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

5. Supporting broader health

Our response to COVID-19 must recognise and take account of wider risks, particularly the critical twin risks in health of a second wave potentially coinciding with the seasonal flu, and the wider pressures that the winter period brings, impacting across health and social care.

The NHS remains on an emergency footing and we will work to balance retaining sufficient capacity for resurgence of COVID-19, managing other winter risks, whilst maximising the safe and effective resumption of planned services.

Health and Social Care

NHS Scotland continues to balance its response to COVID-19 with the need to keep people alive and well through remobilisation of other essential urgent and routine health and social care services to the greatest extent possible – but that can only be achieved by keeping case numbers low, and safeguarding the capacity of services, and the need to treat rising cases of the virus. As we saw at the beginning of the pandemic, any surge in the number of cases, and subsequent hospitalisations, would put our health service under significant strain and necessarily impact on efforts to remobilise services.

There are a number of actions now being taken to prepare for and mitigate against winter challenges across Health and Social Care, and safeguard that remobilisation:

• A Winter Planning and Response Group has been convened to develop our response
• Board Re-mobilisation Plans have confirmed allocations of £1.1 billion to cover additional pandemic-related costs, including £78 million to support additional elective activity
• Plans are in place to deliver surge capacity of over 4,000 repurposed acute beds, utilising the NHS Louisa Jordan and independent sector as necessary
• Facilitating a series of table-top Winter Planning events to allow Boards to develop their plans based on the most up to date scenarios, as part of the iterative planning process
• Work to continue to protect and support our health and social care staff, including a forthcoming PPE Action Plan

Winter preparedness plans relating to both the NHS and Adult Social Care will be published shortly with related statements to Parliament, providing more detail on our response to the challenges of winter.

As part of our desire to ensure people can continue to receive the care they need, when and where they need it, it is vital they can continue to access healthcare services in their communities. General Practices and Community Pharmacies remain open as they have done throughout the pandemic, though these services might be provided in a different way than before such as through telephone consultation or with physical distancing measures in place. The NHS Pharmacy First Service Scotland has also now made Community Pharmacy the first point of call for all minor illnesses, and there remains a dedicated pathway in place through 111 for those who have COVID symptoms that have worsened or not improved after 10 days to be seen at a COVID assessment centre. For dental and eye care issues, community optometrists and dentists are continuing to increase activity levels to deliver a comprehensive range of patient care safely by applying all necessary public health measures.

Recognising the specific threat posed through the winter period, we will deliver the largest immunisation programme ever, with a view to vaccinating 2.4 million people. NHS Boards are working hard to vaccinate as many people as possible, and are using more diverse settings such as drive and walk-through centres as well as community pharmacists to support delivery within GP surgeries, so that the majority of those eligible are vaccinated before the end of the year.

Protecting people at risk

The best protection for people who are most at risk from the virus is to stop its spread in our communities. But if case numbers are too high, we must take clear steps to provide additional protection, in a way which safeguards individual wellbeing and human rights.

Shielding and the clinically at-risk

Building on the support we put in place at the start of pandemic, our future approach to shielding will be based on the following principles:

• advice must be proportionate to the level of infections in the local community;
• it should be set at a level which optimises the benefits of protection and minimises health, social and economic harms;
• it should be practical, empower people to make decisions which are right for them, and be culturally appropriate and tailored to ensure reach and accessibility.

We will introduce levels of advice to protect people with the highest clinical risk, shown below, setting out clearly how advice will change depending on the rates of infection in local areas. As the levels in a local area change, the protection advice for people on the shielding list in that area will change as well. People at highest risk should still follow the advice for the general public as a minimum, but these levels provide additional advice for areas like work, schools, shopping and contact with others.

Shielding

This is advice, consider which level of protection is right for you.

All levels:

We will not ask you to distance from people within your own homes or to stop taking outdoor exercise.

Level 0 & 1

Contact with others

Follow the level advice to the general population

Shopping

Strictly follow the guidelines when shopping

If you cannot work from home

Following a workplace risk assessment, your employer should make the necessary adjustments to your workplace to protect you. You can discuss getting a fit note with your GP or clinician if you still feel unsafe.

School/formal Childcare

Follow the level advice to the general population

Level 2

Contact with others

Reduce the number of people or households you have face to face contact with.

Avoid one metre zones.

Shopping

Strictly follow the guidelines when shopping

If you cannot work from home

Following a workplace risk assessment, your employer should make the necessary adjustments to your workplace to protect you. You can discuss getting a fit note with your GP or clinician if you still feel unsafe.

School/ formal Childcare

Follow the level advice to the general population

Level 3

Contact with others

Limit meeting people outside your own household, avoid indoor public spaces.

Shopping

Strictly follow the guidelines when shopping and limiting the number of times you go to a shop. Shop at quieter times.

If you cannot work from home

Speak to your employer to ensure all appropriate protections are in place. If they are not, discuss getting a fit note with your GP or clinician.

School/ formal Childcare

Parents or guardians should discuss with their GP or clinician whether children should still attend.

Level 4

Contact with others

Minimise contact with people outside your own household if you can.

You should not take public transport.

Shopping

Strictly follow the guidelines when shopping and limiting the number of times you go to a shop. Shop at quieter times.

If you cannot work from home

The Chief Medical Officer will issue an automatic two week fit note to give people on the shielding list protection while they speak to their GP or consultant and get a personal fit note if necessary.

School/ formal Childcare

Children on the shielding list should not attend in person.

This new advice and guidance will sit alongside a package of information, tools and advice to those on the shielding list to enable and empower them to make informed decisions about how to stay safe and protect themselves, and to promoting their health and wellbeing more broadly. We will shortly be publishing a practical guide to help them find this information and to balance what is right for them, including:

• SMS Text Alert Service
• Publicly available Neighbourhood Covid infection data
• Information on high and low risk activities
• Workplace risk assessments
• Information on how to shop safely
• Online priority shopping slots
• Helpline (0800 111 4000)
• Local Authority and Third Sector support
• Mental and Physical Health and Wellbeing support
• Vitamin D offer

We encourage people to adapt this advice to make it right for them. It is a personal decision on how to balance the benefits of protection with quality of life. To do this in practice, people told us they needed information about infection rates in local communities, level of risk specific to their health conditions, and how to manage risks on a day to day basis

Those on the shielding list will still be able to go to shops and pharmacies but there are a range of shopping and delivery options available to make shopping safer, including supermarket support for those who are clinically at risk.

The SMS Text Service will continue to provide updates and alerts, including to people in outbreak areas who are on the shielding list. Updated advice will also be available online and the national helpline will continue to be available for information, advice and to signpost support, including for those who are struggling with access and affordability issues in relation to food.

Minority Ethnic People and Communities

COVID-19 has affected minority ethnic groups disproportionately. The reasons for this are complex, with the interplay between socio-economic disadvantage, high prevalence of chronic diseases and the impact of long-standing racial inequalities being key explanations.

We will take forward a number of recommendations from the Expert Reference Group on Covid-19 and ethnicity (ERG) to better understand the impacts of COVID-19 on black and minority ethnic communities, and ensure that Test and Protect, shielding, vaccinations, NHS remobilisation, public health messaging, and other areas specifically consider and respond to the needs of minority ethnic communities.

Mental Health – Scotland's Transition and Recovery

The pandemic has been tough for people's mental wellbeing, exacerbated by existing inequalities. We announced over £6 million of dedicated funding to create new online and telephone support services, and to increase the capacity of existing services. Building on new initiatives during the pandemic, we are continuing the Clear Your Head campaign which contains a variety of resources and tips to help people take care of their mental health and wellbeing. For those who need more support the Scottish Government has expanded the NHS24 Mental Health Hub so that it is now available 24 hours a day, seven days a week, and increased the capacity of the Breathing Space telephone helpline

We have published Scotland's Mental Health Transition and Recovery Plan. It prioritises rapid and easily accessible support for those in distress and ensures safe, effective treatment and care of people living with mental illness. A tailored programme of work will help individual NHS Boards respond effectively to the anticipated increase in demand in the months ahead.