Meeting of the Parliament (Hybrid) 17 March 2021
Since the Cabinet Secretary for Health and Sport last updated Parliament, in November, we have made significant progress in rolling out our testing strategy and programme.
The strategy that was published in August last year gave five rationales for our priorities for testing for Covid-19 in Scotland: testing to diagnose anyone with symptoms of Covid-19; testing for clinical care of patients; testing to protect those who are most vulnerable to harm from Covid-19; proactive testing to find cases among people without symptoms; and testing for surveillance, to monitor prevalence and understand disease transmission.
I will say more about progress on each of those rationales, but a key aim of the strategy was to increase the daily capacity for polymerase chain reaction testing in Scotland to at least 65,000 by the winter of 2020. That has been achieved.
Since the beginning of December 2020, our focus has been on expanding the coverage of our testing programme and the available testing capacity in Scotland into the areas where we believe it can have the greatest impact as part of our response to the pandemic. That has been aided by the availability of new types of testing technology, including rapid result lateral flow tests, which has allowed us to significantly expand the coverage of people with and without symptoms.
Under our test to care scheme, we have now extended testing to all those who have been admitted to hospital emergency departments, acute assessment centres, maternity units and emergency mental health units, as well as to all medical and surgical elective admissions.
As part of test to protect, all healthcare workers in patient-facing roles in our hospitals, in the Scottish Ambulance Service and in community-based Covid assessment centres, the healthcare professionals who visit care homes and staff working in hospices are now offered twice-weekly testing. The extension of testing to our primary care workforce—including our general practitioners, dentists, optometrists, pharmacists and pharmacy technicians—is also well under way and is on track to be completed by the end of this month. I can announce today that we will now implement testing of all remaining healthcare workers, including those in non-patient-facing roles, providing access to regular testing for more than 170,000 people who are employed by NHS Scotland.
We have also extended testing in social care, offering testing for up to two designated visitors a week for our 42,000 care home residents across Scotland. We have supplemented existing PCR testing of care home staff by providing additional lateral flow testing. We have also completed—a month ahead of schedule—the roll-out of testing to the care-at-home workforce, who are critical to supporting and caring for people so that they can continue to live as independently as possible in their own homes.
Proactive case finding remains a key part of our response to the pandemic. Since 18 February, all close contacts of index cases have been able to book a PCR test between days three and five after exposure to a confirmed positive case.
At a community level, test to find is a core part of the rationale for targeted community testing. Proposals are developed with local partners to address problems of stubbornly high transmission, rapidly rising transmission or specific transmission risks in communities, and I can advise Parliament that proposals for targeted community testing have now been agreed with 20 local authorities across eight health board areas. We have 28 asymptomatic test sites and 12 mobile testing units providing access to community testing, with more sites planned to open soon.
As well as continuing to offer campus testing to students at times of large population movement, we have now extended access to PCR testing to students prior to their travelling to accommodation at university or college. Plans are also being developed to roll out regular testing for university and college students and staff.
To manage the risk of importation of the virus from abroad, from 15 February, quarantine testing was introduced for people arriving in Scotland from outside the common travel area. All such people are tested twice during their quarantine period, on day 2 and day 8 of the 10-day quarantine, with all day 2 positive test results being sent for sequencing in order to detect any possible variants of concern.
The most recent expansion, which was announced in February, extended routine testing to support the maintenance of essential services, to mitigate wider social and economic harms and, crucially, to provide an additional protective layer to support the easing of restrictions for key groups and sectors.
To support the safe return of schools, we have introduced twice-weekly at-home testing for all staff in primary, secondary and special schools and for all secondary school pupils, with the secondary 1 to 3 cohort due to commence testing after the Easter break. Staff in school-based early learning and childcare settings can also receive testing as part of the offer, and I can announce today that, from the end of this month, access to testing will be extended to all stand-alone facilities in the public, private and third sectors that provide early learning and school-age childcare services.
Further roll-out of regular asymptomatic testing is also now available to food production and distribution businesses, whose workplaces, by their nature, can present a higher risk of transmission due to factors such as low temperatures, high humidity and limited ventilation. More than 60 businesses are now registered with the scheme and are undergoing the relevant training and induction processes.
In the public sector, to support the continued safe running of essential services, we have now implemented regular testing in the control rooms of the Scottish Ambulance Service, Police Scotland and the Scottish Fire and Rescue Service, as well as in NHS 24 call centres.
In the early part of this year, we have seen the emergence of new and more transmissible variants of the virus and outbreaks in closed settings. To help to address those, we plan to introduce testing of staff who are working in prisons to reduce the risk of asymptomatic prison staff importing the virus into the prison environment. That will start with three prisons, so that we can assess the operational feasibility and public health impact of that type of testing.
We have made rapid and significant progress across all five priority areas for testing, and it is therefore appropriate that we now publish an updated and refreshed strategy. The fundamental purpose of our strategy and testing programme will not change. Testing on its own is not a panacea. It does not stop transmission in and of itself; it gives us information to help us to take action to stop that spread and to enable us to take the right decisions at the right time. That purpose will become even more important as we determine how best to integrate and deploy our testing strategy and programme to support the safe easing out of lockdown restrictions in the next phase of the pandemic.
The activity that I have just set out will continue. We will continue to test to diagnose people who are ill so that, if they have Covid, they isolate to stop the spread. We will test for the clinical care of people in hospitals and to protect those who are most vulnerable to the worst harm. We will keep testing to find cases wherever we are most likely to find them, whether or not the person has symptoms. We will test to support our essential services and the people who work in them and to mitigate the wider social and economic harms that are caused by the pandemic. We will also continue to test to monitor prevalence, which is crucial to safeguarding the progress that we have made through all our efforts to do the right thing and adhere to the protective measures that are in place and through the success of our vaccination programme.
As transmission continues to reduce, as we hope it will, the next phase will mean a return to more sporadic outbreaks and there will be a continuing risk of importing new variants that could undermine our progress. Whole-genome sequencing improves our ability to address both of those threats. We also need to be ready for the threats of the future, not just for the next three months but for the next three years and beyond. Health threats will continue to emerge, so we must build a legacy that will help us to prepare for those future threats and that will help to build a world-class public health system in Scotland.
Today, the First Minister has announced that, next year, we will invest more than £13 million in developing a truly world-leading Scottish whole-genome sequencing service. Sequencing has already proven to be a powerful method of detecting new variants that are of concern and of investigating links between strains in outbreaks. It helps us to understand transmission better and to design treatments, it gives us early warning of new strains, and it builds a legacy for the future. Scotland’s sequencing science is already world leading. With the investment, we will build on that science to create a service that can help in our next critical stages of responding to the pandemic, that can sequence up to 1,000 cases a day if necessary, and that helps us to deal with the risks of today and tomorrow. The service will underpin our updated approach to testing. That approach will continue to be refreshed as we adapt to the pandemic conditions that we face and seek to incorporate and deploy emerging technologies.
There are two core messages that we want everyone to note from the updated strategy that we have published today. The first is how far we have come. At the start of the pandemic, before test and protect was launched, Scotland had a daily testing capacity of 350 tests. By the end of this month, the daily testing capacity across the entire system will be at least 250,000 tests a day. We now have eight drive-through regional test sites, 42 mobile testing units, 33 walk-through local test sites and 21 small-scale test sites located across the country. I say a heartfelt thank you to everyone who has helped to design, develop and deliver the sites and all our testing capacity—there are literally thousands of workers and volunteers all over Scotland involved in that shared national endeavour.
The second message is that we all need to know when, how and where to get a test. As we learn to live with the threat of the virus and seek to return safely to our everyday activities and lives, we must keep testing and must test more and in more circumstances. Put simply, testing must become part of our everyday lives, offering an important layer of protection in the months ahead, alongside vaccination and other measures including social distancing, self-isolation, hand washing and face covering.
Testing will help us to return to activities that have been largely restricted over the past year, and it will help us to increase social contact, which is vital for our mental wellbeing and relationships. In short, testing will help us to move on from the present and into the future.