Chamber and committees

Those are important issues. NHS staff are working extremely hard and are under intense pressure, but health boards will continue to prioritise critical patients and urgent care as much as possible, in line with the critical prioritisation framework that was published in November 2020.

It is also important to get patients appropriately discharged from hospital. We have invested significantly to enhance care at home services, although the issue of staff absences is a concern for us. Those matters are all being given significant attention and priority.

The health and care workforce are working above and beyond the call of duty and we are now asking them to do more to accelerate the vaccination programme. That is why it is important, as I set out today, that we try to free up capacity in ways that do not ask staff to pause other forms of care when that is avoidable. We will continue to do everything possible to support staff during this difficult winter.

The Scottish Courts and Tribunals Service is working very hard on plans to clear the backlog, which is more on the criminal side than in civil cases. A lot of civil business has continued to happen online. There have, of course, been measures to minimise the impact on criminal business, which has been more severe. I discussed that issue directly with the Lord President just last week. Obviously, the budget helps to ensure that there are resources for the court service and the Crown Office to continue their recovery work.

We will do everything that we possibly can to support those working in the health service. I cannot even begin to find the words to express my appreciation for that work, understanding the pressure that they are working under. There are many patients, including the individual cited by Monica Lennon, who are having disruption to their care.

We will do everything that we can to mitigate those impacts, but we come back, as we so often have during the pandemic, to the hard reality at the centre of this. The impact on services comes from the pandemic. As cases go up, we see a bigger impact in people being off work sick or having to isolate, with an inevitable impact on services. We need to come back, again—hopefully for the last time in the pandemic, although none of us knows exactly what is ahead of us—to the need to pull together to do all the right things to drive infections down. That will do more than anything else to allow us to get the NHS sustainably back on the path to normality.

Yes—I think that that is a reasonable thing to say. I have tried today to set out as clearly as possible that we do not want to put limits on people’s ability to gather with their families on Christmas day, or on boxing day or Christmas eve if that is when they choose to have their main celebration. However, there are things that we need to do now to make that safer, such as reducing our contacts and avoiding socialising with other households, and there are things that we need to do on the day around testing, ventilation and hygiene.

I really want people to be able to do that, but I cannot stand here and tell them that there are no risks around omicron. I think that one of the darkest days for many people—out of many dark days during the pandemic—and certainly one of the darkest days that I experienced was 19 December last year, when, having given people some limited normality, we had to take that away from them before Christmas. Nobody wanted that to happen, and I certainly do not want to be in that position again.

Let us do the things that I am asking for today, limiting contacts and socialising in order to get through Christmas with the freedom to enjoy it, and then continuing to limit socialising so that we do not see a surge in cases afterwards. That is my best advice to people right now in what is a really, really difficult situation.

I will give a general update on Covid and share the latest information that we have on the omicron variant. I will also set out the further protective measures that we consider necessary to help to slow its spread while we accelerate the pace of booster vaccines.

First, I will give today’s overall statistics. Yesterday, 3,177 positive cases were reported. That was 11.3 per cent of all tests carried out. The number of polymerase chain reaction—PCR—tests yesterday was slightly lower than in recent days. Therefore, I appeal to people not to put off going for a PCR test if they have symptoms or a positive lateral flow test. I know that no one wants to test positive or isolate at Christmas, but testing is a vital part of our defence and there is no shortage of capacity, so please do get tested.

Currently, 541 people are in hospital with Covid. That is 20 fewer than yesterday. However, I confirm that we now know of two confirmed omicron cases who are in hospital. Sequencing of other possible cases continues and the actual total is likely to be higher.

Thirty-eight people are in intensive care with Covid generally, which is one fewer than yesterday. Sadly, a further six deaths have been reported. That takes the total number of deaths under the daily definition to 9,725. I again send my condolences to everyone who has lost a loved one.

Our current assessment is that omicron is spreading very rapidly in Scotland. The best indicator of that is the proportion of cases that show what is called the S-gene dropout. For about 95 per cent of cases in Scotland, tests are currently processed in a way that allows us to know whether the S gene is present. That shows that omicron cases are increasing exponentially—faster than any variant that has gone before.

When I made a statement to Parliament this time last week, around 4 per cent of cases showed the S-gene dropout. By Wednesday, it was 7 per cent. On Friday, it was above 15 per cent. Today, it is 27.5 per cent. We estimate that the doubling time is two to three days—more rapid than anything experienced in the pandemic so far—and we expect omicron to become the dominant strain circulating in Scotland within days.

That matters because omicron is significantly more transmissible than the delta variant. The reproduction number—or R number—associated with delta is around 1, but the R number for omicron appears to be well over 2, and it is possibly above 4.

Cases in Scotland in total have increased by a quarter in the past week. They have risen in all age groups except the over-85s and omicron is already contributing to that increase. However, as it becomes the dominant strain, its much higher R number will also dominate, and that will drive a much steeper increase in cases. That is why I warned on Friday that we are facing a likely tsunami of cases in the weeks ahead.

Some are suggesting that omicron may be milder in its impact on individual health than delta. Obviously, we all hope that that is the case. However, we do not yet know that it is. Indeed, there is some initial evidence from Denmark that may suggest otherwise. However, even if it proves to be milder, simple arithmetic means the challenge that it poses will still be very significant.

Let me illustrate that. In recent months, the proportion of delta cases needing hospital care has been around 2 per cent. That means that an average daily case number of around 2,700—as has been the case in recent weeks—will result in around 400 hospital admissions a week. However, if cases rise significantly to, say, 10,000 a day because of omicron’s much greater transmissibility—and that is well within the modelled estimates in the evidence paper that we published on Friday—even if the hospitalisation rate turned out to be half that of delta’s, at just 1 per cent, we would see 700 hospital admissions a week.

The basic and very hard fact is that a much more transmissible infection, even if milder in terms of severe illness, can still place a much bigger burden on the national health service.

More people being infected will result in more severe illness and, tragically, more people will die. A surging level of infection will also result in many more people being off work due to mild illness and self-isolation, so the impact on our economy and on our ability to deliver critical services will also be severe. We are starting to see those impacts already. All that explains why we must take omicron extremely seriously. It is not a choice between protecting health and protecting the economy.

Let me turn to what, in the Government’s judgment, we need to do now to mitigate the challenge. In doing so, I ask everyone again to think in terms of this being a race between the virus and the vaccines. Our vaccination programme is running fast—we are currently the most vaccinated part of the United Kingdom, and 46 per cent of the over-12 population have had booster jags already.

However, just as the vaccines started to win the race, the virus learned to run faster. That means that we must deliver boosters even faster. That is all the more important in the light of early data that tell us that the protection that we have against omicron infection with one or two doses is significantly lower than it is for delta. We need a booster jag to ensure substantial protection against omicron infection, so we are taking steps now to get boosters into arms much faster. Getting fully vaccinated is the best thing that any of us can do to protect ourselves, our loved ones and the country, so please book your booster jag as soon as possible.

Speeding up vaccination is essential, so I assure the nation that that is the Government’s top priority. I will shortly set out more detail on exactly how we are doing that. Although that is necessary, our judgment is that it will not, in the short term, be sufficient. While we are speeding up vaccination, we must also try to slow down omicron. That is why we are today proposing—albeit very reluctantly—some further protective measures. I appeal to everyone to follow today’s advice in order to help to slow down omicron while more of us get our boosters.

Let me be clear: we do not do this lightly, and I know how hard it is. Please believe me when I say that I would not be asking for yet more sacrifice if I did not genuinely consider it to be necessary in the face of a very real threat.

Let me set out what is being asked. First, we want to keep businesses open, but in order to help to achieve that, we are asking them to step up the protections that are in place in their premises. We intend to amend regulations to put a legal requirement on people who run businesses or provide services to take measures that are reasonably practicable to minimise the risk of transmission. We will issue guidance this week to make clear what that means for various sectors. For example, in retail, it will involve a return to the kind of protections that were in place at the start of the pandemic, including measures to avoid crowding and bottlenecks. That will include physical distancing, measures to control the flow of customers and protective screens.

For hospitality, it will mean, for example, measures to avoid crowding at bars and between tables, and there will be a reminder of the requirement to collect contact details of customers, to help with contact tracing.

For employers more generally, the guidance will make it clear that enabling staff who were working from home at the start of the pandemic to do so again is now a legal duty. I am hugely grateful to employers who are already allowing staff to work at home where possible, but we are not yet maximising the impact of home working to reduce the overall number of contacts.

We recognise, of course, that there are people who cannot work from home—for example, people who work in manufacturing, hospitality and key public services. We are asking anyone who is in that position to test regularly before they go to work. We have extended the workplace testing scheme, which delivers lateral flow kits twice a week to all businesses that have signed up to it. I encourage—indeed, I urge—any business that has 10 or more employees to join up, and to encourage their staff to test regularly.

We will also reinforce the rules on face coverings and the public health messaging on the importance of wearing face coverings—and wearing them properly.

My hardest request today is one that I make of the general public. I want to be clear: I am not asking anyone to cancel Christmas, but I am asking everyone, in the run-up to Christmas and in its immediate aftermath, to reduce as far as possible—to a minimum—the contacts that we have with people from other households. I will say more about Christmas day in a moment.

We are not banning or restricting household mixing in law, as happened before. We understand the negative impact that that has on mental health and wellbeing. However, we are asking everyone—we will issue strong guidance to this effect—to cut down as far as possible the number of people from outside our own households with whom we interact. That will help to break transmission chains. My key request today is this: before and immediately after Christmas, please minimise social mixing with other households as much as possible. However, we ask you, if you are planning to socialise, either at home or in indoor public places, to limit to a maximum of three the number of households that are represented in your group, and to make sure that they test beforehand.

I know that that is a tough thing to ask people to do, especially at this time of year, so I want to make it clear why we are making the request. One of the things we have already learned about omicron is that it has a very high attack rate. That means that if just one person in a gathering is infectious, that person will likely infect many more people in the group than was the case with the delta variant. By reducing the numbers of people and households who gather together, we will help to limit the extent of its spread.

I turn to Christmas day specifically—or Christmas eve, boxing day or whenever you have your main family celebration. We are not asking you to cancel or change your plans, and we are not proposing limits on the size of household gatherings. Places of worship will also remain open, with appropriate mitigations. We will, however, issue guidance to help to make Christmas safer.

Reducing contacts in advance of and after Christmas, as I have just strongly advised, will help. Keeping celebrations as small as family circumstances allow is also sensible. You should make sure that everyone in your gathering is vaccinated and has done a test in advance. Keep rooms ventilated and follow strict hygiene rules.

I know how much I am asking of everyone today, after a difficult and painful two years. I would not be doing it if I did not believe it to be necessary. Indeed, it could be argued that we should be going further, which is why I also need to explain a significant limitation on our ability to act in the way that we think is necessary to protect public health. In this context, I am genuinely not seeking to make a political point; I simply want to set out the factual position.

Many of the protections that help to curtail Covid come at a financial cost to individuals and businesses, so wherever we can, we put in place financial packages to protect people’s health, jobs and livelihoods. However, the Scottish, Welsh and Northern Irish Governments cannot borrow to meet the Covid funding challenge. UK funding arrangements mean that we rely on the Treasury to do so on our behalf; the Treasury has responded well throughout the pandemic. Although Scottish taxpayers foot our share of the bill, money flows back to the devolved Governments only when the UK Government makes decisions. Financial support is not triggered when the devolved Governments make decisions that we consider to be appropriate for public health reasons, even although it is our responsibility to make those decisions.

Because the UK Government is not proposing any further protections at this stage—a position that I do not agree with—no funding is being generated to compensate businesses for any protections that we think are necessary and wish to put in place. That is not acceptable in the current circumstances, so we are, with the Welsh and Northern Irish Governments, pressing for a fairer approach that takes account of our devolved responsibilities to protect public health. For now, however, this is the situation that we are in, and it means that our public health response is curtailed by lack of finance.

There are further steps that we could and would have considered today, particularly around the hospitality sector, had we the financial ability to do so, but we do not. However, I can confirm that, with considerable difficulty, we have managed to identify within our own resources about £100 million that we will use to help businesses, mainly in the hospitality, food supply and culture sectors, that are being affected by our advice last week about work Christmas parties, and which will be further affected by what I have said today. The Cabinet Secretary for Finance and the Economy and her officials will engage with affected sectors immediately to consult on and confirm the details of support. We will work to make money available as soon as possible. Businesses that previously received support through the strategic framework business fund will be contacted directly.

We have also identified an additional £100 million to ensure that the self-isolation support grant is available for those who need it, given the expected increase in the number of eligible people who will be asked to isolate.

Making that money available will involve difficult reprioritisation, but we recognise the importance of providing as much help as we can.

However, that is the limit of what we are able to do within our own resources. I know that it does not go far enough in compensating businesses for what we are asking of them now—and, of course, no Government can rule out having to go further in the weeks ahead. We are continuing to press the United Kingdom Government to increase support to enable us to respond adequately to the public health challenges in the weeks ahead.

I turn now to our actions to speed up delivery of booster vaccinations. Anyone aged between 40 and 60 who has not already booked an appointment has now received an invitation to do so. In addition, since yesterday, all 30 to 39-year-olds have been able to book their booster jags online. I can confirm today that 18 to 29-year-olds will be able to book online from tomorrow.

Our aim is that by 31 December everyone over 18 will have been able to book a booster appointment. It is not possible to guarantee that absolutely everyone over 18 will have been vaccinated by 31 December. For a variety of reasons, some appointments will run into the new year. For example, some people will not be eligible by the end of December, because it will still be less than 12 weeks since their second dose. Some people have not yet come forward for a first or second dose and, despite our best efforts, some will not come forward to book a booster, either.

In addition, despite the strenuous work that is under way, we know that some capacity challenges between now and the end of the year—for example, vaccinator staff absences due to Covid—are inevitable.

Notwithstanding all that, we are aiming to reach as close as possible to 80 per cent uptake by the end of December, with the balance of appointments taking place in January. I do not underestimate the challenge of that. Vaccination teams are already making a Herculean effort, and we are asking a great deal of them. In addition, reaching that level of uptake depends on people continuing to come forward to get jags even over the holiday period.

This will not be easy—we know that—but we are working on the basis that the higher we aim, the further we will get.

Let me therefore set out the steps that we are taking to create the additional capacity that is needed. First, given its vital importance against omicron, we will prioritise the Covid booster programme over the remainder of the flu vaccination programme for the next few weeks. That will allow many more booster appointments to be made available. Let me stress, though—and this has informed our clinical advice—that for those in the highest-risk groups for flu, uptake of the vaccine this year is already high; for over 65-year-olds, it is 88 per cent, which is higher than last year.

Secondly, and in line with advice from the UK chief medical officers, the requirement for people to wait in a vaccine centre for 15 minutes after they receive an mRNA vaccine is being removed. That will speed up vaccination times and enable many more appointments.

Thirdly, health boards are working to offer additional drop-in capacity within local vaccination centres. Additional venues for vaccination are also being identified. That will include mass vaccination centres in areas where that is considered appropriate.

In terms of human resources, we plan to extend the number and role of volunteers, to ensure that clinical staff can spend as much time as possible supporting the administration of vaccines. We will continue to expand the size of the overall vaccination workforce as much as possible and we will make full use of any military support that is available.

We will, of course, keep Parliament updated on the delivery of these plans. However, at this stage, I want to again thank everyone who is working so hard to design and deliver the biggest and most important logistical project in our peacetime history.

Let me also stress this: although the focus of my statement today is on boosters, if you have not had your first dose yet, please book it now. It is more important than ever to do so.

In the new year, we will also complete second doses for 12 to 17-year-olds. I very much hope that we might also, soon, get regulatory approval to offer vaccination to under-12s.

Before I close, there are some further issues that I want to highlight. First, I reiterate the changed advice on self-isolation. For now, household contacts of a person who tests positive for Covid are being advised to self-isolate for 10 days. That advice applies to everyone in a household, regardless of age, vaccination status or PCR test result.

Businesses and organisations that provide vital services can apply for an exemption to allow essential workers to return to work, subject to their being symptom free and taking certain precautions, including daily lateral flow tests.

Beyond that advice, we do not recommend that entire school classes should be required to isolate when a pupil tests positive. The advice on school isolation will continue to be risk based.

More generally, a key aim is to ensure that schools stay open if at all possible, to minimise further disruption to education. However, it is vital for schools to be safe for pupils and staff. To help to achieve that, we continue to ask secondary school pupils and all staff to take lateral flow tests regularly—including during holidays and before returning after the break—and to wear face coverings.

The advisory sub-group on education is meeting today to provide further advice on how schools can operate safely in the new year. We will send that advice to schools by the end of this week.

We will continue to consider appropriate protective measures for people who are in institutional settings, such as care homes, while ensuring that visits can continue. Last week, we recommended that care staff should take lateral flow tests daily. We now also recommend that individual visits in care homes should not involve any more than two households visiting any patient at a time. We ask anyone who visits a care home to test before every visit. For hospitals, we recommend that no more than two people should visit a patient at any one time and, again, we recommend a lateral flow test before each visit.

I fully understand that omicron will be especially concerning to people who are on the highest-risk list. I assure all of you that the chief medical officer will write to you shortly with further advice and assurance.

It is an understatement to say that this is not the update that I wanted to give just a few days before Christmas. I am painfully aware that it is not an update that anyone wanted to hear. However, we have a duty to take decisions—no matter how difficult or unpopular—that will get us through this as safely as possible. I will not shy away from that responsibility. The fact that I am asking for further sacrifice today underlines how severe we think that the risk posed by omicron might be, so please follow the advice that I have set out today.

This is, without doubt, a very difficult juncture in the course of the pandemic, but please remember that vaccination still puts us in a better position than last year. Hard and very wearying though this is, we are not powerless in the face of the virus. We know the steps that we can take to slow it down.

I will stress again what we need to do. First, please get fully vaccinated as soon as possible. Secondly, please test regularly. If you are going to meet other people—remember that our advice is to minimise that as much as possible—take a lateral flow test before you go, every time. The tests are easy to take and, despite an issue with online ordering yesterday, they are easy to get hold of. Tests can be collected from local pharmacies and testing centres without a booking, and the online portal is open again today.

Wear face coverings on public transport and in shops and when moving about in hospitality settings. Make sure that your face covering fully covers your mouth and nose. Keep windows open if meeting people indoors, even at this time of year. Follow all advice on hygiene. Work from home whenever possible—that will soon become a requirement that is anchored in law.

Please follow the new advice that I have outlined today. It is guidance, but please do not think of it as optional. Cut down unnecessary contacts as much as possible. In the run-up to and immediately after Christmas, please avoid socialising with people in other households as much as you can. If you are socialising indoors at home or in public places, limit the number of households that are represented in your group to a maximum of three, and test before you go. Please follow the advice that we will give to keep Christmas day as normal but as safe as possible.

We face an extremely difficult period again ahead—I cannot tell you otherwise—but I know that we will get through it more safely if we do right by each other, as we have done all along. Please get vaccinated, test regularly and follow all the other rules and guidance that are in place for our own protection. Let us pull together again and help each other through.

I thank Anas Sarwar for his questions.

On hospitality, I do not think that I addressed the point that was raised in the previous round of questions about whether the money will be delivered before Christmas. We will do our best to ensure that the money, or as much of it as possible, is delivered as quickly as possible—I hope, before Christmas. I absolutely agree that hospitality has taken a sucker punch in the past couple of weeks due to the inescapable and unavoidable public health advice.

We know that omicron is spreading fast generally, but its high attack rate means that if one person in a group of people at a Christmas party has it, almost all are liable to be infected. That higher attack rate has made the advice unavoidable.

On the Covid booster jags, the additional capacity to administer them will start to become available over the next few days and the course of this week in the form of extra centres and, where necessary and appropriate, mass vaccination centres and additional appointments at existing centres. We will make maximum use of the military; there is a UK Government commitment to make more military support available.

Let me stress, however, that the biggest increase in capacity that will be delivered, and which will be delivered most quickly, will be through the changes that I talked about to prioritise Covid boosters over flu vaccinations. That will free up significant numbers of appointments. There will also be removal, on clinical advice—the four UK chief medical officers have given the go-ahead to this—of the requirement for people to wait in vaccination centres for 15 minutes after their vaccination. Those two things will make the biggest immediate impacts on increasing capacity to do more booster vaccinations.

I am absolutely aware of the run rate that we have to achieve to meet the targets that we have set today, although it also depends on people coming forward. We know that, in a normal year, supply and demand in an immunisation programme would dip over Christmas, so we need to work to keep them as high as possible.

On the self-isolation support grant, we have announced today additional funding to support the increased numbers who are likely to be eligible and asked to isolate. We keep the eligibility requirements under review and will look at them again, but we need to maximise the amount of money that is getting to people who are genuinely in need. That will always be a fine balance that we must try to strike.

I encourage parents to continue to send their children to school. I absolutely understand the anxiety that parents will feel at this time. It is important that test and protect, with local health protection teams, works in a risk-based and targeted way to ensure that where cases are identified, the right approach is taken to advice for self-isolation.

There are other mitigations in place in schools, especially secondary schools, requiring use of face coverings and taking of lateral flow tests regularly. I know that those mitigations have been controversial in the past, but they are really important.

As I said in my statement, the advisory sub-group on education is meeting today to consider additional measures that we might advise schools to put in place for the new term. I will not pre-empt those recommendations, but I suspect that they will include more advice on ventilation, for example, because we know how important it is. As I said earlier, we will ensure that the advice is with schools by the end of this week.

I completely understand the anxiety, but I know that parents will also be anxious about disruption to their children’s education. We want to work in a way that minimises that as far as possible during the next difficult phase.

We will ensure that refreshed guidance is issued to health boards to ensure that they understand what the appropriate measures are for hospital visiting. I set out today that we do not want to stop visiting; it is really important that visiting goes ahead. It is important for people in hospital and for their loved ones, but we are suggesting a limit on the number of visitors for each patient at any one time.

Visiting should continue, with appropriate precautions and mitigations. Patients should not be denied visitors except in very short-term and specific circumstances, such as managing an on-going outbreak, in which case hospitals can put in place temporary visiting restrictions. However, even when hospitals are managing an outbreak, we expect what we call essential visits to continue. A person with dementia is a clear example of someone we would expect to receive essential visits, even during an outbreak.

For goodness’ sake, I ask members why on earth I would want to stop public health messages getting to people in every part of Scotland. What could be my motivation for that? That is a bit rich coming from the Conservatives, who spend a lot of their time trying to prevent me from giving public health messages.

I do not know why that is the case. I will look into it urgently. Many, but not all, of our public health messages right now are being done on a UK-wide basis. We are co-operating with the UK Government to ensure consistency of messaging. By all means raise these things, but raising them in a tone of voice that suggests that somehow I have a motivation to stop people in the south of Scotland getting public health messages is utterly ridiculous.