Paper backs more coordination between Scottish and UK Governments. 

The majority of Scots could be vaccinated by summer next year but only if the Scottish Government radically steps up its preparations, a new report says today.

Published by the think-tank Our Scottish Future, the paper warns that the government is “behind the curve” in its preparations to roll out 4 million vaccinations to Scots over the coming months.

It calls for consistent communication across the UK so that mixed messages do not undermine trust in the vaccine programme.

The report calls for the Scottish Government to boost support for health boards charged with rolling out the vaccine, to recruit more staff to help fulfil the job, and to coordinate its plans more closely with the UK Government.

It also backs the appointment of a specific Scottish Vaccines Minister to oversee the roll out of the programme and work hand in glove with their UK counterpart.

Without extra action, it warns that the problems seen with the Winter Flu vaccination programme will be a “precursor” for the far bigger challenges presented by Covid.

The paper was written by OSF researchers following interviews with key health experts in Scotland and the rest of the United Kingdom. It is based on the published proposals already outlined by the Scottish Government.

It comes with the first vaccinations set to begin this week. The Scottish Government has previously pledged to vaccinate 1 million people by January, although it is not yet clear whether this remains an achievable target given vaccine supply and capacity.  

The OSF report says the Scottish Government must learn the lessons from failures in the “test and protect” programme 

Its main conclusions are:

* It is not implausible, and planning should have certainly started, to be able to vaccinate the majority of the Scottish population by late spring / summer 2021 

* However, the Scottish Government’s national framework is “lacking in detail, planning and adequate forward thinking.” Specifically, there is “no real plan” on how to prioritise and engage with the 1.9 million Scots in the so-called ‘third wave’ of the programme – under 65s who are not engaged in frontline health or care.

* Both the Scottish and UK Governments need to coordinate messaging better to boost trust in and compliance with the programme.

* More support staff need to be recruited to support the 2000 vaccinators being identified to carry out the programme

The report says: “Health Boards will require substantial support from the Scottish Government to avoid the same problems that occurred with the flu vaccine, in a roll out 4 times the size, requiring multiple doses. Faster and more efficient vaccination will inevitably save lives, making this process all the more critical. Additional resources, best practice sharing, guidance and technology will be required to ensure the 2020 flu vaccination was a dress rehearsal, not a precursor.”

It concludes: “So far, the Scottish government looks to be behind the curve against strategic and operational requirements, known about for months. Coordination mistakes – ‘devolve and forget’ from Whitehall – combined with a separate communications agenda could lead to further confusion and poor delivery. Issues seen throughout the pandemic could be replicated if the Scottish Government devolve responsibility to health boards without sufficient support.”

Describing the next month as “critical” if plans are to be put in place, the report’s recommendations call for: 

* Deeper coordination between the UK and Scottish governments as the vaccine is rolled out

* A common plan for communicating the benefits of the vaccine to the public at large

* Specific task forces to be established in Scotland to maximise vaccine uptake in traditionally harder to reach communities that have been most negatively impacted by the virus

* Greater resources to be given to Scottish Health Boards to operationalise the roll-out

* Investment to set up of an effective centralised booking and data management platform

*  The appointment of a new Vaccine Minister. 

The paper concludes: “We are at a critical juncture in the fight against the COVID pandemic, but on a path towards a vaccine that can help to turn the tide. Vaccinating Scotland remains an unprecedented challenge. However, there is still a valuable month left to put the right strategy, resources and operations in place to maximise the speed at which the vaccine can be dispensed. This paper therefore argues that greater urgency is required to plan the vaccine rollout, and likely implications, than is being seen today.”

Professor Jim Gallagher, chairman of Our Scottish Future added: “Scotland’s governments have struggled to deal with the Covid crisis. The medical and economic toll Scotland has paid has been among the worst in Europe.

“But the UK government’s highly successful vaccination strategy – for once, genuinely world-beating – presents an opportunity to turn the corner. Now it’s up to the Scottish Government to vaccinate Scotland, and they need a much fuller strategy, clear communications and an operational plan for a logistical programme unprecedented in its complexity where speed is of the essence. A Scottish Vaccines Minister needs to take unequivocal responsibility for delivery. Scotland cannot afford for this to fail.”

“We have to learn the lessons from the way Scotland struggled with rolling out adequate volumes of testing, and with the most recent flu vaccinations. Above all, we need a consistent, UK wide messages to persuade people that vaccination is necessary and safe.”

Commenting on the paper, Professor Hugh Pennington of Aberdeen University added: “This authoritative and detailed analysis demonstrates the urgent need for Scotland and the UK to collaborate to the full now that the roll out of life-saving vaccines is imminent.”

The Scottish and UK Governments should convene an urgent ‘virtual summit’ to agree a joint plan to test, trace and isolate COVID 19 in Scotland, an open letter signed by union leaders and Care Home chiefs declares today.

The letter, brought together by the think-tank Our Scottish Future and addressed to both the First Minister and Prime Minister, has been signed by unions including the GMB, Unison, Unite and Usdaw, and several care home employers around Scotland.

It argues that regular preventative testing for all care workers, NHS staff and frontline workers must be put in place in Scotland without delay, and that a massive increase in testing capacity is therefore needed.

However, it warns that “insufficient cooperation” between the two layers of government in Scotland is hampering efforts to do so.

The letter therefore calls for the two governments to come together along with public health experts, unions and employers to set out a clear, shared plan of action for the months ahead.

The Scottish Government has said it intends to move to a new “test, trace and isolate” strategy by the end of this month.

Responsibility for testing is shared in Scotland between NHS Scotland under the Scottish Government, and the UK Government Department of Health, which is running a series of mobile testing sites across Scotland. Responsibility for analysing and processing the tests is also shared.

A report by Our Scottish Future –  attached  – has concluded that there is a clear need to ensure the two parts of the service are better connected if Scotland is to be successful in delivering regular, preventative mass testing.

However, recent days have provided further evidence that efforts are being hampered by a lack of coordination. It has been reported that:

• Scottish Government figures showing the number of COVID 19 cases do not include feedback from the 30,000 tests so far carried out by UK Government facilities – meaning the total number of cases may be much higher than thought.
• Testing in Scotland is still running well below the capacity being offered by the Scottish and UK Governments – with some waits for results also longer than in other parts of the UK.
• Testing sites run by the UK Government are not being adequately publicised, and therefore are not being used sufficiently
• Calls for all care homes and workers to be routinely tested have not yet been agreed by Ministers.

The letter declares that better cooperation between the two Governments on testing, contact tracing and isolating people is vital to help speed up delivery.

On the specific situation in care homes, it adds: “Unlike the rest of the UK there is no commitment as yet to test every care home worker and every care home resident. It is a dereliction of duty that even now all care residents and workers – as well as all NHS workers and other key workers unable to practice social distancing effectively – are not automatically being tested on a regular basis as part of their daily working practices. Even key workers with symptoms are struggling to get tested because the poorly integrated system of sample collection that has been created in Scotland forces many unwell people to travel for hours to get a test.” 

Professor Jim Gallagher of Our Scottish Future said: “Scotland’s efforts to get ahead of COVID 19 will be successful if the Scottish and UK Governments work hand in hand, sharing expertise, information and know-how. They should be applauded for where they have done so during this crisis. Now we need to see more.”

“Across Scotland, there’s growing evidence that a lack of coordination and cooperation is hampering efforts to get ahead of COVID 19. On the one hand, the Scottish Government is still unable to guarantee routine testing for care workers, as should happen. Yet on the other, testing centres run by the UK Government are clearly running well below capacity.”

“That points to something wrong in the way the testing system has been set up. That’s why Unions and care home managers are now calling on both Governments to get together to agree a plan, and publish it, setting out how they intend to work together on this.”

“Both have responsibility for delivering a workable test, trace and isolate plan – we now need both to step up to the plate.”

*WITH LESS THAN TWO PER CENT OF SCOTS TESTED FOR CORONAVIRUS, COUNTRY NEEDS TO RAMP IT UP, SAYS NEW THINK-TANK REPORT

*SCOTTISH GOVERNMENT’S 15,500-A-DAY TARGET BY END OF MAY ‘NOT NEARLY ENOUGH’, SAYS GORDON BROWN, WHO ADDS IT IS A SCANDAL AND TRAGEDY THAT CARE HOME RESIDENTS AND WORKERS ARE NOT BEING TESTED REGULARLY AS  MATTER OF ROUTINE

*SIX-POINT PLAN CALLS FOR GOVERNMENT TO EXTEND ROLE FOR ARMY, DEPLOY SCOTLAND/UK-WIDE BULK PURCHASING POWER, REPURPOSE MANUFACTURING, UTILISE EMPTY LAB SPACE, SHARE EXPERTISE AND SET HIGHER TARGETS

*MASS PREVENTATIVE TESTING MUST BECOME THE NEW NORMAL IF WE ARE TO DRIVE COVID-19 OUT OF SCOTLAND AND UK, SAYS PROFESSOR HUGH PENNINGTON

*UK AND SCOTTISH GOVERNMENTS MUST WORK TOGETHER TO UPSCALE, WITH ROUTINE TESTING MADE POSSIBLE FOR 800,000 KEY SCOTS

Is devolution problematic to crisis management? In this guest blog, Jim Gallagher provides an overview of the UK and devolved governments’ approach to COVID-19 and discusses how the pandemic is likely to impact upon devolution in the UK.

With the UK’s united approach to managing the coronavirus crisis apparently fraying at the edges, questions are being asked about whether devolution is problematic for crisis management, and even whether the Scottish government is “playing politics” in the midst of a pandemic. Some commentators appear surprised the UK government cannot simply instruct the devolved administrations; others claim the Scottish government is doing better than the UK government and has “attracted commendation from … both at home and abroad”.

Such claims mainly display the preconceptions of those making them. The constitutional allocation of powers cannot just be overridden. Scotland is, however, doing no better than the rest of the UK in controlling the virus. Excess deaths are typical of UK levels; the “reproduction number” is possibly slightly higher than the UK average, and the gap between virus testing in Scotland and England is apparently increasing. It is nevertheless worthwhile reflecting on how coronavirus and the territorial constitution affect one another.

Devolution and Emergencies

Devolution always assumed an integrated UK approach to emergency planning and management. Scottish Ministers became members of the UK Government’s Civil Contingencies Committee, like territorial Ministers before them, not from institutional inertia but because emergencies need operational responses more quickly than normal political processes allow for, potentially cutting across the business as usual boundaries of responsibility.

Like so much of the British constitution, these arrangements are based on administrative practice and have no specific legal, still less constitutional, underpinning.  They seem to have served well enough for the last 20 years, but are under unprecedented pressure from a pandemic which obviously requires swift action across the whole of the UK, coordinated across the constitutional allocation of powers.

Government actions were generally taken in lockstep for the first couple of months. Inevitably, the UK government brings more capacity to this work than the devolved administrations do (eg the technical expertise of Porton Down, or fiscal capacity to support furloughs), but critical parts of the response are in devolved control, not just legally, but in practical terms, eg the operation of the NHS, or responsibility for care homes. 

How successful this joint approach has been is open to question. UK excess deaths are among the world’s highest, and the emphasis on saving the NHS may have put the vulnerable in care homes more at risk. With the crisis far from over, judgements may be premature. Higher mortality might reflect the openness of the UK economy and society rather than government failures. But the UK government and the devolved administrations share responsibility for the decisions and outcomes.

Political Games?

The handbrake turn from politics as usual to crisis management is bound to create tensions: intergovernmental differences have been evident in Germany and the US.  Some divergences may be driven by different objective circumstances, such as the trajectory of the virus, but others perhaps by the different priorities of political leaders. The UK entered the crisis with mistrust between London and Edinburgh and, despite governments working closely together, relations have strained.

This was mostly about presentation rather than substance. Nicola Sturgeon was perceived to steal a march on the UK government by announcing schools policy before them, and Boris Johnson let the devolved governments find out about policy changes on television.

Maybe not surprising, under great pressure, institutions and people revert to their default behaviors. Whitehall still instinctively regards itself as a unitary UK government, even when it knows it is not (after all, 85% of the UK population is unaffected by devolution). Boris Johnson defaults to studiedly ambiguous communications.  

Nicola Sturgeon reverts to her defaults too. She finds it easy to present in a more orderly way than Johnson (their personae could hardly be more different). But it is also easy for SNP politicians to present Scotland as disempowered or disrespected in the management of the crisis (they would say the UK does that normally) and claim Scotland is doing much better, even though halting epidemic spread, protecting care homes or providing tests in Scotland is a Scottish, not a UK government, responsibility.

Differences have come to head over moving out of lockdown. At different times, each government has accused the other of being premature and sending mixed messages. At present the UK government is taking a slightly more forward stance. Governments explain their similar, but not identical, approaches in different terms. Objective differences justifying different approaches are hard to identify. They may reflect different views on the balance of risk or different pressures on governments. But earlier presentational divergence will have made policy divergence more likely.

The underlying problem

Rattiness between politicians under pressure is to be expected. But the resultant mixed messages are unhelpful in managing an almost insoluble policy problem. Emergency lockdown cannot be sustained indefinitely; public behaviour is changing by itself. No government in the UK has an easy to understand strategy that will command public confidence for returning to anything like normal economic activity while continuing to suppress virus transmission. Divergent approaches will worsen that, and create awkward mismatches between devolved and reserved aspects of policy. Just now, the most important gap is a shared one: having enough testing capacity to run an effective “test, track and isolate” approach, routinely testing those most at risk having and passing on the disease.

Filling that policy gap is critical. We need our political leaders to hammer out a credible joint approach, laying aside any mistrust and resisting the temptation to default to the tropes of normal politics, amidst a medical crisis. Those can come back along with rest of normal life.