been unprecedented. We know that there are pockets within communities that remain to be vaccinated, who have previously not attended appointments or who have declined to do so. We are working with Health Boards and expert stakeholders to identify the reasons for this and to ensure that people who may experience barriers to accessing the vaccine are supported to do so and their concerns are listened to.

Some examples of outreach include offering vaccinations in places of worship and other community settings, providing concessionary bus travel to appointments and working with community representatives to promote the importance of uptake. We also monitor the number of Did Not Attend (DNA) appointments and are working with Health Boards to identify reasons for non-attendance and make changes to our programme to enable people to attend where necessary.

We have opened a digital solution for 18-29 year olds to encourage uptake among this cohort, who can now register online for their vaccination.

Next steps

The Medicines and Healthcare products Regulatory Agency has recently extended the approval of the Pfizer vaccine to include 12 to 15 year olds. We will continue to roll out the vaccination programme in Scotland in line with advice from the JCVI, which advises all 4 Nations across the UK on vaccine deployment and prioritisation. If the JCVI recommends the use of the vaccine for children aged 12 and over, the Scottish Government will move as quickly as practicably possible to implement its advice. For now, JCVI advice is to offer vaccination to all those aged 18 and over, and some people aged 16 and 17 where there is a clinical basis for this. We are ready to vaccinate younger age groups as supply allows, if that is what the clinical and scientific evidence and advice supports.

We also anticipate advice from the JCVI in the coming weeks about the need for a COVID-19 booster campaign from this autumn. Initial planning is underway in anticipation of this, and Ministers will decide the final policy position following advice from the JCVI. In addition, the Seasonal Flu Vaccination Programme begins in October 2021 and will be vital in protecting the most vulnerable and reducing pressure across the NHS. Given the impact of COVID-19 on the most vulnerable in society, it is imperative that we continue to do all that we can to reduce the impact of seasonal flu and COVID-19 on those most at risk.

Our future vaccination strategy will encompass wider vaccination considerations whilst applying the experience and learning that we have gained over the last year as part of our response to the pandemic.

2. Test and Protect

Progress

To ensure that new COVID-19 cases can be rapidly identified to stop the virus spreading, and to support an enhanced response to new variants of concern, we have significantly increased access to testing. In particular, targeted community testing is available in every Health Board partnership area and across Scotland we have established:

• 8 drive-through regional test sites;
• 51 walk-through local test sites;
• 42 mobile testing units, which can be split across two geographic areas, allowing for up to 84 individual deployments.

Free lateral flow home test kits are available for pick-up without an appointment from all local walk-through or drive-through test sites, they can also be ordered online or by phone, and from early June have been available to collect from local pharmacies – for people to test themselves twice-weekly. This universal testing offer is aimed at finding cases that would otherwise go undetected, so anyone testing positive can self-isolate and avoid transmitting the virus to those around them.

In addition, we have provided an additional layer of risk reduction and confidence in workforces and communities by rolling out further testing in settings such as food manufacturing and distribution businesses and across critical national infrastructure workplaces. Healthcare worker testing has also expanded to cover all primary care staff, hospice workers and those who work in critical non-patient facing roles that are essential to keeping health services functioning. Further, schools testing is available in every community for all Early Learning and Childcare and school staff and for pupils in S1 to S6.

Where positive cases are identified through testing, we are advising close contacts to get tested and this has been successful in detecting additional cases, interrupting transmission and ensuring further contacts are identified and advised to isolate. NHS Scotland's sequencing services also continue to grow – with increasing tests from NHS labs being sequenced to determine variants and mutations.

Next steps

Looking ahead to the period beyond Level 0, our testing regime will continue to be flexible and agile to respond to changing circumstances. Decisions about future priorities for Test and Protect will be regularly reviewed in the light of the changing nature of the pandemic in Scotland and we will work closely with NHS Public Health teams and other NHS delivery partners to maintain public confidence and trust in our testing offer.

Contact tracing and testing of close contacts will continue as we move forward through the pandemic, including beyond Level 0. Test & Protect will change as the population becomes more protected by vaccination, but will still play a role in mitigating clusters and outbreaks where they arise, slowing infection spread and protecting populations at risk.

Evidence is emerging that the vaccination programme is having an effect on the link between infection and hospitalisations. As this evidence base develops, we will continue to review whether existing self-isolation requirements remain necessary and appropriate.

We will continue to ensure that people who are asked to self-isolate are supported to do so effectively. We have published research^[8] to inform our future self-isolation adherence strategy and have widened the eligibility for payment of the Self-Isolation Support Grant, which will continue to be paid for as long as necessary. People self-isolating will continue to have access to financial support through the Self-Isolation Assistance Service and practical support from the National Assistance Helpline and Local Self-Isolation Assistance Service.

Surveillance

Progress

Surveillance is a critical part of our approach to monitoring and managing the spread and prevalence of the virus. It helps us to determine the right strategies and timing to manage transmission in the community.

Public Health Scotland is carrying out a range of surveillance work to better understand the spread, nature and characteristics of COVID-19. This includes:

• monitoring NHS 24 respiratory calls, which can provide an early indication of trends in cases;
• swab positivity testing in primary care settings, which widens our understanding of the prevalence of COVID-19 within the community; and
• antibody tests of residual blood samples to better understand the numbers who have had the virus among different groups.

In addition, the Scottish Environment Protection Agency (SEPA), working in partnership with Scottish Water, Public Health Scotland and the Scottish Government, has formed a network to analyse wastewater samples for signs of COVID-19 from over 100 sites across Scotland, covering more than 70% of the Scottish population. Samples from these locations are tested regularly (at least weekly), which can be increased when local outbreaks are apparent. This gives public health teams a further unbiased indication of prevalence which is independent of case numbers, and this data is used as part of Scotland's community testing programme to direct testing resources.

An enhanced Outbreak Management Toolkit was shared with our partners in June and aims to bring together in one place a number of different materials to support outbreak response. It sets out in three clear sections the approach to surveillance, response and decision-making and includes interactive links to relevant practitioner documents and supporting materials. Local Health Protection Teams will continue to apply a range of measures, including more testing, increasing the speed of vaccinations and enhanced communications.

We are also working with the UK Government jointly on a number of areas, including the Office for National Statistics' COVID-19 Infection Survey and undertaking joint analysis across a number of projects through the Joint Biosecurity Centre.

Next steps

To understand longer-term surveillance needs for respiratory pathogens, including COVID-19, we aim to develop and implement a syndromic surveillance approach that aligns with World Health Organisation and European Centre for Disease Control recommendations. This type of surveillance – which we expect to be up and running in Scotland by this winter – will allow us to bolster international comparisons of our approach and will provide a stronger early warning system that supports our response to outbreaks.

In terms of the future for wastewater monitoring, the Scottish Government and partners are managing the rapid development of the programme to assist with the detection and monitoring of variants of concern.

3. Protective measures

Progress

Our strategic approach to outbreak management is based on five graduated levels of restrictions which were first introduced in Scotland in November 2020 and which have evolved as a result of regular review in light of epidemiological conditions. Each of the five levels (0 to 4) comprises packages of restrictions designed to apply different degrees of downward pressure to the R number.

Whilst the levels can be applied locally, regionally or nationally, mainland Scotland and some islands moved 'in lockstep' to join the remote islands in Level 3 on 26 April 2021. Since then, epidemiological conditions have allowed some areas to move faster than others. For example, on 17 May, the majority of Scotland moved to Level 2; Glasgow City remained in Level 3 due to an outbreak, while remote island communities were moved to Level 1 due to very low levels of prevalence there.

From 5 June, 13 mainland authorities remain in Level 2, with Glasgow also moving to Level 2. This decision took into account a range of indicators including current case rates, test positivity, and vaccination rates. A group of 15 mainland authorities moved to Level 1, taking into account lower relative and absolute case numbers, generally higher vaccination rates, low hospital occupancy in the relevant Health boards and low mortality. A number of more remote islands moved to Level 0, taking into account the previously listed indicators, as well as the generally lower level of travel to and from these areas, compared to mainland areas, and the provision of testing for people travelling to these areas.

Next steps

Figure 10 shows the anticipated progress through the Levels and beyond Level 0.

Figure 10: Future plans for easing restrictions

Transition through Levels, as data indicates it is safe to do so

Level 2

• Increase to public indoor/outdoor socialising numbers.
• Restricted in-house socialising allowed. In-house physical distancing not required for friends/family.
• Indoor hospitality operating hours increase with 2 hour pre-booked slots. Alcohol permitted indoors.
• Can travel anywhere in Scotland between Levels 0, 1 and 2.
• Travel to England, Wales, NI, Isle of Man and Channel Islands permitted subject to any travel restrictions.
• Colleges and universities move to a blended learning approach.
• All organised sport activity permitted except adult indoor contact sports.
• Work from home where possible.
• Stadia can open. Events allowed (subject to attendance limits).
• Soft play and nightclubs remain closed.

Level 1

• Increase to public indoor/outdoor socialising numbers.
• Capacity at weddings and funerals increases.
• Hospitality operating hours increase. Socialising capacity rules apply.
• Stadia and events capacity increases.
• Indoor organised adult non-professional performing arts activities permitted.
• Soft play can open.
• Nightclubs remain closed.

Level 0

• Increase to public indoor socialising numbers. Outdoor socialising numbers removed.
• Increase to in-house socialising numbers.
• Capacity at weddings and funerals increases.
• Local licensing conditions apply for hospitality operating hours. Socialising capacity rules apply.
• Unrestricted care home and hospital visits subject to local health protection advice.
• Adult indoor contact sports no longer prohibited.
• Phased and limited return to offices can now begin.
• Stadia and events capacity increases.
• Nightclubs remain closed.

Beyond Level 0

Gateway condition: all adults over 40 protected with 2 doses of the vaccine.

• Vaccines protect health and reduce transmission.
• Levels restrictions lifted.
• Measures to reduce importation of the virus remain in place for as long as necessary.
• Guidance and support helps people, organisations and businesses to manage transmission risks.
• Test and Protect capacity and self-isolation support stay in place for as long as necessary.
• Care and support is provided to mitigate harms and drive recovery from the crisis.
• Guidance to maintain high levels of personal hygiene and respiratory etiquette remains.

All measures within the levels will be kept under review to ensure they remain necessary and proportionate to support the ongoing COVID response.

Please check Coronavirus in Scotland to ensure you are viewing the most up-to-date information and guidance about coronavirus.

Please check Coronavirus (COVID-19): shielding advice and support for extra advice at all Protection Levels for people at the highest risk from coronavirus (people on the shielding list).

Looking forward, we expect that the role of restrictions in managing the epidemic in Scotland will be significantly reduced as the protective effect of the vaccine both reduces the direct health harms of the virus and helps to reduce transmission.

However as we move beyond Level 0 we must still ensure that sufficient measures are in place to manage the spread of the virus.

It is difficult to predict accurately which set of baseline measures or behavioural changes will be the most successful in the future. Some measures have a greater epidemiological impact than others, with the impact of each measure depending on the context in which it is implemented, how it is implemented, and interactions between sets of interventions.

As such, measures cannot be considered in isolation and rather, should be seen as an interactive package or set of levers to engage in different ways and at different times. More generally, we believe that the adoption of some public health measures (such as the FACTS) have suppressed other health harms such as seasonal influenza and norovirus. So continuing these measures could lessen the impact of these other viruses as well as protect us from COVID-19 itself.

In considering future baseline measures to retain beyond Level 0, we will take account of social and economic factors as well as the epidemiological impact on transmission and will keep measures under review. As has been our approach from the outset, we will continue to use evidence and judgement to ensure all our decisions are necessary and proportionate.

There are, however, some baseline measures which we currently expect to retain even as we move beyond Level 0. These include:

• Good hand hygiene and surface cleaning.
• Continued promotion of good ventilation.
• Requirement for face coverings in certain settings (e.g. public transport, retail).
• Continued compliance with Test and Protect, including self-isolation when necessary.
• Ongoing need for outbreak management capability, including active surveillance.
• While we will work with business to support a phased return to office working from level 0 onwards, we will continue to encourage a greater degree of working from home than pre‑COVID-19. Where this is possible and appropriate, it will not only assist with controlling transmission of the virus, but also promote wellbeing more generally.

We intend to encourage continued support for home working where possible and appropriate. We recognise the economic and social benefits of people being able to meet and work together in offices and in urban centres but also recognise the importance of home working as a means of reducing transmission and the wider benefits from home working that have been demonstrated during the pandemic.

As we transition to a stage where levels restrictions are lifted, we will continue to provide advice that will help people to understand the risks involved in mixing in different settings and to exercise good judgement in light of these risks. We know, for example, that close contact with others (particularly indoors) represents a high risk of transmission and that ventilation reduces the concentration of viral load in the air where the virus is present. Therefore, it will continue to be important to consider keeping a safe distance from others, meeting outside where possible and to ensure good ventilation in all indoor settings when socialising, including at home.

We are assessing whether COVID-19 status certification would be appropriate in any domestic settings, to support the opening up of the domestic economy, taking account of ethical, equality, clinical and logistical issues and our broader strategy. We will not use certification in Scotland unless we can address the ethical and equality issues that have been raised by experts. We will take account of learning gained from trial use of COVID-19 certification at large events in England as part of Phase 3 of the Events Research Programme.

Physical distancing

We recognise the significant adjustments that businesses and other organisations have made to adhere to physical distancing measures, as well as the major disruption to people's lives caused by social distancing measures. We also continue to monitor the developing evidence base around physical distancing and to take account of the new Delta variant, with its increased transmissibility. And, as discussed above, we continue to assess the balance of harms, particularly as increasing vaccination roll-out has a positive impact in terms of reducing both transmission risk and the risk of serious disease.

Following a review of the physical distancing requirements, we will cautiously ease these restrictions to enable the economy and society to operate in a less restricted way, as set out below. This will build on our updated guidance on physical distancing in indoor and outdoor private settings, which outlines that friends and family do not need to distance from each other in private indoor or outdoor settings in areas subject to Level 0, 1 or 2 measures.

• From 19 July, should the data support it, in all public indoor settings, people within gatherings which respect the permitted number and household limits would no longer be required to physically distance from the members of their gathering/group, but would be required to maintain a distance of at least 1m from all others. Outdoor physical distancing rules would be removed.
• When the gateway condition is met, with an indicative date of 9 August, physical distancing requirements would be removed – indoors and outdoors.

4. Managing the risk of importation

Progress

We know from experience that one of the greatest risks to suppression of the virus is importation from abroad.

Measures remain in place to manage the risk of importation from other countries. Whilst we still strongly advise against international travel due to the risks involved, progress in tackling the virus has enabled us to introduce the traffic light system for international travel, enabling some non-essential travel to restart. Using the latest evidence, countries are assessed by risk in order to determine testing and isolation measures for international arrivals. Arrivals from countries and territories deemed to pose an 'acute risk' remain in managed isolation for 10 days.

Next Steps

Testing remains a crucial part of our policy and we are exploring options to expand the options available for arrivals. Work continues to ensure we keep pace with vaccine certification developments and that our solutions meet international standards.

Wherever possible, we continue to seek to an aligned approach to our decisions with the other governments within the Common Travel Area (CTA) but, if we need to, we will make the decisions that are right to protect Scotland.

There are likely to be targeted restrictions on overseas travel beyond Level 0. However, we will keep restrictions in place only for as long as necessary to respond to the threat of importation. These restrictions are reviewed regularly and will be relaxed when it is safe to do so.

Planning is underway to ensure longer-term solutions are in place to support the Managed Quarantine Service, as well as the monitoring of compliance for those travellers arriving from countries where self-isolation at home is required.

Since 19 May 2021, people in Scotland have been able to get a paper copy of their vaccination record if it is needed for international travel. The permanent solution will take the form of an App with a paper option for people who are not digitally enabled. This will be developed in line with the draft data standards in the WHO smart vaccination programme, which is being refreshed to include negative testing and natural immunity to provide COVID-19 status verification. The system will be fully interoperable with all countries in the Common Travel Area.

Local travel restrictions are currently linked to Levels that are applied across Scotland (and rates of incidence elsewhere in the UK/CTA that are broadly comparable to those informing Levels in Scotland). Moving beyond Level 0, travel within the CTA will probably need to be restricted only where significant hotspots emerge (the likelihood of which should decrease as a greater proportion of the population is vaccinated).

5. Supporting adherence

Progress

Adherence to protective measures plays an important role in supporting our strategic approach and self-reported understanding of measures and adherence to them remains relatively high. Recent polling shows 78% of people agree they feel clear about what is required of them under current restrictions. Self-reported levels of high and complete adherence stand at 69% and 28% respectively, consistent with levels since the end of March 2021.^[9] We recognise that following protective measures can be difficult and we have continued to provide support and encouragement for everyone to do so.

Our values-based communications strategy, 'We are Scotland', has motivated citizens to play their part in suppressing the virus and to keep each other safe during the pandemic and we continue to support vulnerable audiences and communities through signposting to critical services. Our current 'Not Giving In' marketing campaign encourages the public to keep sticking with protective measures, even when they have been vaccinated. This marketing activity is supported by news updates and guidance which is provided in a range of languages and accessible formats, both in print and online.

We recognise that businesses have spent a lot of time and money on developing their practices and systems to make their premises as safe as they can be. We welcome their ongoing commitment to protecting their staff and their customers, which contributes to our collective action to suppress the virus.

We have supported businesses to adhere to regulations and guidance through: updating sectoral guidance; the publication of sector advice cards; the publication of a workplace compliance self-assessment tool^[10] and the roll-out of the Check in Scotland (QR code check-in/out) platform for the collection of contact details.

We also continue to work closely with Environmental Health Officers (EHOs) and Trading Standards Officers to ensure that they have appropriate powers to effectively enforce regulations. We are working with local authorities and EHO representatives to help them to anticipate demands and manage priorities. We have also helped local authorities to recruit additional staff to carry out essential safety checks.

Next Steps

As the vaccine continues to roll out and as restrictions relax, we will continue to monitor public attitudes and behaviours using fortnightly polling. As we move beyond Level 0, it will become increasingly important to empower people to make informed decisions on COVID-19 risk, to keep themselves and others safe.

Going forward, we will continue to improve the Scottish Government website to ensure that public health guidance is as clear, user-focussed and accessible as possible. Our summer marketing campaign will also provide information on making safer choices in a range of different settings and it will encourage employers and employees to continue to work together to minimise transmission risks.

We will also continue to work with business to support ways to help employers to enhance employee and customer adherence to protective measures. This includes creating additional employee training material on COVID-19 safety, drawing on the successful SportScotland COVID-19 e-learning training module^[11] which has been completed by almost 40,000 people.

6. Providing care and support to mitigate the harms of the crisis

The COVID-19 pandemic and the associated restrictions have had a profound impact on our health, economy and society, with damaging impacts on the way of life, human rights and wellbeing of people in Scotland. Protecting and supporting people during these unparalleled times has been the focus of the Scottish Government, and that will continue. The recent Priorities for Government statement puts leading Scotland safely through and out of the pandemic at the centre of these plans, with a focus on improving the lives of the people of Scotland.^[12]

The section below gives an overview of some of our actions to alleviate the Four Harms, since publication of the updated Strategic Framework in February 2021, setting out how we are supporting particular groups and sectors. Because of the extensive range of our response, the examples below are summary and illustrative and are not exhaustive.

Harm 1: Suppress the virus, protecting against the direct and tragic harm to your health

COVID-19 treatments

Progress

NHS Scotland has been actively participating in work to evaluate the efficacy of potential therapies for COVID-19. An example would be the participation of Scottish sites in the recovery programme which focuses on those hospitalised with the disease. ^[13]

NHS Scotland has worked at pace to roll out new treatments where efficacy has been demonstrated. This work is led by the Chief Medical Officer and can be demonstrated by COVID-19 Therapeutic Alerts.^[14]

We have rolled out innovative approaches to service design, including the development of new pathways of care for people with COVID-19. For example, we have rolled out new remote monitoring services for people to use in the community.

All this work has been evidence-led and based on a strong foundation of clinical input. Clinical advice for Scotland has been produced at a rapid pace and is available through the Scottish Intercollegiate Guidelines Network.^[15]

Next steps

The Scottish Government continues to closely monitor all emerging evidence on the effectiveness of COVID-19 treatments and their clinical effectiveness in particular patient groups. As yet, there are no preventative medicines to manage COVID-19, only reactive treatments to help manage symptoms. At this time, these treatments are: dexamethasone, hydrocortisone, remdesivir, tocilizumab, sarilumab and budesonide. With the exception of budesonide, all other treatments are administered in hospital.

Budesonide is the first COVID-19 treatment for use in the UK within a primary care/community setting to those aged over 50 years of age who have tested positive for COVID-19.

There are a number of treatments currently in clinical trials which may be used in primary care if they prove to be successful. These include interferon, invermectin and monoclonal antibodies. A UK national clinical expert group has been established to provide clinical guidance on the use of these treatments in the treatment of COVID-19. The Medicines and Healthcare products Regulatory Agency (MHRA) continues to review the emerging body of evidence regarding potential medicines for treatment or prevention of COVID-19. The Commission on Human Medicines has convened a COVID-19 Expert Working Group that meets on a regular basis to review the latest developments and advise the MHRA.

Long COVID research

Progress

To support the implementation of the clinical guidelines on the long-term effects of COVID-19 ('Long COVID'),^[16] we are working with specialist clinicians to provide practical information for primary care teams on the identification, assessment and support of people with the condition.

We have published information and advice for people with Long COVID on NHS Inform,^[17] and are working with NHS 24 to broaden the range of resources that are available on the platform and improve their accessibility.

We have provided over £460,000 to enable Chest Heart & Stroke Scotland to develop its 'Long COVID Support Service'. This will provide advice and support to people living with the condition.

Next steps

Our Chief Scientist Office is funding Scottish-led research projects on the longer-term effects of COVID-19.^[18] These projects cover a wide range of approaches and address questions that will greatly increase the clinically relevant knowledge base on long-term effects of COVID-19 infection.

With the support of the Chief Scientist Office and NHS Research Scotland, the Scottish medical research community continues to participate in a range of clinical trials to evaluate the effectiveness of vaccines and treatments for COVID-19.

Support for those at highest clinical risk

Progress

We have continued to protect and support people at highest clinical risk from COVID-19 over the past months. The support available to people on the shielding list has included:

• Letters from the Chief Medical Officer that acted as a fit note for people in Level 4
• An SMS text messaging service that provides information including signposting to support or highlighting local changes in advice
• Access to priority supermarket delivery slots
• A helpline which connects people to Local Authority support on food, medication and other essentials as well as practical and emotional support
• A risk assessment tool and guidance on safe workplaces for people at high risk
• Local neighbourhood data on COVID-19, hosted by Public Health Scotland
• Extra clinical advice aligned to each level about going to shops, work, education, and social contacts
• Priority vaccination for adult household members of adults on the shielding list
• Encouragement to access lateral flow device home testing for adult household members of people on the shielding list

Next steps

The vast majority of people on the shielding list have now had two doses of the vaccine. We are working to understand how vaccination changes our definition of who is at highest risk and while some people may now have enough protection to be removed from the shielding list, the evidence is not yet conclusive for some groups. This could include people with weakened immune systems, people who are very old and/or very frail, as well as people who cannot be vaccinated, or people with certain conditions who might be hesitant to take the vaccine. Until we have enough evidence, we are asking people to continue following the advice and for the wider public to recognise that there do remain individuals in our society who are at high risk from COVID-19.

This understanding of who remains at highest clinical risk from COVID-19 will help with any future booster vaccination prioritisation, and will allow us to contact and advise people in the event of local outbreaks. It will also help us to provide protection and support such as fit notes, if necessary, in the event of local outbreaks, or to prioritise any potential future preventative COVID-19 treatments.

Harm 2: Support broader health, protecting our health and social care services, and your health and wellbeing

Mental Health

Progress

We know the pandemic has exacerbated pre-existing structural inequality in society, putting some communities disproportionately at risk and having more adverse impacts on the mental health of some groups of the population. Our Mental Health -Transition and Recovery Plan, published in October, commits to making the mental health of these groups a priority.^[19]

The Plan is supported by a £120m Recovery and Renewal fund, announced in February, to transform services, with a renewed focus on prevention and early intervention. NHS Board allocations of £34.1m have already been agreed to deliver:

• Improved community Child and Adolescent Mental Health Services (CAMHS);
• Expansion of community CAMHS from age 18 up to the age of 25 years old for targeted groups and those who wish it; and
• Clearance of any waiting list backlogs for CAMHS and Psychological Therapies (recognising that this may take up to two years).

Next steps

We have committed to increase the direct investment into mental health services by at least 25% and ensure that, by the end of the parliament, 10% of our frontline NHS budget will be invested in mental health services.

The Plan lays out specific actions, including engaging with women's organisations to better understand and respond to gender-related mental health inequalities and actions to address the needs of those with long-term physical health conditions and disabilities. This includes working with employers, disabled people's organisations and trade unions to mitigate the potentially negative impacts of home working on mental health.

We have established an Equality and Human Rights Forum to provide advice on the implementation of the Transition and Recovery Plan and wider equalities work within mental health policy. This includes representation from women, disabled and LGBTQ+ groups. The first meeting of the Equality and Human Rights Forum was held in February and we are now engaging with organisations to better understand and respond to the mental health inequalities that have been exacerbated by COVID-19.

Mobilisation of health and social care services

Progress

Over the first year of the pandemic, we allocated an additional £1.1 billion to support the health and social care sector to manage the pressures of COVID-19.

Re-mobilise, Recover, Re-design: The Framework for NHS Scotland^[20] was published on 31 May 2020, setting out how Health Boards will follow national and local clinical advice to safely and gradually prioritise the resumption of paused services.

The Framework is designed to protect the on-going delivery of our highest priority services, e.g. urgent and emergency care needs, cancer and other critical services, alongside the pandemic response, and provides the context for Health Boards' own Remobilisation Plans.

Next steps

It is now time, cautiously and safely, to begin to restart as many aspects of our NHS as is possible. As we move forward into the next phase of mobilisation, we will continue to safeguard robust COVID-19 resilience and support for social care, whilst working with Health Boards and their planning partners on how paused services across the whole system will be safely and incrementally resumed.

The First Minister committed to publish a NHS Recovery Plan within 100 days of the latest Parliamentary term. This is in development and we are taking into account the additional capacity and resources required for its effective implementation.

As part of the overall Recovery Plan, we will drive forward the delivery of transformational change and improvements to services to reduce waiting times for patients. This includes delivering nine National Treatment Centres (NTCs), which will deliver services and significantly increase capacity across 14 specialties, and accelerating the recruitment of at least 1,500 additional frontline staff for the NTCs by 2025/26. We will also implement Early Cancer Diagnostic Centres and optimal pathways for patients.

Our Recovery Plan will also focus on improving and streamlining unscheduled care flows to manage demand and reduce occupied hospital bed days to build capacity for recovery. A Strategy for Unscheduled Care will support the overall Recovery Plan, with the aims of providing care as close to home as possible, reducing hospital attendances, avoiding admissions and optimising overall length of stay.

Hospital Visiting

Since April we have moved to a situation where every patient in Scotland is entitled to at least one visitor, no matter which level their local authority is in. More visitors are allowed as restrictions ease in each area, with the expectation that ultimately full person-centred visiting will be reinstated across Scotland.^[21]

Social care

Progress

We published Open with Care – supporting meaningful contact in care homes^[22] on 24 February to support services to safely resume indoor visiting. On 17 May we published additional guidance on outings from care homes which stresses that residents should be supported to go on outings away from the care home, in line with general COVID-19 restrictions for their local area, unless there is clear evidence justifying a more restrictive approach.

Next steps

To ensure our social care system consistently delivers high quality services across Scotland, we intend to establish a National Care Service. The National Care Service will require legislation and we will soon start consultation on this with a view to introducing a Bill in first year of the Parliament. We are committed to giving a strong voice to those who rely on social care, unpaid carers and the workforce listening to their needs and acting on what they tell us.

The National Care Service will oversee the delivery of care, improve standards, ensure enhanced pay and conditions for workers and provide better support for unpaid carers.

As part of a rights-based approach to care, we will strengthen residents' rights in adult residential settings. This will include delivering 'Anne's Law' – giving nominated relatives or friends the same access rights to care homes as staff while following stringent infection control procedures, as called for by Care Home Relatives Scotland

Harm 3: Mitigate social harms, protecting against broader harms to your way of life

Young People

Progress

Younger people have often been seriously affected by this pandemic. Consequently, we have been working with employers and young people to deliver the Young Person's Guarantee. The pandemic has also exacerbated pre-existing structural inequality in the labour market, therefore the Guarantee has equality and fair work at its centre and we have published an Equalities Action Plan^[23] to ensure that no one is left behind.

Our delivery partners are now returning to more face-to-face support, in line with safer workplace guidance, and with the economy opening up we are anticipating that more employers will offer workplace training opportunities and employment, including apprenticeships.

Next steps

Building on our existing investment in education, skills and training we announced in March a further £70m for the Young Person's Guarantee for 2021/22. Our new lead Minister for this work has committed to:

• investing £45m for local partnerships to provide training and employer recruitment incentives for young people;
• funding colleges to deliver around 5,000 more short, industry-focused courses;
• rolling out school coordinators across the country to support young people to access education, work or training; and
• establishing a new graduate internship scheme and increasing places on volunteering and third sector programmes.

Schools

Progress

We prioritised a return to in-person learning for children and young people as we emerged from lockdown in 2021.

To date, we have committed more than £400m to support schools and families during 2020/21 and 2021/22, particularly with required safety mitigations, the challenges of remote learning (including recruitment of additional staff, additional digital devices, and additional family support and continuing our work to close the school attainment gap), and through the continued provision of free school meals. For example, over 1400 teachers and over 200 support staff have been recruited in the 2020/21 school year, and around 70,000 devices and 14,000 connectivity packages have been distributed to learners across Scotland to date.

Next steps

Continuing to deliver excellence and equity, despite the pandemic, with the health and wellbeing of pupils at the forefront of the plans, continues to be a priority.

Recently announced wide-ranging plans for education recovery in the first 100 days of government and beyond include:

• investing over £1bn to close the poverty related attainment gap
• recruiting 3,500 additional teachers and classroom assistants
• ensuring every school child has access to the technology they need to support their education
• making free school lunches available to all P4 children before extending to all primary school children, all year round
• increasing the school clothing grant and the Best Start Food grant
• expanding free early learning and childcare and developing the provision of wraparound care and after-school clubs
• providing interim support – including a £100 payment near the start of the summer holidays – for eligible children before the formal expansion of the Scottish Child Payment next year.^[24]

Further and Higher Education

Progress

We have recognised the particular impacts of the pandemic on students and have taken steps to mitigate this. For example, we have extended provisions until September 2021 which allow students in university/college halls to give 28 days' notice to end their tenancy, in line with the private rented sector.

The support provided to students over the course of the pandemic has been substantial with now over £96 million being provided via hardship funding, digital access, mental health support and for student associations.

Next Steps

In March 2021 and in collaboration with the Learner Journey Task Force, a course completion package for higher education students was announced to support extended study requirements to complete courses or placements (usually over summer) due to COVID-19 disruption. This provides non-repayable payments of up to £1,600 for up to 16 weeks. The Scottish Funding Council has committed to continue payment of weekly bursary awards for further education students extending study into the summer period to complete courses.

An additional £4.4m was announced for college staff and student mental health for 2021/22 and the Scottish Government has also supported the National Universities Scotland "Think Positive" initiative, which now has a COVID-19 focus.

In June, we established a new Summer Student Support Fund of £20m for students unable to find work in the months they do not receive student support.

Enhanced Summer Offer for Children and Young People

All children have been affected by the pandemic, with strong evidence that some children have had worse experiences, exacerbating inequalities. After seeking views from children and young people directly, and recognising the impact the pandemic has had on children's rights generally, particularly around ability to socialise with friends and family, an enhanced programme of summer activities, including digital activity, has been developed which has a specific focus on mental health and wellbeing, through a £20m investment. A Scottish Government marketing campaign will help partners and local authorities to promote the opportunities available to children and young people in their local area as well as to signpost to online resources.

Social Renewal

In June 2020 Ministers created the Social Renewal Advisory Board, which published its independent report in January 2021.^[25] The report offers a bold roadmap to ensuring that reducing poverty and disadvantage, embedding a human-rights based approach and advancing equality is central to our rebuilding post-pandemic.

Our initial response to the report, published in March 2021, outlines the work already underway to address the Board's recommendations and announced additional investment of £25m to take forward a number of actions.^[26] We are committed to ensuring that our renewal ensures a Fairer Scotland for everyone, no matter their circumstances.

Housing

Progress

We are deeply aware of the financial difficulties facing many people as a result of the Coronavirus crisis, and are doing all we can to support them. We have made clear since the start of the pandemic that taking eviction action against those who have suffered financial hardship should be an absolute last resort, and have put legislation in place requiring private landlords to work with their tenants to manage rent arrears before seeking eviction. We also have emergency legislation in place to extend the notice period a landlord must give, and to enable the First-tier Tribunal for Scotland (Housing and Property Chamber) to take all the circumstances into account in repossession cases.

We have provided support totalling £29 million to tenants during the pandemic, including a £10 million interest-free tenant hardship loan scheme for people struggling with rent because of changes to their finances, and money for discretionary housing payments to those needing help with their housing costs.

Next Steps

The experience of the pandemic has shown us what is possible when we work collectively, and has increased our determination to end homelessness and rough sleeping. Drawing on what we have learned from the crisis, we and our partners in local authorities and the third sector will build on this momentum. In 2021-22, we will provide over £12 million to support this work, with an emphasis on the prevention of homelessness and specific actions to scale up Housing First more rapidly; end the use of communal night shelters; advance legislative protections for people experiencing domestic abuse; and explore alternative routes to reduce migrant homelessness.

Justice

Progress

Across the wider justice system, we recognise the pandemic has had considerable impacts. As the criminal justice system recovers from the pandemic, we aim to build a justice system that is fit for the future. We established a Recover, Renew, Transform Programme, to consider proposals for recovery and reform of the justice system, including greater use of digital tools, support for victims and witnesses, and ways to prevent repeat offending and manage the prison population, through more effective community-based interventions.

Next Steps

This year we will make an additional £50 million available to this programme to increase capacity across the system. The Scottish Courts and Tribunals Service plan to commence their court recovery programme from September 2021, which will include the expansion of remote jury centres and an increase in court capacity. Wider costs across the justice system, including prisons, community justice and legal aid, have been recognised and allocated funding to ensure a balanced recovery across the whole system.

Consistent with the wider community, the prison service is now gradually and cautiously lifting regime restrictions that were necessary to protect the health and wellbeing of those who live and work in our prisons. From 26 April, the prison service has enabled greater access to in-person visits in establishments with robust local risk assessments in place and implementation of protective measures for staff, prisoners and visitors.

Harm 4: Support the economy, mitigating the devastating impact for business

Progress

Since the start of the pandemic, businesses in Scotland have directly benefitted from £3.6bn in support from the Scottish Government – more than a third of total COVID-19 funding – £2.6bn in grants and £965m in COVID-19 non-domestic rates reliefs.

The Strategic Framework Business Fund – providing grants of up to £3,000 every four weeks – gave us the flexibility to respond to the evolving nature of the pandemic by providing ongoing support to businesses legally required to close or to modify their operations. The last payments from the fund were made in April 2021 and support was front-loaded to help businesses to re-start as restrictions eased further.

Retail businesses were eligible for grants up to £7,500 and hospitality and leisure businesses were eligible for grants up to £19,500, with a smaller retailer receiving more than three months' grant, and a larger hospitality business receiving more than six months' grant in April.

Our funds have generally been targeted to the specific sectors and businesses most impacted by COVID-19 restrictions and we have also increased the Local Authority Discretionary Fund from £30m to £120m to ensure that local authorities can direct funding to specific groups or sectors in their local economies which are in most in need of additional support.^[27]

That support for business resilience offered by Scottish Government sits alongside UK Government financial support schemes, including the Coronavirus Job Retention Scheme (CJRS). Scottish Ministers have consistently called for the CJRS to remain in place for as long as it is needed. It must also be clear to businesses and workers, well in advance of the furlough scheme ending, what further assistance will be in place – to support jobs and necessary labour market transitions in sectors that are most deeply impacted by COVID-19.

Our recent focus has been on supporting businesses directly impacted by local restrictions. Moving forward, we will work with business leaders and representatives to transition from supporting business resilience to focus more on targeted support for economic recovery.

Working at home has been a vital mitigation to control the spread of COVID-19 as it has prevented the need for a large number of people to travel and interact in person. This has, in turn, allowed us to control the virus enough to allow for the reopening of various areas of the economy and allowed for other parts of life to return to more normality. We recognise, however, the impact that working at home has on the mental health of employees and some potential challenges around productivity. We also recognise that businesses have spent a lot of time and money ensuring that offices are as safe as they can be and are very grateful for that work.

Next steps

We have committed more than £1.2bn since March 2020 to drive economic recovery. We will launch a 10-year National Strategy for Economic Transformation. This Strategy will set out the steps we will take to deliver a green economic recovery and support new, good, green jobs, businesses and industries for the future. We will also work with industry, trade unions and economists to create a new Council for Economic Transformation to shape this strategy and guide its implementation.

In addition, the second phase of the National Transition Training Fund will provide up to £20m to enable people to retrain and is targeted at sectors which need support to recover from the pandemic or to fill identified skills shortages.^[28]

We want to encourage pioneers and entrepreneurs to help reshape the Scottish economy, creating the best conditions for them to seize the opportunities to produce, to invent and to scale up, and in so doing, create secure and satisfying jobs which pay a fair wage. That is why as part of the Economic Transformation, we will deliver a National Challenge competition, providing funding of up to £50m to the project or projects with the greatest potential to transform Scotland.

We still believe that working at home is an important element of minimising the spread of the virus and we would strongly encourage businesses to continue to support staff to work at home some of the time. However, we also recognise that businesses are best placed to understand how their operations work most effectively and also understand their employees' needs and requests for flexible working, based on consultation with staff and unions.

We will therefore work with business organisations to make the guidance on returning to offices, as we move to Level 0 and beyond, as simple as possible and allow individual businesses to determine what flexible working practices work for them and their staff, while recognising the strong encouragement from Government to support working from home.