Scottish Parliament, 19 May 2020

13 contributions from 6 members. The official report.

Topical Question Time

Kenneth Macintosh (Labour, West Scotland)

I know that the Deputy First Minister and Cabinet Secretary for Education and Skills, John Swinney, is also joining us by videolink, so we will pause when we get to that stage.

Contact Tracing (Confidentiality)

Willie Rennie (Liberal Democrat, North East Fife)

1. To ask the Scottish Government, in light of the reported concerns regarding the Nike conference in Edinburgh, how the contact tracing process that is being piloted will balance patient confidentiality and the need to alert people of public health threats. (S5T-02184)

Jeane Freeman (Scottish National Party, Carrick, Cumnock and Doon Valley)

Contact tracing involves the person who has the disease identifying people with whom they have had close contact while they may have been infectious. Outbreaks are investigated by means of a risk assessment, which takes into account patient confidentiality, public health needs and individual consent issues

. To protect patient confidentiality, only close contacts are informed that they may have been exposed, so that they can be given relevant health information and, in the case of Covid-19, know how to self-isolate in order to interrupt chains of transmission. The index case is always asked for permission to disclose their personal details. The use of information about patients is subject to data protection legislation and all personal health information is held under strict ethical and legal obligations of confidentiality.

In circumstances such as this pandemic, there are difficult balancing discussions between the importance of patient confidentiality and the importance of information to the public. As we move to the scaled-up use of test, trace, isolate and support in the next phase of our response, we are giving active consideration to how that balance should be struck.

Willie Rennie (Liberal Democrat, North East Fife)

The issue has moved on again today. In addition to the Lloyds staff, the kilt shop and the digital agency, we now know that the Nike delegates were taken on a walking tour of the old town by tour guides, none of whom were contact traced by the incident management team.

The issue is confidence in the contact tracing system. The First Minister said yesterday that the process was rigorous, but if that is the case, why were those people not contacted?

Jeane Freeman (Scottish National Party, Carrick, Cumnock and Doon Valley)

I believe that, as the First Minister said, the process that was undertaken at the outset and subsequently in contact tracing that we have carried out elsewhere—probably most recently and notably in and around the Home Farm care home in Skye—is rigorous. It is a clinically led process that is governed by Health Protection Scotland, which uses risk and specific infection science.

The member mentioned other contacts. Those will be contacts that the contact tracers were not aware of from their conversation with the index case, which led to the tracing of eight individuals in Scotland and, from memory, 25 individuals globally, and involved other countries and their health protection teams.

I consider the process to be rigorous, and I think that it is the right process. However, a difficult balance has to be struck. Patient confidentiality is an important ethical part of how our clinicians and health service work and it is important that people have confidence that their information is being held confidentially, unless they agree to circumstances in which it should be released. Public health is important, too. Therefore, a difficult balance has to be struck between individual patient confidentiality and public health and the need for the public to understand the situation that they are facing. I therefore understand the concern. As we look to move into the next phase in our response to the pandemic, we are giving careful consideration to what that balance ought to be. We are taking views not only from members and others but from Health Protection Scotland and our clinical teams, including our Caldicott guardians, about what would be the best balance to strike in any given circumstance.

Willie Rennie (Liberal Democrat, North East Fife)

The tracing process is an important part of keeping us safe as we ease out of the lockdown, and the public must have confidence in it. If we are meant to be treating the public as adults, should the incident team not have put the information into the public domain? If that had been done, anyone at the hotel, or anyone who was in contact with the Nike delegates, would have been able to take precautions. I want to protect patient confidentiality, but alerting people about an event, or about a building, does not breach that. In hindsight, should the incident have been made public? Looking forward, is there ever a circumstance in which the knowledge of an outbreak would be put into the media?

Jeane Freeman (Scottish National Party, Carrick, Cumnock and Doon Valley)

All of us have the benefit of hindsight. With the information that we had at the time, I believe that we took the right decision. However, I recognise the competing calls on protecting patient confidentiality and letting the public know, particularly in relation to this virus or any other virus that causes widespread harm. This is a pandemic. Therefore, we are giving that situation—the balance between the judgments that need to be struck—careful consideration as we move to the test, trace, isolate and support strategy, and at the scale at which we will need to do that.

I agree with the member about the need for the public to have confidence in the process. Their confidence needs to be twofold. An individual needs to have the confidence to reveal all the information that we need them to reveal and to be confident that we will hold that securely. Alongside that there has to be wider public confidence in the whole exercise and strategy, with people being confident that it will be capable of spotting, hunting down and suppressing the virus, where outbreaks occur.

It is not straightforward. However, I recognise the concerns and, as we move forward into the next phase of dealing with the pandemic, we are considering whether there are better ways to strike that balance.

Neil Findlay (Labour, Lothian)

Was anyone in the Livingston Nike shop contact traced as part of the post-Nike conference events? Was the shop deep cleaned? Were any other shops in Livingston shopping centre deep cleaned? If so, were staff made aware why that was happening?

Jeane Freeman (Scottish National Party, Carrick, Cumnock and Doon Valley)

I cannot answer the specifics of that question, because I do not have the detail of the contacts that were traced as a consequence of the index case that was linked to the Nike conference. I do not have that information—I would not have that information in the normal course of events; it is something that Health Protection Scotland’s local contact tracing team would know and pursue. I cannot answer the member’s question in any respect.

Ruth Davidson (Conservative, Edinburgh Central)

When the Nike conference infections—Scotland’s ground zero of community transmission—occurred, the Scottish Government said that a contact trace team swiftly got to work. We now know that the team did not contact or test staff, guests or other company conferences that were exposed in the hotel when the outbreak occurred. It did not contact or test staff at a kilt fitters who fitted 10 of the delegates at the ground zero conference. It did not contact the company or test staff who shared public areas with Nike staff at the Glasgow headquarters. It did not contact companies or test staff who shared the retail space at Nike’s Edinburgh hub. It did not contact or test guides who took the delegates on an Edinburgh walking tour.

This was the first major outbreak, so there was no competition for resources. How many contact tracers were put on the incident and actively spoke to individuals whom they deemed to be at risk in Scotland? How many people in Scotland were contacted by the contact tracers after the outbreak? How many people in Scotland, if any, were tested for Covid-19?

If the minister does not have the answers, can she give them in a written response at her earliest convenience please?

Jeane Freeman (Scottish National Party, Carrick, Cumnock and Doon Valley)

I will be happy to provide that written response in due course.

Daniel Johnson (Labour, Edinburgh Southern)

Many people in Edinburgh will be struggling with the fact that this outbreak took place in a very busy hotel, in the middle of their city, on the very doorstep of Parliament. Relying on people’s memories about who they had contact with as they passed through hotel lobbies and bars is, frankly, an impossibility and very difficult to reconcile with seriousness of the outbreak. The cabinet secretary has said that there is a balance to be struck. Does that mean that the guidelines on publicising outbreaks in public places is changing and will be different if future outbreaks occur in similar public places?

Jeane Freeman (Scottish National Party, Carrick, Cumnock and Doon Valley)

It is important to remember what constitutes a contact. It is not someone you pass on the street or in a bar. A contact is someone you have been within 2m of for 15 minutes or more. In that circumstance, we are not being overly reliant on knowing who people passed in a bar—we are not relying on that at all—or who someone passed in the street. The definition of a contact is very specific and it is clinically led for a specific infection to show how the virus was transmitted on the basis of what was known at that time at the beginning of March. That was the definition of a contact and it remains the definition of a contact. It is not as random as the member is suggesting.

On what we will do in future, I will repeat what I have said. I understand the concerns and I understand, as I hope members do, the balance that needs to be struck in these cases. As we look to move into the next phase, in which test, trace, isolate and support will be a central feature of all that we are doing, we are considering whether there is a better way of striking that balance.