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There is considerable work underway way nationally and locally to ensure Scotland’s care homes are fully supported to respond to the COVID-19 outbreak.

The Scottish Government has set out set out a series of steps to provide direct clinical leadership, reporting and assurance for care homes to ensure the wellbeing of staff and residents. This includes: clinical and public health oversight of care homes from NHS Directors of Public Health and other partners; equipping Care Inspectorate for an e ced role of assurance; increasing access to PPE and establishment of a national rapid action group to monitor progress and activate any local action as well as coordinate wider package of support to the sector.

On 13 March, the Scottish Government issued clinical and practice guidance for care homes that set out the risks and the resultant clinical and practical steps to be taken, including the ending of communal activities, communal dining and unrestricted visiting. That guidance was updated on 26 March and again on 15 May. Each iteration is a reflection of the growing understanding of the virus and the situation on the ground in care homes.

As global supply chains for personal protective equipment (PPE) became increasingly challenged and the normal private supply routes to the care home sector were disrupted, the NHS National Services Scotland (NSS) social care triage helpline was launched on 19 March, so that, at national level, steps could be taken to respond to urgent requests for PPE from social care providers, including care homes. NSS order volumes were increased to ensure that we could cope with the additional demand from the social care sector and primary care and pharmacy, as well as the additional demand from acute care.

To make sure that the right PPE was delivered to the right people, direct distribution routes were created, including local PPE hubs for social care providers—which covered care homes—and direct distribution, where that was needed.

Care homes provide an important role at the end of life and we are clear that they should to be supported to provide person centred clinical care which best meets the needs of individuals. Primary care teams continue to be critical in supporting care home residents including for end of life and palliative care support alongside other in-reach services including from palliative care teams.

National Services Scotland (NSS) has arrangements to obtain and supply supportive or palliative care oxygen which can be requested and delivered to any care home where required. Arrangements have been made with health board oxygen leads to ensure that access to additional supplies can be ordered by other appropriate healthcare professionals working within the community to ensure that oxygen is available when required. All medical devices and pharmaceuticals for patients on care homes continue to be delivered by a range of home delivery companies that are contracted by NSS.

The Scottish Government has been working to get students and social care retirees and returners into the system as quickly as possible, and working with partners to support care homes to recruit additional staff. Employers now have direct access to the NHS Education Scotland and the Scottish Social Services Council recruitment portal enabling quick and effective redeployment of care workers. A number of staff have already been matched for work in care homes or care at home under the new portal and more will be joining them in the coming weeks. In addition NHS Boards and Local Authorities who have local oversight of care homes are providing staffing support for example in-reach support from community nursing teams or deploying staff directly to work in care homes.

From 18 May, new arrangements for ensuring appropriate clinical and professional oversight for care homes have been put in place. As part of this multi-disciplinary teams comprising key clinical leads from NHS Boards and Local Authorities including Chief Social Work Officers are providing oversight of local care homes. This approach builds on recent actions and existing local arrangements in helping to keep residents safe.

The Scottish Government is committed to publishing the rail services decarbonisation action plan for Scotland’s railways, this will include its assessment on the use of battery and hydrogen technology powered trains as well as electrification to meet the 2035 traction decarbonisation target.

Network Rail is currently developing a Business Case to support the recommendations of the Far North Line review group. Abellio ScotRail has also been involved in discussions to assess the deliverability and affordability of the options for potential implementation during the next eight to ten years.

Early work had, prior to the Covid-19 disruption, started on developing and trialling enhancements to the Radio Electronic Token Block signalling on the line and this will re-commence as soon as it is safe to do so.

The Scottish Government is committed to publishing the rail services decarbonisation action plan for Scotland’s railways, this will include its assessment on the use of battery and hydrogen technology powered trains as well as electrification to meet the 2035 traction decarbonisation target. Other infrastructure works may also be required to fully capture the benefits and these will be assessed on each line of route based on current and forecast capacity.

Since May 2019, Transport Scotland has worked with the rail industry to increase passenger and freight capacity on Scotland’s railway.

These increases have been underpinned by several service enhancements and infrastructure improvements providing passenger benefits that include: 13 electric services per hour between Edinburgh and Glasgow; 8-car trains offering more seats on the main Edinburgh to Glasgow route; and an hourly Inverurie to Montrose service.

Together with the introduction of all 70 Class 385 electric trains, as well as 17 more four carriage High Speed Trains which are gradually replacing three carriage Class 170 units on routes to Inverness and Aberdeen, these efforts have delivered 130,00 additional weekday seats and circa 500 more services since the start of the ScotRail franchise.

Since 2019, freight capacity has been improved through electrification to the Grangemouth terminal, gauge clearance on the Shotts line, a new southern connection at Blackford, a crossover at Aberdeen Craiginches with work ongoing on improvements at Inverness Needlefield yard and Coatbridge.

The Scottish Government recognises that current lockdown measures can have a particular adverse impact on residents with dementia in care homes, for example in the areas of restricted professional and family visiting and social distancing within care homes, and because of some residents’ limited cognitive ability to understand restrictions because of their stage of dementia.

The national clinical and practice guidance for care homes which was first published on 13 March and updated on 26 and 15 May recognises these impacts and recommends that, if necessary, it may be helpful to have a case discussion in whatever format appropriate to discuss an individual’s unique circumstances and identify ways to mitigate the impact of such measures. Strategies for promoting the wellbeing of residents during this pandemic are contained with the guidance along with advice on therapeutic interventions to help avoid and alleviate increased stress and distress for residents with dementia resulting from COVID restrictions including reduced family visiting.

While visiting is restricted to essential visitors, it may be permitted in some situations based on individual resident need, for a person receiving end-of-life care, to support someone with a mental health issue such as dementia, a learning disability or autism where not being present would cause the resident to be distressed. The guidance sets out steps that should be taken where families or friends are permitted to visit their loved one, and it refers to guiding principles produced by the Royal College of Physicians Edinburgh, the Scottish Academy of Medical Royal Colleges, Marie Curie and Scottish Care on visiting at end of life. It is expected that care homes use sensitivity in balancing the risks to individuals with the need to show compassion.

Guidance on PPE for health and social care workers was last updated on 2 April 2020, having been agreed by the four UK Chief Medical Officers and Chief Nursing Officers following a review of the existing guidance against the latest evidence and World Health Organization (WHO) advice on the safest way to protect health and social care staff.

Current guidance outlines what type of PPE frontline health and social care workers should be wearing in different settings and scenarios. It recommends the safest level of PPE to protect health and social care workers and it specifies the type of PPE that should be worn in the various healthcare and social care settings where patients or residents could be cared for.

The guidance clearly explains the PPE required for different common clinical and care scenarios including primary care, outpatient and community care.

Given the recognised sustained community transmission of COVID-19, the guidance includes detailed advice around risk assessing use of PPE, including aprons, gowns, fluid-resistant surgical masks and eye protection in a range of different clinical and care scenarios, including community settings, such as care homes. The guidance also asks that organisations themselves undertake risk assessments to ensure that they provide the correct PPE for the safety of their staff.

A joint statement, published on 9 April 2020 by the Scottish Government, COSLA and the Trade Unions emphasised that social care staff can wear a face mask if they consider doing so necessary.

To support NHS National Procurement during the Covid pandemic, a working group has been established under direct Ministerial control. The priority focus of the group is to identify quickly those offers that can supply the largest volumes at the correct quality specifications, and only the best qualified suppliers are passed through to National Procurement specialists for decision.

The Government has received over 2000 pieces of correspondence containing offers to supply NHS Scotland in response to the COVID-19 outbreak. Many suppliers offered to supply more than one type of product and suppliers often submitted multiple offers.

Removing duplicate offers the total number of offers received by 30 April 2020 was 1,347: (a) 186 relating primarily to ventilators, (b) 670 relating primarily to personal protective equipment and (c) 491 other offers.

Supplier offers recorded in the Scottish Government database are not categorised by the terms “accepted” or “rejected”. At 30 April 2020, 413 offers had been closed or placed on hold and the remaining cases were in progress.

The Scottish Government is working closely with COSLA and all local authorities to deliver the business grant schemes. This includes the development of monitoring arrangements to record the numbers of applications received and payments made. We will ensure this information is in the public domain and updated weekly.