Public Health Scotland 2020/21 Quarter Three Report

Public Health Scotland

2020/21 Quarter Three Report

PHS Paper 01/21

Agenda item 6

Date of meeting: 3 February 2021

Purpose

This paper offers the Board an overview of Public Health Scotland’s work, achievements and impact for Quarter 3.

Recommendation

The Board is asked to comment on and endorse this report.

Lead Director / Head of Service

Vicki Bibby, Head of Strategy, Governance and Performance

Paper authors

Tim Andrew, Organisational Lead: Strategy, Planning & Change

Public Health Scotland

2020/21 Quarter Three Report

1. Purpose

This paper offers the Board an overview of Public Health Scotland’s work, achievements and impact in quarter three of 2020/21.

2. Overview

The third quarter has continued to be fast paced for Public Health Scotland with supporting Scotland’s response to COVID-19 continuing to be important.

This quarter’s report remains narrative-driven, although it contains more measures than previous quarters. We want this to continue to develop as we mature as an organisation. We have started a draft performance framework, which we will share this with the board shortly for discussion. We are also working Directorate Delivery Plans as part of our planning for next financial year. These will include measurements which will help demonstrate progress and success in future quarterly reports.

3. COVID-19 Response

COVID-19 remains our main focus in quarter three. During the quarter, we:

• supported 150 local incident management teams • issued more than 900 ‘real time epidemiology’ reports to Scottish Government since April • supported the contact tracing of 114,712 cases and contacted 438,685 people to self-isolate between 28 May 20202 and 3 January 2021 • we called 26,840 travellers who had entered Scotland and needed to self- isolate – up from 5,812 in quarter two • 14.3 million visits to our public facing COVID-19 Dashboard • supported 111 COVID-19 research projects

As well as our immediate response, we have continued to work closely with COSLA, Directors of Public Health, health boards, and health and social care partnerships to remobilise services.

Surveillance

We worked with policy makers and local authorities to make inform decisions by developing a suite of outputs on enhanced surveillance of COVID-19 in educational settings. These outputs included a linkage study to estimate the risk of COVID-19 in teachers and additional work to estimate the number of schools that have been affected.

We also informed Scottish Government assessments about the need for lockdown restrictions. We did this by providing daily intensive care unit bed data that included COVID-19 positive patients, by linking Scottish Intensive Care Society Audit Group (SICSAG) data to our electronic surveillance system (ECOSS) to the daily dashboard for wider distribution.

As in previous quarters, we worked with the Scottish Government to publish daily COVID-19 information to inform a range of Scottish Government officials and ministers, including the First Minister. Key reports include daily summaries of COVID-19 cases, deaths, COVID-19 inpatients in hospital and Intensive Care Unit plus testing results from care homes and healthcare workers. Other ad hoc reports, including those on variants of interest and lateral flow testing results (initially for students and then for healthcare workers), have been added.

Maintaining an increasing number of reports alongside the rapid cumulative increase in case volume over quarter three was challenging and has required full cover at weekends – as it has all year. This has enabled us to consistently meet the short turnaround time between data submission and “cleaned” data for daily submission to Ministers. Work continues to simplify and standardise data streams across Public Health Scotland and in collaboration with the government.

The First Minister and her team have thanked us for our contributions to pandemic reporting. Positive feedback has been received from ministers and special advisors around our contributions over the festive period.

Public Health Scotland informed public understanding on the discharge of patients with COVID-19 to care homes by producing a report with validated statistics and analysis. This required new data streams to be established to analyse the pathways and outcomes for these patients. The report was published on 28 October 2020.

In addition, to the routine reporting of COVID 19 case data, teams from the areas, as above, generated numerous outputs for a wide range of stakeholders including those within the Scottish Government, NHS Boards (in particular Health Protection Teams) and Local Authorities. These outputs included weekly reports on

• COVID in Educational Settings • Enhanced Surveillance of COVID (data on COVID related early indicators, symptoms, prevalence of infection, past infection and mortality) • Forecasting (future cases, hospitalisations and deaths) • The State of the Epidemic (an overview of COVID in Scotland informing, in particular, the National Incident Management Team).

Public health microbiology

In a new development, the Scottish whole genome sequencing (WGS) service went live in November 2020 and, through a prioritisation group, supported outbreak investigations and the investigation of new SARS-COVID-19-2 variants of concern. 49 requests for sequencing were actioned, including requests related to the Danish, Kent (VOC202012/01) and South African variants.

The new Kent (VOC202012/01) variant was identified as of concern given it was associated with an apparent increased rate of transmission. The epidemiology and the public health microbiology teams have worked to investigate the presence of this variant in Scotland. This has included the molecular typing undertaken in the Edinburgh virology lab of respective 4

samples from across Scotland to confirm the presence of the strain, its distribution and linkage of these mutations to deaths. Fortunately, a proxy marker for this variant (S gene drop out) can be detected and work was undertaken to establish the number, distribution and trends of S gene drops across Scotland and to develop a new surveillance report based on this data. A briefing note was prepared for NHS Boards to highlight this new variant and Public Health Scotland contributed to the UK response into this variant. Additional work has been undertaken by NHS labs (via their regional hubs) to re-test some NHS specimens and initial analysis has been undertaken and shared with the NHS laboratories and the public health microbiology team.

A second new variant of concern, originating in South Africa, has been investigated. This involved sequencing samples initially from cases recently returned from South Africa but now from surrounding countries in sub- Saharan Africa. Information on this variant and the results of our investigations have been communicated to NHS Boards. Work has started to establish a reporting stream to PHE to regularly provide updates on these and other new variants of concern (VOC) in a systematic manner.

Public Health Scotland also collaborated with Scottish Government colleagues on aspects of national testing strategies, including the use of point of care tests and the introduction of lateral flow devices.

Guidance

While quarters one and two saw the production of new guidance, the emphasis in quarter three has been updating existing guidance in line with the evolving evidence base and Scottish Government policy decisions. In quarter three, 32 updates were made to existing guidance.

Care homes

On 18 August 2020 the Cabinet Secretary for Health and Sport, commissioned us to carry out work to identify and report on discharges from NHS Hospitals to care homes during the first wave of the COVID-19 Pandemic. Both the University of Edinburgh and the University of Glasgow were partners in the production of this report.

We published the report on 28 October 2020, focussing on people aged 18 and over who were discharged from an NHSScotland hospital to a care home between 1 March and 31 May 2020. Existing national data does not currently readily identify patients discharges from hospital to a care home so a considerable amount of work was undertaken by the team to identify the cohort of patients. The report explains the methodology in defining the cohort of patients who were discharged, and describes their demographics and COVID-19 testing status. The report also describes care home outbreaks of COVID-19 with an analysis of the factors associated with those outbreaks, specifically including hospital discharges.

Further analysis is currently underway and will be published in due course (date to be confirmed). The report also contained a series of recommendations, particularly relating to data collection, which are being taken forward by PHS and partners.

Immunisation

Immunisation is a key tool to controlling the COVID-19 pandemic. As an integral partner in the national programme, we enabled Scotland to start the COVID-19 vaccination programme (the largest ever immunisation programme in Scotland) in December 2020. Initially this was using the Pfizer-BioNTech Covid-19 vaccine and then, once approved, the AstraZenica vaccine from the 6 January 2021.

By 4 January 2021, almost 100,000 health and care workers and care home residents had received the first dose of the Pfizer-BioNTech COVID-19 vaccine.

We enabled the first phase roll-out of COVID-19 vaccinations to those most at risk, residents in a care home for older adults and their carers, people aged 80 and over and frontline health and social care workers, by developing quality- assured information to help individuals to make informed decisions about whether to get vaccinated. We did this by developing a suite of information resources and toolkits aimed at each group. These outputs were provided in print and seventeen languages as well as easy read, British Sign Language

(BSL) and audio online. We worked closely with NHSInform to ensure the website content was accurate, and NSS to ensure helpline scripts were consistent with agreed national messaging, responded to frequently asked questions and updated as needed. We also worked with Scottish Government and NHS National Services Scotland (NSS) to ensure all printed materials and letters were distributed to recipients as required.

We provided educational material to vaccinators in the use of the new vaccines to enable clinics to commence. Public Health Scotland worked in close collaboration with NHS Education for Scotland and stakeholders to lead the workforce education work stream to develop educational resources relating to the new COVID-19 Vaccine AstraZeneca vaccine which are published on TURASLearn. Three national webinars relating to the use of the COVID-19 Vaccine AstraZeneca were facilitated with over 5,100 attendees. This followed three previous national webinars held for the PfizerBioNTech COVID-19 vaccine with over 3,000 attendees, bringing the total to over 8,100 attendees since mid-December. Educational resources relating to COVID-19 vaccination programme core information (e.g. adverse events framework and consent) have also been published.

During quarter three, Public Health Scotland established the clinical governance and vaccine safety (monitoring and response arrangements) for the programme. We created and led the establishment of a new Clinical Governance structure for COVID-19 immunisation that involves senior clinical colleagues from national organisations and Scottish Government. The structure has the ability to monitor and respond at short notice, for example, to potential safety concerns and adverse events reported from local health boards and for monitoring adverse events through routine analyses of national linked health datasets. This system is consistent with systems and processes established across the four nations and in accordance with international standards.

Public Health Scotland leads the Vaccine Confidence, Informed Consent and Equity work stream and worked with NHS Boards, community and voluntary sector to ensure service delivery plans for COVID 19 and the flu vaccination

extension are inequality impact assessed in order to achieve equitable immunisation services. To enable informed consent to vaccination, we have also produced and delivered a range of toolkits to support care homes, GP practices and NHS Boards to provide clinically accurate information to eligible groups to maximise uptake for the public health benefit.

We have worked in close collaboration with the Scottish Government, and stakeholders across work streams, to update guidance and resources for the public in light of the new AstraZeneca COVID-19 vaccine.

Following, the new national end to end digital solution for vaccination going live mid-December, Public Health Scotland has significantly progressed in developing its protocols for vaccine failure reporting and vaccine effectiveness.

We have worked with neurologists to contact multiple sclerosis patients with COVID-19 to discuss changes to their treatment regime or need for additional support by linking the Scottish Multiple Sclerosis Register to ECOSS.

We have enabled nephrologists to identify patients with COVID-19 to enable them to advise on best renal replacement therapy options by linking the Scottish Renal Registry data with ECOSS

Knowledge and Research work supporting COVID-19

We produced 21 complex and comprehensive evidence searches and three evidence summaries in order to provide a robust evidence base for the work of Public Health Scotland and our partners. Additionally, we subscribed to Scopus, the world’s largest database of peer-reviewed literature, in order to ensure access to a comprehensive cross-disciplinary overview of the world's research output in responding to the COVID-19 pandemic.

Public Health Scotland contributed to the international research evidence base by publishing 40 papers this quarter in peer reviewed journals to support decision-making by policy makers and the wider research community (we will share more information on the impact of these in our quarter four report)

COVID-19 Daily Public Facing Dashboard

We continue to provide the public and professionals with access to up to date and accurate information on the pandemic through our daily updated dashboard. The dashboard has continued to draw very favourable comment from many quarters and is considered a vital resource in helping people understand the risks nationally and locally. The dashboard is under a state of continual development in order to ensure it remains relevant. It was amended to provide a medium for sharing two of the five metrics used in informing the Government’s decisions on COVID-19 levels (test positivity rate and 7-day positive rate per 100,000). More recently the colour coding was adjusted to make it more sensitive to variation at local levels. Work is currently underway (expecting completion end of January) to incorporate vaccination data in the dashboard.

COVID-19 Wider Impact Data Dashboard

We worked with the NHS in Scotland, policy makers and NHS Boards to inform decisions about services by continuing to develop the information published on this dashboard. Since July 2020, 37,000 users have accessed this Dashboard. Some examples of the information released in quarter 3 includes:

• Cancer incidence indicators with detailed local breakdowns. This indicator has been the subject of positive feedback from policy makers and cancer networks in Scotland. The rapid development of the new indicator was based on using provisional cancer registrations based on pathology data – a novel approach that has successful delivered more timely data than previous methods. The indicator has been rapidly developed using R/Shiny open source software. • Indicators for child health include detailed local information on trends in method of delivery, induction of labour, gestation at delivery and antenatal bookings. These indicators have been the subject of positive feedback from policy makers. In addition, Public Health Scotland has received positive emails from international agencies on the work that produced them. The rapid development of new dashboards has been 9

based on doing this differently from previous approaches – the dashboards have made use of open source software, allowing rapid and iterative development and avoiding expensive licensing arrangements. • For cancer intelligence novel information estimating the number of new cancers in Scotland. This provides early insight into some of the consequences of the pandemic which showed that 4,000 fewer cancers have been diagnosed than otherwise might have been expected. • Information on breastfeeding and on child development included for the first time on 30 September 2020 – this appeared to show a slight shift upwards in the percentage of children recorded as overall breastfed at their first health visitor visit. • Information on uptake of pre-school child health reviews. Information has now been added at Health & Social Care Partnership level to inform national and local planning.

We continue to produce the monthly non-COVID-19 harms management report for NHS Chief Executives and Directors of Public Health.

COVID-19 Seroprevalence Dashboard

We also enhanced public understanding of the proportion of the population who have had COVID-19. We did this by developing a new seroprevalence dashboard. Seroprevalence estimates the proportion of the population who have antibodies to COVID-19 in their blood. It does this by testing blood given for other purposes for the presence of COVID-19 antibodies. Since antibodies to COVID-19 stay in the blood for up to six months, this information gives us a good sense of the levels of the virus in the community. It showed that the proportion of people attending community healthcare settings who had antibodies to coronavirus is estimated to be 7.9% (95% CI: 6.7%-8.9%) in the 5-week period up to and including week beginning 14 December 2020.

Whole System Modelling

We are supporting health boards and health and social care partnerships in their remobilisation planning through the development of a whole system

service recovery model that allows them to look at the interaction of COVID and non-COVID demand and capacity. The model was completed in October; a rollout process commenced in November to familiarise the boards with the model and its capabilities; this rollout will continue in January. Work is underway to build a long term sustainable capability based on the foundations of this model that will support a whole system approach to planning.

Outbreak Management

We are leading in the development of improved COVID outbreak management capability through two related developments. We have developed a geospatial based capability that enables health protection teams look at the connections between cases and contacts. A working prototype was initially made available to two heath boards; it is planned that the first minimally viable product will be made available to all boards by the end of January. Alongside this, work has commenced to develop an outbreak management module building on the contact tracing Case Management System. This will help health protection teams better manage outbreaks by negating the need for transferring data to HPZone (a web-based software suite for managing infectious diseases at the local level).

COVID-19 Research

We continue to play a vital role in COVID-19 research through the National Core Studies Data and Connectivity Programme for Health Data Research UK (HDRUK). The range of COVID-19 related data we manage in the National Safe Haven continues to grow and support from Public Health Scotland and NSS colleagues in expediting access to these is vital as demand continues to grow. In addition to this the National Safe Haven is providing secure collaborative spaces for NHS Board colleagues and Scottish Governments in support of the COVID-19 Data and Intelligence Network.

Education

We have informed policy makers’ and the public’s understanding of the prevalence of COVID-19 in educational settings. This provides a vital fact- base to debates about whether to open or close schools. We did this by

publishing the first COVID-19 Antibody Survey of Education Staff (CASS) report which aims to find out the proportion of people working in education in Scotland who have had COVID-19 by testing for antibodies in their blood. This type of test looks at whether someone has been infected in the past. By testing people through the school year, we will be able to track if this is changing over time.

4. Mental Wellbeing Mental health was a significant issue for Scotland’s wellbeing before COVID- 19. The pandemic has only exacerbated this. We provided policymakers and the public data to understand the impact of the COVID-19 pandemic on mental health services by publishing a range of mental health service indicators on our wider impact's dashboard.

National Records of Scotland published statistics on the number of probable suicides in 2019. This showed more people had died by suicide than in 2018. In support of this we published supporting information.

We also published public messages and resources to improve the confidence of the general public to talk about suicide and to inform them about where to seek help if required. By 10 January, over 2,000 people have actively signed up to the United to Prevent Suicide (UtPS) digital hub. A refreshed version of The Art of Conversation (developed by PHS) is provided to all who sign up and two e-newsletters have been circulated to maintain ongoing contact and explore how best to harness their involvement in ongoing activities. The digital hub has been accessed over 30,000 times since its launch on 9 September 2020. Additional resources located on the Hub include: the 30s film promoting the importance of opening up conversations with friends, family and colleagues; the short awareness raising animations on mentally healthy conversations and suicide prevention developed jointly by PHS/NES; and a series of stories from the Lived Experience Panel.

In partnership with Suicide Prevention Local Leads, NHS 24, and National Suicide Prevention Leadership Group Members we provided training and support to health and care staff and the Suicide Prevention Leads Network. A

total of 86 facilitators from across Scotland are now using the Ask Tell facilitators packs for the adult focused animations – this will help with further awareness of mental health and suicide prevention across different workforces. Examples of this in practice include:

• DWP have delivered the Ask Tell sessions to their frontline staff as well as to staff involved in a safeguarding and support role. • NHS Borders delivered the Ask Tell informed level training to Live Borders (the leisure, culture and sport provider in the Borders). The five ‘tutors’ via NHS Borders have now started to cascade it throughout their own organisation.

We hosted a Workshop with West Lothian partners (local Authority, public health, community regeneration) to begin to develop a partnership project plan for taking a public health approach to mental health in West Lothian, using whole systems approach. Feedback from attendees on this initial session has been very positive.

5. Communities and Place We are providing support to local Alcohol and Drug Partnerships through the deployment of the Drug and Alcohol Information System (DAISy). The system went live as planned on 1 December with rollout planned for completion by 1 April 2021.

We worked with Transport Scotland to identify how COVID-19 is affecting the use of transport systems, and to develop and implement both transport and planning policy at a national and local level by providing information in evidence papers and associated briefings.

We prepared a report for the Social and Systems Recovery – Environment and Spaces Group (hosted by PHS) to look at Greenspaces. The report is for is for national and local government, NHS Boards, the third sector and other professionals involved in environment and planning policy development and implementation in both the public and private sector. It covers how COVID-19 has influenced the use of green and open space, the reported benefit of this

for mental and physical health during lockdown and recommendations for action to support future decision making.

We produced sectoral guidance to support those working in homelessness settings, including people who are working with migrants and asylum seekers, to give advice to their staff and users of their services about how they can prevent the spread of coronavirus. This guidance was produced in partnership with COSLA, Scottish Government and our stakeholders and partners within the homelessness sector, this participation and co-production will assist with upholding the right to health across Scotland. This guidance has been shared with Scottish Government and all our stakeholders working in the homelessness sector. It will also be uploaded onto PHS.com for wider access.

We worked with deputy directors at a SG roundtable to consider how to achieve the National Performance Framework outcomes by producing a framework for understanding how inequalities in power manifest within the population.

Published three case studies developed in partnership with Linstone Housing Association, South Ayrshire Council and Homes for Good as part of housing providers to deliver trauma-informed services.

We contributed to workshops with City of Edinburgh Council assessing impacts of two models of housing development (including 20 minute neighbourhood) and with North Ayrshire Council assessing a local development masterplan for Ardrossan.

We are submitting research proposals, with the Inclusion Health group, to build an understanding of the lived experience of COVID-19 for marginalised community. The research will focus on people with experience of homelessness, mental health issues, commercial sexual exploitation and seeking asylum/refugee status.

We provided advice to the Chief Medical Officer, Scottish Government and the UK CMOs Communications Committee to enable implementation of the UK CMOs Physical Activity Guidelines. We also provide advice to SG on the

approach to delivering the programme for government commitment to ‘improving healthy eating for people on low incomes’.

The Scottish Clinical Trial Research Unit are supporting the Chief Scientist Office as a representative for Scottish Clinical Trials Units at the National Research Scotland (NRS) Cancer Trials Resilience Sub Group, This group is supporting the recovery of the Cancer Clinical Trial Portfolio across Scotland by advising on and monitoring the trial portfolio data, by identifying and proposing solutions to barriers in recruitment of patients to trials, by addressing emerging challenges that may require national support or guidance. This group reports on the above to the Scottish Government National Cancer Recovery Group and the NRS Operational Restart Group.

We are working with the Scottish Government, the Drug Deaths Task Force and local partners to drive forward work to reduce drug-related harm. Our clinically-led drugs team supports local authorities, NHS Boards, health and social care partnerships and third sector service providers to improve service quality. This includes supporting improvements around the safety, equity, effectiveness and person-centredness of services that care for and support people who want to reduce their consumption of drugs. We do this by taking an evidence-informed approach that targets the root causes of harms and by providing enhanced support for translating evidence into action.

We are leading on two areas highlighted in the First Minister’s statement to parliament on 20 January:

• the development of national standards for the consistent delivery of ‘no barrier’ medication assisted treatment in Scotland • the development of a public health surveillance system for ongoing analysis and interpretation of health-related data

6. Poverty and Children We are working with local weight management services in Type 2 diabetes prevention and delivery of Tier 2 and Tier 3 weight management services for children and young people. This is being achieved through the collection and curation of the first core dataset from weight management services. This 15

dataset will support the evaluation of current services against standards, as well as providing insight and direction on future planning of services to support the prevention agenda

We produced a series of evidence summaries on the impact of COVID-19 on children and young people’s development to inform Ministers’ briefings and policy and practice discussions.

As ongoing members of the COVID-19 Scientific Advisory Subgroup on Education and Children’s Issues we provided an evidence scan of the current and rapidly growing evidence base on the impact of the pandemic on education and child health and wellbeing.

We worked with the World Health Organization to interpret the evidence base around safe schooling and provide advice to Ministers of Health and Education from around Europe through our membership of the Technical Advisory Group on Safe Schooling during the COVID-19 Pandemic.

As part of the Scottish Government Social Renewal Advisory Board Addressing Local Income Policy Circle we provided data and evidence to support the development of recommendations on employment, education and training.

Presented at the Living Wage Week event on the contribution of NHS Scotland organisations as anchor institutions and highlighted why this should be the business of the NHS through the role anchor institutions can play in tackling poverty and providing good and fair work.

Provided a keynote address at the Scottish Attainment Challenge learning event on poverty and its impact on attainment under COVID19 and beyond.

7. Other highlights Research

In November Public Health Scotland became a member of the Health Data Research (HDR) UK Alliance. This will better position Public Health Scotland to influence the work of this increasingly important health research organisation. Most recently HDR UK has had a leading role in coordinating 16

Sir Patrick Vallance’s National Core Connectivity and Data Study. Whilst focused on health data it is important to note that HDR UK has a strong interest in public health.

Unscheduled Care

Collaborating with partners (NHS 24, SAS, Ayrshire and Arran) we are continuing to provide data, analytics, intelligence and public health expertise to the Redesign of Unscheduled Care. Providing daily and weekly reporting to understand the impact of the service changes for pathfinder project. The SG plan to roll out the model of delivering unscheduled care nationally in the coming weeks.

General Practice In collaboration with the Scottish Government and Scottish General Practice Committee, we are undertaking a weekly survey of GP practices on the pressures from winter and COVID.

8. Transformation Public Health Scotland’s 2019 Target Operating Model 2.0 committed us to publishing a Transformation Plan (sometimes referred to as an organisational change plan) by December 2020.

We set out our approach and what we will deliver as we transform Public Health Scotland in 2021 and subsequent years in Transformation Plan which we brought to Public Health Scotland’s board in December 2020. Because we judged that sharing a plan for changing the organisation immediately before or during the Christmas break was imprudent, we shared the latest version of the plan with staff in January 2021.

Our Transformation Plan outlines what we need to do to deliver transformation, how we will do it, and how we will measure it. It sets out:

• transformation programmes of work • phases of transformation • governance for transformation

The development of the plan built on the engagement with staff and stakeholders throughout reform and the development of our strategic plan. We engaged with staff through a series of workshops in November and December and plan to continue to engage widely throughout 2021.

9. FOIs and Parliamentary enquiries We continue to respond to multiple COVID-19 and non-COVID-19 related FOI requests as well as many Parliament Questions. The number of both continues to raise in Q3 covering the period 1st October to 31st December:

• 131 FOI requests received, 94 related to COVID-19 and 37 to non- COVID-19. • 82 Parliamentary questions had been lodged with 55 of these related to COVID-19 and the remaining 27 relating to a range of other subjects including cancer referrals, flu vaccine uptake and suicide statistics

10. Workforce The section aims to provide an overview of the configuration of Public Health Scotland’s workforce along with some additional information. Throughout this year, the flexibility of our workforce has enabled Public Health Scotland to be adaptable in our response to the demands placed on it as a result of COVID- 19.

On 31 December 2021:

• Public Health Scotland has a headcount of 1,093 staff, which equates to 999.9 whole time equivalents. There were 17 agency workers, of which 13 were in Clinical Protecting Health. • December highlights a current year to date position of 1.35% absence, with a monthly position of 1.26% this is a slight reduction of 0.40% from the November position of 1.66%. This reduction is in relation to a decrease in Long term absence to 0.87% in December. Long term absence which has been consistent over the past 4 months peaking at 0.96% in November.

• Short term absences which have been steadily on the rise since June also highlights a slight reduction of 0.02% in December resulting in a current FY position of 0.48% • PHS turnover rate is at 5.66%. • Current month turnover is 0.46%. Turnover still remains on target and forecast to end the FY year at approximately 6% which is below the 7% target currently set. • Currently 50 posts advertised within financial year

o 171 vacancies (29.94% permanent 54.8% fixed term or secondment)

o 16 live adverts o 16 conditional offers o 8 interview stage

The measures to reduce the spread of COVID-19 have had an impact on our staff too – especially the move to remote learning for many in schools and universities. We are supporting staff to work flexibly and in some cases work reduced hours while they support their children to learn from home.

11. Workplace Recovery

Working at home remains the default position for Public Health Scotland and is likely to be for the foreseeable future, due to the new lockdown across mainland Scotland. As exemplars of public health practice, it is vital we set a good example and this means that, wherever possible, staff should work from home. A return to the workplace will continue to be subject to appropriate lifting of restrictions and progress through the Scottish Government Route Map.

Public Health Scotland (Public Health Scotland) Workplace Recovery operational plan is ensuring that colleagues can work safely and their health and wellbeing is supported during the COVID-19 pandemic.

During Quarter 3 the team have:

• Continued to ensure that staff are safe at home by co-ordinating staff attending the office to uplift and borrow equipment • Developed new form (via MS Teams) for staff to order necessary IT equipment and furniture (desk and chair) and processed 80 orders • Enabled 374 staff to receive their flu vaccination • Carried out 16 Display Screen Equipment (DSE) assessments • Review and update guidance as it becomes available from the Scottish Government.

The team continue to signpost staff to available health and wellbeing supports via the PHS Need to Know communication channel. PHS received reports on the recent national Everyone Matters staff survey and the findings and will identify areas for focus and improvement.

12. Workforce Health and Wellbeing A Public Health Scotland Wellbeing coordination group is being established to oversee the approach to all areas relating to wellbeing across PHS. It will be co-chaired by Vicki Bibby and Claire Sweeney and has a range of participants and directorate representatives as well as staff side colleagues and representatives from our Share Service provider. In addition, Dr Anna Black (non-executive of PHS) will be our Board sponsor for this group.

The role and remit of the group has been developed and first meeting to take place early in January 2021. The aim of the group is as follows:

“To deliver a consistent Wellbeing approach for PHS which is supported by policy, practices and a culture which commits to the prevention of injury and illness within the workplace, but empowers colleagues to take steps to positively engage and improve their physical, mental and emotional health.”

During this quarter PHS received its first Everyone Matters report (this was an abridged version of the employee experience measure iMatter). A short summary of the results is summarised below and whilst there is scope from improvement – PHS performs well with regards to staff feeling support by line

manager’s health (87%) and organisation (76%) with regards to health and wellbeing.

Public Data Place Clinical & Strategy, Health Driven and Protectin Planning Scotland Innovatio Wellbein g Health and n g Performa nce

Response Rate 74% 71% 73% 69% 83%

Overall, working 7.24 7.51 7.27 6.67 7.30 within my organisation is a .....[10 Very Good Experience, 1 Very poor]

Your Wellbeing (Average Score)

Overall, how satisfied 6.8 6.9 6.7 6.6 7.0 are you with your life nowadays?

[Low 1-4, Medium 5-6, High 7-8, Very High 9-10]

Your experience at work over the last 6 months (the ‘COVID period’)

I feel my direct line 87% 85% 88% 86% 89% manager cares about my health and wellbeing.

I feel my organisation 76% 76% 76% 68% 80% cares about my

health and wellbeing.

Each of the Directorates will review their reports in more detail to look at both success and areas for improvement. Overall actions for PHS will be included and overseen in the Staff Governance Action Plan (SGAP).

In December the national employee experience report was also published and for PHS here are the key points.

• PHS response rate to the survey was the second highest of national Boards, (74%) after HIS (79%) • Of the 9 national Boards, our staff who completed the survey rated the overall experience of working in the organisation (which includes ‘would recommend as a place of work’) at an average of 7.2/10 – the 4th highest of the Boards and we are one of four National Boards with a higher recommendation score than all Geographic Boards • Most (73%) of our staff who completed the survey said ‘they get what they need from other teams and services within the organisation to do my job’. • Public Health Scotland also has a high score for ‘my line manager cares about my health and wellbeing’ (87%) but performs less well for the ‘my organisation cares about my health and wellbeing’ (76%). The report notes that this "perhaps reflects the newness of the Board".

13. Finance

Overview - Revenue

At the end of quarter 3 of 2020/21, Public Health Scotland is reporting a revenue surplus of £0.1 million. This position is a significant swing from the previous YTD surplus reported in previous months due to re-phasing and return of funds to Scottish Government.

The main driver of this position is the reduction of COVID funding previously included within the core area of the organisation to backfill baseline funded posts for individuals working on contact tracing. Despite strong drive to recruit in quarter 3, filling vacancies has been challenging during this period due to the high demand for Public Health related roles. PHS will continue to drive this forward with a view to have roles filled by the end of quarter 4.

Public Health Scotland is regularly assessing the financial impact of COVID- 19 on its operating budget, with formal reporting to Scottish Government on a monthly basis. At the end of quarter 3, Public Health Scotland is forecasting it will achieve all its statutory financial targets for 2020/21.

Income / Funding

Quarter 3 income shows an income shortfall of £0.9m vs a budget of £55.8m. This mainly is a result of staff being diverted to work on COVID-19 related projects with some income streams paused or target not being achieved due to vacancies mentioned above. The shortfall has been reduced due to additional income received by SG.

Public Health Scotland is regularly assessing the financial impact of COVID- 19 and any related deficits will be fully funded by SG.

Expenditure

Pay costs are £0.3m lower than the YTD budget of £40.645m (0.7%) driven by an average of 10 WTE vacancies in core budget.

In addition, 177 vacancies being recruited for to support COVID-19 projects. COVID-19 related costs are fully funded by SG via additional allocations and do not pose a risk in the YTD and FY position. Surplus funds will be returned to SG. 23

Non-Pay costs total £14.1m YTD against a budget of £14.8m, resulting in a £0.7m underspend. Much of this is due to the reduced activity within previously noted income streams and staff related costs (i.e. office costs, travel and training). In Q4, NSS Finance and PHS will continue to focus on non-pay to ensure that all in-year commitments are fully accounted for.

Cash Releasing Efficiency Savings (CRES)

Public Health Scotland is required to evidence CRES of £2.4m (5% of the £47m baseline allocation retained within the Board to support developments and other pressures). Year to date CRES has been reported at £1.7m which has been delivered by actively managing core vacancies. There are no concerns in delivering the CRES target in full by year end.

Capital

The capital budget for Public Health Scotland for 20/21 is £1.1m, with £0.7m allocated to specific projects in 20/21. The planned underspend vs budget is a result of capacity constraints as resources allocated to PHS projects have been reallocated to COVID-19 specific projects. PHS will review the impact of this delay and ensure projects are re-prioritised according to its priorities.

Summary

Public Health Scotland is on track to meet all of its statutory financial targets for 20/21 with low risk in Q4 due to additional C-19 funding from SG. The key focus areas for Q4 for PHS Senior Leadership Team and NSS Finance are: (a) recruitment and on-boarding of staff (b) scrutiny of the in-year financial position to ensure all risks are mitigated and (c) setting a 3 year financial plan which is aligned to PHS’s strategy.

14. Communications

This section of the report is to inform the Board on key aspects of Communications work, in particular media coverage and management, engagement with our web content and summary social media data.

Media Coverage and Management

Public Health Scotland responded to up to 14 media enquires a day during October – December 2020, although it is more common to respond to between 4 and 6 media enquiries on a daily basis.

The following provides a general analysis of media coverage in Quarter 3 and has been provided independently by Press Data who monitor our press coverage.

Coverage was largely neutral (1,721 items) with 28 positive and 10 negative articles. Of those, most were from online and UK press (879 and 752 respectively) sources.

Media coverage over this period was heavily focused on COVID-19 and in particular, our COVID-19 weekly data reports, hospital discharges into care homes including our report, published on 28 October, which provided management information to understand the data around those discharges which was highly anticipated and reported on.

Corporate Website

Overall we had 327,140 visits to the website generating 885,412 page views and people stayed on the site on average for just under 2 minutes (01:58) each time.

Social Media

Currently, the key social media platform used to support communications with stakeholders is Twitter and the organisation has approximately 38,700 followers to its corporate Twitter account. (The organisation is also building its presence on Instagram and currently has 3,445 followers.)