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

Providing care and support to mitigate the harms of the crisis

A key element within our approach to managing the pandemic is the provision of care and support to those people, organisations and businesses affected by the crisis. This requires partnership working across all levels of government and the public, private and third sectors. In this section, we outline some of the types of care and support provided for different groups and sectors and more general activity to mitigate the harms of the pandemic. Though it is not exhaustive, it gives a good impression of the scale and range of such activity across our public services, the economy and society more generally.

Treatments for COVID-19 in hospital

The link between cases and serious disease including hospitalisation and death has been significantly weakened by the vaccine but not completely broken. The surge in cases in August and September 2021 translated into high levels of both COVID-19 hospital admissions (peaking at over 150 per day) and COVID-19 bed occupancy at a time when hospital pressures were already significant.

Improvements in the management of COVID-19 in hospital and novel treatment approaches that have been informed by new research have helped to manage the severity of symptoms and in many cases now prevent the escalation of care needs to intensive care (ICU). These have included safer approaches to respiratory support with oxygen and steroids and enhanced monitoring.

NHS boards have flexed and adapted to rising demand and created safe pathways for patients being admitted to hospital which have reduced the risk of transmission of the virus within hospitals. Boards have expanded ICU capacity as they have needed to do to adapt to the demand for more beds although the rate of admissions has not reached the levels seen at the peak of March 2020.

We have offered boards additional support as part of our £300 million package over the winter to help them facilitate and support discharge for patients from hospital and create additional capacity over the winter months ahead, when general admissions are expected to be higher.

We will offer new treatments as they become available to treat the infection. These include the new antiviral drugs that have been developed to directly tackle the virus as well as immunological treatments that help those with a weakened immune response or increased vulnerability. We are creating clinical pathways to make these new treatments available for those who need them.

In addition we have indicated our willingness to participate in UK-wide trials of developing antiviral treatments that may help reduce the severity of disease or speed up recovery. Whilst the benefits of individual drugs cannot be guaranteed ahead of clinically-led scientific research, we are willing nationally to be at the forefront of testing and deployment of treatments that are shown to be of benefit to patients and continuously supporting our highly skilled NHS workforce to improve outcomes for patients.

Non COVID-19-related challenges faced by the NHS in Scotland include staff availability, delayed discharges and higher levels of attendances at A&E, which is adding to delays at the front door and longer lengths of stay. To support the whole healthcare system going forward, the NHS Recovery Plan has a focus on recovering elective care, but also includes plans for the development of new and innovative ways of working through the Centre for Sustainable Delivery, and for increasing capacity through the creation of new National Treatment Centres taking the total to 10 across Scotland with the accompanying recruitment of 1,500 staff.

On 5 October the Scottish Government announced significant new investment to help get people the care they need as quickly as possible this winter. This included specific funding of £300 million to support winter pressures such as elective capacity and delayed discharge. Within this funding is an ambitious plan to recruit 1,000 extra carers and up to 200 nurses to support frontline services, in addition to funding for transitional care placements and community multidisciplinary teams to help support people at home.

Long COVID

While most people's symptoms of COVID-19 resolve within a few weeks, some people experience persisting or new symptoms after their initial infection with the virus. NHS Scotland continues to deliver its full range of services to support the needs of people with long COVID. Our response to long COVID depends on having a range of well-integrated sources of support, given the wide spectrum of needs that people affected can sometimes have.

In September 2021 we published a paper outlining our approach and commitments to improving care and support for people with long COVID in Scotland. Our approach is based on maximising and improving the broad range of existing services across our health and social care system and third sector that are relevant to the spectrum of symptoms that people are experiencing.

Through the £10 million long COVID Support Fund that we have established we will provide NHS Boards with the resource they require to respond in a flexible and tailored manner to the needs of people with long COVID. The fund will support local services to develop and deliver the best models of care appropriate for their populations.

We have published information and advice for people with long COVID on NHS Inform and have undertaken a public awareness campaign to support people to access relevant information and advice. We continue to support the implementation of the clinical guidelines on the long-term effects of COVID-19 ('long COVID'), including through integration with the SIGN Decision Support web platform and app.

Research is essential if we are to develop novel and effective approaches to the diagnosis and treatment of long COVID. £2.5 million of funding has been committed to funding nine new research projects across Scotland through the Chief Scientist Office's Long Term Effects of COVID-19 Infection Call. These projects will greatly increase the clinically relevant knowledge base on long-term effects of COVID-19 infection.

We will continue to work closely with NHS Boards and third sector and other partners to fulfil the commitments outlined in the approach paper.

People on the Highest Risk List

We will continue to provide advice and guidance to help everyone on the Highest Risk List manage their own risk and transition back to a more normal way of life, as well as supporting people on the list for whom the vaccine may not be as effective to make the right decisions to keep themselves safe.

As evidence continues to emerge, we are gaining a better understanding of how vaccination changes our definition of who is at highest risk. Early evidence suggests that the vaccine is just as effective for the majority of those on Scotland's Highest Risk List as for the rest of the population. But the evidence does highlight that is not always the case for people who are severely immunocompromised or severely immunosuppressed, which is why we have followed JCVI advice to offer everyone in Scotland in those categories a third dose of the vaccine.

The make-up of the Highest Risk List in Scotland will evolve based on emergent evidence and the deployment of the University of Oxford's QCovid tool. Some people may no longer be at highest risk from COVID-19 post-vaccination, and we will continue to support those people as they are removed from the Highest Risk List.

For people for whom the evidence is inconclusive, or who remain at highest risk, our support will be person-centred. The advice of clinicians and GPs is paramount, as they and the individual know their condition and personal circumstances best. Many people in this group would have taken additional steps to reduce their risk as a result of their health condition even in a world without COVID-19.

We will continue to provide advice on mental health support and services to people on the Highest Risk List. We know the pandemic has disproportionately affected the mental health and wellbeing of those at highest risk and we will continue to talk and listen to users to gain insight into their ongoing support needs.

Families

We recognise the significant impact that the pandemic has had on the wellbeing of families across a broad spectrum of issues.

In 2020, in response to the pandemic, and in the context of The Promise, the COVID-19 Children and Families Collective Leadership Group (CLG) identified the priority need for a step change in how families access and receive support. It developed a vision and blueprint for Family Support which noted that:

all families need support sometimes and we want families across Scotland to be able to access the support they need where they need it, when they need it and for as long as they need it, to protect and promote children and young people's wellbeing, enable children and young people to achieve their potential, and keep families together wherever possible; and connected and supported in the exceptional circumstances where this is not.

A route map for delivering this ambition was subsequently co-produced with the sector.

In this year's Programme for Government, it was announced that, over the life of this Parliament, at least £500 million will be provided to create a transformational Whole Family Wellbeing Fund. The Fund will be used to provide whole family support and to act as a transformation fund to shift from chronic to preventative interventions as we #KeepThePromise. It will enable the building of universal, holistic support services, available in communities across Scotland, giving families access to the help they need, where and when they need it.

Looking ahead, we will design and deliver a Fund that is focused on enabling the transformational change necessary to meet our vision for Family Support. We will also develop and deliver a programme of activity to improve holistic whole family support, including facilitating local Children's Services Planning Partnerships to scale up Family Support services delivered directly to families through universal and targeted approaches.

Housing

The pandemic has put greater emphasis than ever before on the importance of home as a place of safety. Guidance on the effective provision of housing support and services in the context of the virus has been made available in partnership with the housing sector and has been frequently updated.

We remain fully 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 £39 million to tenants during the pandemic, including a £10 million Tenant Grant Fund for people at risk of homelessness because of changes to their finances, and money for discretionary housing payments to those needing help with their housing costs. 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. We also know that disruption to housing services is creating challenges for local authorities and the third sector in provision of normal services and we will continue to work with partners to support our collective recovery.

Schools

We continue to keep measures in schools under close review, based upon ongoing advice from the Advisory Sub-Group on Education and Children's Issues ('the Sub-Group') and through consultation with the COVID-19 Education Recovery Group (CERG). Updated 'Reducing Risks in Schools Guidance' was published in August 2021. This confirmed that the vast majority of mitigations from the previous term would remain in place at the start of the new academic year.

The key change introduced from the start of term was to adjust the self-isolation and contact tracing arrangements to reflect the significant public health impact of high vaccination coverage and to minimise any future disruption to learning. Against the backdrop of increased case numbers across wider society in September, we subsequently made the decision to maintain all other mitigation in schools until at least the October holidays.

We are currently undertaking weekly monitoring of key data regarding case rates and seroprevalence, with the intention of easing those restrictions further at the earliest opportunity. Importantly, continuing with this cautious approach is also allowing more time for 12 – 15 year olds to take up vaccination.

Absence rates amongst pupils and staff are monitored daily and the most recent data from November shows COVID-19-related absences of pupils are around 2% each day. Of these, almost 70% are absent through self-isolation.

Other data and evidence is also positive. Public Health Scotland (PHS) analysis indicates that, of close contacts in school settings identified during the last academic year, just 5% of pupils later tested positive within 14 days of contact. This 5% includes community as well as in-school transmission. We also know that 62% of positive pupil cases had no close contacts that tested positive within 14 days.

Ongoing emphasis remains on compliance with existing mitigations to drive down COVID-19 transmission as well as targeted messaging to help guard against increased prevalence of influenza, coughs, colds and other illnesses over the winter period. We provided additional funding of £10 million to enable local authorities to undertake CO₂ monitoring to assess the ventilation levels in all learning, teaching and play spaces. We also continue to work closely with local authorities to promote the importance of uptake and reporting of at-home asymptomatic LFD testing.

Our priority remains to deliver excellence and equity, despite the pandemic, with the health and wellbeing of pupils at the forefront of our plans. Our Education Recovery; Key Actions and Next Steps document includes some of the key next steps, how we plan to build on the innovation and strengths that have emerged during the pandemic, and how the significant additional investment we have been making is being used to support on-going education recovery. This includes:

• investing over £1 billion during this Parliamentary cycle to close the poverty-related attainment gap;
• recruiting 3,500 additional teachers and 500 classroom assistants in the same time period;
• ensuring every school child has access to the technology they need to support their education, establishing how the National e-Learning Offer can support learning and development of a National Digital Academy;
• publication of the implementation plan in response to the OECD recommendations on the Curriculum for Excellence;
• considering what changes may be required to our qualifications and assessment system in light of the OECD's comparative analysis of assessment and qualifications approaches; and
• ensuring that local authorities and schools continue to prioritise personalised support to meet the individual needs of all children and young people, including the Scottish Government's Young Person's Guarantee, to provide long term support where it is needed most.

We will continue to work with our partners from across the system, and to engage widely with all stakeholders, including CERG, the refreshed Scottish Education Council and the new Children and Young People's Education Council to monitor progress and achieve improvement

Early learning and childcare

We have supported the Early Learning and Childcare Sector to continue to provide high quality and nurturing services to children and their families during the pandemic, including:

• successfully implementing the expansion of funded early learning and childcare from August 2021 despite the challenges of the pandemic, almost doubling the entitlement of all 3 and 4 year olds and eligible 2 year olds to 1140 hours;
• making more than £22 million of dedicated financial support available to daycare of children services and up to £3.2 million to childminding services since the start of the pandemic.
• On 4 December 2020 we confirmed that qualifying day nurseries will continue to benefit from 100% relief on non-domestic rates until at least June 2023, worth on average £12,000 to each eligible setting.

Registered childcare settings provide an essential service to children and families, and are vital in supporting children's learning and development. Recognising this, we have retained a robust set of COVID-19 safety measures for these settings – to ensure they remain open for children and families, while keeping staff safe. Our COVID-19 safety guidance is developed with the advice of the Advisory Sub-Group on Education and Children's Issues and Public Health Scotland – who consider evidence across the four harms. For the ELC sector, these harms include: access to childcare that supports children's development and parents' ability to work, and the health harms caused by COVID-19 for both staff and children.

Where the evidence and advice from the Sub-Group supports this, since June we have adjusted our safety measures where these were impacting on one or more of these harms. For example:

• In July, the guidance was revised to allow some mitigations to be eased allowing settings to remove restrictions on visits by specialist staff, use of mobile staff, cohort sizes and blended placements.
• On 9 August guidance on physical distancing was revised to give settings flexibility to apply one metre distancing between adults and to take account of wider changes to the policy on self-isolation.
• Changes to the rules on self-isolation for contacts of positive cases were also made when Scotland moved beyond Level 0. Provided they show no symptoms, under 5s who are close contacts of a positive case can now continue to attend childcare settings without being required to return a negative PCR test. Under 5s who are close contacts are encouraged but not required to take a PCR test. The guidance makes clear that children of any age who display symptoms should not attend childcare settings but should self-isolate and take a PCR test.
• In August, the guidance was also revised to allow face to face visits by parents, including to support their child starting nursery, in a carefully managed way.

• We have also continued to make at-home asymptomatic LFD testing available to childcare staff, and are focusing on encouraging ongoing uptake and reporting.

To support the wellbeing of the childcare workforce, the Scottish Government has worked with Early Years Scotland to develop the #TeamELC Wellbeing Hub. Alongside the website, a series of free online wellbeing events have been held over recent months and recordings of these are available for practitioners to watch at any time. We have also launched an online e-learning module for childcare practitioners to support their understanding of, and confidence in, our COVID-19 safety guidance. The module includes measures to take outside of the workplace and includes information on vaccination.

As a result of the guidance and the support available from the Scottish Government and our partners, and thanks to the hard work of practitioners in settings across the country, levels of transmission within registered childcare settings have remained low.

Looking ahead to the coming months, the Sub-Group will continue to advise on risk mitigations in childcare settings to ensure that we strike the right balance of harms and that our approach is informed by the latest evidence. We will also continue to engage closely with the sector and with parents to ensure any changes to our COVID-19 safety guidance is communicated clearly.

Advanced Learning and Science

We have recognised the particular impacts of the pandemic on students and staff and have taken steps to mitigate this. For example:

• Taking account of expert advice we have worked collaboratively with universities, colleges, trade unions and student representatives to develop beyond Level 0 guidance in order to support the resumption of in-person learning for the Academic Year 21-22.
• All students and staff, across universities and colleges, are being offered regular rapid-result testing with PCR confirmation for positives.
• Health boards are working with institutions in their area to maximise vaccine uptake, and the opportunity for vaccination on campus is also available, where appropriate.
• We have extended the provisions to continue to allow students in university/college halls to give 28 days' notice to end their tenancy, in line with the private rented sector.

The positive collaborative work on the guidance and mitigations put in place (that go beyond the national baseline measures) have helped support the return of students to some in-person learning in the first term of 2021/22.

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

• We met our first 100 days commitment providing £20 million to help alleviate the financial pressure and stress facing many students over the summer period.
• A £5 million Digital Inclusion Fund was provided to support over 13,500 post-school learners access online learning.
• An additional £4.4 million was announced to support college staff and student mental health for 2021/22 and we have also supported the National Universities Scotland "Think Positive" initiative, which now has a COVID-19 focus.

By May 2021, the Learner Journey Taskforce, as a priority, worked to maximise the number of students completing their courses in the Academic Year 20-21, reducing deferrals by up to 70%.

Looking ahead, we will maintain and build on the work done on mitigation measures that will help to keep the virus suppressed. This will include taking expert advice and engaging with the COVID-19 Advanced Learning Recovery Group on whether and when these mitigations should flex.

We will continue to engage across the sector to ensure that our colleges and universities continue to promote safe practice.

Communication is a key part of sustaining progress on compliance with the baseline measures. We continue to encourage students to get vaccinated, if they have not already done so. In addition to our student vaccination social media campaign, we continue to encourage institutions to work with their local health boards and student representatives to maximise vaccine uptake and encourage regular testing.

Young Person's Guarantee

The Young Person's Guarantee is playing an important role in helping to make up for the opportunities lost to young people during the pandemic. We want to ensure that every person aged between 16 and 24 will have the opportunity to study; take up an apprenticeship, job or work experience; or participate in formal volunteering – with targeted measures to support those with experience of the care system, from low socio-economic groups, and for young disabled people.

We committed £60 million in 2020/21 and up to £70 million in 2021/22 to support the implementation of the Guarantee. This funding includes provision of up to £45 million to local employability partnerships to deliver employability training, support to help young people into and sustain employment as well as financial awareness training and mental health support. We are clear that opportunities created must provide Fair Work and be underpinned by a package of training that supports young people transition into employment. This is why as part of the Guarantee we are providing, where appropriate, wraparound support to young people participating on the UK Government's Kickstart programme.

We are continuing to work closely with employers to encourage them to sign up to the '5 Asks' that are proportionate to the size of any business.

The Guarantee will continue to be driven by the needs of young people, which is why we are working with Young Scot and partners to take forward the Leadership Panel. The Panel will help shape the future direction, ensuring youth engagement and leadership are embedded in the implementation and future decision making.

Business support

Since the start of the pandemic, businesses in Scotland have directly benefitted from £4.4 billion in support from the Scottish Government. This includes the extension of 100% non-domestic rates relief for all retail, leisure, aviation and hospitality premises. Most funding has been targeted to the specific sectors and businesses most impacted by COVID-19 restrictions applicable at any point in time. That support augmented UK Government financial support schemes, including the Coronavirus Job Retention Scheme.

We have also included all businesses in Scotland with 10 or more employees in workplace testing. Any business enrolled in the scheme can access free LFD tests. Several pieces of sectoral guidance were consolidated and refined to create guidance to support businesses and workplaces to create and sustain safer workplaces as we moved beyond Level 0 of the COVID-19 levels system.

Moving forward, we have announced a £25 million COVID Business Ventilation Fund which will allow small and medium-sized businesses to claim back costs to improve ventilation and air quality and reduce the risk of COVID-19 transmission. Businesses will also be able to access advice on improving their ventilation. This support will help these businesses make necessary adjustments to their premises including, for example, the installation of carbon dioxide monitors or alterations to windows and vents. The Fund will target higher risk sectors where people spend significant amounts of time in close proximity to each other, such as hospitality and leisure. This support will help businesses to make indoor settings safer, especially through the winter months.

Supporting staff to work from home, where possible and appropriate, has been an important mitigation in controlling the virus and ensuring that we can continue to minimise other economic and social restrictions. To support employers to plan for a gradual return to offices when Scotland moved beyond Level 0, we developed guidance which encourages employers to facilitate flexible working practices based on discussions with their staff and unions where appropriate. It is recognised that a wide variety of working models have been explored by businesses in consultation with their workforce, such as hybrid models of home and office-based working which we continue to encourage.

We still believe that working at home is an important element of minimising the spread of the virus. This will be particularly important over the coming winter months and we strongly encourage employers to work with their employees to consider, for the longer term, hybrid working models. These may of course have benefits which go beyond the need to control the virus – for example, attracting and retaining talent, supporting wellbeing and environmental initiatives. However, we also recognise that employers are best placed to understand how their operations work most effectively and also to understand their employees' needs and requests for flexible working, based on consultation with staff and unions. We trust businesses to make balanced and risk assessed decisions and we also recognise the need to consider the wider impacts working from home may have on a range of areas (such as mental health, retail and investment in city centres). We will be establishing a working group to consider what hybrid working may look like in the longer term beyond the pandemic and will continue to engage with business organisations on these issues.

Throughout the pandemic, we have worked closely with local authorities, their officers and other regulators to maximise compliance with legal requirements on businesses and applicable issued guidance. And we have supported them with supplementary guidance and additional funding.

We will continue to engage with local authorities and other regulators to ensure that compliance with regulations and guidance is maintained in business and event settings, with the support of businesses, and their staff and customers. In particular, we will work with local authorities following the introduction of enforcement of vaccine certification requirements.

We will continue to work with business leaders and representatives to transition from supporting business resilience to focus more on targeted support for economic recovery.