Coronavirus (COVID-19) - testing strategy: Health Secretary's statement 25 November 2020

Last week in this chamber, I updated members on our plans to deliver COVID vaccinations. Today, I am grateful for the opportunity to update on our plans to significantly expand testing.

This further expansion is possible because of increases in our testing capacity - coming from the 3 new NHS regional hub laboratories, from Lighthouse laboratories, and from new testing options.

Yesterday the Glasgow Lighthouse Laboratory reached the remarkable milestone of 5 million tests processed. Work on our three new Regional Hubs in NHS Scotland is progressing and I want to thank our microbiology, virology and healthcare science workforces who have built the largest diagnostic capacity and are a critical part of Scotland’s COVID response

New options come from innovation in testing outside our labs – notably the new lateral flow devices – bringing us significantly greater capability to test more people, more often.

I will come on to how we will use this capability, but first, I would like to say a few words on these new tests.

Lateral Flow Devices are rapid turnaround tests, where samples are processed on site with no lab required and results are available in under half an hour. The type we are using first in our expansion – the Innova lateral flow test – has had extensive clinical validation by Public Health England and Oxford University.

This validation found the Innova lateral flow test has an overall sensitivity of 76.8% - meaning it will identify more than 7 in 10 positive cases of COVID. That rises to over 95% of those with high viral loads – those that are likely to be those most infectious.

Understanding this matters, because as we have said consistently from the outset, no test is 100% accurate, and testing on its own, does not reduce transmission. It only helps stop transmission through the actions taken following the result – to isolate if positive and give contact tracers all the information about where we have been in the period when you may have been infectious, so close contacts can be identified and told to isolate, all of that aimed at killing off the chain of transmission.

Testing is one layer of protection. All the others from reducing contacts, keeping our distance, wearing face coverings, enhanced infection prevention and control in our NHS and care settings to vaccines when they come all of them only work to greatest effect when they work together.

Our senior clinical and scientific advisers recently reviewed our Testing Strategy, and their advice was clear and unanimous: test people with symptoms, test for clinical care, and when capacity allows – prioritise to protect those most vulnerable from the worst harm. We now have that increased capacity and will extend testing now to many more people

By the start of December we will extend testing to all hospital admissions to emergency departments, acute assessment centres, maternity units and emergency mental health units. By mid-December we will extend that testing to all medical and surgical elective admissions.

We will extend our routine testing of healthcare workers. Everyone working in patient facing roles in all of our hospitals, the Scottish Ambulance Service, Covid Assessment Centres in the community and the healthcare professionals who visit care homes, will receive twice weekly testing.

The scale of this challenge is not to be underestimated – NHS Scotland employs over 170,000 people – and, while not all are in patient facing roles, the number who are is considerable.

We know our frontline NHS staff are at the highest risk of being exposed to COVID-19. We know when community transmission rises, so too does the risk of outbreaks in our hospitals.

So we will phase in this extension from the start of December, to be completed by the end of that month.

I know that all those NHS staff who continue to deliver an extraordinary service and understand so well all they need to do to protect themselves and the patients they care for will welcome this additional layer of protection.

We will extend testing in social care. There are up to 42,000 care home residents across Scotland, all of whom are entitled to a designated visitor. We will use lateral flow testing on the day of the visit, so that if that test is positive family members can take immediate action to isolate and avert the harm that could have arisen.

We will roll out lateral flow testing to up to 12 early adopter care homes across 4 local authority areas from 7th December. Learning from that we will roll out to a further number of homes across an additional 7 local authorities before the 21st December, with full roll out across all homes completed over January and early February.

Whilst this is positive progress and I hope it is good news, I am mindful of the approaching Christmas period and I do not want any resident or family member to be disadvantaged. So for those not included in the lateral flow early adopters before Christmas, we will provide access to PCR testing in the weeks beginning 21, 28 December and 4 January.

Family and loved ones know better than anyone that testing provides an additional layer of protection. On its own it doesn’t give risk-free visiting but combined with appropriate PPE and strict hand hygiene I hope it allows more relatives to visit their loved ones, reduces isolation and loneliness for care home residents and gives providers the additional confidence they need to facilitate more visits

There can be no question that the home care workforce do one of the most critical jobs – supporting and caring for people so they can continue to live as independently as possible in their own home. From mid-January, we are extending our testing programme to them, including permanent and visiting staff and personal assistants to a person’s home and covering residential settings, sheltered housing and day care.

This is a large group of people doing very important jobs but the very nature of the job they do means they work individually in a number of different homes and settings.

The logistics of this are not straightforward and we will phase this in for care at home staff also from mid-January, starting in those local authority areas with the highest virus prevalence at the time and expanding out from there to cover the whole sector by March.

With the significant capability now available to us we are also extending asymptomatic testing to entire groups and communities – to help us find positive cases even before a person develops symptoms.

As members know, we are doing this first in partnership with our universities so that tens of thousands of students can travel to their family homes safely at the end of this term.

All students leaving their term-time address will be offered two lateral flow tests, three days apart, from next week.

And as part of the details to be set out shortly for the staggered return of University students in the New Year, testing will be put in place for them once more

All school staff can currently access testing if they are concerned they have been at risk from infection and we have enhanced surveillance in schools undertaken by PHS.

But I know that as transmission has risen or stayed stubbornly high in some of our communities, especially those now in Level 4, school staff may have had concerns about risk. We will maintain current access to asymptomatic testing but last week the Deputy First Minister also gave a clear commitment to explore extending testing further.

I am pleased to confirm that from the return of the school term in January, we will undertake a number of pathfinder testing programmes on deliverability in the school environment with the objective of establishing a sustainable programme of asymptomatic testing amongst school staff.

Our testing capability now enables us to work with local partners to trial whole community testing in exactly those areas where transmission has stayed stubbornly high. Next week we will be deploying up to six additional MTUs and 20,000 home test kits to support work in five local authority areas - Glasgow, Renfrewshire, East and South Ayrshire and Clackmannanshire.

We will also set up an asymptomatic test site using lateral flow testing in Johnstone in Renfrewshire, which has one of the highest new cases per 100,000 of any local authority in Scotland. This centre will have the capacity to test up to 12,000 people over the course of the week. And we are actively planning wider targeted deployment for early January, including further asymptomatic test sites.

In deploying mobile units, home test kits and trialling the Asymptomatic Test site, we will work closely with local communities to harness their expertise to encourage high participation.

Presiding Officer, testing is undeniably important, but it is just one layer of protection. Many layers are needed to fight this virus.

Our increased capability now to test more people, more often is potentially powerful as we navigate our way through the coming months as safely as we can and alongside our nation-wide vaccination programme.

With the plans I have set out in this chamber today, we will move to testing hundreds of thousands of people without symptoms to actively find the virus and with the continuing cooperation of people across Scotland, prevent and break down chains of transmission before COVID-19 can cause the harm we know it is capable of.