Covid Scotland: Cases rise for second week in a row


COVID rates in Scotland have climbed for the second week in a row and are currently the highest in the UK, according to the latest surveillance by the Office for National Statistics. 

The ONS estimates that one in 45 people in Scotland had Covid in the week ending September 5, up from one in 50 and one in 55 over the previous two weeks. 

The figures are based on household sampling – excluding people in hospital and care home settings – to evaluate the prevalence of the virus in the community. 

Scotland is currently the only part of the UK seeing an increase in cases nationally, which may be linked to schools reopening in mid-August.

The highest virus rates appeared to be concentrated the the east of Scotland, including Dundee and Fife.

HeraldScotland: Scotland has seen a small uptick in virus rates over the past two weeks (Source: ONS)Scotland has seen a small uptick in virus rates over the past two weeks (Source: ONS)

According to the ONS, England is continuing to see a decrease while the trend in Northern Ireland and Wales was said to be “uncertain”.

In England, the case rate was estimated at one in 75 compared to one in 110 in Wales and one in 55 in Northern Ireland. 

However, there is evidence of a recent uptick in cases and hospital admissions in patients testing positive for Covid in south-west England.

HeraldScotland: Virus rates appeared to be highest in the region covering Clackmannanshire, Fife, Falkirk, Stirling, Angus, Dundee, and Perth & KinrossVirus rates appeared to be highest in the region covering Clackmannanshire, Fife, Falkirk, Stirling, Angus, Dundee, and Perth & Kinross  The apparent increase in virus rates in Scotland comes after the Scottish Government confirmed plans to stop routinely testing asympatomatic frontline NHS workers for Covid due to a “consensus that we are now in a downward trajectory from the most recent wave”. 

The Scottish Government said regular testing would “pause” from September 28, but would be “kept under clinical review”. 

The move followed similar changes to protocols in England, where testing of frontline hospital staff and patients, and care home staff and residents, was suspended from August 31. 





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Scots care home fee rises prompt calls for change


A charity leader has said it is time to think “more creatively”about how we look after our elderly as new figures showed care home fees have doubled in one area of Scotland.

Aberdeen City has recorded the highest growth in weekly rates over the past 10 years, according to a report by Public Health Scotland.

In 2012, elderly residents could expect to pay £823 a week to live in care home in the Granite City, including nursing care.

New figures show the average cost has doubled to £1645 in the last decade.

HeraldScotland: NewsquestNewsquest

East Lothian, which takes in rural areas including Musselburgh, Prestonpans, North Berwick and Dunbar, was not far behind with weekly fees increasing by 99%, from £701 to £1394.

The region also experienced the highest annual rise in fees, rising by 99% since 2021 when residents were paying an average of £1084 per week.

The estimated average gross weekly costs were calculated using data submitted by care homes open on March 31 of each year and 70%  contributed.

READ MORE: Care home owners ‘ripping off’ elderly with £69,000 annual fees

Residents with savings and property valued at less than £18,000 are currently funded by their local authority while those with capital between £18,000 and £28,750 will partially contribute.

Anyone with capital worth £28,750 or more is expected to fully fund their living costs but will receive a contribution towards care. .

This year’s payment is £212.85 a week for personal care and £95.80 a week for nursing costs.

HeraldScotland: Agency Agency

The Shetland Islands recorded the lowest percentage increase in weekly fees from 2012 to 2022 at 49% but costs are among the highest in Scotland at £1423.

Those who live in the Western Isles are paying the lowest amount for care home places at £926, a 29% rise since 2012 when the average was £720.

Weekly charges in Glasgow have risen by 64% to £1052, according to the data.

HeraldScotland: Public Health Scotland Public Health Scotland

The figures also show a widening gap in the amount self-funders pay for care home places compared to local authorities.

Self-funders across Scotland are paying 72% more than they were 12 years ago (£699 to £1200) while the average weekly cost for local authority funded places has risen by 49%, from £574 to £856.

The Scottish Government has said the new National Care Service will aim to support more elderly Scots to remain in their own home.

Henry Simmons, Chief Executive of Alzheimer Scotland said there was a “lot of misunderstanding” about how people find their way into a self-funded care home placement.

HeraldScotland: NewsquestNewsquest

He said: “Often what happens is that the person and their family will be doing what they can in terms of supporting someone at home and it reaches a point that the local authority doesn’t have any more resources to go any further.

“The families often find it hard to see what alternatives might be able to be put in place.

“There is an assessment process that takes place that will explore what community based alternatives are there. Our view is there isn’t a lot of alternatives to your traditional large scale care home.

“We think that is a fundamental flaw in the process of commissioning, particularly when you look at the more rural and remote areas.

He added: “If the assessment determines you need to go into a care home no one says to you at this point that this will cost you £1200 per week or more.

“No one ever says, ‘see that money you are going to have to pay for a care home what could we do with that as an alternative?’ There are other ways that we could think about for using that money creatively.”

He said there was a need for a national debate on the issue and the charity is to host a series of discussion events later in the year, which will inform a major report.

He said:”Everyone is talking about the National Care Service solving all the problems under the sun but what we are not doing is looking at how it is going to solve problems.

“We think that for the amount of money people are being asked to pay and the lack of choice and control they have over that, we need to be talking about different models and approaches.

“Why have we relied on the large scale model that people often have to travel substantial distances for.

“We’ve just accepted what we have. Most of the care homes will be providing good care but their costs are going through the roof and it’s getting passed on to the self-funders.”

READ MORE: Dementia will be rare condition within 20 years says Scots expert

The census shows that as of March 31, there were 1,051 care homes for adults and 40,579 registered places – 20% and 5% fewer, respectively than twelve years ago.

Approximately 66% of all long stay residents in care homes for older people in Scotland were fully or mainly publicly funded and 34% were fully or mainly self-funded 

Most care home provision is delivered by the private sector. The number of residents in voluntary or not-for-profit residential care has decreased by 868 (27%) and by 1,049 (25%) in the local authority/health board sector.

Cathie Russell of Care Home Relatives Scotland said: “It’s the only area of life where the tax rate is 100% of what you and your partner have accumulated over a lifetime.

“The near total privatisation of the care home industry means that thousands of people who bought their own home or have worked hard to accrue some savings are subjected to massive financial exploitation.

“Other illnesses would be covered through the NHS – but if you take dementia or another neurological disorder,  everything you have is up for grabs.

“This has to be looked at through the National Care Service reforms.”

An  estimated 33,352 residents aged 18 years and over are living in all adult care homes – 11% fewer than 31 March 2012 (37,335).

Residents in care homes for older people accounted for 92% of occupants in all care homes for adults (30,552 out of 33,352).

The Herald is supporting Alzheimer Scotland’s Fair Dementia Care Campaign.


 





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More than half of excess deaths due to non-Covid illnesses


EXCESS deaths from non-Covid illnesses have overtaken those caused by the infection for the first time since the pandemic began, amid spiralling pressures on the NHS.

Figures compiled by the Herald from official statistics show that 53 per cent of the 2,708 excess deaths recorded in Scotland over the six months to August 28 were “non-Covid” – meaning the disease was not cited as the underlying cause on death certificates.

This contrasts sharply with the pattern seen in 2021, when 81% of excess deaths were directly caused by Covid, and 90% since the beginning of 2020.

ANALYSIS: Chickens coming home to roost? There could be worse to come

Commenting on the shift in mortality, Professor Linda Bauld, a Scottish Government advisor and chair of public health at Edinburgh University, said: “I suspect it is a ‘hangover’ from people not being treated and health problems that built up during the pandemic – late diagnosis, no diagnosis, and ongoing problems accessing care.”

Links have also been drawn with growing A&E waits.

HeraldScotland: The number of patients waiting over four, eight and 12 hours in A&E has been climbing steadily, particularly since summer 2021The number of patients waiting over four, eight and 12 hours in A&E has been climbing steadily, particularly since summer 2021

The most recent monthly statistics show that a record 4,483 people spent more than 12 hours in A&E during July – a key signal of the extreme bed shortages facing the NHS.

Research estimates that one extra death occurs for every 82 patients who wait more than six to eight hours in emergency departments before admitted into a hospital bed, due to factors such as delays in receiving pain relief, antibiotics and other vital treatment, as well as increased risk of acquiring hospital infections.

The longer the wait, the higher the risk.

HeraldScotland: Chart showing 30-day standardised mortality ratio plotted against duration in emergency department from time of arrival up to 12 hours (Source: Emergency Medicine Journal, January 2022)Chart showing 30-day standardised mortality ratio plotted against duration in emergency department from time of arrival up to 12 hours (Source: Emergency Medicine Journal, January 2022)

Long stays in A&E are also known to trigger delirium in elderly patients, while staff working in overcrowded A&E departments are less able to monitor patients for signs of deterioration.

Bed shortages also mean patients are more likely to be transferred at night, when wards are quieter but staffing levels lowest.

Figures covering the six months to August 28 show that nearly 63,000 patients spent more than eight hours in A&E, suggesting that at least 800 excess deaths could be traced back to hospital logjams.

READ MORE: Routine Covid testing of asymptomatic NHS staff ‘paused’

Dr John-Paul Loughrey, vice chair of the Royal College of Emergency Medicine, said Scotland is facing a shortfall of around 1000 beds and at least 100 consultants, with expanded workforce and bed capacity required “urgently”.

He added: “Long waits in crowded emergency departments can lead to diluted quality of care, and a lack of monitoring and assistance.

“This potential for harm transfers to those patients waiting in the backs of ambulances outside emergency departments, which in turn transfers to patients in the community waiting for ambulances facing delayed handovers – this only happens because emergency departments are dangerously overcrowded and cannot move patients on into the hospital in a timely manner

“We know the sickest and most vulnerable patients tend to experience the longest waits.

“If you’re a patient with a serious condition, it is likely to be at best severely uncomfortable and at worst seriously damaging if your treatment is delayed.”

Dr Loughrey added that while delays of six to eight hours are known to cause harm, there is currently “little research into the harm and additional mortality for those patients spending more than 12 hours, or even days, on a trolley” – a situation that has becoming increasingly common in the NHS over the past year in both Scotland and the rest of the UK.

HeraldScotland:

Excess deaths are counted by the National Records of Scotland by comparing mortality against a five-year average to identify abnormal spikes.

For the past six months, and during 2021 as a whole, the total number of deaths from all causes has been running at 10% above expected levels.

The figures for 2022 are compared against 2016-19 plus 2021, while 2021 was compared against 2015-19.

The shift towards a majority of these excess deaths being due to causes other than Covid may also reflect the protective effect of multiple vaccinations, antivirals, and drug treatments, all of which have helped to reduce mortality from the disease.

Statistically, it is now no more lethal than flu, even for the elderly.

READ MORE: Number paying for private hip and knee replacements trebles 

However, very high virus rates compared to earlier in the pandemic mean that it has still been responsible for nearly 1,300 deaths in Scotland since the end of February.

Of the non-Covid excess deaths over that period, around one in three – 458 – are due to “circulatory” causes, such as heart attacks or strokes.

Allan Cowie, interim chief executive at Chest Heart & Stroke Scotland, said the NHS is being “forced to operate in crisis mode” as a result of the impact of the pandemic on health.

He added: “We’re already seeing a dramatic increase in deaths from stroke and heart disease; nearly 500 more people died of ischaemic heart disease in 2021 compared to 2019 and stroke deaths were higher in 2021 than they were before the pandemic.

“If we don’t see urgent action the NHS will be in a permanent state of crisis management which will affect hard-working NHS staff and the care we receive.”

HeraldScotland: Dr John MontgomeryDr John Montgomery

Dr John Montgomery, a Deep End GP whose practice is based is one of the most deprived areas of Glasgow, said his patients had been disproportionately harmed by Covid and were now more likely to be in deteriorating health.

He said: “We’ve got a higher incidence of cancer and our patients tend to present later, with the worst outcomes, so you’re certainly seeing that.

“Then of course that’s compounded by the delays in getting investigations and referrals, so you’ve got that triple whammy of more cancer to manage, presenting late, and then delays in investigations and onward referrals.

“Then you’ve got ongoing issues with substance and alcohol misuse, and again late presentations seeking assistance and then delays getting them into the system to get help.

“We’ve got 50% above average COPD patients in our practice, and more type 2 diabetes – again tending to present later and with complications.

“So you’ve got a patient population with multiple problems presenting later, more severely affected, and with poorer outcomes, and then there’s the whole demand issue.

“Our consultation rate is still running at 1,860 per month, up from 1,100 before the pandemic, but you’re having to trying to sift out the most important ones to prioritise for face-to-face.”

READ MORE: Can we really say the NHS in Scotland is ‘in recovery’ from Covid?

The Scottish Government said the 80% of excess deaths over the past six months listed Covid as either an underlying or “contributory” cause.

Death certificates can include only one underlying illness as the main cause of death, but mention multiple other factors as contributors.

A spokesman said it is “not possible” to determine from NRS statistics “whether deaths are linked to waits for treatment”, adding: “We recognise the impact of long waits, which have grown as a result of Covid-19, on people’s physical and mental health. That is why we have introduced ambitious targets for NHS Scotland to tackle the backlog of planned care.

“We are working hard with health hoards to remobilise the NHS in the safest possible way, while also supporting boards to prioritise elective activity based on clinical urgency and long waits.”





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Scots care home fee rises prompt calls for change


A charity leader has said it is time to think “more creatively”about how we look after our elderly as new figures showed care home fees have doubled in one area of Scotland.

Aberdeen City has recorded the highest growth in weekly rates over the past 10 years, according to a report by Public Health Scotland.

In 2012, elderly residents could expect to pay £823 a week to live in care home in the Granite City, including nursing care.

New figures show the average cost has doubled to £1645 in the last decade.

HeraldScotland: NewsquestNewsquest

East Lothian, which takes in rural areas including Musselburgh, Prestonpans, North Berwick and Dunbar, was not far behind with weekly fees increasing by 99%, from £701 to £1394.

The region also experienced the highest annual rise in fees, rising by 99% since 2021 when residents were paying an average of £1084 per week.

The estimated average gross weekly costs were calculated using data submitted by care homes open on March 31 of each year and 70%  contributed.

READ MORE: Care home owners ‘ripping off’ elderly with £69,000 annual fees

Residents with savings and property valued at less than £18,000 are currently funded by their local authority while those with capital between £18,000 and £28,750 will partially contribute.

Anyone with capital worth £28,750 or more is expected to fully fund their living costs but will receive a contribution towards care. .

This year’s payment is £212.85 a week for personal care and £95.80 a week for nursing costs.

HeraldScotland: Agency Agency

The Shetland Islands recorded the lowest percentage increase in weekly fees from 2012 to 2022 at 49% but costs are among the highest in Scotland at £1423.

Those who live in the Western Isles are paying the lowest amount for care home places at £926, a 29% rise since 2012 when the average was £720.

Weekly charges in Glasgow have risen by 64% to £1052, according to the data.

HeraldScotland: Public Health Scotland Public Health Scotland

The figures also show a widening gap in the amount self-funders pay for care home places compared to local authorities.

Self-funders across Scotland are paying 72% more than they were 12 years ago (£699 to £1200) while the average weekly cost for local authority funded places has risen by 49%, from £574 to £856.

The Scottish Government has said the new National Care Service will aim to support more elderly Scots to remain in their own home.

Henry Simmons, Chief Executive of Alzheimer Scotland said there was a “lot of misunderstanding” about how people find their way into a self-funded care home placement.

HeraldScotland: NewsquestNewsquest

He said: “Often what happens is that the person and their family will be doing what they can in terms of supporting someone at home and it reaches a point that the local authority doesn’t have any more resources to go any further.

“The families often find it hard to see what alternatives might be able to be put in place.

“There is an assessment process that takes place that will explore what community based alternatives are there. Our view is there isn’t a lot of alternatives to your traditional large scale care home.

“We think that is a fundamental flaw in the process of commissioning, particularly when you look at the more rural and remote areas.

He added: “If the assessment determines you need to go into a care home no one says to you at this point that this will cost you £1200 per week or more.

“No one ever says, ‘see that money you are going to have to pay for a care home what could we do with that as an alternative?’ There are other ways that we could think about for using that money creatively.”

He said there was a need for a national debate on the issue and the charity is to host a series of discussion events later in the year, which will inform a major report.

He said:”Everyone is talking about the National Care Service solving all the problems under the sun but what we are not doing is looking at how it is going to solve problems.

“We think that for the amount of money people are being asked to pay and the lack of choice and control they have over that, we need to be talking about different models and approaches.

“Why have we relied on the large scale model that people often have to travel substantial distances for.

“We’ve just accepted what we have. Most of the care homes will be providing good care but their costs are going through the roof and it’s getting passed on to the self-funders.”

READ MORE: Dementia will be rare condition within 20 years says Scots expert

The census shows that as of March 31, there were 1,051 care homes for adults and 40,579 registered places – 20% and 5% fewer, respectively than twelve years ago.

Approximately 66% of all long stay residents in care homes for older people in Scotland were fully or mainly publicly funded and 34% were fully or mainly self-funded 

Most care home provision is delivered by the private sector. The number of residents in voluntary or not-for-profit residential care has decreased by 868 (27%) and by 1,049 (25%) in the local authority/health board sector.

Cathie Russell of Care Home Relatives Scotland said: “It’s the only area of life where the tax rate is 100% of what you and your partner have accumulated over a lifetime.

“The near total privatisation of the care home industry means that thousands of people who bought their own home or have worked hard to accrue some savings are subjected to massive financial exploitation.

“Other illnesses would be covered through the NHS – but if you take dementia or another neurological disorder,  everything you have is up for grabs.

“This has to be looked at through the National Care Service reforms.”

An  estimated 33,352 residents aged 18 years and over are living in all adult care homes – 11% fewer than 31 March 2012 (37,335).

Residents in care homes for older people accounted for 92% of occupants in all care homes for adults (30,552 out of 33,352).

The Herald is supporting Alzheimer Scotland’s Fair Dementia Care Campaign.


 





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Excess deaths: Why the worst is probably still to come


WHEN Covid first swept through Scotland in 2020, the total number of excess deaths recorded – 6,324 – was the highest in peacetime since the Russian flu outbreak of 1891.

Compared to the previous five years, total mortality was 11 per cent higher.

A tragedy undoubtedly, but one that could be partly blamed on a new and deadly disease against which there were no vaccines, no antivirals, and initially, no medicines.

And, partly, on failures to adequately contain it, of course.

READ MORE: Non-Covid illnesses overtake Covid to cause more than half of Scotland’s excess deaths 

Yet two and a half years on, excess mortality has barely changed: the total number of excess deaths from February 28 to August 28 – 2,708 – is still 10% above average for the same six month period in 2016-19 plus 2021 (2020 is excluded as an anomaly).

What has changed is the main cause, and it is no longer Covid.

On the downside, the diminishing lethality of Covid has been offset by much higher rates of the virus, which continues to translate into a significant number of deaths.

HeraldScotland:

HeraldScotland: Covid rates have been much higher over the past year, but the case to fatality ratio is much lower (Source: Public Health Scotland)Covid rates have been much higher over the past year, but the case to fatality ratio is much lower (Source: Public Health Scotland)

All things being equal, however, the excess death toll should still have shrunk.

Instead, we now find other, non-Covid, causes increasingly making up the difference.

It is not impossible that the coming winter could even see excess deaths overshoot the 11% rate seen in year one of the pandemic.

Covid is no longer top of the agenda in public attitudes: polling shows most Scots are primarily worried about rising fuel and grocery bills, with spiralling NHS treatment backlogs and delays to operations close behind.

Nearly 60 per cent surveyed in August said catching Covid now would be “an inconvenience rather than a real concern”.

READ MORE: Appointments cancelled as health board says only most ‘time-critical’ treatments will go ahead on day of Queen’s funeral 

Meanwhile, the legacy of Covid is probably only just beginning to bite.

The number of people dying from cancer in 2022, for example, remains below pre-pandemic levels – yet we know that diagnoses fell during lockdown as screening was paused, and that patients currently being referred with symptoms are facing much longer waits for tests.

Not everything is down to Covid, however.

HeraldScotland: The number of hospital beds lost to 'delayed discharge' - patients well enough to leave hospital but unable to - reached a record high in July, the same month that the number of people spending over 12 hours in A&E also reached an all-time highThe number of hospital beds lost to ‘delayed discharge’ – patients well enough to leave hospital but unable to – reached a record high in July, the same month that the number of people spending over 12 hours in A&E also reached an all-time high

For many, these excess deaths are the chickens coming home to roost after more than a decade of bed cuts carried out without corresponding investment in social care at a time when the size of the population of over-70s with multiple chronic illnesses – exactly those most in need of social care – has soared.

The result? Roughly three in 20 hospital beds lost to patients well enough for discharge, while others languish for for hours – or days – in overcrowded and understaffed A&E’s.





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