Public Health Scotland annual review 2024

COVID-19 has never gone away. It remains with us and will probably remain with us for some time. What we do see, though, is surges of activity, particularly around the winter period. This year we also saw a surge of activity just before the summer holidays.

PHS have been very clear that one of the key things people can do to protect themselves is to get vaccinated if they are in one groups that are particularly susceptible to the adverse effects of COVID-19. This includes pregnant women, those with certain existing health problems and older people. There is very clear evidence of the link between being older and vulnerability to the most severe infection. NHS Inform, the online, public-facing resource for health advice, has a wealth of information describing other measures that people can take to protect themselves. PHS regularly directs people to NHS Inform and the website is also promoted and accessible to healthcare staff across Scotland.

We should be clear that infection control guidance sits within the remit of Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), which is part of NHS Assure, based within NHS National Services Scotland (NSS).

Public Health Scotland is committed to monitoring and reporting the impact of COVID-19 infections. During the winter periods, we have weekly publications which provide information about levels of infection, admissions to hospital, vaccine coverage and so on.

During the springtime, we usually reduce publication to a less frequent reporting period. But this summer we noticed an increase in activity and therefore we moved from monthly reporting to weekly reporting.

As the question acknowledges, this was to provide information to the public for awareness and so they could take appropriate measures should they feel they needed to. The information on current infection rates is available on the PHS website.

We have a surveillance system which routinely operates through primary care, whereby GPs take swabs from individuals with a predetermined set of symptoms – the swabs are then sent for testing, and we report these results. This is called CARI, or Community Acute Respiratory Infection surveillance. CARI has been developed as a direct consequence of the pandemic, and indeed, it gives us a very accurate assessment of what's happening in the community.

The wastewater monitoring referred to in the question also complements what we do, but CARI, the community surveillance system, really gives us a really good handle on what is happening.

There was a change in the laboratories used for testing. Testing moved away from the Scottish Environment Protection Agency (SEPA), who had been undertaking wastewater testing throughout the pandemic, and moved across to NHS Lothian. As you transition from one laboratory to another, you have to go through a period of validation, and that has meant that for a short period we were not reporting those data until we were confident that the results are validated with the new laboratory.

Testing will be resuming shortly. This is really there to provide an additional layer of information and it is the community surveillance that really provides the best picture of what’s happening.

I believe we are providing a good level of surveillance information. Perhaps we need to think about how we raise awareness of this, but the information is freely available on the PHS website. Finally, to make the point again, vaccination remains the most important measure that individuals can take to protect themselves.

We continue to work closely with other health boards and with the Scottish Government on how best we can support the continued monitoring and intervention around both COVID-19 and other infectious diseases. Public Health Scotland have been contributing very actively to the COVID-19 Public Inquiries, and that will continue.

PHS is absolutely committed to reflecting and learning from the inquiries, particularly as we look to ensure preparedness for any future pandemic.

Public Health Scotland has an obligation to monitor, to identify issues, to offer solutions. Clearly, the operational delivery of that rests with the health boards and other agencies, and

we will work with them and support them to provide the information they need to make, in their view, the best decisions they can.

Long COVID is an unfortunate condition. It belongs to a group of conditions that we do see after viral infections. Several viral infections produce a post-viral syndrome with symptoms consistent with long COVID: fatigue; tiredness - all debilitating conditions. The challenge with long COVID is actually clearly defining it, and without this it makes differentiating it from some of the other causes of post-viral fatigue and post-viral syndromes which in turn makes trying to estimate the size very difficult. Public Health Scotland has worked with at least one university, Glasgow Caledonian University, to try and understand the extent of the problem. And in fact, we’ve undertaken some work looking at primary care data to try and see if we can estimate the size of the problem within Scotland. This has, however, been hampered because of issues around being able to access the data. But we’re now confident we have a solution to that. The intention is that that work will pick up and that may help us trying to understand the extent of the problem, because understanding the extent is part of the solution.

PHS has been working with local boards, local systems, but also with lived experience groups to understand the impact of long COVID, and also to design services by allowing local systems to be able to design the services and referral pathways that are needed.

This journey has been going on for the last two and a half years, and we still have another year and a half left, working with both Scottish and local government and local systems to develop a framework to allow local systems to deploy the right pathways needed.

We’re using knowledge and experience from the wider systems from looking across the four nations, and also internationally what we can garner, to understand how that can impact Scotland as we get our own insights and evidence in order.

COVID vaccination is available to various groups in the population, such as people with an existing underlying medical issue and anyone over the age of 65. So it is available. I’m not sure where this issue about healthcare workers has arisen, but again, it’s something we're very happy to look into, and I can pick up.

We are working very closely with the Scottish Government in terms of ensuring that we are well prepared for a future pandemic. The very focussed work we’re doing to respond to the COVID-19 Public Inquiries is helpful in that regard. For example, we're very clear that possibly the most significant preparation we can do for a future pandemic is to tackle the health inequalities that we’ve already covered in the presentation, because we know that it’s those already experiencing the poorest health outcomes that were most susceptible to harm in terms of the COVID pandemic and in all likelihood would be most susceptible to harm going forward.

A key element of our presentation to the COVID-19 Public Inquiry, and we’re not alone in this, as many other organisations have emphasised, is that in this period we are resolute in tackling the health inequalities that have already been faced.

One of the things that the pandemic inquiry has highlighted across the whole of the UK, and in fact globally, is that there were certain aspects that we could have been better prepared for. In response to the COVID-19 pandemic and also the swine flu pandemic we saw in 2009, we have been strengthening a number of areas, through resources made available by Scottish Government. This allows us to look at how we improve our respiratory surveillance, our ability to detect and to then monitor a pandemic, and also how are we better able to test people through our laboratories.

One of the challenges during the pandemic was testing people at scale. We now have better laboratory capacity to undertake the levels required. We’ve been looking at the data requirements, making sure that we can link data so we understand what's happened, understand the groups that are particularly affected and can also, importantly, monitor the impact of anything that we do, either positively or negatively, because there’s always an assumption that everything we do is positive, but we do need to be able identify adverse impacts as well.

Finally, PHS are members of the Scottish Committee on Pandemic Preparedness, established by the Scottish Government. One of the key recommendations that came out of the committee was to think about how we should be looking forward in the form of a pandemic preparedness group. We’ve been working with SCOPP, or the Committee on Pandemic Preparedness, and are currently working with Scottish Government to submit some proposals as to what such a ‘centre for pandemic preparedness’ might look like and the areas that it might cover.

So those are some positive developments. And then finally, pandemic preparedness is not just in Scotland. We have to look in terms of the UK context, and we work very closely with UK Health Security Agency and the devolved administrations in Wales and Northern Ireland, so that we have a coordinated UK approach, to ensure insights and benefits are shared.