Dentists have warned that the Scottish Government’s last-minute extension of financial support for NHS practices must go hand in hand with meaningful reform to avert a crisis in the service.
A new ‘bridging payment’ will replace the current ‘multiplier’ set to expire on 1 October, uplifting NHS fees a rate of 1.2 for the next three months, falling to 1.1 for the period up to April 2023.
The Cabinet Secretary had previously told the BDA that the multiplier – which at its current level increased NHS fees by 1.3 – had not been included in the Scottish Government’s budget forecasting. The professional body has not ceased reminding officials that without an adequate interim funding package several key treatments including extractions, and anything – like dentures – that requires laboratory work, risk being delivered at a financial loss.
The BDA stress that the new support package cannot presage a return to ‘business as usual’ from April 2023. Dentist leaders stress that in the months ahead efforts must be made to deliver needed change to the broken high volume/low margin model NHS dentistry is based on. Without reform, this package will simply delay an inevitable exodus of dentists from the NHS that is already evident in other UK nations.
While COVID emergency measures have been withdrawn, dentistry in Scotland has not returned to anything resembling pre-pandemic norms, with practices continuing to work under capacity in the face of an historic backlog. Latest figures indicate 261,537 claims were made by dentists delivering NHS treatments in July 2022, less than 60% of the number made in the same month in 2019.
Recent research by the BBC indicated 9 in 10 practices UK-wide were unable to take on new adult patients. In Scotland figures stood at 82%, the multiplier likely playing a decisive role.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“The Scottish Government seem to have recognised the wholesale inadequacy of the funding model for NHS dentistry.
“It’s not rocket science. Without additional support, the basics of NHS care – from extractions to dentures – would have been delivered at a loss. No business can operate on that basis.
“We now need some serious long-term thinking. Unless Ministers are prepared to revisit the system this service is built on, this funding will amount to sticking plaster on a gaping wound.
“If this is just delaying the return to a broken ‘business as usual’ then millions of patients stand to lose out.”
“These are the second worst data on record. Too many patients are waiting too long. We know long waits contribute to patient harm. In August over 29,000 patients waited over 12 hours after a decision to admit was made, with some patients waiting up to three days for a bed.
“We think the consequence of this is shown in the ONS data as 500 excess deaths a week. We must not accept these long stays as normal. We need to see leadership and meaningful action that gets to grips with this crisis.
“We urge the new Prime Minister, Liz Truss, and incoming Health and Social Care Secretary, Therese Coffey (above), to make tackling the crisis in Emergency Care a priority.
The scale of patient harm occurring is shocking. The Emergency Care system is failing to its core functions; it is vital that we mitigate the impact of this crisis ahead of winter and do all we can to keep patients safe and reduce these dangerous waiting times.
“The Prime Minister and Health Secretary must urgently bolster the social care workforce. Thousands of beds are occupied by patients who are medically fit to be discharged, but the lack of social care service means that getting patients home is a slow and complex process.
“This means that hospitals have difficulty in discharging patients in a timely way, leading to exit block, poor flow throughout the hospital and subsequent problems in Emergency Departments and ambulance waits. The need for investment in social care couldn’t be clearer.
“Staff are exhausted, overwhelmed and in the midst of the worst crisis the NHS has ever faced. Widespread shortfalls of staff across all grades and departments mean health care workers are spread increasingly thinly and more prone to burnout – there are currently around 130,000 vacancies in the NHS almost 10% of its workforce.
“The Prime Minister must deliver the fully funded long-term NHS workforce plan that the government pledged to deliver in 2019. Emergency Care is in crisis and there is a shortfall of 2,000-2,500 Emergency Medicine consultants and widespread shortages of vital nursing staff, trainees, SAS doctors and junior and supporting staff are contributing to the challenges.”
There were 1,304,378 attendances at major Emergency Departments
There were 1,988,779 total attendances at all Emergency Care facilities
28,756 patients were delayed for 12 hours or more from decision to admit to admission
This is the second highest number of 12-hour waits on record, just 561 short of the previous record in July 2022
There have now been 178,770 12-hour waits (from decision to admit to admission) so far this year
Four-hour performance at major Emergency Departments was 58.0%, this is the second worst four-hour performance on record, the lowest was recorded the previous month, July 2022
More than 2 in 5 patients were delayed by four-hours or more
Type 1 admissions stood at 350,618 (a daily average of 11,310)
130,528patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
Bed occupancy stood at 92.8% (far higher than the recommended 85%)
Guidance relaxed in line with latest clinical advice
Social care staff and visitors are no longer being advised to wear facemasks at all times under new guidance published today (7 September).
The recommendation has been lifted due to a sharp drop in coronavirus infections and a reduction in severity of illness, which has been driven by Scotland’s successful vaccination programme which has so far seen more than 12 million Covid-19 vaccine doses administered in Scotland.
Care home residents and their loved ones will benefit from these more relaxed visiting arrangements. Masks and face coverings in social care may still be worn if recommended in certain situations, such as a local outbreak of COVID, or if staff deem it necessary. Staff and visitors remain free to wear one if they choose.
This guidance balances the risk of harm from COVID-19 with the impact masks can have on communication, mental wellbeing and rights and choices of those working in and using social care services.
Social Care Minister Kevin Stewart said: “Our phenomenally successful vaccination programme has driven down infections and saved the NHS from untold pressures.
“Removing the need for facemasks in social care settings including care homes is the latest step in our path to recovering from the pandemic.
“This will make communication and relationships easier in care settings, benefiting mental health and promoting the rights and choices of those working in and using social care.”
‘this should ring alarm bells to all political and health leaders’ RCEM says
Responding to the latest Emergency Department performance figures for Scotland, Dr John-Paul Loughrey, Vice Chair of the Royal College of Emergency Medicine Scotland, said:“The latest Emergency Department performance figures for July should ring alarm bells to all political and health leaders.
“These are the worst performance figures since records began, with over 4,000 patients waiting 12-hours or more in major Emergency Departments in Scotland – equal to nearly one in every 25 patients.
“The depth and scale of this crisis is deeply concerning. Patients are already coming to harm, a consequence of long and dangerous waiting times. These data must be a call to action, especially as winter is fast approaching.
“The government must urgently expand capacity where safely possible; we know there is a shortfall of 1,000 beds in the health system in Scotland. The Scottish government and local authorities must also bolster the social care workforce. Good social care underpins an effective health service.
“Ensuring the timely discharge of patients, which relies on good social care, is crucial for freeing up beds, admitting patients and encouraging flow throughout the hospital.
“Lastly, we must see a long-term workforce plan for the NHS in Scotland. Staff have been pushed to the brink; burnout and distress are leading to health workers considering leaving the workforce.
“We must do all we can to retain staff as well as look to recruiting new staff into the health service. Without the workforce, more and more patients will face longer and longer waits and come to further harm.
“Our priority is patient safety and delivering effective care, that is only possible with a workforce that is not overwhelmed, not burnt out and not undervalued.”
Following on from the previous advice on which vaccines should be used in this year’s autumn booster programme, the Joint Committee on Vaccination and Immunisation (JCVI) has updated its published advice to include an additional bivalent vaccine now approved by the Medicines and Healthcare products Regulatory Agency (MHRA).
Studies indicate the Pfizer-BioNTech bivalent vaccine produces a marginally higher immune response against some variants than the Pfizer-BioNTech mRNA Original ‘wild-type’ vaccine. The clinical relevance of these small differences is uncertain.
‘Bivalent’ vaccines have been developed by global manufacturers since the emergence and dominance of the Omicron variant. These vaccines are targeted against antigens (substances that induce an immune response) from 2 different COVID-19 strains, or variants.
All of the available booster vaccines offer very good protection against severe illness from COVID-19. As more vaccines continue to be developed, the committee will consider their use in the autumn programme.
Professor Wei Shen Lim, Chair of COVID-19 immunisation on the JCVI, said: “It is very encouraging that more vaccines continue to become available and we now have another option to add to the vaccines already advised for the autumn booster campaign.
“Winter is typically the time of greatest threat from respiratory infections. We strongly encourage everyone who is eligible to have their booster vaccine this autumn when it is offered. This is our best defence against becoming severely ill from COVID-19.”
Pfizer/BioNTech bivalent COVID-19 booster approved by UK medicines regulator
A second, “bivalent” vaccine was yesterday approved as a booster by the Medicines and Healthcare products Regulatory Agency (MHRA) after it was found to meet the UK regulator’s standards of safety, quality and effectiveness.
The updated booster vaccine made by Pfizer/BioNTech, targeting two coronavirus variants, has been approved for use in individuals aged 12 years and above. This decision has been endorsed by the Commission on Human Medicines, after a careful review of the evidence.
In each dose of the booster vaccine, ‘Comirnaty bivalent Original/Omicron’, half of the vaccine (15 micrograms) targets the original virus strain and the other half (15 micrograms) targets Omicron (BA.1).
The MHRA’s decision is based on data from a clinical trial which showed that a booster dose with the bivalent Pfizer/BioNTech vaccine triggers a strong immune response against both Omicron and the original strain. Safety monitoring showed that the side effects observed were the same as those seen for the original Pfizer/BioNTech booster dose and were typically mild and self-resolving, and no new serious safety concerns were identified.
Dr June Raine, MHRA Chief Executive said: I am pleased to announce that we now have a second approved vaccine for the UK Autumn booster programme. The clinical trial of the Pfizer/BioNTech bivalent vaccine showed a strong immune response against the Omicron BA.1 variant as well as the original strain.
“Bivalent vaccines are helping us to meet the challenge of an ever-evolving virus, to help protect people against COVID-19 variants.
“We have in place a comprehensive safety surveillance strategy for all UK-approved COVID-19 vaccines, and this will include the updated booster we approved today.”
Professor Sir Munir Pirmohamed, Chair of the Commission on Human Medicines said: “Following an independent review of the safety, quality and effectiveness of the vaccine, the Commission on Human Medicines and its COVID-19 Vaccines Expert Working Group supports the MHRA’s decision.
“As with any medicinal product, including vaccines, it is important to continually monitor effectiveness and safety when it is deployed, and we have the relevant processes and expertise in this country to do that.
“The Joint Committee on Vaccination and Immunisation (JCVI) will advise on how this vaccine should be offered as part of the deployment programme.”
Patients and healthcare staff will no longer face second-hand smoke at hospital doors as a nationwide ban comes into effect tomorrow (Monday 5 September).
The new legislation means anyone found lighting up within fifteen metres of a hospital building could face a fixed penalty notice of £50 or a fine of up to £1,000 if the case goes to court.
This is the latest step in the Scottish Government’s plan to create a tobacco free Scotland by 2034 and supports the voluntary smoke-free hospital grounds policy introduced in 2015.
The new law will apply to NHS hospital settings used for the treatment and care of patients and includes a ban on lighting up beneath overhanging structures.
Public Health Minister Maree Todd said: “Everyone knows that smoking is bad for our health and hospital patients in particular should be protected from the harmful effects of second-hand smoke.
“This new law is the latest step in our bold plan to make Scotland tobacco-free by 2034 – building on our dedicated stop-smoking services and early intervention measures to stop youngsters picking up the habit altogether.
“Anyone looking to quit can contact the NHS QuitYourWay Helpline or speak to their local pharmacy to discuss the range of help available.”
ASH Scotland Chief Executive Sheila Duffy said: “Extending current legislation to include outdoor areas will have the positive impact of protecting people from the harmful effects of breathing in toxic tobacco smoke through vents, windows or doorways while they are being treated and recovering in hospital.
“We urge people who smoke to be considerate in remaining outside the 15-metre perimeter, ensuring hospital patients do not face unnecessary additional risks to their health caused by inhaling harmful substances.
“This is particularly important as Scotland challenges the normalisation of smoking on our journey towards becoming tobacco-free.”
If you’re due a wheelie bin collection TODAY or FRIDAY, please put BOTH your green and grey bins out for collection.
Bin collections and street cleansing services resumed on Tuesday but it’s looking increasingly likely that strike action will start again from Tuesday 6 September.
Because of this, we are making changes to bin collection schedules this week:
If you are due a bin collection on Thursday 1 September or Friday 2 September, you should put out both your green AND grey wheelie bins, and any bagged extra waste. Please put them out by 6am on your normal collection day and we will aim to empty them BOTH.
There may be some delays and they may not be collected on the same day as each other, so please leave them out until the end of the day on Monday (5 September).
If you are due a food waste collection, you should put this out as usual, by 6am.
Garden waste collections will be suspended on Thursday 1 September and Friday 2 September. We’re very sorry for this and will be in touch with details of how we’ll compensate you for any recently missed collections.
The glass collection service remains suspended. We’ll provide an update when this is due to restart.
Red box and gull proof sack collections will continue as normal this week.
We are collecting recycling and non-recyclable waste separately. Unfortunately, in some cases recycling bins will have too much non-recyclable waste in them. This means we will not be able to recycle those bins and they will be collected alongside grey wheelie bins. We will be recycling as much as we can.
We are working hard to catch up on collections after the strike action. Thank you for your patience and understanding.
Please let your neighbours, family and friends who might not have heard about the latest guidance know.
You can find full details of bin collection days, the recovery plan and advice on dealing with waste at www.edinburgh.gov.uk/binstrike
Find out more about changes to collections this week on the city council website:
Work to clear mountains of rubbish on Edinburgh’s stinking streets begins tomorrow
The City of Edinburgh Council is preparing to resume waste and cleansing services following industrial action.
With the scheduled strike due to end at 4.59am on Tuesday, additional resources are being deployed to support street cleansing and communal bin collections, particularly in the city centre and other areas most affected by the strike.
Residents receiving kerbside collections are being asked to put their bins out as normal on their scheduled collection day. Extra waste will be collected during this time, if it is bagged and put next to wheelie or communal bins
Blue box (glass) collections will continue to be suspended to prioritise resources, though Household Waste and Recycling Centres will reopen from Tuesday with extended hours. Bookings can be made online as normal.
Council Leader Cammy Day said: “I regret the impact this national crisis has had on our Capital city and am continuing to press the Scottish Government to fund an acceptable settlement. Talks are continuing over the weekend and I’m hopeful we can reach agreement and prevent any further disruption.
“As I’ve said throughout, I fully respect the right of our colleagues to take this action and have their voices heard. As a trade union member myself, I’ve joined the picket lines in support of fair pay for our workforce and will do so again.”
He may have joined a picket line, butEdinburgh’s Labour council leader has been criticised for voting AGAINST a 5% pay offer to the striking workers, instead voting with the Tories at a Cosla meeting to support an increase of just 3.5% – an offer that would never have been acceptable to the trade unions.
However Cllr Day went on:”This dispute has brought the value of our waste and cleansing teams – and their right to fair wage – into sharp focus and I’m delighted they’ll be back out from Tuesday, helping to return our city to its best.
“While they’ll be working hard to catch up on collections and making every effort to collect litter across the city, it’ll take time for things to return to normal. Please bear with them as they do so and, if you can store your extra waste safely for a little longer or are able to book an appointment at a recycling centre, please do so.
“If your bin is not collected on its normal day, please leave it out and it’ll be picked up as soon as possible thereafter.
“I appreciate that this has been an extremely challenging period for us all and I would like to thank our residents, businesses and visitors for their continued patience and understanding.”
While the industrial action in Edinburgh ends tomorrow, the pay claim has not been resolved and further strikes will follow unless a settlement can be reached. Some progress has been made however and a deal is edging closer – Cosla and the trade unions will meet for a fifth day of talks later today.
Services restart 30 August
Our bin collection and street cleaning services will restart onTuesday 30 August.
We’ll be working hard to catch up on collections after the strike action.
If you are able to take excess waste, such as cardboard, plastics and other dry recycling, to the household waste recycling centres, please book an appointment. This would help our teams collect other waste more quickly. Recycling centres hours have been extended.
Thank you for your patience and understanding.
Communal services
Communal bin collections are restarting from 30 August.
We will collect excess waste – please bag it and place it neatly beside the bin. If you can, please put mixed recycling in a clear bag.
We have additional council teams helping with collections however it may take time for collections to get back to normal and we appreciate your patience.
Kerbside services
Restarting on 30 August and will be focused on key services.
There may be some disruption as we catch up on the backlog.
If your bins are not emptied on your normal collection day, please leave them out until we get to them.
Non-recyclable waste collections (grey bins)
Restarting on 30 August. Please put your bin out on your next scheduled collection day.
We will collect excess waste as long as it is bagged. Please bag your extra waste neatly beside your wheelie bin on your scheduled collection day.
Mixed recycling collections (green bins)
Restarting on 30 August. Please put your bin out on your next scheduled collection day.
We will collect excess waste as long as it is bagged. Please bag your extra waste neatly beside your wheelie bin on your scheduled collection day. If possible, please bag your mixed recycling in a clear bag.
Food waste collections
Restarting on 30 August.
Please put your food bin out on your next scheduled collection day. Please do not present excess food waste outside the caddy.
Glass collections (blue box)
To allow us to catch up with collecting other waste, kerbside glass collections is still suspended. We will let you know when this collection will restart.
Restarting on 30 August. Please put your bin out on your next scheduled collection day.
If you’re a garden waste customer, we’ll be in touch shortly with details of how we’ll compensate you for any collections missed during the strike.
Gull proof sacks
Please put your sack out for collection on your scheduled collection day this week.
We will collect extra waste. Please bag it and leave it neatly beside your sack.
Litter bins and street cleansing
These services will restart from 30 August.
Our street cleansing teams will be prioritising the city centre, town centres, and areas with high footfall and many on-street bins.
We’ll be working hard to collect litter across the city but it may take time to catch up on the backlog. Thank you for your patience.
Request and replacing bins and boxes
Our repair, replacement or removal of bins and boxes service is still suspended. This is to allow us to divert resources to cleansing and waste collections.
Waste reporting and enquires
We have removed online reporting for waste and cleansing as we focus on catching up with cleansing and waste collections.
If you need to report an emergency issue where waste is causing injury or hazard, please phone and listen to the new options carefully. Phone 0131 608 1100 from
A list of the most frequently asked questions has been prepared to help give families in East Lothian more information around E-coli following a cluster of cases linked to local nurseries.
If, after reading this list, you still have questions or concerns about your own family circumstances, please get in touch.
A general information line on 0800 22 44 88 has been created through NHS24 to help families answer many of the questions they may be facing.
Background:
A cluster of cases of E-coli has been linked to nurseries in East Lothian. Four nurseries remain closed.
Cases of E-coli have been identified in Church Street Pear Tree Nursery and Meadowpark Pear Tree Nursery. Families have been informed of the actions they need to take.
Two other nurseries – West Road Pear Tree and Musselburgh Bridge Street Private Nursery – remain closed as a precaution after symptoms of a sickness bug were reported. Families have been informed and asked to provide samples if their child has had any symptoms to rule out the presence of E-coli.
There are currently in excess of 34 confirmed cases.
All children and staff from both Pear Tree Nursery at Church Street Pear Tree Nursery and Meadowpark Pear Tree Nursery have been formally excluded under the Public Health Act and need to go through the clearance process.
Children and staff attending the Pear Tree Nursery at West Road and Musselburgh Bridge Street Private Nursery have been advised to hand in samples if they have had Gastrointestinal symptoms.
Information last updated 22nd August 2022
General Questions
Q. What are the main symptoms of E.coli?
A. E.coli can cause:
Nausea
Vomiting
Stomach pains
Diarrhoea
Bloody diarrhoea
Fever
Q. Why is E.coli so serious?
A. Infection with this bug can have a range of effects from mild diarrhoea, to bloody diarrhoea and in a small proportion of cases it can cause serious complications such as kidney failure. Complications are more common in children aged under five or the elderly.
Q. Where does E.coli infection come from?
A.This bug is carried by a proportion of healthy animals such as cattle. It can be picked up from contact with animal faeces in the environment.
People can also become infected through eating contaminated food for example meat which has not been adequately cooked, or contaminated fruit or vegetables which have not been adequately washed. Unpasturised milk or contaminated water can also cause infection.
E.coli can also be passed on from someone who is infected with the bacteria.
Q. How is E.coli spread?
A. The infection can be spread person to person in families, nurseries or other institutions when contaminated faeces from an infected person are somehow ingested by another person (faecal-oral route). It can also be spread through contaminated food, water or from environmental contamination, including animal parks and gardens.
Q. How can E.coli be prevented?
A. Firstly, thorough hand washing with soap in running water after going to the toilet, before preparing food and after contact with animals or farm environments. Handwashing after nappy changing is very important as is environmental cleaning. Secondly, good food hygiene is essential, for example cooking all meat products thoroughly, washing all salads, fruits and vegetables before consumption and keeping raw and cooked food separate with separate utensils.
Q. My child does not attend any of the above named nurseries, but has diarrhoea, do they have E.coli and what should I do?
A. There are many causes of diarrhoea particularly in children and in most cases it is due to a virus such as norovirus or rotavirus. We would recommend that you take your child to the GP for assessment if their symptoms do not settle down after 24 hours or you are concerned about your child. All children with symptoms of diarrhea should remain off school or nursery until at least 48 hours after their last symptoms. This also means that children should not attend any other settings or clubs where there are children under the age of 10. They should also not be allowed to play with their friends until they have fully recovered.
Q. My child has no contact with any of the above named nurseries, but had diarrhoea 2 weeks ago and is better, what should I do?
A. If your child had a bout of diarrhoea or vomiting which has resolved and they have had no contact with the named nurseries it is highly unlikely that they have an E-coli infection. If you are concerned about your child or their symptoms return please speak to your GP.
Q. My child has no contact with the above named nurseries but has bloody diarrhoea, what should I do?
A. If your child develops bloody diarrhoea, you should contact your GP for an immediate medical assessment taking a stool sample from your child to your GP. Your child may have an E.coli infection that is not linked to the nurseries.
Q. Should I take any special cleaning precautions at home as I have young children?
A. The main preventative action to prevent the spread of diarrhoeal illness is good hand washing with soap under running water, after using the toilet, nappy changing and before eating.
Wipes can be used to remove faecal matter from your hands after changing a nappy but may not act as an anti- bacterial and hand washing is also needed. Alcohol gels should only be used if soap and running water is not available and are only effective on hands that are already visibly clean.
Surfaces should be cleaned using warm water and detergent for surfaces followed by drying with a paper towel. Bleach, or other household disinfectants may be used on appropriate surfaces depending on manufacturer’s recommendations.
Q. My child does not attend the above nurseries and has symptoms – none of which are listed at Q1, but I’m worried about E.coli .
A. It is unlikely that your child has E coli infection. Seek advice from your GP or Health Visitor in the usual way if you are concerned about their health and follow the precautions mentioned above.
Q. Can an E.coli infection be treated with antibiotics?
A. Antibiotics are not routinely recommended for E.coli infection, and in some cases may make the illness more severe. Anti-motility drugs, such as Imodium are also not recommended for diarrhoea caused by E.coli.
Children who are diagnosed with an E.coli infection in their poo will be seen by the pediatricians at the Royal Hospital for Children and Young People. They will give advice to parents on what treatment the child will receive while they have E.coli infection.
Q. My child was at a party/other group where a child from the above nurseries attended, what should I do?
A. There is a very low risk of spread of infection if the other child from the nursery had no symptoms at the time. E.coli is more likely to be passed on when a child has active diarrheal symptoms. If your child does develop symptoms of E.coli you should take them to your GP.
Q. My child started P1 last week and was in a class with a pupil who has since been excluded from Meadowpark Pear Tree Nursery, should I be worried?
A. There is no need for concern. The IMT acts in line with Public Health Scotland guidance which states that people should be excluded from work or school once there is a confirmed presence of E-coli.
In this case, there were only reports of general sickness symptoms. As a precaution, the nursery was closed on August 12, children and staff asked to stay home and report any sickness symptoms over coming days which included the start of the new school term on August 17.
E-coli went on to be detected in a small number of cases on August 19. None of the children who were starting P1 had symptoms of any infection and therefore the risk to others was extremely low.
They have only now been excluded as a precautionary measure to rule out infection as possible contacts within the nurseries with confirmed E.coli and can return to school when negative samples have been received.
Q. My child has been playing with a child who attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, should they continue to do this?
A No, at this time children who are excluded from nursery should not play or socialise with anyone outwith those who normally live within their household until they have been contacted directly by the Health Protection Team and advised that they can do so.
Q. My child has been playing with a child who attends the Pear Tree Nursery in West Road or the Musselburgh Bridge Street Private Nursery, should they continue to do this?
A As long as the child from either of these nurseries has been asymptomatic or symptom free from at least 48 they can continue to play and socialise. This is because there are currently no confirmed cases of E.coli in these nurseries.
Q. When can we expect to get further updates on the situation
A. The situation is changing regularly, and as new information comes to light the Health Protection Team will update parents. Information will be sent to the nursery management team to distribute to parents.
The Health Protection Team are working with Environmental Health, the Care Inspectorate and the Nursery management to ensure that the nurseries open as soon as possible and it is safe to do so.
Q. When will the Nurseries re-open?
A We are unable to answer that at present. This will depend partly upon when individual staff and children have been notified that they are able to return to pre-school establishments, and the nurseries meeting required standards for safety and care and standards for the control of infections.
The investigation into the outbreak is ongoing and as new cases emerge it is difficult to predict when each nursery will reopen. The nurseries may reopen at different times and we will communicate this to parents as more information becomes available.
We understand that this is a very difficult time for parents and once the Health Protection Team, Environmental Health Team and the Care Inspectorate are satisfied that the nurseries are safe, your children will be allowed to return.
Q. I am a Parent/Headteacher/Nursery Manager and we have a sibling of a child from the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark.
A If the child from Pear Tree Nursery at Church Street or Pear Tree at Meadowpark is symptomatic or confirmed to have E.coli infection, and their sibling is aged 10 years or under, the Health Protection Team will risk assess and likely exclude the child as a contact.
This means that the sibling cannot attend nursery or school until they have been contacted directly by the Health Protection Team and are advised they can do so.
Q. I am a Parent/Headteacher/Nursery Manager and we have a sibling of a child from the Pear Tree Nursery at West Road or Musselburgh Bridge Street Private Nursery.
A As long as the nursery sibling has no symptoms, this is fine. If the nursery child develops symptoms medical advice should be sought for that child and the situation would be reviewed. All schools and nurseries should enforce the rule that children with diarrhoea or vomiting should remain off until 48 hours after their last symptoms.
Q. I am a nursery manager in another nursery, how will I know when a child who also attends one of the affected nurseries can return to my establishment?
A For children attending the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark, all parents of these children will receive a letter from the Health Protection Team indicating that their child’s results are negative and that they can return to preschool groups.
They cannot return to any preschool group until they are notified directly by the Health Protection Team. If the Health Protection Team have been made aware that a child attends another nursery, that nursery will receive a formal exclusion letter for the child and will also receive a clearance letter from the Health Protection Team once the child is cleared to return.
For children attending the Pear Tree Nursery at West Road or Musselburgh Bridge Street Private Nursery, the children can continue to attend as long as they have not had symptoms or have been symptom free for at least 48 hours.
Questions for those Families or Staff with links to Pear Tree Nurseries in Meadowpark or Church Street
Q. My child is due to start Primary School but attended the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street
A. All children who have attended these nurseries from the 15th July 2022 have been formally excluded under the Public Health Act. This is because both of these nurseries have confirmed cases of E.coli infection.
Your child needs to submit 2 stool samples at least 24 hours apart to their GP. The Health Protection Team will check that those samples are clear for E.coli infection.
Once the laboratories have reported the negative results, the Health Protection Team will contact you directly and lift the Public Health exclusion allowing your child to return to school.
Q. Why are two samples needed for clearance?
A Two samples are needed in line national guidance. The stool samples should be taken a minimum of 24 hours apart to ensure the results are robust.
Q. Where do I take the samples?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory.
Please ensure that samples are collected at least 24 hours apart and that the label is completed with all the relevant information. Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends.
Until you have been notified directly by the Health Protection Team about the results of the samples, your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
Q. When will the screening test results be available?
A We expect results to be available within 2 weeks. The majority of samples have to be processed at the E coli reference lab in Edinburgh. At this time, our labs are using extra capacity but the samples have to be carefully processed.
You will be notified by telephone of the results. Please do not call the Health Protection Team for results. The Health Protection Team will contact you as soon as both results are available. The Laboratories are processing in excess of 500 tests so there may be delays in getting results to staff and parents.
Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the infection could be spread any further.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street as well as another nursery or playgroup, can they attend the other nursery?
A Your child should not attend any pre-school group such as crèches, playgroups, toddler groups, sports groups or other nurseries until the Health Protection Team have advised you they are able to do so. This is to ensure that there is no further spread of the infection.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, can they go to a birthday party, children’s sports, swimming or soft play area?
A All children who have attended these nurseries from the 15th July 2022 have been formally excluded under the Public Health Act. This is because both of these nurseries have confirmed cases of E.coli infection.
Your child has been formally excluded they should not mix with other children until the Health Protection Team have advised you they are able to do so. This is to ensure that there is no further spread of the infection.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street but has had no diarrhoea can they go to another nursery?
A No. All children must not attend any other pre-school group such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are advised by the Health Protection Team that they can do so. This is because occasionally people can carry the infection without having symptoms and it is essential that we minimise any chance of further spread.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street and has diarrhoea, what should I do?
A You should attend your GP for assessment and submit a stool sample.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street and has bloody diarrhoea, what should I do?
A You should seek immediate medical attention via your GP and submit a stool sample.
Q. I am a staff member from the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, can I work at another nursery?
A No, you must not work in any pre-school establishment, caring for children, or handling food until you have been notified directly by the Health Protection Team that you are clear to do so.
This is to ensure that any chance of further spread is minimised as occasionally people can carry the infection without having symptoms.
You may be eligible for compensation for loss of earnings, from the Health Protection Team if you have been formally excluded under the Public Health Act. A compensation form will be attached to your exclusion letter.
Q. I visited one of the Pear Tree Nursery branches: Church Street, Meadowpark or West Road since 15th July 2022, do I need to be checked for infection?
or
I visited the Musselburgh Bridge Street Private Nursery since 09th August 2022, do I need to be checked for infection?
A If this was a short visit where you did not eat food or use the toilet facilities within the nursery, the risk of infection is low, however, please be vigilant for any signs of infection such as those listed at the beginning of this document and contact your GP if symptoms do present.
Q. I have worked in the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark since 15th July or my child has attended one of these nurseries since 15th July and have not received any letters from public health, should I have?
A Yes, the Health Protection Team have sent inform and advise information out to all the staff and parents via the Nursery Management Team’ The Health Protection Team have sent out or are in the process of sending out formal exclusion letters to all staff and children who’s details have been supplied by the Nursery Management Team.
Questions for those Families or Staff with links to Pear Tree Nurseries in West Road
Q. My child is due to start Primary School but attended the above nursery
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can return to school. This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which may or may not be due to E.coli. If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. My child attends the Pear Tree Nursery in Westroad, can they go to a birthday party, children’s sports, swimming or soft play area?
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can attend events and locations outlined above.
This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness could be due to a number of infections, including E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. Where do I take the samples if my child develops symptoms?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory. Please ensure that the label is completed with all the relevant information.
Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends. Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are at least 48 hours clear of symptoms or until they have the result of their sample.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
Q. I have worked in the Pear Tree Nursery at West Road since 15th July or my child has attended this nursery since 15th July and have not received any letters from public health, should I have?
A. You should have received what we call an ‘inform and advise letter’ from the Health Protection Team. This would have been sent to you by the Nursery Management Team. We have not sent out individual letters to parents or staff.
Questions for those Families or Staff with links to Musselburgh Bridge Street Private Nursery
Q. My child is due to start Primary School but attended the above nursery
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can return to school. This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which may or may not be due to E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. My child attends the Musselburgh Bridge Street Private Nursery, can they go to a birthday party, children’s sports, swimming or soft play area?
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can attend events and locations outlined above.
This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which could be due to a number of infections, including E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. I have worked in the Musselburgh Bridge Street Private Nursery since 9th August 2022 or my child has attended this nursery since 9th August 2022 and have not received any letters from public health, should I have?
A. You should have received what we call an ‘inform and advise letter’ from the Health Protection Team. This would have been sent to you by the Nursery Management Team. We have not sent out individual letters to parents or staff.
Q. Where do I take the samples if my child develops symptoms?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory. Please ensure that the label is completed with all the relevant information.
Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends. Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are at least 48 hours clear of symptoms or until they have the result of their sample.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
For cases who have confirmed E coli infection
Q. My child has confirmed E coli infection, will they get better and when?
A. Before your child can go back to a nursery or a pre-school establishment they need to be completely free of infection. In some cases, this can be several weeks after the initial illness, and repeat stool samples are needed. It is extremely important that your child does not attend any pre-school establishments until they are notified directly by the Health Protection Team that they are free of infection.
Family members may also need tests and may be excluded from some types of work such as food handling or health care professions.
In a small percentage of cases, complications arise including Haemolytic Uraemic Syndrome which can cause renal failure. These children will be monitored extremely carefully in hospital.
Q. What is Haemolytic Uraemic Syndrome?
A This develops in a small percentage of people with E.coli infection. It affects blood cells and can cause kidney failure, therefore it is a serious complication.
Q.My child has confirmed E.coli and I have been excluded from my own work, when can I go back?
A You have been formally excluded from your work because you are a contact of a case of E.coli and work in a risk group, you will need two negative specimens taken at least 24-hours apart before you can return to work. The Health Protection Team will advise you further on this.
It is extremely important that you do not go back to work until you receive direct communication from the Health Protection Team indicating that you can do so. This is to reduce the risk of any further spread. You may be eligible for compensation for loss of earnings, a compensation form should be included with your exclusion letter.
Q.My child has confirmed E.coli infection but is well and we are due to go on holiday, what should we do?
A It is not recommended that you go on holiday until all required tests have returned negative, and this has been directly communicated to you by the Health Protection Team. This is to avoid the possibility of further infections occurring or members of other families needing to be excluded from work or school.
Q. My child has been invited to a party, should they attend?
A. No, Your child must not attend any parties, pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the bug could be spread any further.
Q. Can my child socialise with with any other people or families?
A. No, Your child should not be socialising with other children or families outwith those who normally live in your household until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the bug could be spread any further.
What does Exclusion Under the Public Health etc (Scotland) Act 2008 mean?
Q. Why is a person excluded?
A Exclusion or restriction from work, school or nursery under the Public Health etc (Scotland) Act 2008 is applied when an individual(s) has an infectious disease or has been in close contact with someone with an infectious disease and when there is considered to be a risk that this disease could be passed on to other people.
Exclusion under the Public Health Act is used to reduce the risk of spread of infectious diseases from person to person via the ‘faecal oral route’: when you put something in your mouth, which has been contaminated by the stools/faeces of someone with the bug.
Q. Who can be excluded?
A. Children under the age of 10 are excluded under the Public Health Act when they have been diagnosed with an infectious disease that could be spread to others. If a child under the age of 10 is in close contact (e.g. a sibling) of someone who has an infectious disease, they may also be excluded.
Q. Where/what is a person excluded from?
A. Children who are excluded under the Public Health Act should not attend nursery, school or childcare facilities for the duration of the exclusion. Your child’s nursery/school/childminder will receive a letter to inform them of the exclusion; this will not include specific details of your child’s diagnosis.
In addition to exclusion for nursery/school, there are other activities that may be linked to possible spread of infection to vulnerable groups of people and should therefore be avoided.
Examples of activities and places to avoid during exclusion are:
Swimming
Soft play facilities
Children’s parties /crèches / playgroups / toddler groups / nurseries / after school clubs
Sports clubs
Other gatherings of children
Contact with children under the age of 10 years who are not part of your household
Q. What happens next?
A. You may have initially been told about your child’s infectious disease by your GP, an Environmental Health Officer or a doctor at the hospital. Exclusion under the Public Health Act is the responsibility of a Consultant in Public Health. Should you need further advice or information please contact the Health Protection Team.
Your child’s exclusion can be lifted when they have been formally cleared of infection. Clearance requires testing of stool samples, which you give to your GP surgery. Your child’s first sample can be submitted 48 hours after their last episode of symptoms. Samples should be collected at least 24 hours apart, 2 consecutive negative samples are required to show that your child is free from infection.
Once the Health Protection Team has received the results of samples and confirmed that your child’s exclusion can be lifted, we will inform you by telephone and in writing. Your child’s nursery/school will also be informed.
TALKS to resolve the local government workers strike ended without an agreement being reached yesterday.
Unions had sought clarity over a 5% offer tabled at a meeting with local government organisation Cosla but the employers were unable to give sufficient reassurances to enable unions to call off planned strikes across the country.
This means the ongoing strike in Edinburgh will continue, with other council areas also being hit by industrial action for the first time today.
Edinburgh North and Leith SNP MP Deirdre Brock said the capital’s Labour-run council had failed to put forward a decent pay offer.
Edinburgh council’sLabour leader Cammy Day was criticised last week for offering just 3.5% to council workers while other council leaders were pushing for a 5%pay rise for their workers.
Ms Brock said: “The SNP in government put an extra £140m on the table, on top of the £100m extra given to councils earlier in the year, yet Labour refused to offer that money to refuse workers for over a week, leaving our capital streets an eyesore.
“Residents and tourists alike need to see a plan from Labour to clean up the capital starting today. All we’ve seen so far is ineptitude.”
Her Edinburgh SNP colleague Angus Robertson MSP weighed in:
The Labour administration in Edinburgh is propped up by the Scottish Conservatives and the Lib Dems, but the Tory Local Government spokesperson Miles Briggs MSP had a go at both the Labour-led council and the SNP Holyrood government:
Lamenting the city council’s ‘astounding’ lack of contingency planning – trade unions have made their plans very clear in the run-up to the strike – Lothians list MSP Miles Briggs said: “More could have been done to prepare the city, such as working with private companies or providing additional bins.
“The SNP government must get around the table and fix this before it’s too late. They cannot stand by and watch while a situation that they created by giving councils a poor funding settlement spirals out of control.”
Scotish Lib Dem leader Alex Cole Hamilton lays the blame squarely on the Scottish Government:
“Think of the white elephants the SNP has splurged cash on: independence, the ferries debacle, the embassies so they can play ‘dress-up diplomat’. All of this could have gone to councils to allow them to settle these very reasonable pay expectations.”
Talking of white elephants, our cash-strapped city council chose yesterday to announce £1 BILLION plans for a new North-South tram line … but that’s another story!
Responding to the Edinburgh refuse workers’ industrial action, Labour Lothian list MSP Foysul Choudhury said:“SNP representatives should get off their high horse about the ongoing industrial action when they should have been canvassing their own party in the Scottish Government to agree extra cash with COSLA for councils to pay workers a fair wage, rather than expecting Edinburgh City Council to cut services elsewhere.
“It is up to the Scottish Government and COSLA to agree further funding, and then up to COSLA and the unions to agree the terms of any new pay deal, not Edinburgh City Council. As a former City Councillor, Deidre Brock knows this and yet has pretended otherwise in the media.
“Nobody wants to see the streets of Edinburgh in their current state, but the ongoing industrial action shows what a crucial job refuse and recycling workers do and demonstrates why we should be paying them fairly for their work.
“At the same time it is ridiculous for SNP representatives to lay the strike at the hands of a Labour-led council when it is their party which has repeatedly slashed local government budgets in real terms, forcing councils to cut their services to the bone.
“If the SNP really wanted to avoid these strikes rather than play politics, they should have come to an agreement with COSLA sooner, or better still, avoided imposing successive years of painful austerity for local authorities across Scotland.”
UNITE City of Edinburgh Branch pointed out: “Misinformation on #edinburghbinstrikes today is rife. Strike is a national dispute—one council can’t stop it. 14 more councils tomorrow.
“Local government funding has been slashed for a decade. Idea that 5% definitely would have stopped this is a fantasy. An insulting one at that.”
STUC General Secretary Roz Foyer is backing the striking unions. In a tweet yesterday, Ms Foyer said: “Solidarity to all of you. Keep fighting!
“All Scotland’s local government workers deserve a decent pay rise for the vital work you do. Let’s show our support on the picket lines across Scotland tomorrow.”
PLANNED INDUSTRIAL ACTION:
Unison
School and early years workers will strike on 7th, 8th, 9th, 10th September, joining UNISON waste and recycling staff who will have already started their strike action on 26th, 27th, 28th and 29th August and 7th, 8th, 9th, 10th September.
Unite
Strikes will be held between the 18th August – 30th in Edinburgh with a second wave expected in a further 14 local authorities this week.
Aberdeen City, Angus, Clackmannanshire, Dundee, East Ayrshire, East Lothian, East Renfrewshire, Falkirk, Glasgow, Highland, Inverclyde, South Ayrshire, South Lanarkshire and West Lothian.
In the first wave of action cleansing workers will strike in Aberdeenshire, Clackmannanshire, East Renfrewshire, Glasgow City, Inverclyde, North Lanarkshire, Stirling and South Lanarkshire councils for the first wave of strike action to take place on 26th, 27th, 28th and 29th August and 7th, 8th, 9th, 10th September.
Cleansing workers will strike in Aberdeenshire, Clackmannanshire, East Renfrewshire, Glasgow City, Inverclyde, North Lanarkshire, Stirling and South Lanarkshire councils for the first wave of strike action to take place on 26th, 27th, 28th and 29th August and 7th, 8th, 9th, 10th September.
City of Edinburgh Council: Disruption to Waste Services
We appreciate the impact and inconvenience this will cause you and appreciate your understanding. Please help us to keep the city as clean and safe as possible during the strike by following this guidance:
Regularly check our website and Twitter account for updates on services suspended and when collections will restart in your area. Be aware normal collections may take a while to get back to schedule after the strike ends.
Don’t put any bins, boxes or bags out for collection until the situation changes.
Stock up on strong black bags, and be prepared to fill, seal and store these with extra waste.
When separating your recycling, please try to flatten all cardboard and crush drinks cans and bottles. You can bag these up, separated, to empty into the recycling bin when you can.
Store waste sensibly and safely. If possible, use and share empty garage space with your neighbours or store bags in your garden or driveway.
Don’t store waste in stairwells or landings, where it could become a fire hazard.
Be careful not to block bin chutes or overfill them.
Keep all food waste separate and in an enclosed container, to help prevent smells attracting wildlife.
Talk to your neighbours and share responsibility for keeping spillages to a minimum. Help neighbours who may need support managing their waste. Explain the situation to those who may not have heard.
Please do not leave bags or any bulky items next to full bins. These will not get cleared away and could become a hazard.
Join with neighbours to do local litter picking clean ups, especially around on-street bins and litter bins on your street.
If a bin is full to overflowing, don’t use it, particularly for dog fouling. Please either use a bin that’s not full or take it home and double bag it to reduce smells.
Report a waste emergency
If you need to report an emergency issue where waste is causing injury or hazard call us and listen to select an option carefully. Phone 0131 608 1100, from Monday -Thursday 1000-1600 and Friday 1000-1500. After these hours, phone 0131 200 2000.
You can also email waste@edinburgh.gov.uk with the specific location and details of the issue.
