Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 17, 2020

Official Report 946KB pdf

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Covid-19

The next item of business is a statement from the First Minister on Covid-19. The First Minister will take questions at the end of her statement. I encourage all members who wish to ask a question to press their request-to-speak buttons.

14:18  

First, I will give a summary of today’s statistics. The total number of positive cases that were reported yesterday was 1,248. That represents 9.7 per cent of all tests carried out, and it takes the total number of cases to 83,259. The number of people in hospital is 1,249, which is an increase of 22 from yesterday, and 95 people are in intensive care, which is three fewer than yesterday.

I regret to say that, in the past 24 hours, a further 37 deaths have been registered of patients who first tested positive over the previous 28 days. That means that the total number of deaths under that measure is now 3,323. Once again, my deepest condolences go to all those who have lost a loved one.

National Records of Scotland will publish its weekly report tomorrow. That report records deaths confirmed through a test as being Covid related and those that are presumed to be so. It is very likely, based on the numbers that we have reported in the past seven days, that the death toll, under that wider measure, will this week pass 5,000. That is a sombre and deeply distressing milestone. It is important that we acknowledge it, and that we remember every individual whose life has been lost to the virus.

Those figures remind us of the harm and the heartbreak that Covid causes if it is allowed to spread. They also provide important context for today’s statement, in which I will report on the outcome of the Scottish Government’s review of the Covid protection levels and set out the difficult but necessary decisions that we have reached about the appropriate level of protection in each local authority area.

In reaching these decisions, the Scottish Government has taken careful account of case numbers and test positivity in different parts of Scotland. We have also considered the trends in each area and the pace—or otherwise—of those trends, and we have assessed what all that might mean for hospital and intensive care capacity. We are publishing today the up-to-date and detailed data for each local authority area on the Scottish Government website.

We take advice from the national incident management team, the chief medical officer and the national clinical director on the measures that are needed to control the virus, and from a range of senior officials on minimising the wider harms that result from Covid restrictions. We also consult with local authorities before reaching a final judgment, which the Cabinet did this morning. I understand that Parliament will have the chance to debate the decisions on Thursday.

This week, given that the levels system has now been in place for almost three weeks, we have had the chance to reflect on what we have learned so far about the effectiveness of different levels in reducing the prevalence of the virus, and on the importance of acting quickly and firmly against Covid.

I turn to an assessment of the situation that we face before I set out the decisions that we have reached. First, I want to be very clear that the restrictions that have been in place in recent weeks on household gatherings and hospitality have made a difference. They have slowed down the increase in cases considerably, and they have helped to flatten the infection curve. In early October, we were on a trajectory that, without action, would have seen us reporting around 3,000 cases each day by now. That has not happened—daily case numbers are almost a third of that figure and, at this point, prevalence in Scotland is lower than in other United Kingdom nations. We have made progress, which is thanks to people across the country, but the overall level of infection remains higher than we need it to be, and the national picture is masking significant regional variations.

While some areas have low and even slightly declining infection rates, a number of local authorities across central Scotland have case numbers and test positivity rates that are significantly above the national average. Although the situation in many of those areas has stabilised, it has done so at a stubbornly high level. That creates concern for a number of reasons, which I will set out in a moment.

In summary, therefore, the Cabinet has decided as follows. Nineteen council areas—the majority—will see no change to their levels this week. I am pleased to say that, from the start of next week, assuming that there is no significant deterioration in the situation before then, two areas will move down from level 3 to level 2. However, 11 local authorities will, from 6 pm on Friday and for a strictly limited period, move from level 3 to level 4. I will set out the details of all those decisions in a moment.

I am acutely aware that, for many individuals and businesses, those decisions will be both disappointing and distressing. They demand more sacrifice from all of us. I therefore want to take a moment to remind people why the decisions are necessary and what they are intended to achieve.

First, the decisions are necessary to ensure that the national health service can cope with the range of pressures that it will face over the winter. We must ensure that hospital and intensive care services are there not just for those with Covid, but for everyone who needs them. That means that we must get case numbers down from current levels before we go into a period in which winter pressures are very likely to increase.

Secondly, the decisions will give us the best possible chance, albeit in a limited and careful way, of being able to ease restrictions in all parts of Scotland for Christmas. That is something that all of us want to look forward to, but we know that it will increase the risks of transmission, so we must get infection rates to a lower baseline now.

Thirdly, the decisions will help us to limit the impact of the virus, including through loss of life, as we steer a path through the next few months towards the brighter times that are now within sight, as vaccines and better treatments become available.

Difficult though today’s decisions undoubtedly are, please do not forget that an end to all this is now within our grasp, but we must get through the next few months as safely as possible. That means that tough decisions cannot be avoided, no matter how much you and I fervently wish they could be.

I turn now to the detail of our decisions, starting with local authorities that are remaining at their current level. I can confirm that Orkney, Shetland, the Western Isles, Moray and Highland will remain in level 1. For now, in common with the rest of the country, we are asking people in Moray and the Highlands not to visit other people’s houses. However, for all areas in level 1, it will be permissible from Thursday this week to meet outdoors with up to eight people from a maximum of three households.

I can confirm that Aberdeen City, Aberdeenshire, the Borders, Dumfries and Galloway and Argyll and Bute will all remain in level 2. We hope that those areas—perhaps Argyll and Bute in particular—will be able to move to level 1 soon. However, in some of those areas there has been an increase in cases in recent days. We are particularly concerned about quite sharp increases, albeit from a relatively low level, in Aberdeen and Aberdeenshire.

That leads me to make a general point—a plea—to everyone living in level 1 and 2 areas. Please do not assume that being in one of the lower levels means that you can ease up. On the contrary, having fewer restrictions means that the virus has more opportunities to spread, so it is more vital to abide by all the rules and precautions. Please use the postcode checker on our website to remind yourselves of what the restrictions are in your area, and please stick to them.

I am pleased to report that East Lothian and Midlothian have both had a marked decline in infection rates and that prevalence in those areas is significantly below the level for Scotland as a whole. On that basis, I can confirm that, assuming that there is no significant deterioration before then, East Lothian and Midlothian will move down from level 3 to level 4—sorry; from level 3 to level 2—from next Tuesday, 24 November. Between now and then, those local authorities will be able to undertake necessary environmental health and compliance checks and work with NHS Lothian to minimise any risk of increased transmission that the move to level 2 will bring.

I can confirm that the City of Edinburgh, Clackmannanshire, Falkirk, Inverclyde, North Ayrshire, Dundee, Fife, Perth and Kinross and Angus will all remain at level 3 for now. To varying degrees, those areas are all making some progress, although it remains fragile. However, we are hopeful that, if that progress continues, they will move to level 2 soon.

I turn now to our decisions about level 4. The council areas that will move to level 4 for a limited period from Friday are: Glasgow City, Renfrewshire, East Renfrewshire, East Dunbartonshire, West Dunbartonshire, North Lanarkshire, South Lanarkshire, East Ayrshire, South Ayrshire, Stirling and West Lothian. In all those areas, there are grounds for continued and significant concern.

In the seven days up to Friday, Scotland as a whole had just over 140 new cases of Covid per 100,000 people. All the areas moving to level 4 were above that level, ranging from West Lothian, with a rate of 158 cases per 100,000, to Glasgow, with 277. Test positivity for all those areas, with the exception of West Dunbartonshire, was also above the average. Stirling has experienced a particularly sharp increase in cases over the past week. While some of that can be attributed to specific outbreaks, there is also a level of community transmission there that must be tackled.

In the other areas, infection rates have stabilised or even fallen slightly as a result of level 3 measures. However—and this is the key point of concern—the infection rate in all those areas remains stubbornly and worryingly high. At such levels, we simply do not have the assurance that we need that hospital services and intensive care units will be able to cope as we go deeper into the winter. In those areas, pressure on hospitals and on those who work in them is already severe. With the additional pressure that the coming weeks may bring, it could easily become intolerable. Furthermore, at these levels, we would not have the flexibility that we need in order to ease restrictions over Christmas—which, in common with the other nations of the United Kingdom, we so desperately want to do.

Therefore, the clear advice of our public health experts is that we must drive infection rates down further in those areas, and they are not confident that level 3 restrictions will do so to the extent necessary. That is why, albeit reluctantly, we have taken the decision to place those areas into level 4 for a limited period.

The level 4 restrictions will be in place for three weeks, and will be lifted on 11 December. I want to be clear on that point, because I know that people are frustrated that other restrictions have remained in place for longer than planned. Level 4 is intended to be short and sharp. In this situation, it is specifically intended to have an impact in advance of Christmas and the most challenging winter period. Lifting the level 4 restrictions then, as we will do, also means that they will not be in place for most of the Hanukkah period. Again, although celebrations may be different, there will be a greater degree of freedom.

Nearer the time, we will assess the level that will apply in each area when the level 4 restrictions end on 11 December. Even if it does not happen immediately for all of them, we hope and expect that the action that we are taking now will allow those areas to move down to level 2 much more quickly than would otherwise be the case.

I will talk about what level 4 means for people living in those areas. First, as is the case already, people must not visit other people’s homes, although they can still meet outdoors with up to six people from two households. However, our advice is that people should stay at or close to home as much as possible. The purpose of level 4 is to reduce interactions between people from different households as much as possible, in order to reduce transmission as quickly as possible. That means limiting work and social contacts. Those who can work from home should do so, although, unlike during lockdown earlier in the year, construction and manufacturing workplaces will remain open.

Only essential indoor retail premises will remain open for the three-week period, and non-essential retail will close. Close-contact services, such as hairdressers and beauty salons, visitor attractions, leisure and entertainment settings and indoor gyms will also close for that period. With the exception of takeaway services, hospitality premises will close, too. Therefore, except for some very limited purposes, including childcare, caring for someone who is vulnerable, exercise or shopping for essential goods, people living in level 4 areas should not be going out and about over the three-week period.

I know that it will be tough. The pandemic is having an impact on mental health for most, if not all, of us. If people need someone to talk to, they can find out what support is available at clearyourhead.scot or by calling NHS 111. However, please remember: our objective in taking action now is to protect the NHS, create the prospect of seeing some loved ones at Christmas and complete the journey to next spring with as few restrictions as possible, and with the minimum impact on life and health.

I now turn to the issue of travel. Notwithstanding today’s difficult decisions for significant parts of the country, the levels system is still allowing us to avoid a national, one-size-fits-all lockdown, such as is currently in place in England. In my view, that is important. It means that people and businesses in lower-prevalence areas, such as the Highlands or parts of Lothian, are not forced into level 4 restrictions by the situation in higher-prevalence areas such as Glasgow.

The ability to maintain that targeted approach depends on us not spreading the virus from high-prevalence to low-prevalence areas, which becomes even more important with parts of the country in level 4. To put it bluntly, and we will require to monitor this, if we see evidence that people from East or South Ayrshire are visiting places in North Ayrshire, or that people from Glasgow are going to Inverclyde, we will have no choice but to consider level 4 for those areas, too. We do not want to do that, so it is essential that we all abide by the travel restrictions.

To underline how important that is, I confirm that, from Friday, the guidance that has been in place in recent weeks will become law. That means that people living in level 3 or level 4 must not travel outside their own council area, except for certain essential purposes. People living elsewhere in Scotland must not travel to level 3 or level 4 areas, except for essential purposes. There must be no non-essential travel between Scotland and other parts of the UK.

I know that it is difficult, but it is essential. Broadly comparable restrictions have been, or continue to be, in force in England and Wales. If we are to maintain a targeted approach and allow those in low-prevalence areas to live with fewer restrictions, I cannot stress enough how important it is that we all abide by the rules.

I will say a few words about schools, those in the shielding category, business support and, finally, the wider action that we are taking to beat the virus.

I am aware that some people argue that schools should also be closed at level 4. However, our very clear view is that the harm that is done to young people by closing schools significantly outweighs any impact that schools have on transmission. Keeping schools open is therefore a priority. However, we will keep the guidance for schools—and how it is being implemented—under close review. A further evidence paper on school safety will be published by the Deputy First Minister tomorrow. Specific measures are also in place for those who are on the shielding list. We currently recommend that children who were shielding should not attend school in person in level 4 areas.

More broadly, I know that this is an anxious time for people who were shielding. We are not advising the same strict isolation as in the previous lockdown; we know how harmful that is to wellbeing. Instead, the advice is to be especially vigilant. The chief medical officer will be writing directly to all people in level 4 areas who were on the shielding list, to provide more detailed advice.

The restrictions are also very difficult for business, so we are making more financial support available. In addition to the UK furlough scheme, all businesses that require to close, at any level, are eligible for a four-weekly grant of £2,000 or £3,000, depending on rateable value, and grants of £1,400 or £2,100 are available to businesses that are open but subject to trading restrictions. Eligible businesses can apply for those grants now, through their local authority. In addition, we are establishing a £30 million discretionary fund to enable local authorities, if they consider it to be necessary or justified, to provide additional support for businesses—for example, businesses in supply chains, or taxi drivers who are suffering a severe but indirect effect.

We will also make an additional £15 million available for newly self-employed people who have not been able to access other forms of support, and we are making available to local authorities an additional £15 million to help with the community and social impact of a move to level 4. More details on those funds will be made available shortly.

In my statement, I have focused, necessarily, on restrictions. However, increasingly and much more positively, our focus is now also on the other ways of beating the virus. We have real reason to be optimistic that science will get us out of this pandemic—and soon. Later this week, the Cabinet Secretary for Health and Sport will set out to Parliament our plans to start vaccinating the most vulnerable as soon as stocks of an approved vaccine are available—we hope that that might even be before the end of this calendar year—and then to roll that out across the adult population as quickly as supplies allow.

Now that we have a supply of lateral flow tests, the health secretary will also, next week, set out our plans for mass testing. That will include more detail on the plans that we have already announced to test care home visitors, NHS staff and students. She will also set out plans for geographic mass testing—drawing on the lessons of the pilot that is under way in Liverpool—and the options for extending mass testing to other groups of key workers.

That is perhaps an appropriate point to end on. The pandemic is taking its toll on all of us—and on some much more than others. I know that today’s decisions will add to that for many, and I am truly sorry for that. Whether you agree with the decisions or not, please know that they are not taken lightly but are essential to get us to the other side of this as safely as possible. That means all of us sticking to the rules and remembering FACTS in everything that we do—wear face coverings, avoid places with crowds of people, clean your hands and hard surfaces regularly, keep a 2m distance from people in other households, and self-isolate and get tested if you have any of the symptoms of Covid.

It also means holding firm to what this is all for. In a global pandemic that is nobody’s fault, this action is necessary in order to protect ourselves and those we love from a potentially deadly virus. It is essential in helping the NHS look after all of us who need it, in giving us the hope of some respite and time with loved ones at Christmas, and in helping us, with as little suffering and loss of life as possible, to complete the final stage of this horrible journey to the point—next spring, I hope—when we will be vaccinating, testing and treating our way back to normality.

I can never thank everyone enough for all the sacrifices that are being made, and I will never underestimate how difficult it is. I hold to the belief that love and solidarity, albeit with a lot of help from science, will get us through this, and that soon we will be looking back on it, not living through it. Please, try to stay strong, and, please, stick with it and stick together.

The First Minister will now take questions.

We all appreciate that there are no guarantees in a situation such as this, but if the evidence points to an essential calculation—accepting three weeks of level 4 restrictions for those authority areas affected in order to win a more general easing of restrictions over the Christmas and new year period—that is, with regret, a judgment that we will take at face value.

The need to get through the next few months with the virus as widely suppressed as possible is all the more important given the enormously encouraging news in recent days that vaccines with efficacy rates of 90 per cent and more are a real prospect by the year’s end.

However, whatever the promise of an eventual vaccination programme, today’s news will come as an immediate hammer blow to thousands of small businesses in the affected areas, which have fought since March to stay open, keep their heads above water and survive the spring lockdown and late summer and autumn restrictions, only to be faced with a further period of closure. Sustained Government support will be critical to those businesses’ survival. We have seen the concerns that business organisations have expressed over the past 24 hours and we expect ministers to address those concerns head on.

I want to ask about the situation in our hospitals. The latest projections and the documents that accompany the statement show that NHS Lanarkshire, NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran could run out of Covid hospital beds over the next few weeks and that ICU capacity will soon be reached in those areas and in NHS Fife and NHS Forth Valley. We must hope that that will not be the case.

We must hope for the best; we must also plan for the worst. Will the First Minister say whether each hospital in those health board areas has a contingency plan to manage the situation, should it arise? Will she provide an update on the progress of mutual aid arrangements between NHS boards to ensure that there is enough capacity to deal with peak demand, as set out in “Winter Preparedness Plan for NHS Scotland—2020/21”?

According to the winter preparedness plan,

“at least four months’ supply of all the key”

personal protective equipment

“commodities”

was to have been procured “from end October”, and

“a national stockpile of 60 ICU and supportive care medicines”

was to have been procured by the end of November. Can the First Minister confirm that all those items have been secured? Our NHS staff have worked heroically over the past eight months. We must spare no effort in making sure that they have the resources and protection that they need for the very worrying period ahead.

I thank Ruth Davidson for those questions; I will try to address them all as briefly as possible.

First, I reiterate the point that I made in my statement. These decisions are unpalatable, but they are necessary. They are necessary to protect the NHS, to open up space—I hope—at Christmas and to get us through what I increasingly hope is the final stage of this journey with as little loss of life as possible. That is why we have reached these decisions. I know that there will be people who disagree with these decisions; I can hear that there are people in this chamber who strongly disagree with them. I respect that, but I hope that nobody will think that these decisions have been taken lightly or without very serious consideration and assessment of their necessity.

The impact of this pandemic is, first and foremost, on individuals, but I absolutely understand the impact on businesses of all sizes and small businesses in particular. I make two points in that regard, which members will want to follow up in the days to come. First, it is concern for businesses that makes me so determined to stick with the levels approach as far as we can, so that small businesses in Highland are not being closed down because of high prevalence in Glasgow or Lanarkshire. I think that that is important. I say that genuinely and not as a criticism of decisions that other Governments have taken—every Government is trying to take the best decisions that it can take. We have so far avoided—and I hope that we will continue to avoid—a national lockdown. That is the targeted approach that I think is good for businesses as well as for individuals.

Today we are making available additional financial support to help businesses. As I understand it, in England, local authorities are given a discretionary 5 per cent—I think— above the level of grant support. The discretionary funding for local authorities that we have announced today is significantly more than that. It will never be enough to compensate every business for every loss—I recognise that—but we will continue to ensure that maximum support for businesses is available.

On hospital and ICU capacity, one of the reasons why we have taken the really difficult decisions that we have taken about Greater Glasgow and Clyde, Lanarkshire and Stirling—as far as it relates to Forth Valley—is to ensure that our hospitals and ICU facilities do not, over the winter, get to the point at which they cannot cope. I believe that the action that I announced today will help to protect our health service.

All health boards have contingency plans in place for ICU, including plans to double and, if necessary, treble ICU capacity. Mutual aid is already under way. For example, one of the reasons why Forth Valley is under pressure right now is the assistance that it is giving to some Lanarkshire NHS Board patients. Mutual aid arrangements will continue to work, where necessary.

Finally, I can confirm, and will make some of this information available through the Scottish Parliament information centre, that we have all the supplies of personal protective equipment that we have assessed are required. We have healthy stocks of PPE. I think that it is true for Governments across the UK that, at the start of the pandemic, PPE was all imported. A significant proportion in Scotland is now from Scottish companies. We have been able to build some economic resilience there, as well as health resilience. We also have a much greater supply of intensive care ventilators than we did at the start of the pandemic, should they be needed.

I thank the First Minister for advance sight of her statement.

Swimming pools and gyms closed, driving lessons stopped, visitor attractions closed, tourism shut down, hairdressers closed, non-essential retail shops closed and hospitality shut down completely: that is the stark difference between tier 3 and tier 4. In Parliament last week, the First Minister said that the Cabinet’s decision on which tier people live in was a judgment, and that

“judgment must combine with the hard data.”—[Official Report, 10 November 2020; c 20.]

Can the First Minister explain to people, such as those in North and South Lanarkshire, what the hard data is? What is the evidence for moving them up a tier at a time when the transmission rate in Lanarkshire is coming down? What assurance can she give them and millions of others who are moving to level 4 this Friday that this time, three weeks really does mean just three weeks?

On that last point, I understand that people have been frustrated that restrictions that were meant to be limited have not been, but, for the reasons that Richard Leonard has set out, level 4 is meant to be a short, sharp intervention. We have looked carefully at the Welsh experience. It is still too early to say what the impact has been of the firebreak in Wales, which it lifted after two weeks. It may be after three weeks here we do not have all the evidence flowing through into the data, but the level 4 restrictions will end on 11 December, and we will decide then what levels those areas will go into.

I readily acknowledge the difference to the economy and people’s lives between living in level 3 and living in level 4, but I hope that Richard Leonard will take seriously the point that the difference between level 3 and level 4 for Lanarkshire, Glasgow and those other areas may be that fewer people die over the next period, and it may be the difference between our NHS being able to cope and its being unable to cope.

Richard Leonard asked me for the evidence. As he is aware, the data for each local authority is being published today. If we look at cases per 100,000 over the past seven days, the national average is 141. In North Lanarkshire it is 238 and in South Lanarkshire it is 229. For test positivity, the national average is 7 per cent. In North Lanarkshire it is 10.3 per cent, and in South Lanarkshire it is 9.5 per cent. Rates have declined very slightly, but the 238 in North Lanarkshire at the end of last week is only down from 274 at the start of November. The number has stabilised and slightly decreased, but it must come down faster to deal with the biggest and most important bit of evidence, which Ruth Davidson referred to in her question, which is that if we do not act now, there is a risk that, as winter pressures kick in, hospital and ICU services in NHS Lanarkshire will be unable to cope with Covid and other winter pressures. That is why we are taking this action now. I know that it is a difficult thing to do, but I believe that it is the right thing to do, in the interests of protecting the national health service and saving lives. Fundamentally, that is the most important responsibility that I have right now.

The continued rise in cases as we go into winter is a cause for deep concern. The Scottish Greens acknowledge the impact that lockdowns have, but we support the move into tier 4 for the local authorities most affected and, given the transmission of the virus across the country, we recognise the need to put travel restrictions into law.

However, would we be in such a grave situation had the Scottish Government followed the World Health Organization mantra of test, test, test? We provided the First Minister with evidence in support of regular testing six months ago, and Parliament has now voted for that to happen. I note that the First Minister said that a statement next week will cover “options” for extending testing to other groups of key workers. I sincerely hope that setting out options does not suggest any further delay. Can the First Minister confirm that that statement will finally see the Scottish Government introduce regular testing for all key workers in healthcare, in education and in our communities, as a matter of the greatest urgency?

I will address those points directly because they are important. On the question whether we would be in this situation, in relation to testing or anything else, we have only to look across the UK, Europe and the world to see that Scotland is far from unique. Actually, Scotland has a lower prevalence of the virus right now than all other UK nations and many countries across Europe. That does not mean that we have done everything right—far from it—but we are in the midst of a global pandemic and that cannot be cast aside.

In relation to polymerase chain reaction testing, which is the main diagnostic test that we have had available, we have prioritised testing those who have symptoms, because that is how we need, through test and protect, to best break those chains of transmission. We have not had the technology to do routine regular testing on a mass scale until relatively recently. We now have lateral flow testing; we hope to have more of those tests, but we have a supply already. That opens up, from now, the potential to do much more, although there are still some hurdles and limitations. For example, unless this has changed over the course of today—we are expecting this to potentially change in the next day or so—lateral flow testing is not licensed for unsupervised use. We hope that that will change, which would allow tests to be provided to employers, whether in the public or private sector, to use routinely with their workers.

As the technology advances, so too does the approach that we take. Obviously, there are logistical issues. We are looking carefully at the pilot in Liverpool in relation to rolling out mass testing on a geographical basis, and there are important lessons there in relation to supporting maximum take-up of testing. We are moving forward with developing technology as soon as we are able to do so and the Cabinet Secretary for Health and Sport will set out more details of that next week.

Five thousand deaths is truly a terrible toll—it is a dark day. That heavy toll is the reason why I have supported a cautious approach. People want to help and they deserve an explanation. Why are the thresholds in the strategy framework, which was published only three weeks ago, being replaced already? Why are restrictions, including a serious travel ban, being ratcheted up in parts of the country where the number of cases is going down? Why is the Government shutting down sectors of society and business without clear evidence that they are the cause of the spread? The impact of that on mental health, as well as on business and the economy, will be considerable, so is the First Minister sure that those sacrifices will help to cut the number of cases of the virus? Is the First Minister sure that that will work?

I am as sure as I can be, in an inherently uncertain and unpredictable situation, that what we are announcing today will drive infection rates lower, so that they are closer to the levels that we need them to be in those central belt areas. The restrictions that have been in place so far have stopped what would otherwise have been a rapid increase in cases, and they have stabilised cases and slightly reduced them in some areas. However, for all the reasons that I set out, if we are being sensible, we cannot go into winter with a stubbornly high level of cases across the most populated part of our country.

The thresholds in the levels framework have not been changed; we look at the thresholds—or indicators, or however you want to describe them—and we apply judgment around that. If you look at NHS Greater Glasgow and Clyde and NHS Lanarkshire, their case numbers and test positivity rates are at the level where we would be starting to consider level 4, but what tips them over into that, apart from the stubbornly high nature of the number of cases, is the pressure and the potential pressure on hospital services. The same is true about hospital services in Ayrshire and, in relation to NHS Forth Valley, Stirling. We pay attention to those indicators, but we have to apply judgment on the advice of clinical and public health experts about what is necessary to get infection levels down.

We always have to make balanced decisions. I am under no illusions about how difficult all this is for everybody, and countries the world over are going through it right now. Thankfully, we are managing to avoid applying a lockdown across our country and I hope that that will continue. However, assuming that the optimistic scientific news materialises, as we all fervently hope that it does, in the spring of next year, over the final stage of this, I want us to minimise the loss of life and minimise the number of people—including young people—who, this time next year, will be suffering from long Covid and the health complications of Covid.

I also want to minimise economic damage, because there is a fallacy that if we do not have restrictions to control the virus, the economic pain will not happen. What will happen is that the virus will run more out of control and the economic pain will be deeper and longer.

None of that is palatable for anybody. I hate standing here announcing decisions like this and I can never find the words properly to encapsulate how much I hate it. However, my job is not to do what is popular, but, by taking account of all the advice and judgment that I can, to do what I think is necessary to get us through the next phase of the virus as safely as possible.

Thank you. We move to questions from back benchers. If we have succinct questions and answers, I hope that we will get through all the members.

Last week, in Dundee, there was a 29 per cent decrease in case numbers per 100,000 people; this week, it is disappointing that there has been an increase of 11 per cent. Has the data identified specific areas that are the cause of the increase, in order to ensure that every effort is taken within those areas to reverse it?

Dundee has had a slight increase over the past seven days, but, generally speaking, it has made good progress since it went into level 3 and we hope that that will continue.

It is understandable—I also find myself doing this—that people want to know exactly the cause of an increase and what is driving it. We look carefully at what comes through test and protect and other information, but, fundamentally, the virus spreads because people are interacting and allowing it to do so. That means that, overall, when we have community transition—and that is the really tough bit of all this—we have to reduce those interactions, whether they are in social settings or workplaces.

I know how difficult the household restrictions are, and those are probably the restrictions that people are most likely to try to get around or think that they can safely breach on one occasion. I understand that and am not criticising anybody for doing that. I know how much all of us, me included, are missing our families. However, that is one of the areas where we give the virus the most risk of spreading, and I appeal to people, partly so that we can ease restrictions a bit for Christmas, not to mix in each other’s houses, because that gives the virus opportunity to spread. I say that to people in Dundee and across the country, with the exception of Orkney, Shetland and the Western Isles.

How will the laws that implement a ban on travel in and out of level 3 and 4 areas be policed and enforced? Does the First Minister acknowledge the serious difficulties that the ban creates for those who live on or near council boundaries?

None of the restrictions that we have put in place are easy to enforce. The regulations—

It is impossible.

Order, please.

If Mike Rumbles wants to ask a question, I am happy to answer it, but he is shouting repeatedly at me from a sedentary position. I know that he vehemently disagrees with what I am setting out, but I hope that he will have enough respect to understand that the decisions are not easy and are not being taken lightly.

To come back to the important and perfectly legitimate question, the police will enforce the regulations in the way that they have enforced all the regulations that have been in place. In other words, they will do so as a last resort. The police will use the same approach that they used for household restrictions, such as the stay-at-home regulations, earlier in the pandemic. If they have reason to believe that people are breaching the rules, they will remind and advise them of the rules and encourage them to comply. Only when there is a clear and flagrant breach will they use enforcement.

It is not for me to tell the chief constable how to do that operationally. I know that it is not easy for the police. However, ensuring that people understand the reasons for the restrictions and the reason why it is so important that people do not travel from high to low-prevalence areas is essential. In my judgment, where the law is for people not to leave their home without a reasonable excuse—as happened previously in Wales and is happening in England, albeit in a different form—passing the regulations sends a clear and strong message about the importance of our complying with the rules.

I am sure that everyone is relieved that an effective vaccine for Covid-19 could be with us in weeks. Some constituents have already been in touch with me, anxious to know where they might be on the vaccination prioritisation list. It is obvious that the most vulnerable must be vaccinated first. Will there be a clinically agreed, all-Scotland vaccination protocol, about which the public will be informed, and will vaccine distribution be based on the number of vulnerable people in a health board area, rather than simply its population, to ensure that areas such as Ayrshire and Arran do not lose out and that there is an even spread of vaccination according to risk?

The Joint Committee on Vaccination and Immunisation will provide expert clinical advice that will inform decisions on how any vaccine is used. As I said earlier, the Health Secretary will set out more detail about our plan on Thursday in the Parliament. Interim advice has already been provided by the JCVI, which proposes older adult residents in care homes, care home workers, health and social care workers and those over 80 as the initial priority groups. That advice could change as further clinical or scientific evidence emerges, and we will adjust our plans if necessary.

Arrangements for delivery of the vaccine, which will include health board allocation, will depend on several factors, including regulatory and advisory bodies approving the vaccines for use, the supply that we have and the particular characteristics of the vaccine. We are considering several different delivery routes to ensure that any vaccines that become available can be used effectively. We will be making specific provision to ensure adequate vaccine supply to rural and island communities. Jeane Freeman will set out our initial plans on Thursday and we will keep the Parliament updated as we get towards getting the first vaccinations to people, which I still hope will happen this year.

Glasgow’s infection rates have been showing a downward trend, so it is very disappointing that Glasgow is moving to level 4. Can the First Minister give Glaswegians some hope that there will be an end to the pain and that we will not simply end up at level 3 on 11 December? Does the First Minister recognise that December is a really important period for non-essential businesses, during which they could recoup some of their losses, and does she agree that the business support grant should take that into consideration? Is the First Minister confident that £30 million for 11 local authorities is enough to recognise the need of such businesses?

The £30 million is over and above the other business support that is available. We will of course keep it under review. As I understand the arrangements elsewhere in the UK, that is more than is being provided elsewhere, although it will not necessarily help all businesses with every loss. We will continue to do the maximum that we can.

Pauline McNeill is right that, over the past seven days, we have seen a very gradual decline in cases in Glasgow. However, it is very gradual: people can go on to the website, where they will see that the line on the graph for Glasgow is very flat. Without the restrictions that people have been living with, the line for Glasgow would not have been flat but would have shot through the roof. Flat is not bad, but it is not good enough. We must get infection rates down if we are to ensure that the health service can cope and that we have that ability to ease up over Christmas.

One of the other reasons for places such as Glasgow to go to level 4 is to accelerate a move to level 2. It remains for an assessment nearer the time for us to know whether it will go straight from level 4 to level 2, or whether it will have to go via level 3. Looking at Glasgow right now, without further action, it seems as though level 3 would have to be in place for an extended period yet. For places such as Glasgow, a period in level 4 may actually be a quicker route out of level 3 than simply remaining in level 3. That is difficult for people, but I believe that, in the medium to long term, it will be better for Glaswegians—of which, of course, I am one.

I extend my deepest condolences to the families and friends of residents at the Fairview care home in Bannockburn who have died as a result of Covid-19 and, of course, to everyone who has lost a loved one.

Under level 4, small and boutique shops in my Stirling constituency will have to close, but are very concerned that mixed-retail shops will remain open and continue to sell non-essential goods, which will give them an unfair advantage during the crucial sales period prior to Christmas. Shopkeepers are looking for a level playing field in respect of mixed retail and supermarkets. What assurances can the First Minister give in that regard? Will she advise whether non-essential shops can offer collection services to support them in continuing to sell goods online or by telephone?

My condolences also go to friends and family members who have lost loved ones at the Fairview care home. The health and social care partnership and the public health team are providing regular support to the service in order to manage the outbreak there.

In level 4 areas, retailers that are required to close can continue to trade online or through click-and-collect and telephone ordering services. Additionally, as I have set out, grant funding is available for businesses that have to close temporarily, and there is the additional discretionary funding that I have spoken about. Information on eligibility and how to apply for that funding is available on the findbusinesssupport.gov.scot website.

I understand that there will always be perceived unfairness. We will try to make the arrangements as fair as possible, and we will consider that on an on-going basis. Of course, people require to continue to have access to essential retail, which is what we are seeking to achieve.

The closure of non-food retail shops in 11 local authority areas for three weeks in what is normally the busiest shopping period of the year, in the run-up to Christmas, will be devastating for those businesses. Over the past few weeks, the Scottish Government has received additional guaranteed funding of £1.7 billion from the UK Government. Will the First Minister ensure that adequate support is given to affected businesses—not just those that have to close, but those in the supply chain that are legally permitted to trade but which will suffer substantial losses due to the closure of other premises?

I know how devastating what I have announced is to large and small businesses in every sector. It weighs heavily on me, as I know it does on all of us, but I also know how devastating the virus is to families who lose loved ones to it. We are trying to navigate a way through that.

I can give an assurance that we will ensure that every possible penny of business support is made available. We provide grant support for businesses that are not legally required to close, but whose trading is restricted. I have set out the details of that support, which we provided before the UK Government decided to make consequential funding available. That is important.

The discretionary funding that I have announced today is also important. That funding will enable councils to deliver more support for businesses in the supply chain, and for people who are indirectly but severely affected; for example, taxi drivers have made a very strong case, recently. The support will also give local authorities some discretion to provide additional funding if they think that there is a case to be made for doing so.

We will continue to ensure that as much funding as possible is made available. As I said earlier, I obviously do not know all the details of how the systems work in England, but my understanding is that, over and above the funding for the grant level, local authorities have an additional 5 per cent discretion. What we have announced today will be more than that.

I am not standing here and saying that any business will think that it is enough, but we will continue to ensure that we treat businesses as fairly as possible. We are asking them to do unprecedented things, so it is important that we respond with unprecedented support.

I wanted to ask the First Minister about support for long Covid sufferers, but in the light of the announcements relating to East, North and South Ayrshire, will she please say a little more about the reasons why East and South Ayrshire are to move to level 4 while North Ayrshire remains at level 3? I am being inundated with inquiries about that, as the meeting continues.

I do not think that I am breaching any confidences by saying that that was one of the most difficult decisions that the Cabinet reached this morning. The reason is that, right now, there is a lower level of prevalence and test positivity in North Ayrshire. There have been 140 cases per 100,000 people in the past seven days, which is slightly below the national average, and the test positivity rate is 5.7 per cent, which is also below the national average of 7 per cent.

In South Ayrshire, case numbers per 100,000 and test positivity are above the national average. I am struggling to find the figures, but that is even more the case in East Ayrshire. The reason for the difference is, basically, that we are seeing more evidence of sustained decreases in North Ayrshire than we are seeing in East Ayrshire and South Ayrshire.

I know the geography of Ayrshire very well—as Willie Coffey does—and one of the worries is that people from East and South Ayrshire could go to North Ayrshire and take the virus from areas of higher prevalence to areas of lower prevalence. That illustrates why travel restrictions are so important; they exist so that we do not have to put North Ayrshire on a higher level merely to mitigate risk.

In many respects, Ayrshire illustrates the difficulty of some of the judgments we have to make when there are tiered levels. Inverclyde, which is within Greater Glasgow and Clyde NHS Board’s area does, too. The alternative would be to put all areas at the higher level, driven by the areas that have the highest levels of the virus, which would not be fair, either. We are trying to take as targeted and as proportionate an approach as possible.

This morning, Unison Scotland published a survey of its members who are in charge of keeping our schools clean. Unison says that only 18 per cent of cleaners said they had enough time and the right materials to clean schools properly and to keep themselves safe in schools.

Surprisingly, freedom of information requests show that many authorities have not, despite the hygiene issues that come with Covid, increased the number of cleaners whom they employ. I understand the Government’s priority of keeping our schools open, but does the First Minister understand the concerns of Unison and my concerns that our children must be kept safe when they are in school?

I absolutely agree. I have not yet had the opportunity to see the survey. I will have a look at it, and if there are issues that we need to address with local authorities based on it, we absolutely will do that.

The Health and Safety Executive previously commented that the preparations for school return were good. We made available to local authorities £50 million specifically to help them with enhanced cleaning and other arrangements that were required for schools to return.

However, we are not complacent about any of this. As I think I said earlier, the Deputy First Minister will tomorrow publish another evidence paper about safety in schools. Parliament will debate it tomorrow afternoon.

We want to keep schools open, because we think that that is best for children. However, we are not, and never will be, complacent about the safety of young people, teachers or others who work in schools. That is an issue that we take extremely seriously.

I know that visiting care homes is an extremely difficult subject. It affects my mother, who is in a neighbouring authority. Can the First Minister say anything about that, as some areas move into level 4?

I understand that the health secretary wrote to care home providers today to update them on how adult care home visiting is affected by the protection levels. She will give a statement to Parliament on that shortly.

Current care home visiting guidelines continue to be recommended for areas that are in levels 1 to 3, unless they are advised otherwise by local directors of public health. For level 4, only essential window and garden visits are recommended.

The advice also makes it clear that visiting people in care homes is exempt from national travel restrictions. People can travel into and out of level 4 areas to see loved ones in care homes, because that is deemed to be essential travel.

Does the First Minister accept that, in order to defeat the virus, it is absolutely essential that there is full public trust in the Scottish Government’s guidelines, and that in order to achieve that the guidelines must be clear and consistent? My constituents have been complaining to me that that has not always been the case. For example, the announcement on 30 October said that all pupils in secondary 4 to S6 in level 3 and 4 council areas would need to wear face coverings in class. However, that instruction did not appear in the general guidelines for levels 3 and 4.

Does the First Minister recognise that that could cause confusion, and will she ensure that local government and the Scottish Government work together to avoid inconsistency?

I am genuinely not aware of the specific problem that Liz Smith mentioned about guidance on face coverings. However, I am happy to look into it. The guidance on face coverings in schools has been widely promoted by local authorities, and I believe that it is widely understood. Although not everybody will agree with all advice about that, I think that the reasons for it are understood.

More generally, I accept and take seriously the responsibility to set out, as clearly as I can, not just what we are doing but why we are doing certain things. That is not always easy, as we deal with what we are dealing with now. Some of what we do is a judgment; some of it is what we think—but cannot be sure—will make a difference. I have tried to be open about the uncertainties and unpredictabilities. We must make sure that the guidance reflects them. I am genuinely not aware of the particular issue that Liz Smith has raised but, if there is an issue, I will look into it and will be happy to write to her.

A report last week from Public Health England found that people with learning disabilities were at least six times more likely to die of Covid-19. That is the latest in a number of reports that show that group’s vulnerability and show why the suppression of the virus is so important. Given that the group was not specifically mentioned in the original strategic framework, will the First Minister tell us what work is being done to keep them safe and, in particular, when their carers will be offered regular testing?

A lot of work is being done and has been done throughout to ensure that people with learning disabilities—who, as Joan McAlpine points out, are at enhanced risk—are kept as safe as possible. They are included in the plans for testing that the health secretary will outline in more detail next week. I will ask the health secretary to write to Joan McAlpine more generally to set out the work that is continually being done to make sure that we are taking all the right precautions.

The current round of restrictions in the west of Scotland started in September. The 16-day reset began 39 days ago. My constituents were told at the time that restrictions would be for the short term if they complied with the rules, but restrictions have only got tighter. Most of the west is now entering level 4. Is the First Minister’s only explanation that that is down to my constituents’ failure to comply with the rules, or is there another reason, such as the Government’s failure to deliver mass testing and effective tracing in the areas that need them most?

Not only is that not my only explanation, it is not even one of my explanations. I have never tried to blame anybody during the pandemic. What I have done is say clearly that this is a global pandemic that is nobody’s fault, but that it is unfortunately down to all of us to tackle it. The biggest responsibility for that lies with Government. That is right and proper. However, we all have to play our part with an infectious virus. That is not blaming people; it is being honest with people about the challenges that we face and how we can overcome them. I would not be doing my job if I did not set out the importance of complying with the restrictions.

I say to Neil Bibby and to others that Scotland, like many other countries, faces a challenging situation. We are seeing that sharply today as a number of areas go into the top level of restrictions. However, we are also in a position whereby—even with the prevalence levels that we are worried about now and want to reduce—we are already seeing prevalence levels that are lower than those in the other nations of the UK and in many other countries across Europe.

The actions that we have taken in the past few weeks have avoided a situation that we would otherwise have faced in which I would have been standing here announcing 3,000 cases every day. If I had been doing that, I would also have been announcing three times the number of people—if not more—in hospital and perhaps three times the number of deaths. Through our sacrifices, we have managed to prevent that from happening.

I must also be frank. If we are to get through the next—and, I hope, final—phase as safely as possible, we must go further. We must not just stabilise infection levels but get them down further. That is not blaming anybody; it is recognising the nature of the challenge that we face and what we must do collectively to get through it.

I am not—no one is—accusing the First Minister of making decisions lightly. I want to make that clear. These are difficult decisions; we all understand that. However, for the first time, the First Minister intends to use regulations to make it illegal to travel from one area to another. That is without the authority of Parliament and may be illegal, as it is unenforceable and may not be a proportionate measure in law.

Does the First Minister understand that these draconian changes in law—which everybody would agree are, in the true sense of the word, draconian—should be a decision that is made not by her alone? It could be helpful if the changes were made not by her alone but by the Parliament before such measures could come into effect. Will she ask the Parliament to debate and vote on the proposals before Friday, when she signs the regulations into law?

I accept what Mike Rumbles says and I respect his vehement disagreement. The decisions are not easy, and they are obviously not uncontroversial. However, I reacted earlier because, during my announcement, he shouted continuously, which did not recognise the difficulty and severity of the situation that we face. I will put that to one side.

I understand that the Parliamentary Bureau proposes to set aside time for a debate and a vote on a motion on Thursday, although the Parliament has not voted on that yet. The travel restrictions will be in regulations. We have said that we are keen for the Parliament to approve regulations before they come into force, and I understand that the Parliament is still considering the procedure for that. I am not entirely sure where that has got to, but I am equally not sure that it is down to the Government to deal with that. Perhaps such a process will be possible before the regulations come into force—in no way do I object to that.

On the substance, this is the first time that we have put travel restrictions in law in Scotland—although, back in the early days of the pandemic, legal restrictions were placed on people leaving their house without reasonable excuse. Under the national lockdown in England now, it is against the law for people to leave their house without reasonable excuse. Moving between parts of Wales has been restricted in law, and moving into or out of Wales is now restricted in law. The Republic of Ireland also has restrictions in law. In France, people are not allowed to leave their house unless they have papers that demonstrate that they are entitled to do so.

To keep people safe, countries are having to take what we would see as the most unbelievable decisions if we went back a year. We are trying to keep people safe and to ensure that parts of the country do not live under restrictions when they do not have to. If we did not have travel restrictions, the only way to prevent the virus going from Glasgow to the Highlands would be to have a national lockdown. I am really trying to avoid that: a national lockdown is not right if we can avoid it. However, avoiding it involves a trade-off, which I am being frank and honest with people about.

Last week, a number of the crew on the MV Isle of Lewis tested positive for Covid-19. That required a full crew changeover and meant that the vessel had to be deep cleaned. Given the threat that any wider loss of lifeline ferry services would represent, what steps will be taken to prevent a recurrence of such a situation?

The priority of CalMac Ferries throughout has been to ensure the safety of passengers and crew by implementing the guidelines on travel and transport. It is unfortunate that the outbreak occurred. CalMac and other ferry operators keep their cleaning, hygiene and physical distance processes under review.

CalMac’s processes include a strict new on-board regime to keep staff and customers safe; detailed cleaning every 90 minutes; the implementation of physical distancing, signage and customer announcements; and the use of personal protective equipment. All passengers need to wear face coverings in inside areas, and the on-board food offering is restricted.

Along with Transport Scotland officials, the transport secretary engages weekly with ferry operators to ensure that they are fully updated on any changes to guidance and regulations. That will continue.

The application of level 4 restrictions to the Stirling Council area is deeply regrettable and will be a severe blow for local residents, workers and firms, who have done everything that has been requested of them. What precise data is available from test and protect and from other sources on the spread of the coronavirus in the area? On the basis of that data, what is the First Minister’s understanding of the main factors in the spread of the virus in the area?

It is regrettable that Stirling has seen a sharp increase recently. In the past seven days, case numbers per 100,000 have increased there by more than 20 per cent. Specific outbreaks are contributing to that, including outbreaks in food plants. Work is being done to control that and to minimise the spread. The view of the national incident management team and the local director of public health is that there is also a wider spread of community transmission, which comes from the same interactions, such as those in family gatherings and hospitality settings—albeit that they are restricted. Other areas that have come through test and protect include shopping and personal contact services. That does not mean that it is absolutely certain that that is where people are contracting the virus, but those are the settings that we are now seeing coming through much more strongly in the test and protect data.

We will have to finish proceedings there. Apologies to the half a dozen members whom I was not able to call for questions. Members may be interested to know that the Parliamentary Bureau will discuss later whether to put some time aside for debate on Thursday, given the significance of these matters.

I thank the Presiding Officer for his comment. When the bureau looks at the issue of whether to set aside time for a debate and a vote on Thursday, will he use his best endeavours, as the Presiding Officer and the defender of the Parliament, to make sure that members on the back benches and other parliamentarians have a chance—whether rightly or wrongly—to debate and vote on these very important issues? The First Minister has made it clear that she does not object to that. It is an issue not for the Government but, rather, for the Presiding Officer and the members of the Parliamentary Bureau.

Mr Rumbles will be pleased to note that that point was raised by business managers when we discussed the matter—not pre-empting the decision that we will make this afternoon.