INTRODUCTION
It is over nine months since the first cases of COVID-19 were recorded in Scotland. Tragically, there have been 6,092 deaths related to the pandemic* as of 13th December. This has been an incredibly difficult year, and we would like to add our thanks to all who have been working on the frontline, and keeping us going, including those working in the NHS, care workers, shop workers and many, many others. We also thank those who have volunteered to help in their communities. The Scottish Government has received some praise for its response to the COVID-19 pandemic, often in comparison to the UK Government’s response in England. There is no doubt that this has been an extremely challenging crisis to manage for every government, with a multi-faceted and ever evolving approach needed to react to the latest problems. But it is reasonable at this stage to examine just how well the Scottish Government was prepared for and reacted to the pandemic. *This is the number of deaths that have been registered in Scotland where COVID-19 was mentioned on the death certificate, the measure used by the National Records of Scotland (NRS).
THE FACTS
Preparedness In 2015, ‘Exercise Silver Swan’ was carried out across the public sector in Scotland to assess the country’s preparedness for a flu pandemic. It flagged up gaps in social care, Personal Protective Equipment (PPE) and storage for ‘mass fatalities’. In March 2018, ‘Exercise Iris’ simulated a coronavirus outbreak in Scotland. It exposed a ‘clear gap’ and unease at the lack of clarity on Personal Protective Equipment (PPE) availability, training and testing. Concerns were raised about PPE stocks in Scotland by senior health chiefs in January 2020, before the first cases of COVID-19 were recorded here. Nicola Sturgeon missed six UK Government Cobra meetings on coronavirus and didn’t join the sessions until 2nd March.
In September 2019, it was revealed that 6.3 per cent of nursing and midwifery posts were vacant as of 30th June, the worst level since September 2007. Around 1,000 of these posts had been vacant for more than three months. In December 2020, the data revealed a 2.2 per cent decrease in the number of nursing staff from the last quarter, with a shortage of 3,293.5 whole time equivalent (WTE) nursing and midwifery staff at 30th September 2020. The Outbreak The first case of COVID-19 made public by the Scottish Government involved a patient from Tayside who had travelled from Italy and was announced on 1st March. However, a BBC investigation in May discovered there had been an outbreak in Edinburgh following a Nike conference in the city on 26th and 27th February. At least 25 people subsequently contracted the virus, but the details were not made public – sparking accusations of a cover-up. It was reported that the North East of England’s ‘patient zero’ attended the conference in February and the infection was passed to a second person in Newcastle at a child’s birthday party. Public Health England was alerted to a case associated with the Edinburgh conference on 2nd March, but the decision about what to make public was for the Scottish Government.
Lockdown
Lockdown was introduced in Scotland on 23rd March. At this point, the Nike outbreak was still not public, and several major events had been held in Scotland:
Scotland played France at Murrayfield in Edinburgh on 8th March in front of 67,000 fans.
Rangers played Bayer Leverkusen on 12th March in front of 47,000 fans.
The Scottish Government was also prepared to allow the Rangers v Celtic match to go ahead on 15th March – it was only cancelled by the SPFL.
A team of epidemiological scientists at University of Edinburgh concluded that more than 2,000 coronavirus deaths could have been prevented if Scotland had locked down two weeks earlier.
Care Homes It took until the 21st April for it to become a requirement for patients to have two negative COVID-19 tests before leaving hospital. A total of 3,599 elderly patients were discharged to care homes between 1st March and 21st April, and only 650 of these patients had been tested. Of that total, 68 patients tested positive and were sent to care homes without getting a negative result. Allyson Pollock, professor of public health at Newcastle University, described sending patients who had tested positive for COVID-19 back to care homes as "...like putting a lit match to dry tinder and starting a forest fire because we know that infection control measures weren’t good in care homes, we know care homes were understaffed and we know that older people are very vulnerable to Covid-19." The total number of patients discharged to care homes in this period was originally put at only 300 before the Scottish Government corrected its mistake. In the period up to 10th May, an international report from the European Centre for Disease Prevention and Control revealed that 1,438 deaths involving COVID-19 had been reported from care homes in Scotland, representing 45% of all deaths. The corresponding figure for England was 21%, and 25% in Wales. The latest figures show that 2,101 people have died in care homes (43%) and 2,419 people have died in hospitals. A BBC investigation revealed that the Care Inspectorate received 30 red warnings that care homes did not have enough staff to properly care for their residents during lockdown, and 149 amber warnings that staffing was stretched. For care home residents with coronavirus, Scottish Government guidance about sending them to hospital originally stated: "It is not advised that residents in long-term care are admitted to hospital for ongoing management but are managed within their current setting.” This later disappeared from the government’s website.
In November, the First Minister said she could not reveal how many people have been discharged from hospital to care homes without a negative COVID-19 test.
PPE
In April, more than 100 medical professionals wrote to the Scottish Government to express ‘grave concerns’ about the protective equipment they had been given.
The same month, almost half of high-risk environment nurses said they had been asked to re-use single-use PPE, according to a survey. The union Unite also reported that hospitals were having to reuse PPE.
A letter from the chief nursing officer initially claimed that masks were unnecessary, which Scottish trade unions warned could have left home and social carers receiving less protection than colleagues in other parts of the UK. UNISON Scotland secured agreement from the Scottish Government that the UK-wide guidance on PPE would apply.
In April, a leaked official report from the organisation responsible for delivering health and social care services in Edinburgh said the supply of PPE for key workers was still a ‘concern’.
A helpline for staff to report PPE shortages received more than 1,000 calls.
Surgical masks were being issued with expiry dates of April 2016, with labels covering the date with a revised expiry date of July 2021. In July, it emerged that thousands of out-of-date masks had to be destroyed by Scottish health boards after they were found to be disintegrating.
Shielding
Over 150,000 people in Scotland were placed on a vulnerable shielding list. But people struggled to access vital home delivery services because the Scottish Government failed to share data with retailers.
Elderly Scots who did not fall into the shielding list were still advised to remain at home, but it was reported that people struggled to get home deliveries and weren’t receiving support from helplines.
Almost 18,000 people were sent advice which wrongly said shielding would end on 8th June and they could leave their homes. The actual date agreed by health experts was 18th June.
More than 3,000 people were forced to shield unnecessarily during the coronavirus pandemic due to misidentification of cancers.
Testing On 16th March, the World Health Organization issued guidance to countries to ‘test, test, test’. Professor Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, told MSPs in April that ‘we had the test but we did not use all the facilities that were available’. Professor Pennington – one of the world’s foremost microbiologists - also warned that care homes were at great risk. He was not brought in to offer direct advice to Scottish ministers. In April, the First Minister set a target of 10,000 tests-a-day. By the end of the month, Scotland had tested fewer than half this target. It was reported that testing centres in Glasgow and Aberdeen were largely empty, with staff sent home early. In May, Scotland was carrying out less than one third of the tests it had the capacity to do, and by June was on course to top half-a-million available tests which had not been used. Routine testing for care home staff wasn’t introduced in Scotland until May, after the GMB union said ministers were ‘fiddling while the care home sector burns’. In the first week of June, only one in 16 Scottish care home staff were tested. Around half of all tests in Scotland are conducted through UK Government laboratories.
In August, the Scottish Government was criticised by a public health expert for failing to publish data on the number of people contacted by NHS Test and Protect. Prof Linda Bauld said the ‘missing’ data was essential for researchers to check the system was working. At the start of September, the number of coronavirus tests halved in less than a week, falling from 27,246 on 2nd September to 12,203 on 7th September. Contact Tracing Across all health boards, a total of 106 contact tracers were in place on 12th March, the date when Scotland moved from the containment phase to the delay phase. Three health boards - Ayrshire and Arran, Dumfries and Galloway and Tayside - had no contact tracers in place. By mid-May, the Scottish Government had failed to hire a single Contact Tracer to help implement the ‘test, trace, isolate’ policy despite over 8,000 applications for the role. Prior to the formal launch of the Test and Protect system, all NHS Scotland boards were asked to collectively make available up to 2,000 staff to participate in contact tracing activity. By 10th September, the Health Secretary admitted the June target had not been met, with only 874 staff capable of undertaking contact tracing activity available for deployment. In May, Nicola Sturgeon said ‘all the work of identifying and tracing contacts will be done within Scotland’s NHS’. In October, it was announced that two private companies had been hired to help with the contact tracing system. In the week ending 18th October, it took over 72 hours for contact tracing to be completed in 1,200 cases - a 5.1% increase on the week prior. It also emerged that the system had failed to contact 2,249 people who tested positive for coronavirus since at least June, including 672 people in the week ending 18th October. In November, it emerged that the Test and Protect system was performing up to five times worse than previously claimed. Around half of recent positive cases weren’t contacted within 24 hours of being told of their swab results, revised data revealed.
From 30th November to 6th December, 4,387 Covid positive individuals were unable to be contacted by Test and Protect. Quarantine In July, Nicola Sturgeon declined to rule out quarantining visitors from England. She claimed the ‘prevalence of the virus in Scotland, right now, is five times lower than it is in England’. She was later censured by the UK’s chief statistician for using incomplete and unpublished data. Scottish hoteliers warned that bookings were being cancelled following the First Minister’s incorrect claims. On 20th July, the Scottish Government lifted quarantine rules on travellers from Spain. They were reimposed just days later. Justice Secretary Humza Yousaf said ‘approximately 20 per cent of travellers’ had been contacted by health officials to check if they had developed coronavirus symptoms. It later emerged that not a single spot check took place in June or the first week of July. Mr Yousaf later corrected his error. Education National clinical director Jason Leitch said on 13th March he could 'absolutely guarantee there is no plan right now, and no substantive rumours, that we're going to close schools next week’. On 18th March, the First Minister announced that schools would close. In June, Education Secretary John Swinney said part-time schooling from August was the ‘best’ possible plan and to do otherwise would ‘be playing with the public health of individuals’. He said schools were ‘unlikely’ to return to normal for the duration of the upcoming year. Ten days later, there was a U-turn and he announced pupils would return full-time in August. Due to COVID-19, pupils in Scotland were unable to sit exams. In August, it emerged that the grades system disadvantaged poorer pupils. The government later performed another U-turn and agreed to accept teacher estimates of scores.
At the end of November, the GMB union warned that it would be March 2021 before every home care worker has testing at work. It was also reported that two of the three new NHS Covid testing labs due to open by the end of the year will not be ready on time. The regional hubs in Glasgow, Edinburgh and Aberdeen are needed to speed turnaround times for routine tests of care home staff. In August, the independent advisory group Sage said universities should test all students and staff for COVID-19 as they arrive on campus and avoid face-to-face teaching, and academics warned that reopening universities could spark a second coronavirus wave.
Professor Mark Woolhouse, professor of infectious disease epidemiology at Edinburgh University, said potential campus outbreaks had been modelled and considered to be ‘inevitable’, but Scottish Higher Education Minister Richard Lochhead said he had not seen the modelling. Draft Scottish Government advice on 30th August said those attending university would be expected to learn virtually where possible, but this was later omitted from a published document on 1st September, which said universities could "commence a phased return to on-campus learning as part of a blended (or ‘hybrid’) model with some remote teaching”. On 23rd September, Scotland recorded what was at that point the highest ever daily COVID-19 count following an outbreak in university accommodation. Students across Scotland were told not to go to pubs and hospitality venues over the weekend. Students who had moved into accommodation were initially told by the Scottish Government they could not return to live with their parents. Guidance was later updated to allow students to return home on a long-term basis. A Disclosure Scotland documentary in October found that many student halls were 100% full despite the risks of spreading COVID-19, with Professor Stephen Reicher - who advises both the UK and Scottish governments - stating the spread was an ‘accident waiting to happen’.
The Vaccine
The UK became the first country in the world to approve the Pfizer/BioNTech COVID-19 vaccine for use, with Scotland receiving thousands of doses. Nadhim Zahawi was appointed as a minister specifically to oversee rollout of the Covid vaccine in England, but the SNP government has so far failed to appoint a Vaccines Minister.
On 2nd December, the SNP Minister for Public Health, Sport and Wellbeing, Joe FitzPatrick MSP, struggled to answer a question about the vaccine roll-out.
The First Minister claimed on 14th December that Scotland was the first part of the UK to start vaccinating care home residents. This is not true.
Deaths A total of 6,092* deaths have been registered in Scotland where it was mentioned on the death certificate. A country’s ‘excess mortality’ rate shows the impact of the coronavirus, and there have been nearly 5,000 more deaths than would be expected in a normal year, based on a five-year average. Scotland recorded the third highest excess death rate in Europe, behind only England and Spain, according to official data up to the week ending 29th May. *As of 13th December 2020
CONCLUSION
It is legitimate and justifiable to examine the Scottish Government’s handling of the coronavirus pandemic. Devolution was created so that our Scottish Government could take responsibility for public health decisions here in Scotland. But too often there have been examples of Scottish exceptionalism – the myth that we have avoided the catastrophes witnessed in other countries. So too have failings sometimes been dismissed because performance has, on occasion, been worse in England. That offers no comfort to those who have lost loved ones. This is not a competition. It is beyond all reasonable doubt that the Scottish Government’s response to the coronavirus crisis has fallen short.