Delivering for a Scotland where everybody thrives in 2020 to 2021
Since 1 April 2020, Public Health Scotland has been leading and supporting Scotland to respond to its health challenges – and making a difference to the lives of people in our communities.
Public Health Scotland was founded on 1 April 2020, bringing together Scotland’s national capacity to improve and protect health into one organisation for the first time. The creation of a new leadership body for public health in Scotland was one of the three pillars of the public health reform programme, along with the development of shared national public health priorities and a whole-system approach to public health. Jointly led by the Scottish Government and the Convention of Scottish Local Authorities (COSLA), the aim of the reform programme was to provide the people of Scotland with a public health system equipped and ready to meet Scotland’s well-documented health and wellbeing challenges.
The new organisation had to immediately adapt and respond to a new challenge to Scotland’s health and wellbeing; the COVID-19 pandemic. We share some examples in what follows of how teams adapted and responded at a fast pace, enabling us to play a significant role in Scotland’s response to the pandemic, while also continuing to drive improvements in other areas of public health.
Our approach has, from the outset, been collaborative and founded on the principle that we are at our most effective in public health when we work together. We provide leadership, evidence and expertise, supporting decision-makers and practitioners to take action that will make a difference in our communities. We maintain a sharp focus on inequalities and work with partners to target services and resources effectively. We lead the development and innovation of high-quality digital tools so that partners across all sectors have the data and intelligence they need at a local and national level. Working with our partners, we are confident that, together, we can create a Scotland where everybody thrives.
Jim McGoldrick, Chair
Angela Leitch, Chief Executive
1,137 staff employed at March 2021
We supported the contact tracing of 201,378 cases resulting in 487,548 people being contacted to self-isolate (up to 4 April 2021)
Over 27 million visits to our COVID-19 Daily Dashboard
We helped create 5 major COVID-19 vaccination leaflets, printing over 11 million copies and distributing them to over 5,000 vaccination centres
Over 4,500 real-time epidemiology reports and data extracts sent to stakeholders
We supported 425 local incident management teams as part of the COVID-19 response
Our health protection guidance web pages were viewed 1,177,390 times and 1,975 people subscribed to receive notifications for guidance updates
480 Freedom of Information requests received
By April 2021, in just one of our secure data environments, we supported 78 active research projects, which have played a key role in COVID-19-related research across the UK
2,800 mentions of Public Health Scotland in the UK press
Twitter posts generate an average of one million impressions each quarter
40,188 learners are registered on our online training platform - 6378 of them new in 2020/21
Research that Public Health Scotland has led, partnered or enabled has made headlines around the globe. Public Health Scotland has been generating world-leading practical insights into COVID-19 since it emerged. It has linked researchers to Scottish data and given busy planners and policymakers fast, easy access to quality research.
For example, on 22 February 2021, news organisations around the world reported promising news on the COVID-19 vaccine effect. ‘Vaccines Sharply Cut Coronavirus Hospitalization, UK Studies Show’ ran the headline in the New York Times. The headline referred to the work of the Early Assessment of Vaccine and anti-viral Effectiveness (EAVE) II project and is just one example of world-leading research Public Health Scotland has led, partnered or enabled in 2020 to 2021. Research that has reached beyond academia and shaped practical action in Scotland and beyond.
EAVE II findings, published in The Lancet, showed the Oxford-AstraZeneca and Pfizer-BioNTech vaccines reduced the number of people being hospitalised with COVID-19. Randomised controlled trials had already shown the vaccines were safe and effective, but EAVE II provided the first evidence that it had an effect at a national level.
EAVE II did this by linking data on vaccinations with data on people going into hospital using each individual’s unique Community Health Index (CHI) number. Scotland’s size and data infrastructure, plus the speed of the rollout of the UK-wide vaccination programme, meant we were the first in the world to be able to publish such findings.
Working closely with the University of Edinburgh’s Usher Institute, we brought together:
- NHS Scotland hospital data and vaccine data
- researchers from the universities of Glasgow, Strathclyde and St Andrews
- funding from the Medical Research Council and National Institute for Health Research
- support from the Scottish Government.
The work on whole genome sequencing (WGS) is another case of science into action. Sequencing the SARS-CoV-2 virus genome from cases helped us to:
- understand whether restrictions, such as closing pubs and restaurants, had any effect on stopping the spread of the virus. We did this by tracing outbreaks linked to the specific variants of SARS-CoV-2 involved
- understand ways to stop it being brought back into Scotland by tracing the virus’s family tree back to its introduction into Scotland
- monitor the changes of the SARS-CoV-2 virus to assess whether any new variants could transmit more easily, make people more ill or evade the immune response generated by our vaccines.
WGS is an established science, but it has never been so successfully applied to outbreak management at scale as it is now.
We have partnered with WGS experts in universities and laboratories to link WGS data with other sources of data to identify new variants, and we made the case to secure funding to expand the scale and scope of WGS in Scotland. This is offering scientists and policymakers unique insights unavailable in previous pandemics.
We have enabled researchers across Scotland and the UK to contribute to the international response to COVID-19. We can support this research by curating, linking and providing permissioned, secure access to the data we have on patients in Scotland.
We have been able to link COVID-19 researchers to data faster than before by
pre-populating our secure data environments with commonly used datasets, and by working with ethics bodies to streamline the permissions process.
Work where we have played a key role includes:
- Health Data Research UK National Core Studies programme supporting COVID-19-related research across the UK
- International Severe Acute Respiratory Infection Consortium (Coronovirus Clinical Characterisation Consortium) (ISARIC4C) research advancing our understanding of COVID-19 in relation to risk factors for death, immunity, who is likely to be hospitalised, its impact on children, ethnicity and more.
The volume of research generated by COVID-19 has itself become a problem. The variety of formats and sites it is stored on makes it hard for busy policymakers, researchers and service planners to find and keep themselves up to date.
By creating a fully searchable COVID-19 Research Repository with higher education institutions in Scotland, we have made research faster and easier to find and reduced duplication of effort. We know of no other country with such a resource and it is already generating interest in Scotland and across the United Kingdom.
Public Health Scotland has been working to strengthen and increase Scotland’s local public health resources as part of a world-class public health system.
As Scotland’s national public health body, we are at the heart of a whole system of organisations and people working to create a Scotland where everybody thrives. 2020/21 has challenged us to work better together more effectively than ever before. An example of doing this in 2020/21 is the set-up of Scotland’s nationwide COVID-19 contact tracing service.
Contact tracing can reduce the spread of COVID-19 by tracing those who have been in contact with people who test positive for COVID-19 and helping them to self-isolate. That means if they have the disease too, they are less likely to give it to others.
Public Health Scotland plays a lead role in the delivery of contact tracing in Scotland by working closely with the Scottish Government, Directors of Public Health, and local NHS Board health protection teams as part of NHSScotland’s Test and Protect strategy.
Scotland’s contact tracing approach to COVID-19 was developed rapidly during spring 2020 and implemented in May 2020. We led this collaboration between local and national NHS Boards, putting in place an infrastructure which would deal rapidly with peaks and troughs in contact tracing demand based on cases of COVID-19 in the community.
Local health protection teams and the National Contact Tracing Centre (which is run by NHS National Services Scotland) together run Scotland’s contact tracing service. To support the effective coordination of contact tracing, and the rapid identification of ‘hot spots’, which cross NHS Board boundaries, we led the development of a digital tool for recording all contact tracing activity. This has been used by all NHS Boards and the National Contact Tracing Centre since July 2020. We also lead on the development of guidance and training resources to support contact tracing.
Public Health Scotland has been working with colleagues across Scotland to keep vital services safe and to minimise disruption.
COVID-19 disrupted much of our economy, society and life in 2020 and 2021. But there are some services than cannot, should not, or we will not close – even in the face of a disease like COVID-19.
Public Health Scotland and our partners have worked to keep these vital services as safe as possible. Two examples of this are our work with colleagues in education and on the 2021 Scottish Parliamentary elections.
2020/21 has seen the education of thousands of children and young people significantly disrupted. The challenge was to return our children and young people to in-person education safely and sustainably.
Public Health Scotland worked closely with local authorities, Scottish Government, COSLA, Trade Unions, Education Scotland and Directors of Public Health to minimise this disruption and meet this challenge. We did this by leading work to understand the impact on children of closing nurseries and schools and to equip decision-makers with evidence, data and expertise on COVID-19 in education settings.
The findings of our COVID-19 Early Years Resilience and Impact Survey (CEYRIS) fed directly into local and national policy and practice. The findings informed decisions like the reopening of parks and deciding not to restrict the number of young children that could meet outdoors.
Our COVID-19 Antibody Survey of education Staff (CASS) and Record Linkage provided local and national policymakers trustworthy estimates on the COVID-19 risk in teachers.
We also supported policymakers with weekly surveillance reports, evidence scans on subjects like the transmission of COVID-19, and intelligence from across the public health system. Writing to the Public Health Scotland representative on the COVID-19 Advisory Sub-Group on Education and Children’s Issues, Deputy First Minister John Swinney said:
‘[The advisory sub-group's] impact cannot be overstated. The advice that it has considered and developed, often at pace, on complex issues at the intersection of science and its implementation, has been first rate...I have seen at first-hand the value of sub-group members explaining advice to member of the COVID-19 Education Recovery Group.’
While many things have stopped for COVID-19, it is vital that democracy continues. Public Health Scotland worked closely with the Electoral Management Board for Scotland, Electoral Commission and Scottish Government from summer 2020 to ensure campaigning, hustings, voting and counting of votes in the Scottish Parliament were safe for everyone involved.
Together, we produced guidance for local authority returning officers. It included advice on the key actions that can be taken to help reduce the risk of spread of COVID-19, including the need for physical distancing, good hand hygiene, and use of face coverings.
Working closely with local environmental health and health protection teams helped us reflect the practical challenges they faced preparing for this election. Their input helped us address issues and shape the guidance available to campaigners, returning officers, and electoral registration officers. By working with so many partners, we were able to address a wide range of public health concerns and ensure that the same consistent guidance was followed, with the same processes put in place across Scotland, no matter the location.After the election, a local elections official wrote to us:
‘The support and advice that you provided was essential to the successful delivery of these polls…you gave advice that was measured, accessible and easy to apply. You responded quickly, recognising the deadlines and time pressures that we faced. As a community we were able to conduct this election with confidence that our approach was informed by your expertise and this was very reassuring to all involved including our staff and the voters.’
COVID-19 vaccines prevent serious illness and death, as studies like the EAVE II study (external website) have shown. Public Health Scotland played a vital part in the Scotland and UK-wide effort to vaccinate people against COVID-19 so that by 31 March 2021, 2,903,647 vaccines had been administered in Scotland – with as many as 64,483 people receiving a dose on a single day.
Public Health Scotland contributed to this life-saving initiative by helping train and educate a workforce of vaccinators and informing millions of people about the benefits of vaccines.
Before anyone can have a vaccine, they need to be able to give informed consent.
Public Health Scotland has led the development and delivery of communications resources to support vaccine rollout in Scotland. Our work provides the public with clinically accurate and up-to-date information on which to make an informed choice about getting the vaccine.
Working quickly and collaboratively, we:
- worked with clinical and service delivery colleagues to devise and print over 11 million copies of five major leaflets
- distributed these resources to more than 5,000 vaccination centres
- ensured the key messages and updates were consistent on the scripts used by the COVID-19 Vaccination Helpline
- created a series of digital resource toolkits for frontline professional staff
- worked with NHS inform to provide up-to-date, user-focused and accessible vaccination information, including videos on the NHS inform website, whose COVID-19 pages averaged 50,000 page views per day for the first quarter of 2021
- translated these resources into 25 languages and other formats (including Easy Read, BSL, audio and large print), liaising with territorial health boards and Scottish Government to ensure local community needs were met
- continually improved and updated information in response to frequently asked questions, misinformation about the vaccines (by stating the facts) and including new information about the vaccination programme as it emerged.
Our rapid development and distribution if accessible and inclusive informed consent information across multiple channels, allied to a robust clinical approvals process, ensured that the priority groups had the information they needed when vaccinations started in early January.
Across Scotland, thousands of healthcare practitioners and healthcare support workers have joined the vaccination programme to administer COVID-19 vaccines. They have a variety of experiences, are spread across Scotland, and even when trained need to be kept up to date. With NHS Education for Scotland, we have turned these practitioners into vaccinators who can safely and competently give the COVID-19 vaccines.
Together, we developed a series of webinars that have managed to reach 11,300 practitioners and keep practitioners up to speed on the:
- Pfizer/BioNTech, Oxford/AstraZeneca and Moderna COVID-19 vaccines
- guidance on the vaccines and pregnant or breastfeeding women
- guidance on the vaccines and allergies
- evidence on the thrombotic syndrome associated with the Oxford/AstraZeneca vaccines.
We accompanied these webinars with a series of online resources, hosted by NHS Education for Scotland’s TURAS platform. These included a 15-hour e-learning course and slide sets for sharing information on the vaccines in NHS Boards.
Public Health Scotland has continued to lead and support local and national efforts to address some of Scotland’s long-term health challenges.
COVID-19 has, rightly, been the chief health challenge facing Scotland and the world in 2020 and 2021. However, Scotland’s existing health challenges have not gone away.
We have continued to work on these challenges while also playing a leading role in Scotland’s response to COVID-19.
National Records of Scotland figures showed that 1,264 people in Scotland died of a drugs-related death in 2019. That is 77 (6%) more than 2018 and the highest figure on record.
Public Health Scotland is leading work to improve our data on drugs deaths in support of the Scottish Drugs Deaths Taskforce (external website) – a collaboration of partners aiming to prevent drugs deaths.
In partnership with Police Scotland, we started updating data monthly on trends in suspected drug-related deaths during the COVID-19 pandemic. This showed increases in the weekly number of suspected drug-related deaths between April and June 2020 and between December 2020 and February 2021.
We drew on our experience of implementing similar approaches for monitoring hospital-acquired infections to develop a bespoke model that Police Scotland could use prospectively. Now in place, partners can identify within a matter of days a trend that needs to be investigated further and could be helped by focused prevention efforts. We will continue to refine the technique to improve its applicability for NHS Boards.
Scotland has a troubled relationship with alcohol. It is a major harm to our health and wellbeing. In 2019 an average of 20 people a week died from a cause wholly attributable to alcohol, with death rates six times higher in the most deprived areas compared to the least deprived.
In Public Health Scotland, our research and data systems give local and national policymakers and service planners valuable insight into alcohol consumption. We analysed alcohol sales data and found that during the first lockdown there was an overall drop in alcohol consumption. The increased sales in shops and supermarkets were cancelled out by the loss of sales through pubs, clubs and restaurants.
We wanted to understand whether while overall consumption might have dropped, some vulnerable groups might have been affected more than others. To do this, we commissioned the University of Sheffield to analyse survey data on drinking behaviour. Results for total consumption were similar but there was also some evidence of changes in drinking behaviour in some higher risk groups.
As well as informing decisions now, these analyses are part of the decade-long Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) programme MESAS will inform the Scottish Parliament’s decision whether to continue with Minimum Unit Pricing (external website) beyond 2023.
Public Health Scotland has supported local services to care for people who need specialist drug and alcohol treatment by leading the development of a new Drug and Alcohol Information System (DAISy).
DAISy gathers drug and alcohol referrals, waiting times, and outcomes information. It is a single system that provides high quality, complete data on treatment for problematic drug and alcohol use.
DAISy went live on 1 December 2020. Whereas before users had to record information on multiple different systems, DAISy now allows the seamless tracking of an individual from referral through to treatment, follow-up and discharge. It supports better collaboration across organisations by having one service user record. Elimination of duplicate data entry saves time and increases efficiency.
By gathering demographic and outcome data on people who engage with treatment services, DAISy will inform national policy, service and practice development. It will provide timely information to support local service delivery, improvement and planning.
Public Health Scotland has provided timely, trusted, reliable and valuable data and statistics to the public and policymakers on the COVID-19 pandemic.
In a year when:
- Scotland has faced a quickly changing situation as a virus has spread through our communities. Public Health Scotland has developed timely, reliable data that has equipped policymakers to make difficult decisions
- Our leaders have asked the public to accept unprecedented restrictions to their lives, Public Health Scotland has developed and shared trustworthy, clear and relevant data which is important to keeping the public’s trust.
Two examples of our work in this area are our COVID-19 dashboard and our real time epidemiology reporting.
At the height of the uncertainty and rapid change of 2020, Public Health Scotland put timely, robust and clear information about COVID-19 in the hands of people living in Scotland.
We quickly developed the COVID-19 Daily Dashboard and associated Open Data. They provide daily updates on the disease in Scotland including data on confirmed positive cases, hospital admissions, people admitted to intensive care units and deaths. Later they included data on vaccine uptake. Much of this data is available down to local neighbourhood level and various demographic breakdowns.
This was not straight forward. We had to rapidly establish flows of accurate and consistent data from across Scotland to feed COVID-19 reporting in the Daily Dashboard and elsewhere. This frequently involved covering new or unfamiliar data, systems, processing and linkage. We collaborated between teams and organisations, often against the clock.
The dashboard is highly used, with a total of over 27 million hits in the last six months of 2020/21, and consistently high levels of use each day. The associated Open Data files have been similarly popular, viewed 1.2 million times in 2020, peaking at over 48,000 page views on a single day in October 2020.
The course of the pandemic evolved over 2020/21 – at times rapidly. Policymakers were faced with challenging decisions about how much to restrict Scotland’s society and economy to stop the spread of COVID-19.
Public Health Scotland led Scotland-wide work to gather, aggregate and share the latest data and intelligence on the course of the pandemic. This involved putting in place systems to gather new sources of data and working with local areas to overcome issues collecting data and making sure data was being gathered consistently.
We provided frequent analyses of the latest data on the pandemic to policymakers. Over 2020/21 we produced 4,500 such real-time epidemiology reports.
We also provided public weekly statistical reports. These official statistics gave a quality assured, trustworthy description of the course of the pandemic.