Speedy movement essential as Freeman and Lennon clash over tests.

 By Bill Heaneyb

It was red faces all round for the SNP government once again when they made a serious error by posting wrong information on an official website about Covid-19 testing of patients on discharge from hospital into care homes.

The mistake was exposed when Labour MSP Monica Lennon asked Cabinet Secretary Jeane Freeman to provide clarification on the current Covid-19 testing policy for people being discharged from hospital to care homes, and what clinical guidance is currently in place for care homes.

Jeane Freeman said the current Covid-19 testing policy for people who are being discharged from hospital to care homes is twofold.

First, if a patient has been in hospital because of the virus, they should give two negative tests before discharge. Tests should be taken at least 24 hours apart, and preferably within 48 hours of discharge.

Secondly, if a patient was not in hospital because of the virus, a single test is required to be taken 48 hours before discharge. Those patients should be isolated for 14 days from the date of discharge. 

Jeane Freeman said: “All other admissions from the community should have one test performed before or on admission to a care home, and should be isolated for 14 days. That is the most recent Health Protection Scotland guidance, from 1 May.

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Dr Gregor Smith

“In addition, the chief medical officer for Scotland, Dr Gregor Smith, and the chief nursing officer for Scotland, Professor Fiona McQueen, have published clinical and practice guidance that provides additional practice-based information on preventing and managing Covid in care homes.

“That was first published on 13 March and has been updated since. The guidance is being updated again to take account of new requirements. The draft updated guidance was published in error on 8 May, before it had been agreed by the CMO and me.”

Monica Lennon pursued her question: “The guidance that was published on Friday 8 May watered down the earlier guidance from HPS by stating that patients should ‘ideally’ give two negative tests before discharge.

“The chief nursing officer tweeted about that guidance on Saturday, only for the cabinet secretary to tell the media the following day that the guidance had been issued in error. It was subsequently withdrawn from the Government website, on Sunday.

“However, two days later, an error message remains in place on the website. Does the cabinet secretary understand that that looks chaotic and confusing to people on the outside? What steps has she taken during the past few days to provide clarity to clinicians, front-line workers and, importantly, families who received a letter on Friday with that guidance in it?”

Jeane Freeman became rather testy at this point, and this was reflected in her answer: “Let me repeat: the guidance that was published on 8 May was draft guidance, and what was said is not currently the policy of the Government.

“The policy of Government is what I have just provided from Health Protection Scotland. That is the policy position that has been turned into guidance for care homes, care home staff, residents, relatives, care home owners and our clinicians in hospital settings, about what testing approach should be undertaken for patients who are being discharged from hospital to a care home, and for community admissions to care homes.

“The guidance that appeared on the website on 8 May was draft guidance; it was an error that it was published. It has—as Monica Lennon said—been withdrawn. I am grateful to Ms Lennon for giving me another opportunity to make clear, in the chamber, what the testing policy is.”

Officials have been in touch with care homes and others to ensure that they understand that the current guidance is the guidance that was published on 13 March and updated in some measure on 26 March, and to ensure that they are aware—they are—of changes in testing policy for admissions to care homes from 1 May, be they from hospital or the community.

“The revised and updated guidance will be published as soon as it meets my requirements and those of the chief medical officer, and as soon as it reflects all the changes that we have instituted to ensure that we are focusing on Covid-19 in our care homes,” the Health Secretary said.

Monica Lennon: replied: “I am prepared to be corrected, but I do not believe that the guidance said ‘draft’ when it appeared on the website on Friday. I wonder why draft guidance would be sent to thousands of care providers and to local authorities, health boards and integration joint boards. It would be good to have some clarification.

“I am certain that thousands of people across Scotland are very concerned about their loved ones who are in, or who might be admitted to, care homes. There is still a feeling that testing is too slow, that there is not enough testing and that results are taking too long.

“Does the cabinet secretary believe that any care home residents have died after contracting Covid-19 from discharged patients? If so, what lessons are being learned?”

Obviously riled  by this, Jeane Freeman told Ms Lennon: “I repeat: publication of that guidance on the Government’s website was an error. It was not a conspiracy; it was a mistake that was made by people in the health directorate who have been working non-stop on the matter since the turn of the year.”

She added: “I do not and cannot know whether any care home residents who have contracted Covid-19 did so as a consequence of the admission of residents who already had Covid-19.

“I cannot know that because of the length of the incubation period and because I do not know exactly what conditions individuals might have had before we instituted the testing policy.”

Ms Freeman repeated that the posting had been an error – “It was a mistake: I have apologised for that and we have made sure that all those who might be affected because they have to apply the policy know what the policy is. We will publish the revised guidance when it meets my requirements, and those of the chief medical officer and the clinicians involved.

“We are working very hard on testing. As the Deputy First Minister [John Swinney] said earlier, our capacity for testing has increased significantly. It must increase even further in order to meet our needs for the full test, trace, isolate and support strategy, which will be critical to any easing of the current measures. However, capacity has increased significantly.

“Our work now is not only to continue to increase the capacity for testing, but to increase its use. That involves speeding up the turnaround time from the point when the sample is taken to the point when the result is given. At the moment, that ranges from four to 48 hours, which is not good enough; the advice that I have from clinicians is that the turnaround time should be under 24 hours. If we can bring results in in under 24 hours, that will be very helpful for the test, trace, isolate and support strategy. The process should take 24 hours at most.”

Work is now under way on logistics [transport arrangement] to ensure that samples are taken quickly, that they get to the laboratories as quickly as possible, and that we have everything that is needed in the labs to process samples. Laboratories need equipment and chemical reagents, for which we are working on a solid supply line.

“A bit like the case of the supply line for personal protective equipment, lots of people are chasing the same global supply line. Work is under way to speed up the testing turnaround time.”

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