The Scottish government could have been better prepared for the pandemic, the country’s public spending watchdog has said, although ministers did act quickly to prevent the NHS from being overwhelmed.

In a report published today, Audit Scotland emphasises that treating the backlog of patients build up during the pandemic will ‘be hard to deal with’ alongside the financial and operational challenges for health boards that pre-date the pandemic.

When it hit, covid-19 was a new virus with unknown characteristics and the Scottish government had no plan in place to manage this specific kind of outbreak, meaning its initial response was based on a UK flu pandemic strategy from 2011.

But according to today’s report, the government had failed to include an influenza pandemic ‘as a standalone risk in its corporate or health and social care risk registers’, despite the risk of such an outbreak being classified as ‘highly likely’ by both the Scottish government and the UK National Risk Register of Civil Emergencies 2017.

In the years before the covid outbreak Scotland took part in three pandemic preparedness exercises, but not all the actions identified in these exercises were fully implemented and ‘progress to address any recommendations has been slow’, auditors say, including steps to ensure staff had access to enough PPE.

Steps were also missed when it came to responding to social care capacity – an area that became ‘a significant issue’ during the first wave, according to Audit Scotland.

The report – NHS in Scotland 2020 – does praise staff across the NHS and the Scottish government for taking early action during the first wave to increase intensive care capacity and pause non-urgent treatment, but says there are still ‘clear lessons’ to be learned from an outbreak that has cost the lives of over 9,000 people in Scotland.

Auditor General for Scotland Stephen Boyle said: "NHS staff have shown extraordinary commitment to treating and caring for Scotland's people during a pandemic that has highlighted the need to deal with long-standing health inequalities.

"Getting the full range of health services back up and running will be challenging. But there are clear lessons to be learned from the pandemic, both in how the country could have been better prepared and in the innovation that we've seen. It's essential that these advances are now retained and built upon.”

PPE

One of the government’s pandemic preparation programmes – Exercise Iris – found in 2018 that ‘substantive progress’ was needed when it came to PPE availability and use across Scotland.

During the first wave, volunteers stepped in to sew thousands of pairs of scrubs following “desperate requests” from frontline staff, while the government had to charter planes to bring in PPE supplies amid shortages of critical kit.

Given the concerns raised throughout covid about a lack of PPE across health and social care, auditors say the government needs to update guidance to include lessons learned from this pandemic, as well as to prepare for future influenza outbreaks which remain a high risk.

“There is obviously some concern that the Scottish government could have been better prepared and acted quicker on learning from various planning exercises,” the Chair of BMA Scotland Dr Lewis Morrison said in response to the report.

“This would seem particularly true on doctors’ experiences of PPE – where early concerns needed to be rapidly addressed.

“Going forward, lessons such as these must be learned so that such issues are addressed before they arrive, given the safety of the staff caring for patients must be at the top of the list of priorities during times like this.”

Social care

The Scottish government has faced accusations previously of neglecting the social care watchdog during the pandemic when the death toll continued to rise substantially, and of protecting the NHS at the expense of social care.

Audit Scotland says concerns about the capacity and capability of social care to cope in a pandemic arose during planning exercises but updated guidance that took account of such concerns was not updated and never published following a consultation exercise in 2019.

Following a government-commissioned review of social care that reported earlier this month, Jeane Freeman has signalled the government intends, in the aftermath of covid, to create a national care service in which government would have enhanced oversight and control of the sector.

Health inequalities

Auditors highlight the worsening trend of inequality that has developed in Scotland over the last ten years.

The report also draws attention to the fact the poorest Scots and those from black and minority ethnic backgrounds make up a disproportionate number of the 9,000 who died directly because of covid-19 or where the virus was a contributing factor, with twice as many people from the most deprived areas dying from covid compared to those from the richest parts of the country. People of South Asian origin in Scotland have experienced around a two-fold increase in the risk of admission to critical care with covid-19.

Restarting services

A worrying backlog of non-covid patients requiring treatment has built up since the NHS was placed on an emergency footing in March 2020.

Remobilising services will be ‘challenging’ and maintaining some of the innovations and learning developed during covid will be essential, auditors say, including video consultations, half a million of which had taken place by November 2020 after a surge in their use through the first lock-down.

The BMA meanwhile has said before any kind of normality resumes, staff must be allowed to take a break to recover from working through the pandemic:

“We will not be able to return the NHS to a more normal state if we simply drive staff even harder to meet pent up demand for care and risk forcing them out of the workforce for good,” Dr Morrison has warned.

He says the report from Audit Scotland “absolutely underlines” the BMA’s long-held view that the NHS is “substantially underfunded”.

“Going forward we need an honest conversation with the public about what our NHS can deliver, within the resources we are able or willing to make available to it,” he added.

 

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