Contents
- Attendance
- Next Steps
- Ministerial Statement
Ministerial Statement
Under agenda item 2, the committee will take evidence from the Cabinet Secretary for the Constitution, Europe and External Affairs, Michael Russell MSP; Professor Jason Leitch, national clinical director; and Dominic Munro, director for Covid-19 exit strategy, Scottish Government. This session gives members the opportunity to take evidence on this week’s statement by the First Minister on Covid-19.
As ever, you are welcome cabinet secretary; I invite you to make a brief opening statement.
Thank you, convener. I do not have legislation or regulations to propose this week, but I will make a brief statement about the First Minister’s statement and the progress that we are making on the pandemic.
As members will know, on Tuesday, the First Minister set out the details of the updated strategic framework for tackling Covid, which the Scottish Government has published. She provided an indicative timeframe for cautiously easing restrictions and restoring greater normality to our lives—we would all greatly welcome that—as quickly as we can and in a safe and sustainable manner, ensuring that we are driven by data and not merely by dates.
We have made one significant relaxation of lockdown this week. From Monday, children returned to early learning and childcare settings, and pupils in primaries 1 to 3 returned to school. That is very welcome. Some secondary school students are also now going back to school for essential practical work. It is important to see what impact that has on transmission before we commit to further relaxation.
The current position is positive and promising, but it is still quite precarious. If we are to sustain our progress, we need to exercise care and caution. Maximum suppression is important for our chances of getting back to normal. We intend to publish a further document in mid-March that gives more detail on the sequencing of reopening the economy from late April onwards. However, we have set out the overall approach to easing restrictions over the next few weeks.
Let me turn to the priorities and the indicative timeframe. I confirm that, if all goes according to plan, we will move fully back to a levels system from the last week in April. We hope that, at that stage, all parts of the country that are currently in level 4 will be able to move out of it and back initially to level 3 and that those in level 3 may move to level 2—possibly with some revision to the content of the levels—and afterwards to levels dependent on the incidence and prevalence of the virus at that time. Moving back to the variable levels system at that time will also be contingent on our having offered vaccination to all Joint Committee on Vaccination and Immunisation priority groups 1 to 9. We hope to have done that by mid-April, supplies permitting.
From the last week in April, we expect to see phased but significant reopening of the economy, including the reopening of non-essential retail, hospitality and services such as gyms and hairdressers. We envisage a progressive easing of the current level 4 restrictions, which apply across most of Scotland, at intervals of at least three weeks along with changes nationally on education and care home visiting, with the immediate priority being the continued return of schools and, of course, the easing of restrictions on care home visiting from early March.
As I have said, the next phase of easing will be a minimum of three weeks later—so, indicatively, from 15 March. We hope that that will include the next phase of school return, which will start with the rest of the primary school years—years 4 to 7—and getting more senior phase secondary pupils back in the classroom for at least part of their learning. We also hope to restart outdoor non-contact group sports for 12 to 17-year-olds. We will aim to increase the limit on outdoor mixing between households to four people from a maximum of two households, compared with two from two at the moment.
I hope that the stay-at-home restriction will be lifted at a minimum of three weeks after that—from 5 April. We would aim for any final phase of school return to take place on or after that date. I hope that communal worship will start at the Easter weekend—that is, the weekend of 4 April—albeit with restricted numbers to begin with, but taking into account the timing of major religious festivals. We will seek to ease the restrictions on outdoor gatherings so that at least six people from two households can meet together. That phase will begin the reopening of retail. That will start with an extension of the definition of “essential retail” and the removal of restrictions on click and collect.
Three weeks after that—from 26 April—assuming that the data allows it, we will move back to levels with, I hope, all of Scotland moving to level 3, albeit with some possible modifications. At that stage, we will begin to reopen the economy and society in the more substantial way that we are all longing for and looking for.
In mid-March, we hope to set out more details of the further reopening that will take place over April and into May and into a summer in which we hope to be living with much greater freedoms than we have been able to today.
I hope that that has been useful. I am, of course, available to take any questions, as are those who are with me. Jason Leitch has been here with me many times before, and Dominic Munro has special knowledge of the frameworks. I am sure that that can be helpful.
Thank you very much, cabinet secretary. As ever, that was very useful.
We turn to questions. I remind members that we have approximately eight minutes each for questions, so it would be helpful if we could keep questions and answers concise. If there is time for supplementaries, I will indicate that once all members have had a chance to ask questions. We have to finish before First Minister’s question time, which will take place later this morning.
I will ask the first question, which is about the sense that the decline in cases is slowing or that there is at least a stalling in their improvement. Specific locations, such as the Lothians, have been mentioned in that context. I suspect that this question would be best directed to Jason Leitch. Why is that happening now? Why did it not happen three weeks ago, for instance, when we were in more of a lockdown?
Good morning, everybody. It is nice to be back.
There are multiple reasons for that, none of which is definitive, because we will not know the answer until we get beyond this moment. However, you are right: it appears that all four UK countries have stalled or slowed the decline in the number of cases. In rough terms—it is not an absolutely accurate figure—everybody has got to about 100 cases per 100,000 of the population, and it has kind of stopped there.
It is easier to reduce big numbers to small numbers. The last bit is always slightly more difficult, because the cases are harder to find. We are also on the edge of what we can manage with test and protect, because we are not dealing with big outbreaks any more; it is perhaps more about stubborn community transmission.
From research, we know that non-pharmaceutical interventions—the description for the things that we are all doing as individuals—still work for the new variant, but they do not work as quickly. The curve for what we might call the old virus has fallen at the same rate at which it fell in April and May 2020. That for the new virus, which is now the most dominant in the whole of the UK, is falling much more slowly, but it is still falling. However, in the past week, we have gone from 104 new daily infections to 104, which has given us cause for reflection. We still think that it is safe to open schools and early learning, but one of the reasons why we are suggesting that the Government should not do much more than that is so that we can monitor the three weeks, which represent roughly one and a half incubation periods, to see what happens to the prevalence of the virus across that period.
The other thing that will catch up is vaccination. As I have said to the committee many times, vaccination is not an end in itself; it is about reducing the prevalence of the virus. We are therefore concerned not so much with vaccine coverage as we are with what that does to the prevalence of the virus. As we get to vaccinating the lower age groups, as we are doing now, and they engage with society—unlike care home residents, who are mainly isolated from it—that will begin to affect prevalence. We are therefore very hopeful that prevalence will continue to fall.
Thank you for that. My final question is about the new framework and the return to the levels system, which the cabinet secretary mentioned earlier. In one of the summary diagrams in the new framework, there is mention of “revised metrics”. Could the cabinet secretary, Professor Leitch or, indeed, Mr Munro, elaborate on what those might be?
Dominic Munro and Jason Leitch are in a position to answer that question.
Can you hear me okay?
Yes, we can hear you.
Thank you.
I do not know whether colleagues have the strategic framework in front of them, but we have set out, in table 1 on page 60, indicators that have been advised by the World Health Organization in interim guidance. The table shows weekly case numbers per 100,000 people and test positivity, and the existing metrics that we use in those areas are contrasted with those that have been advised by the World Health Organization. Those are two of the key sets of metrics that we will use.
More generally, we will use the World Health Organization’s six key conditions for easing restrictions, which are also set out in the document. In the middle of March, we intend to publish further information on indicators in the publication that Mr Russell outlined in order to provide complete clarity.
There are two answers to the question about what will be different. Exactly as Dominic Munro said, the first relates to the nature of the data. However, the categories will look quite similar to the previous ones.
The other thing that will change is where we go with the ranges in which we make choices. As the global pandemic enlarges and decreases around the world, the WHO gets more knowledge and gives us better advice. We know what a positivity rate or a prevalence number means more deeply, so we can make better choices and give better advice.
The new variant means that the ranges will probably be tighter or lower, because no country has done what we are about to do, which is to relax during the new variant. Therefore, as you will note from the table that Dominic Munro mentioned, we have moved the range downwards. That means that, on yesterday’s data, only seven local authorities have fewer than 50 cases per 100,000 and only two local authorities—Orkney Islands Council and Shetland Islands Council—have fewer than 20 cases per 100,000. That is just one of the data points. We have to look at that data in the round, of course. We are being slower, through the three-week reviews, in order to get us to the point when we can start to use the data to take a more regional approach.
Thank you for those answers and for pointing me to the page in the document that has been referred to. That is incredibly helpful.
Good morning. I have two quick questions. The first is on health inequalities, so it might be most appropriate for Jason Leitch to answer it.
I have looked at two studies. The first, which was published just this week by Professor McVie from the University of Edinburgh, shows that people in deprived areas are 11 times more likely to be penalised for Covid breaches than those in wealthy areas. The second study, with which you will be familiar, was in The Lancet. It looked at all 90,000 patients in England who had a hospital stay between March and May 2020. I think that there was a 30 per cent death rate but, as you would expect, there were strong links to deprivation and comorbidities such as diabetes and chronic obstructive pulmonary disease, which are themselves connected to deprivation.
Can any general connections be made? My rather simplistic political line is that, to battle Covid, we need to battle poverty, but that is perhaps for another discussion at another time. What is your view, Professor Leitch?
I completely agree with you, Mr Stewart—whether that is political or not. I think that it is apolitical to suggest that, to tackle infectious disease, we have to tackle inequality. It is probably public health 101 that pretty much everything about someone’s health is related in some way to their social demographic. That is, of course, not the case universally. Some very wealthy and privileged people die of Covid, as do some poor people. However, in the round, public health is often about inequality.
11:00I will leave the question about criminal justice and the first study that you mentioned for Mr Russell. The second study that you mentioned reaffirmed what we already know about infectious disease. If a person is poor, they get worse outcomes. Poor people catch the infection more and they die of the infection more, pretty much across the infection spectrum.
A long lecture would be required to explain why that happens. We should bring back Sir Harry Burns to give us that lecture if we want to hear about the subject in real depth. However, it is fundamentally about pre-existing conditions, such as obesity, diabetes and respiratory disease, which are more likely in the poorer groups—forgive the shorthand. Those are all more common in lower socio-demographic groups. Again, that is not universal. We should not put everybody into bands and say, “That’s you. You’re written off.” That is not what I mean at all. However, our response should reflect those differences. The GP practices, the community-based vaccination teams, the third sector and social care in those areas have wrapped up their services in order to try to address some of those inequalities. How we deal with structural inequalities to help us to get out of this pandemic and any future pandemic that comes along is a matter for you and other politicians, including Mr Russell.
I would welcome the cabinet secretary’s response on my final question, which is on the big picture of where we are going and what our overall strategy is. You may have picked up that our earlier evidence session considered whether suppression, mitigation or elimination is our strategy. Again, I apologise for quoting stats at you, but I will quote three things that I picked up recently. First, the University of Oxford said that the UK has the third strictest lockdown in the world, after Venezuela and Lebanon, which is partly good news. Secondly, we have the second-highest vaccination rate in the world, after Israel, which is good news. Finally, although this is perhaps a lag statistic, the UK had the highest death rate per million in the world. I appreciate that there are probably some time differences between those three snapshots.
What is our overall strategy and can Jason Leitch say something about the three snapshots that I have given? Where are we going and what is the strategy? Without meaning to be frivolous, I note that, as you will recall, a German military leader once said that every strategy is destroyed on first contact with the enemy. I am not suggesting that we are facing an enemy, but it is easy to have a desktop strategy that does not meet the reality of day-to-day life.
Some of that is for Mr Russell. The strategic framework says that the strategy is to reduce prevalence to as low a level as possible and hold it there sustainably. There is a long discussion about the four harms in the framework document, which the committee understands better than many other people because we have talked about them so often—health and social care effects; societal effects such as loneliness; care home restrictions; and economic effects.
Part of the academic conversation is dancing on the head of a pin—is it mitigation, suppression or elimination? The fact is that everything will get better if we reduce the prevalence to a very low level. Normality will return if we are sure that hospitals will not be overwhelmed, fewer people will die and fewer people will be hospitalised, and all of that stems from case rates. Vaccination will help us, because if you get the virus and have been vaccinated, you are less likely to get hospitalised, so hospitalisation becomes slightly more prominent in our decision making when vaccination starts to affect what positivity means. Does that make sense? Positivity is still important for now and, as we move through the stages of the pandemic, positivity will still matter, but not as much, because the consequence of being positive will be less grave. That is what vaccination does, which is why the vaccination programme is so good.
I think that the advice to aim for as low a level as possible is right. We can look at global examples of where that is done—depending, of course, on which stage of the pandemic we are in. We cannot be like New Zealand in February 2021, but we can be like New Zealand in February 2020—that is a completely different argument. However, can we drive the prevalence down to as low a level as we can, in order to get domestic normality, with kids going back to school and people back to seeing their families? Yes. I still believe that that is the correct strategy to use.
Your final piece of data about the death rate will be an important thing for us to study. None of those deaths should be taken lightly. I think that the excess mortality across Europe—including our responses to the pandemic and the nature of the virus—will be studied for years to come. I am afraid that we can now see other countries getting the Kent variant and beginning to think about locking down again. In France numbers are rising, as they are in Norway, Denmark and Sweden. People are getting concerned because the new variant is being exported from the UK—not imported—and those numbers are rising.
Thank you, Professor Leitch. I appreciate that answer. Does Dominic Munro or the cabinet secretary wish to comment in response to my questions?
I am happy to come in if Mr Russell is happy for me to do so.
Can I perhaps say something? I tried to come in before, but I do not think that whoever is controlling the microphones is watching particularly closely. I wanted to make a point about inequalities, and Mr Stewart has already raised that important issue.
I do not think that anybody would disagree with the general thesis that health inequalities are serious and need to be addressed. I noticed that they came up in the committee’s discussion with the previous panel, too. I also noticed discussion on, I think, Monday, in the wider UK context, of the fear that there could be communities, and parts of communities, that simply are not able to be accessed either for vaccinations or for other actions. We need to be very aware of that, as Jason Leitch has indicated, and we need to take action to ensure that that does not happen in Scotland. There will be certain communities in which take-up will be lower and there will be resistance to it. From the figures that we have on prevalence among younger age groups we also know how important that will be—particularly to get to younger men, who, as Mr Stewart will know from a variety of other areas, are resistant to involvement in wider initiatives. That issue is being taken very seriously.
On strategic intent, what Jason Leitch has said is really important. We have a clear strategic intent in our document. It has to apply to everybody, so that also deals with inequalities. I think that our document refers to those perhaps half a dozen times—which is not the case in the UK Government’s strategy—so we are very aware of the issue.
Finally, I draw the committee’s attention to a piece in this morning’s Financial Times, which talks about the differences of approach—which are not enormous—and the dividends that have come from those, which are important.
I am sorry; Dominic Munro wanted to come in, too.
Thank you, cabinet secretary. I want to reinforce what both Mr Russell and Professor Leitch have just said. If you want to see the specific wording on the strategic intent in the framework, it is set out on page 7 and is repeated elsewhere in the document. That is a key point: it is consistent throughout the document, as it has been over time. It is the same strategic intent that we published back in October, and it has served us well. If the committee would like to see an elaboration of it, in her foreword, the First Minister talks about the principle of maximum suppression and why it is right to aim for that, which again is consistent with the remarks that Professor Leitch and Mr Russell have just made.
On one other dimension of your question, Mr Stewart, you made a point about strategies not surviving the first engagement. That is key, because the return to the levels approach that Mr Russell outlined will give us flexibility, within the strategic framework, to respond to the conditions that we find towards the end of April or whenever it may be. It is not a rigid plan, which will be advantageous to us as we move forward in pursuit of our strategic aim.
In our earlier evidence session, Professor Woolhouse told us that we are finding only half of the people who need to self-isolate. He talked about how robust the track and trace mechanism needs to be. You will know that, a number of times in the past, I have raised the issue of supermarkets and retail centres, which, as far as I can see, do not operate any form of track and trace system. If that is still the case, are we worried about that? If so, what can we reasonably do to improve the track and trace approach in such settings?
That is a point for Jason Leitch, but I can say that we are constantly looking at, improving and working on the whole issue of testing and tracing contacts. Our system is a good one, which is working well, but that does not mean that it cannot improve.
Let us call what we are doing “case finding” in the round. That is absolutely crucial, and will be particularly so as we open up. That is why you see us expanding asymptomatic testing to some workplaces, such as food processing plants, and to schools. My wife did her first lateral flow test this week, as she goes back to teaching kids. We also now have senior pupils involved in the case-finding process as much as we possibly can, so that we can find as many cases as we can and then trace their contacts.
We have previously discussed transient moments, such as where we walk past people in the park or are briefly in a shop for essential purposes. The science suggests that the tracing bit of the test and protect strategy is not quite as important for such transient moments as it would be, for example, for people who are in restaurants or bars, once we start to reopen them, or in schools, where people sign in and sign out.
However, we will consider anything that makes case finding better, particularly as we come out of the curve, because we have to find as many positives as we can in order to allow people to get back to normal.
Thank you. I ask my second question on behalf of sufferers of myalgic encephalomyelitis in Scotland. I raised a question about that on Tuesday and have since been contacted by a number of people who seek clarification on the issue. Could you clarify whether sufferers of ME are in the shielding group and whether they are also in group 6 for vaccination purposes?
I think that that question is for Jason Leitch.
The basic answer is no, but there is some complexity in there. As you will remember, group 4 consists of clinically extremely vulnerable people who were formerly shielding. Group 6 consists of those who are clinically vulnerable. Roughly speaking—it is not exactly the same, but it is a summary of the position—it also includes those who would be in the flu vaccination group, unpaid carers and a number of others. Those groups are based on the risk of death from Covid. I am sorry to be so blunt about that.
The data that the world has presently, and that the Joint Committee on Vaccination and Immunisation uses, says that, in the round, having ME does not increase a person’s risk of death from Covid, therefore they are not included in group 4 or group 6 as a big group. However, ME involves a range of conditions. Clinical teams, including general practitioners and those involved in secondary care, such as hospital clinical teams, have the capacity to place individual people in group 4 or group 6, based on their clinical judgment. Some people with ME will have respiratory symptoms that put them at risk. With their clinical team’s agreement, they would be able to go in one of those two groups. Some people with ME will have been in the shielding group. However, it is a bit like the position for people with diabetes: having that condition does not necessarily put them in the shielding group, but at the edge of that group of people some were shielding because their clinical teams decided, in consultation with them and their families, that that was the right risk basis to put their case on.
How does such a decision come about? Does a person have to consult their GP to say, “I think that I’m suffering additional symptoms” or whatever, or does a GP contact their patient to say, “We think that, from your case history, you might benefit from having the vaccination earlier”. Which way round would things work?
It could happen in either way. If patients or their organisations are worried about that, I suggest that a consultation is sought—probably on the phone—with the general practitioner or community-based team looking after that individual. That conversation would be based on the risk of death from Covid. Unfortunately, it is not necessarily about how the patient feels. A lot of people feel unwell with whichever disease they have—whether it be through physical or mental illness or whatever else is going on—but that might not put them at more risk of dying from Covid. The vaccination priorities are based on the risk of death from Covid.
The only postscript that I would add is that we are coming for everybody. The vaccination will be for every adult. We are coming to everybody quickly. People might not get it tomorrow, but we are coming.
Okay. It has been helpful to clarify all that. Thanks very much. Back to you, convener. [Interruption.]
I think that we must have lost the convener.
11:16 Meeting suspended.11:20 On resuming—
I apologise for the brief break in proceedings. It is Mark Ruskell’s turn to ask questions.
I was reflecting on Professor Woolhouse’s points from earlier, especially what he said about our finding only fewer than half the cases—[Inaudible.]—of those people, as well. That raises questions about a strategy for occupational workplace testing. I want to ask a bit more about that.
The updated framework document from Tuesday talks only about expanding that workplace testing to two specific areas: food production businesses and emergency service control rooms. Will you expand on what that strategy will look like in the weeks and months to come?
I think that I should ask Jason Leitch to answer that question. It is quite clear that we recognise that issues arise in workplaces. Jason Leitch is in a good position to talk about how we would respond to them.
Mr Ruskell has made a good point. We are limited by technology. I do not mean that we are limited by price or volume of testing; rather, we are limited a little by the tech. A full polymerase chain reaction test still takes quite a long time. People have to go and get it, and that technology needs to catch up a little bit. Lateral flow testing is improving, which is why we have given it to teachers, senior pupils and school staff. It is getting better all the time, but it is still not as reliable as we would like it to be.
Yesterday or the day before—I forget which—the First Minister and the Cabinet Secretary for Health and Sport committed to a new testing strategy. We have kept the testing strategy up to date as the pandemic has developed. I think that members will see a greater focus on local authority-based asymptomatic testing—that may be workplace, geographic or deprivation-related, depending on where the prevalence is—and on specific workplace-based testing, which will probably be lateral flow testing.
Yesterday, I did the lateral flow test with my wife, Lynn, for the first time. There are 16 steps, which include having to open a bottle, a thing you have to do, and then you have to put it in the cardboard—the test is not quite there yet for huge use because it is so complicated. That does not mean that we should not use it or that we should not train people in how to use it. We should use it for what we think it is useful for.
There is a lot of very interesting work on saliva testing and faster test results that I think will help us as time passes.
I am trying to get a sense of where we are going with that. You talk about the limitations of PCR and lateral flow testing, and about something else possibly coming along. Is it about restricting the application of those tests at the moment to teachers, emergency service control rooms and food production with the assumption that there will be better tests to come that could be rolled out to all small to medium enterprises, large companies and workplaces in Scotland? It is not really clear where that is going. What should an employer, for example, expect right now as regards the availability of that testing? We do not seem to have a strategy on occupational workplace testing.
Mr Russell, should I keep going?
Please do.
The next phase of the testing strategy will have to address that issue in a more meaningful way. We have a plan for that, which has evolved over the past year, and we now have it in many more places than we did initially. We started in care homes then moved into other workplaces, and we are now doing the whole of the education system. That is quite an undertaking for our testing processes. As well as our back-office, supply and procurement systems, there are the digital solutions that are needed for the test results and so on, so that is quite a big deal.
You are right that we will have to move. I do not think that we have to wait for better testing to have that conversation, and our testing advisory groups—the groups that tell us scientifically what we should use the tests for and when—will help us with that decision making.
Okay. Do you know when that will happen?
Not with any certainty. I think that we can probably get you that information; Mr Russell’s or Ms Freeman’s office could write to you to say, “This is the plan for the next version of the testing strategy.”
I am happy to commit to that, but it is important to note that none of this is standing still; every week brings new developments and new debates and discussions about how things should move forward. All our actions and reactions should move us forward, and that will continue to be the case. We are also mindful of the concerns of members when such matters are raised at committee, and we want to think about and respond to those individual issues. I will make sure that we provide a response to Mr Ruskell, and I make it clear that we are changing and developing in just that way.
That is welcome. I will finish by asking a central question that the citizens panel and lots of stakeholders have focused on—what do you consider to be an acceptable level of Covid infection in the population as we go forward?
I want Jason Leitch to answer that, but I go back to what is in the document about the strategic intent, because you are coming at the issue from one angle and I want to come at it from another. The strategic intent is to
“suppress the virus to the lowest possible level and keep it there, while we strive to return to a more normal life for as many people as possible.”
In my view, it is not a question of what is an acceptable level; it is a question of making sure that we are able to return to a more normal life for as many people as possible. That is what people want to do, and our aim must be to find a way to that position. There is a clinical view of the issue, too, on which Jason should respond.
I wish that it were as binary as my presenting advice to Mr Russell or the First Minister and saying, “Right, from 1 September there will be 9,000 deaths for the rest of the year or there will be 9,000 deaths caused by our response to Covid. Which would you like?” Of course, it is not like that, and we do not know enough about the disease—for example, we now think that 10 to 20 per cent of people get a chronic disease, but we do not know what happens to that chronic disease in the longer term, because nobody has had it for long enough for us to know.
The comparisons with other diseases are somewhat but not entirely helpful; there has been a debate this week—a slightly geeky debate—about whether we should compare Covid with flu or measles. In a flu season, there are usually around 9,000 deaths across the UK; this disease has killed at least 120,000. The flu comparison does not work, except in the sense that we will have to live with the virus in some way.
It is not flu, though; it is more akin to SARS. It is a SARS virus.
That is correct. SARS viruses in south-east Asia can be lived with and you can see their response to this SARS virus and their previous SARS virus in on-going non-pharmaceutical interventions—for example, not going to work if you have symptoms. In our country, people traditionally go to work with symptoms and do not wear a face covering in crowded areas, but in south-east Asia people wear one. Would that continue for some time? I think that it would be part of a strategy to learn to live with the disease.
The only other point that I would make—this should probably form part of a longer session about living with the virus—is that the virus is easier to live with if you have 100 cases than it is if you have 25,000 cases; that is for sure. Therefore, the WHO’s six tests for recovery—low prevalence, managing outbreaks, including from the importation of new cases, and so on—make that process much easier. That is the lens that we should use, which is what the strategic framework does. To live with the virus, we need to use those six tests to get us to that point. We can then begin to slowly open, as we did on Monday with the return to school of thousands of children.
11:30
I have been contacted by a constituent who works in a respite facility for young people with additional support needs. They asked a question about getting tested regularly, because they work closely with and care for children. Is there any expectation that testing will be expanded to people who work in that area? Is any planning for that being done?
There is not only a plan, but work is now under way and is being undertaken on testing in educational establishments. If the facility where your constituent works is an educational establishment, it should be covered by that. If you want to refer the specific case to me, I will be happy to look at it and to get you a response.
The First Minister provided an update earlier this week but, disappointingly, she failed to include any reference to the plan for islands that are already at level 3. Such an omission makes it difficult for people to trust that the specific circumstances of island communities are being properly considered and thought through as part of the plan. That is reflected in correspondence that I have received from constituents this week. Will you reassure people in the northern isles that assuring the best-case scenario for island communities features actively in the Government’s discussions on levels? Will you commit to making sure that that is addressed in future announcements?
I represent more islands than any other constituency MSP, so I am in a good position to answer that question. The needs and requirements of the islands are always addressed—I am one of those people who insist that that is the case. To counter what you just said, you might want to make it clear that, on Friday, you and others will meet the relevant minister to discuss the transport issue that you raised at this committee last week. Not only are those requirements being taken care of, but we ensure that conversations with islands members take place at ministerial level so that ministers hear their concerns. Like your postbag, mine is full of specific island issues that people have raised, which are being addressed by their hard-working, assiduous member—I am sure that you are one of those.
Therefore, I do not share the concern. Indeed, I mentioned a move from level 3 to level 2 in my remarks at the start of the meeting.
I am grateful for last week’s intervention, and I am looking forward to tomorrow’s meeting with the islands minister.
Last night, a constituent emailed me with concerns about various things, including the fact that his school-age children have not returned to school this week, as they are not among the cohort that has gone back. He says:
“Why is it that we seem to be held prisoners to what is happening in Glasgow and the central belt?”
Can you offer an update on whether schools in level 3 areas might take a different route to those in level 4 areas?
That is being and will be kept under constant review, and if we can make a difference to that, we will. This is not the first COVID-19 Committee meeting at which I have referred to this, but I will do it again: we are aware that cases of the virus can break out anywhere and everywhere. We use Barra as an example of that. From your experience as MSP for Shetland, you will know that there was an early outbreak there that could not have been predicted and which was severe. We have to balance that with the legitimate view of people in island communities that they should come out of lockdown more quickly, particularly in the area of education. The local education authority is in a good position to have conversations about that with central Government and to influence discussions that are taking place in the education recovery group.
I stress, as I did in my opening remarks, that we must err on the side of caution in the present circumstances. There is a piece on, I think, the BBC website that makes it quite clear that, if we were to apply the WHO criteria, that would show that we are far from out of the woods as yet, so we have to show as much caution as we can. Nobody doubts how difficult this is. People say, “Here’s an easier solution,” but the reality is that these things are thought about and considered all the time. The local authority needs to engage on such matters with the Scottish Government, as I am sure it does, and members have to engage, too. We will keep such matters under constant review.
I have a couple of questions. I am not sure to what extent the witnesses had the chance to hear the previous session—they can obviously look back later—but Professor Woolhouse suggested that there does not appear to be any reason why there should not be a resurgence of staycations, particularly in the Highlands and Islands, this summer. Will the cabinet secretary, given his interest from his constituency’s perspective, give his thoughts on those comments?
I did not hear the specific comments, but I am happy to comment on tourism and hospitality. I would love to see staycations becoming available again and people staying in the Highlands and Islands—particularly, if I may be very selfish, in Argyll and Bute—during the summer, but that will depend on the progress that we make, on the data and on our ability to move to that position. We have been very clear on the indicative dates on which decisions will be made on how we move forward, but we cannot be more specific than that, because we have to see what happens between now and April and May.
I am hopeful. I would love to see staycations being allowed, but the decisions will be driven by the data and where we are rather than by anything else. Nothing would give me greater pleasure than to achieve that. If Professor Woolhouse is confident that we can achieve that, I am glad. I want to see the data and to be driven by the data.
I am sure that we would all like to see that.
In his announcement this week, the UK Prime Minister seemed to set great store on a particular date—21 June—for an erga omnes approach to life. Does the data support making such a definitive determination that that will be, in effect, D-day?
We have been very clear about what we expect and about the points that we have set at which decisions will be made and, we hope, things can develop and change. They do not extend as far as that but, to the extent that we agree on things, the programmes are, by and large, not dissimilar from now until, broadly, Easter. There are some small differences of emphasis and dissimilarities, but I do not think that they are major. It becomes more difficult to see precisely what will happen beyond then, but we are hopeful. I am not going to get involved in swapping dates with the rest of the UK. I am confident that we are taking the right and cautious approach at this stage.
Jason Leitch might want to say a word or two more, because he is one of the keepers of the data. He recognises where the decision making is in that regard and informs the Cabinet about it.
At a simplistic level, the further out we get, the less certainty we have—that is not complicated. If you read the UK Government’s document rather than some of the headlines with the dates attached to them, you see that the further out we get, the more the UK Government caveats its dates. Its version of Mr Munro has written in deep caveats to the 17 May and 21 June dates. That seems to me to be the right thing to do. I said to the media this week that, if you want to circle 21 June in your diary and hope for a staycation in Scotland in July or August, that is terrific. I genuinely hope that that will be possible; my problem is that, at the end of February, I cannot tell you whether it will be.
Thank you both for your answers. Perhaps, sometimes, newspapers would better serve the population by focusing more on caveats than going for a glib headline, but there we are.
Professor Leitch, I think that on the radio the other morning you said that when we get back to the levels, there could be a different geographical approach. For example, several local authorities could combine to be in the same level and there could be a reconsideration of the restrictions that currently apply to the levels, in terms of what hours of opening and so on might be available to hospitality. What work is going on now to tweak the levels approach that was most recently set out in December? I think that people in the hospitality industry would wish to understand where they might stand as we come to sunnier times.
I would like to hear from Professor Leitch on that to start with, but I would also like to hear comments from Mr Munro and the cabinet secretary.
The strategic framework includes the caveat that, all being well, we will move to a levels framework in the week beginning 26 April. Of course, we will have to have given notice of what that will look like before then. The framework does not say that everyone will move to level 3, or that everyone in a local authority area will move to a single number, and it does not say what the levels will contain. It says that all that will be discussed with stakeholders and the Cabinet in the lead-up to that work. The analysis paper that Dominic Munro has already talked about will be part of that. If the situation allows, it is possible that quite a lot of the country will move to level 2.
The most recent version of the levels is the one that we remember. However, if you go back a little bit further, you will remember that, at some points, we had central belt restrictions, not individual local authority restrictions. Therefore, it may be that we could divide the country into different cohorts—groups of local authorities or health boards, or perhaps larger areas than that. Alongside that, there is the debate that we have had with Ms Wishart and others about what we should do with island communities, such as those in Mr Russell’s constituency and others. We might have to divide up some local authorities and take different approaches in various areas.
We want the process to be as simple as possible. We do not want to set out levels every week, because that was too often and created confusion for the public, rather than shedding light on the matter, so we have said that we will do that every three weeks. We have also said that what is in each level will be talked about in more depth. The basics will be the same: there will be sections on hospitality, tourism, family interaction and so on. However, issues such as the nature of what hospitality is allowed, whether alcohol can be served, whether there can be two sittings and so on are exactly what we will negotiate over the next two weeks with stakeholders, civil servants and politicians.
Professor Leitch has covered most points, but I will elaborate on two.
The point about the contents of the levels is absolutely correct. We will look at that in mid-March. We are already engaging with the business community and others on that, as we have been for some time.
It is important to bear it in mind that, if you ask any stakeholder what they would like, they will typically ask for an easing for their particular sector. We understand why that is, but we need to be really careful that, in considering sensible easings, we do not reduce the effectiveness of the levels, because they are designed to suppress the virus.
There is a process of engagement, and we will continue to engage through to mid-March, but we need to do that carefully, because the levels have a job to do in suppressing the virus.
On the point about geography, as Jason Leitch says, the regulations are set up in such a way that we could use local authorities as the building blocks—the WHO has some relevant interim guidance on that. However, quite possibly, it will make sense to use bigger agglomerations of local authorities, and, if we need to, go below that area, as we did when we moved Barra and Vatersay into level 4 before the rest of the Western Isles.
We have the flexibility to do all those things and we want to carefully consider what the best approach is before we start using geographically variable levels again. Unfortunately, there is no perfect solution. Every option that we take has some advantages and disadvantages. What we have to do is to find the most sensible approach among those.
11:45
I do not have much to add to that, apart from to emphasise the point about building blocks. Towards the end of last year, before we had the Barra and Vatersay situation, we faced the question whether Coll and Tiree, Mull and Iona, Jura and Islay and certain outliers including Colonsay should be at level 2 or level 1. It was a difficult decision. Local authorities were the building blocks, but there was a proper recognition of the difference between those islands and, for example, Helensburgh, which is in Argyll and Bute, but not in my constituency. As a result of that, questions were raised, which arose again in a different and more crucial sense in the last couple of months or six weeks at the end of 2020, with regard to Barra and Vatersay. In such circumstances, there are questions that we have to answer.
As Dominic Munro said, there is no perfect answer to this, but there are answers that perhaps meet the current set of circumstances better than the previous ones. That is also true of content. The approach must always be to do with where we are at that moment, what we have learned getting there and what we expect to happen. That is how it should be. The approach has to be flexible.
Thank you for your response to my questions on childcare by family members, such as grandparents. They were much appreciated.
What is the Scottish Government’s contingency plan for dealing with any reduction in the production of vaccine, particularly the Pfizer-BioNTech vaccine—currently, the machinery that produces it is being changed over—in order to keep the Scottish Government’s vaccination plan on track?
If you talk to any GP who has been involved in the delivery of the vaccine, they will tell you that the biggest challenge is the lumpiness of the supply—you raised that issue a few meetings ago. I believe that the word “lumpiness” was first used in this context by the UK minister with responsibility for the vaccine.
We are capable of delivering very large numbers of vaccinations every day, but we can do that only if the supply flows through. We are taking a four-countries approach to vaccine supply, so the issue is regularly discussed among the four countries’ health ministers and at higher-level discussions involving the First Minister; we will continue to keep the issue under review. Provided that the commitments that we understand exist are honoured, we anticipate being able to meet the targets that have been set. However, as you will understand, that is the one thing that is completely outwith our control. We have to have the vaccine in order to vaccinate—that sounds like a tautology, but it is true—and that involves ensuring that the supply continues to flow.
We should reflect on the remarkable nature of where we are. This vaccine did not exist six months ago. It is remarkable that a vaccine has become available so quickly. Of course, there is not just one, but two, with a third one having recently been approved, and you will have seen reports this week about the Johnson & Johnson single-dose vaccine being approved in America. That is a remarkable set of circumstances.
We are gearing up to a global demand for vaccines—it is important not to forget those countries that we do not wish to leave behind; one sees that all the time and it is very important not to forget about that—so supply is bound be problematic. However, I assure Mr Corry that the issue is constantly in people’s minds, work is constantly done on it, and there is a constant desire to do what we can do, which is to vaccinate large numbers of people quickly.
I want to talk to Professor Leitch about cluster zones springing up. There have been very recent significant rises in case numbers in Edinburgh and the Lothians and in the Dunbartonshire and Stirling area. Case numbers are rising in more deprived parts of those areas. What action is the Scottish Government taking to deal with that?
I will briefly add to Mr Russell’s response on vaccine supply. It is important to underline that, when supply falls, it falls across the whole of the UK. Scotland is getting our population share, as are the other three countries, and that system is working well.
What can we do? We can plan as best we can for supply. We now know that we will get some Moderna vaccines, so what does that mean for our ramp-up? We have now proven that we can carry out 400,000 vaccinations a week so, if we get 400,000 doses a week, we can put them in arms. If we get 200,000 doses, we can put them in arms, which, it would seem, is roughly what will happen this week. Pfizer has been very good at keeping in touch. Adapting its factory to ramp up supply was exactly the right thing to do. We have good relationships with the companies, and the procurement people in the four nations of the UK are doing a good job of getting us the vaccines at a country level.
Mr Corry is right that there are community transmission hotspots around the country, as there have always been. They are in East Ayrshire, Clackmannanshire and Falkirk, and we are beginning to see an increase in numbers in the Lothians. Our response is exactly as you would predict it would be. It has got more mature. Local authorities are much more involved. We can send in more case-finding machinery, including mobile testing units and regional testing units. We can talk to those communities via the local authorities and, particularly if they are hard to reach, through third sector organisations and other organisations that reach those groups. In addition, the test and protect system is active and functioning, and its response times are really good.
Of course, we rely on human beings and individual behaviours. There is only so much that we can do about that. It is about communication, using trusted voices and being inside those communities to try to help their understanding. At a superficial level, the increases do not appear to be the result of big rule-breaking occasions, although there is still some of that—there are house parties, and we have mechanisms for dealing with that. There appears just to be a low level of community transmission. People might just have dropped their guard. Even people who follow the rules can catch the virus so, at some level, we all have to be careful. That is why, at this stage in the pandemic, the rule is to behave as though you have the virus.
There were questions about ME earlier, and I want to spend a little more time on vaccination cohort 6. I think that there are about one million people in it, so it seems to be one of the largest cohorts, if not the largest cohort. It is also a bit vaguer, because it is not fixed on age; there are bits around the edges. Are we aiming to have reached all those in cohort 6 by mid-April, in line with all nine cohorts? At what stage should people expect to hear about being vaccinated? Parents of disabled young people, for example, are already on at me about that. Should I just tell them to wait and that they will hear by, say, the end of March? Can you say anything more on that? It is probably a question for Professor Leitch.
I would like Jason Leitch to answer that, but I echo what he said earlier about the fact that we are coming for you. He said that in his typical style, but it is absolutely true. People will be vaccinated. There is no doubt about that. Jason Leitch might want to say more about the details.
As Mr Mason said, cohort 6 is complex and large. I would not use the word “vague”, but it is certainly more flexible than some of the other groups, because it is not just about getting to people through their community health index number and date of birth. However, we know, in the main, who is in the group, because we have very good joined-up primary care data in this country, which allows us to take out disease codes—the codes that people get because they have diabetes or severe asthma—and find them. We also know where their GP practice is and we can contact them.
Lots of people in cohort 6 already have their appointments. I ask people to be a little more patient. We have not said when we will finish with that group, because it is so big. I ask people to certainly wait until mid-to-late March before they start bombarding the helpline to ask why they have been missed.
Clearly, we cannot do a million people in the same week; we have to space them out with the supply of vaccine, but we will get to them. The First Minister, along with the three other UK countries, has publicly committed, pending supply, to perhaps April for the top nine groups, which includes cohort 6 plus everybody over 50. That means that March has to go faster than February—that is clear—which is why we need the supply to come. There needs to be patience just now, then in mid-March to the end of March we will be able to give people information if they feel that they have been missed off. Being missed off is a rare event not a common event, so do not panic if you have not heard.
That is helpful; that gives us a steer on what we can say to constituents; some are more patient than others, let us say.
On a slightly separate subject, in the previous evidence session we talked about quality-adjusted life years, which was a new term for me; I think that the abbreviation is QALYs. Normally we would spend £20,000 to £30,000 on drugs and that would keep somebody alive for a year, but it appears that we are spending a lot more than that if it is Covid. I do not know whether this is more for the cabinet secretary, but are those kinds of indicators relevant or are we in quite a different situation from a normal drugs purchase situation?
That is for Jason Leitch, because that is a difficult and sensitive question and I want to hear a clinician’s view.
It is QALYs, Mr Mason; it is a well-trodden public health path that gets quite complex quite quickly. It is how public health in the round and new medicines conversations happen. It is not about saying, “a fiver gets you this” or “a tenner gets you this,” it is a much more complex environment in which the cost to society of a new drug is judged. Say a new drug for multiple sclerosis or kidney cancer costs 10p. Clearly, you should invest in it, but if it costs £10 million to save one year for an 85-year-old—forgive me—is it worth it? At some level, you make those judgments, but it is not binary; it is not that once you get over a certain threshold, you can buy the drug and if you do not, you cannot buy it. The Scottish Medicines Consortium is our mechanism for that.
I did not hear the previous evidence session, but I will watch it back. I imagine that the QALYs conversation was in relation to the cost of Covid care in the round, including testing, restrictions and everything else that has gone on. We are not spending that much money on drugs for Covid, because there are not many drugs for Covid, so it relates to the overall cost. In time, that will be a big matter of research, a big consideration for inquiries and on an on-going basis in relation to what the pandemic has cost society—not only in Government investment but the harm that we have caused by our responses and the harm that Covid has caused families, and QALYs will be part of that conversation. I have not seen any work that relates that to Covid yet, but it will come.
That is helpful. We were given very rough and ready figures, and similarly to you, Professor Leitch, the previous witnesses gave very qualified answers.
That concludes questions from members. I thank the cabinet secretary, Professor Leitch and Mr Munro for their evidence. That concludes our business for the meeting as we have no legislation before us. The clerks will update members on the arrangements for the next committee meeting in due course.
Meeting closed at 11:59.Previous
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