Health secretary admits she might have taken 'different view' on Covid-19 care home strategy

Scotland’s health secretary has admitted that she “might have taken a different view” on its widely-criticised strategy surrounding care homes during the Covid-19 pandemic, but stressed that the Scottish Government “did not ignore” the sector.

Jeane Freeman said that with the benefit of hindsight, she may have taken a different view on the government's Covid-19 care home strategy.

Ministers have come under increasing pressure over why hundreds of hospital patients were discharged to homes without being tested, with First Minister Nicola Sturgeon admitting that the spread of the virus throughout care homes "will haunt a lot of us for a long time.”

Jean Freeman said that with the benefit of hindsight, she did not think she would be the only one who would advocate a change in the government’s approach.

At a virtual meeting of Holyrood’s health and sport committee, Miles Briggs, the Scottish Conservatives’ health spokesman, asked if the government’s priority had been to free up NHS capacity.

Ms Freeman stressed: “We did not ignore care homes. We were conscious of that when the first piece of guidance came out on 13 March, approved by the chief medical officer, Health Protection Scotland, and others.

“Where we are now, looking back there, I don’t think I would necessarily be the only one of us who thinks if I knew then what I knew now that maybe we might have taken different views or additional views.

“But that’s where we were a short time ago, and that’s the approach we took, and it was certainly a collective approach across the four nations of the UK.”

Mr Briggs pointed out that Ms Sturgeon had accepted the care home transfer policy had likely contributed to the death toll of residents, and asked why patients were not being tested on discharge from hospital.

Ms Freeman stressed that testing was not the only precautionary measure in place for care homes, pointing to PPE use, visiting restrictions, and other infection prevention control methods.

She said the government had subsequently introduced “very specific” standards for pre-admission testing, adding: “I am sure that if I look back at decisions that were taken by me individually, or as part of government, at various points along this journey, if I had the information, knowledge or the experience that I have now, then I may have made different decisions.

“But I didn't have hindsight then, Mr Briggs. I have it now.”

New strategy requires ‘significant compliance'

Responding to a question from Emma Harper, the SNP MSP for the south of Scotland region, Ms Freeman emphasised that the government’s new ‘test and protect’ strategy will involve a “very different message to the public” that what it has been used to so far.

The new approach, which will be rolled out from Thursday, will ask anyone who is symptomatic to take “immediate steps” to be tested, and ensure that they - and members of their household - self-isolate until the results are available.

If the test is positive, people will need to provide the details of everyone they have had close contact with.

“It’s a very different ask of the public, and it requires significant compliance from the public in order for it to work,” Ms Freeman said.

She later told the SNP’s George Adam of her “real concern” that the revised messaging would be perceived by the public on a “negotiable” of “take it or leave it” basis, warning that such a scenario would undo the progress made during lockdown.

“If the public do not do as we ask them - which is, if you have symptoms of the virus, you must now contact us, book a test, and isolate - then what will happen is, as we ease lockdown measures, the virus incidence in the community will rise, there is a serious risk of a second wave, and all the gains of the past three months are lost,” Ms Freeman said.

At the outset of the virtual meeting, Ms Freeman referenced research into the effectiveness of the so-called PCR tests, which found they have a sensitivity of 91 per cent, meaning that nine out of 100 clinical cases of Covid-19 would not be identified.

However, she said the tests have a “specificity” of 100 per cent, which means they are accurate in detecting only the virus that causes Covid-19, and not other viruses which may produce similar symptoms.

“The tests also can’t tell us if someone is early in incubating the disease, but doesn’t yet have high enough levels of virus to be picked up,” she added.

Ms Freeman also said that over the course of June, an “enhancement” would be built into the new test and protect system, which will allow symptomatic individuals to proactively share details of their contacts, a process that would take the form of a web-based system, and not that of a dedicated app.

Individual data to be 'siloed'

She said that individual contacts would be “siloed” from one another, so that only contact tracers would be able to see the entire network of potential transmission between people.

Addressing privacy concerns, she said that the NHS-led operation ensured that the data would be held confidentially by the NHS, and that the Scottish Government would have no access to it.

“It centrally requires the public to comply with this and therefore trust that their data is held confidentially,” she added.

“That is why it is an NHS led exercise, and why it’s really important people understand that data is held with the same degree of protection and confidentiality as medical records.

“Ministers cannot access it, and it will be held for this purpose only, and then no longer held.”

Questioned by Brian Whittle, the Scottish Conservative MSP, over the scope of the contact tracing strategy, Ms Freeman said the facility for people to upload their contacts was not “central” to the new strategy, but was a way for people to “help.”

“It’s not central to the work, The real work, the boots on the ground, are the contact tracers who are in touch with people are taking them through a series of very important questions about who they’ve been in touch with and where they were.”

‘No value' in proximity app

She reiterated that the Scottish Government was not developing its own proximity app, and that it was not yet clear if the UK government’s app - trialled in the Isle of Wight - would be used to aid the response in Scotland.

“The difficulty with the proximity app as I understand it so far, and why the UK government is looking at it again, is its sensitivity,” she told the committee. “There is no value in a proximity app that pings with everyone I walk past, because I’ve not been within two metres of them or in face to face contact for longer than 15 minutes. It’s not specific enough to really aid contact tracing.

“But that doesn’t mean it can’t be, and that’s what the UK government is looking at. What we’ve said all along is that if we can get a point where it has that clarity, and can be used in a clear, focused way with the right information channels, then that will be a significant enhancement But it’s not there yet.”

Scottish Labour’s David Stewart raised the issue of antibody testing, and asked if Ms Freeman foresaw a long-term situation in which key frontline staff, such as NHS workers and police officers, would be issued immunity certificates.

“I would not rule that out,” Ms Freeman replied. “That does not mean I’m ruling it in, but I wouldn’t rule it out, and the reason for that is partly because there’s a degree of genuine controversy, there’s some ethical issues to work through.

“But also, how long do you have immunity? We don’t know yet if Covid-19 is going to perform in the way the coronavirus that gives us the flu performs, when new strains emerge.”

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