Contents
- Attendance
- Excess Deaths Inquiry
- Ministerial Statement, Coronavirus Acts Reports and Subordinate Legislation
Ministerial Statement, Coronavirus Acts Reports and Subordinate Legislation
Coronavirus Act 2020 (Alteration of Expiry Date) (Scotland) Regulations 2022 (SSI 2022/40)
Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 4) Regulations 2022 [Draft]
Health Protection (Coronavirus, Restrictions) (Directions by Local Authorities) (Scotland) Amendment Regulations 2022 [Draft]
Under agenda item 2, we will take evidence from the Scottish Government on the ministerial statement on Covid-19, the two-monthly reports on the Coronavirus Acts, and subordinate legislation. I welcome our witnesses from the Scottish Government: John Swinney, Deputy First Minister and Cabinet Secretary for Covid Recovery; Professor Jason Leitch, national clinical director, who is joining us remotely; Dominic Munro, director of Covid-19 exit strategy; and Elizabeth Blair, unit head, Covid co-ordination.
Deputy First Minister, would you like to make any opening remarks before we move to questions?
Thank you, convener. I am grateful for the opportunity to meet the committee, and I will make a brief opening statement.
On Tuesday, the First Minister set out to the Parliament the revised strategic framework. The “Scotland’s Strategic Framework Update” document details the Scottish Government’s approach to achieving a sustainable return to a more normal way of life while remaining prepared for potential future threats from Covid. That approach will support us to manage Covid effectively through sensible adaptations and public health measures that will strengthen our resilience and support our recovery as we build a better future. In time, we will seek to rely much less on legally imposed measures and instead rely more on vaccines, treatments and good public health behaviours.
We will continue to ensure the maximum possible availability and uptake of vaccination, in line with expert advice. Indeed, from mid-March, we will start issuing vaccination appointments to all five to 11-year-olds. We will also begin providing an additional booster to care home residents, those aged over 75 and those aged over 12 who are immunosuppressed.
Testing has been, and will continue to be, a vital part of our management of Covid. Over time, and in a careful and phased manner, it is reasonable to move away from mass population-wide asymptomatic testing toward a more targeted system that is focused on specific priorities. We will publish a detailed transition plan for test and protect in March, by which time we will hopefully have much-needed clarity from the United Kingdom Government on testing infrastructure and funding.
From Monday 28 February, the guidance on how often to take a lateral flow test will change. We will revert to the advice to test at least twice a week, particularly if going to a crowded place or meeting anyone who is clinically vulnerable.
The updated strategic framework sets out a number of additional proposed changes to public health protections during the coming weeks. First, from Monday 28 February, the Covid certification scheme— which requires certain venues to check vaccine status—will end. Although the app that supports the scheme will remain operational for businesses that want to use it voluntarily to reassure customers.
Secondly, from Monday 21 March—assuming that there are no significant adverse developments—the legal requirement to wear face coverings in certain indoor settings and on public transport will end. From 21 March, we also expect to lift the legal requirement for businesses, places of worship and service providers to have regard to Scottish Government guidance on Covid and end the requirement to retain customer contact details.
The strategic framework details the kinds of behaviours and adaptations that will be encouraged in different circumstances, which include: enhanced hygiene, improved ventilation, increased hybrid and flexible working and face coverings in some indoor places. It is now less likely that those measures will be legally imposed in the future, but we will advise their use for as long as they help to control the virus and protect those who are most vulnerable.
The approach that is set out in the strategic framework will support us all to return to normality and ensure a safe and sustainable recovery.
I am happy to answer any questions that the committee might have.
I will ask the first question. First, I thank the Scottish Government for the revised strategic framework that was announced this week. The lifting of restrictions later next month is welcome news for many.
There is currently uncertainty regarding the future of testing, but as our framework identifies three broad threat levels—low, medium and high—if testing is reduced in capacity considerably, how will it be possible to monitor outbreaks of new variants to determine what threat level we should be at?
My officials will provide further detail on that, but that is a material issue. An on-going level of testing infrastructure will be involved, and that is the key point that I want to reassure committee members about.
We cannot simply turn off testing, and it would be a mistake to do so. There has to be a mix between measures such as the Office for National Statistics infection survey, which is absolutely critical for intelligence purposes on the prevalence of the virus, and levels of testing that enable us to reliably gather the basic information that enables genomic sequencing to be undertaken so that we can identify any new strains or variants. We will consider that as part of the testing plan.
There has to be a degree of on-going intelligence about the prevalence of the virus in our society to enable judgments to be made about what stage we are at, and more detailed testing will be required to enable us to form a picture of what, if any, new strains are emerging in our society. There are almost two different elements and requirements that are necessary in that process to inform our judgments about the state of the pandemic and for us to be able to contribute to the international effort to identify any new strains or variants, which it is our absolute duty and obligation to participate in. If there had not been good international co-operation with the authorities in South Africa and good testing infrastructure, we would have had less early warning of the omicron variant than we had.
I invite Professor Leitch and Dominic Munro to add anything on the judgments that will be made.
Professor Leitch, I do not know whether you can hear me. I think that you are on mute.
I am not now—somebody turned me up. I just said good morning, that was all.
Thank you for allowing me to contribute virtually this morning. That has helped significantly with logistics. I appreciate that.
The Deputy First Minister covered it very well. We need testing for four reasons. We need it for surveillance; we need it so that we know what disease we are treating, so we have to test before we treat; we need it so that we know what is happening in high-risk institutions such as prisons, social care homes and hospitals; and we need it to enable us to manage outbreaks, whether they are in a chicken factory, a school or wherever else. The question is how to do that.
The end point for all western European countries is the same: we will test less. You do not test for flu in your home, but we test for flu in hospitals. That is where we are all headed, and we hope to be headed there relatively soon, but we do not know if we are going there yet. That is why our advice to the Deputy First Minister and the First Minster was to maintain the testing regime as it is presently with one principal change, which is the removal of daily or every-time-you-have-a-social-event asymptomatic testing and a move to twice weekly testing, which is what we did before omicron.
We will continue to monitor the pandemic. Currently, our case level in the population is one in 25—that is, there are four positive cases in every 100 people—so we think that it is too early to remove the present levels of protection, given the risk to others that an individual might represent. This morning, for example, I heard about a wedding that was attended by 120 people, with 30 positive cases being reported within a few days of the event. Keeping the positive cases out of those events, cinemas, care homes and public transport is still a crucial part of our protection. However, as prevalence falls, we can adjust our testing regime. That is the advice that we will give as prevalence falls, but I am afraid that it is not showing signs of doing that very quickly.
I do not have much to add what the Deputy First Minister and Professor Leitch have said. Coming back to the convener’s question and putting it in the context of future threats, the two key parameters that we will need to know with any new variant are: how much more severe it is than the current strains that are dominant in Scotland; and how much more transmissible it is. Whatever the arrangements for testing that we have in place, which the Deputy First Minister and Professor Leitch have set out, we need to be able to ascertain those two things quickly. We need to ensure that our infrastructure, including targeted polymerase chain reaction—PCR—testing, waste water sampling and a sufficient ONS infection survey, enables us to get the kind of data that enables us to quickly ascertain severity and transmissibility.
As I have already said, the announcement regarding the removal of some of the restrictions in March is very welcome, but a lot of people will have concerns, particularly our most vulnerable people—perhaps those who have been on the high-risk list during the pandemic. What measures will the Government take to ensure that our most vulnerable people at high risk still feel supported as we move on to the next stage?
That is a vital issue. I quite understand the appetite on the part of individuals to return to something like normal life, although there are some in our society who are frankly terrified by that prospect in the light of Covid. The first thing that we must do is be respectful of their views and concerns, and we must understand the anxiety that they face. That is why we have taken a gradual approach. We have tried to respond in a measured way to build as much resilience as we can within the population. Vaccination is critical to help us on that journey. Some people are vulnerable and cannot get vaccinated, for entirely understandable clinical reasons, which increases their anxiety further. Vaccination is critical to building resilience.
There are routine measures and, although we may remove the legal obligation to wear face coverings on public transport on 21 March, we will still be saying to people that it would be advantageous to wear them, and that it would a good civic gesture to protect other people.
We want to ensure that those who are very vulnerable have access to the clinical support that they will require. For example, individuals who are immunosuppressed have had communication from the chief medical officer that antivirals will be available to them because of their clinical vulnerability, which they should access. There is mental health support that we would want to make available to people to support them with their anxiety. In general, we want to work to ensure that people have the support that they require, recognising that the relaxation of restrictions is not universally welcomed within our society. We ignore the anxieties and fears of individuals in our society at our peril.
Good morning. My first question is a neat follow-on from the question that the convener has just asked. We have now seen a move from the Scottish Government, announced by the First Minister on Tuesday, away from legal restrictions towards a situation where we are increasingly relying on personal responsibility and individuals complying with public health guidance. That is very much in tune with what has happened elsewhere in the United Kingdom. First, the Welsh Government announced that, then the Northern Irish Government, and the Prime Minister announced the same for England on Monday, albeit on slightly different timescales.
Is it now the assessment of the Scottish Government that the public are in a place where they will, in the main, comply with public health guidance without it being required to be set in law that they behave in a particular way?
That will be our general assumption in relation to the management of the pandemic, but we have to ensure that we have the legal and statutory capacity in place to respond to a deteriorating situation, should that be the situation that we face.
Thank you for that response. We have seen from the discussion around the rules on self-isolation this week that the Scottish public have complied very well with the public health guidance. When the Prime Minister announced that the self-isolation rules for England would be dropped, a lot of criticism was made of him in some quarters, and some people seemed oblivious of the fact that, in Scotland, there has never been a legal requirement to self-isolate following a positive test, except in the very limited circumstances of international travellers. I think that we are in a good place in terms of the public.
The reason why I ask the question, as you can imagine, is that we have an instrument to consider shortly on extending the extraordinary powers that the Scottish Government currently has for a further six months. Given that we know that the Scottish public responds very well to public health advice, why can we not just trust people to follow the advice because we know that they will do so, rather than having those legal powers continue?
10:45
It is because we may face a deteriorating situation and might have to take some more severe action. I hope that we do not have to, but we might.
As I have rehearsed with the committee previously, on one Tuesday morning in November, the Cabinet thought that the pandemic was pretty stable and that we could look forward to a pretty straightforward Christmas, but 48 hours later Michael Matheson was on a call with the United Kingdom Government about applying travel restrictions on South Africa and various other African countries because omicron had descended on us. To be blunt, omicron was the variant of the virus that came closest to tipping over Scotland’s national health service—it came very close.
That all happened in the space of 48 hours, so I cannot predict what lies ahead. However, I have sat in Parliaments for nearly 25 years, and I have listened to members of Parliament demand—rightly—that the statute book be capable of dealing with situations that we face. At this moment, given all the history of the past two years, I simply want to ensure that Scotland has a statute book that can be used, if it needs to be, to protect the public. I stress the word “can”—it can, not must or will, be used.
I suspect that I might be exposed to a good amount of criticism for not foreseeing this or that. In this particular situation, the Government has decided to try to foresee some of the difficulties that we might face and put in place a statute book that gives us the ability to respond in a way that we hope that we do not have to, but we may have to.
I suspect that we may have to agree to disagree on that particular point.
I suspect that, on that particular theme, we may just have to.
I have time for one more question. This morning, I was looking at statistics from the Office for National Statistics that suggest that, although there is a downward trend for infections across the rest of the UK, that is not the case in Scotland. The latest figures seem to show that we have an infection rate in Scotland of one in 20, whereas it is one in 25 in England and one in 30 in Wales. That would seem to suggest that, despite the fact that we have had more legal restrictions in Scotland over the past few months in comparison with other parts of the UK, in particular England, that has not had a beneficial impact on the case rate.
As I am sure that you have seen, there was a study in the Financial Times two weeks ago that analysed the figures for the past six months. It suggested that, again, despite the fact that there were more restrictions in place in Scotland, including a requirement to wear face masks in certain settings, there was in fact no beneficial outcome. In fact, the Financial Times suggested that the rate of death in Scotland from coronavirus was higher than in the rest of the UK. Does that not suggest that the Scottish Government’s approach of having more restrictions has not delivered better outcomes than elsewhere?
No. I am, obviously, aware of the ONS infection survey data from this morning. If my memory serves me right—I stand to be corrected on this—this is the first week of the survey, certainly since the onset of omicron, in which the incidence ratio in Scotland has been at a poorer level than elsewhere in the UK—that is certainly the case in comparison with England; the situation may well be different with regard to some parts of Wales, where there have been restrictions in place. This is the first occasion on which that has been the case.
The Financial Times assessment raises a lot of questions because, essentially, the death rate in Scotland—I hate to talk in this kind of language, but the question has been put to me, so I have to do so—has been comparatively lower than the death rate in England throughout the pandemic. I am not quite sure where the Financial Times gets its conclusions from.
It is important that we take measures that we consider to be proportionate and appropriate. The Scottish Government has done that throughout with the objective of protecting the public. If the position in Scotland had been any more serious than it was—and it has been serious—I am sure that many people would be queueing up to demand that the Scottish Government take even stronger action than it has done. Indeed, some people have demanded that.
People are free to make those arguments but we have to make balanced judgments. Protecting the public has been at the heart of those judgments.
I would love to pursue those issues further but I fear that we are out of time.
We continue to have a problem with misinformation and people who are Covid sceptic or vaccine sceptic. I understand that some of the data that has been produced has been misused, misquoted or twisted and, as a result, Public Health Scotland will not continue to publish some of the figures. There was an interesting article by Helen McArdle in Saturday’s Herald, which, to be frank, I struggled to understand. Will you clarify what the problem was? I think that it might have been to do with how the unvaccinated population is counted. Will you clarify why the data is not solid and why it is not being published?
I invite Professor Leitch to come in on that point, or we might have to write to the committee on it.
I am not entirely clear what the issue is, so writing to the committee might be the best idea.
My best—I was going to say “guess”, but you should never say “guess” in front of the Deputy First Minister or a parliamentary committee. My best thinking on that is that one of the translational challenges in the vaccinated and hospitalisation data is working out why it looks as though more vaccinated people than unvaccinated people are in hospital. It is a good question. The reason why is that the vast majority of people in the country are vaccinated. Therefore, we still end up with more vaccinated people in hospital because our denominator is so huge compared to the small numbers of unvaccinated people.
However, if we look at the proportion of vaccinated people who end up in hospital compared to the proportion of unvaccinated people who end up in hospital, we see a stark difference. That shows globally that vaccinations stop hospital admissions, ICU admissions and deaths. They do not stop them in their tracks, of course. They do not reduce them to zero, but they reduce them significantly. Therefore, when you go to intensive care—as I did this week at the Queen Elizabeth university hospital—you are proportionately much more likely to see unvaccinated people in the unit.
I will look at Helen McArdle’s article and we will get back to you on the specifics, but I imagine that that is what the issue was.
I think that that is the area that article touched on. There was also mention of ghost patients. I understand that the population of people who are registered with a GP is higher than the population as a whole.
Yes, that is correct.
That seems to be another part of the issue.
Mr Mason will understand that, although I try my best to keep abreast of newspaper articles, I do not read every one of them. If that was the case, I would do nothing else in life. If the committee will forgive me, we will write to the convener with a response on that point.
That is fine. Professor Leitch’s answer dealt with the problem. It is helpful to get it on the record.
We are expanding the vaccinations slightly and some people are getting a fourth dose or second booster. Will you give us an indication of where that might be going? Will we go right through the population again from the oldest to the youngest or will annual boosters wait until the autumn for the under-75s?
I am again speculating, but the advice that we have received from the Joint Committee on Vaccination and Immunisation will result in us issuing vaccination appointments to all five to 11-year-olds very shortly. We will start issuing them in mid-March and do most of them around the Easter holidays. Additional boosters will be provided to care home residents, people who are over 75 and people who are over 12 who are immunosuppressed. That activity will dominate the spring and the period towards the summer. That probably makes it likely that we are heading towards a booster programme in the autumn, but we will await JCVI advice on that particular question. Assuming that there is no substantive deterioration in the situation, I think that we will be moving into a period when we will be relying on vaccination to provide us with effective resilience.
My next question is on testing, which has been mentioned already. If we do not get funding from the UK, or if the UK does not fund the testing kits and so on, will that seriously curtail what we can do?
Obviously, we have judgments to make about the nature of the testing programme that we can take forward. That is informed by the decisions that are taken by the United Kingdom Government. Clearly, the financial arrangements that support an expansive testing programme will, if they are curtailed, have an effect on our ability to deliver such a programme.
We have to pursue the detail of the UK Government’s announcement that was made earlier this week. It was pretty obvious that there had been a tense set of discussions within the UK Government—some might call it chaotic—which led to the announcements on Monday. That has not provided us with particular clarity about its intentions. We are now seeking that clarity, and that will inform the testing programme. I assure Mr Mason and the committee that the points that Professor Leitch and I put on the record in our responses to the convener will very much inform the formulation of the plan that the Government puts in place.
On the strategic framework, there has been some mention of what we can perhaps do for Malawi, Zambia and Rwanda. Can you say anything about what we might do for them?
We are obviously working closely with the long-standing relationships that we have with those countries to play our part responsibly to support the vaccination programmes that are under way there. As a Government, we accept the importance of fulfilling our international obligations to ensure that the whole world is protected from Covid, because only by the whole world being protected from Covid do we have as much assurance and security as it is possible to have. Our co-operation will be to that end.
Good morning, Deputy First Minister and colleagues. I will take this opportunity to extend the conversation that we had with our previous panel about lessons learned and what we can do in the future. In most of the submissions that we had from experts, the word “anecdotal” appears a lot regarding the collection of data and what is happening, especially on what is happening with non-Covid-related conditions, and I note from the written evidence that
“deaths from other conditions may have increased”,
although the Royal College of Physicians of Edinburgh is
“not aware of any published data to support this.”
This is an extension of work that was done by the Health and Sport Committee in the previous session of the Parliament on collection of data. Fortunately, one of the experts speaking to us this morning raised the issue of the IT system that is currently available in the NHS, and words such as “clunky” came out. There are three different systems that the NHS works with just now. Looking ahead, I think that it would be beneficial if one of the investments that are made is to deliver an IT system that allows the proper collection and deployment of appropriate data. Covid has taught us that data is incredibly important.
I know that the Government was considering this in the previous session; I wonder where we are with the potential development of a new IT system for the NHS.
11:00
The first observation that I would make on Mr Whittle’s question is that, in a sense, he has just echoed one of the fundamental points that I made in my response to Mr Fraser. It is important that we deduce lessons from the pandemic and, if they are important, that we learn from them and apply them. I happen to take that view about the statutory framework and Mr Whittle has put to me an entirely legitimate point about data and IT.
Scotland has been very well served by some critical decisions that were made a long time ago on the unique identifier—the community health index or CHI number—which has acted as the foundation for the administration of healthcare in Scotland based on the individual. It enables information on and records for an individual to be accessed appropriately to ensure that high-quality healthcare is delivered for that individual. That has been a strong foundation of our system but, of course, every development that comes along puts extra pressures on the core system. Covid has put many data demands on the system, particularly with regard to vaccination records and all that comes with such issues.
The Government has been taking active steps to ensure a strong approach to the delivery of digital care, and I think that it has got ever stronger over the course of the pandemic. What lies at the heart of the system is appropriate information technology capability to ensure that we can identify and meet the needs of individuals, and the Government will be working closely on that with health boards to keep the foundations of our IT system up to date and ensure that we meet the needs of individuals.
Healthcare professionals definitely vented some frustration this morning at the interface between primary and secondary care and the inability of secondary care to access primary care data when a patient re-presents. I worked in this area before my time in Parliament, and what interests me is how we get the ability to port that information and data. Covid has highlighted and exacerbated the issue and, looking ahead and thinking about the lessons learned that you referred to, Deputy First Minister, I think that we have a very good opportunity to look at how and what data is collected and how it is accessed. That will require an IT system that is universally applicable to the whole of the country, which is not the case at the moment. Where are we with the development of that kind of structure?
I would want to look at exactly what circumstances the clinicians were raising with the committee this morning, but my understanding is that, throughout the health service, the capacity and capability exists to access critical information about the healthcare of each individual. That is why I referred to the CHI number, which underpins and drives the system. I want to understand a bit better some of the deficiencies that have been highlighted but, in principle, I agree with Mr Whittle’s points about the availability of data and the necessity of collecting the appropriate data in our healthcare systems. I think it important to have a system that can be accessed in all different spheres of the health service. I am very happy to look at those issues and the particular points raised by the clinicians this morning, and I will encourage the health secretary to look at these questions and determine what further action requires to be taken.
I will finish here, convener, but I would encourage the Deputy First Minister and the health secretary to look back at the Health and Sport Committee’s work in the previous parliamentary session. Listening to this morning’s evidence, I have to say that the sort of universality of access that you have described is not the case in Scotland. If you input data in Glasgow, it cannot be accessed in Edinburgh and has to be reinput over here.
We are getting into an area here, but I think—it is not a criticism—that there is an opportunity to consider a system-wide change that would be to the huge benefit of our population and our NHS workers.
The characterisation that Mr Whittle puts to me is not my understanding of the situation, but I will go away and look at it again. There is accessibility for critical information, though perhaps not all information—I accept that—but I will certainly consider the issues that Mr Whittle raises and encourage the health secretary to do so.
I reiterate what Mr Whittle has just said: the message that came across clearly this morning was that you cannot follow a patient regardless of where they are—the information does not follow them from one department to another. My understanding was that it could go right across the country but, from what we heard this morning, that is not the case.
There are so many things that I would like to talk to you about.
It is always like that. It is part of our relationship.
I know. Given where we are in the pandemic, what is the World Health Organization’s advice on testing?
I will turn to Professor Leitch to answer that point, but the World Health Organization’s advice to us at this stage of the pandemic in general is to take care and not to think that everything is over and done with. The position that the Scottish Government has taken on, for example, the continued use of face coverings as a mandatory provision is in line with the guidance from the World Health Organization. The WHO will encourage us to maintain a testing infrastructure that enables us to identify what the prevalence of the virus is in our society and what we can contribute to international understanding of the virus by virtue of the information that we collect and the experience that we have.
In relation to specific measures and restrictions, the World Health Organization may set out what it thinks is desirable, but we as a Government have to judge whether that is proportionate, because we have to be satisfied that we could withstand legal challenge to any of the decisions that we take. Generally, however, the advice of the World Health Organisation at this pivotal moment of the pandemic is to take care. I turn to Professor Leitch to answer the specific question on the WHO’s testing advice.
Very briefly, I will not go down the digital health tunnel, but I commend to the committee the October update to NHS Scotland’s digital health and care strategy, which sets out the present position and plans for the future. The committee may want to consider that in deeper detail, and the Health, Social Care and Sport Committee certainly will.
Mr Fairlie, my four categories come directly from the WHO’s advice. Mr Swinney is correct that the fundamental advice is that we should be cautious. The next variant—there will be one—will come from either a highly vaccinated country with a high prevalence, which is what we have, or an unvaccinated country. The virus will either find a way through vaccines—if it has high prevalence, it gets more opportunity to do that—or it will find a way of transmitting in an unvaccinated community.
The vaccine squeeze, which is what the virologists call it, is when the virus finds a way to infect new people. That means that we need to do surveillance, which requires genetic surveillance. We need PCR testing for that. We need to do that, if we can, randomly across the country, like the ONS survey, but also for those with symptoms. We need to test in high-risk locations, we need to have the capability to manage outbreaks and we need to know who to treat, because as the therapeutics improve, we need to know who to give them to. It is a fairly basic clinical formula: does this person have Covid, so should I give them Covid medication, or does this person have something else, for which they would have different medication? In order to make that decision, clinicians need testing. Traditionally, we do that once people reach healthcare.
The challenge with the disease that we face is that many of the great therapeutics that we are now developing are helpful before you reach healthcare and before you are sick enough to need traditional medication. It may be that antivirals could stop the heart transplant patient or the 85-year-old reaching healthcare at all. Therefore, we need to move testing up the chain and do it earlier so that we get treatment options. That is what the WHO says we should do and that is the advice that we are giving to the Scottish Government.
The point that I am trying to get to is this: how do we surveil to ensure that, if a virus is moving about in our community, we catch it as early as possible? We know that the current system is sufficient. Will what we are moving to be sufficient?
Those are the discussions that we are having as part of the formulation of the testing transition plan. It has to be accepted that we cannot sustain the level of testing infrastructure that we have had in place for most of the past two years but we cannot have none in place.
There is a really interesting global point on one of the lessons from the start of the outbreak. Many of the Asian countries have been able to withstand Covid to a greater extent because, due to their experience of the severe acute respiratory syndrome-related viruses in the past, they have always maintained a much greater testing capacity and capability than was ordinarily the case in western countries. We might not go to those levels, but we certainly have to go some way towards them to maintain surveillance, so we have to have a debate on sufficiency.
We believe that a sufficiently credible and capable ONS survey is vital to enabling us to be properly prepared. We must have a level of testing infrastructure that enables us to detect and identify any new strains and we must have capacity to identify any emerging issues within individual populations. For example, Dominic Munro made a point about waste water sampling. It is a good way of determining the parts of the country where there might be, comparatively speaking, more incidence of the virus. The Scottish Government will sustain such sampling on an on-going basis.
There is not a definitive answer to Mr Fairlie’s question today. It is an important and legitimate question. Over the next few months, we will have to find a satisfactory answer to the question of what level of capacity we should retain.
I will ask one more very quick question, if possible.
I am sorry, Mr Fairlie. We are running out of time. We move to Alex Rowley.
There is a thing called political balance.
It is not unreasonable to look for an extension of the powers for another period of time, given where we are, Deputy First Minister. If you were saying that you wanted the powers for ever more, that would be a different matter. That is why I welcome the announcement that work will be done on future pandemics.
Professor Leitch talked about possible variants. I worry that we are starting to get to a point where everybody thinks that the pandemic is over and we can get back to some kind of normality.
On the reports that are coming in the spring, are you considering a proposal for how we prepare and plan Scotland-wide? You say that you are talking to local authorities. Are we looking at regional approaches throughout Scotland so that we are prepared at a regional level?
Part of the evidence that we heard this morning from the Royal College of GPs was that, seven years on from the incorporation of health and social care into the integration joint boards, it is hit or miss at the local level as to whether services such as mental health and social work are joined up and working at the GP level. It is fine to have big, central plans, but we do not seem to be able to get them through on the ground and put in place a decentralised system of governance that delivers.
11:15
I am grateful to hear that Mr Rowley has taken his usual rational and considered approach to the regulatory infrastructure. [Laughter.] I welcome that and look forward to its being shared universally across the committee.
I very much agree with Mr Rowley’s sentiment that there is a danger of people thinking that Covid is all over and done with. It is not. I know that I sound like a broken record with my omicron example, but these things can happen quickly. As international travel takes off again, we do not know how quickly Covid variants might be able to spread across the world. It is absolutely legitimate to make that point.
On the preparedness question, Mr Rowley is correct. We are undertaking further work on future pandemic preparation. That has to be an all-Scotland approach, although that is not to say that the work must be done only at national level. It must be an all-Scotland approach that involves our resilience partnerships in every part of the country. From his long experience in Fife, Mr Rowley will be familiar with the local authority’s role as a key member of the resilience partnership at local level, where it works with the health board, the police, the Scottish Fire and Rescue Service and various other players. We rely on them—as we have done during the pandemic—to deliver an appropriate response. Indeed, we have relied on them in relation to stormy weather, too.
Those local resilience arrangements must be effective, so we must engage with those partners. I regularly meet the Scottish resilience partnership, which brings together the local resilience partnerships. We reflect on the current threats and challenges that we face, how we should respond to them and what learning we can apply in every part of the country. We undertake that work, and it is all valid because we should be focused on pandemic preparation.
If I was to reflect on the past few years, when we have conducted an annual stocktake of the resilience threats that face Scotland, a pandemic has always been right up there, but we sit there waiting for it to happen. Stormy weather, on the other hand, comes along very frequently, as we know, as do flooding and various other things. It is important that we have that foresight capability.
Mr Rowley went on to raise a fundamental issue that is relevant to the debate about a national care service. He is absolutely correct. He and I will agree that there are variations in the quality of the delivery of care around the country. The question is what we do about that. I would contend that the arrangements that we have in place currently do not provide assurance that every member of the public in every part of the country who needs care services is able to get services of sufficient quality to a sufficient extent. Following the research that was undertaken as part of the Feeley review, the Government’s view is that that would be best addressed by the establishment of a national care service. Parliament will have extensive discussions on that within the foreseeable future.
I emphasise that I acknowledge the importance of every member of the public, regardless of where they live, being able to rely on the ability to get a quality experience from a quality care service.
This week, we discovered that one in eight people in Scotland are on an NHS waiting list. Earlier in the meeting, I asked the health professionals what data is available on that so that we can understand the knock-on effects. I think that, a few weeks ago, Professor Leitch told me that most of the data on that should be available.
I gave the example of two constituents who needed a hip replacement and were suffering as a result. One of them was able to get together £15,500 and go and get it done privately—they are now sorted—while the other cannot afford that. That is having a knock-on effect on their mental health and so on.
What are we going to do about the waiting lists? Is regional planning being done health board by health board? How will we get the waiting lists down? How will we address the knock-on effects that these unacceptable waiting times are having on people’s health and wellbeing?
We have had discussions in this committee and across Parliament on countless occasions, and Mr Rowley has consistently questioned me on the impact on people of non-Covid health harms. Those questions are absolutely legitimate, and I would be the first to acknowledge that waiting lists are larger and longer than they were before the pandemic, but that is a direct result of the pandemic.
No health board in the country wants to put off tackling those waiting lists—they want to get into a position to be able to do so as early as possible. However, we have to be mindful of the presence and prevalence of Covid. Although we have seen a fall in Covid admissions to hospitals in general over the past few weeks, Covid admissions are unfortunately rising again, to our unease, as is the number of people in hospital with Covid.
I assure the committee—this is part of the NHS recovery plan, and it is inherent in the Government’s investment in elective treatment centres—that we are anxious to expand the capacity to enable us to address the very issue that Mr Rowley fairly puts to me, so that members of the public who are suffering with pain and need a hip replacement, for example, can expect to have that treatment within a reasonable timescale.
Should we not be saying to each health board that they need to identify exactly what the demands are in their area and start to bring forward some kind of proposal for how they will meet those demands?
I contend that that is what the NHS recovery plan does. It focuses entirely on the issue of making up for the treatment that has been lost because of Covid. Each health board is under an obligation, in respect of the plan that it has had to submit to the Cabinet Secretary for Health and Social Care, as to how it is going to go about doing that. We are keen to ensure that we make progress as swiftly and as early as possible on advancing that treatment.
I am sorry—we have run out of time for this part of the agenda. That concludes our consideration of item 1, and I thank the Deputy First Minister and his officials for their evidence today.
We move to item 3, which is consideration of the motion to approve the draft Health Protection (Coronavirus) Requirements (Scotland) Amendment No 4 Regulations 2022. As members will be aware, we will take the motions on the other two instruments that are listed under agenda item 2 at a future meeting, once the Delegated Powers and Law Reform Committee has reported on them.
Deputy First Minister, would you like to make any further remarks on this Scottish statutory instrument before we consider the motion?
I think that it would help if I put some comments on the record regarding the regulations. The committee has on its agenda three SSIs and a motion to approve the Health Protection (Coronavirus) Requirements (Scotland) Amendment No 4 Regulations 2022. Those three instruments all put back the date on which the key coronavirus provisions would otherwise expire by default, and thus act to protect our ability to have in place any measures that are considered necessary.
The draft Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 4) Regulations 2022 amend the date on which the Health Protection (Coronavirus) (Requirements) (Scotland) Regulations 2021 expire, from 28 February 2022 to 24 September 2022. If the expiry date is not changed, the baseline measures will automatically cease on 28 February.
Although we are starting to take steps to remove the baseline measures, regulations that were shared with the committee yesterday will remove the Covid certification scheme from the regulations. It is important that the other baseline measures can remain in place after 28 February to support our review of the baseline measures on the basis of the latest data. We expect that the other legal requirements will be converted to guidance on 21 March, but as the First Minister said on Tuesday, that is subject to there being
“no significant adverse developments in the course of the virus”.—[Official Report, 22 February 2022; c 18.]
The draft Health Protection (Coronavirus, Restrictions) (Directions by Local Authorities) (Scotland) Amendment Regulations 2022 amend the date on which the Health Protection (Coronavirus, Restrictions) (Directions by Local Authorities) (Scotland) Regulations 2020 expire, from 25 March 2022 to 24 September 2022.
The directions regulations will continue to be reviewed every 42 days, as the regulations require. Keeping those regulations in place for a longer period of time will support local outbreak management of coronavirus. Local action to control or close premises or businesses at the centre of an outbreak can, in many cases, be the most effective and proportionate response.
The Coronavirus Act 2020 (Alteration of Expiry Date) (Scotland) Regulations 2022 extend the expiry date of five provisions within the UK Coronavirus Act 2020 for a further six months, until 24 September. Without the regulations, those provisions would otherwise expire automatically on 24 March, alongside the majority of the act’s provisions. The provisions that are being retained for a further six months relate to: the remote registration of deaths and stillbirths; removing the requirement for vaccinations and immunisations to be delivered by or under the direction of a medical practitioner; powers for Scottish ministers to give either boarding or student accommodation directions that restrict access or confine occupants; the power for ministers to give educational continuity directions and to enable education and childcare provision to continue; and powers for ministers to make health protection regulations such as the Health Protection (Coronavirus) (Requirements) (Scotland) Regulations 2021, which were mentioned earlier.
All those provisions are in the Coronavirus (Recovery and Reform) (Scotland) Bill, which is undergoing scrutiny by this and other relevant committees. The Government thinks that those particular provisions should be legislated for permanently from September 2022, should the Parliament agree to the alteration of expiry date regulations—that is, of course, a matter for separate determination by the Parliament.
The alteration of expiry date regulations have been made under the made affirmative procedure. At the time of laying, our understanding was that that was the only procedure available to us for the regulations. It has since come to our attention, after discussion among lawyers, that we could have used the affirmative procedure. Even with that understanding, however, we are assured that Parliament would have 40 days for scrutiny prior to the regulations coming into force on 24 March 2022.
I move,
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No. 4) Regulations 2022 [draft] be approved.
I will comment briefly, given the time and given that we have already rehearsed these arguments in the committee.
The draft regulations before us seek to extend the extraordinary and emergency powers for a period of six months. As I outlined earlier, I think that we are now in a place—as I think the Scottish Government has more or less conceded at this point—where, in future, we will increasingly rely on the good sense of people to follow public health guidance, rather than being required to act in particular ways by the law. I believe that the experience that we have had over the past two years shows that people respond very well to public health guidance. I suggest that it is not appropriate for the powers to be extended. I believe that we should test the good judgment of the Scottish people, who have thus far demonstrated in spades their willingness to comply with public health guidance. For those reasons, I oppose the motion that is before us.
At this point, I believe that it is proportionate and reasonable for the Government to make the extension. We should not take our eye off the fact that we are not through this situation by any means. The longer term raises a different issue, and it is an issue that this and other committees will debate, but I do not think it is unreasonable to have a six-month extension.
Deputy First Minister, I vividly remember your bringing the emergency powers to the chamber, and quite rightly you had universal support from across the chamber for those emergency powers, given the situation that you faced at the time. However, you and the First Minister have said that the powers would be used only if appropriate, that they would be kept for the minimum amount of time and that they would face parliamentary scrutiny as quickly as possible. I remember how quickly the emergency powers were brought into being, when they were brought before the Parliament and voted on.
As my colleague Murdo Fraser says, we are in a different time now. The Government should not hold such powers unless absolutely necessary. Given that you could bring the measures back before the Parliament and given that the emergency powers could be reinstated very quickly if required, along with my colleague, I will have to oppose the motion.
11:30
In people’s thinking, there is a little bit of a difference between what is law and what is just guidance. I was down in England last week, where the restrictions tend to be more based on guidance and, despite what Murdo Fraser said about people’s good sense, people were not adhering to a lot of that guidance. Therefore, it is too early to lift the restrictions. I agree that we do not want the legislation to be in place for any longer than it needs to be, but it is a little bit too early to change direction.
Because people sometimes just put their hands up and say, “No, no, we’re not doing it any more,” the Government must have the ability to say that something will happen because of whatever the circumstances are. We are far from being out of the pandemic. I know that I may be one of the more cautious members of the committee but, as far as I am concerned, until we are through it, we are not through it. Therefore, it is essential that the Government has the powers to take proportionate action.
I invite the Deputy First Minister to respond to the contributions that have been made.
I acknowledge that there is a difference of opinion among members on the issue. There is a duty on the Government to have in place a statute book that enables us to respond to the circumstances that we face. Colleagues have indicated that there are likely to be challenges ahead for us. The measures that are in place have appropriate safeguards and there is no obligation to use them. The obligation for us as parliamentarians is to have in place a statute book that can respond to the challenges that we face.
To respond to Mr Whittle’s point, I have heard the criticism of Parliament that we did not have the necessary legislation in place to deal with a pandemic. If we are going to prepare properly for pandemics, we must ensure that we have the legislation in place with appropriate safeguards. I reiterate the point that, although the provisions will extend the regulatory infrastructure that is in place, they do not oblige the Government to use it in all circumstances.
On the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 4) Regulations 2022, if we want to continue the legal obligation to wear face coverings on public transport and in public places to 21 March, it must be put into place today or it will fall on 28 February. Therefore, in that short term, I appeal to colleagues to support the regulations, which will be the subject of a vote. There are two other instruments that will be subject to discussion in due course.
The question is, that motion S6M-03168 be agreed to. Are we agreed?
Members: No.
There will be a division.
For
Brown, Siobhian (Ayr) (SNP)
Fairlie, Jim (Perthshire South and Kinross-shire) (SNP)
Mason, John (Glasgow Shettleston) (SNP)
Rowley, Alex (Mid Scotland and Fife) (Lab)
Against
Fraser, Murdo (Mid Scotland and Fife) (Con)
Whittle, Brian (South Scotland) (Con)
The result of the division is: For 4, Against 2, Abstentions 0.
Motion agreed to,
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No. 4) Regulations 2022 [draft] be approved.
The committee will, in due course, publish a report to the Parliament setting out its decision on the statutory instrument considered under this agenda item.
That concludes our consideration of the agenda item and our time with the Deputy First Minister. I thank him and his supporting officials for attending.
The committee’s next meeting will be on 3 March, when we will take evidence from stakeholders on the Coronavirus (Recovery and Reform) (Scotland) Bill.
That concludes the public part of our meeting.
11:33 Meeting continued in private until 11:37.Previous
Excess Deaths Inquiry