The next item of business is a statement by the First Minister on Ebola. As the First Minister will take questions at the end of her statement, there should be no interventions or interruptions.
I call Nicola Sturgeon. First Minister—you have about 10 minutes.
14:25
I want to pass on my best wishes for 2015 to you, Presiding Officer, and to every member in the chamber.
Since Parliament last met, in addition to nurse Pauline Cafferkey’s Ebola diagnosis on 29 December, which I will address substantively in my statement, two other major events have cast dark shadows over the festive period, and have caused the individuals and families who have been affected deep distress, suffering and sorrow. I refer, of course, to the dreadful tragedy that occurred at George Square in Glasgow on 22 December and the sinking of the cargo vessel in the Pentland Firth on 3 January. I am sure that I speak on behalf of every member in the chamber when I convey my sympathy to all those who have been affected, especially to the families of those who have lost their lives.
The Glasgow tragedy in particular touched us all deeply. As the funerals of the victims have been taking place, I know that our thoughts will have been with those who lost loved ones, just as they continue to be very much with all those who are recovering from injury and trauma.
Both of those tragedies and, indeed, the response to the Ebola diagnosis remind us yet again of how much we owe our emergency services, including the coastguard and the Royal National Lifeboat Institution, and all the staff of our national health service. We value their professionalism, compassion and commitment every single day of the year, but we do so especially at times like these. I am sure that members will join me today in thanking them sincerely for their contribution.
Members will have just heard Michael Matheson respond to a topical question about the George Square tragedy, and Richard Lochhead answered a question on the incident in the Pentland Firth. However, given the wider public health implications of Ebola, I thought it appropriate to make a full statement about Ms Cafferkey’s diagnosis, our response to it and Scotland’s general state of preparedness for handling the risk that Ebola poses.
I will start with a brief recap of the background to the case. It was confirmed on 29 December, following her return to Scotland, that Pauline Cafferkey, who had been working in Sierra Leone to help people who are affected by Ebola, had tested positive for the condition. Early that morning, she had reported feeling unwell, and at about 8 am she was admitted to the Brownlee infectious diseases unit at Gartnavel hospital in Glasgow. In the early hours of 30 December, following confirmation of the diagnosis, she was transferred by military aircraft to the United Kingdom’s high-level isolation unit at the Royal Free hospital in London.
First and foremost, our thoughts are with Pauline Cafferkey and her family during this extremely difficult and distressing time. My officials spoke to the Royal Free hospital earlier today, and they report that her condition remains critical. I know that we all wish her a full and speedy recovery.
I want to take this opportunity to thank all the NHS Scotland staff who have helped to treat Pauline Cafferkey, including staff in the Scottish Ambulance Service, in the Brownlee unit and in Health Protection Scotland. I want to thank the Ministry of Defence for arranging her transfer from Glasgow to London, and the staff at the Royal Free hospital, who continue to ensure that she receives the best possible care and attention.
Our chief concern at this time is of course, as I have said, for Pauline Cafferkey’s wellbeing. However, her diagnosis has inevitably raised wider issues relating to public health, the response to this particular case and our general preparedness to handle cases of Ebola. I turn now to those issues.
The first point to stress—it is important, as I am sure all members will agree—is that the risk to the public in Scotland continues to be very low. The Ebola virus cannot be contracted from someone unless they are displaying its symptoms. Furthermore, it is not an airborne virus; even if someone has a fever, the disease can be transmitted only by direct contact with their blood or bodily fluids.
In the case of Pauline Cafferkey, she was screened on leaving Sierra Leone and then again on her arrival at Heathrow. In her initial screening, her temperature was found to be within the acceptable range, so she was cleared to fly from Heathrow to Glasgow. However, due to concerns that she may have had an elevated temperature, she was reassessed and her temperature was taken another six times over a 30-minute period. Her temperature remained within the acceptable range and she was again cleared to fly. I will come back to that point later on.
As has already been made clear, because she was not at that point displaying any symptoms that would have given rise to onward transmission, the risk to other passengers on her flights was extremely low. However, given the nature of Ebola, a highly precautionary approach has—rightly, in my view—been adopted by health authorities across the United Kingdom. It is in that context that a decision was taken to contact all passengers on the flights that Ms Cafferkey had taken from Casablanca to Heathrow, and then from Heathrow to Glasgow. I am grateful to staff at Health Protection Scotland who have now contacted all the passengers on the London to Glasgow flight and ensured that they have the appropriate advice and reassurance. Ms Cafferkey had, on her return to Scotland, contact with only one other person, and he has also been contacted and given advice and reassurance.
NHS 24 established a special helpline, which was up and running within two hours of notification of the positive diagnosis. The helpline provided advice, assistance and reassurance to more than 100 people on the evening of 29 December, and has received 179 calls in total. Only three calls have been received since Hogmanay, so the helpline will be closed from 6 pm tonight. However, it can be reactivated quickly should the need arise in the future.
The prompt response to the diagnosis demonstrates the wider point that Scotland is well prepared to deal with cases of this nature. We have well-tested NHS systems for managing unusual infectious diseases when they arise. For example, we have established three regional units for the management of possible or confirmed cases of Ebola, one of which is the Brownlee unit. We participate in UK protocols in respect of more specialised high-level isolation facilities and, where necessary, we fund treatment for Scottish patients at the Royal Free hospital.
We have also updated the Scottish Ambulance Service’s procedures for transferring patients with suspected or confirmed Ebola, and a new testing system for diseases such as Ebola has been available in Scotland since 1 December. That means that samples no longer have to be transferred to Porton Down in Wiltshire; instead, test results now go to the NHS Lothian testing facility and can, therefore, be confirmed much more rapidly. All those systems and procedures have worked effectively in recent days.
In addition, the Scottish Government works closely with the UK Government to ensure that we have a fully co-ordinated approach. As well as chairing meetings of the Scottish Government resilience committee on Monday and Tuesday last week, I participated in a COBRA meeting and was in close touch with the Prime Minister. I am grateful to counterparts in the UK Government for their co-operation and I know that they appreciate the good work that is done by the NHS and other agencies in Scotland. We will continue to work with the UK Government to review the handling of the case and to see what lessons can be learned for the future.
For example—this is the point that I said I would return to—questions have, understandably, been asked about whether Ms Cafferkey, even though her temperature readings were within the acceptable range, should have been allowed to travel to Glasgow, given the concerns that she had raised. They are important questions that deserve to be properly considered, in line with the highly precautionary approach that we all agree should be taken to possible Ebola cases. Health Protection Scotland is therefore currently working closely with Public Health England to review screening procedures.
Protocols at airports have already been revised in the light of the case. Guidance has been strengthened to ensure that anyone from a higher risk group who feels unwell will be reassessed. Advice will also be sought immediately from an infectious diseases specialist, and the passenger will be referred on for testing if that is considered to be appropriate. Procedures will be reviewed again in the coming days to assess the effects and effectiveness of those changes. We will continue to work with the UK Government on further improvements to how we manage the risk of Ebola.
In all this, there is a final but very important point to make, with which I hope all members will agree. By far the most effective way of reducing the risk of Ebola in Scotland and the rest of the UK is to halt its spread in west Africa. That is why the Scottish Government has donated £1 million in money and equipment to support the Ebola response there. It is why we are so deeply grateful for the quiet heroism of Pauline Cafferkey and many others like her from Scotland, the rest of the UK and many other countries, who make all of us safer by placing themselves at risk. They are not simply helping people in west Africa, although they are certainly doing that; they are also helping people right around the world. We owe it to them, as well as to the wider public, to ensure that the measures that we are taking to tackle Ebola here in Scotland are as good as they possibly can be. I assure you, Presiding Officer, and Parliament that the Government will ensure that the measures are robust, that the public continues to have accurate and up to date information about Ebola, that screening procedures are as effective as possible, and that when necessary—we hope it will be rarely—patients get the best possible care and treatment.
The Government will keep Parliament informed of further developments as they arise. For now, I am happy to answer any questions.
The First Minister will take questions on issues that were raised in her statement. I intend to allow around 20 minutes for the questions, after which we will move on to the next item of business.
I thank the First Minister for her statement and send the sympathy and thoughts of those on these benches to all the families who have been affected by the tragic events at George Square and in the Pentland Firth. I would also like to pay tribute to our staff in the NHS, the coastguard, the Royal National Lifeboat Institution and our emergency services for their compassion and dedication.
I, too, would like to pay tribute to Pauline Cafferkey. Her bravery is extraordinary. Hero is a word that we use too readily and, in so doing, we diminish its value. The definition of a hero is someone who risks their own life for others; someone who puts themselves in danger for the benefit of others; someone who does not think of what doing something will cost them personally but who acts because they must—because someone must. Pauline Cafferkey is a hero, as are all of the aid workers who are helping to fight Ebola—heroes whose names we will never know.
I also want to take this opportunity to recognise the vital work of UK charities such as Save the Children, Oxfam and Christian Aid, which are doing much to respond to the outbreak.
Ebola has taken hold in countries that are least equipped to cope with it. The outbreak has devastated health systems in Liberia, Sierra Leone and Guinea, leaving many unable to receive treatment for conditions such as measles and malaria, which increases the death toll.
There is a huge difference between the response and care that the NHS is able to provide here and the equivalent in western Africa. I am proud of the UK’s international development work and I welcome the £1 million that the Scottish Government has committed to that end. Can the First Minister tell us more about how that money will help tackle this outbreak in western Africa and guard against another in the future?
I thank Kezia Dugdale for her question and, indeed, for the tone in which it was asked. I agree strongly with her comments about the heroism of Pauline Cafferkey and of the health workers, the aid and charity workers and, it is fair to say, the representatives of media organisations across the world who are covering the issue so that the rest of us can be updated on its progress. All of them, without exception, put their lives on the line to do their work.
We hope that those people will be safe. The procedures and the protocols are in place to ensure their safety, as best as can be done, but they all take a great personal risk and all of us should be grateful to them and appreciative of them for that. As I said in my statement, and as Kezia Dugdale has echoed, they are not only helping people in the affected countries in west Africa; they are helping all of us to stem the spread of that disease.
On Kezia Dugdale’s specific question, I have indicated that the Scottish Government has, to date, donated £1 million in cash and equipment to the effort to halt the spread of Ebola in west Africa. That breaks down to £500,000 that we have made available to the World Health Organization, £300,000 in medical equipment and a further £200,000 that we contributed to the Department of Energy and Climate Change appeal not long before Christmas. All of that money will be used by those organisations and individuals on the ground to ensure that the facilities are in place, with the right equipment, and that the right staffing expertise and skill is in place in order to do everything possible to halt the spread of this disease.
Although that is what we have done, the Government and I remain open to anything more that we can do not only to prepare in Scotland for any further cases of Ebola but to ensure that we are playing our part in what is a co-ordinated international effort to do everything that we can to halt the spread.
On the evening of 29 December, I telephoned all the party leaders to update them on what we knew of the Pauline Cafferkey case, and that is very much the spirit in which we will continue to deal with the matter. I would be happy—I know that Shona Robison would be happy, too—at any time to give either the party leaders or the health spokespersons a briefing on what we are doing to help in west Africa or on our preparedness here in Scotland.
I thank the First Minister, her ministerial colleagues, officials and all those in the emergency services who went about their roles with quiet dignity when they were faced with the various traumas that we are discussing this afternoon. The way that they faced those matters creates a great sense of quiet pride in Scotland in the face of enormous tragedy.
I wonder whether the First Minister agrees with me that, in this social media age, although social media can be a useful information tool, it would be better if those who know nothing said nothing and if those who have no need to be in the vicinity stay away. I think that that would be a useful lesson for the wider public to learn for the future.
Our thoughts are with Pauline Cafferkey. I know that that can trip off the tongue glibly, but it should not. She is deserving of nothing less than the support, love and affection of everyone in the chamber, in Scotland and in the wider United Kingdom. She and all those like her who selflessly put themselves in the way of great hazards in the service of others deserve our total support, and we all wish her well in the fight that she now faces to get back to greater health.
My only further question is in respect of something that the First Minister touched on. Given Pauline Cafferkey’s experience as a healthcare worker, should not the concerns that she expressed on arriving in the UK—not just about other passengers on the flight but about herself—have been taken more seriously? Might she not have been saved the trauma and somewhat sensationalist coverage of her return to the Royal Free hospital in London if a more precautionary approach had been taken, given her experience, and she had had the opportunity to stay in London and be properly assessed at that point?
I am grateful to Jackson Carlaw for his comments. I am sure that all the front-line staff in the NHS, the police and the fire service who have dealt collectively with these challenges will appreciate his words of support. When tragedy hits, it is important that we all try to come together and present the right response collectively. Scotland can be proud of how it has done that in recent times.
I agree with Jackson Carlaw about social media. I am an avid and possibly prolific user of social media, as Jackson Carlaw is, and I know that it is a wonderful innovation. It is good for democracy because it opens up our public debate to many more people than would otherwise be able to participate in it, but it has its downsides. Particularly at times like these, everybody should behave responsibly and be careful about the information that they communicate and their actions.
It would have been better if many people, who will remain nameless, had stayed off social media in the aftermath of what we have seen over the past couple of weeks. However, they are the tiny minority. In the aftermath of the Glasgow tragedy, social media was very helpful in encouraging people who were in the city centre to contact their loved ones to let them know that they were okay. That took the pressure off the helpline that the police had set up for those who really needed it.
The short answer to Jackson Carlaw’s substantive question is yes. He makes a reasonable point, which I touched on in my statement. As he might expect, the issue was interrogated closely by me, by my Government colleagues and by colleagues in the UK Government. It is important to stress that the guidance and protocols around screening were adhered to in the case of Pauline Cafferkey; the question that arose was whether the protocols and guidance were precautionary enough.
Pauline Cafferkey is an experienced health professional, and the question that is being and has been looked at is whether, when there is concern about somebody who has been in an infected area, they should be treated with more precaution. That consideration lies behind the changes that I have spoken about and will be very much behind the on-going review of the screening protocols that will be under way in the days to come. It underlies the approach that all of us are taking.
The risk is low—I do not think that we can say that often enough at the moment in terms of public reassurance. The risk to all of us right now is very low and the risk to people who came into contact with Pauline Cafferkey last week was low to the point of being negligible. Nevertheless, the understanding of and learning about the virus is still developing. Given the stage that we are at, we need to act on the highest possible basis of precaution, which is exactly what we will do.
As others have done, I pay tribute to the selfless work of Pauline Cafferkey and others, and I pray that Pauline makes a full recovery.
I understand that 25 healthcare workers will return from Sierra Leone in the next fortnight or so, and there is speculation in the media over a range of new safeguards that may be put in place, including when to isolate individuals who are potentially at risk. Does the First Minister agree that additional safeguards should be proportionate, based on emerging scientific evidence and kept under review? Does she also agree that information is vitally important and that the families of healthcare workers who are involved in the field in Sierra Leone are deeply worried at this time about their loved ones and should be given adequate information to reassure them?
Yes. I agree absolutely with Bob Doris’s points, particularly the last point about ensuring that there is information not just for the general public but for those who have loved ones in the affected countries or returning from them.
I should say two things quickly. First, we will keep all the procedures under review. It is important that we learn lessons from the case of Pauline Cafferkey and from any other cases that might arise. I hope that no other cases are identified in Scotland and the UK, but it is likely that we will see a small number of additional cases. We need to keep learning from the experience of dealing with them. I have already commented on the screening process and how we need to learn lessons around it.
My only other point is that we have in place robust arrangements for monitoring people who come back for the entirety of the incubation period for Ebola, which is 21 days. Depending on the risk category that somebody returning from one of the affected countries is in, there will be restrictions on travel and in all cases there will be monitoring of temperature, for example. In some of the high-risk categories, there will be daily contact with local occupational health services or with Health Protection Scotland.
We have robust arrangements in place, but we will continue to keep them under review. Finally, I agree with Bob Doris that we must ensure that everything that we do is driven by expert advice and by the science of those who are looking very carefully at the disease.
We agree that, as the medical advice and the First Minister have stated, the risk is very low in Scotland. However, I know that the First Minister is as concerned as we are about how prepared our health service is. Guidance for primary care and for hospitals is on the Health Protection Scotland website. Is the First Minister confident that our health professionals in all our communities across the country are familiar with those lengthy guidelines and that they can respond swiftly, confidently and accurately if a potential case of Ebola is presented?
It is our job and that of the health service to ensure that that is the case. I will not stand here and say with any hint of complacency that there is no improvement that we can make as we learn more about the virus and as we have the experience of dealing with a case, because there clearly will be. All of us who have been involved in dealing with this issue over the past few days have our own thoughts about how we can improve things going forward. However, what I know from the experience of Pauline Cafferkey’s case is that the health professionals in Scotland who dealt with that case did so very professionally and in line with all the guidance and protocols that are in place.
Clearly, the staff at the Brownlee unit at Gartnavel hospital were at the front line in that case and deserve our enormous thanks and gratitude. The Scottish Ambulance Service was also in the front line and will continue to be in terms of transporting patients—the guidance that it follows has been updated. I am confident that what we saw last week was a very professional and very expert response.
However, not just those of us in the Government but those of us who were dealing with that case at the front line will want to continue to ensure that everything is as it should be. There is always—not just in this case, but in all cases of unusual diseases—an on-going need to ensure that guidance is up to date and developing in line with developing knowledge and understanding, and that health professionals are familiar and conversant with the guidance so that they know what to do if they find themselves dealing with a case.
I associate myself with other members’ comments about Pauline Cafferkey.
Given the First Minister’s previous comments, can she elaborate on what discussions have taken place to ensure that there is robust screening of passengers who arrive at Scottish airports whose journeys originated in countries of high concentrations of Ebola virus contamination?
We will keep the issue of screening at Scottish airports under review, but it is important to point out a couple of things. It is estimated that somewhere in the region of 97 per cent of travellers to the UK from affected countries are captured by the current entry screening arrangements that are in place in England, and many of the remainder are screened elsewhere in Europe before they travel on here. The number of travellers to Scotland who arrive here via routes that do not include English hubs is very small.
The second point to make is that one of the things about screening that people must be aware of is that, however important screening is—it is important—there is a risk that it might lead to false reassurance. As I have said, the incubation period for Ebola is 21 days. If someone is screened and their temperature is found to be within the normal range, that means that they are okay at the time, but it does not mean that they will not go on to develop the symptoms of Ebola later on. That makes the monitoring arrangements, on which I have already gone into a bit of detail, extremely important. I think that they are the most important arrangements when it comes to the notification from Health Protection Scotland of expected returners and the system that kicks in, which involves Health Protection Scotland and local health boards, to ensure that people are monitored depending on the degree of risk that they are in. I am confident that those arrangements are robust and that they worked well last week but, as I have said in response to other questions, we will continue to keep them under review.
I join other members in saying that our thoughts are with Pauline Cafferkey and her family, and with the families and friends of all those who suffered as a result of the Glasgow tragedy and the one in the Pentland Firth. I also thank our brave emergency service workers.
As we know, Save the Children is investigating how Pauline contracted the disease. It is crucial that the source is isolated as quickly as possible to safeguard the wellbeing of our brave overseas volunteer staff who are caring for Ebola victims. Can the First Minister provide an assurance that the Scottish Government will support Save the Children in carrying out that investigation and that, if needed, it will provide medical expertise or technical resources to assist the charity in doing so?
Mention has been made of the fact that Health Protection Scotland is working closely with Public Health England in reviewing the screening procedures. Can the First Minister give an indication of when that review will be completed and reported on?
Jim Hume’s first question was about how Pauline Cafferkey contracted Ebola. Save the Children is to be commended for the very swift and rigorous review that it has embarked on, which must be allowed to take its course. I freely make the offer that the Scottish Government would be happy to provide any support and assistance that Save the Children thought was required. Jim Hume is right to raise the point. We can have all the procedures that we want in place here, but we hope that people who are working on the front line do not contract Ebola. For that to be the case, the protocols and procedures there have to be absolutely robust.
Jim Hume’s second question was about the review of the screening procedures. That review will be on-going. As I have said, some changes have already been made to the procedures that are in place to ensure that a more precautionary approach is taken with someone who is in a high-risk category. How the revised procedures operate will be reviewed over the coming days and weeks. I am sure than any substantial changes to the protocol and procedures that are in place would be communicated in the normal way. It is not a case of doing a review and that is it; it is a case of making sure that the arrangements are kept under on-going review.
I join other members in paying tribute to my constituent Pauline Cafferkey, whose courage and compassion are an example to all of us. I am sure that all members’ thoughts are with her family. We wish her a full recovery.
The First Minister said in her statement that all passengers who travelled on the flight from Heathrow to Glasgow had been contacted by Health Protection Scotland and provided with advice and assurance. Has there been any follow-up to that to ensure that, in the intervening period, no passengers have begun to exhibit any signs of being at risk from Ebola?
First, I agree, as everyone does, with James Kelly’s initial comments about Pauline Cafferkey and how difficult a time this is for her family.
On James Kelly’s question about follow-up with the passengers on the plane, there were effectively two categories of passengers who were considered to have been in close proximity to Pauline Cafferkey. To cut this short, those were the passengers in the two rows behind and the two rows in front of where Pauline Cafferkey sat. From memory, I think that eight passengers were in that category. They have been contacted and they are being monitored.
The other passengers, who were considered not to be in close proximity to Pauline Cafferkey, were contacted principally to be offered advice and reassurance. They were told what to do should they experience anything untoward.
Public Health England took the same approach with the passengers on the Casablanca to Heathrow flight, and a similar approach was taken to the one other person who Pauline Cafferkey had been in contact with.
The only other point to make—I have already made it implicitly—is that that approach was taken on a highly precautionary basis. It was not intended to give any indication that there was any concern about the health of the passengers on the plane; rather, because we were operating on a highly precautionary basis, it was deemed to be the right thing to do. I certainly think that it was the right decision.
Do other health boards have the necessary procedures in place to isolate patients who are considered to be potential Ebola carriers while they are being tested?
The short answer is yes. Health Protection Scotland has assessed the capacity in NHS Scotland to accommodate suspected cases, and all NHS boards have appropriate plans and equipment in place.
As both I and the health secretary have said, we have established three regional units—they are in Glasgow, Edinburgh and Aberdeen—for the management of possible or confirmed cases. Across those three units, we have 14 negative pressure rooms and more than 50 isolation rooms.
Patients who require high-level isolation will go to the Royal Free hospital. All four UK nations co-operate in UK protocols.
The Royal Free is a very specialist facility. In the United States of America, which has a population of around 300 million people, there are only four units of the same type as that in the Royal Free—that is how specialist the unit is. Many other European countries do not have facilities of that standard. It is absolutely right that when patients need such treatment, that is what they get.
My final point is that NHS Scotland pays for any treatment in the Royal Free that Scottish patients get.
I very much welcome how the Government, Health Protection Scotland and all the health professionals involved have dealt with the issue. I also welcome the fact that the First Minister has made it clear that the protocols will be updated, because I was very concerned that someone with an elevated temperature—even if it was within an acceptable range, although I have no idea what that means—was allowed to fly on to Glasgow without further testing.
It is not only health workers who will return from west Africa; travellers constantly come in from there. Although the most common disease that they are likely to catch in west Africa is malaria, what advice is being given or displayed to them to ensure that those who return to this country having travelled from that area are aware that, should they develop a temperature, it could relate to Ebola? What information is being given not just to the 97 per cent who fly through Heathrow, but to the remaining 3 per cent who travel directly to Scotland from other areas?
That is an important point. I have mentioned the danger of screening creating false reassurance. Notwithstanding that, a big benefit of screening—it is not the only benefit—is the contact with people, whoever they are, who come from affected countries to make sure that they have the right information, advice and guidance on what to do should anything of concern arise.
I have gone through the monitoring approach, but Health Protection Scotland has also worked with stakeholders so that people who are likely to travel to affected countries, whether they are aid workers, oil and gas workers or students, are registered on the Ebola monitoring programme, which then triggers the notice and the information that is given when people return.
People are given information before they leave to advise them about what they should and should not do, and are contacted on their return so that the risk assessment can be carried out and appropriate advice can be given. Posters and leaflets have been developed by Health Protection Scotland and deployed at ports of entry to provide information to travellers.
A whole range of work has been done to raise awareness of what people should do, and that work will continue in the weeks and months to come.
The First Minister has detailed the work that is under way in the UK at present, but given the international nature of the threat, what steps are being taken at the European Union level to co-ordinate a response to Ebola, and what influence does the Scottish Government have in those discussions?
That is a very good point. In order to combat Ebola at source, there is, and there will continue to require to be, a very co-ordinated international response. Public health specialists from Scotland are and will continue to be involved in discussions at the European level on the response to Ebola. Crucially, that includes participation in the European Commission’s Health Security Committee, where these matters are discussed and taken forward.
I reassure Stewart Maxwell that we will continue to play a full part in all aspects of the international response, as well as ensuring that we are doing what requires to be done at home so that our preparedness is up to scratch.
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