Contents
- Attendance
- Excess Deaths Inquiry
- Ministerial Statement and Subordinate Legislation
Ministerial Statement and Subordinate Legislation
Coronavirus (Scotland) Acts (Amendment of Expiry Dates) Regulations 2022 [Draft]
Coronavirus (Scotland) Acts (Early Expiry of Provisions) Regulations 2022 (SSI 2022/64)
Health Protection (Coronavirus) (International Travel and Operator Liability) (Scotland) Amendment (No 3) Regulations 2022 (SSI 2022/53)
Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 5) Regulations 2022 (SSI 2022/74)
I welcome the Deputy First Minister and his supporting officials, Professor Jason Leitch, the national clinical director; Greig Walker, the Coronavirus (Recovery and Reform) (Scotland) Bill team leader; Elizabeth Blair, the unit head for Covid co-ordination; and Stewart Cunningham, a Scottish Government lawyer, who joins us online.
As members will have seen, following the First Minister’s statement on Tuesday, the Minister for Parliamentary Business has written to the committee. In his letter, the minister explains which legislation the Scottish Government is revoking in the light of the statement. I draw the letter to members’ attention, as those changes affect the secondary legislation on our agenda.
I invite the Deputy First Minister to make some brief opening remarks before we move to questions.
I am grateful to the committee for the opportunity to discuss a number of matters, including updates to Parliament on Covid-19.
As the First Minister set out on Tuesday, there has been a recent increase in cases driven by the BA.2 sub-lineage of the omicron variant. It is now the dominant strain in Scotland and accounts for more than 80 per cent of all reported cases.
Encouragingly, there is no evidence that BA.2 causes more severe illness than BA.1 or that it is more effective at evading natural immunity or immunity through vaccination. We continue to observe strong evidence that the link between infection and serious health harm has weakened considerably due to immune protection. Therefore, extension of the vaccination programme is on-going, in line with Joint Committee on Vaccination and Immunisation advice.
Letters inviting five to 11-year-olds who are not in higher-risk groups for vaccination started arriving at the end of last week. Booster jags for older adults in care homes also started last week. Additional boosters for those who are immunosuppressed will start from mid-April.
As the First Minister announced, from Friday, and in line with other UK nations, all remaining Covid-related travel restrictions in Scotland will be lifted. Although we have some concerns about that, UK travel patterns mean that diverging from the rest of the UK would cause economic disadvantage without delivering any meaningful public health benefit.
From Monday 21 March—with one temporary exception—the remaining domestic legal measures will be lifted and replaced with appropriate guidance. That means that, on Monday, the requirement on businesses and service providers to retain customer contact details will end. So, too, will the requirement for businesses, places of worship and service providers to have regard to Scottish Government guidance on Covid and to take the reasonably practicable measures that are set out in the guidance. The exception relates to the requirement to wear face coverings on public transport and in certain indoor settings.
Given the current spike in case numbers, continued widespread use of face coverings will provide some additional protection, particularly for the most vulnerable, at a time when the risk of infection is very high, and it may help us to get over the spike more quickly. We will review it again in two weeks’ time.
The other issue that the First Minister covered on Tuesday was testing. For the next month, until Easter, there will be no change to our testing advice. However, from 18 April, with the exception of health and care settings, we will no longer advise people without symptoms to test twice weekly. From the end of April, all routine population-wide testing will end, and, from 1 May, instead of a population-wide approach, we will use testing on a targeted basis. That marks steady progress back towards normal life and a more sustainable way of managing the virus.
We will do everything we can to support those who have worked on the testing programme during the transition. I echo the First Minister’s gratitude and thank all of them for their invaluable contribution over the past two years.
I am happy to answer questions from the committee.
Thank you, Deputy First Minister.
I will ask the first question. With numbers still high in Scotland—the Cabinet Secretary for Health and Social Care told us that this week could be one of the worst weeks from the point of view of pressure on the NHS—and concerns being raised in relation to the reduction in funding for certain Covid-19-related studies and data collection exercises from the end of March, including the ZOE Covid symptom study and the SARS-CoV-2 immunity and reinfection evaluation, or SIREN, and Vivaldi studies, which monitor infections in health workers and in care homes, Dr Stephen Griffin, who is a virologist at the University of Leeds, said that the decisions by the UK Government on Covid surveillance would
“slow the country’s ability to respond and adjust to future waves or surges of infection”
or new variants.
Deputy First Minister, do you feel comfortable with the UK Government’s current approach?
The issue is a challenging and sensitive one, and I will invite Professor Leitch to add some comments to my initial remarks.
To ensure that we have knowledge of the emerging situation, we must have adequate surveillance measures in place at two levels. First, we must have such measures in place at a population-wide level. It would be difficult to justify on a persistent, long-term basis the type of intense testing arrangements that we have had in place at a population-wide level, but we need to have some population-wide information. We believe that a high-quality Office for National Statistics infection survey, combined with the data that we collect from waste water, for example, gives us a sufficiently strong base of information at a population-wide level to be able to assess what I might describe as the generality of the position on the prevalence of Covid in our society.
The second important element is our contribution—which is the same as the contribution of other countries around the globe—to developing the detection, understanding and appreciation of any new variants that may emerge. We must be able to continue to do a sufficient level of testing in the population to enable us to identify any variants that are emerging, in the way that the testing approach that was taken in southern Africa identified the omicron variant, which was then identified in a number of other jurisdictions very quickly. We were alerted to that and were able to respond swiftly.
That matters because, as I have rehearsed with the committee before, we took decisions very quickly to tackle the situation that we faced in relation to omicron. I am pretty certain that, if we had not done so, the national health service would have got into very deep difficulties. We averted that because of the speed of our actions. I know that our actions were controversial and that they did not command universal support, but the alternative would have been seeing our national health service overtopped. Intelligence about new variants is critical in enabling Governments to respond appropriately.
I do not know whether Professor Leitch wants to add to that.
The convener’s question is crucial, and it allows me to deflect between advice and solutions. We have given very strong advice that the UK as a whole needs to continue to do three things. It needs to do surveillance—the Deputy First Minister has described that—and that surveillance has to include genetic testing. It needs to do research on the course of the disease. That is what SIREN has done for us. For those of you who do not know, in SIREN, health and social care workers who get the disease are followed over a long period to check their immunity and long Covid status.
We need to continue to monitor the course of the disease and treatment for the disease, which is what the randomised evaluation of Covid-19 therapy, or RECOVERY, and platform adaptive trial of novel antivirals for early treatment of Covid-19 in the community, or PANORAMIC, studies have done. PANORAMIC in particular relies on testing of the population. A person needs to know whether they are positive or negative to join the study. If we stop testing, PANORAMIC will have to find a new way of finding patients in order to enrol them to get the treatment and see whether it works.
From a public health perspective, we require to continue to do those three things, and the world requires to continue to do those three things. That will evolve over time. We do not do flu testing when people brush their teeth. We have to change the approach over time, but we need to continue to do those three things. We will give advice, as we have done, to the Deputy First Minister and others, as we have to the UK Government, that we need to continue to do those three things for us to help the population to live with the disease.
My other question relates to test and protect staff who have been working for the past 18 months and have been in touch with me in the past couple of days. They feel that the announcement last Tuesday was a kick in the teeth. Forgive me if this is wrong information, but the information that was relayed from them was that the health boards told them that funding was in place for test and protect until September. Therefore, there was an assumption that they would be in the roles until September and not out of a job in April. Can you give any clarity on that and the funding options?
There will always be judgments to be made about the longevity of the testing arrangements. Obviously, there is financial provision in the budget for 2022-23 that enables some testing activity to be undertaken. I would have to clarify what specific guidance on that point was previously given to health boards, because that relates to an internal health portfolio transaction and advice, so I had better write to the committee about that specific point.
That said, I would not imagine that it was likely that commitments were given to that extent or to that degree of specificity. There might have been a commitment in respect of, say, the need for on-going testing—I would not be at all surprised by that—but I will check and write back to you to provide clarity on the point.
Thank you—I would appreciate that.
10:30
Good morning, cabinet secretary and colleagues.
I have a couple of questions about the vaccination programme. Earlier, Professor Leitch mentioned the recent report in The Lancet, which was very significant in highlighting the importance of the programme in suppressing the virus. However, a report in The Scotsman this morning states that 27,000 doses of the vaccine were thrown away in February after fewer people than expected came forward to be vaccinated. Is that report accurate? If so, should we be concerned about it? Are we seeing a drop-off in the number of people coming forward for vaccination?
There will always be a degree of waste—I suppose that there is no better word for it—in the vaccination programme. I think that we all accept that, and ministers have made it very clear that we want to minimise that. If memory serves, I think that the vaccination programme commenced with an assumption that there might be as much as 5 per cent waste, but the practical reality is that, throughout the programme, there has been less than 1 per cent waste. If it is a question of performance against expectation, I think that we would have to say that that was a very good performance.
I would have to check the detail of the newspaper report that you referred to, but we are endeavouring to maximise participation in the vaccination programme. We are doing that because vaccination is absolutely the key to minimising the harm of Covid. One thing that concerns me about the narrative with regard to the discussion in recent weeks about Covid—particularly omicron—is the suggestion that omicron has been milder than previous variants. I think that that is the wrong way to look at the issue. I think that the vaccination programme is giving a lot more protection from what happens to be called omicron. There are numerous cases of people with the omicron variant who have faced very severe health consequences, because they have been unvaccinated.
We have to be careful about undervaluing the impact of the vaccination programme, as it has been crucial in tackling the effect of Covid, whether that be omicron or whatever. Fellow citizens of ours are having a very hard time with omicron—in many cases, that is because they are unvaccinated. The strength of the arguments in support of vaccination is, in my view, absolutely overwhelming, and the Government is using those arguments to encourage uptake of vaccination.
The more we have a sense that the worst of Covid is past us, the more there might be a sense that people do not need to get vaccinated. I would take entirely the opposite view and say that it is vaccination that is giving us the protection against Covid that people need.
Exactly as you would expect, Mr Fraser, I am going to take your 27,000 and raise it by the number of vaccinations that have actually been done.
For some context, I point out that, in January, we gave 472,000 doses and, in February, we gave 184,000 doses. Once the Pfizer vial is taken out of the freezer, it has to be used within 12 hours or thrown away. As the numbers go down a little and we get some of the stragglers instead of the 75,000 a day whom we were doing before Christmas, we will inevitably end up with some marginal differences, particularly in small vaccination centres where not all the doses can be used.
At the beginning, we said 5 per cent. We are still way below that. Nobody—particularly the vaccinators—wants to throw out any vaccine. That indicates that we are in a phase in which we are dealing with a group that is slightly harder to persuade to come to be vaccinated. We have vaccinated the massive bulk of people. As we deal with the over-75s, who are a big chunk again, and the youngsters, who are another big chunk, I anticipate that that waste will fall even further.
The top line of the story in The Scotsman this morning was that fewer people than expected have come forward for vaccination. Is that correct?
No. I do not think that that is fair. I think that that is an extrapolation from a piece of data on waste. We do not take vaccines out of the freezer unless we know that there are people in the room. If you have got one or two people, you have to take the vial out of the freezer and it has to defrost, so you have got to think about that before people come. If you have appointments for 100 people, you might take out enough vials for 100 people, but then only 80 people might turn up. If you multiply that over a month, you get to 27,000 relatively quickly, because there are six doses in a vial.
I do not think that we have seen levels dropping off more than we thought that they would. We always knew that we would see a drop off after the big push for new year. That does not mean that I do not want everybody to come forward to be vaccinated.
I have a specific follow-up question that arises from the case of one of my constituents who had quite a serious adverse reaction to the second dose of the vaccine. I know that that is rare, but it does happen. He then went to his GP, who advised him not to get the booster. His concern was that, if he was required at some point in the future to provide certification of full vaccination status, he would need to get an exemption. He then applied for an exemption, but he was told that he was not eligible. However, nobody spoke to his GP and nobody asked to see his medical records. He is now in limbo, because his GP has told him that he should not get a booster, but he is not entitled to an exemption. Where does he go from here?
Ministers have made clear to the Parliament on countless occasions that you can write to me about certification issues. Mr Fraser is welcome to write to me, and I will see that there is a resolution to that particular issue.
I did write to you, Mr Swinney, and I got your reply last month. You gave me two pages of very general advice. However, that did not address the specific issue that that man’s GP has told him not to get a booster at the same time that the NHS, without asking to look at his medical records, has told him, “Sorry, you are not eligible for an exemption.” I am slightly confused about how somebody can reach that conclusion about his personal circumstances without liaising with his GP.
I am happy to look at that to see exactly how that can be resolved. We sometimes face competing medical opinions about the right thing to do. I will not give clinical advice, but I will ensure that the issue can be addressed.
Okay. I will write to you again. Thank you.
On the entirely different topic of care homes, restrictions on visiting care homes have been lifted, which is very welcome. A constituent contacted me to say that she has an elderly relative in a care home in which, if a member of staff tests positive, the entire care home is locked down and residents are not allowed to leave their rooms to go into common areas. That is very distressing for residents who have already had to put up with two years of isolation, and that happens with some frequency because of the high incidence of Covid. As far as I can tell, that approach is not set out in Government regulations, but it would be helpful if you could confirm that and say whether any advice is being offered to care home operators on such issues.
That is not the Government guidance, although quite a lot of risk assessment is done by care homes, which all look very different. Some are Georgian houses and some are very modern establishments, so we have to be generic and give some power to care home managers to make those choices.
If you contact us about that specific care home, I will ensure that somebody gets in touch to make sure that the managers are familiar with the most recent guidance. In light of the announcements on Tuesday, particularly around testing for staff and residents, the guidance will be redone. We hope that that will allow a further relaxation of some of the protections.
Those are our most vulnerable citizens, so we must be cautious but, as you have illustrated, other harms result from being locked in rooms and not being able to use communal facilities if someone tests positive. We are hoping to relax some of that.
That individual care home is not following the national guidance, but there might be good reason for that, such as its environment. Let us get in touch with it to make sure that we are doing all that we can for it.
I agree with the Deputy First Minister about the testing staff. I have been for a few tests in winter weather in Dunfermline and Cowdenbeath, and those people have worked through it all. They deserve our gratitude and thanks.
Given that we are going to scale back that work, how many staff are involved? Is the Government saying that health boards should start to look at a programme that will give people opportunity? We know that we have staffing shortages throughout the economy, and we certainly have tonnes of shortages in social care and the NHS. Are opportunities being put in place? Is there a programme for working with people who have given their all during the past year or two and getting them into other posts? Is there a plan in place for that?
The testing programme has been delivered through a number of channels. Some testing is delivered under the auspices of the NHS in Scotland, and some is delivered within the test and protect infrastructure that was put in place by the UK Government and its contractors.
There are different employment relationships in there. For example, the NHS in Scotland turned over substantial proportions of its lab testing environment for the purposes of Covid. There will be ways in which that will be redeployed for other purposes. There are therefore different ways of approaching the matter.
The key point—this is where I agree with Mr Rowley, and I want to reassure him—is that we have staff shortages in a range of areas within the health and social care system. Individuals who have been involved in testing have also been involved in that activity, so it would seem natural to make sure that they have access to recruitment opportunities within the NHS, as well as appropriate training opportunities. That will be taken forward by individual health boards, all of which have in place recruitment strategies to fill vacancies at different levels of activity in the health service.
That leads me to my next question, which I also asked the Cabinet Secretary for Health and Social Care. In the past couple of weeks, we have taken evidence from third sector organisations that have said that joined-up working can be a bit hit or miss. Some health authorities welcome those organisations and they have an input, but others have to wait until they are called upon. It seems to me that there is a massive resource problem, but there is a massive resource out there in the third sector, health and social care, the NHS and local government, and I am not sure that it is all coming together. We have also asked GPs whether they have all those support services around them, and even they have said that it is a bit hit or miss.
That is a question of leadership. Government is not about micromanagement, but surely we must ensure that we are getting the best from the resources that we have out there. Do you think that we are?
Mr Rowley is tempting me to go into an area that has been a significant source of frustration for me for some time. The Government could not be clearer about the need for joined-up working and person-centred activity at the local level. I have been banging on about that for years, and it is central to the Covid recovery strategy.
I would not describe the situation as casually as saying that it is “hit or miss”, as Mr Rowley does, but I do not think that it is perfect. The strength of third sector contributions is suitably, or possibly even fully, taken into account in some parts of the country, but I do not think that it is in other parts of the country, and I do not think that it is all person centred. I think that there is still an increasing extent to which members of the public are expected to join up public services, whereas it should not be for them to do that; it should be for public services to be joined up and available to members of the public to access.
10:45Those messages are absolutely central, and I am very confident that the message that Mr Rowley seeks to put forward is being put forward by ministers. I hear it being put forward by the health secretary and by the social justice secretary in her dialogue with local government. I certainly put it forward in my dialogue with both of them. Indeed, those two Cabinet colleagues and I used the opportunity of a discussion with more than 200 people who work in the leadership of health and social care activity around the country—the fact that 200 people had to be on the call tells its own story—to stress the importance of ensuring that all capacity, no matter whether it comes from the third sector, the private sector or the public sector, is woven together into a single proposition that is available for members of the public.
I think that that is strong in some parts of the country. In other parts of the country, there is still a distance to be travelled.
Okay. We know that we have a major problem coming our way—which is getting worse—in the cost of living crisis. At some point, will the free lateral flow testing cease? Will people have to pay for it?
No.
Okay. That is good.
For the absolute avoidance of doubt, lateral flow tests will remain free of charge.
Thank you.
I asked you this question at committee some time ago, Deputy First Minister, and I am going to ask it again. The last time I looked, the number of people in hospital was 1,999. I look at the figures every day, and that figure concerns me quite a lot. We heard from the health secretary earlier that the hospitals are really toiling. Should we really be lifting any restrictions on Monday?
There are two numbers that I encourage Mr Mason to look at. The total number of people who are in hospital with Covid is important, but just as important is the number of new admissions week by week, by comparison. The latter number—the number of people being admitted to hospital week by week—is beginning to show a reduction. I was going to say that it is tailing off. I do not think that I could justify saying that, but it is certainly reducing on a weekly basis. That indicates to me that we appear to be getting over the peak of the challenge that we face from BA.2.
On that justification, I think that we are in an appropriate place to undertake the relaxations that will take place on Monday. However, I also note that the Government has taken the difficult decision, which I recognise is not universally popular, that one of the relaxations that was proposed for Monday will not be permitted. That is the relaxation of the legal obligation to wear face coverings in public spaces. We judged that, given where we are in this challenge, it is appropriate and proportionate to extend that measure for a further two-week period, and then to review it. By that time, we should have clearer evidence that we are over the peak of BA.2 and we will be able to more confidently take that step. I appreciate that that position is not universally supported, but I judge the decision that the Government has made to be the right one.
I move on to testing, as I would like clarification on one or two points. Testing is going to carry on if somebody visits a care home and in certain other circumstances. As an example, I might want to visit my elderly aunt. In the past, I have tested before going to see her because I feel that she is vulnerable. It is not going to be possible for me to do so in the future, is it?
If you have any lateral flow testing kits available, you will be able to do so.
If I keep them, yes, but I will not be able to get any new ones after the end of April.
That is correct.
I read that two months’ worth of testing capacity will be kept in case of another uptick. Presumably, however, the kits go out of date after a while and will have to be thrown out. How often will we—or the Government—have to keep replenishing them?
There will be an on-going element of testing as we go forward. It is not that we will just have all those testing kits in a locked warehouse. The supply will be replenished to avoid exactly the situation that Mr Mason—very fairly—puts to me, so that we utilise the resources that we have at our disposal.
The isolation grants are also due to cease as part of the overall measures. Does that mean that we will go back to the other system whereby, if anyone has to isolate for Covid or any other reason, the health board has financial responsibility for getting them to do so?
We are looking carefully at the issues around self-isolation grant support. Fundamentally, we need to recognise the interaction between individuals’ practical circumstances and the necessity of interrupting the circulation of the virus. The advice that will be available will encourage people to remain at home, in the same way that we would advise people with other conditions who might run the risk of spreading illness to other members of society.
We are looking carefully at the arrangements around self-isolation, because I recognise the challenge that Mr Mason raises. It might not be financially practical and possible for individuals to be able to self-isolate without loss of income. The points that Mr Rowley put to me about the cost of living crisis that people are facing is another dimension of it, and we are looking carefully at what other arrangements can be put in place.
I stress that the arrangements under the Public Health etc (Scotland) Act 2008 are designed for very limited outbreak purposes, and are not really suitable for the much wider proposition regarding the scenario that Mr Mason puts to me.
Yes—that point came up when we looked at the legislation.
Yes.
I move to my final area of questioning. Murdo Fraser touched on vaccinations and take-up levels. As usual, I have looked at some of the figures that we have been given. I see that among 30 to 39-year-olds, only 57.6 per cent of males have had a booster. That is quite a lot lower than the proportion in older age groups. I also looked at the figures for Glasgow, where I saw the lowest figure—66.1 per cent—for those who have had three vaccinations, including the booster. Are we making any progress on those numbers, or do we just accept that it is an on-going challenge?
We have to persist with the message about the importance of vaccination. As I said in my answers to Murdo Fraser, I am concerned by an attitude of mind that says that omicron is much softer than previous variants. That view is allowed to prevail precisely because of the robustness of vaccination. If we do not have robust vaccination, we will be exposed to much more serious illness.
That brings me back to Mr Mason’s first question, about hospital admissions. If people are more seriously ill and spend more time in hospital, those numbers will not come down, and our hospitals will face a problem. I come back to the point that I have reiterated to the committee on a number of occasions: our national health service came closer to being overtopped during omicron than during any other part of the experience of Covid.
I want to follow up John Mason’s comments about occupied beds. Cabinet secretary, you alluded to the fact that we are starting to see a switch from beds being occupied by Covid cases to beds being taken up by patients with other conditions. That issue was also mentioned during the previous agenda item. Are we getting to a point at which the other conditions that have been delayed are beginning to present? Is that the next crisis that the NHS will face? Will dealing with delayed presentations maintain the pressure on it?
I do not have the precise comparative numbers in front of me today, so I hope that Mr Whittle will forgive me for giving rough numbers based on my recollection. Three weeks ago, when the Government set out the strategic framework, the number of people in hospital with Covid was about 1,060—that is the figure that comes to mind. On Tuesday, that number was a few short of 2,000. It had virtually doubled in the space of three weeks. That high level of in-patients is why the Government has not followed through on all the steps that we intended to take on 21 March.
Obviously, there is a world of a difference between having about 1,000 patients in hospital with Covid and 2,000 patients. It leads to significant challenges relating to the treatment of patients with Covid, such as the need to isolate them from other patients, which undermines hospital capacity.
We really must see those numbers come down significantly. We are seeing signs of that happening now, but we need there to be further reductions to create the space for smoother access to hospital care for people with a variety of other conditions.
My concern is that, if we reduce the prevalence of Covid to the hoped-for levels, the pressure on the health service will simply move from treating Covid to treating other conditions whose presentation has been delayed. Is that a reasonable assumption to make?
Yes, that is a fair assumption. As Mr Whittle has said, the issue that most troubles leaders in the health service right now is that we have come out of an intense period of managing Covid, and it is likely to be followed by an intense period of managing non-Covid conditions.
Winter in the national health service is lasting an awful long time. In fact, winter feels like it is here all the time. Winter pressures tend to last between October to March. We are almost at the end of March and it does not look like the situation in hospitals is improving to any extent whatsoever. That places a huge burden on members of staff, who are already very tired. Some of them will also have been ill, and they might still be trying to fully recover. As we all know, one of the effects of Covid is that people often experience fatigue over a long period. Health service staff are putting in very demanding shifts. If they are tired when they start them as a result of their having had Covid, which is highly likely, given where they are working, that is an additional burden for the health service to manage.
There are three predictable categories in which the pressure will, without question, continue. Those are: late presentations of new disease; existing presentations in which people are on waiting lists; and mental health. All those are worse post Covid because of Covid. You simply cannot treble intensive care capacity without that having an effect on what you can provide.
There is some positive news. We do not have any flu or any respiratory syncytial virus to talk of. Also, some of the elective care is done by different teams from the teams that I talked about in the previous agenda item and the people that the Deputy First Minister has just said are tired. Some of our surgical teams are very much ready to go and looking forward to getting back to treating people. However, about 15 per cent of our beds still have Covid patients in them. I know that we say this all the time, but the key is to get prevalence down. Then, you can get stuck into—forgive the tone—those three categories, because we must get them done.
11:00As I have said previously in this committee, 40 per cent of people who end up with a cancer diagnosis do not have a cancer referral—they are referred for something else, and we discover that they have cancer during their pathway. If you are on an out-patient waiting list for pain or a lump, and you wait for a long time, your cancer diagnosis will be late. That is true in Scotland and in every major developed healthcare system in the world. That is why we need to get into those waiting times and late presentations.
We know that that pressure is coming, and I am sure that it is a global issue rather than something that affects Scotland in isolation. How do we prepare for the fact that, as I said, there are conditions that will continue to put pressure on the health service?
Essentially, we have to make considered judgments about the prioritisation of cases and resources. Although some treatments were paused during the pandemic, we maintained cancer treatment throughout it because it is important, and we also obviously maintained emergency care and interventions for individuals. We have to ensure that we prioritise, and that we maximise capacity.
The recovery plan proposals that the health secretary set out are about expanding capacity, recruiting more personnel to support us and ensuring that we have in place all the capacity that we need to enable us to support people. We then need to maintain our vigilance and our practical interventions to try to suppress the levels of Covid, which—as Professor Leitch just said—occupies a significant amount of capacity in the national health service.
Mr Swinney, Alex Rowley asked whether testing will continue to be free for people, and you said yes. However, John Mason then asked whether people will have to pay for it after April. I am confused by your answers. Have I picked them up wrongly?
I did not say that to John Mason at all. We are currently advising people to test twice weekly. That advice will stop.
In April?
Yes. However, if there is a requirement for people to test beyond April—there are some other requirements listed in the “Test and Protect Transition Plan”; the schematic indicates “Testing to Protect high risk” and “Testing for Clinical Care”, for example—those tests will be free.
That clarifies that point—thank you. However, to go back to John Mason’s point, if someone wishes to continue to test, perhaps not regularly but for a particular reason, such as to visit a care home or an elderly relative, the test will not be available free of charge as it currently is.
There will not be an obligation on people to do so. That is what is different.
The judgment is made, and the change in definition is about what is high risk and what is not. Free testing will remain for high-risk settings. If someone is visiting a care home, we anticipate that they will still be provided with free lateral flow devices before they go. Mr Mason’s quite legitimate question was about whether he will get a free LFD test to enable him to visit an elderly relative in a house, not in a care home. He will not. That is what the “Test and Protect Transition Plan” says.
Would the Government prefer to be able to continue to supply free tests for people who want to continue testing?
There is a fine judgment to be made. There is a question—Government has to wrestle with this at all times—regarding what constitutes proportionate action. If the prevalence of Covid was to reduce significantly in our society but we were still testing as if it was as virulent as it has been in recent weeks, I think that the Government would face some challenges as to the proportionality of our actions and requirements, and the use of public money, because there was not the community-wide prevalence that would justify a testing infrastructure of the type that we have had in place until now. That is why the risk-based assessment that is included in the transition plan is relevant for the judgments that we have made.
Okay, but I am going to challenge you on that. We have just heard from the health secretary evidence that this week has been the hardest week in hospitals because of the pressures of Covid. It is now early March, and we are talking about testing being phased out by April. Are you confident that we can relax the testing regime by the end of April, given the current numbers?
We think that that is the case because, as I said in my previous answers, we believe that we have passed the peak of the BA.2 variant. We see that in a number of respects, including in cases and hospital admissions. Although the numbers in hospital are high, they are not being added to with the same vigour as was the case previously. Provided that that pattern continues, I would content, in the face of the evidence that Mr Fairlie puts to me—I know that this is a contested proposition and not everyone agrees with us—that the Government has taken prudent steps to deal with that.
If, for example, we had gone ahead and removed the legal obligation for face coverings on Monday, I think that Mr Fairlie would have had legitimate additional questions to put to me. However, we took the decision that we did. It caused some controversy—a number of people are kicking off about it—but, in my view, it was the responsible thing for us to do in order to provide a bit more protection and to try to get the situation under control.
I am definitely one of the more cautious ones. I want to see a continuation of testing, as I want to ensure that we know where the virus is.
That takes me on to a technical question for Jason Leitch. On a number of occasions, Mr Swinney has talked about waste water testing. Will you explain that, please?
Yes. I will try to do so politely, because it is still morning.
There is not a polite way of describing it.
Fundamentally, when someone is positive with Covid, they shed virus in their bodily fluids, whatever those might be. We can find genetic material from Covid in the sewage around the country so, depending on where the sewage sites are and how small or big they are, we can tell in rough terms where Covid is. That gives us an early warning because people often shed the virus in their bodily fluids before they have symptoms.
As the Deputy First Minister is sitting beside me, I ask him whether he remembers the three sisters chicken outbreak.
Yes—it was the 2 Sisters factory.
I am sorry. I gave them an extra sister. [Laughter.]
You have exaggerated by 50 per cent.
At the 2 Sisters chicken factory, we knew that Covid was there because we found it in the sewage plant that served the plant, as there were so many people around. We can also do that in relatively localised areas of Glasgow, for example, so we can tell where Covid is. It gives us an early warning, and we will then be able to intervene with outbreak management and advice to the population. Crucially, the science has recently allowed us also to do genetic testing, so we can now tell which variant is in which place. That is just coming online.
We can think of waste water testing as an early warning score for Covid outbreaks in an area. If we were going to have an outbreak in a big call centre or in Arbroath or Elgin, we would get an early warning.
Okay. I accept your science. However, with my cautious approach, I would much rather still see people testing on a regular basis.
What I have described does not replace testing. It adds to our ability to do surveillance. It certainly does not replace individual testing.
I return to the answer that I gave to a question from the convener, or perhaps from Mr Fraser: we are operating at two levels. On population-wide surveillance, a large measure of what we do has until now been informed significantly by polymerase chain reaction and lateral flow tests. We are now moving to a situation in which population-wide surveillance will be done through waste water testing and Office for National Statistics infection surveys. That recognises that the pandemic is changing. The strategic framework that the Government has set out indicates the developments that are taking place in the pandemic and how we need to respond to them. It is appropriate that we adapt our stance as the nature and composition of the pandemic changes over time.
Okay. I genuinely take your point, but I am asking these questions. We are also talking about people’s perception of where we are with the virus. You spoke earlier—quite rightly—about people seeing omicron as being okay because it is milder, and you want to flip that view around. However, it seems to me that taking away testing adds another layer of complacency to people’s thinking.
I unreservedly accept that there is a danger that people will become complacent about Covid. However, I want to assure the committee that the Government does not take that view. We have insisted on undertaking population-wide surveillance activity so that we are able to assess the general position on infection. Waste water sampling allows us to narrow that down to parts of the country and see where levels of infection are perhaps more intense. That can then inform outbreak management. We will still be active in that field. Some of the regulations that the committee will consider today are all about enabling us to undertake outbreak management. Without the regulations, we would not be able to do that as well as we should.
In addition, the risk-based approach to testing is part of the plan that the Government has issued.
Okay—thank you. Do I have time to ask about outbreak management, convener?
Yes.
I will be quick. I know that I am taking up a lot of our time.
Skimming through the strategic framework update, I see that one of the paragraphs states:
“To inform the response to an outbreak of a potentially dangerous variant of COVID19, the Scottish Government with Public Health Scotland ... Local Government and other partners, are developing the COVID-19 Outbreak Management Plan, which will set out the process and methods for responding to future outbreaks. We aim to publish this in spring 2022.”
How far away are you from publishing the plan?
It will be published shortly. Essentially, the thinking around the plan has been informed by two years of experience of dealing with various outbreaks of different shapes and sizes around the country. Professor Leitch mentioned the significant outbreak at the 2 Sisters plant, and we have had a number of other examples in industrial, education and community settings, and in localities. Local health protection teams have developed a lot of good intelligence on how to respond in given circumstances.
In relation to the 2 Sisters plant, I remember the very effective approach that was taken by the public health team in Tayside, which decided not to recommend a localised lockdown, but to recommend isolation for staff and their families. That was a supremely successful intervention that was well executed and communicated. Essentially, that population was insulated from the rest of the population and there was no community transmission. That has been possible at certain moments of the pandemic.
In future, that is a more likely intervention to be undertaken than has been the case in the past six to nine months, when there has been extensive community prevalence, meaning that such tactics have been less relevant. The plan will draw on the expertise that has been built up over the past two years.
Thank you. We will come on to the legislative side of things.
Brian Whittle has a question, after which we will move on to agenda item 3.
Thank you, convener. I appreciate the opportunity to ask this question. I want to go a little bit further with Jim Fairlie’s line of questioning. The aspects that we should continue to monitor as we travel on this journey were alluded to earlier. In an earlier session with the Cabinet Secretary for Health and Social Care, Professor Leitch mentioned the extensive data in a paper in The Lancet, which includes global measurements. What should we continue to monitor locally so that we can put our data into a global perspective, perhaps using the World Health Organization’s advice on data gathering?
11:15
There are different elements to that. We have to continue to monitor locally for two purposes. The first is to assess prevalence. Do we have the right positioning? The strategic framework sets out risk levels. Just now, we consider ourselves to be at a medium risk level. I hope that we will get to a low risk level fairly soon. Obviously, if we get to a high risk level, we will have to take other steps. That is about pandemic management in our society, for which we have absolute responsibility.
The second element is our contribution to the global understanding of where we are. Professor Leitch might want to add elements to what I say on that, but if we see the emergence of a new variant in our society, we have an absolute obligation to make sure that we alert every other jurisdiction. If a new variant of the virus develops in Scotland, it will be our global obligation to identify it and share the information with others.
There are two levels. First, how do we control the pandemic in Scotland? Do we have the right positioning? Are the strategic and testing frameworks appropriate for the times or do we need to shift what is in them? Secondly, are we able to contribute to the international understanding of what is happening with Covid? Without the tremendous research that was undertaken in southern Africa, we would not have got as much information—or information of such quality—about omicron. That helped us to respond as quickly as we did and to avert a very serious risk of undermining our national health service.
That covers surveillance very well. Those are the two things that we need to know. We need to know numbers and about variants, and we need that information at a global level. For example, there is almost no testing in Haiti so, if the variant comes from there, we will be completely in the dark. There is extensive genetic testing in South Africa so, if it comes from there, we will know. If it comes from here, we will know.
As I argued in the earlier session, we also need two other things. We need research on disease course so that we know how the disease is changing, who it is affecting, who is living and who is dying. We also need to know about treatment. This early in a new infection—it is two years since the disease arrived—we have to continue to follow people so that we know whether our drugs are working. That requires considerable resource and investment, and we need to follow patients over a long period. The work includes trials with universities, as well as Government support across the UK and the world, to allow us to get better at finding the disease and treating it.
That concludes our consideration of that agenda item. I thank the Deputy First Minister and his officials for their evidence today.
Agenda item 3 is consideration of the motions on the made affirmative instruments that were considered in the previous agenda item and on two instruments on which we took evidence at our meeting on 24 February. Deputy First Minister, would you like to make any further remarks on the Scottish statutory instruments listed under agenda item 3?
I will make some comments on the contents of these sets of regulations.
The Coronavirus Act 2020 (Alteration of Expiry Date) (Scotland) Regulations 2022 extend the expiry date of temporary provisions in the UK Coronavirus Act 2020 by a further six months, thus ensuring that specific powers in the UK act will continue to be available to ministers until 24 September 2022.
The Health Protection (Coronavirus, Restrictions) (Directions by Local Authorities) (Scotland) Amendment Regulations 2022 change the expiry date of the local authority direction regulations and will ensure that the powers given to local authorities in those regulations continue to be available to manage local outbreaks of coronavirus.
The Coronavirus (Scotland) Acts (Amendment of Expiry Dates) Regulations 2022 extend all the provisions in part 1 of each of the two Scottish coronavirus acts from 31 March 2022 to 30 September 2022, except for four provisions that will be expired by a further statutory instrument, the Coronavirus (Scotland) Acts (Early Expiry of Provisions) Regulations 2022.
Finally, the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 5) Regulations 2022 remove from the principal regulations of the Health Protection (Coronavirus) (Requirements) (Scotland) Regulations 2021 the provisions in relation to the Covid-19 vaccination certification scheme.
Are members content for the motions on the agenda to be moved en bloc, with the set of the three extension regulations that relate to the UK and Scottish coronavirus acts taken together, followed by the remaining two instruments?
Members indicated agreement.
I invite the Deputy First Minister to move the motions.
Motions moved,
That the COVID-19 Recovery Committee recommends that the Coronavirus Act 2020 (Alteration of Expiry Date) (Scotland) Regulations 2022 (SSI 2022/40) be approved.
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus, Restrictions) (Directions by Local Authorities) (Scotland) Amendment Regulations 2022 [draft] be approved.
That the COVID-19 Recovery Committee recommends that the Coronavirus (Scotland) Acts (Amendment of Expiry Dates) Regulations 2022 [draft] be approved.—[John Swinney]
Do members have any comments?
Consistent with the view that we have taken on other occasions, I oppose the motions. We have been round the houses on this issue a number of times, so I will not tire the committee by going over all the arguments again.
The instruments seek to extend by another six months the emergency powers that were taken by the Scottish Government to deal with the coronavirus pandemic. We had some discussion earlier around the paper in last week’s Lancet, which, as the first peer-reviewed global estimate of excess deaths, observes no clear relationship between levels of excess mortality and different levels of restrictions. In addition to that, given that we know that the public adhere quite strictly to public health guidance, my view is that we should proceed to address Covid through public health guidance rather than through extending those extraordinary and emergency powers by another six months, as the instruments seek to do.
I recognise that some aspects of the instruments are beneficial, such as the provisions to allow nurses, rather than doctors, to administer vaccines. As ever, the classic challenge for an Opposition party is that we cannot amend the statutory instruments before us; we must either accept them as a whole or reject them as a whole. Given the extent of the emergency powers that they seek to extend, we must, in this case, reject them as a whole.
As we have just heard in the evidence session, there are 1,999 people in hospital. We hope that things will get better, but as things could get worse and there could be more variants in the next few weeks, this is not the time to end those emergency powers.
I whole-heartedly agree with Mr Mason.
Murdo Fraser has just said that, by and large, the people of this country follow the rules or guidance but I recall that, in the chamber earlier this week, Sandesh Gulhane opposed the wearing of masks, saying that most people do not wear them properly anyway. I do not see the consistency in the message. Right now, given the numbers that we have, it would be crazy to do anything other than keep the possibility of using restrictions if we need them.
John Mason has made the point that the virus is not over. I hope and pray that we do not have other variants that mean that we have to go backwards again, but there is no certainty in any of that. I think that, given where we are, given where we have been and given the level of Covid just now, the majority of people in Scotland believe that the restrictions are not unreasonable. In fact, somebody said to me the other day that everybody knows somebody with Covid, so I do not think it unreasonable for us to have some protections, such as face coverings.
In a BBC television interview last night, somebody said that if, after all the suffering that there has been in Scotland, the worst that we had to suffer was having to wear a mask for a few more weeks just to have those protections, such a proposal would be perfectly reasonable. This debate is more about playing party politics than anything else. It is trying to create division where we should be creating unity, so I will certainly support the motions today.
To be honest, I am disappointed with Mr Rowley’s characterisation of the matter, because it is entirely not the case.
The general public do not know that the majority of the rules that they face are not law, but guidance. They have been following them. My point is that the speed with which, as has been demonstrated, we can bring emergency legislation to the Parliament means that there is no need to continue with the emergency legislation that is in force. If it is required, it can be brought swiftly to the Parliament.
I reiterate to Mr Rowley that my opposition to the motions has nothing to do with party politics. The fact is that the majority of the rules that we follow are guidance, not law.
The arguments have been well aired. The points that Mr Mason and Mr Rowley have made recognise that the pandemic is not over in any shape or form. As a consequence, we must have measures available to enable us to respond, should the situation deteriorate.
On the issue of local outbreak management, which Mr Fairlie raised with me, the Health Protection (Coronavirus, Restrictions) (Directions by Local Authorities) (Scotland) Amendment Regulations 2022 provide for the necessary interventions for effective outbreak management in trying to deal with local outbreaks that might create a wider difficulty.
The Government seeks this extension to enable us to have the capacity to respond should we need to. It is not because we will exercise the powers; it is to give us the capacity to do so, as members of the public will expect. I would therefore appreciate it if the committee would support the regulations that are in front of it.
The question is, that motions S6M-03075, S6M-03169 and S6M-03349 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.
Motions agreed to.
We now move on to the second group of motions. I invite the Deputy First Minister to move motions S6M-03202 and S6M-03354.
Motions moved,
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (International Travel and Operator Liability) (Scotland) Amendment (No. 3) Regulations 2022 (SSI 2022/53) be approved.
That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 5) Regulations 2022 (SSI 2022/74) be approved.—[John Swinney]
Motions agreed to.
That concludes consideration of the motions. The committee will, in due course, publish a report to the Parliament, setting out its decision on the statutory instruments that were considered at the meeting.
That concludes our consideration of this agenda item and our time with the Deputy First Minister. I thank him and his supporting officials for attending, and I suspend the meeting to allow the witnesses to leave.
11:29 Meeting suspended.11:30 On resuming—
Item 4 is consideration of SSI 2022/64, on which we took evidence under item 2. Members should refer to paper 4 in our meeting pack, as well as the policy note that accompanies the regulations.
This is a negative instrument and the deadline for lodging a motion to annul is 19 April 2022. As outlined in the policy note, it expires some of the provisions in the Coronavirus (Scotland) Act 2020 and the Coronavirus (Scotland) (No 2) Act 2020.
When the Delegated Powers and Law Reform Committee considered the regulations on 1 March, it had no points to raise, and no motion to annul the regulations has been lodged to date. If no member wishes to make any comments, does the committee agree to make no recommendations on the regulations?
Members indicated agreement.
The committee’s next meeting will be on 24 March, when we will continue to take evidence on the Coronavirus (Recovery and Reform) (Scotland) Bill.
That concludes the public part of the meeting. We now move into private for consideration of our final item.
11:31 Meeting continued in private until 11:42.Previous
Excess Deaths Inquiry