Mobilisation Recovery Group minutes: 26 March 2021

Attendees and apologies

Attendees

• Susan Aitkenhead, Director of Royal College of Nursing (Scotland)
• John Burns, NHS Board Chief Executives’ Group representative
• Donna Bell, Director of Mental Health and Social Care
• Sandra Campbell, Convenor, Scottish Social Services Council
• John Connaghan CBE, Chief Operating Officer, NHS Scotland
• Iona Colvin, Chief Social Work Adviser
• George Crooks, Chief Executive, Digital Health & Care Institute
• Cllr Stuart Currie, Health & Social Care Spokesperson, COSLA
• Graeme Eunson, BMA Scotland (deputising for Lewis Morrison)
• Tom Ferris, Chief Dental Officer
• David Garbutt, NHS Board Chairs’ Group representative
• Cllr Kieron Green, Vice Chair, IJB Chairs & Vice Chairs Group
• Philip Grigor, Scotland Director, British Dental Association
• Annie Gunner-Logan, Coalition of Care and Support Providers
• Pauline Howie, NHS National Boards’ representative
• Caroline Lamb, DG, Health & Social Care and Chief Executive, NHS Scotland (Chair)
• Jason Leitch, National Clinical Director
• Donald MacAskill        , Chief Executive, Scottish Care
• Peter Macleod, Chief Executive, Care Inspectorate
• Carolyn McDonald, Chief Allied Health Professions Office, Scottish Government
• Harry McQuillan, Chief Executive, Community Pharmacy Scotland
• Patricia Moultrie , Deputy Chair of BMA SGPC
• David Quigley, Chair, Optometry Scotland
• Sir Lewis Ritchie, Mackenzie Professor of General Practice
• Claire Ronald, National Staff Side representative, Chartered Society of Physiotherapy
• David Shackles, Joint Chair, RCGP Scotland
• Alison Strath, Interim Chief Pharmaceutical Officer, Scottish Government
• Angela Thomas, Royal College Of Physicians Of Edinburgh
• John Thomson, Vice President Scotland, Royal College of Emergency Medicine
• Ian Welsh, Chief Executive, Healthcare & Social Care Alliance Scotland
• Carole Wilkinson, Chair, Healthcare Improvement Scotland
• Andrea Wilson, Convener, Allied Health Professions Federation Scotland

Apologies

 

• Dave Caesar, Interim Deputy Chief Medical Officer, Scottish Government
• Amanda Croft, Chief Nursing Officer, Scottish Government
• Jane Anderson, UNISON representative  
• Andrew Buist, Chair, GP Committee, British Medical Association
• Nicola Dickie, COSLA
• Angela Leitch, Chief Executive, Public Health Scotland
• Joanna Macdonald, Chair, Adult Social Care Standing Committee, Social Work Scotland
• Miles Mack, Chair, Academy of Medical Royal Colleges and Faculties
• Kathryn McDermott, UNISON National Staff Side representative
• Christine McLaughlin, Director, Test & Protect, Scottish Government
• Lewis Morrison, Chair of Scottish Council, British Medical Association
• Peter Murray, Chair IJB, Chairs & Vice Chairs Group
• James O’Connell, National Staff Side representative, UNITE
• Linda Walker, National Staff Side representative, GMB
• Gregor Smith, Chief Medical Officer
• Cleland Sneddon, Health and Social Care Spokesperson, SOLACE

Apologies due to the pre-Election period

 

• Jeane Freeman MSP, Cabinet Secretary for Health & Sport
• Mairi Gougeon MSP, Minister for Public Health, Sport & Wellbeing
• Clare Haughey MSP, Minister for Mental Health

In attendance

 

• Marion Bain , Deputy Chief Medical Officer
• Derek Bell , Special Advisor, Scottish Government
• Victoria Bruce , Workforce Leadership, Culture and Wellbeing, Scottish Government
• Heather Campbell, Interim Deputy Director, Primary Care, Scottish Government
• Catherine Calderwood, Clinical Director, Centre for Sustainable Delivery (Golden Jubilee)
• Aidan Grisewood, Interim Director, Primary Care, Scottish Government
• Helena Jackson, Health Performance & Delivery, Scottish Government
• Michael Kellet, Director of Population Health, Scottish Government
• Helen Maitland, Director of Unscheduled Care
• Jennie Marshall, Health Operational Planning, Scottish Government
• Niamh O’Connor, Test & Protect, Scottish Government
• Diane Murray , Deputy Chief Nursing Officer
• Sean Neill, Deputy Director, Health Workforce
• Gillian Russell, Director of Health Workforce, Leadership and Service Reform, SG
• Richard Foggo, Director of Covid 19 Public Health
• Stephen Gallagher, Director for Local Government and Communities (Vaccination Policy)
• Christine Gilmour, Director of Pharmacy, NHS Lanarkshire

Official Support

• Andrew Fleming, Health Performance & Delivery, Scottish Government
• Angela Gibson, Health Performance & Delivery, Scottish Government
• Jake Macdonald, Health Performance & Delivery, Scottish Government
• Sean More , Health Performance & Delivery, Scottish Government

Items and actions

Item 1: Welcome

1. Caroline Lamb chaired the fourteenth meeting of the Group and commenced proceedings by welcoming attendees and noting apologies. She also welcomed Dr Catherine Calderwood, Clinical Director at the Centre for Sustainable Delivery, as a guest to the meeting.

2. The Chair provided an update to the Group on key issues of importance since the last meeting: notably that the Scottish Parliament has risen for the Election which will take place on Thursday 6 May.  Special arrangements currently apply to Government business, focused on the need for the Civil Service to remain impartial and ensure the appropriate use of official resources.  This means Ministers will not be attending the Group during this period, and the agenda relates to essential coronavirus business only.  The First Minister had also provided an update to Parliament on 15 March outlining: indicative dates for the re-opening of the economy and society; that, whilst excellent progress had been made, there were potentially some supply issues that might impact the vaccination programme; and some countries across Europe are now starting to experience what may be a third wave of coronavirus.

Item 2: Note of Previous Meeting Held on 22 January 2021, Action Log & Matters Arising

3. No amendments had been received from Group members and there were no outstanding action log items (other than the standing action that encourages members to approach the secretariat with any suggestions for future agenda items); nor matters arising noted.   As such, the note of the meeting on 5 March was agreed and will be published on the Group’s page on the Scottish Government website.

4. Looking towards future meetings, the Chair noted that members are invited to propose agenda items, though any business for the next meeting on 16 April must be in line with the guidance around the pre-Election period.  Whilst the future of the Group will be determined by the incoming Cabinet Secretary, the Chair also sought views on what has worked well or less well since the Group was set up last year: asking members to provide their views to the Secretariat.

Item 2: State of the Pandemic

5. Jason Leitch provided an update on the state of the pandemic and suggested that, after briefly outlining the situation in Scotland, he would focus on the situation in Europe and the rest of the world.  On the R number, he noted that it had increased in the last three weeks and currently sits between 0.7 and 1.0. Incidence per 100,000 of the virus provides an effective metric for comparing prevalence across different countries and regions:  across the UK, the four nations seem to have aligned at around 60-70 per 100,000 incidence of the virus.  Whilst prevalence of the virus has decreased, Scotland is still currently recording high numbers of cases per day: between 500 and 700.  The number of infections in those vaccinated is decreasing, whilst prevalence in younger age groups is increasing as we relax restrictions.  In terms of modelling, it is currently forecasted that infection numbers may continue to fall but at a slower rate.

6. Internationally, incidence of COVID-19 is extremely high in Eastern Europe.  In addition, France, Italy, Germany, the Republic of Ireland and Sweden are all registering higher incidence than the UK.  France is in a particularly challenging situation as it is dealing with the UK variant as well as the South African variant: Paris recently recorded an incidence of 400 cases per 100,000.  Germany is experiencing a resurgence of the virus which has caused the Government to cancel the planned relaxation of restrictions over Easter, leading to anti-lockdown protests in several major cities.  South America is also in a very challenging situation with countries like Brazil and Chile experiencing pressures that threaten to overwhelm local health systems.  In terms of vaccinations, it is clear that there is significant differentiation in rates around the world: Israel having vaccinated more than 50% of its adult population, the UK around half, Europe around 15%, and Africa less than 1%.

Discussion

7. The Chair thanked Jason for his update and offered members of the Group the opportunity to ask questions.

8. Stuart Currie asked about the Government’s plans for vaccinating younger age groups.  Jason Leitch explained that to vaccinate the whole population in one go, Scotland would require around 9 million doses.  As supply issues in the early stage of the vaccination programme mean this is not possible, we need to prioritise.  The Joint Committee on Vaccination and Immunisation (JCVI) makes decisions and provides advice on which order of priority should be given.  At the beginning of the rollout, the objective is to decrease mortality; by the end of the programme and subject to supply, vaccinations are being carried out for population benefit rather than for individual protection.  It is important that there is clear and effective public messaging so that the public understand the importance of vaccinating the younger generation, even if individual risk is perceived to be reduced.  As we work to vaccinate the younger population, we need to keep in place other mitigations to ensure the safety of the population.

9. Angela Thomas followed up on the issue of risk versus benefit perceptions for the younger population.  She noted that although we are assured as far as possible, based on available data, that the vaccines are safe and effective, it is important to have further data to demonstrate that the benefit continues to outweigh the risk.

10. Graeme Eunson queried whether, as we move towards an approach which focuses on protecting the population rather than just the prioritised at-risk groups, we would look to vaccinate teachers and college staff more rapidly than if they were to be called through a general public health approach.

11. On communicating the benefits of the vaccine to younger people, Jason Leitch confirmed that the Government has been working on making the case for the vaccine to younger people, notably through organisations like Young Scot, working with colleges, and the National Union of Students.  The JCVI continue to review all of the available evidence to ensure data on safety is up to date and relevant; they currently meet twice weekly for this purpose.  On Dr Eunson’s question, the JCVI do not currently advise that the vaccination programme should be reprioritised according to profession; their advice continues to be to prioritise according to age and based on pre-existing conditions.  A fully inclusive programme necessitates vaccinating hard-to-reach groups such as those who may not traditionally engage with the health service.

Item 3: State and Resilience of NHS Health and Social Care Services, Testing, and Vaccinations

12. Andrew Fleming outlined the position on acute NHS capacity.  Since the last meeting, acute COVID-19 bed occupancy had further fallen, as has ICU occupancy. However, the overall ICU system is still very busy.  Compared to the last meeting, the pressures on acute hospitals in Scotland continue to ease, though some Health Boards are still experiencing localised pressures.

13. Aidan Grisewood provided an update on primary care and noted that, in terms of assessment centres and NHS 24 calls, pressure has increased slightly since the last meeting.  For general practice, there has been a reduction in the number of GPs experiencing increased pressure; however, attendances at GPs – both virtual and face to face – have increased. Dentistry and optometry activity levels remain suppressed due to infection prevention and control measures.

14. Gillian Russell highlighted key issues facing the health workforce.  We are continuing to monitor pressures across the country: COVID-19 pressures have declined but there are continued capacity and non-COVID pressures.  In terms of staff wellbeing, there are a range of resources that are available to support health and social care staff.  This includes the new Workforce Specialist Service, delivered by NHS Practitioner Health, which is a confidential, multidisciplinary mental health treatment service with expertise in treating regulated health and social services professionals.  This service has been very positively received: officials are currently carefully considering the range of issues which have been raised to ensure there is sufficient capacity to provide further support.

15. Donna Bell reflected on an improving position in adult social care: both in terms of incidence as well as mortality.  Outbreaks are reducing in size and the percentage of care homes awaiting confirmation of an outbreak has declined considerably.  This position is reflected in wider services for care at home, and other social care services.

16. On Test and Protect, Niamh O’Connor confirmed that the programme is on track. Some of the key testing expansions include schools, primary care, and the extension of testing in non-patient-facing NHS workforce, where this will help to maintain the delivery of essential services.  The new testing strategy was published last week in line with the updated strategic framework, which sets out six rationales for testing: test to diagnose, test to care, test to protect, test to find, test to support, and test to monitor.

17. Stephen Gallagher provided an update on the vaccination programme: just over half of the Scottish adult population have received their first dose of vaccination, and the programme is progressing well, despite intermittent supply issues.  In terms of reaching the younger population, it is important to note that some have been vaccinated already due to the order of priority set out by the JCVI.  In addition, a portal has been opened for unpaid carers to self-declare their status to allow them to receive their vaccination.  In total, over 87,000 unpaid carers have received their vaccine. The current focus is to continue to progress cohorts 1-9 by mid-April, and to offer all adults the first dose by the end of July. Officials are working to understand the reasons why some people are not attending: the programme needs to be fully inclusive and so we must work with groups who might be hesitant or may find it difficult to identify themselves, or to be reached by their Health Board. Public Health Scotland has recently published data outlining the demographic profile of those who have been vaccinated which will support this analysis.  Finally, the Moderna vaccine should be introduced to Scotland during April.

18. John Connaghan made some closing remarks before the item was opened for discussion.  Firstly, Jason Leitch’s presentation demonstrates that the country and health service is still in a fragile situation: discussions with Health Boards must take cognisance of the requirement to maintain capacity to deal with any resurgence of coronavirus.  Secondly, as part of discussions with Boards on how to remobilise, we will reconsider the appropriate baseline ICU provision.  If there are any additional waves, the health service must be prepared and those preparations must consider the significant backlog of urgent and semi-urgent cases which will present into the system.  Finally, officials recognise the burden which will continue for some time in primary and community care as we manage the backlog of patients who will need to be referred to secondary care.  John suggested that these key planning risks should be discussed at a future meeting of the Group, as informed by the NHS Boards’ agreed remobilisation plans.

 

Discussion

19. Patricia Moultrie queried the planning and modelling involved for general practice. How do officials plan to facilitate the management and treatment of an increasing amount of acute illness in the community?  How sustainable is the COVID-19 community pathway? 

20. The Chair noted that these were important points that merited further discussion and analysis; alongside the planned review of data in terms of understanding GP activity and pressures.

21. Stuart Currie raised the correlation between delayed discharge and service pressures in specific areas; pointing out that there may be further opportunities to have better conversations about returning to a care home setting where this is appropriate, given the ongoing improvements in adult social care.  Donna Bell confirmed that there is an ongoing exercise underway to assess the issues with delayed discharges and committed to sharing the results of this with COSLA colleagues and Stuart Currie when this has been completed.

22. Graeme Eunson asked about the longer term strategy to deal with unscheduled care pressures and community COVID-19 hubs.  Local clinicians are having ongoing discussions but there is still a question mark over the length of time primary care will be expected to run these services and which parts of them will be embedded in any new model of care: it is important to have joined up thinking and planning to ensure that localised issues do not present themselves.  In addition, he queried how long health services will we be required to follow enhanced infection control processes as this is a significant limitation on capacity in terms of remobilising services.

23. Andrea Wilson noted that, from an Allied Health Professional point of view, it is important to recognise the need for pre and post treatment rehabilitation.  There are people who have had operations and treatment delayed so there is a significant requirement for these services: this will impact community care, as well as from a discharge perspective.  It must be a whole system community effort so we need to think about how we can do that in the most effective way possible.  Angela Thomas supported the views of Andrea Wilson and highlighted the importance of strengthening community care to ensure people can leave hospital in a timely and supported fashion.

24. Caroline Lamb reiterated that we must ensure our planning is joined up across the whole system whilst maintaining the workforce availability and resilience to support that. 

25. Graeme Eunson queried the paper provided to the Group on the updated strategic framework and indicative dates for exiting lockdown.  Jason Leitch noted that, at present, the Government hopes to move between levels as a whole country in three week intervals.  Due to the unpredictability of the virus, we cannot say with confidence at this stage the exact rules which will apply to each level.  The position continues to be kept under close review.  

26. Caroline Lamb reiterated her thanks to everyone for their contributions, noting that they have been helpful and informative, before closing the meeting.