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Covid-19: Scotland failed to apply measures identified in pre-pandemic exercises, says report

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n469 (Published 17 February 2021) Cite this as: BMJ 2021;372:n469

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  1. Bryan Christie
  1. Edinburgh, UK

The health service in Scotland should have been better prepared to respond to some of the challenges posed by the covid-19 pandemic, the country’s auditor general has said.

A report on the performance of NHS Scotland in 20201 praises the early action taken in the first wave of the pandemic to prevent hospitals from being overwhelmed, but it is critical of the failure to implement measures identified in pre-pandemic planning exercises.

Scotland was involved in three pandemic planning exercises in the five years before the covid-19 outbreak. Each highlighted several areas that required improvement, including ensuring the availability and correct use of personal protective equipment and increasing the capacity and capability of social care to cope during a pandemic. Despite these warnings, insufficient action was taken which left patient facing staff unprotected and has resulted in 39% of all covid-19 deaths in Scotland taking place in care homes.

The report calls on the Scottish government to update and publish national pandemic guidance for health and social care as a matter of priority. This should include lessons learnt from covid-19 and all previous pandemic exercises.

It adds that NHS staff put themselves at risk to meet the demands presented by covid-19, reflecting their “extraordinary commitment to public service.” New measures have been introduced to support staff during the pandemic and the report calls for regular reporting on these to assess if sufficient progress is being made.

Service innovations, such as expansion of the use of video consultations, which rose from 300 a week in March last year to more than 18 000 a week in November, have contributed to keeping services running. There is now a major challenge in dealing with a substantial backlog of non-covid patients whose treatment has been delayed. This will need to be tackled by NHS boards alongside the existing financial and operational challenges they already face. The report calculates the additional cost of the pandemic to NHS Scotland at £1.67bn (€1.92bn; $2.32bn) for the current financial year which is being met with extra funding from the UK Treasury.

“Getting the full range of health services back up and running will be challenging,” said Stephen Boyle, auditor general for Scotland. “But there are clear lessons to be learnt 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.”

There have been around 9000 deaths linked to covid-19 in Scotland so far with the death rate in deprived areas more than twice that of the most affluent areas. People of South Asian origin or of Caribbean or Black ethnicity have also been disproportionately affected. The report says this again highlights the need to tackle long standing health inequalities.

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