Lessons to be learned from pandemic response - Audit Scotland Report

17th February 2021

Audit Scotland report published today (17 February 2021) on how the Scottish Government and NHS Scotland handled the pandemic.

The Scottish Government acted quickly to prevent the NHS from being overwhelmed by Covid19, but it could have been better prepared to respond to the pandemic.

Staff across the NHS and Scottish Government took early action during the first wave in 2020, including increasing intensive care capacity and pausing non-urgent treatment. Service innovation,

such as a huge rise in video consultations, also happened within weeks and it is important these are learned from. However, there is now a substantial backlog of patients, with NHS boards prioritising

those in most urgent need. It will be hard to deal with this backlog alongside the financial and operational challenges already faced by boards.

The Scottish Government based its initial response to Covid-19 on the 2011 UK flu pandemic preparedness strategy. Scotland took part in three pandemic preparedness exercises in the years

before the coronavirus outbreak. But not all the actions identified in these exercises were fully implemented. These included measures to ensure access to enough PPE and to quickly address

social care capacity, both of which became significant issues during the first wave of Covid-19.

Covid-19 has caused or contributed to the deaths of around 9,000 people in Scotland so far. People from the most deprived areas, of South Asian origin, or of Caribbean or Black ethnicity are among

those who have suffered disproportionately from the pandemic. Deaths from other causes were also higher than average at the start of the pandemic.

Stephen Boyle, Auditor General for Scotland, 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."

Intensive Care Unit capacity increased from 173 places to 585 from March 2020. The number of people waiting longer than 12 weeks for an inpatient or day case admission to hospital increased from

28,179 in March 2020 to 60,074 in September 2020.

The death rate from Covid-19 is more than twice as high in the most deprived areas (183 per 100,000 population) than in the least deprived areas (79 per 100,000 population). There is around a

two-fold increase in risk of admission to critical care or death from Covid-19 among people of South Asian origin. There is also evidence of an increased risk of hospitalisation due to Covid-19 among those of Caribbean or Black ethnicity. The National Records of Scotland records deaths involving coronavirus. The lower daily rate mentioned in the First Minister's briefings is a death from any cause within 28 days of testing positive for Covid-19.

Most NHS boards met their savings targets in 2019/20 - but four boards needed additional support from the Scottish Government to break even. Existing financial and operational challenges in the NHS have since been exacerbated by Covid-19, which is predicted to cost around £1.7 billion across health and social care in 2020/21.

Digital improvements were rapidly rolled out across the NHS in response to the pandemic, including software to facilitate working from home, and the use of virtual appointments such as Near

Me Video consultations increased from about 300 per week in March 2020 to more than 18,000 per week in November 2020. By December, more than 500,000 video consultations had taken place.

In addition to pandemic planning exercise actions not being fully implemented, there was not adequate corporate oversight of the risk of a flu pandemic, despite it being assessed as a high risk.

Read the full report HERE