Warning of new wave of virus in damning critique of government handling of Covid outbreak

Scottish Care, which represents 400 social care organisations, has revealed in documents deemed "confidential" by the Scottish Parliament – but leaked to The Herald on Sunday – that workers are still not being sufficiently screened, which could lead to a further spread of the virus.

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Its observations about the flawed Scottish Government strategy were made to a private Scottish Parliament inquiry as new data reveals the Scottish Government's "missed" daily tests rate has nearly doubled.

Scotland has been testing at little over a third of its capacity on the three days since Nicola Sturgeon said the ability to screen had been ramped up in preparation for the national Test and Protect scheme.

Scottish Care said there were elements of strategy, especially in relation to the delayed exclusion of test-positive workers, which are causing "real concern".

Some social care members had informed the umbrella body of areas where only suspected individual Covid cases were being tested and highlighted that a fortnight ago, care workers were turned away from testing centres "despite public messaging from the First Minister that they should have access through local health boards".

In some areas staff were considering training care workers to take swabs themselves, "which needs proper training and support to achieve effectively and safely".

And it said that delays in testing access were forcing some staff to use Glasgow's Lighthouse lab testing facilities instead.

The organisation called for a more mobile approach in testing provision in order to take account of the fact that staff do not always have cars and cannot travel what may be long distances to get tested.

It highlighted "extremely mixed" waiting times for receiving test results, from as little as a few hours up to "many days".

And it said the "mixed picture" across the country "is no longer acceptable when lives are at stake".

Scottish Care warned that over the course of the pandemic "we have unfortunately seen various examples of omission, inconsistency and slowness to respond to the sector's testing needs, and these need urgently addressed in order for testing to play its full and necessary role".

And in its most stark warning, it said: "It has been, and continues to be, important to address the testing needs of the care home sector, but it is also clear that the testing of homecare staff and their families has not been sufficiently prioritised. There is no targeted or strategic testing for those supported by or working in care at home and housing support services happening at all."

It added that, because much of care work required staff to shift between households, without "equivalent monitoring and action", there was a real risk that we could see a "shift of virus setting as we have from hospitals to care homes"  in outbreaks and deaths into the community.

"This is of particular concern as the country moves towards the easing of some lockdown measures, which will inevitably see more family interactions and travel between homes and therefore potentially higher community transmission rates."

It added: "It is not only unfortunate but potentially life-threatening that as some areas are progressing well and moving with alacrity to test not only staff and residents and doing so within hours, there are still other parts of the country which are much further behind.

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"Lessons must be learned from the areas which are operating testing systems well and adopted with urgency by other partnership areas."

Across Scotland around 68,000 people receive home care support, 34,000 are residents in care homes and 125,000 are employed in these services.

While on Friday there were 2,331 deaths in Scotland from coronavirus, care homes continued to account for the majority of deaths recorded in the last full week – 54%. Cases of the virus have been reported in 60% of Scotland's care homes, with a total of 5,635 residents affected.

The First Minister described the impact on the sector as "heartbreaking".

The Scottish and UK governments have already faced criticism over their handling of the virus in care settings and ministers in Scotland were accused by the GMB Union of "fiddling while the care home sector burns".

Scottish Care called at the end of last month for testing of all care home residents and staff where there had been a single case confirmed, moving towards routine testing. This was accepted and announced by the First Minister on May 2.

The group said interim guidance on testing was finally published on May 14, 12 days after political announcements "and against a backdrop of haphazard local approaches to testing".

That guidance issued by Health Protection Scotland on May 16, accepted that while the Scottish Government outlined extending testing to residential care homes in three scenarios, including as a measure to support outbreak investigations, it accepted there was "unlikely to be adequate physical or laboratory test capacity" to extend the testing "hence some local NHS board level prioritisation will be necessary".

The guidance further accepted that there was a potential risk for care home workers as in some cases there may be "an unavoidable delay" in finding cover for staff who have tested positive for the virus.

It said care home workers who test positive for Covid-19 should finish their shift if there are staff shortages, the health agency said. In such circumstances, this "could create an unacceptable risk to the safety" of the care provided, it added.

"If such a situation occurred, then any staff that had to continue working must only do so for the absolute minimum period (eg, to complete a shift) pending their replacement."

The Herald on Sunday has been aware of concerns that the guidance placed conditions and unacceptable delays on commencing testing in "linked" care homes.

The Health Protection Scotland guidance stated: "If an outbreak investigation is extended to include one or more linked care settings, then prior to commencing testing, assurances must be sought that the care home has contingency plans in place to manage the consequences of finding test positive residents and staff.

"In particular, assurances should be sought about ready access to supplies of PPE and assurance that plans are in place to organise the rapid replacement of any staff that have to be excluded from work."

It also stated that for uninfected care homes, the Scottish Government instruction is "not clear".

Plans to extend coronavirus testing to all care home staff were announced by the Health Secretary on May 18.  Jeane Freeman said all care home staff in Scotland would be offered routine tests in a bid to curb following evidence from health officials that workers were the main vectors of the disease. 

Scottish Care said it regretted the UK Government's decision to depart from the early test-trace-and-isolate strategy saying it represented a "missed opportunity" to reduce risk in the care sector.

"We welcome its reinstatement and whilst we recognise there are capacity issues, those supported by and working in the social care sector must be the first priority of its rollout," it said.

Scottish Care said testing was "core to the objective of preventing infection outbreaks and minimising spread" and that it is "even more critical" as our collective understanding around asymptomatic spread has developed.

"Inevitably social care workers who require to undertake intimate personal care will be at risk of unknowingly carrying the virus between the people they support and their colleagues if their Covid-status is not known," it said.

"The fear of this occurring is causing significant distress among the social care workforce and inevitably amongst the loved ones of those supported by services too.

"Scottish Care has been clear in our articulation of the very real and difficult balances social care services are having to strike in ensuring the health and safety of the people they support in relation to Covid-19, whilst also recognising the equally detrimental impact of the pandemic response on individuals? wellbeing and mental health."

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Last week the Herald revealed that the Royal College of Nursing Scotland, has told ministers it had noted the "increasing divergence" in testing policy between the Scottish and UK government and believed that the nation "needs to match England" on the extent of testing.

It said the nation had to "go further" on testing and roll out more routine tests for health and care workers, care home residents and hospital patients to "help detect cases early, reduce and prevent transmission in hospital and community health settings and better protect staff and the patients they care for".

Adam Stachura, head of policy and communications at Age Scotland said there was further concern that people had not been tested when going from a hospital to care homes.

"We've heard a lot about the movement from people from hospital to care homes and there not being testing," he said.

"More information is much more valuable than less of it so tests should always be part of that. New residents have been put into isolation for the first couple of weeks in a care home over the last month, but infection control is at its maximum effect when you know what you are fighting against.

"Furthermore, care staff not being tested could have been a problem as they might have brought the virus in against their knowledge."

The outbreaks in care homes across Scotland include one on Skye which is under police investigation.

Officers are looking into the circumstances surrounding the deaths of three women – aged 84, 86 and 88 – at Home Farm in Portree.

On Friday police outlined the support officers will provide to the Crown Office and Procurator Fiscal Service review over care homes.

Assistant Chief Constable Duncan Sloan said: "We understand the significant public anxiety caused by reports of deaths among those being cared for and staff in the health and care sectors as a result of coronavirus.

"This is a matter of great concern for us all."

A Scottish Government spokesperson said: “As the Health Secretary announced on May 18 work has begun to offer testing to care home staff regardless of whether the care home in which they work has a Covid-19 case.

“Health boards and local health protection teams are working to ensure care homes are supported in the transition to this new increased testing regime and are prioritising testing needs based on clinical advice. We are engaging with Health Boards to offer support and to ensure that that this is done in a planned way, and in line with national guidance.

“The Health Secretary has also made clear that the safety, protection and wellbeing of residents and staff in our care home sector is a priority and that is why we have taken a number of steps to significantly expand testing for this group.”