Hansard

Last week in the chamber, I updated members on our plans to deliver Covid vaccinations. Today, I am grateful for the opportunity to provide an update on our plans to significantly expand testing. The further expansion is possible because of increases in our testing capacity, which is coming from the three new national health service regional hub laboratories, from Lighthouse laboratories and from new testing options.

Yesterday, the Glasgow Lighthouse laboratory reached the remarkable milestone of having processed 5 million tests.

Work on our three new regional hubs in NHS Scotland is progressing and I thank our microbiology, virology and healthcare science workforce, 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 that capability, but I will first say a few words about the new tests. Lateral flow devices are rapid turnaround tests whereby samples are processed on site with no lab required and results being available in less than half an hour. The type that we are using first in our expansion—the Innova lateral flow test—has had extensive clinical validation by Public Health England and the University of Oxford. That validation found that the Innova lateral flow test has an overall sensitivity of 76.8 per cent, meaning that it will identity more than seven in 10 positive cases of Covid. That rises to more than 95 per cent of those with high viral loads—those who are likely to be the most infectious.

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

Testing is one layer of protection. All the others—from reducing contacts and keeping our distance, to wearing face coverings, enhanced infection prevention and control in our NHS and care settings, and vaccines, when they come—work to greatest effect only 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 who are most vulnerable to the worst harm. We now have that increased capacity and we will extend testing 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 who works in patient-facing roles in our hospitals, in the Scottish Ambulance Service and in Covid assessment centres in the community, and the healthcare professionals who visit care homes, will receive twice-weekly testing. The scale of that challenge is not to be underestimated: NHS Scotland employs more than 170,000 people and although not all are in patient-facing roles, the number who are is considerable.

We know that our front-line NHS staff are at the highest risk of being exposed to Covid-19 and we know that when community transmission rises, so, too, does the risk of outbreaks in our hospitals. We will therefore phase in that 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 who understand so well all that they need to do to protect themselves and the patients whom they care for, will welcome that 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 four local authority areas from 7 December. Learning from that, we will roll out to a further number of homes across an additional seven local authorities before 21 December, with full roll-out across all homes completed over January and early February.

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

Family and loved ones know better than anyone else that testing provides an additional layer of protection. On its own, it does not give risk-free visiting; however, combined with appropriate personal protective equipment and strict hand hygiene, I hope that it allows more relatives to visit their loved ones, reduces isolation and loneliness for care home residents and gives providers the additional confidence that they need in order to facilitate more visits.

There can be no question but that the home care workforce do a most critical job in supporting and caring for people so that 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 in a person’s home, covering residential settings, sheltered housing and day care.

This is a large group of people, who are doing very important jobs, but the very nature of the jobs that they do means that they work individually in a number of different homes and settings. The logistics of this are not straightforward, so we will phase in the testing for care-at-home staff also from mid-January, starting in the local authority areas that have the highest virus prevalence at the time, and expanding 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 that, 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 who are leaving their term-time address will be offered two lateral flow tests, three days apart, from next week, and, as part of the details that are to be set out shortly for the staggered return of university students in the new year, testing will again be put in place for them.

All school staff can currently access testing if they are concerned that they have been at risk of infection. In addition, enhanced surveillance in schools has been undertaken by Public Health Scotland. However, I know that, as transmission has risen or stayed stubbornly high in some of our communities, especially those that are now in level 4, school staff may have had concerns about risk. We will maintain the current access to asymptomatic testing, but, last week, the Deputy First Minister also gave a clear commitment to exploring the further extension of testing, and I am pleased to confirm that, from the return to school in January, we will undertake a number of pathfinder programmes to test deliverability in the school environment, with the objective of establishing a sustainable programme of asymptomatic testing among 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 mobile testing units and 20,000 home test kits to support work in five local authority areas: Glasgow City, Renfrewshire, East Ayrshire, 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 numbers of new cases per 100,000 people of any local authority in Scotland. That centre will have capacity to test up to 12,000 people a week. We are also actively planning wider targeted deployment for early January, including further asymptomatic test sites.

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

Testing is undeniably important, but it is just one layer of protection. Many layers are needed to fight the virus. Our increased capability to test more people, more often, is potentially powerful as we navigate our way through the coming months as safely as we can, alongside our nationwide vaccination programme.

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