24 June 2020

I thank the First Minister for advance sight of her statement.

We all welcome the news that the number of Covid-19 deaths continues to fall and that we can look forward today to an easing of the lockdown.

However, if we are going to turn the page, we should also look back on the chapter just written.

Of Scotland’s population, only 0.7 per cent live in residential care homes, and yet today’s figures confirm that more than 50 per cent of all deaths from Covid-19 have occurred in that tiny section of our community.

We do not need hindsight to tell us that, at a time in their lives when they were at their most susceptible and in need of greatest help, those most vulnerable people were badly let down.

Writing to me last week, Judith Robertson, the chair of the Scottish Human Rights Commission, stated:

“The situation experienced in care homes raises a number of serious human rights concerns.”

She went on to reference:

“the right to life, the right to be free from inhuman and degrading treatment, the right to a private home and family life and the right to non-discrimination”.

I agree with the Scottish Human Rights Commission. When the SHRC wrote to the Scottish Government to raise those concerns back in April, I agreed with it then, too. Why did the First Minister not agree?

The First Minister (Nicola Sturgeon):

I agree with the Scottish Human Rights Commission, and I actually agree with the sentiments—and, to be fair, the tone—of Richard Leonard’s question.

I feel, as we all feel—more deeply than I can find the words to articulate—what has happened in care homes in Scotland over the past three months. I do not say this in any way to minimise or excuse that, or to imply that we do not have to look hard at what has happened, but we have seen it happening in countries across the world, and I simply say that we should not consider it as something that has happened only in Scotland. Nevertheless, it is our responsibility to consider what has happened in Scotland and to make sure that we learn lessons, and I have a very deep commitment to doing that.

Where I disagree with Richard Leonard—I hope that he will take the spirit and intent of what I say—is on the connotation of what he said that we have somehow not acted as best we can to try to protect people in care homes. Richard Leonard may think—he is perfectly entitled to do so, and I am sure that there will be others across the country who think the same—that we did not do the right things or that we did not do things at the right time. That is a perfectly legitimate view to hold.

However, at every stage, from making sure that we issued guidance stressing the need for clinical risk assessments of people going into care homes; to issuing guidance for care homes around isolation and moving away from communal living, to the strenuous efforts led by the Cabinet Secretary for Health and Sport to ensure that care home providers had top-up supplies of personal protective equipment for their staff; to some of the things that we have done to ensure that care home workers get a death-in-service benefit and a top-up of their statutory sick pay if they have to be off because they have the virus; through to the work that we are doing around testing, we have taken steps to protect older people in care homes as best we can.

I will say two things finally. First, as I have said before, we will require to take a long, hard look at everything about the virus and, within that, the situation in care homes. Secondly, as I have also said before, looking ahead, there is a big debate to be had for us in the Parliament—I look forward to Richard Leonard taking part in that debate—about the future structure and model of our care home sector in Scotland. We should all engage in that debate constructively.

Richard Leonard:

The First Minister mentioned Government advice. One of the issues that the Scottish Human Rights Commission raised back in April was that, despite what the First Minister has said in Parliament, the clinical advice that the Scottish Government issued was that care home residents should not be treated in hospital if they were suspected of having Covid-19. That policy remained in force until 15 May.

It is not just the Scottish Human Rights Commission that has questions; many grieving families desperately want answers, too. This week, I was in contact with the family of Margaret Laidlaw. Margaret lived in an intermediate care home until late April, when her family were informed that she would be moved to Drummond Grange care home in Midlothian. Residents in both homes had Covid-19. Not long after moving, Margaret displayed the symptoms and caught the virus. She was kept in the home and her family were told that, because of the Government’s policy, she would not be treated in hospital. Sadly, within weeks, Margaret passed away. She was 65 years old. Margaret’s family are angry. They want to know why the care home was so unprepared and why hospital care was not available.

Sadly, Margaret’s story has been all too common. What does the First Minister have to say to Margaret’s family and families like them? Does she regret that it took so long for the Government’s official advice to be replaced?

The First Minister: I say to Margaret Laidlaw’s family what I would say to any family that has lost a loved one to the virus and, in particular, to anyone who has lost a loved one who was in a care home: I cannot find the words to adequately sum up the sense of sorrow that I feel and the depth of my condolences to them.

It is not possible, and it would not be appropriate or helpful to the family, for me to start to comment in the chamber on individual cases that I do not have the full details of. However, I agree that families have a right to answers. They have a right to know what happened to their loved ones, to question things that were done and were not done, and to get the answers as far as possible. As I have said on previous occasions, I have a very deep and strong commitment to doing what is required to facilitate that process.

On what Richard Leonard has described as Government policy—he will have heard not just me and the health secretary but the chief medical officer say this—it is not a matter of policy whether an individual in a care home or anywhere else is admitted to hospital. Clinical advice that will have been issued in many different circumstances for many different scenarios is applied and interpreted by clinicians, who have the job, often in consultation with families, of deciding where the best location of care is for an older person. Richard Leonard will have heard the chief medical officer say in the past that, in some cases—perhaps in many cases—admission to hospital for older people and, in particular, admission to invasive and intensive care, is not in their best overall interests, but if the clinical view is that it is, that should happen. It is simply wrong to say that any Government policy stops that happening. It should be clinicians who decide what the best circumstances and the best location of care are for the people whom they are caring for.

Richard Leonard:

I have the clinical guidance with me. It says:

“It is not advised that residents in long term care are admitted to hospital for ongoing management but are managed within their current setting.”

That is what it says. That has been one of the greatest scandals of the pandemic.

Just yesterday, the heads of the royal colleges sent an open letter, calling for a rapid review of our preparedness to tackle the virus, warning that

“local flare-ups are increasingly likely and a second wave a real risk.”

The question whether the Scottish Government is ready for that is a matter of concern for us all, but is especially concerning in the setting of our residential care homes. We cannot allow a second wave to result in a second scandal.

On 27 May, ahead of the move to phase 1 of the easing of the lockdown, I called on the First Minister to conduct an urgent review of the Government’s approach to care homes, so that we would be prepared for the future. She gave no such commitment.

Today, will she listen? Will she listen to the heads of our royal colleges? Will the Scottish Government rapidly review the support and guidance for care homes, so that they are ready for any second wave, or any flare-ups? Will she do it, so that the rights to health and safety of care home staff, and the human rights of care home residents, are protected?

The First Minister: I will start at the end of Richard Leonard’s questions, with what I hope is a helpful answer.

In principle, yes; we are reviewing on an on-going basis all aspects of our handling of the virus.

Although some of the more fundamental look back will take longer, and will have to wait until we are out of the crisis, we are trying, as we go, to learn any appropriate lessons.

I am very happy to consider how we open that process, particularly on care homes, so that others have an opportunity to feed in to that and an opportunity to scrutinise it in Parliament. I will take that away, and I will discuss with the Cabinet Secretary for Health how we facilitate that.

Richard Leonard has read from clinical advice. I make the serious point that clinical advice is prepared by clinicians who advise the Government. It is not prepared by ministers; I am not qualified to give clinical advice. The chief medical officer—with the chief medical officer’s office—acts independently in such matters, on the basis of clinical knowledge and expertise. Advice is given to cover the generality of a situation.

My point—which many clinicians will make—was that it is often not in the best interests of an older person to go into hospital when they can be better cared for in their own home. Fundamentally, however, decisions about care lie in the hands of individual clinicians. That is as it should be, as it has been, and as it always will be.

Richard Leonard is right to warn of the risks of a second wave. It is not fair to me to say that I am not cognisant of that risk. I spend much of my time in advising and warning people that the virus has not gone away, and that we face a real risk of the resurgence of the virus—I do not like the phrase “second wave”, because it presupposes that we are out of the first wave, or that somehow it lies in the future.

That risk is there and will be there all the time, and we must guard against it. Everything that we do right now, therefore, from the pace of coming out of lockdown, through the care that we are taking over all those decisions, to the continued building of test and protect, is all about avoiding that. As we go, we genuinely want to learn lessons. At the very outset of this, I said that mistakes would be made. I absolutely readily concede that that will have been the case.

To end my answer where I started, I am very happy to look at how Parliament contributes to a review of our experience to date on care homes, so that we can learn any lessons as appropriate.

Richard Leonard (Central Scotland) (Lab): I welcome many of the recommendations in the advisory group’s report.

The analysis that young people are more likely to be on insecure contracts, in low-paid work and in locked-down sectors is important in understanding the scale of the challenge that they face and therefore the scale of the challenge that we face as a society.

That is why the call for a jobs guarantee scheme—a Scottish guarantee—to counter the huge rise in youth unemployment is one that we have been making for some time and will continue to make. It is therefore welcome to see it as a central conclusion of the report. I hope that the Government will not just vote for our amendment but will do what it says and give our young people a guarantee of a quality job or a quality training place.

Gillian Martin (Aberdeenshire East) (SNP):

Richard Leonard often talks in the chamber about precarious contracts. Would he welcome power over employment law coming to the Scottish Parliament and Government so that we can ensure that there will be no more precarious contracts in Scotland?

Richard Leonard:

I have said on a number of occasions that I am in favour of the devolution of employment law, not least in the context of Brexit, when we will see a transfer of powers from the European Union to the United Kingdom that, in my view, should come to this Parliament.

It is important that the report also identifies national leadership.

Those of us who have lived through times of mass unemployment know what its unequal burden does to the fabric of society and to the fabric of families. It is important to note that the advisory group explicitly states that there can be no repeat of the mistakes of the 1980s and that, although the report talks variously of tight public finances, it is also clear in its view that “another round of austerity is not the right answer.”

I hope that the Cabinet Secretary for Finance has got that message, too, and that she recognises the importance of “direct funding to families”, which the report also highlights as a way of getting the economy moving again. That is why the decision to delay the Scottish child payment, just when child poverty in Scotland is going up, needs to be reversed—fast.

We live in a time in which there is no shortage of useful, purposeful work to be done and in which a just and green recovery must be our goal. Older people are still shivering in the cold in our winters and suffering from hypothermia, while engineers and electricians are looking for work. Let us therefore have that green investment in domestic heating and energy efficiency to generate the jobs that we need.

We still have more than 150,000 households on housing waiting lists across Scotland, so, in the weeks ahead, while construction workers may have idle hands and apprentices could be trained, we need to see action in that area and a major council house building programme.

Let us give local councils the resources that they need. Our schools are calling out for extra teachers and extra resources to build the capacity that they need, not least to meet the consequences of the Deputy First Minister’s U-turn this afternoon.

Transport investment is rightly identified in the report as a priority, so let us look urgently at bringing the railways back into public ownership, and bus services back into municipal ownership, too.

That we need an investment-led recovery is often asserted, but not always acted upon. It is correct to bring forward the Scottish National Investment Bank’s bond-issuing rights, to pave the way for investment in housing and infrastructure projects, but the cabinet secretary should be pressing for the Scottish National Investment Bank itself to be up and running, not by the end of the autumn or by early winter, but by the middle of this summer. We need it now; this is a national emergency.

A revamped Co-operative Development Scotland agency would be an important start in the pursuit of the goal of the extension of community wealth building—the idea that we should be building more democracy, co-operative ownership and employee ownership into the economy.

I finish by touching on an area in relation to which I do not think that the report goes far enough. It does not properly recognise the need for economic planning or the importance of a national plan for the Scottish economy. It does not properly recognise the importance of bringing together employers, trade unions, Government and agencies to democratically plan, at industry level, where we want to be—not just next year, but in five years’ time and 10 years’ time. We need a plan that is comprehensive, that works for the whole of Scotland, that is effective and action oriented, that focuses on delivery and that is accountable to the Parliament.

That will take resolve, commitment and conviction, but that must be our duty, because, after what we have been through, after the sacrifices that have been and are still being made—the lives lost—we cannot allow the people to be demoralised. We must lift their spirits and give them hope to rediscover their self-confidence. We must give them a burning flame of hope: hope that we cannot go back to the old inequalities; hope that, instead, we can dare not only to think big, but to act radically; hope for a just and green recovery; and hope so that, together, we can build a better future and a better Scotland.

I move amendment S5M-22119.4, to insert at end:

“, and welcomes the focus on establishing a jobs guarantee scheme, which should be tailored to ensure it provides necessary additional assistance for young workers, women and BAME and disabled workers, who are all likely to be hit hard by this economic crisis.”

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