Scots care body registers 'lack of faith' in Covid testing system as lab issues lead to checks chaos

Scottish Care said the problems have led to a "lack of faith in the integrity, resilience and rigour of the national testing programme" and has called for Scottish Government intervention.

A letter sent to care home managers from Scottish Government officials last week revealed that laboratory issues meant that not just the timing but the number of tests carried out was expected to be impacted over the coming weeks.

The circular from Tracey Slater, interim deputy director of the Scottish Government's Health Performance & Delivery section with responsibility for Test & Protect said: "The DHSC [Department of Health and Social Care] experienced a significant surge in demand across the entire network over the last week. As a result samples are taking longer for processing. We understand that this is impacting on care home test results being issued. We are also aware this may lead to fewer staff tests being completed over the coming weeks."

Scotland’s health secretary, Jeane Freeman announced on May 18 that all 53,000 care home staff would be offered weekly tests to help cut infections in homes, the site of around half of Scotland’s Covid deaths.

Data covering August 21 to August 27 has revealed that 37,010 (70%) were now having weekly coronavirus tests. At the start of July around 64% were being tested.

Care homes were meant to be fully participating in the care home safety huddle tool, which allows the ministers to see any Covid-19 issues, as well as any other staffing problems by August 24. It is to take the place of Excel spread sheets.

But at a presentation made to care home executives on August 27 it was revealed that some 83 care homes were still required to be registered.

Scottish Care which hosted a webinar presentation to promote the safety huddle tool has said that some care homes has been having connectivity issues which were being addressed.

But new Scottish Government figures revealed that as of the week ending September 1, 496 staff were reported as absent in adult care homes due to Covid-19. But this was based on returns received from 74% of Scotland's adult care homes.

Meanwhile Scots care home entrepreneur Robert Kilgour has said it was "scandalous" that the Scottish Government will not carry out a swift 'lessons learnt' review over how Covid-19 ripped through care homes, with nearly 2,500 deaths and over 20,000 positive cases.

Question marks have further been raised over Scottish Government-produced guidance produced on September 3 for implementing a staged approach to visits in care homes which says that people and professionals who visit the care home from organisations such as the NHS, voluntary organisations, Healthcare Improvement Scotland or Care Inspectorate inspectors, Scottish Fire and Rescue Service (SFRS), and workmen "may not always need to be tested for Covid 19 before accessing care homes, "and should follow requirements for infection prevention and control, PPE, and symptom awareness".

It goes on: "It is not recommended that all people and professionals who visit care homes should be tested due to the current scientific evidence. Among other things, this is also because those who will come into close proximity with residents to provide a service (e.g. health professionals) will have access to PPE equipment or they may be regularly tested as part of their own employment or work. This will remain under constant review."

But it adds that there "may be occasions" when the local health protection team recommends that such visitors should be tested for Covid-19, in an area or in a particular home.

"Therefore, testing people and professionals who may need to visit care homes should be considered as part of the local risk assessment processes taking into account the prevalence and incidence of infection in the local community; including any outbreaks or hotspots which may increase risk of infection among visitors to care homes. "

UK ministers abandoned a promised to test all people, including residents in care homes regularly throughout the summer in early August.

In a leaked memo sent to local authority chief executives, Professor Jane Cummings — the government’s adult social care testing director — said “previously advised timelines for rolling out regular testing in care homes” were being torn up because of “unexpected delays”.

The Scottish Government has since recalibrated its pledge and set a target that 70% of available staff should be tested each week, to take into account those workers who are on leave or off sick and unable to be tested.

In July, the Herald revealed that the tracking of how many coronavirus tests are being carried out on residents and staff at Scotland's care homes partly aimed at 'naming and shaming' underperforming NHS boards was abandoned because it had become unreliable.

Ministers decided to no longer publish the number of tests carried out on staff and residents saying that the data provided by health boards was considered "increasingly incomplete".

Now Scottish Care has raised its continuing concerns saying: "Over the last few weeks it has become increasingly evident that there has been both a disruption and delay of the weekly staff testing regime that is required of care homes.

"This has been documented in numerous forums, telephone calls and emails from care home providers highlighting concerns over delays in receiving test results and a considerable number of test results returned as inconclusive.

"Since the second week in August there has been a gradual slowing down in the time taken for test results to be returned. This has seen an increase from a 1 - 3 day waiting period initially and a very high level of response to around 5 and 6 days and incidences of seven to ten days for those tests that were undertaken the week commencing the August 24.

"This timeframe can be connected to the opening of schools across the country which saw a dramatic increase in the request for tests from families whose children were displaying COVID symptoms. It also relates to increased demand and problems directly associated with the UK Government Social Care portal."

The Scottish Government ramped up laboratory facilities to meet its target to have the ability to do 15,500 daily coronavirus tests across Scotland to deliver Test and Protect in May.

But for weeks testing were runing well under capacity. It was running at a third of capacity in the three days after the First Minister said the ability to screen had been ramped up in preparation for the national Test and Protect scheme going live.

Last week, the Scottish Government said Covid-19 testing capacity was to be further increased due to a "spike" in demand. Three new mobile testing units were to increase capacity by between 1,200 and 1,500 tests per day.

That came as people trying to book a coronavirus in Ayrshire were being told through an online booking system that their nearest available centre was in Northern Ireland.

Scottish Care added: "These circumstances mean that staff are currently in the position of being asked to undertake another test while not having received the results of their previous test. This understandably has generated a lack of faith in the integrity, resilience and rigour of the national testing programme which in turn puts at risk their commitment to undergoing tests.

"The importance of these issues cannot be understated as the weekly testing regime has a critical purpose of protecting residents from staff who may be unknowingly carrying the virus. The impact will be felt also in staffing levels and sustaining service delivery as infected workers will pass on the virus to colleagues and staff absence levels will rise."

"In addition, a robust testing regime is a key requirement of enabling family members to visit their relatives in care homes and as autumn and winter starts we need to do everything we can to ensure that indoor visiting is protected. We have a real concern for the coming weeks and months as further impacts will be felt not least from the return of Universities and Colleges and the remobilisation of NHS services.

"Scottish Care acknowledges that Scottish Government officials have been very responsive to our concerns and have been working hard to address these issues with the UK Government Social Care portal. The UK portal system has been unresponsive to the needs of the care sector in Scotland. We now believe that it would be in the best interests of both staff and residents if the whole testing of staff was taken over directly by Scottish Government."

One care director who was advocating the 'safety huddle' tool at the Care Scotland-hosted presentation admitted that data collection had been an issue before Covid hit.

He said: "One of the frustrations was that we ran into Covid national colleagues who knew nothing or little about care homes. That was a weakness in the system. "I don't want that to ever happen in the future. And so by me providing data that we were collecting anyway, into a national forum the profile of care homes is going to be on a par with every hospital that collects this information in a hospital setting. "The First Minister was being asked about the number of people moving from hospital to care homes. There was no way for the government to know that. So they are having to do a specific piece of work. This would help us have that level of importance going forward.

"In the care home sector, we were largely anonymous in terms of data, in terms of understanding with the exception of an annual return we did to the care inspectorate.

"The greater, wider organisation and systems, didn't know about us, didn't know what we did, didn't understand what we did. That clearly came through at the beginning, in terms of how information was shared, what was gathered, what we were asked for.

"This is a huge opportunity for us to actually be at the forefront of saying, no we are important, you need to understand what is happening, you need to understand what we do, and how much of it we do. "This safety huddle tool is a way for us to be able to influence the government, to be able to influence the health boards and partnerships in what we do. And demonstrate we are a really dynamic, really busy, really engaged sector. My personal plea, is please get this data in."

He added: "With the greatest respect to my NHS colleagues it is not all about hospitals. "Actually, there are more of us. There are more rooms in our care homes tonight than there will be NHS hospital beds. So, my personal plea is let's get on board with this."